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COLUMN ONE : Cracking a History of Skepticism : Their college is quirky and a bit hard to find. But the Clevelands, one of chiropractic’s founding families, are training students to carry on their decades-old battle for respect.

TIMES MEDICAL WRITER

Drivers who venture off the Hollywood Freeway at Vermont Avenue will see a trio of green signs directing them to institutions of learning: the Braille Institute, Los Angeles City College and West Coast University. What they will not see, because it is not there, is a sign for Cleveland Chiropractic College.

This is not for lack of trying. City and state officials, for reasons that are a mystery to those who run this little family-operated school, refuse to put one up. “You can’t fight City Hall,” sighs the chancellor, Dr. Carl S. Cleveland Jr.

Cleveland knows about fights. At 75, he is the patriarch of a chiropractic dynasty, a heavyweight in a field that has fought for survival since its inception. Well-known in chiropractic circles but otherwise anonymous, his family has for decades carried the torch of one of health care’s most controversial professions.

Cleveland’s grandmother was a chiropractor; she learned the craft from D. D. Palmer, the Iowa fish salesman who founded chiropractic 99 years ago when, the legend goes, he restored hearing to a deaf man by adjusting his spine.

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Cleveland’s parents became chiropractors in the days when people got arrested for it. They founded the first Cleveland Chiropractic College in Kansas City, Mo., in 1922, with three students in a brick and stone duplex. He remembers his parents’ urgent whispering at every knock at the door: Was it a new recruit? A prospective patient? Or the local flatfoots, coming to take them away for practicing medicine without a license?

His late wife, Mildred, was . . . You guessed it. So is his son, Carl Cleveland III, president of the Kansas City college and the sister school in Los Angeles. So too, will be his grandchildren. Says Carl Cleveland III, 47: “I was 11 years old before I realized that everybody doesn’t grow up to be a chiropractor.”

Their Los Angeles campus is a crucible in a field that is constantly being tested.

In a sense, the school is a metaphor for chiropractic itself, a David clinging to unconventional principles, slinging stones at the Goliath of traditional medicine. Within its peach-colored walls, the profession and its practitioners, their triumphs and follies, are laid bare for all who care to look.

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Here, eager students line up for back adjustments from a professor after class. Neck pain, back pain, stomach pain, step right up, Dr. Kevin Kelly will handle all comers. A few cracks here, a pop and a crunch there and Kelly sends his customers happily on their way.

“Thank you very much, Dr. Kelly,” one young woman says after her back has been adjusted. “It was sooooo good.” To which Kelly, a former construction worker who became a chiropractor after he injured his back, says: “I’m the best damn adjuster in the world. I love adjusting people. I could sit here and do this all day.”

Those who teach and study at Cleveland are acutely aware of the perception that chiropractors are quacks. Debates about the profession, its image and its future, echo through the stairwells and corridors. White-coated student interns revel in their successes, such as the man whose back pain stifled his bedroom activities. After several treatments, he bounded into the school’s clinic, grinning ear to ear.

“I had sex! I had sex!” he bellowed to the bewildered intern. “You’re a miracle worker!”

Here, the clinic’s star patient--a recovering alcoholic in a wheelchair who nearly died after being beaten unconscious on Skid Row--visits a class of incoming students to lecture them about what they can expect from their studies.

James Fadely is a rough-looking 54, with a beard that resembles steel wool. He wears a bolo tie and kelly green vest festooned with seven buttons that each read: “Remember the McMartin case. Support Michael Jackson.”

Midway through his message, Fadely slowly rises to his feet. He is wobbly, and knobby-kneed. But he is standing.

“I’m the best audiovisual aid this school has,” he declares proudly. “As I told Dr. Cleveland, ‘You damn chiropractors! You don’t know how good you are.’ ”

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Cleveland is one of 14 accredited chiropractic colleges in the nation, and is one of two in Los Angeles; the other is Los Angeles College of Chiropractic in Whittier. Of the 14, only the Cleveland schools are family-run. But, as nonprofit institutions, they are not family-owned. “We don’t own a brick,” Carl Cleveland III says.

The students pay about $50,000 for three years and four months (10 trimesters) of training. By the time they finish, they are steeped in anatomy, physiology and the varied techniques of chiropractic. More important, they will know philosophy. Not Plato, but rather Palmer.

Their immersion begins with a course taught by Dr. Carl Cleveland Jr. (With so many Clevelands here, and junior being senior, the elder Cleveland is known simply as Dr. Carl. His son is Dr. C. III.)

The course lays out the basic principle of chiropractic: that misalignments of the spine--called “subluxations"--can cause disease by preventing the nerves from flowing freely to the organs. Chiropractic (Greek for “done by hand”) asserts that once the vertebrae are put back into alignment, the body has the “innate intelligence” to heal itself. Drugs and surgery are shunned.

Skeptics abound. The biggest and most powerful is the American Medical Assn. For decades, the AMA forbid its members to refer patients to chiropractors--until some chiropractors filed a federal lawsuit, which they won in 1987.

“Chiropractors saying they can cure disease (more effectively than) medical physicians is like the Boy Scouts arguing with Caltech about who understands nuclear physics,” says Dr. Seth Asser, a pediatrics professor at UC San Diego. “It’s just wishful thinking.”

Dr. Carl Cleveland Jr. likes to say he is living proof that the critics are wrong.

Portly and balding, he looks like a kindly pediatrician in a Norman Rockwell painting. He has never visited a medical doctor, other than for an insurance exam, and has never had a vaccination. Nor has he had mumps or any other childhood disease, except the measles, which he got in high school “for half a day.” He was cured, he says, after his father adjusted him.

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“Now, I’m not telling you that chiropractic is a cure-all,” Cleveland announced to his class one morning. “But in my lifetime, all the conditions that I suffered from were handled by my parents. I had my first adjustment at 2 days old and then I was adjusted whenever my parents felt it was necessary.”

Students never tire of hearing him talk of the old days, of how his grandmother became a disciple of Palmer after a chiropractor cured her of diabetes, how his father escorted patients to see jailed chiropractors, how he earned money as a boy by dissecting cadavers in the duplex’s former kitchen.

“These people kept it alive,” says Jessica Ramirez, 32, one of 30 students who will graduate Saturday to become a D.C.--doctor of chiropractic. “They fought. They’re the originals.”

Fought indeed. Like a gnat on an elephant’s ear, the Clevelands and their fellow chiropractors have been nibbling away at organized medicine, and they have racked up some striking victories.

An estimated 21 million Americans visited chiropractors last year. Many insurance plans--including government-funded Medicare--reimburse for chiropractic. And although there is no evidence to support claims that it can cure disease--or even that subluxations exist--recent research, including a 1991 study by the RAND Corp., shows the method eases lower back pain.

Meanwhile, about 50 hospitals nationwide allow chiropractors to admit patients when a medical doctor co-signs the order. At Coast Plaza Doctors Hospital in Norwalk, Cleveland College interns are doing rotations--observing surgeons, pathologists and radiologists.

The profession has taken some hard hits, as well.

Stanford University researchers recently reported that in rare cases twisting the neck during chiropractic treatment can cause a stroke. And a recent expose on TV’s “20/20" uncovered serious lapses in the treatment of children by some chiropractors. In one case, a boy was paralyzed after chiropractic treatment.

Mainstream chiropractors, including the American Chiropractic Assn., have denounced the doctors featured on the show. But they insist that adjusting children--even infants--is appropriate.

Thus, seven years after the profession’s big victory in federal court, practitioners say there still are battles to be fought. Inclusion in President Clinton’s health care reform package is one. Winning respect, ever-elusive, is another.

“My mission, my reason for being on this Earth,” Carl Cleveland III declares with deadly seriousness, “is to position chiropractic as a first-class clinical science on a global basis.”

His local launching pad for this campaign is a rickety building at 590 Vermont Ave., in the heart of workingman’s Hollywood.

With 520 students and 32 full-time faculty members, CCC-L.A., as the school is known, isn’t the biggest chiropractic college in the nation; Palmer College of Chiropractic in Davenport, Iowa, has 1,800 students. As to whether it is the best, that is a matter of opinion.

One student says he enrolled because “it’s supposed to be the Harvard of all chiropractic schools.” But Dr. Kathleen Wells, who teaches palpation techniques--the art of identifying the vertebrae through touch--offers a more subdued assessment.

“It’s like Avis,” she says. “We try harder.”

The students are a varied lot. Their average entering age is 30; for many, chiropractic is a second career. Thirty-nine countries are represented, and 40% of the students are women. Of the 300 to 400 applications received each year, admission officials say, 180 are accepted. About 8% drop out.

If they finish, they may be well-compensated; the average American chiropractor earns $102,000 year, about the same as a general practitioner. Before practicing, however, graduates must pass qualifying boards and be licensed by the state.

A four-year college degree is not required for admission, although it will be by 2000--a big step for a profession that once gave out diplomas by mail order. The current requirement is 75 college credits--about 2 1/2 years of undergraduate work, including courses in biology, biochemistry and physics. As one Cleveland official said wryly: “Welding doesn’t count.”

Who comes here? Some are would-be doctors who couldn’t get into medical school. Others, like the Clevelands, are following a family tradition. Kelli Molthen, a 29-year-old from Cerritos, will be the 60th chiropractor in her family. “There was never any question,” she says, “that I would go to Cleveland.”

Many select chiropractic after good experiences as patients. Thus Jeff Parent, a 37-year-old contractor who was helped by a chiropractor, is now becoming one. So, too, are Hugh and Drew Gordon, 28-year-old identical twins from Beverly Hills who played minor league baseball until Drew got cut and Hugh got injured.

“My mother always wanted a nice Jewish doctor in the family,” Hugh says.

The place where they learn what the school calls “the philosophy, science and art of chiropractic” is so unobtrusive that many Angelenos don’t even know it is there.

(This might change, of course, if it had a freeway sign. City policy says a facility must be of “widespread general public interest” to warrant a sign, and Caltrans requires 1,000 full-time students, although the Braille Institute says it has only 800.)

The heating and cooling system is a little out of whack, and so on hot days the windows are cranked wide open, and the noise from busy Vermont Avenue and the nearby Hollywood Freeway is sometimes so deafening that students strain to hear. When trucks rumble by, it feels like an earthquake. No one ever remarks on this. They just talk louder.

The display in the audiovisual center is tired, with various bones encased in yellowing plexiglass. Paint is peeling, walls are cracked--courtesy of the Northridge quake. The plastic classroom chairs are so uncomfortable that some students bring their own.

The clinic, which treats the poor for free, is crowded. Many patients walk in off the street because they have nowhere else to go, which puts the interns in the position of managing their care, referring them to medical doctors when necessary. This is a point of pride at Cleveland. Interns see patients with AIDS, cancer, diabetes--a population far more diverse than most will treat in private practice.

Then there is the delicate matter of the mice. “I didn’t say this, OK?” one intern confides. “But every once in a while, you see a little mouse scamper through here.” Once, a patient stepped on a trap and squished a furry critter.

Such physical shortcomings are not lost on the chancellor and his son. They dream of making their little college state-of-the-art--if only they could afford it. But with a $4-million annual operating budget, the school struggles to make ends meet.

The electric bills alone run $385 a day. Tuition, which costs $4,280 a trimester, makes up 80% of the school’s income. Alumni donations and clinic fees account for the rest. There are no dormitories, no big endowments, no help from state taxpayers, no research grants from the National Institutes of Health (the federal government has yet to fund a study of chiropractic.)

By comparison, the annual operating budget of USC Medical School is more than $350 million, and tuition, at close to $24,000 a year, accounts for just 5% of it.

“I look around and I see all the things that medical colleges have that we don’t . . . and I get very discouraged,” the elder Cleveland laments. “But then I think about what my parents had to work with, how little they had compared to what we have now.”

The younger Cleveland, recently elected president of the Council on Chiropractic Education, which accredits chiropractic colleges, is out to improve their standing. By 2005, he says, he wants to see chiropractic colleges incorporated into universities, the same as schools of medicine or law.

USC-Cleveland College of Chiropractic? He thinks it has a nice ring to it.

He has other plans, as well, to carry on the work of his forebears. He wants the military to offer chiropractic treatment. He would like to see more chiropractors practicing in hospitals. He hopes health plans will name them primary care physicians--the so-called gatekeepers who care for basic patient needs and decide when to call in specialists.

And if they could just get that sign. . . .


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