English

Adjective

osteopathic

1. of or pertaining to osteopathy

Osteopathic medicine is a branch of the medical profession in the United States. Physicians who graduate from osteopathic medical schools are sometimes known as osteopathic physicians and hold a doctorate in osteopathic medicine (DO), in contrast to MDs, who hold the title Doctor of Medicine. When a distinction is needed, osteopathic professional literature will sometimes refer to MD qualified physicians or organizations as "allopathic," although this usage is disputed. The existence of this distinction and of DOs as licensed physicians is not widely known.

Founded as osteopathy by frontier physician Andrew Taylor Still as a radical rejection of the prevailing system of medical thought of the 19th century, the profession gradually moved closer to mainstream medicine in its practices, and came to be called "osteopathic medicine". Today, the training of osteopathic physicians is virtually identical to that of their MD counterparts. Osteopathic physicians use all conventional methods of diagnosis and treatment but are trained to place additional emphasis on the achievement of normal body mechanics as central to maintaining good health. DO physicians receive training in Osteopathic Manipulative Medicine (OMM), a form of manual therapy shown to be of some benefit for patients with certain musculo-skeletal disorders. However, this form of therapy is used by a minority of osteopathic physicians in actual practice. In the United States, osteopathic medicine is considered by some both a profession and a social movement.

Although US osteopathic medical physicians currently may obtain licensure in 47 countries, osteopathic curricula in countries other than the United States differs. DOs outside the US are known as "osteopaths" and their scope of practice excludes usual medical therapies and relies more exclusively on osteopathic manipulative medicine and other alternative medical modalities.

Discussions about the future of osteopathic medicine frequently debate the feasibility of maintaining distinctiveness within the broader US physician community. More recently, the topic of for-profit medical education has become an issue.]] From its inception, the osteopathic profession has been smaller than the older MD profession. Currently, there are 25 accredited osteopathic medical schools in 28 locations in the United States and 126 accredited US MD medical schools.

• In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic medical schools.
• In 2002, there were 49,210 physicians from 19 osteopathic schools.
• Between 1980 and 2005, the number of osteopathic graduates per year increased over 250 percent from about 1,000 to 2,800. This number is expected to approach 5,000 by 2015.
• In 2007, there were 25 colleges of osteopathic medicine in 28 locations. One in five medical students in the United States is enrolled in an osteopathic medical school.
• By 2020, the number of osteopathic physicians will grow to 95,400, say expert predictions, according to the American Medical Association.

Osteopathic physicians are unevenly distributed in the United States. The states with the highest concentration are Michigan and Oklahoma where osteopathic physicians comprise over 20% of the total physician workforce. The state with the greatest number of osteopathic physicians is Pennsylvania, with 5,500 DOs in active practice in 2007. The states with the lowest concentrations of DOs are Louisiana, Massachusetts and Vermont where only 1-2% of physicians have an osteopathic degree. Public awareness of osteopathic medicine likewise varies widely in different regions.

Osteopathic principles

In addition to the Hippocratic oath, Osteopathic medical students take an oath to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:

1. The body is a unit, and the person represents a combination of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function. They suggest that osteopathic philosophy is a kind of social movement within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the primary care physician within the health care system. Others liken the American Osteopathic Association's emphasis of the core principles to professional indoctrination, a process which glorifies osteopathic practices and beliefs while misrepresenting those of the MD community. Still others point out that there is nothing in the principles that would distinguish DO from MD training in any fundamental way. One study, published in the Journal of the American Osteopathic Association found a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles, and some would even endorse them generally as sound medical principles. He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were arsenic, castor oil, whiskey, and opium. In addition, unsanitary surgery often resulted in more deaths than cures.

He intended his new system of medicine to be a reformation of the existing 19th century medical practices he knew and imagined that someday "rational medical therapy" would consist of manipulation of the musculoskeletal system, surgery, and very sparingly used drugs. He invented the name "osteopathy" by blending two Greek roots osteon- for bone and -pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.

In 1969, the AMA House of Delegates approved a measure allowing qualified osteopathic physicians as full and active members of the Association. The measure also allowed osteopathic physicians to participate in AMA-approved intern and residency programs. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur, MD sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of DO and MD professions. Today, a majority of osteopathic physicians are trained alongside MDs, in residency programs governed by the ACGME, an independent board of the AMA.

AMA, quackery and OMM

Osteopathic medical schools teach a form of manual therapy called Osteopathic manipulative medicine (OMM). In the past, the AMA considered manual therapy to be an unproven, unscientific method of treatment. Before 1980, Principle 3 of the AMA Principles of medical ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Also, up until 1974, the AMA had a Committee on quackery that openly challenged what it considered to be many unscientific forms of healing, including OMM and chiropractic medicine. The AMA changed its policies towards osteopathic manipulative medicine largely as a result of a court ruling regarding chiropractic medicine, the Wilk case. In that case, the AMA was convicted of unlawful conspiracy in restraint of trade. Following the ruling, Principle 3 was removed from the AMA statement of medical ethics.

Non-discrimination policies

Practice Rights from the States

In the United States, laws regulating physician licenses are governed by the states. Between 1901 to 1989, osteopathic physicians lobbied state legislatures to pass laws giving those with a DO degree the same legal privilege to practice medicine as those with an MD degree. In many states, the debate was long and protracted. Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was California in 1901, the last was Nebraska in 1989.

Current Status

Education and training

According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic [MD] physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification."

DO-granting US medical schools have curricula identical for the most part to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine.

Graduate Medical Education

Each country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the US Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States. Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained DOs are currently able to practice in 45 countries with full medical rights and in several others with restricted rights.

The Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) is an independent board of the American Osteopathic Association. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained DOs. Towards this end, the BIOMEA works with international health organizations like the World Health Organization (WHO), the Pan American Health Organization (PAHO) as well as other groups.

The procedure by which international countries consider granting physician licensure to foreigners varies widely. For US trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, MD or DO Many countries recognize US-trained MDs as applicants for licensure, granting successful applicants them "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained DOs similarly to their MD counterparts, with some success. In 44 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council of Great Britain announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath." The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD qualified physicians.

Osteopathic medicine and primary care

Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts. Some osteopathic organizations make claims to a greater emphasis on the importance of primary care within osteopathic medicine. However, the proportion of osteopathic students choosing primary care fields, like that of their MD peers, is declining. Currently, only one in five osteopathic medical students enters a family medicine residency (the largest primary care field). In 2004, only 32% of osteopathic seniors planned careers in any primary care field; this percentage was down from a peak in 1996 of more than 50%.

Criticism & Internal debate

OMM

Traditional osteopathic medicine, specifically OMM, has been criticized for techniques such as cranial and cranio-sacral manipulation. A recent study questions the therapeutic utility of osteopathic manipulative treatment modalities. A Harvard medical school reviewed website cites numerous studies demonstrating that there are some ailments for which the benefit of manipulative therapy has "firmly established" scientific support. Also, New York University health information website claims that "it is difficult to properly ascertain the effectiveness of a hands-on therapy like OM."

Research emphasis

Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at DO schools in comparison to their MD counterparts.

Maintaining distinctiveness

There is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care. JD Howell, author of The Paradox of Osteopathy, Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus: As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.

For-profit medical education

The accreditation of RVUCOM generated some controversy before the school held its first class. Like all osteopathic medical schools, RVUCOM is accredited by a board of the American Osteopathic Association (AOA). Unlike the other 28 osteopathic and 126 MD medical colleges in the US, RVUCOM is organized as a for-profit corporation. Critics claimed the AOA's approval of a for-profit school "erodes creditability" of osteopathic medical schools, especially in comparison to their MD counterparts. The Liaison Committee on Medical Education, which accredits the MD-granting US medical schools, has banned for-profit schools. School officials insist the for-profit status of the school will not compromise the integrity of its educational mission. AOA president Peter Ajluni responded, "there are many socially minded for-profit companies that contribute time, resources, and profits to their communities" and "for-profit institutions like RVUCOM can further the cause of osteopathic medicine in the United States."

References

Further reading

• The DOs: Osteopathic Medicine in America, Norman Gevitz, 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0-8018-7834-9 (An excellent review of the history and development of ostepathic medicine and medical education in the United States)
• Science in the Art of Osteopathy: Osteopathic Principles and Models, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
• An Osteopathic Approach to Diagnosis and Treatment , Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5

External links

US Osteopathic regulatory bodies

• American Osteopathic Association (Website)
• American Association of Colleges of Osteopathic Medicine (Website)
• Association of Osteopathic Directors and Medical Educators (http://www.aodme.org/index.cfm)

Journals

• Chiropractic & Osteopathy An online journal published by BioMed Central
• International Journal of Osteopathic Medicine
• Journal of the American Osteopathic Association The official journal of the American Osteopathic Association
• Osteopathic Medicine and Primary Care An online journal published by BioMed Central
• The Journal of the American College of Osteopathic Family Physicians.

Student groups

• Student Osteopathic Medical Association
• Council of Osteopathic Student Government Presidents
• Unified Student Movement for Osteopathic Integration
• Osteobook.net