Letters to the Editor  |   March 2005
Faith versus Evidence: The Real Question in Osteopathic Medicine?
Article Information
Emergency Medicine / Evidence-Based Medicine / Gastroenterology / Medical Education / Neuromusculoskeletal Disorders / Ophthalmology and Otolaryngology / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Pediatrics / Professional Issues / Being a DO / Graduate Medical Education / Curriculum / Low Back Pain / Osteopathic Cranial Manipulative Medicine / OMT in the Laboratory
Letters to the Editor   |   March 2005
Faith versus Evidence: The Real Question in Osteopathic Medicine?
The Journal of the American Osteopathic Association, March 2005, Vol. 105, 126-128. doi:10.7556/jaoa.2005.105.3.126
The Journal of the American Osteopathic Association, March 2005, Vol. 105, 126-128. doi:10.7556/jaoa.2005.105.3.126
To the Editor:  
We were saddened to read a recent letter to the editor by Dr Bledsoe (“The Elephant in the Room: Does OMT Have Proved Benefit? J Am Osteopath Assoc. 2004;104[10]:405). The sadness we felt came not so much from the writer's cogently expressed anger, but from an awareness that many osteopathic physicians arrived at their first day of osteopathic medical school at least agnostic in their attitudes toward osteopathic philosophy—and later graduated feeling betrayed and angry. 
Having passed our twelfth and twenty-eighth years in practice, respectively, we find it increasingly difficult to blame earlier generations of DOs for the failure of the colleges of osteopathic medicine (COMs) to convert their students more successfully to osteopathic principles and practice (OPP). If such “conversions” were easy, they would not be so deeply felt as we have experienced them. 
At the core of the debate is one question: Is osteopathy simply a meta-physical paradigm requiring faith, or is it a scientific paradigm supported by evidence? 
A cursory examination of the literature yields successive generations of osteopathic physicians and researchers providing scientifically validated evidence of the effectiveness of OPP—all of which were appropriate and suitable to their time. 
In the early decades of the 20th century, Louisa Burns, DO, DScO, published extensively.14 The scientific papers of Irvin M. Korr, PhD, spanned three decades.5 In the 2004 Scott Memorial Lecture, Dennis J. Dowling, DO, summarized the scientific papers of the last 20 years that have each met the evolving requirements of evidence-based medicine.6 In the November 2004 Supplement to JAOA, another article by John C. Licciardone, DO—the same author who prompted Dr Bledsoe's October letter—presents further pertinent references (“The Unique Role of Osteopathic Physicians in Treating Patients With Low Back Pain [review].” J Am Osteopath Assoc. 2004;104[11 Suppl 8]:S13-S18). 
From 1992 to 1996, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) issued several well-known clinical practice guidelines using an evidence-based format. In the clinical practice guideline Acute Lower Back Problems in Adults, a preponderance of evidence supported manual treatment for acute low back pain.7 Because of the process the Agency used for selecting evidence, however, their researchers arrived at this conclusion with only one of their 360 sources cited referencing osteopathic medicine8 and only four sources referencing chiropractic treatment modalities. 
During the last decade, as DOs have increasingly disconnected from their heritage of OPP, allopathic groups are offering more manual medicine courses. Michael A. Seffinger, DO; R. Todd Dombroski, DO; and Carl W. Steele, DO, presented a workshop at a national meeting for the American Academy of Family Physicians (see'michael%20seffinger,%20DO%20aafp'). In addition, S. Noone, Executive Director of the American Academy of Osteopathy, indicated that in August 2004, Jerel H. Glassman, DO, MPH, presented a manual medicine workshop at Harvard Medical School in Cambridge, Mass, that was sold out (oral communication, March 2005). Finally, the Association of American Medical Colleges will convene a special panel to write a Medical School Objectives Project special report regarding the importance of musculoskeletal education as part of the predoctoral curriculum at the nation's medical schools (S. Noone, oral communication, March 2005). 
Benjamin Asher, MD, is a surgeon and board-certified otolaryngologist who served as chief resident at the University of Iowa in Iowa City, after which he completed a fellowship in pediatric otolaryngology at Children's Hospital Boston. After serving as an assistant professor at Harvard Medical School and Dartmouth Medical School in Cambridge, Mass, and Hanover, NH, respectively, he went on to private practice. When Dr Asher's son needed tympanoplasty, however, this physician and surgeon was “open minded enough to visit an osteopath who was well trained in cranial work.” After a few treatments, his son no longer required surgery. In addition, the DO had corrected a problem with the child's crawling. Dr Asher was so impressed by these results that he began to study with the DO and took courses in cranial osteopathy. When Dr Asher saw the positive results of osteopathic manipulative medicine among his own patients, he gave up surgery and has now become dedicated to applying OPP to a wide variety of ear, nose, and throat problems (B. Asher, MD, oral communication, January 2005). 
Scientific peer-reviewed papers on the applications of OPP cumulatively present a crushing preponderance of evidence in support of osteopathic medicine—yet there remains a disconnect between book evidence and its translation into practical medical expertise. 
It is perhaps unrealistic to expect COMs to select out candidates with a natural proclivity for OPP; the pool includes too many bright students whose primary goal is to acquire a medical education. The challenge remains for the COMs to provide their students with scientific evidence and validation of core OPP in action by personal example. 
We further propose that the dichotomy between scientific and meta-physical is an arbitrary one; scientific evidence will continue to provide proof sufficient for those with “ears to hear and eyes to see,” and those with a faith-based leaning will continue to find deeper meaning in the personal exploration of OPP. Perhaps if Dr Bledsoe is not able to find practical value in OPP, he should turn his energies toward providing practical proofs in the allopathic paradigms, where only 10% to 20% of all procedures currently used in medical practice have been proven efficacious in controlled trials.9 
The process will never be perfect. The center of osteopathic evolution may pass from its point of origin to different continents. In the meantime, the current generation of DOs should continue to ask the difficult questions, forge new tools and methods, and deepen our understanding of the practice of medicine. 
If there is any “historic dogma of OMT,” to borrow the words of Dr Bledsoe, it is dig on—continue to apply OPP to the practice of medicine in an evidence-based fashion. It may well be that core osteopathic principles will continue to be relevant to the osteopathic physicians of tomorrow. 
Burns L. Studies in the Osteopathic Sciences: Basic Principles. Vol 1. Los Angeles, Calif: Occident; 1907.
Burns L. Studies in the Osteopathic Sciences: The Nerve Centers. Vol 2. Cincinnati, Ohio: Monfort;1911 .
Burns L. Studies in the Osteopathic Sciences: The Physiology of Consciousness. Vol 3. Cincinnati, Ohio: Monfort; 1911.
Burns L. Studies in the Osteopathic Sciences: The Cells of the Blood. Vol 4. Cincinnati, Ohio: Monfort; 1911.
King HH, ed. The Collected Papers of Irvin M. Korr. Indianapolis, Ind: American Academy of Osteopathy;1997 .
Dowling DJ. Don't raise your hand—Put it on the patient. Amer Acad Osteopath J. 2004;14(4):10 –16.
Bigos SJ, Bowyer OR, Braen GR, Brown K, Deyo R, Haldeman S, et al. Acute Lower Back Problems in Adults. Clinical Practice Guideline No. 14. Rockville, Md: US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Centers for Disease Control and Prevention. December 1994. AHCPR Publication No. 95-0642. Available at: Accessed March 17, 2005.
MacDonald RS, Bell CM. An open controlled assessment of osteopathic manipulation in nonspecific low-back pain [published correction appears in Spine. 1991;16:104]. Spine. 1990;15:364 –370.
Tunis SR, Gelband H. Health care technology in the United States [review]. Health Policy. 1994;30:335 –396.