Letters to the Editor  |   June 2010
Realigning the JAOA to Sharpen Our Focus
Author Affiliations
  • Daniel K. Mangum, DO
    Advantage Medical Group, Portland, Oregon
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   June 2010
Realigning the JAOA to Sharpen Our Focus
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 320-321. doi:10.7556/jaoa.2010.110.6.320
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 320-321. doi:10.7556/jaoa.2010.110.6.320
To the editor:  
In the November 2009 issue of JAOA—The Journal of the American Osteopathic Association, an editorial by Felix J. Rogers, DO,1 outlined ideas to help promote the profession by focusing on several key tenets, including the one that has defined the profession from its inception: The musculoskeletal system plays a primary role in health and disease. 
The problem is, in my opinion, that that tenet is not true. The concept that the musculoskeletal system has a major influence on a person's health was first proposed by the surgeon and anatomist John Hilton in 1863 and was affirmed a decade later by Andrew Taylor Still, MD, DO,2 who became convinced that this system was critical for maintaining good health. Three years after the first osteopathic school was opened, in 1892,3 Daniel David Palmer, a magnetic healer, started the chiropractic profession.4,5 Both Still and Palmer concluded that impairment in the flow of information from nerves to various organs was the source of all medical conditions, from croup to liver disease.5,6 
As Dr Still wrote, “I could twist a man one way and cure flux, fever, colds, and the diseases of the climate; shake a child and stop scarlet fever, croup, diphtheria, and cure whooping-cough in three days by a wring of its neck, and so on.”6 We know today that none of these claims could be true. Mr Palmer decided that when a bone was out of place, it pressed on a nerve and impaired the flow of some special force that he called the “Innate” (always with an initial capital letter), a force he believed was necessary to allow the body to heal itself.5 
The ignorance of both gentlemen living in the late 19th century is understandable. There was little to no understanding of disease (the germ theory was still a hot topic), and there were no modern studies in physiology or biochemistry. Medicine was still in its infancy. Today there is no excuse to hold to such a belief. The musculoskeletal system does not play a primary role in health and disease. Compared with many other organ systems, the musculoskeletal system would rank near the bottom as an agent of disease prevention (certainly more important are the immune system, the circulatory system, the endocrine system, the integumentary system, the respiratory system, and even the digestive system). 
While some today may still argue otherwise, I know of no evidence that spinal adjustments improve the function of these other systems. It should be pointed out, however, that musculoskeletal problems are exceedingly common. Back pain and related problems are the second most common reason for visits to primary care physicians.7 Injuries, headaches, and fibromyalgia are other reasons people frequent various healthcare providers at times, looking for options other than medications. 
If the osteopathic medical profession must focus anywhere, it seemingly should be on these musculoskeletal problems. Our profession can and should embrace the ability to offer manual medicine in these cases. The superiority of osteopathic manipulative treatment (OMT) compared with other treatments remains debatable, but few would argue against its potential value in musculoskeletal problems, and everyone recognizes the demand for this kind of care. 
More importantly, we must be completely willing to abandon any and all unproven claims in which good evidence is lacking, and especially distance ourselves from claims that OMT may prevent disease or modify illness when there is no reasonable physiologic explanation or proof that can be offered. 
Rogers FJ. Realigning the JAOA to sharpen our focus. J Am Osteopath Assoc. 2009;109(11):577-578. Accessed May 17, 2010.
Homola S. Bone Setting, Chiropractic and Cultism. Panama City, FL: Critique Books, 1963. Accessed June 16, 2010.
Education firmly established. American Osteopathic Association Web site. Accessed May 18, 2010.
History of chiropractic care. American Chiropractic Association Web site. Accessed May 18, 2010.
Palmer DD. A brief history of the author and chiropractic. In: The Chiropractor's Adjuster [excerpt]. Portland, OR: Portland Printing House Company; 1910:17-19. June 16, 2010.
Still AT. Chapter VIII. Autobiography of A.T. Still. Published by the author; 1897. Accessed May 17, 2010.
Orthopaedic fast facts. American Academy of Orthopaedic Surgeons. Accessed June 16, 2010.