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Letters to the Editor  |   September 2010
Letters
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Imaging / Medical Education / Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Being a DO
Letters to the Editor   |   September 2010
Letters
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 512-552. doi:10.7556/jaoa.2010.110.9.512
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 512-552. doi:10.7556/jaoa.2010.110.9.512
To the Editor:  
I read with interest the letter by Eric E. Shore, DO,1 in the May issue titled “The Anachronistic Fight for Osteopathic Distinctiveness.” Although Dr Shore presents cogent and insightful arguments—many of which I agree with—there are two issues in which he appears to over-simplify, thereby nullifying his suggestion to assimilate the osteopathic medical profession with the allopathic medical profession. One issue is his American-skewed view of the global osteopathic profession. The other issue concerns the value of a distinctively osteopathic approach to patient management, including—but not limited to—the use of osteopathic manipulative treatment. 
Healthcare systems and their regulation are the purview of each sovereign nation. Surely such systems need to be grounded in science, as well as in the social structure, of each country. Since the founding of the Kirksville College of Osteopathic Medicine in 1892, the thoughts of Andrew Taylor Still, MD, DO, have impacted healthcare systems in Europe and elsewhere, resulting in varied expressions of Dr Still's vision. Amid this diversity, there remain many common features—most notably the emphasis on the musculoskeletal system and the means of restoring its integrity. 
Osteopathic medicine/osteopathy, in its expression with or without the medical degree, has received official recognition in many countries and by the World Health Organization.2 It is also supported by the Osteopathic International Alliance,3 which, in turn, is supported by the American Osteopathic Association. The medicalized osteopathic physician model we have chosen in the United States has many strengths. However, this model is not seen as the optimal expression of osteopathic concepts in the contexts of all countries. This difference admittedly presents a problem for us in that our US DO degree is not viewed everywhere as being equivalent to, or as socially acceptable as, an MD degree. But such attitudes are to be expected in our diverse global culture, are they not? 
The US expression of osteopathic medicine, as Dr Shore1 recognizes, is indeed floundering for its identity, mainly because of the split in strategies regarding how to achieve parity in privileges and public recognition with MDs. In one sense, this fight is won. We have achieved success in surviving the criticisms of the 1960s through 1980s, the collapse of the osteopathic hospital system during the economic consolidations of the 1990s, and the resultant emergence of dual-staff institutions. Yet, a more subtle loss of distinctive self-image has emerged as successive classes of osteopathic medical school graduates confront the ambiguity over the identity of our profession4 and as many of these graduates are trained in allopathic residency programs, in which mentoring of distinctive osteopathic behavior is extremely limited or nonexistent.5 
Many of us continue to view Dr Still's teachings beyond how those teachings have been accommodated to the model of medicine-by-algorithm based on laboratory and imaging diagnostic tests and pharmaceutical and surgical treatments. Yes, medical science has progressed wondrously since Dr Still's time. But what do we say to a patient who presents to a DO with back pain after undergoing serial laminectomies when that patient notes, “You are the first physician who touched me”? 
Regardless of results shown by magnetic resonance imaging, the fact that the patient has a body that can be examined and cared for with osteopathic manipulative treatment is still worth factoring into management decisions. 
Returning to the issue of osteopathic medicine in the context of the American experience, DOs in the United States are in an uncomfortable marriage. Some of us, like Dr Shore,1 are more than satisfied to assume our privileged place alongside our MD counterparts and to use this status as the basis of our identity. However, others of us prefer to teach and practice in ways that attempt to blend the principles and motivations of Dr Still with the findings of modern medicine to make medicine “something more.” In this regard, we are joined by both physician and nonphysician DOs worldwide in efforts to establish a higher standard that integrates traditional osteopathic principles into progressive bioscience and healthcare delivery. 
As stated by Norman Gevitz, PhD,6 osteopathic medicine is a type of reform, and reform is ongoing. Today, there is an ongoing global effort to blend the strengths of the various models of osteopathic medicine/osteopathy to form a stronger profession with a consensus of proficiency standards. 
The debate about the identity of the osteopathic medical profession long predates the issues raised by Dr Shore1 in his letter. In fact, such debates formed the basis of the schism that developed between Dr Still and John Martin Little-john, who introduced osteopathy into the United Kingdom in the early 1900s.7 Such disagreements are inherent in any movement based on “philosophy.” Debate and tension within our profession will undoubtedly continue—though there is merit in maintaining a unified profession during this dialectic, rather than creating two separate minority factions. The latter option has been tried, and it does not seem to be wise. 
Much more could be said, especially about the dynamics of international osteopathic practice and its continual evolution. However, I will close by simply noting that I am excited for the future of our profession. 
Shore EE. The anachronistic fight for osteopathic distinctiveness [letter]. J Am Osteopath Assoc. 2010;110(5):299-300. http://www.jaoa.org/cgi/reprint/110/5/299. Accessed July 19, 2010.
International—about international osteopathic medicine. DO-Online Web site. https://www.do-online.org/index.cfm?PageID=lcl_main&au=A&SubPageID=lcl_interntnl. Accessed July 19, 2010.
About the Osteopathic International Alliance. Osteopathic International Alliance Web site. http://www.oialliance.org/about.htm. Accessed July 19, 2010.
Steele KM, Baker HH. Clearly distinct: outcomes of initiative to increase integration of osteopathic principles and practice at West Virginia School of Osteopathic Medicine. J Am Osteopath Assoc. 2009;109(11):579-590. http://www.jaoa.org/cgi/reprint/109/11/579. Accessed July 19, 2010.
Bates BR, Mazer JP, Ledbetter AM, Norander S. The DO difference: an analysis of causal relationships affecting the degree-change debate. J Am Osteopath Assoc. 2009;109(7):359-369. http://www.jaoa.org/cgi/reprint/109/7/359. Accessed July 19, 2010.
Gevitz N. `Parallel and distinctive': the philosophic pathway for reform in osteopathic medical education. J Am Osteopath Assoc. 1994;94(4):328-332. http://www.jaoa.org/cgi/reprint/94/4/328. Accessed July 19, 2010.
History of osteopathy. European Federation of Osteopaths Web site. http://www.efo.eu/portal/index.php?option=com_content&view=article&id=68&Itemid=74. Accessed July 19, 2010.