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Letters to the Editor  |   May 2012
Osteopathic Medical Students' Beliefs About Osteopathic Manipulative Treatment at 4 Colleges of Osteopathic Medicine
Author Affiliations
  • William F. Duerfeldt, DO (retired)
    Asheville, North Carolina
Article Information
Medical Education / Osteopathic Manipulative Treatment
Letters to the Editor   |   May 2012
Osteopathic Medical Students' Beliefs About Osteopathic Manipulative Treatment at 4 Colleges of Osteopathic Medicine
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 262-263. doi:10.7556/jaoa.2012.112.5.262
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 262-263. doi:10.7556/jaoa.2012.112.5.262
To the Editor: 
I just finished reading the interesting medical education article by Brian B. Draper, DO, and colleagues in the November 2011 issue of JAOA—The Journal of the American Osteopathic Association (“Osteopathic Medical Students' Beliefs About Osteopathic Manipulative Treatment at 4 Colleges of Osteopathic Medicine.” 2011;111 [11]:615-630). The results of the authors' survey on osteopathic medical students' attitudes toward osteopathic manipulative treatment (OMT) were depressing indeed. Although Dr Draper and his coauthors present several conclusions as to why a growing number of graduates of colleges of osteopathic medicine (COMs) may not be using OMT in their clinical practices, at least 1 important factor was not assessed in their survey—namely, the type and quality of the OMT currently being taught in COMs. The authors assume that all forms, techniques, and theories of OMT being taught in COMs are of equal value and, hence, equally valid. I contend that this assumption is not necessarily correct. Furthermore, I suspect that much of what is being taught to first- and second-year osteopathic medical students may actually have a detrimental impact on their decisions regarding whether to use OMT in their clinical practices after graduation. 
I am a 1975 graduate of A.T. Still University-Kirksville College of Osteopathic Medicine (known simply as Kirksville College of Osteopathic Medicine [KCOM] back then). The primary focus of my OMT classes at KCOM concerned structural diagnosis and treatment using high-velocity, low-amplitude (HVLA) techniques. To be sure, other forms of OMT were also taught, including such esoteric and pseudoscientific treatment regimens as “cranial manipulation,” but the main emphasis during my 2 years of OMT classes at KCOM was HVLA and other direct OMT techniques. Moreover, after I graduated, I continued honing my manipulative skills through informal mentoring with a number of osteopathic family physicians who were highly proficient in structural diagnosis and HVLA techniques. Needless to say, I used OMT regularly and effectively in my own family practice during the next 3 decades. 
In 1980, I joined the faculty of 1 of our Midwestern COMs. Being a strong believer in and user of OMT in my own practice, I was immediately assigned to the OMT teaching team. I continued in that role during most of my tenure at the college. Initially, our OMT curriculum consisted of the classic direct techniques, including HVLA, muscle energy technique, and soft-tissue technique—procedures that would have been familiar to A.T. Still himself. (The scientifically questionable cranial manipulation was offered as an adjunct course to interested students, but it was not part of the college's standard OMT curriculum.) 
Sometime in the mid-1990s, more and more unorthodox theories and practices began working their way into our college's OMT curriculum. Such suspect and pseudoscientific manipulative techniques as Chapman reflex, other reflexology techniques, and visceral manipulation eventually became part of our standard curriculum. One faculty member was allegedly even telling students how to “manipulate energy auras”! Along with these questionable techniques, our faculty also began teaching some rather unpleasant manipulative procedures, such as “intraoral muscle energy,” “intra-anal coccyx manipulation,” and “pelvic spread.” 
I write all this only to ask a single question: Could the primary factor driving our osteopathic medical students further and further away from OMT be our teaching of scientifically questionable and controversial manipulative techniques under the rubric of osteopathic principles and practice? Students choose to study and practice osteopathic medicine for a variety of reasons. However, 1 thing that all students have in common is that they have been steeped in the scientific method and they recognize good ol’ bovine scatology when they see it. 
If the statistics reported by Dr Draper and colleagues are accurate reflections of osteopathic medical students' feelings concerning OMT in all of our COMs—and I fear that they may well be—we as a distinct profession of health care providers will soon be going the way of the snake-oil salesmen and the phrenologists of yore.