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Letters to the Editor  |   April 2014
Moving From EBM to EBOM: An Osteopathic Perspective on Evidence-Based Medicine
Author Affiliations
  • Jay B. Danto, DO
    A.T. Still University-Kirksville College of Osteopathic Medicine, Missouri
Article Information
Evidence-Based Medicine
Letters to the Editor   |   April 2014
Moving From EBM to EBOM: An Osteopathic Perspective on Evidence-Based Medicine
The Journal of the American Osteopathic Association, April 2014, Vol. 114, 235-236. doi:10.7556/jaoa.2014.047
The Journal of the American Osteopathic Association, April 2014, Vol. 114, 235-236. doi:10.7556/jaoa.2014.047
To the Editor: 
As I was drinking my morning tea and reading a POEM (Patient Oriented Evidence that Matters) by Allen Shaughnessy, PharmD (POEM Research Summaries listserve, December 11, 2013), one of my mentors and a US leader in evidence-based medicine (EBM), it occurred to me that EBM is not entirely concurrent with osteopathic philosophy. The POEM by Shaughnessy asked the clinical question, “Do lifestyle interventions decrease adverse clinical outcomes in patients with, or at high risk for, type 2 diabetes?” In short, Shaughnessy said the answer was no. This conclusion was largely reached because the concept that if the evidence does not show how an intervention can prolong life or decrease morbidity or mortality, then the evidence base does not support its use. 
I propose that because the osteopathic philosophy is fundamentally different from that of allopathic medicine, it is incumbent on us osteopathic physicians to apply our philosophy to the evidence and use what I would like to call “evidence-based osteopathic medicine” (EBOM). The fundamental difference from EBM is that EBOM includes optimum health as a central theme. The third edition of our profession's textbook, Foundations of Osteopathic Medicine, highlights that “Health is the adaptive and optimal attainment of physical, mental, emotional, and spiritual well-being.”1 Never in the history of osteopathic medicine has the central theme stopped at managing disease. As osteopathic physicians, we have always sought optimum health for our patients. 
Evidence-based medicine is an important contribution to the practice of medicine, and I believe all physicians need to make decisions based on EBM. Practicing EBM means that we apply our clinical expertise to the clinical state of the patient while paying particular attention to the patient's preferences and belief systems and integrating that information with the research evidence to create unique, evidence-based treatments. However, as osteopathic physicians we have the added responsibility to ask if the evidence has a positive or negative impact on our patient's abilities to achieve optimum health. Osteopathic medicine has always been about offering something more, and I believe that tradition should continue with EBOM—our approach to EBM. 
Reference
Reference
Seffinger MA, King HH, Ward RC, Jones JM, Rogers FJ, Patterson MM. Osteopathic philosophy. In: Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2011:21.