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Letters to the Editor  |   April 2016
Landmark Article Supports Osteopathic Medicine? Setting the Record Straight
Author Notes
  • Innovative Health Systems, White Plains, New York 
Article Information
Cardiovascular Disorders / Neuromusculoskeletal Disorders / Being a DO
Letters to the Editor   |   April 2016
Landmark Article Supports Osteopathic Medicine? Setting the Record Straight
The Journal of the American Osteopathic Association, April 2016, Vol. 116, 200. doi:10.7556/jaoa.2016.040
The Journal of the American Osteopathic Association, April 2016, Vol. 116, 200. doi:10.7556/jaoa.2016.040
To the Editor: 
In the November 2015 issue of The Journal of the American Osteopathic Association, Hoegerl1 praises the 2015 Nature article by Louveau et al2 for discovering functioning lymphatic vessels in the central nervous system. Hoegerl1 claims this study “has provided evidence for what osteopathic physicians have been doing clinically since the time of Andrew Taylor Still, MD, DO.” 
However, Louveau et al2 have simply added to evidence cited in the 38th edition of Grays Anatomy: “Although the evidence from tracer studies is scarce in man, there are anatomical pathways in the human central nervous system which correspond to the lymphatic drainage pathways of the brain identified in experimental animals.”3(p1202) Also, citing Szentistvanyi et al,4 “Physiological studies emphasize that the extracellular space of the brain is in continuity with the CSF [cerebral spinal fluid] such that substances entering the extracellular spaces of the brain may drain either into ventricular CSF or along the perivascular and, ultimately, lymphatic drainage pathways.”3(p1222) 
Although the findings by Louveau et al2 are important, they should be properly positioned in basic anatomy rather than be considered a validation of osteopathic principles and practice. 
References
Hoegerl C. Landmark article supports osteopathic medicine [letter]. J Am Osteopath Assoc. 2015;115(11):646. doi:10.7556/jaoa.2015.134. [CrossRef] [PubMed]
Louveau A, Smirnov I, Keyes TJ, et al Structural and functional features of central nervous system lymphatic vessels [published online June 1, 2015]. Nature. 2015;523(7560):337-341. doi:10.1038/nature14432. [CrossRef] [PubMed]
Williams PL. Gray's Anatomy. 38th ed. London, England: Churchill Livingstone; 1995:1202.
Szentistvanyi I, Patlak CS, Ellis RA, Cserr HF. Drainage of interstitial fluid from different regions of rat brain. Am J Physiol. 1984;246(6 pt 2):F835-F844. [PubMed]