Letters to the Editor  |   July 2008
Article Information
Medical Education / Being a DO
Letters to the Editor   |   July 2008
The Journal of the American Osteopathic Association, July 2008, Vol. 108, 355-357. doi:
The Journal of the American Osteopathic Association, July 2008, Vol. 108, 355-357. doi:
We appreciate the comments from Dr Prozialeck, Dr Licciardone and colleagues, and Dr Harper regarding our medical education article1 and editorial2 that appeared in the November 2007 issue of JAOA—The Journal of the American Osteopathic Association. We agree with Dr Prozialeck's analysis of the data indicating a strong correlation between number of full-time faculty and amount of extramural funding at the colleges of osteopathic medicine (COMs). As noted in our medical education article,1 the four highest totals in extramural funding in 2004 were from publicly supported COMs with an average faculty size of 140. 
Dr Prozialeck also points out that the privately funded University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Me, had a high ranking (fifth) among COMs in total extramural funds received in 2004. It should be noted that the average faculty size of 140 for the top four state-funded COMs was 23% greater than the average faculty size of 114 noted for all the state-funded COMs.1 Although UNECOM had 87 faculty members—which was 61% more than the average of 54 faculty members at the other private COMs—UNECOM still fell 24% short of the average faculty numbers at the state-supported COMs.1 
In addition, Dr Prozialeck indicates that Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg has established a fairly substantial research program—even though that institution is also privately funded and less than 10 years old. It should be pointed out, however, that VCOM's total funding in 2004 was exceeded by all but one of the state-supported COMs and by three of the private COMs.1 Of these three private COMs, only UNECOM was less than 100 years old. 
Another potential confounding variable that may directly affect the research success at both UNECOM and VCOM is their proximity to large undergraduate institutions with campus research resources that may enhance those of the smaller, private COMs. Nevertheless, we agree with Dr Prozialeck that the success of a COM's research program includes the culture and environment relative to rewards for research efforts—factors that may not specifically be tied to the age of the institution. 
In their commentary, Dr Licciardone and colleagues emphasize the need to continue osteopathic professional funding to maintain the success generated by The Osteopathic Research Center (ORC), as well as to support additional regionally based osteopathic research centers (RBORCs). In our medical education article1 and associated editorial,2 we suggested that new RBORCs should be funded to increase both the breadth and depth of osteopathic medical research across the United States. 
Dr Licciardone and colleagues mention that the National Center for Complimentary and Alternative Medicine (NCCAM) Expert Panel typically recommends an annual budget of $1 million to $1.5 million to maintain the infrastructure of a research center.3 Although this recommendation is a generality, one must consider that the original investment for The ORC was $1.1 million over 4 years ($275,000 per year), followed by an additional $900,000 for the next 4 years ($225,000 per year). It is clear that, despite an initial investment that was far below the amount recommended by NCCAM, The ORC has been able to sustain and increase its infrastructure. The second cycle of funding was less than the initial cycle—even without adjusting for inflation—suggesting that either the infrastructure cost of The ORC diminished or other income sources were filling the funding void. The former explanation is unlikely because The ORC staff, faculty, and space have increased during the past 7 years. Thus, the latter explanation is clearly the more appropriate answer. 
The purpose of the initial funding for The ORC was to support the infrastructure of a start-up national research center that would drive scientific investigation for the osteopathic medical profession. The ORC should be commended for accomplishing that goal. The rationale for The ORC's second funding cycle was to further support the infrastructure so that more substantive funding from federal sources, such as NCCAM, could be obtained. Again, The ORC should be commended for accomplishing that goal. In order to maintain a research infrastructure through the long term, funding streams need to come from a variety of sources. The ORC has accomplished this objective with local, federal, and foundation funding. 
Given the success of The ORC, one might question whether the American Osteopathic Association, American Osteopathic Foundation, and American Association of Colleges of Osteopathic Medicine should continue to fund The ORC as a unique national research center; continue to fund The ORC while initiating additional start-up funds for a second RBORC; stop funding The ORC and transfer this support to a new RBORC; or decline funding any national research center. 
Considering the volatility of the financial markets and fluctuating funding sources today, the osteopathic medical profession needs to carefully prioritize where it expends its financial resources. To resolve this dilemma, it may help to understand this issue from a national perspective. 
In a recent review of funding of the US biomedical research community, Heinig et al4 reported that allopathic medical schools projected average annual debt incurred by the total costs of research per institution to increase from $3.5 million in 2003 to nearly $7 million in 2008. Research is expensive, but the following quote from the review by Heinig et al4 underscores the necessity of not only continuing our current research efforts, but expanding them: 

The percentage increases (actual and projected) in research space and faculty in most research-intensive schools were similar to those in all other medical schools, reflecting the shared conviction in all corners of the community that an enhanced research mission not only would benefit human health and well-being but also would contribute to local and regional prosperity.

Thus, the osteopathic medical profession may have no option but to continue to financially support The ORC and to institute financial support for other RBORCs. Not only is this the right thing to do for our profession, it is the right thing to do to fulfill the implied social contract between our profession and the public. We need to continue to use scientific rigor to prove that distinct osteopathic principles and practice (OPP) make a substantive difference for our patients and for society. 
Although it could be said that the combined National Institutes of Health research funding at all of our COMs would rank only 163rd among the top 500 research institutions,5 it could just as easily be argued that our combined funding ranks first in dollars from the National Institutes of Health allocated toward unique OPP. To date, the pilot studies focusing on aspects of medicine specific to OPP have been funded only by entities affiliated with our profession. It is essential that we keep this funding line viable and robust; without it, the osteopathic medical profession will not produce the research data that are necessary to contend for the larger competitive grants from government agencies and private foundations. 
The osteopathic medical profession's continued support for The ORC demonstrates to other funding organizations that we believe in our research center and its mission, and this, in turn, opens the door for other potential sources of funding. Research is expensive, but—as shown by The ORC—it can produce a sizeable return on investment. This return includes not only financial dividends, but also a sharpening of the definition of our professional image and improvement in the public awareness of osteopathic medicine. Most importantly, continued research in osteopathic medicine helps us better treat our patients with the unique therapeutic modalities first envisioned by Andrew Taylor Still, MD, DO. 
Lastly, we wish to thank Dr Harper for his kind remarks. We agree with the sentiments of Dr Prozialeck, Dr Licciardone and his ORC colleagues, and Dr Harper that research in the osteopathic medical profession needs the continued support of all of our national professional organizations, and this support must include all of the COMs—both public and private. We are a relatively small profession, and our research component makes up a sliver of the whole body of medical research conducted in the United States. Nevertheless, we should never underestimate its potential impact. To quote the late anthropologist Margaret Mead: 

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.6

 Editor's Note: Drs Clearfield and Cavalieri are members of the JAOA`s Editorial Advisory Board. Dr Guillory is the chairman of the External Advisory Committee for The Osteopathic Research Center, which resides at the University of North Texas Health Science Center—Texas College of Osteopathic Medicine in Fort Worth. In addition, Dr Clearfield previously served as associate dean of clinical research at the Texas College of Osteopathic Medicine and had a supervisory role with The Osteopathic Research Center.
Clearfield MB, Smith-Barbaro P, Guillory VJ, Cavalieri TA, Wood DL, Sharp GF, et al. Research funding at colleges of osteopathic medicine: 15 years of growth. JAm Osteopath Assoc. 2007;107:469-478. Available at: Accessed July 3, 2008.
Clearfield MB, Smith-Barbaro P, Guillory VJ, Cavalieri TA, Hahn MB. How can we keep research growing at colleges of osteopathic medicine [editorial]? J Am Osteopath Assoc. 2007;107:463-465. Available at: Accessed July 3, 2008.
National Center for Complementary and Alternative Medicine. National Center for Complementary and Alternative Medicine (NCCAM) Research Centers Program Expert Panel Review. Bethesda, Md: National Center for Complementary and Alternative Medicine, National Institutes of Health; 2002. Available at: Accessed July 3, 2008.
Heinig SJ, Krakower JY, Dickler HB, Korn D. Sustaining the engine of US biomedical discovery. N Engl J Med. 2007;357:1042-1047.
NIH awards to all institutions by rank, fiscal year 2004, rank 1 to 500. National Institutes of Health Web site. Available at: Accessed July 3, 2008.
Quotations by Margaret Mead. The Quotations Page Web site. Available at: Accessed July 3, 2008.