Letters to the Editor  |   June 2010
Author Affiliations
  • Felix J. Rogers, DO
    Downriver Cardiology Consultants, Trenton, Michigan
Article Information
Cardiovascular Disorders / Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment
Letters to the Editor   |   June 2010
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 321. doi:
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 321. doi:
I thank Dr Mangum for his provocative letter. The first step is to defuse our reaction to the language used by Dr Still in materials Dr Mangum quotes. While Still is widely revered throughout the osteopathic medical profession as creative and innovative, the fact is that he sometimes used outrageous language to emphasize a point or to shake up conventional thinking. I think the hyperbole described by Dr Still is just such an example. 
Dr Mangum issues a clear challenge: that the tenet describing the primary role of the musculoskeletal system in health and disease is simply not true. When our ad hoc committee got down to the task of developing the new tenets and principles that we proposed in 20021, we faced several challenges. The first was to be sure that the tenets and principles accurately reflected the published record of our profession. Largely due to the efforts of Michael Seffinger, DO, and his careful assessment of a century of osteopathic literature, I am confident that we did so. 
Implicit in Dr Mangum's thoughtful letter are two other important concerns. First, is the tenet “The musculoskeletal system plays a primary role in health and disease” in fact true? The first stumbling block is the word primary. Who of us would doubt the primary role played by the cardiovascular, pulmonary, neurologic, and gastrointestinal systems in health and disease? In fact, how many “primary” systems can there be? My November editorial2 indicated we were staking out new territory to provide evidence that this tenet can be demonstrated in research-based practice and the scientific literature. I welcome this challenge, and I hope that we will answer concerns about this and the other tenets as well. Over the next several months, these articles will deal with the role of the musculoskeletal system in type 2 diabetes mellitus, the role of lifestyle modification including exercise in the treatment of chronic coronary disease, and sports medicine, where the application is much more obvious. In each of these instances, the research evidence in support of osteopathic manipulative treatment (OMT) as an intervention into the musculoskeletal system is scant. 
The second, equally important issue is this: what has the osteopathic profession done to advance this tenet about the primary role of the musculoskeletal system, either in clinical practice, research, or scholarly publications? I part company with Dr Mangum when he states that our profession needs to focus on back pain and musculoskeletal problems per se. The authors of these tenets1 and the section editors for our new series in the JAOA all support the idea that a much more comprehensive and all-inclusive approach to the musculoskeletal system is necessary. Palpatory diagnosis and OMT are valuable tools, but we have other options in the toolbox, many of which are interventions into the musculoskeletal system with proven value. 
Dr Mangum is right on the money with his letter, and his challenge is a critical one for all of us. Tenets should not be adopted. Instead, tenets should be challenged and tested. If they prove their worth in the scientific arena, then they are valuable. Otherwise, these tenets and principles are just slogans that could be shortened for bumper stickers or marketing tag lines. 
 Editor's Note: Original research related to the discipline of osteopathic medicine remains The Journal`s top publication priority.
Rogers FJ, D'Alonzo GE Jr, Glover JC, Korr IM, Osborn GG, Patterson MM, et al. Proposed osteopathic tenets and principles for patient care [new and noteworthy]. J Am Osteopath Assoc. 2002:102(2):63-65. Accessed May 17, 2010.
Rogers FJ. Realigning the JAOA to sharpen our focus [editorial]. J Am Osteopath Assoc. 2010;110(11):577-578. Accessed May 17, 2010.