Editorial  |   May 2019
The Art and Science of Osteopathic Medicine
Author Notes
  • From the Division of Infectious Diseases at Mayo Clinic Arizona in Phoenix. Dr Orenstein is the editor in chief of the American Osteopathic Association. 
  •  *Address correspondence to Robert Orenstein, DO, Editor in Chief, 142 E Ontario St, Chicago, IL 60611-2864. Email:
Article Information
Gastroenterology / Geriatric Medicine / Pulmonary Disorders / Being a DO
Editorial   |   May 2019
The Art and Science of Osteopathic Medicine
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 281. doi:
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 281. doi:
In this issue of The Journal of the American Osteopathic Association (JAOA), we embark on a new series entitled the Art and Science of Osteopathic Medicine. 
The JAOA is creating this new section to enhance the education of our readers on the pathogenesis of common problems seen by generalist physicians. Articles in this section will begin with a brief clinical vignette followed by an up-to-date review of the pathogenesis of the condition. These articles should link the discussion to osteopathic principles, and the conclusion should be hypothesis generating to stimulate further work in the area. 
Why create this new section? Most osteopathic physicians are engaged in the care of patients. We practice the art of osteopathic medicine every day by partnering with our patients to uncover solutions to their health needs. But to advance our understanding and improve solutions, we need to have a more in-depth and up-to-date understanding of why patients present with certain syndromes and how we might learn more to help them. How can we, as osteopathic physicians, help restore our patients to health? Scientific inquiry and scholarly activity can enhance and advance that art of care. 
One hundred eighteen years ago, in its very first issue, the JAOA published a paper from J. Martin Littlejohn, DO, titled “Osteopathy an Independent System Co-extensive With the Science and Art of Healing.”1 In his paper, Littlejohn tells us that “Osteopathy is that science or system of healing which emphasizes . . . the diagnosis of disease by physical methods with a view to discovering, not the symptoms but the causes of disease.”1(p25) Yes, pathogenesis—understanding the causes of the disease and how the host responds to restore health. The application of therapeutics to restore homeostasis can be achieved through numerous means: physical, nutritional, pharmacological, and environmental. 
Littlejohn wondered how osteopathy and the germ theory of disease could be integrated. He explained, “the germ or microbe organism is simply a foreign cell trying to insinuate itself into the mass of cells forming the organism.” He continued, “We have in our throats and lungs the germs of pneumonia and other diseases, from which we are rendered immune, because we have the germicide.”1(p32) Although Littlejohn and Andrew Taylor Still, MD, DO, believed that that germicide was blood, the osteopathic concept was later expanded to understand that the body has many intrinsic mechanisms to protect itself from microbes. 
The first article of this series tackles an all too common health problem, recurrent Clostridium (or Clostridioides) difficile infection.2 C difficile is a toxin-mediated diarrheal illness that affects more than half a million people in the United States annually,3 particularly elderly people and patients with chronic disease. In this first Art and Science of Osteopathic Medicine article, the pathogenesis of this common infection and how the human host has evolved mechanisms to prevent this illness are reviewed.2 The aforementioned comments of Littlejohn are prescient as we learn that the most effective means for preventing recurrence is restoration of the normal microbial structure of the human colonic microbiome—yes, we do have the germicide. 
Littlejohn JM. Osteopathy an independent system co-extensive with the science and art of healing. J Am Osteopath Assoc. 1901;1(1):22-34.
Orenstein R, Patron RL, Seville MT. Why does Clostridium difficile recur? J Am Osteopath Assoc. 2019;119(5):322-326. doi: 10.7556/jaoa.2019.054
Lessa FC, Mu Y, Bamberg VM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-834. doi: 10.1056/NEJMoa1408913 [CrossRef] [PubMed]