Misleading Claims By the American Osteopathic Association

Osteopathic physicians (D.O.s) are the legal equivalents and, in most cases, are the professional equivalents of medical doctors (M.D.s). Most states have separate licensing boards to regulate the two professions, but but both professions have the same scope of practice. Osteopathic medical schools place more emphasis than medical schools do on musculoskeletal problems, but otherwise their teachings are similar. After graduation, D.O.s are free to apply for residency programs at medical institutions—and many of them do so.

Despite these similarities, the American Osteopathic Association (AOA) promotes the idea that osteopathy offers something extra [1]. Toward this end, its Web site contains radio messages that were recorded at an osteopathic convention in 2004. The messages were prepared by Sound Targeting, which prepares and distributes interviews with members of its client organizations to local and regional media [2].

In March 2005, I discovered that the company had produced at least 75 messages from osteopathic physicians [3] and that four of them were posted to the AOA Web site. The most significant of these messages was from Brian Loveless, D.O., a third-year family practice resident at the Chino Valley Medical Center in Chino, California. The Center’s Web site lists his hobbies as “debating, OMM, and debating about OMM.” (I assume that OMM means “osteopathic manipulative medicine.”) Here’s a transcript with the questionable phrases underlined.

 

Christopher Michael: Medicine faces many challenges. Some of the answers come from doctors with a hands-on approach to healing and prevention  And, with an eye toward that, the American Osteopathic Association is meeting in San Francisco. Among them, Dr. Brian Loveless, from Chino Valley Medical Center who spoke to reporter Christopher Michael on the topic of “What is a D.O.?”Michael: If you’re going to see your doctor or you’re in a hospital situation and you look at the tag and after the name are the letters “D.O.,” what does that mean to the patient? Loveless: D.O.s are physicians who are fully licensed and trained to practice all types of medicine and surgery. But in addition we also receive about 400 hours of additional training in using our hands and trying to use the musculoskeletal system as a way of helping us diagnose and treat the body. Michael: This would mean, of course, you spend more time with the patient. Loveless: Typically if you’re gonna be putting your hands on someone, you’re gonna make a more complete diagnosis, you definitely have to spend more time with them. That’s true. Michael: How does this change the treatment of the patient? Loveless: What we would like to do as osteopathic physicians is really get to the root of the problem. And we find that a good majority of illnesses are complicated by musculoskeletal problems—things going on in the spine and the nervous system. So using osteopathic manipulation, we can address that and try to help the body heal itself [4].

This message is questionable for several reasons:

• I doubt that the “400 hours of additional” training are actually additional. If the amount of time medical and osteopathic students spend in school is similar—and I suspect that it is—”adding” 400 hours of something would mean subtracting 400 hours of something else. Moreover, the amount of training time spent with patients is not limited to undergraduate medical education. Most physicians who enter practice have far more patient contact during their postgraduate (residency) years. Again, the total time spent is similar, and many D.O.s enter medical residency pathways that do not involve osteopathic manipulative treatment.
• I don’t know how one can use the musculoskeletal system in any special way to diagnose or treat “the body.” Many standard tests are useful for evaluating the musculoskeletal system. But I don’t know of any special test or treatment that osteopaths offer that has any special value related to the whole body.
• It’s not clear to me how osteopathic training could enable practitioners to make “more complete” diagnoses.
• I don’t see how training about the musculoskeletal system would enable osteopathic practitioners to get to the “root” of health problems. Most health problems do not have a musculoskeletal cause. The statement seems to imply that there there is an underlying cause of disease that osteopaths can find and medical doctors can not find. This resembles fundamentalist chiropractic claims that spinal misalignments (“subluxations”) are the underlying cause of disease.
• The statement that “a good majority of illnesses are complicated by musculoskeletal problems . . . things going on in the spine and the nervous system” strikes me as absurd. I wonder whether the American Osteopathic Association can supply a list. Moreover, for problems that might fit this description, it isn’t clear to me that osteopaths are better equipped than medical doctors to manage them.
• I don’t believe that osteopathic manipulation stimulates or enables the body to “heal itself.” This, too, sounds like the fundamentalist chiropractic claim that spinal manipulation mobilizes “nerve energy” that stimulates self-healing.

References

1. Barrett S. Dubious aspects of osteopathy. Quackwatch, Aug 18, 2003.
2. Services. Sound Targeting Web site, accessed Match 2, 2005.
3. Radio stations: Why wait for good stories? Sound Targeting Web site, accessed March 2, 2005.
4. Loveless B. The D.O. difference. Downloaded from the American Osteopathic Web site, March 1, 2005.