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It seems that much of the public is just noticing that there are essentially two distinct medical degrees offered in the US, MD (medical doctor) and DO (doctor of osteopathy). This fact became apparent because the president’s personal physician, Sean Conley, is a DO (he graduated in 2006 from the Philadelphia College of Osteopathic Medicine). Without getting into the details, his care of the president both over the course of this pandemic and during his recent illness with COVID-19 has been curious to other medical experts, and he appears to be subjugating good medical communication (if not care) to political expediencies. This has prompted many to ask what role his DO plays in this behavior.

While I have no personal information about Dr. Conley except what is already public knowledge, I thought it would be a good time to review osteopathic medicine – what is it, exactly?

The history of osteopathic medicine (OM) has some similarities and important difference from chiropractic. OM was founded by a physician, Andrew Taylor Still, in 1874. The core idea on which he founded OM was the notion that the bones and their connections (ligaments, tendons, fascia) represent a continuous energy that can heal the whole body. This was not an unusual idea at the time, a manifestation of the “life force” (or vitalism), and all you have to do is free or support this force and the body will heal itself. This is also the essence of chiropractic.

This notion is also completely wrong. The notion of a life force was always a placeholder of our own ignorance, and was discarded by medicine once we learned how biology actually works. No life force has ever been discovered by science, and there is no plausible mechanism for such a force. There is also no evidence tying the bones to healing in the way imagined by Still.

To give an idea of his thinking, here is a quote from his writing (spelling errors all in the original):

The Heart. Its Commission, The powers delegated to it; by some wise government. Is evident by the work it does – I do not mene the muscles of its physical form. I men the soul of its commission. A commission is allways written on a sheet of paper, or Parchment. The has no paper, that is visable until it makes the paper. and It writes or specifys all the plans it must exacut and says thus far and no farther. you can go – in your commission you have power to build and power to repare. and vitalise all divisions & unit all into one being, And leave the Substance of knowledge to rule and govern by the mandates of knowledge whos law is absolut and must be obeyed to the last letter or death is the penalty.

This is a clear statement of vitalistic philosophy. This is how osteopaths represent their philosophy today:

His research and clinical observations led him to believe that the musculoskeletal system played a vital role in health and disease. He concluded that the body contained all of the elements needed to maintain health, if properly stimulated.

Dr. Still believed that by correcting problems in the body’s structure, through the use of manual techniques now known as osteopathic manipulative medicine (OMM), the body’s ability to function and to heal itself could be greatly improved. He also promoted the idea of preventive medicine and endorsed the philosophy that physicians should focus on treating the whole patient, rather than just the disease.

The original OM philosophy is still there, amazingly, but they try to “retcon” this philosophy into the more modern notions of “holistic” and preventive medicine. There is nothing holistic about vitalism, and Still did not invent preventive medicine. This philosophy is pseudoscientific baggage, and OM would do well to just rid themselves of it.

But here is where the history of OM diverges from chiropractic. The originator of chiropractic, DD Palmer, and even more so his son, were hostile to MDs and mainstream medicine. They wanted nothing to do with it. This has shaped their history of the last century. But Still was an MD himself, and when medicine was undergoing a massive reform (prompted by the Flexner report of 1910) OM went along. Colleges of OM adopted the scientific and quality control reforms that medical schools did (while chiropractors resisted any notion of merging with mainstream medicine).

The result is that today the medical education provided by an OM education is roughly equivalent to those provided by a traditional medical school. In fact, many DOs will attend the same internships and residencies that MDs do (and that is where you actually learn most of the medicine you will eventually practice). When we have discussed osteopathic medicine in the past, SBM authors have always pointed this out. John Snyder wrote, for example:

I would like to preface this post by stating that I have worked with many DOs (Doctors of Osteopathy), and I have helped train many pediatric residents with DO degrees. I have found no difference in the overall quality of the training these students have received, and some of the very best clinicians I have ever worked with have been DOs. I would never prejudice my assessment or opinion of a physician based on whether they have an MD or a DO after their name.

I agree. I have not personally witnessed any difference. Mark Crislip also pointed out that DOs are using less and less osteopathic manipulation in their practice. This is a good thing, and hopefully it will eventually completely fade away. Essentially we need to distinguish between osteopathic medicine, which is mostly equivalent to standard medicine, and osteopathic manipulation, which is pure pseudoscience akin to straight chiropractic.

The fact that any individual physician is a DO rather than an MD really tells us nothing. However, osteopathic medicine really should ditch the manipulation based on quaint notions of vitalism. They should also stop selling themselves as “holistic” or pretending that they invented preventive medicine.

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Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.