Osteopathic Medicine:
The Future of Affordable
Health Care?
Chris Benner
November 27, 2002
Biology Senior Seminar
Thesis:
With the ability to provide alternatives to costly medications
and focus on preventive measures,
the doctor of osteopathy is the model for affordable health care.
I. Introduction of the D.O.
A. Makeup of doctors
B. AOA survey
C. Overview of paper
II.
Osteopathy: past and present
A. Dr. Andrew Taylor Still
1. Founding of osteopathy
2. Foundations of osteopathy
B. Establishment and accomplishments of AOA
C. Modern Osteopathy
III. The fight for identity and the modern health care crisis
A. Osteopathic identity crisis
B. Rising health care costs
IV.
Establishing an identity and fighting costs
A. OMT reduces medication spending
1. Case studies
B. Preventive health care can reduce expenses
1. Spending statistics
C. Improving the doctor-patient relationship
D. Limitations
1. Argument for legitimacy
V.
Conclusion
A. Intention of argument
1. Integration osteopathic techniques
B. Restatement of main ideas
1. D.O. as model of affordable health care
Currently there are two main types of licensed physicians in the
United States. The first is the medical doctor or the allopathic
doctor. About 95% of licensed doctors have been educated
at one of over 120 allopathic medical schools and have thus obtained
a medical doctor degree (M.D.). The second type of doctor,
the doctor of osteopathy, is less common. Osteopathic doctors
make up about five percent of the physicians in the nation (Peters 730). Although
this represents a significant amount of physicians many people
are unfamiliar with the second type of doctor. In a 1981
the AOA (American Osteopathic Association) released the results
of a survey about public familiarity with the osteopathic doctor.
Only 20% of the 1,003 individuals surveyed, age eighteen and over,
were familiar with the D.O. (doctor of osteopathy) abbreviation.
Furthermore only 50% of those that were familiar with the title
could correctly give the unabbreviated version (Gevitz 154-55).
The results of this
survey are to a certain extent outdated, but an overall atmosphere
of unfamiliarity still looms about the doctor of osteopathy.
The following discussion will attempt to clarify this modern enigma.
A brief history of the much-maligned doctor of osteopathy will
be provided along with a contemporary description of the doctor's
focuses and responsibilities. Given the current situation
of health care costs the legitimacy of the D.O. will be discussed
as well as the capability to contest these rising costs intrinsically
possessed by this form of doctor. Finally, the integration
of D.O. and M.D. treatments will be discussed. Through subsequent
arguments the reader will learn that the doctor of osteopathy
is not only a legitimate form, but it may also be more adept to
deal with the current health care situation. With the ability
to provide alternatives to costly medications and focus on preventive
measures, the osteopathic doctor is the model for affordable health
care.
II. Osteopathy: past and present
Dr. Andrew Taylor
Still is considered to be the founder of osteopathic medicine.
Dr. Still practiced as an orthodox medical doctor until spinal
meningitis claimed the lives of three of his children in 1864.
Convinced that using drugs for the treatment of ailments was not
necessarily a scientific form of therapy, Still searched for alternatives
(Gevitz 125).
Through interactions with his peers, he began to see the human
body as a "vital mechanical organism, with all its parts
structurally and functionally coordinated" (Berchtold 2). Consequently, health was maintained
when all body parts could interact in a harmonious manner and
the flow of bodily fluids was unobstructed (Gevitz 127). Unlike his allopathic counterparts,
Still tended to look at the body as a whole while emphasizing
the body's inherent ability to produce remedies against disease.
However, the human body could only take care of itself if "structural
relationship was normal, environmental conditions favorable, and
nutrition satisfactory" (Berchtold 2).
To help restore a patient
to health Dr. Still began to use a landmark technique in osteopathic
medicine: osteopathic manipulation. By manipulating bones,
muscles and other tissues Still believed that he could remove
unhealthy obstructions to lymph and blood flow and thus restore
the body to its natural state ("D.O.
in the House" 6). Only in
this state could the human body combat disease and infection.
In 1892, after officially
deciding to call his newly found practice "osteopathy,"
Dr. Still opened the American School of Osteopathy (ASO) in Kirksville,
Kentucky (Gevitz
129). Others interested in this type of medicine decided
to open additional schools. Although intended to be an alternative
to allopathic medicine the osteopathic curriculum was highly scrutinized
for being inadequate and providing less patient interaction opportunities
for students than standard training. Issues such as this
persuaded followers of osteopathic medicine to establish the American
Osteopathic Association (AOA) in 1904 to help govern the curriculum
required for graduation at the handful of newly established schools
(Gevitz 132-33).
Along with this administrative
task the AOA also had to fight for the legitimacy of its schools.
Based on reports given by Abraham Flexner in 1910, an official
who monitored the practices of United States medical schools,
accreditation was only given to those schools that practiced the
allopathic model. As a result, state licensing boards also
became committed to this model of medicine. In effect this
ushered in the beginning of modern American medicine while at
the same time it challenged the validity of all other forms (Tyler 59). Thus
began the long, uphill battle for acceptance. Only as recently
as 1973 and 1974 when Mississippi and California respectively
passed laws allowing D.O.s to practice in their states did the
doctor of osteopathy become an official form of physician in all
fifty states (Gevitz
153).
Modern osteopathy is
an outgrowth of an early faction called broad osteopathy.
Broad osteopaths believed that in order to rank among allopathic
doctors they must be able to provide the same range of services.
In accordance to their beliefs they decided to accept any case,
using the necessary means to treat the patient, whether treatment
included OMT (osteopathic manipulative therapy) or the prescription
of pharmaceuticals (Gevitz
135). Today, graduates of osteopathic medical schools go
through the same board exams and residency programs as those of
allopathic schools. Like their allopathic counterparts,
D.O.s also have the same privileges including the ability to prescribe
medications, admit patients into a hospital and perform surgery
("D.O. in the House" 6). The main difference between allopathic
and osteopathic doctors is that the former "focus on conventional
treatments, based on symptoms, tests, and diagnoses" while
the latter "see the body as a whole, focusing on how one
system can affect another" (Stieg
and Jones 50).
III. The fight for identity and the modern health care crisis
The role of the osteopathic doctor has actually become quite similar
to that of the medical doctor during the late twentieth century.
In fact many lay people are not able to distinguish between the
two types based on treatment alone. This is largely due
to the fact that OMT has fallen out of practice. A 1997
survey supported this fact when it found that only about six percent
of D.O.s use manipulative techniques on more than half of their
patients while nearly one third use OMT on less than five percent
of all patients ("D.O.
in the House" 6). As this
practice continues to be abandoned with the passing of time osteopathic
doctors have become less unique and more like allopathic doctors.
The dying art of OMT seems to exemplify the current struggle within
osteopathic medicine to "maintain its current Îseparate
but equal' status, and carve out a distinctive image for itself
" (Gevitz
156).
At the same time the
current health care system gravely needs those that practice osteopathy
and its ideals to the full extent. The average premium for
employer-sponsored health plans went up by 12.7% during 2002.
While employers have been willing to absorb most of these costs
in the past they will most likely "push more of the price
tag onto their employees" in the coming years (Lankford and Popowsky
78). However, given the fact that health care costs are
growing at "eight times the rate of general inflation"
the majority of American citizens will not be able to afford insurance
if their employers begin to dump the weight of increasing premiums
on them (qtd. in McGirt
146).
IV. Establishing an identity and fighting costs
Osteopathic doctors have two unique characteristics that can help
them curtail rising costs as well as one characteristic that can
help them improve the doctor patient relationship in general.
The first thing that osteopathic doctors can do to help combat
health care costs is to bring back the alternative therapeutic
practices such as OMT that distinguished them from other types
of doctors during the early and mid-1900s. How can this
help to reduce the cost of health care? Currently, spending
on prescription drugs is the fastest growing category of health
care costs. By the year 2004 spending on prescription drugs
is expected to be double that of spending in 1999 and medication
prices are expected to rise by about 11% each year through 2010.
The growing senior citizen population only complicates this matter
(McGirt 146-47).
In spite of rising
drug costs osteopathic practices have been shown to reduce the
demand for medications. A New England Journal of Medicine
study comparing the treatment of chronic back pain by doctors
at the Chicago College of Osteopathic Medicine and conventional
medical doctors showed that the results were nearly identical.
The main difference was that patients of the osteopathic doctors
used less medication and physical therapy ("D.O.
in the House" 6). The study,
which was performed at Rush Presbyterian-St. Luke's Medical Center
in Chicago and at the osteopathic college, showed that osteopathic
doctors "prescribed 30% fewer painkillers than M.D.s and
19% fewer muscle relaxants" (Altshul 50). Furthermore, the prescription of
less drugs correlated with a significant reduction in overall
costs (Newswanger,
2414).
Contrary to some beliefs
the use of osteopathic methods is not only useful for joint pain,
but for dealing with general and inflammatory pain. A preliminary
study in Women's Health Weekly suggested that OMT had a greater
effect than drugs in reducing post-operative pain after hysterectomy
operations. Data was collected in the study by measuring
blood levels of morphine, which was administered by the patients
through analgesia pumps. The study showed that patients
receiving OMT administered less morphine giving a treatment option
that was "more cost-effective with fewer side effects for
patients" (Henderson 21). The results of these two studies
suggest that osteopathic manipulation can be equally effective
as conventional methods while requiring considerably less money
for prescription drugs.
Although this can be
seen as one area where osteopathic doctors can help to fight rising
health costs the limitations of the evidence must also be considered.
Pain medications make up only a small part of all medications.
More studies are needed dealing with the effects of osteopathic
manipulation on the demand for heart, circulatory system and diabetic
medications. Undoubtedly, observing a connection between
the use of manipulation and a reduced demand for these types of
drugs would give osteopathic doctors a marked advantage in reducing
health cares costs while at the same time establishing an unmistakable
identity for themselves.
However, studies dealing
with the use of osteopathic procedures to reduce the demand for
medications may be slow to develop. Osteopathic doctors
can find other methods to distinguish themselves from medical
doctors while at the same time fighting to reduce health care
spending. Foremost among these methods is the osteopathic
tendency to focus on prevention of disease. The focus on
preventive medicine is inherent in the D.O.s holistic approach
(Peters 730).
Osteopathic doctors emphasize the importance of nutrition and
body structure in the maintenance of the interdependent organ
systems. Placing the emphasis on preventive medicine can
make long term contributions to the struggle against rising health
care costs; perhaps even more so than using alternative procedures
such as OMT.
The need for preventive
health care is strongly supported by health care spending statistics.
Medical breakthroughs were responsible for 22% of costs for 2001-02.
Many of these breakthroughs deal with areas where preventive medicine
could reduce the need for this type of technology. Cardiac
emergencies and care for premature babies are two situations where
high cost technology is used (McGirt 146). At the same time preventive measures
can significantly reduce the occurrence of cardio-pulmonary and
prenatal emergencies. Therefore, osteopathic methodology
must again be considered competent in the area of lowering overall
patient expenditures.
Improvements in the
doctor-patient relationship could not only serve to better the
health care institution, but could also influence health care
costs. Physicians must place as much emphasis on communication
skills as they do on technical skills. The fact that many
doctors often encourage their patients to undergo unnecessary
procedures suggests that patient-physician relationships are lacking,
especially when expert listening skills are required. Once
again, osteopathic doctors have a marked advantage in their orientation.
A 1999 survey in the Journal of General Internal Medicine reported
that 63.8% of osteopaths described themselves as "socioemotionally"
oriented compared with only 40.1% of allopathic doctors (Peters 734). Simply
stated, physicians that strive to establish good relationships
while at the same time using their technical skills can reduce
costs by adequately investigating and addressing the needs of
their patients.
Consequently, OMT also
helps to establish a good patient-physician repertoire because
the "hands-on nature" of the therapy helps the patients
to be reassured of the doctor's presence and concern ("D.O. in the House" 6). Another study involving OMT in the
treatment of depression showed that all patients receiving OMT
in addition to standard psychiatric treatment returned to the
normal range on the Zung Depression Scale after eight weeks.
Of those that only received standard psychiatric treatment, 70%
still showed signs of moderate depression (qtd. in "OMT may Benefit"
13). This may have implications for saving expenditures
on medications, but more importantly it shows the significance
of meaningful patient-doctor interactions.
Osteopaths do not necessarily
have advantages over allopathic physicians in all matters because
osteopathic students usually fall short of allopathic medical
students academically. Statistics from the 1999 U.S. News
& World Report graduate school rankings suggest that it is
much easier for pre-medical students to matriculate into an osteopathic
school than an allopathic school. Furthermore, in terms
of the MCAT (Medical College Admissions Test), osteopathic schools
represented 16 of the bottom 25 medical schools in average scores
(qtd. in "D.O. in the
House" 6). Despite this fact,
D.O.s and M.D.s both must pass the same licensure exam ensuring
that they measure up to national standards. In other words,
osteopathic doctors must pay their dues by proving that they are
technically and academically fluent before being allowed to practice.
The fact that D.O.s and M.D.s are held to the same standards is
in itself an argument for the legitimacy of the osteopathic doctor.
The argument presented must not be taken as one for the superiority
of the doctor of osteopathy. Instead, this argument was
intended to suggest methods for helping osteopaths to maintain
a separate identity from allopathic physicians. At the same time
this argument was not presented to encourage osteopaths to amalgamate
with M.D.s, but the exact opposite (Gevitz 124). Allopathic doctors could greatly
benefit from becoming familiar with osteopathic techniques.
Not only have these techniques shown potential for saving money,
but they have also been proven in the establishment of good relationships.
As a new century dawns
on the health care institution, perhaps it is time to explore
the possibilities of osteopathic medicine. Doctors of osteopathy
are equipped with the right tools to help reduce health care spending
and to maintain a unique identity. Among the available tools
are the use of alternative therapies and more importantly, the
emphasis on preventive care. In light of uniform national
standards the question of legitimacy no longer resides with the
doctor of osteopathy. As the barrier of legitimacy has been
broken perhaps the doctor of osteopathy will become the new standard
for affordable health care.
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Berchtold, Theodore A. To Teach, to Heal,
to Serve: The Story of the Chicago College of Osteopathic Medicine.
Chicago: Chicago Col.
Of OM, 1975.
Gevitz,
Norman, ed. Other Healers: Unorthodox Medicine in America.
Baltimore: Johns
Hopkins UP, 1988.
Henderson, CW. "Osteopathic Manipulation
Reduces Medication Needed for Post-Surgical Pain."
Women's Health Weekly
22 Jan. 2000: 21.
"Is There a D.O. in the House?" Harvard Health Letter 25.7 (2000): 6.
Lankford, Kimberly and Matt Popowsky. "Open
Season." Kiplinger's Personal Finance
56.12 (2002):
78-79.
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American Family
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Benefit Patients."
Women's Health Weekly
11 Oct. 2001: 13.
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Antoinette S., Nancy Clark-Chiarelli and Susan D. Block.
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Primary Care."Journal of General Internal Medicine 14.12
(1999): 730-39.
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