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The DOs: Osteopathic Medicine in America
by Norman Gevitz, 2nd ed, 242 pp, $44.95, ISBN 0-8018-7833-0, paper, $24.95, ISBN 0-8018-7834-9, Baltimore, Md, Johns Hopkins University Press, 2004.
JAMA. 2004;292:1615-1616.
Norman Gevitz, professor of the history of medicine and chair of the Department of Social Medicine at Ohio University, has updated his original 1982 edition of The DOs in an outstanding second edition. He has added two new chapters ("In a Sea of Change" and "The Challenge of Distinctiveness") and provides a wealth of new material to older chapters, bringing his history into the present and giving the reader a remarkably insightful understanding of osteopathic medicine and the challenges facing it today.
Unlike other major sectarian schools (ie, eclectics, physiomedicals, and homeopaths) that arose out of a crisis of faith in so-called medical orthodoxy in the first half of the 19th century and which declined as their distinctive therapies failed to maintain a compelling raison d??tre during the rise of scientific medicine, osteopathic medicine survived the challenges that brought its predecessors to an untimely end. Osteopathy was founded in the 1880s by Andrew Taylor Still (1828-1917), who began his medical career as an apprentice to his father but who gravitated to an assortment of drugless substitutes, including magnetic healing and bonesetting, before discovering that manipulative therapy had applications beyond typical orthopedic problems. By 1889, Still had opened his own infirmary in Kirksville, Mo, and introduced to the country his new science of healing. Five years later, he incorporated the American School of Osteopathy.
By the turn of the 20th century, while other sectarian groups were showing signs of decay, osteopathy was growing in the numbers of colleges (seven by 1915) and hospitals; benefiting from favorable state practice laws; and working to improve its curriculum and research. Like other sectarian groups, however, osteopathy suffered from a rash of internal squabbles that weakened its public image. Differences between its liberal and fundamentalist wings, the rise of osteopathic diploma mills and correspondence schools that issued unearned degrees, the challenges brought about by the emerging fields of bacteriology and immunology, the rivalry stemming from Daniel David Palmer?s chiropractic, and the scope and validity of its therapeutic modalities ("adjuncts") were just a few of the ongoing issues. A new generation of DOs came face to face with the limitations of Still?s fundamental principles, which viewed any modality other than OMT (osteopathic manipulative treatment) as having no place in his system.
Gevitz writes expertly on osteopathy?s response to Abraham Flexner?s Medical Education in the United States and Canada (1910) and the educational changes that schools underwent in the period between 1910 and 1935. However, the author?s greatest contribution is his deft handling of osteopathy?s problem of identity, ie, how osteopathy began as a radically unique approach to pathology and healing; how it shifted from chronic to broad-based practice; how it chipped away at its distinction from regular medicine by displacing OMT with pharmacotherapy, surgery, and other modalities; and how, as the DOs came closer to the MDs in terms of patient management, they became almost invisible in the public?s eye.
One outcome of this dilemma was the effort initiated by some to leave organized osteopathy for regular medicine, and the resulting debate within the American Medical Association on the issue of amalgamation vs cultism. Concomitant changes came by way of federal legislation and third-party providers that resulted in unprecedented growth of osteopathic schools (19 by 2002), making it the fastest growing physician population in the United States, producing a seven-fold increase in graduates since 1962. Yet, ironically, there continues to be a marked decline in traditional osteopathic teaching and continuing erosion of its distinctive identity.
Perhaps what has made it a success in today?s medical marketplace is the fact that, simply put, osteopathy provides medicine economically. Osteopaths have made few contributions to basic and applied research. As Gevitz points, out, "if all nineteen osteopathic schools were treated as one institution, it would rank 212 in the National Institutes of Health funding" (p 175).
Today, the stigma that so long trailed DOs has largely disappeared, albeit not forgotten. DOs and MDs routinely work together in myriad professional relationships. Nevertheless, osteopathy, which was once a social movement as well as a medical profession, remains largely invisible in the public eye. Gevitz suggests a program for revitalizing osteopathy?s independent existence, but his arguments lack conviction. Making the change from a medical minority to a medical elite will require a quantum leap from its present status as a school of second choice for many prospective medical students. In the last analysis, Gevitz concludes, "the future of osteopathic medicine may ultimately rest in the DOs own hands?and how they use them" (p 191).
This is a superbly written book, well researched, thoughtful, and enjoyable to read. Gevitz has made an important contribution to the canon of medical literature. The DOs should be required reading for both DOs and MDs alike.
John S. Haller, Jr, PhD, Reviewer
Southern Illinois University
Carbondale
[email protected]
Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.
by Norman Gevitz, 2nd ed, 242 pp, $44.95, ISBN 0-8018-7833-0, paper, $24.95, ISBN 0-8018-7834-9, Baltimore, Md, Johns Hopkins University Press, 2004.
JAMA. 2004;292:1615-1616.
Norman Gevitz, professor of the history of medicine and chair of the Department of Social Medicine at Ohio University, has updated his original 1982 edition of The DOs in an outstanding second edition. He has added two new chapters ("In a Sea of Change" and "The Challenge of Distinctiveness") and provides a wealth of new material to older chapters, bringing his history into the present and giving the reader a remarkably insightful understanding of osteopathic medicine and the challenges facing it today.
Unlike other major sectarian schools (ie, eclectics, physiomedicals, and homeopaths) that arose out of a crisis of faith in so-called medical orthodoxy in the first half of the 19th century and which declined as their distinctive therapies failed to maintain a compelling raison d??tre during the rise of scientific medicine, osteopathic medicine survived the challenges that brought its predecessors to an untimely end. Osteopathy was founded in the 1880s by Andrew Taylor Still (1828-1917), who began his medical career as an apprentice to his father but who gravitated to an assortment of drugless substitutes, including magnetic healing and bonesetting, before discovering that manipulative therapy had applications beyond typical orthopedic problems. By 1889, Still had opened his own infirmary in Kirksville, Mo, and introduced to the country his new science of healing. Five years later, he incorporated the American School of Osteopathy.
By the turn of the 20th century, while other sectarian groups were showing signs of decay, osteopathy was growing in the numbers of colleges (seven by 1915) and hospitals; benefiting from favorable state practice laws; and working to improve its curriculum and research. Like other sectarian groups, however, osteopathy suffered from a rash of internal squabbles that weakened its public image. Differences between its liberal and fundamentalist wings, the rise of osteopathic diploma mills and correspondence schools that issued unearned degrees, the challenges brought about by the emerging fields of bacteriology and immunology, the rivalry stemming from Daniel David Palmer?s chiropractic, and the scope and validity of its therapeutic modalities ("adjuncts") were just a few of the ongoing issues. A new generation of DOs came face to face with the limitations of Still?s fundamental principles, which viewed any modality other than OMT (osteopathic manipulative treatment) as having no place in his system.
Gevitz writes expertly on osteopathy?s response to Abraham Flexner?s Medical Education in the United States and Canada (1910) and the educational changes that schools underwent in the period between 1910 and 1935. However, the author?s greatest contribution is his deft handling of osteopathy?s problem of identity, ie, how osteopathy began as a radically unique approach to pathology and healing; how it shifted from chronic to broad-based practice; how it chipped away at its distinction from regular medicine by displacing OMT with pharmacotherapy, surgery, and other modalities; and how, as the DOs came closer to the MDs in terms of patient management, they became almost invisible in the public?s eye.
One outcome of this dilemma was the effort initiated by some to leave organized osteopathy for regular medicine, and the resulting debate within the American Medical Association on the issue of amalgamation vs cultism. Concomitant changes came by way of federal legislation and third-party providers that resulted in unprecedented growth of osteopathic schools (19 by 2002), making it the fastest growing physician population in the United States, producing a seven-fold increase in graduates since 1962. Yet, ironically, there continues to be a marked decline in traditional osteopathic teaching and continuing erosion of its distinctive identity.
Perhaps what has made it a success in today?s medical marketplace is the fact that, simply put, osteopathy provides medicine economically. Osteopaths have made few contributions to basic and applied research. As Gevitz points, out, "if all nineteen osteopathic schools were treated as one institution, it would rank 212 in the National Institutes of Health funding" (p 175).
Today, the stigma that so long trailed DOs has largely disappeared, albeit not forgotten. DOs and MDs routinely work together in myriad professional relationships. Nevertheless, osteopathy, which was once a social movement as well as a medical profession, remains largely invisible in the public eye. Gevitz suggests a program for revitalizing osteopathy?s independent existence, but his arguments lack conviction. Making the change from a medical minority to a medical elite will require a quantum leap from its present status as a school of second choice for many prospective medical students. In the last analysis, Gevitz concludes, "the future of osteopathic medicine may ultimately rest in the DOs own hands?and how they use them" (p 191).
This is a superbly written book, well researched, thoughtful, and enjoyable to read. Gevitz has made an important contribution to the canon of medical literature. The DOs should be required reading for both DOs and MDs alike.
John S. Haller, Jr, PhD, Reviewer
Southern Illinois University
Carbondale
[email protected]
Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.
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