A new direction for osteopathic medicine....

[sleepdoc17]

Fellow D.O.'s and student D.O.'s,

The same topics come up over and over again:
- Lack of awareness of osteopathic medicine in public and professional world.

Our field needs a reboot and a rebrand. The $xxx,000,000 that have been spend on advocacy and awareness over the past few decades has not worked to make us 'Separate but Equal', just 'Separate;' .

I am a proud D.O.
We need more marketing.

---

Members don't see this ad.

 

[chasm-e-baddoor]

where would you like our field to be?

 

[HooliganSnail]

DOs are 5% or so of practicing physicians, but 20% or so of current medical students. I think that our field is doing just fine.

As far as evidence, do we really need RCT's for every technique we employ. Beware of the current "evidence base medicine" trend, as it has a huge push from Corp. Med and pharmacy companies who can control the flow of "evidence" that dictate our practice. The fact is there will never be a big RCT for OMM as no one but the practitioner makes any money from it, and these trials cost millions and millions. RCT's are done for medications, preferable ones that need to be taken every day, for which a company has a patent and exclusive rights for a decade, and can therefore justify the cost of doing said RCT.

 

[babdoc]

Too many confounding variables to do a good RCT for OMT. The study size would be prohibitively large.

 

[Osteotastic]

Fellow D.O.'s and student D.O.'s,

The same topics come up over and over again:
- Lack of awareness of osteopathic medicine in public and professional world.

Our field needs a reboot and a rebrand. The $xxx,000,000 that have been spend on advocacy and awareness over the past few decades has not worked to make us 'Separate but Equal', just 'Separate;' .

I am a proud D.O.
We need more marketing.

This intention is actually as old as the DO title. I am not trying to knock it. It is worthy and righteous. The fact of the matter is though it is futile. Medicine is not about branding. We are not talking about Micky Ds and Burger King. Medicine is about evidence, reproducability and excellence.

The only solution is to merge. Ultimately this would entail DOs transitioning to an MD title. I think that one day this will happen. DO may remain after this but it will probably be more similar to the European DOs and I think that is fine. They will not be medical doctors, they will be Osteopath purists more akin to the DCs.

In the mean time the best solution is MDO or MD,DO to establishing ourselves as Medically trained and separate from the pure - old school European. Though I still have trouble believing that the second option is possible as it is two degrees.

Again, your goal is a good one but I do see it as futile. What is proven and reproducable is adopted into allopathic (MD) medicine anyhow. So if OMM is ever thoroughly and well researched- and I do think there is some value in the bath water full of non-valuable things (there are some babies in there too) so yes we don't want to throw them out with the bath water - these valuable things will then be added to the body of evidenced based medicine that allopathic medicine is based in.

I know there a lot of young idealistic and naive youngsters on here that still buy the DO difference. There is no real "differnce" folks. It comes down to the doctor. I know many many MDs that are very holistically minded and at the same time scientifially minded as well as a some DOs who also have this balance. I know of some MDs and DOs who don't have much of a balance of either of these as well.

Bottom line is that current DOs need a title that accurately represents modern US training. We are Medically trained physicians thus MDO or MD,DO is now necessary.

 

[Escape_Goat]

Is "Separate But Equal" really what DOs should be? I mean, that doesn't really have a good historical precedent.

 

[DrEnderW]

Agreed that the branding will only go so far without more serious research to back up OMM. It's hard to gain base support within the greater medical community when one of your central tenets needs greater scientific backing.

Without the support of the general medical community, it's hard to brand yourself to the public when you comprise a small percentage of the physician population. If the overwhelmingly vast majority of physicians and health care practitioners in the country don't buy into OMM, why would the public be convinced of it when people can't be convinced to eat healthy, understand 8th grade science, agree to flu shots, and take their prescriptions correctly?

 

[Kevin Baker]

DOs are 5% or so of practicing physicians, but 20% or so of current medical students. I think that our field is doing just fine.

As far as evidence, do we really need RCT's for every technique we employ. Beware of the current "evidence base medicine" trend, as it has a huge push from Corp. Med and pharmacy companies who can control the flow of "evidence" that dictate our practice. The fact is there will never be a big RCT for OMM as no one but the practitioner makes any money from it, and these trials cost millions and millions. RCT's are done for medications, preferable ones that need to be taken every day, for which a company has a patent and exclusive rights for a decade, and can therefore justify the cost of doing said RCT.

I see what you're saying but when we're taught, tested, and licensed on techniques based on "gills of a fish" and moving skull bones, there needs to be some push back and evidence based balance. And if you look at the RCTs out there for OMM, it's pretty appalling, both at the lack of positive ones and the poor design. Do we even know if OMM is good for low back pain?

 

[Kevin Baker]

Too many confounding variables to do a good RCT for OMT. The study size would be prohibitively large.

What's prohibitively large? Is 500 or 1000 patients prohibitively large? As long as the effect size isn't tiny and the power isn't crazy high, we should be fine with 1000 patients. And if the effect size is so small as to make the sample size prohibitively large, why bother funding the study?

 

[Drrrrrr. Celty]

Agreed that the branding will only go so far without more serious research to back up OMM. It's hard to gain base support within the greater medical community when one of your central tenets needs greater scientific backing.

Without the support of the general medical community, it's hard to brand yourself to the public when you comprise a small percentage of the physician population. If the overwhelmingly vast majority of physicians and health care practitioners in the country don't buy into OMM, why would the public be convinced of it when people can't be convinced to eat healthy, understand 8th grade science, agree to flu shots, and take their prescriptions correctly?

How do you gain support for it in the greater medical community when even most DOs don't really support it or even use it? I mean I understand that it's osteopathic medical school, but at what point does the actual applicability to the students come into play? Like I mean why even teach Cranial anymore?
I'm not a DO student so I probably don't have much right to say this. But I think they need to condense OMM down to first year and teach it as a clinical skills type thing at the very least. I mean at the very least doing this will probably bump student's usmle scores.

 

[koan]

We are Medically trained physicians thus MDO or MD,DO is now necessary.

I agree with everything you say up to this point. "MDO" does nothing to clarify to a patient who they are speaking to; it is another title that will require explanation and identify those physicians who hold it as something "other" than a standard MD. Many osteopathic doctors embrace being seen as "other" and are proud to be a DO. I am proud to become a physician and I see our title as something of an impediment to clearly communicating to patients that we are equal physicians to our MD colleagues. There is an interesting phenomenon occuring in anesthesiology where CRNAs are referring to physician anesthesiologists as "MDA" (MD of Anesthesia)... a thinly-veiled disparagement of their training and position by a group that is militantly encroaching on it. MDO is not a disparagement, but rather an unecessary and unhelpful distinction.

It's true that many patients are oblivious to the word salad of degree and certification acronyms that confront them on name badges in the hospital / clinic. That in itself has blurred the lines between physician and midlevel and raised the question of who can call themselves a "doctor". If anything in this period of history physicians need to work together to fight for their ground, and I believe merging the MD and DO professions is an inevitable step in that process. The title by default should be MD. Those who attend schools that include training in OMM can go on to become board certified, do an OMM/NMM residency, others could do a fellowship in OMM as they would for sports medicine. I agree with others such as Law2Doc who have predicted that this merger is the beginning of further mergers including COCA/LCME, NMS/NRMP, NBOME/NBME. The timeline may be uncertain, but what is certain is that many DOs will go kicking and screaming through the process, crying that we are "losing our identity" and "distinctiveness". But I have to ask, how is that important to the best interests of the patient if the training is still available?

 

[docnotsopc]

This intention is actually as old as the DO title. I am not trying to knock it. It is worthy and righteous. The fact of the matter is though it is futile. Medicine is not about branding. We are not talking about Micky Ds and Burger King. Medicine is about evidence, reproducability and excellence.

The only solution is to merge. Ultimately this would entail DOs transitioning to an MD title. I think that one day this will happen. DO may remain after this but it will probably be more similar to the European DOs and I think that is fine. They will not be medical doctors, they will be Osteopath purists more akin to the DCs.

In the mean time the best solution is MDO or MD,DO to establishing ourselves as Medically trained and separate from the pure - old school European. Though I still have trouble believing that the second option is possible as it is two degrees.

Again, your goal is a good one but I do see it as futile. What is proven and reproducable is adopted into allopathic (MD) medicine anyhow. So if OMM is ever thoroughly and well researched- and I do think there is some value in the bath water full of non-valuable things (there are some babies in there too) so yes we don't want to throw them out with the bath water - these valuable things will then be added to the body of evidenced based medicine that allopathic medicine is based in.

I know there a lot of young idealistic and naive youngsters on here that still buy the DO difference. There is no real "differnce" folks. It comes down to the doctor. I know many many MDs that are very holistically minded and at the same time scientifially minded as well as a some DOs who also have this balance. I know of some MDs and DOs who don't have much of a balance of either of these as well.

Bottom line is that current DOs need a title that accurately represents modern US training. We are Medically trained physicians thus MDO or MD,DO is now necessary.

Finally someone who gets it!!! Wish i could like twice

 

[docnotsopc]

How do you gain support for it in the greater medical community when even most DOs don't really support it or even use it? I mean I understand that it's osteopathic medical school, but at what point does the actual applicability to the students come into play? Like I mean why even teach Cranial anymore?
I'm not a DO student so I probably don't have much right to say this. But I think they need to condense OMM down to first year and teach it as a clinical skills type thing at the very least. I mean at the very least doing this will probably bump student's usmle scores.

Not a DO student and yet you seem to get the big picture just fine. Less OMM, more science based medicine. I've heard time after time that the OMM in DO schools adds up to about 200 hours of training in the first two years. I know I would personally rather have 50 hours of OMM as clinical, as you suggested, and spend the other 150 hours on solidifying my score on the USMLE. This can either be an extra three weeks for board studying OR vacation OR time spent relearning pharmacology, etc and drilling it into our heads for the USMLE. However, the problem is that many schools aren't efficient with what they teach vs whats board relevant. I know at least at my school, they would give too many details on low yield topics.

 

[HooliganSnail]

This intention is actually as old as the DO title. I am not trying to knock it. It is worthy and righteous. The fact of the matter is though it is futile. Medicine is not about branding. We are not talking about Micky Ds and Burger King. Medicine is about evidence, reproducability and excellence.

The only solution is to merge. Ultimately this would entail DOs transitioning to an MD title. I think that one day this will happen. DO may remain after this but it will probably be more similar to the European DOs and I think that is fine. They will not be medical doctors, they will be Osteopath purists more akin to the DCs.

In the mean time the best solution is MDO or MD,DO to establishing ourselves as Medically trained and separate from the pure - old school European. Though I still have trouble believing that the second option is possible as it is two degrees.

Again, your goal is a good one but I do see it as futile. What is proven and reproducable is adopted into allopathic (MD) medicine anyhow. So if OMM is ever thoroughly and well researched- and I do think there is some value in the bath water full of non-valuable things (there are some babies in there too) so yes we don't want to throw them out with the bath water - these valuable things will then be added to the body of evidenced based medicine that allopathic medicine is based in.

I know there a lot of young idealistic and naive youngsters on here that still buy the DO difference. There is no real "differnce" folks. It comes down to the doctor. I know many many MDs that are very holistically minded and at the same time scientifially minded as well as a some DOs who also have this balance. I know of some MDs and DOs who don't have much of a balance of either of these as well.

Bottom line is that current DOs need a title that accurately represents modern US training. We are Medically trained physicians thus MDO or MD,DO is now necessary.

I disagree that the only solution is to merge with the MDs. While the AOA may have shot itself in the foot by expanding its medical schools without expanding its GME spots, and a merger with the ACGME is now necessary, it does not mean we need to change the name of our degree. We need only to merge our GME.

DO's have fought the MDs for a hundred years. We have fought hundreds of political and legal battles to have the rights and respect that we enjoy now. They called us quacks and frauds. They attempted again and again to block our ability to practice medicine, but we are still here, and we are stronger than ever. 30 years ago, it was unlikely a DO could do anything other than general practice. Thanks to the pioneering efforts of those before me I have a reasonable shot to practice any specialty or sub-specialty I want. We should not just seek to assimilate just because we have finally arrived.

I also disagree that there is no difference. In my experience DO's are far more comfortable touching patients than our MD counterparts, and we are far superior in handling musculoskeletal complaints, especially the daunting "low back pain".

 

[HooliganSnail]

Not a DO student and yet you seem to get the big picture just fine. Less OMM, more science based medicine. I've heard time after time that the OMM in DO schools adds up to about 200 hours of training in the first two years. I know I would personally rather have 50 hours of OMM as clinical, as you suggested, and spend the other 150 hours on solidifying my score on the USMLE. This can either be an extra three weeks for board studying OR vacation OR time spent relearning pharmacology, etc and drilling it into our heads for the USMLE. However, the problem is that many schools aren't efficient with what they teach vs whats board relevant. I know at least at my school, they would give too many details on low yield topics.

There is so much wrong with this. OMM is a real skill that can be used to help real patients. Like any other clinical skill, it takes time, practice, and repetition.

The USMLE is a licensing exam. Its purpse is to ensure that everyone who trains to be a physician is at least minimally competent. Since our GME situation is so underfunded, it has recently been used to phase out applicants to competitive residencies. The USMLE does not really matter. Scoring a 280 on the USMLE or a 680 on the COMLEX will not make you a better doctor.

The idea that a medical school should choose not to teach a valuable clinical skill so that it can raise its students test scores is a real shame.

 

[sylvanthus]

I think you are blowing out of proportion how valuable this clinical skill is. If it was really this valuable, more DOs would use it when they graduate, more MDs would want to learn it, and more legitimate research would have been done on it. Valuable skills do not just get tossed out by the vast majority of practitioners, questionably valid skills do.

 

[dyspareunia]

Bottom line is that current DOs need a title that accurately represents modern US training. We are Medically trained physicians thus MDO or MD,DO is now necessary.

Anyone who looks down on the DO degree does so because "DO" is not "MD". Creating a new title, like MDO, does nothing to alleviate that.

There is so much wrong with this. OMM is a real skill that can be used to help real patients. Like any other clinical skill, it takes time, practice, and repetition.

The USMLE is a licensing exam. Its purpse is to ensure that everyone who trains to be a physician is at least minimally competent. Since our GME situation is so underfunded, it has recently been used to phase out applicants to competitive residencies. The USMLE does not really matter. Scoring a 280 on the USMLE or a 680 on the COMLEX will not make you a better doctor.

The idea that a medical school should choose not to teach a valuable clinical skill so that it can raise its students test scores is a real shame.

OMM won't make you a better doctor. If it would, then all the DOs would be using it.

 

[meliora27]

Does anyone know any published studies that purport to show what percent of practicing DO's actually use OMM? I've heard anecdotally it's as low as 5%.

 

[Drrrrrr. Celty]

Does anyone know any published studies that purport to show what percent of practicing DO's actually use OMM? I've heard anecdotally it's as low as 5%.

Under 10% was what the study came up with.
However what was funny was the AOA had a Townhall and basically stated that the problem was that DOs were uncomfortable in their OMM skills and because they weren't getting the right training.

 

[Drrrrrr. Celty]

I think you are blowing out of proportion how valuable this clinical skill is. If it was really this valuable, more DOs would use it when they graduate, more MDs would want to learn it, and more legitimate research would have been done on it. Valuable skills do not just get tossed out by the vast majority of practitioners, questionably valid skills do.

The AOA says it's because you weren't trained enough in it ;P

 

[cbrons]

OMM exists to justify the existence of the talentless hack bureaucrats at the top of AOA. Without it, there would be no logical reason to remain a separate pathway.

 

[HooliganSnail]

Anyone who looks down on the DO degree does so because "DO" is not "MD". Creating a new title, like MDO, does nothing to alleviate that.



OMM won't make you a better doctor. If it would, then all the DOs would be using it.

OMM definitely makes you a better, well rounded doctor. OMM is a great clinical modality. It reduces pain, increases range of motion, and promotes healing. It does not require the use of a medication, and for most patients involves one to two treatments.

Sadly, not enough DOs use manual medicine. I think it stems from a lack of interest as a medical student, and this underlying hostility toward the practice (as exemplified by posts on this forum). I have actually seen more interest in developing OMM skills from the MDs I practice with than the DOs, and that is the real tragedy.

Its not the end all of medicine, but it is a nice tool to have in the toolbelt. If you don't want to use it, then don't, but to choose to not develop a skill that could really benefit your patients is pure ignorance.

 

[HooliganSnail]

I think you are blowing out of proportion how valuable this clinical skill is. If it was really this valuable, more DOs would use it when they graduate, more MDs would want to learn it, and more legitimate research would have been done on it. Valuable skills do not just get tossed out by the vast majority of practitioners, questionably valid skills do.

As I described in a post above.....

Almost all research in the U.S. is funded by private companies. RCT's with enough power to provide grade A or B evidence are astronomically expensive. As such, that money is only invested in areas where a pharmaceutical company has potential to make enough back to justify the cost. OMM is and never will be the kind of thing that is going to generate research trials.

Evidence based medicine is great. However, it has a real possibility for abuse for two reasons.

1. A faulty assumption seems to have weaseled its way into previously intelligent discussion. The idea that the lack of research on a subject is equivalent to negative evidence. They are not the same. Lack of research is lack or research. Period. If none exists, then you move down the line to case series, case presentations, and anecdotal evidence. While not as strong as a RCT, they still have value

2. The flow of "evidence" in this country is controlled by private companies who have a vested interest in one outcome over another. Often, these studies are biased, and there is a serious conflict of interest. That does not mean that all the drugs a pharmaceutical company comes up with are crap. It does mean that we have to treat even RCTs with skepticism.

 

[Petypet]

Too many confounding variables to do a good RCT for OMT. The study size would be prohibitively large.

There are many more variables for in cancer research, yet RCT still get done. Osteopaths are too slow at adapting with evidence based method and would rather be lazy and claim anecdotal evidence rather than invest in our future.

Evidence based medicine is great. However, it has a real possibility for abuse for two reasons.

Boy you been drinking the cool aid way too long. There isn't much of a money potential in it, sure, but if some pioneers figured out how stuff worked, that could easily lead to a TON of publications and tenure for said faculty. The lack of evidence is because after drinking the coolaid, 90% of us realize it is a useful modality, but 1. it is poorly taught and 2. it is shoved down our throats so much that I would rather not learn it out of spite.

 

[DocEspana]

<ahem>

I swear to God I will pistol whip the next guy who insults evidence based medicine

 

[HooliganSnail]

There are many more variables for in cancer research, yet RCT still get done. Osteopaths are too slow at adapting with evidence based method and would rather be lazy and claim anecdotal evidence rather than invest in our future.



Boy you been drinking the cool aid way too long. There isn't much of a money potential in it, sure, but if some pioneers figured out how stuff worked, that could easily lead to a TON of publications and tenure for said faculty. The lack of evidence is because after drinking the coolaid, 90% of us realize it is a useful modality, but 1. it is poorly taught and 2. it is shoved down our throats so much that I would rather not learn it out of spite.

Thats a great attitude, you're tip top.

Its a core tenant of osteopathic medicine. The schools are right to force the students to learn it. You went to a DO school. You are a DO. Have some self-respect.

OMM has been around for a hundred years. It is accepted by the U.S. military. It is a billiable service accepted by every insurance, including Medicare and Medicaid. Millions of people have been positivly affected by its utlization, including myself. How is aknowledging these facts "Drinking the Kool-Aid"?

Please explain to me after all this time, how is the safety and efficacy of OMM still under debate among those who are supposed to be the nations best and brightest?

 

[HooliganSnail]

<ahem>

I swear to God I will pistol whip the next guy who insults evidence based medicine

Pointing out resonable limitations of its use is not an "insult", it is an appropriate critique. Every research paper I've ever read or written has a sections about limitations and flaws.

Do you deny my analysis of the limitations of EBM are valid?

You are free to post a valid counter argument rather than making a threat which you could not possible carry out

 

[Setto]

In Quebec being an Osteopath is a very respected profession. They are up there is physiotherapists and athletic therapists. However I don't understand why so much importance is placed on OMM during medical school. As far as the majority of Canadians are concerned: it works but just because it works doesn't mean it's useful for all practices. It just makes it another tool in the toolbox.

 

[Petypet]

Its a core tenant of osteopathic medicine. The schools are right to force the students to learn it. You went to a DO school. You are a DO. Have some self-respect.
Please explain to me after all this time, how is the safety and efficacy of OMM still under debate among those who are supposed to be the nations best and brightest?

And I am saying just because I went to a DO MEDICAL school, doesn't mean I can't question that which is 1. taught poorly and 2. taught without science. I went DO because it was cheaper and and better for me and my family, not because I adhere to the tenants of a 100 year old philosophy created by a quack. Yes, OMM feels good, cures cancer, etc but there needs to be more research, and to blindly say its too hard to research or there is no money/value in it is absurd. If you took our OMM classes to an MD school, or frankly any major hospital and said, accept this without question, and implement it blindly without question, you would be laughed at. Palpate the mesenteric ganglion, massage this chapman's point, move your cranial bones to fix your UTI.

This isn't questioning the efficacy or safety, but more importantly the why. We learn the how, but not the why. Does that not bother you?

Do you deny my analysis of the limitations of EBM are valid?

Its naive. More work has gone into 1 RCT for an antibiotic than has gone into almost all OMT studies combined. Still makes our profession look weak and unintelligent

<ahem>

I swear to God I will pistol whip the next guy who insults evidence based medicine

shinanigans

 

[dyspareunia]

As I described in a post above.....

Almost all research in the U.S. is funded by private companies. RCT's with enough power to provide grade A or B evidence are astronomically expensive. As such, that money is only invested in areas where a pharmaceutical company has potential to make enough back to justify the cost. OMM is and never will be the kind of thing that is going to generate research trials.

Evidence based medicine is great. However, it has a real possibility for abuse for two reasons.

1. A faulty assumption seems to have weaseled its way into previously intelligent discussion. The idea that the lack of research on a subject is equivalent to negative evidence. They are not the same. Lack of research is lack or research. Period. If none exists, then you move down the line to case series, case presentations, and anecdotal evidence. While not as strong as a RCT, they still have value

2. The flow of "evidence" in this country is controlled by private companies who have a vested interest in one outcome over another. Often, these studies are biased, and there is a serious conflict of interest. That does not mean that all the drugs a pharmaceutical company comes up with are crap. It does mean that we have to treat even RCTs with skepticism.

I'm glad we agree that OMM is not real medicine. Take a break from the Koolaid my friend.

 

[Drrrrrr. Celty]

Again, I don't think it's just that people come in all that anti-OMM. Even I can admittedly say I'm somewhat interested in the techniques and what not.

So I think that the anti-OMM sentiments start in medical school.

 

[Drrrrrr. Celty]

Thats a great attitude, you're tip top.

Its a core tenant of osteopathic medicine. The schools are right to force the students to learn it. You went to a DO school. You are a DO. Have some self-respect.

OMM has been around for a hundred years. It is accepted by the U.S. military. It is a billiable service accepted by every insurance, including Medicare and Medicaid. Millions of people have been positivly affected by its utlization, including myself. How is aknowledging these facts "Drinking the Kool-Aid"?

Please explain to me after all this time, how is the safety and efficacy of OMM still under debate among those who are supposed to be the nations best and brightest?

But how do you reconcile the fact that you do learn techniques that are largely impossible to work? Cranial?

I mean as a whole most aren't using it. I don't think it's because they feel like they're not good at it, but because when they spend the morning on biochem and the evening on omm it's obvious that one is not like the other.

 

[Petypet]

Again, I don't think it's just that people come in all that anti-OMM. Even I can admittedly say I'm somewhat interested in the techniques and what not.

So I think that the anti-OMM sentiments start in medical school.

Exactly. I came in unbaised and willing to learn. After 1 year, I felt that I learned all I could in the classroom, and thus year 2 has just been a waste learning weird techniques that are taught on anecdotal evidence. I even liked first year because most of the techniques made sense and felt good, now I just loathe OMM as its time spent away from real material.

And I know I am not alone in this sentiment. To reply to the original OP about rebranding, we need new faculty teaching us with EBM. Until our profession catches up with the rest of the world, we can't rebrand

 

[chasm-e-baddoor]

I think you are blowing out of proportion how valuable this clinical skill is. If it was really this valuable, more DOs would use it when they graduate, more MDs would want to learn it, and more legitimate research would have been done on it. Valuable skills do not just get tossed out by the vast majority of practitioners, questionably valid skills do.

I dont know why you assume these things. Many DO's do not use OMM not because it isnt valuable. They dont use it because :

a) MDs dont use it, and MDs practice at the legal standard of care. As long as DOs can practice like MDs, and that means that they dont have to use OMM, they wont.
b) They do not know how to do it properly. OMT is unlike prescribing medication etc - for it to be effective, knowledge alone is not sufficient. Effective OMT requires pinpoint accuracy, excellent execution of technique, and proper indications for se. In fact, in order to effectively implement OMT into treatment, residency training should be required.

I dont know how much you know about OMM, but here are the facts - most of the treatments are based on established physiologic concepts. If these modalities werent valuable, then physicians would not send patients to physio/occupational therapists. If OMM were not valuable, the 3 MD's in my immediate family would not go to the same DO to have certain issues (musculoskelatal) that several of their top MD colleagues from various specialties could not handle besides suggesting modalities like surgical intervention.

I think that the fact that DOs have been allowed to apply to MD residencies is a great position to be in for the osteopathic profession. ACGME could easily have shut out - regardless of anything, it was in their power. I dont know why DOs and people in osteopathic medical schools are so quick to bury the institution that allowed them to have a chance to be trained in MD residencies, especially considering that most of the DOs applied to allopathi schools but couldnt get in. Hell, the US government treats them as equals i dont know what more you could ask for to be handed to you.

True equality, to me, would be to bolster ther osteopathic profession to a point where nobody really cares whether they get into allopathic or osteopathic school, MD or DO residency. If that were the case, then the equality, recognition, etc would all come by itself.

I just see a bunch of people complaining that they arent the same exact thing as MDs, when they themselves agreed to enroll in an osteopathic school. And now theyre trying to erase the identity of the profession that took them in.

 

[Drrrrrr. Celty]

Exactly. I came in unbaised and willing to learn. After 1 year, I felt that I learned all I could in the classroom, and thus year 2 has just been a waste learning weird techniques that are taught on anecdotal evidence. I even liked first year because most of the techniques made sense and felt good, now I just loathe OMM as its time spent away from real material.

And I know I am not alone in this sentiment. To reply to the original OP about rebranding, we need new faculty teaching us with EBM. Until our profession catches up with the rest of the world, we can't rebrand

Honestly most doctors seem like awful researchers to begin with. And DOs seem even worse if JAOA is somehow their best.
I think in the end OMM can remain regardless of useful or not as a first year class. But by 2020 everyone needs to honestly be taking the usmle and for people to not majorly tank they need more study time and less OMM.

But I think the AOA will fight that to the death.

 

[GUH]

Honestly most doctors seem like awful researchers to begin with. And DOs seem even worse if JAOA is somehow their best.
I think in the end OMM can remain regardless of useful or not as a first year class. But by 2020 everyone needs to honestly be taking the usmle and for people to not majorly tank they need more study time and less OMM.

But I think the AOA will fight that to the death.

What makes you think that DO students "majorly tank" on the USMLE with the status quo?

 

[GUH]

I think you are blowing out of proportion how valuable this clinical skill is. If it was really this valuable, more DOs would use it when they graduate, more MDs would want to learn it, and more legitimate research would have been done on it. Valuable skills do not just get tossed out by the vast majority of practitioners, questionably valid skills do.

I would argue that 50% or more of the stuff I'm learning right now during preclinical education (outside of OMM) will not be useful when I'm practicing. That doesn't mean they should stop teaching it.

 

[dyspareunia]

What makes you think that DO students "majorly tank" on the USMLE with the status quo?

Maybe the significantly lower pass rate for DOs compared to MDs?

 

[Drrrrrr. Celty]

What makes you think that DO students "majorly tank" on the USMLE with the status quo?

Most DO students don't take it and those who do don't exactly score average compared to MDs

 

[DocEspana]

Do you deny my analysis of the limitations of EBM are valid?

Yes I do.

As I described in a post above.....

Almost all research in the U.S. is funded by private companies.

Estimates vary from 50-65% for clinical trials. But you know.... 50-65%. That's almost all.

Its hard to pin down how much is done by industries that don't have a stake in it (Celera, for example, was a massive source of clinical research but has no horse in the race, it simply wanted a massive bounty offered to whomever sequenced the genome and published TONS of research from the ancillary discoveries). But it is known, and proudly stated, by the federal government that they sponser 35% of all clinical research trials and >50% of all non-clinical medicine-centric research. But yea. "almost all" seems accurate.

On the othe RCT's with enough power to provide grade A or B evidence are astronomically expensive.

Almost all grade A or B evidence is created by metanalysis of grade C evidence. So I have *no* clue where you are getting this from. For the very reason that no one does research that wold yield A or B level research given the absurdly difficult task that is for any single research trial. Now if you could create grade A or B evidence from a single RCT I have no doubt it would require basically pulling a farmingham (paying an entire town for decades to be involved) which is obviously expensive. But no one is doing that anywhere AFAIK.

As such, that money is only invested in areas where a pharmaceutical company has potential to make enough back to justify the cost.

No doubt that Pharma invests in its own products. But thats like criticizing me for spending my money on food and toilet paper for my own apartment rather than yours. If I invest enough money in food to actually have something good to share, I will.

OMM is and never will be the kind of thing that is going to generate research trials.

A bigger issue is that OMM is similar to surgery (which is totally find with EBM yet can never be double blind tested), it requires a skilled practioner to perform and you cannot possibly double blind since it would be unethical to the patient to send incorrectly trained people in to do things and it would be non-blinded to send in correctly trained people to be the control group's doctor. But that lack of double blind researching has never stopped surgery from embracing research and experimental design to the max. The max just tops out at case reviews and retrospectives. OMM can do that.

Evidence based medicine is great.

However, it has a real possibility for abuse for two reasons.

1. A faulty assumption seems to have weaseled its way into previously intelligent discussion. The idea that the lack of research on a subject is equivalent to negative evidence.

Let me stop you there.

you are correct. People who feel this way are like libertarians who judge porn stars and strippers. They have a massive gap in a basic understanding of how their beliefs are supposed to work if they are being logically consistent.

They are not the same. Lack of research is lack or research. Period. If none exists, then you move down the line to case series, case presentations, and anecdotal evidence. While not as strong as a RCT, they still have value

But there aren't case series. Or retrospectives. Or studies without large flaws in them. There are seas of case reports, but even those rarely get collected (though, yes, if you want to show me 5. you will be able to. im talking big picture) into anything of any meaning. There are plenty of deeply flawed studies out there.

A lack of research is only a lack of research. An abundance of weak research is a bit different. OMM can (and I believe should) be researched at much higher levels than it is, but there is some sort of subtle pervasive hesitancy to actually arrange for these types of studies on it.

A person that doesn't have a job is not necessarily a bum. There may be 100 reaosns why they are unemployed at any given moment. But if you look at all the effort they put in and its only lackadasically mailing out apps to burger king and taco bell when he has a degree in nuclear physics, you get a feeling (a feeling that *means* nothing but you cant help but feel) that they are either hiding a defecit in there qualifications or are just afraid to enter such an intense field with all its professional scrutiny. They aren't trying anywhere near as hard as they should to market themself, and you wonder why.

2. The flow of "evidence" in this country is controlled by private companies who have a vested interest in one outcome over another.

Complete horsecr@p. Already told you that 35% to 50% of all clinical research has no private company finger prints on it and >50% of the benchwork is the same deal. Even if they were both only 25%, the fact that 25% of the research was moving freely would put INSANE pressure on the other 75% to release quicker and produce more.

Often, these studies are biased, and there is a serious conflict of interest.

Yes, often the papers that do have private funding do have conflicts of interest. Its why we are all trained extensively in knowing how to actually read and understand statistics and medical jounral critiques. There will never be a shortage of people who want to make a name by ripping a hole in the tiniest of flaws in medical research. Believe me... when the conflict of interest causes an issue 1) only those without medical/statistical literacy are fooled and 2) plenty of people will blow up the document within a month of its publication.

Perhaps more important, and I'm throwing you a bone, is the percentage of research that is done by people just to have research. Stuff that is going to change any treatment or outlooks on pathology. It simply exists to get a publication under someone's belt and exists as static that we have to tune out. THOSE are the annoying part of EBM, because you have to always hyper-analyze these to make sure there are no redeeming qualities. and when there aren't you're angry you wasted your time discovering what the 4th best option for treatment of the 3rd most common cause of bacterial otitis media is.

That does not mean that all the drugs a pharmaceutical company comes up with are crap. It does mean that we have to treat even RCTs with skepticism.

No. No we dont. If you're reading it with skepticism you are reading it incorrectly.You need to know how to read stats and realize that in most studies if there isnt a NNtT or a NNtC there is something they are hiding about the drug. If you dont see a positive predictive AND negative predictive value, there is something odd about the test they are hiding. You need to read them with a *purpose*. You have to know what the drug claims to do and what the singlular stat you need to see to prove that is.

Everyone shows their best looking diagram and the "name" of the test often puts you in a false sense of security, but if the NNtT/C or the PPV/NPV isnt there you should be asking for it. Its what EBM is all about. A RCT is inherantly a pure thing. The raw data, minus unethical tampering, is the gold that you base your clinical practice on. The bars and charts only mean something if they are the *correct* bars and charts for what you want to do with it.

 

[DocEspana]

To be fair to H-Snail.... The things he brought up werent even real criticism of EBM. They were fears that big Pharma have taken control of the system. A common fear, but one that (depending on how terrified you are) is either overblown or entirely fictional because the actual influence of pharmacy on the total research output is nowhere near monopolisitic.

There are real criticisms of EBM, but those werent them.

 

[TXKnight]

Maybe the significantly lower pass rate for DOs compared to MDs?

Maybe that is a consequence of having two tests? I can see how many DO students would take the USMLE just "to see what happens", specially if they are OK with going AOA for residency.

 

[dyspareunia]

Maybe that is a consequence of having two tests? I can see how many DO students would take the USMLE just "to see what happens", specially if they are OK with going AOA for residency.

Regardless of the reason, a lower pass rate and lower average score can be interpreted as "tanking". While step 1 scores aren't indicative of how good/bad of a doctor you will be, MD applicants are judged pretty heavily on their step 1 score. If DO students want to be viewed as "equal" to MD students, it follows that they should be performing "equal" to MDs on USMLE exams. I think we can all agree that DO/MD physicians are relatively equal. This whole thing is about students and applicants and DO/MD applicants certainly are not equal. MDs score higher on USMLE implying that they are better prepared for the exam. Whether or not this is indicative of curriculum differences, intelligence, test-taking ability, or whatever else people attribute the discrepancy to is not important. If one group performs better than another (for any reason), then there is a difference in quality. AOA programs want MD applicants to go through OMM training, which (correctly) indicates that MDs are deficient in a skill valued by COCA/AOA.

However, as far as your explanation I doubt many students are willing to pay $580 just "to see what happens". A lot of ACGME programs accept COMLEX and the ones that require USMLE are likely very competitive anyway. Meaning, someone who takes it "to see what happens" isn't going to be getting a high enough score to merit applying to a program that does not accept COMLEX. In all, I see very little reason to take the USMLE just "to see what happens".

Just to reiterate, the results matter. The reason(s) for the results don't necessarily matter.

 

[TXKnight]

Regardless of the reason, a lower pass rate and lower average score can be interpreted as "tanking". While step 1 scores aren't indicative of how good/bad of a doctor you will be, MD applicants are judged pretty heavily on their step 1 score. If DO students want to be viewed as "equal" to MD students, it follows that they should be performing "equal" to MDs on USMLE exams.

However, as far as your explanation I doubt many students are willing to pay $580 just "to see what happens". A lot of ACGME programs accept COMLEX and the ones that require USMLE are likely very competitive anyway. Meaning, someone who takes it "to see what happens" isn't going to be getting a high enough score to merit applying to a program that does not accept COMLEX. In all, I see very little reason to take the USMLE just "to see what happens".

I didn't mean to regard those attempts at the USMLE as taking it just "for kicks". I guess what I'm trying to convey is that maybe the fact that you have "two" first shots at the boards, DO students who are leaning towards AOA but may want to try to be eligible for ACGME residencies are the ones who practiced the USMLE the least and then tanked it. Now, this is just hypothetical since I have not set foot in med school yet, until my ms-1 starts in August.
What is actually interesting is finding out if those students are indeed weaker overall by comparing COMLEX and USMLE scores for testers who took both; assuming they are equal in difficulty, but different in style.

 

[dyspareunia]

I didn't mean to regard those attempts at the USMLE as taking it just "for kicks". I guess what I'm trying to convey is that maybe the fact that you have "two" first shots at the boards, DO students who are leaning towards AOA but may want to try to be eligible for ACGME residencies are the ones who practiced the USMLE the least and then tanked it. Now, this is just hypothetical since I have not set foot in med school yet, until my ms-1 starts in August.
What is actually interesting is finding out if those students are indeed weaker overall by comparing COMLEX and USMLE scores for testers who took both; assuming they are equal in difficulty, but different in style.

Oh that's a different story then. I'm not a DO student, but I have read (here on SDN) that the general idea is to study for the USMLE and then review OMM before you take the COMLEX. My guess would be that a DO student who takes both exams scores about the same on both exams, but I don't think any data on that actually exists.

 

[Drrrrrr. Celty]

Maybe that is a consequence of having two tests? I can see how many DO students would take the USMLE just "to see what happens", specially if they are OK with going AOA for residency.

It's because DOs have 4-6 hours less a week of time to study for the boards. The MDs I know spend all of 2nd year preparing for the boards where as most DO schools maintain a traditional classes first then boards.
Which in the end screws DOs over.

Like I've said before. OMM needs to be removed second year if we want DO board pass rates and scores to be competitive enough to not relegate them to FM.

 

[Seth Joo]

Fellow D.O.'s and student D.O.'s,

The same topics come up over and over again:
- Lack of awareness of osteopathic medicine in public and professional world.

Our field needs a reboot and a rebrand. The $xxx,000,000 that have been spend on advocacy and awareness over the past few decades has not worked to make us 'Separate but Equal', just 'Separate;' .

I am a proud D.O.
We need more marketing.

Did the people at the AOA who used that slogan fail history class? "Separate but Equal" was used during the Jim Crow era, and it was anything but equal.

 

[GUH]

Maybe the significantly lower pass rate for DOs compared to MDs?

I don't consider a 90+% first-time pass rate for DO's compared to the 95% or so for MD's to be such a major issue as to require eliminating half of the OMM curriculum, especially in the absence of any evidence that cutting down half of the OMM material would result in a significant positive change.

 

[Seth Joo]

I don't consider a 90+% first-time pass rate for DO's compared to the 95% or so for MD's to be such s major issue as to require eliminating half of the OMM curriculum, especially in the absence of any evidence that cutting down half of the OMM material would result in a significant positive change.

DO schools will never do this, its the main reason these schools exist.

 

[GUH]

It's because DOs have 4-6 hours less a week of time to study for the boards. The MDs I know spend all of 2nd year preparing for the boards where as most DO schools maintain a traditional classes first then boards.
Which in the end screws DOs over.

Like I've said before. OMM needs to be removed second year if we want DO board pass rates and scores to be competitive enough to not relegate them to FM.

Even when DO's score equally as well as their MD counterparts, they still face discrimination by ACGME PD's. Telling DO's to cut out OMM training will not magically end this discrimination.