okay, lets put this to rest...
To clarify a few points made thus far:
1) Osteopathic Medicine has a philosophy
•••quote:•••Originally posted by Dr. Nick:
•I never refuted Osteodoc's claim that Osteopathic medicine has a philosophy (that would be absurd)
•••••Osteopathic medicine was founded on a philosophy of "holism" i.e. "the body is a unit". This is promoted in all the literature, and is taught (or at least espoused) at all of the DO schools so far as I know.
This philosophy is really rooted in homeopathy from the 1800's, and has since been borrowed by osteopathy, chiropractic, "allopathic" medicine, and virtually every other field of healthcare to greater or lesser degrees.
is the philosophy unique to osteopathic medicine? NO.
is this philosophy promoted in osteopathic medicine relative to allopathic medicine? YES (with reservation). you can argue that it is taught equally in some schools, yet you would be hard pressed to say that it is promoted in the same fashion since not all allopathic schools pay it any regard.
is this philosophy taught in osteopathic medical schools relative to allopathic schools and other branches of healthcare? MAYBE. This appears to vary considerably, but since the attempt has been made to promote this way of thought at all of the DO schools, and it is particularly applicable to primary care (which seems to be what many DO schools target in applicants)- it seems safe to say that this is a unifying philosophy adopted by osteopathic profession.
note: this would not be correctly called "osteopathic philosophy" since it clearly doesn't have osteopathic origins- but lest we bury ourselves in semantics, lets forgive those that use the term loosely.
2) Allopathic medicine has no philosophy
•••quote:••• Dr. Nick in regards to Osteodoc?s post: •
What I disagreed with was the misguided claim that Allopaths lack a philosophy. To support my argument, I offered an accepted definition of philosophy and then proceeded to offer several good examples of such. I think I made a good argument.
•••••....going back to your previous post....
•••quote:••• Dr. Nick in regards to Osteodoc?s OTHER post: •
phi?los?o?phy
n. pl. phi?los?o?phies
A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising.
A system of values by which one lives: has an unusual philosophy of life.
~~~~~~~~~~
Let's consider for a moment the very basics, the Hippocratic oath for example.
• ••••I would hardly call this an argument, but the hippocratic oath is indeed a place to start:
•••quote:•••
The Oath
By Hippocrates
Written 400 B.C.E
Translated by Francis Adams
•
I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
•••••This indeed can loosely be called a philosophy, but it is by most regards closer to a system- there are few guiding principles and many rules (but we?ll disregard this). Some points are obviously still relevant, others are debatable (abortion and euthanasia), and others are clearly not (what about that bit swearing to Apollo or regarding one?s professor as a father and their children as brothers?). NO ?allopathic? physicians live their lives by this purely, but a few of the tenants are held dear. These very same tenets are also held dear to osteopaths, and I would challenge you to find any that principles held dear to ?allopaths? that are not shared by a similar contingent of osteopaths.
I would argue that the Hippocratic oath, if a philosophy, is a philosophy of medicine, and NOT of allopathic medicine. The holism principle is more specific, and thus can be claimed as a philosophy specific to the field of osteopathic medicine.
•••quote:•••Dr. Nick in regards to Osteodoc?s post:•
?You state that Allopaths "lack a philosophy" - yet you go on to say that we believe largely in chemical causes. If what you argue is true, that in and of itself would also be an example of such a philosophy.
••••• •••quote:••• Osteodoc?s post:•
?(the allopathic community in general has never paid much attention, preffering to be led by the pharmaceutical induatry towards chemical causes, and thus chemical remedies, for disease.)
•••••If you consider allopaths being led around by the pharmaceutical industry a unifying philosophy, then I?d believe you.
This is indeed more a philosophy of apathy rather than a unifying principle for ?allopathic medicine?. I have yet to see a unifying philosophy for allopathic medicine that is specific for the field.
Hmm? well, I guess I figured it out. It was the enlightenment actually- those years of anti-non-science and the rise of the scientific method. I was about to say that allopaths only exist as a construct created by the medical tangential fields such as homeopaths and osteopaths, but this isn?t entirely true. While allopaths were attempting to weed out their homeopathic, herbal doctors, and snake oil salesman competition back in the day, they adopted the scientific method as their underlying philosophy- rational reductionism- it ain?t ?real? unless its proven in the lab- and they claimed to practice only that which was proven (though allopaths still often don?t live up to this).
Of course, allopaths only tested the stuff they themselves used and could turn a profit with (and there wasn?t funding to put common folk remedies to the test- since it would be tough to turn a profit with them). And thus, you also put it out of reach of the common person to understand, thus specializing the profession and getting yourselves (and now us osteopaths) more money today.
Guess you?ll like this Dr. Nick. This worked out well for allopaths, though this unifying philosophy has ultimately not been enforced in areas that you guys have historically had control over but had trouble testing (such as surgery and psychiatry).
Now, in the day, osteopaths only really did manipulative medicine and surgery (since ?medicine? sucked- just bloodletting and the like). With antibiotics and the scientific boom, OMM wasn?t adopted since few MD?s could do it, while surgery was adopted even though there was little scientific research outside of outcome-based studies to prove it worked (good outcomes must have been good enough- and they knew they could charge for it).
Since DO?s have adopted much the allopathic philosophy along with the tools of the MD trade for purposes of survival, this allopathic philosophy cannot be held as unique, however it is a common principle of all allopathic fields(at least theoretically), so it could rightly be regarded as a unifying principle of allopathic medicine.
I would also go so far as to say this may in part have led allopaths to inadvertently begin seeing their patients as test subjects rather than people- and hence the patch adams phenomena, the modern rise of alternative/integrative medicine backlash we see today (and the allopathic rush in some schools to over-emphasize the humanistic components of medicine). Many of the remedies and treatments back in the day that were left behind in the interests of funding may have been more effective and less costly, and patients see this. Osteopaths have always held this as well, and perhaps ?osteopathic philosophy? is the biproduct of the profession emphasizing values it has always held dear.
In any case- I just wanted to explore these lines logically to their ends to stop the endless wheel spinning and cut to the chase.
To sum up: THE PHILOSPHY ARGUMENTS ARE A WASTE OF TIME
give it a rest people.
DO pamphlets will continue to say we?re more holistic and better at caring for patients than allopaths.
Allopaths will maintain osteopaths aren?t as scientific as allopaths.
Both are generalizations and therefore bogus, but both are also grounded in a rich history of support and see enough support even in this day and age to propagate.
If one is to generalize, it should be in regards to specifics across schools (such as the average time in class teaching patient care-skills, average time in research methods classes, etc.) or outcome-based studies of patients with specific disorders that see DO?s vs. MD?s (some claim DO?s have better primary care outcomes but I have yet to see a worthy study).
I?d also like to see allopaths hold surgery to the same research standards they put to OMM before they decry how unscientific OMM is- since this is a field of patient treatment they understand. Both surgery and OMM are something of an art form, so they are inherently difficult to do anything but outcome-based research on. Even with outcome-based research, research is complicated because outcomes vary from one doctor to the next due to differences in skill and subtle differences in technique.
Both specialties can be performed skillfully with little knowledge of ?medicine? but both are clearly aided-especially in tough cases, by a broad pool of medical knowledge- and both take inherent skill, a huge knowledge base of anatomy (at least in the areas they work on the most), and many years of training to master.
Surgeons take extra years during residency rather than working them into the undergrad curriculum for all MD?s. DO?s put OMM right into the undergrad curriculum even for non-specialists (perhaps since it is less dangerous and a better adjunct to primary care). This, however, builds complications that all DO?s are aware of.
•••quote:•••From me: •
"but you also clearly intend to do more by them than "figure out" what osteopathy is."
•
From Dr. Nick:
•
I disagree. I may not always believe what I am told and I may not always tell you what you wish to hear but I don't think I have any sinister motives. Actually, I do think I am learning something through this spirited discussion. In fact, I got in an argument the other day with a colleague that claimed DOs could only effectively practice primary care. Imagine that, Dr. Nick sticking up for the DOs! See, no sinister objectives here.
•••••ahem, lets see?
List of gems by Dr. Nick:
Hi there, buddy. Forget your meds today?
"For your information OMT don't take away anytime or anything from other basic sciences course."
Oh, I see. In DO-land, are there 34 hours in the day? No? OK, I didn't think so. 'Nuff said.
FYI - it's not spelled, "cirriculum"
Listen Mr. Maxy, I am not trying to "lash out" at DOs. Rather, I am trying to figure out what exactly Osteopathy is and whether many of the unsubstantiated claims made by the profession are valid or not.
Thank you, Osteodoc - you've made my day. These 2 are priceless
Do you really believe this is unique to osteopathy? That is too funny.
Dr. Nick, do you see my point? You make comments like these and then expect rational answers? Although I am somewhat embarrassed at the defensiveness of my colleagues about their profession, and you do have courage coming onto a DO board and attacking us-your choice of words leaves little chance of rational debate. Remember that there are DO?s that would rather be in MD schools and are left with inferiority complexes. All they may have left is the DO propaganda to justify where they are (so they do not feel inferior to MD?s in ALL ways).
You need not attack these people (directly or indirectly) with your inflammatory statements to make a point. If all you want is information, I have plenty- is there a particular explanation you want?
My overall argument is that there is value to the DO education. Clearly those thinking of specializing in OMM have no other choice, but DO schools are also great choices for those desiring a career in family practice, peds, or OB/GYN with a focus on holistic medicine. You may get the holistic approach at some MD schools, but clearly not all, and OMM is a great adjunct to any of these specialties. I would even argue even that DO schools are great for surgeons since we have so many extra hours spent in anatomy (240 at KCOM vs. 140 at most MD schools)- and an extra 200 + hours of hands-on applied anatomy via OMM. By the time you?re cutting someone open you know EXACTLY what to expect- and the ambitious can even verify most diagnosis with their hands before they whip out the knife (perhaps saving a few lives or limbs down the road by catching mistakes). Of course, you?ll need to figure out how to get into a competitive residency coming from a DO school, but top students get these spots regularly and without difficulty from DO schools, so long as they have strong board scores and know some people in the field. Of course, nobody cares if you have a DO once you?re a neurosurgeon.
Regarding one of your earlier comments as Kurtz (assuming you?re the same person)- you kept regarding OMM as chiropractic (perhaps another attempt to raise some tempers for your amusement).
I will not put down chiropractors, as many are very skilled. Many use the holistic philosophy every bit as well as we do, and some can treat everything in their patients- from spine to stones. Most, also have in the neighborhood of 500 hours of hands on time in their training (vs. our 200). There are good ones and bad ones, like any other field.
So, what is the difference you ask? Are we a combo of a chiropractor and an MD? Well, history and other factors aside, we CAN do something neither of the other professions are fully qualified to do- diagnose with our hands. Anything from musculoskeletal problems to autonomic disturbances to virtually any trauma induced or chronic issue you can think of.
MD?s do rudimentary diagnosis with their hands, and chiropractors are taught some basic medical skills, but probably not enough to be accurate with many of the difficult cases we see regularly. Musculoskeletal problems (and a surprising variety of other things) can be treated effectively by OMM as well, and for things like tumors, patients can be quickly caught (think how much earlier a tumor can be found by a primary care doc that has their hands on a patient anyway? perhaps well before discomfort or other symptoms arise)
The ultimate counter to this that pops up-
Can DO?s using OMM really do what they claim?
Can surgeons? Patients come in with a massive debilitating complaint and they leave without it- never to come back. Hmm.. is that proof? No, I guess not. Does it happen often? Well, yes- it does with some of the good docs. Can diagnosed illnesses be cured via OMM? Well, it happens frequently, but we have very few if any studies. Is it all placebo? Well, is surgery? I know they did sham surgery experiment for one procedure back in the day that showed an equal and significant improvement for both real and sham surgeries. It would be great to do similar work with OMM to remove the questionable procedures- but keep in mind not all surgeries used today have been held up to this level of scrutiny- and think of how dangerous that is? the best that most do in surgery is outcome studies- and we have the same for much of what we do in OMM (perhaps not published in the best journals, but the work has been done).
Is the benefit of surgery all placebo? I doubt it. ?so long as the cause is removed. What if the cause is musculoskeletal and accessible via the hands? What if only the symptoms are musculoskeletal? At least in the latter case the symptoms can be relieved and the cause addressed via regular medicine. Now, think of how many illnesses and diseases there are with either a structural cause or structural/somatic symptoms that may be relieved via OMM. OMM is simple mechanics- there is no magic involved (okay, maybe a little...). If you know enough anatomy, why shouldn?t it be possible to fix messed up anatomy with your hands?
We have a pathetic base of research upon which to lay our claims, but everyone who uses OMM in their practice (and their patients) see the benefits. In the meantime, how can you justify studying something that isn?t proven? Do you wait until they ?prove? surgery works before you do it? I say, so long as the outcomes are good- do it, and keep doing the best you can as the research comes in- challenge everything you can, but discount nothing until it can be adequately challenged.
Tear anything and everything up that you want from this post- but if you want to keep me happy, please restrict your arguments to either disrupting my premises or my lines of reasoning, rather than the easy way out as has been used in the past
I love hearing counterpoints, and my goal is to find the underlying truths of these matters rather than argue an agenda. If you have better ideas than those I posted- fill me in!!!
Ugh? back to work.
bones
KCOM '05