DO/PhD

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Originally posted by sluox
Uh? is there any particular reason why you (anyone) would want to do a DO/PhD besides the fact that...you may not be able to get into an MD/PhD program?

I'm not asking this in a sort of contemptuous way...I'm just wondering what a DO would add to your PhD degree...are you going to focus on OMT research? OMT physiology?

If someone wants to do translational research, I don't understand what's the advantage of doing a DO??? I really don't know why DOs should spending more money on research: really i thought that's not what the training is for? The odd thing is it's probably much easier to get into a very good biology PhD degree program if you are a US citizen--in which case you are much better prepared for a career in research than a PhD degree from any of the DO institutions.

Correct me if i were wrong, but recently i've been reading the DO forums and it started to appear to me that there are two different lines of thoughts:

(1) There is no essential difference between MD and DO. Therefoer, DO is simply a "default" option for people who for one reason or another, cannot get into an MD school to make up their dues so they get another oppurtunity once they apply for residency. I.e. MSU-DO -> Johns Hopkins residency -> Chief of Neurosurgery somewhere

If this were you, then I can (possibly) see why you would want to do a DO/PhD. However, my recommendation is going to be, do your PhD at some other more established research institution. OSUSOM et al will be looked very badly upon, even if you were just a straight PhD. I mean, Oklahoma State or Michigan State perhaps are still acceptable places to do your PhD...but really, I seriously recommend against doing your PhD (in molecular biology) at New Jersey School of Osteopathic Medicine...most academic researchers (i.e. grant reviewers) don't KNOW what a DO is! (unless, as I'm clearly unaware of, there is some expert in OMT...but...i've already argued that OMT is scientifically hokey :) j/k)

(2) There is a HUGE, foundamentally philosophical difference between MD and DO. DOs don't want to go to MD schools even if it were offered to them on a silver platter. DOs don't want to do MD residencies in the first place. DOs are better trained for primary care/rural medical care.

In that case, if you (one) wanted to have a research based career, clearly it's not right to get a DO...it's almost unethical in that sense because you are taking a spot from someone who wants to provide quality primary/rural care...you are just using it so you could have clincial practice prilliage once you get your own lab.


Whew. This whole post is very interesting (although I could easily use another "I" word) :p

Where do I start? Well first off you talk as if DOs only learn about OMT and nothing else. If DO students take all the same basic science courses as MD students, why isn't it reasonable to think that some of them may be interested in studying one of those sciences on a deeper level...ie PhD? The question should not be what a DO degree will add to a PhD degree but how the PhD can add to the DO degree. (Hello this is the same concept for MDs getting a PhD) I am SOOO very confused why people assume DO means "I hate research" or "I am incapable of being interested in research" or "I am incapable of being a competent researcher". Regardless of whether one chose osteopathy because of the 'huge philosophical difference' or as a 'default', whenever ANYONE chooses to pursue a phD...they must be obviously interested in research of some sort..usually translational research.

Furthermore, being excited about osteopathy because it provides a different approach to patient care and you firmly believe it prepares you to be a better clinician (primary or specialty) than most allopathic programs, does NOT preclude you from being interested in the research that could help you better treat some of your patients OR help another physician better treat a patient. SIGH. Therefore DOs should be just as interested in funding for physician-scientist programs and research as MDs. IF we all agree that biomedical research eventually translates to better treatments/care for patients...then why is it so impossible to concede that DOs (as another type of physician) should/could be involved in such research.


Now in regards to where someone does their PhD in a joint program. Granted neither MSU and OSU is Harvard or JHU...but would your advice also be extended to those students pursuing a MD/PhD at those institutions? Should those students just get their PhD at a 'better' school also? Because as has already been said in this thread....the DO students and MD students have access to the same faculty for basic science research. And what about the plain graduate students? Maybe we should stop research all together at institutions that aren't as 'established'.
:confused:
Furthermore, as compared to MSU's osteo school and OSU's osteo school ALONE...UMDNJ-School of Osteopathic Medicine ALONE has received more NIH monies/grants for research. But UMDNJ-SOM is not free standing either. It is part of the ONLY health professions school system in NJ. Therefore the DO/PhD students have access AND utilize the research faculty of the Graduate School of Biomedical Science which the other UMDNJ schools (2 allopathic and 1 dental) use for their joint programs also. (Is anyone else getting de ja vu? ;) ) And I am guessing grant readers have heard of UMDNJ before even if they have never heard of a DO.

But I beg to differ on that point also. I believe most scientifically educated people (MD, PhD..essentially the folks making the decisions) have heard of a DO. Wouldn't it be odd for the grant readers not to know of a credential that is in the request for proposal specifications. (ie grants usually specify the degrees a person must possess to be qualified to apply etc...usually it is listed MD, DO, DVD, DDS, PhD or Pharm D etc.) I don't think its a questions of grant reviewers not knowing about DO, but more so about them not RESPECTING DO or being biased AGAINST DO for historical reasons.


I am not sure why I always get sucked into such discussions. I guess its good to keep the brain cells working. Perhaps its because I was taught to be a critical and logical individual and occasionally people put up very illogical arguements...that i HAVE to say something. I don't know. This previous post was just funny to me. I have to ask....sluox, did you read the entire thread?

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very well said, bullhorn.
 
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I'm still a wee bit confused. Now having in mind that I don't want to flame any body i just hope that you can clarify a little more,

so, here is the summary of what you've said.

(1) You are going into a DO program because you think it provides a better clincial training than most if not all the MD programs.

Ok, not knowing whether this is true or not, let's accept it as an assumption for the moment.

(2) You are going into a PhD in the same institution because you think...its physical proximity? logistically more reasonable? You know some faculty members who work specifically on the area that you are interested in working on? So does a DO/PhD program train you to become primarily a clinician or primarily a scientist? Don't say both...NIH's MSTP is specifically designed to train scientists, and not even "clincial" scientist.

The problem here is, yes, there is a substantial historical bias against DOs (or DVDs or PharmDs) doing research, primarily because such degree programs do not train you for a career in research. MD degree recipients, on the other hand, have a historical record of producing very high quality research. So even though MD programs are not really specifically training you to become a researcher, it is considered to be an acceptable pathway to a career in biomedical research. And, for that matter, there is still a bias against MDs doing research, as well. Thereby the MD/PhD programs--the reason for an MD/PhD program is NOT, as what you have said, to have MDs who are interested in the science on a deeper level to do research. In the world of research, the PhD is the essential credential, as it should be, because PhD degree programs (and nothing less) are specifically designed to train you to become sucessful independent investigators.

Many MD programs have a FOCUS on research. They have journal club meetings, talks, researchs opps for students. So if you make the argument that DO programs are better for clinical medicine, maybe I can make the arugment that MD programs are better for biomedical researchers? Does that sound reasonable?

So if that is the case and you (not you personally, but say any college student) are ready to devote yourself to a career in translational basic science, I fail to see any legitmate reason to advise him/her to consider a DO degree, (or, for that matter, a Pharm D, DVD etc). Obviously a pharmacist and a vet would care about translational research as well...do you propose that pharmacy schools and vet schools trying to spend a substantial amount of their energy in getting more research grants? I mean, do we REALLY want to have a dentist-scientist who fixes up your dentures 2 afternoons a week and do research the rest of the time, seeing that grants in basic science is already scarce.

I don't see how my argument doesn't extend to primary care physicians. Again, clincial research excluded, do we really want a physician scientist who's medical practice has absloutely nothing to do with his research? Treating a diebetic on a daily basis...alas, has essentially nothing to do with molecular biology
of beta-cells, and it probably distracts one from doing well in either.
 
I am always suspicious of link-references, so I looked up all 5 of drusso's references. Only one DO/PhD was really doing any PhD quality research, and he got his PhD from the Netherlands (also, one of the websites only listed the articles REVIEWED by that person rather than anything that person did). I think it's important to realize the GOAL of a PhD in a traditional MD-PhD program is to do hard core basic science, even though many joint degree holders decide not to do that afterwards. I doubt that DO-PhDs want to do research full time, as a DO degree hardly adds to a basic research career UNLESS you want to get all your grants from the Complementary Medicine arm of NIH and do research on complementary and alternative therapies, as one of the 5 listed researchers does. Basically, if you want to do basic research full time and use medical information to complement your PhD work, go to an MD-PhD program - since we teach "the same thing" anyway at the two schools.

So far I have only seen exceptions to the rules as evidence of DOs being capable of getting a PhD or doing research. I don't think anyone here is saying that exceptions to the rule do not exist, but most people in the traditional research field here seem to think that it shouldn't be the rule (nor will it likely become the rule) that DOs do research or DO schools have joint degree programs. I think it's idealistic to add a PhD to everyone with a professional degree, including MD, DO, DVD, PharmD, JD, MBA, so everybody can think critically regardless of what they are doing. However, with limited federal money overall we should be realistic and make wise but not charitable investments. Nobody will ever stop you from spending your own $$$ to get a PhD, so that's always an option if a DO degree holder or the DO schools ever feel like competing with the mainstream researchers.
 
Originally posted by sluox


1) So does a DO/PhD program train you to become primarily a clinician or primarily a scientist? Don't say both...NIH's MSTP is specifically designed to train scientists, and not even "clincial" scientist.

2) Many MD programs have a FOCUS on research. They have journal club meetings, talks, researchs opps for students. So if you make the argument that DO programs are better for clinical medicine, maybe I can make the arugment that MD programs are better for biomedical researchers? Does that sound reasonable?

3) So if that is the case and you (not you personally, but say any college student) are ready to devote yourself to a career in translational basic science, I fail to see any legitmate reason to advise him/her to consider a DO degree, (or, for that matter, a Pharm D, DVD etc). Obviously a pharmacist and a vet would care about translational research as well...do you propose that pharmacy schools and vet schools trying to spend a substantial amount of their energy in getting more research grants? I mean, do we REALLY want to have a dentist-scientist who fixes up your dentures 2 afternoons a week and do research the rest of the time, seeing that grants in basic science is already scarce.

4) I don't see how my argument doesn't extend to primary care physicians. Again, clincial research excluded, do we really want a physician scientist who's medical practice has absloutely nothing to do with his research? Treating a diebetic on a daily basis...alas, has essentially nothing to do with molecular biology
of beta-cells, and it probably distracts one from doing well in either.

I'll try to take your points one-by-one:

1) DO/PhD programs have the same goals as MD/PhD programs. They aim to train physicians (in this case osteopathic physicians) to be scientists. You seem to be hung up on what osteopathic schools ARE and ARE NOT and what it means to have a FOCUS versus an EXCLUSIONARY INTEREST.

Osteopathic medical schools FOCUS on training physicians to provide comprehensive primary care. In a sense, they are like "liberal arts medical schools." That does not mean that osteopathic schools do not train specialists or scientists. It only means that they have a different set of educational priorities. Just like attending a small liberal arts undergraduate college will give you a different educational experience, so too will attending an osteopathic medical school. It's not that the education is bad at small liberal arts colleges (Smith, Bryn-Mawr, Wellesley, Rice, etc), it's just that these schools have as part of their mission a broader set of educational objectives. Let's look at some mission statements:

Reed: "Since its founding in 1908 as an independent undergraduate institution, Reed College, in Portland, Oregon, has remained steadfast to one central commitment: to provide a balanced, comprehensive education in liberal arts and sciences, fulfilling the highest standards of intellectual excellence."

VS

MIT: "The mission of MIT is to advance knowledge and educate students in science, technology, and other areas of scholarship that will best serve the nation and the world in the 21st century."

Both Reed and MIT are great institutions---but the flavor of the education one would receive at each institution would be different.

Similarly let's compare medical schools:

KCOM: "As the founding school of osteopathy, the mission of the Kirksville College of Osteopathic Medicine is to educate osteopathic physicians and related health professionals so as to obtain compassion, integrity, and ability and to preserve and advance osteopathic principles, practice, and philosophy. Our goal is to train health science professionals and osteopathic physicians who are prepared for postgraduate training in the primary care disciplines to serve the family and yet possess the comprehensive educational foundation necessary for successful training and practice in other specialty areas."

VS

Univ of Penn--SOM: "Our mission is to create the future of medicine through: Patient Care and Service Excellence; Educational Pre-eminence; New Knowledge and Innovation; National and International Leadership."

Certainly very different, right? Perhaps not better nor worse, but different to say the least. Neither mission EXCLUDES the training of physicians-scientists, medical ethicists, or humanitarians but one certainly gets the sense that the kind of education received at Penn differs from what would be expected in Kirksville.

2) DO schools have journal clubs too. And, DO schools with well developed biomedical science degree programs offer good opportunities for research. But, broadly speaking, you are right: Most DO schools just haven't developed a lot of depth in biomedical research. That doesn't mean "no research" or "no opportunities" it just means less developed. There are, however, opportunities.

3) There are indeed students who with to pursue research training (in any variety of disciplines) and want to be grounded in an osteopathic approach to patient care. The two are not incombatible desires. Osteopathic principles represent a worldview or a conceptual lens through which to view health and disease and health care related issues. Below is a link that describes how from a phenomenological and hermaneutic perspective osteopathic students learn to interpret osteopathic principles. Also included is a link to a very good book recently published that describes how osteopathic medicine is grounded in a social movement in health care. It's these fundamental differences (a philosophical worldview and a sense of social reformation) that makes training in a DO school a different experience from training in a MD school. Still, the fundamentals of biomedical science apply. The Krebs Cycle is the same at Kirksville as it is at Hopkins.

COMMUNICATION FOR OSTEOPATHIC MANIPULATIVE TREATMENT: THE LANGUAGE OF LIVED-EXPERIENCE IN OMT PEDAGOGY

Osteopathic Medicine: A Reformation in Progress

4) You obviously haven't been on rotations. Believe me, more than any other set of physicians, primary care physicians need urgent training in research---if nothing else how to be at least educated "consumers" of research and how to apply evidence-based medicine principles to practice. And, I think it would be great if all primary care doctors were engaged in some kind of meaningful research related to their discipline. The American Academy of Family Physicians has launched a campaign to educate family physicians in Patient Oriented Evidence That Matters (POEMs). Essentially, it's a movement in primary care medicine to change the culture to stress the application of research and evidence-based medicine to daily practice. This is something that all health care providers (physicians, dentists, vets, pharmacists, etc) could certainly benefit from embracing.


Patient Oriented Evidence That Matters

Does any of this clarify things for you or are you still confused?
 
actually i read what you posted...

KCOM "our goal is...train in the primary care disciplines...yet possess..practice in other specialty areas".

No mention of science/scientific research

Penn "new knowledge and innovation" (research is one of their PRIMARY goals)

what you've posted is a direct support for my argument that research career bound college students should NOT choose a DO degree program.

-------------

KCOM: "As the founding school of osteopathy, the mission of the Kirksville College of Osteopathic Medicine is to educate osteopathic physicians and related health professionals so as to obtain compassion, integrity, and ability and to preserve and advance osteopathic principles, practice, and philosophy. Our goal is to train health science professionals and osteopathic physicians who are prepared for postgraduate training in the primary care disciplines to serve the family and yet possess the comprehensive educational foundation necessary for successful training and practice in other specialty areas."

VS

Univ of Penn--SOM: "Our mission is to create the future of medicine through: Patient Care and Service Excellence; Educational Pre-eminence; New Knowledge and Innovation; National and International Leadership."

Certainly very different, right? Perhaps not better nor worse, but different to say the least. Neither mission EXCLUDES the training of physicians-scientists, medical ethicists, or humanitarians but one certainly gets the sense that the kind of education received at Penn differs from what would be expected in Kirksville.
 
Ok I am answer Toforious and Sluox in one post...


1. We agree that PhD programs and them alone are designed specifically to train one to become a successful independent investigator. Allopathic programs (and this is a generalization) are more 'research oriented' but for the most part are not up to snuff to ALONE train one to become an independent investigator. Essentially research oriented means if one wants to do research on the side at an allopathic school, the opportunities are there but the generic curriculum: 2 years of basic science and 2 years of clinical work (outside of PBL) can NOT and do not do what PhD programs do. Osteopathic schools are more patient/primary care oriented and therefore if one wants to do research on the side...they will probably have to LOOK for it etc. Most osteo schools are not equipped to provide ample opportunities but some are there. The generic curriculum is basically the same as allopathic school with the addition of OMT principles and training. All this is saying to me is that if I definitely want a CAREER in research, I should do a PhD program...probably alone.

2. MD/PhD and DO/PhD programs are not graduate programs that ADDED on a medical degree. It is the reverse. Students entering these programs more likely chose to be physicians first and then thought to get the PhD. This is also evident in the way ALL the programs are set up. The Medicial portion is not shortened to produce a condensed program. While most of the PhD-alone students I know expect to spend 4-6 years working on their PhD....combined physician scientist programs are designed to complete the graduate portion in 3-5 years. Having worked with both, this is a reason PhD-only folks think that joint programs (specifically MD/Phd) are problematic and doesn't represent a REAL PhD...NIH funding or not. So one should not be asking what the medical degree ADDS to the PhD....unless someone pursued the degrees seperately and in reverse order (PhD first). "Basically, if you want to do basic research full time and use medical information to complement your PhD work, go to an MD-PhD program" I disagree toforious. Basically if you want to do basic research full time and use medical information to complement your PhD work, the best thing is to do the PhD alone...and later go to medical school or do the PhD alone, start your lab and hire an MD/DO consultant to work with you.

3. So, the question is what the PhD adds to the MD or DO. Not the reverse. And what it adds primarily are OPTIONS. Students start those programs for a few reasons a) the option of doing clinical work and/or research work b) to go into academic medicine (to teach) and do research-ie neurosurgery etc c) free medical school (let's keep it real) d) to be a research-oriented or minded physician but to a more 'expert' level of research than someone just doing 'research on the side' during their medical schools years. NIH/funding bodies are essentially taking a gamble that students choose the research pathway. But as toforious said, most MD/PhD students don't choose that pathway after graduation (probably because they are slighly discriminated against and/or never really planned on doing so anyway)...Toforious also says that he/she doubts DOs would want to do just research...I agree but not because the DO degree doesn't add to basic science research(I told you how i feel about this statement already) but because historically DOs have not received funding for basic research and for the same reasons MDs might not want to do just reasearch. This is in fact one of my pet peeves in scientific research...we determine what is meaningful research (worthy of funding) essentially based on one determining body....a body of mostly white male ivy-league phd-ers (good old boys club). I am sorry but I am just not that naive. I think the NIH is a great resource, however, I know plain as day the historical biases that STILL dominate how they determine which schools and people receive funding. I know this does not necessarily directly correlate to who is doing great /important research. Scientific research, I have found, is about 90% who you associate with than what you are doing. TONS O' POLITICS...and I think that is an understatement. But I digress sorry.

4. I agree that DOs doing research is an exception to the current rule. But not long ago MDs doing research was the same. In fact, I can't really say it still isn't as having a MD/PhD is STILL a rarity (just check out the number of posts on this pre-mstp forum). So, I would argue that a physician PERIOD doing research fulltime is an exception to the rule. And I would also argue that most traditional researchers (phD-only) don't think ANY joint programs should become the rule. And why, simply the reason that sluox gave (except he gave it ONLY for DOs)...trying to do both distracts one from doing well in either. It is the fundamental problem with any joint doctorate program...MD/JD, DO/JD included. I can't say whether I agree or disagree, but I do know that PhD-ers can often be impervious to the people their research is designed to help. I believe the implementation of the joint programs was designed to train scientists who (having had clinical training) have a better idea of the bigger picture....research that translates into better treatment and care for patients. In theory these scientists would have a better idea of where their basic research can be applicable to the medical community. Having said this, I have to ask why should it be 'expected' that DOs (having received almost the same professional training as MDs) should be excluded from this option?

5. Osteopathic schools that do have joint programs, do so in conjunction with real GRADUATE pograms, usually within a larger health professions/science system. I think this is now the third time I have said this. OSU, UMDNJ, and MSU (I believe 3/4 places) to offer the DO/PhD option fit this profile. What the medical school focuses on (research oriented, primary care) has nothing to do with what is learned while doing th PhD portion of the program. Because as you all probably already know, after the second year of med school...joint degree students then matriculate into the GRADUATE school to work towards their PhD. Since we ALL agree that the PHD is the essential element to becoming an independent investigator...I ask again what is the difference between the PhD portion for a MSU MD/PhD student and a MSU DO/PhD student. The answer is NOTHING. They have access and utilize the same faculty for their courses and research options. In theory, they have received the same level of critical thinking training, so I ask why (again) should later on a NIH grant reader overlook a DO/phD from MSU for a MD/PhD from MSU assuming all things equal in research proposal? I have the answer already...because of historical DISCRIMINATION. Same reason why a black female PhDer from princeton university's mol bio department will be overlooked for the white male phD-er from princeton university's mol bio department. And that, quite frankly is sad.

6. Now before I get flamed...let me end this with my concessions..because I do I have some. Osteopathic schools HAVE to step up if they want to legitamately have a claim to research funding. While I don't think schools should change their focus on primary care, I do think they need to realize that research like Drusso said is just as important to the state of primary care in this country as it is to specialty care. I know the schools that currently have the DO/PhD option have put a significant amount of school resources in the past 5-10 years in developing more research opportunities within the MEDICAL school. But 4/20 hmm is not very good lol, in my opinion. Although, just dealing with answering posts on this thread, I can see why some schools just don't even try because it is such a ridiculously UPHILL battle. But I think in the long run they are doing a disservice to their missions (primary care focused or not).

7. Finally, I agree with you sluox in terms of allopathic schools (for the most part) better training their students to be biomedical researchers. Someone with just a MD will more likely be much better prepared to conduct research on his/her than someone with JUST a DO. This is because of things I stated earlier..opportunity for 'research on the side'. It is more likely that a MD-only graduate will have had some sort of research experience during medical school. So, if we are talking about MD-ONLY graduates and DO-ONLY graduates, hands down they are better prepared to go into biomedical research without having gotten a phD. HOWEVER, I would argue that a DO/PhD-er is more likely better prepared for a biomedical research career than a MD-ONLY graduate...because they have received formal graduate training instead of a hodgepodge of research experiences 'on the side'. And DO/PhD-ers and MD/PhD-ers are equally prepared simply because they both have that formal graduate training and in 3/4 current DO/PhD programs..they received the graduate training amongst the same faculty and program.
 
While I am not agreeing or disagreeing with bullhorn's post on a whole, there is one point that is not true and another point that I'd like to address.

Originally posted by bullhorn
The Medicial portion is not shortened to produce a condensed program. While most of the PhD-alone students I know expect to spend 4-6 years working on their PhD....combined physician scientist programs are designed to complete the graduate portion in 3-5 years.

The medical portion is indeed shortened to produce a condensed program. At schools like Penn and Yale, there is a required research program in the fourth year that MD/PhD students are exempted from. This knocks off 3 - 6 months immediately. Further, MD/PhDs at every integrated program I know of have less elective requirements in third/fourth year, which also knocks off 6 months or so. This all leads to a total clinical training time of 3 or 3 1/2 years, as opposed to 4.

The reason the PhD training is shortened for MD/PhDs has to do with a number of factors. One factor is that MD/PhDs typically knock off 1 - 3 (depending on the program) rotations before they even enter grad school. Sometimes they have to do less rotations (2 for example, easily done before entering). Typically, they have less course requirements, thanks to taking the required courses in medical school. Also, they frequently have reduced or non-existant TA requirements.

All of these things contribute to a reduced graduation time without a reduction in time spent in the thesis lab or in meaningful training. Typically, the MD/PhD spends 4 - 5 years in PhD work (to make the total 7 - 8), while a regular PhD student is probably spending just slightly more on average, again not due to factors related to quality of thesis. One could argue that TAing is a vital part of your training, but some, including myself, would disagree. Certainly there is some grauation pressure and that manifests itself as a pressure to get on a project, start producing, jump onto a different project if things aren't working, and get graduated without a ridiculous amount of time investment. Shouldn't all these things apply to graduate students as well? Indeed, graduate students can get screwed over in so many ways in these regards, and they should not be allowed to flounder around in labs or be held around because the PI needs a pair of hands. Of course MD/PhDs aren't immune to all this, but a quality MD/PhD program should be on the lookout for it.

My point is, MD/PhDs and DO/PhDs simply are more effecient in their medical and graduate training. If PhDs wish to write us off as "not real PhDs", they either do not understand the facts or have no desire to. Besides, regardless of the training which I find to be equal, we all have to be productive as faculty to succeed in basic science research. At that level, it ceases to matter which degree you have.

From that, I find point 2 and 3 invalid and agree with tofurious.
 
good post bullhorn. Although I have to disagree with your intrepretation of the goals of NIH's MSTP. MSTP is primarily designed to train scientists who spend a significant amount of time doing researcher, rather than clincians who want to become an expert in a small specialized area of clincial science. For that you do a NIH fellowship instead. To that end, the MD/PhD programs, in general, is a PhD focused program rather than the reverse. Indeed, many of the MD PhD programs cut the MD portion rather than the PhD portion. Although, this is as moot in the MD/PhD community right now as well, how such a program ought to be organized.

Not to take it personally however, as you've admitted, an MD program probably has better options for a research career bound college student. Do you agree that, for the purpose of everybody who's reading these threads, that under the current circumstances, regardless of whether "historical discrimination" exists, such individuals should probably choose an MD/PhD program rather than a DO/PhD program? In fact, seeing such a low level of research in DO schools in general, wouldn't you advise any pre-meds who have strong inclination to do research to avoid DO schools in general? (that is, unless they plan to do a PhD at Michigan State et al) Of course, this situation may or may not change in the next 50 years, but for right now, do you think this is true?
 
Originally posted by tofurious
I don't think anyone here is saying that exceptions to the rule do not exist, but most people in the traditional research field here seem to think that it shouldn't be the rule (nor will it likely become the rule) that DOs do research or DO schools have joint degree programs.

What a bizarre and anti-intellectual statement: So, let me get this straight, you DON'T think that DO's and osteopathic institutions have an ethical obligation to train physician-scientists or gather data on the validity of osteopathic approaches to patient care? Interesting...

I think that many would disagree and argue that osteopathic institutions *SHOULD* be developing their research engines at 110% effort! A necessary part of doing that means training DO/PhD's


Research at Colleges of Osteopathic Medicine: A Decade of Growth

Researched and Demonstrated: Inquiry and Infrastructure at Osteopathic Institutions
 
Neuronix, the two programs you pointed out I believe to be exceptions. MOST MD-only programs do not require a thesis..this is one of the things that Yale 'advertises' (along with their no tests/no grades system) as 'unique' to their curriculum.

Obviously you are in Penn's MD/PhD program and I am not, but I do have TONs (~20) o' friends in programs (at various stages) currently at various schools and no, their MD portion is not condensed at all. But if this is not the case in MOST combined programs, somebody should let the old school PhD-ers know... It is most certainly a BIG reason why they don't like the combined programs.

Now, I guess the rest of your post lost me. Why is my point 3 invalid? Maybe because its late where I am, but I can't quite place how your post even pertained to my point 3.

Now Sluox, I never disagreed about what NIH's MSTPs are designed for. We all know they want to train scientists who do research full time. But its important to understand the historical significance behind physican-scientists. I think I mentioned it...essentially these scientists(while focused on basic research) should be readily able to see the 'big picture' and realize where their research can potentially translate into medical advances. I only mentioned physicians who want to be research-oriented as a reason a student might do a joint program. What the NIH wants and why students do the programs on the whole are not same...assuming we all agree that MOST md/phd graduates do not choose the path of research fulltime.

Now, in terms of your question. First let me say that there are ONLY 4 DO/PhD programs in the country and 3 are Michigan State et. al. So, I have already said the PhDs are essentially the same in my opinion. If someone was my advisee (and a few have been), I would say first decide the level of interest one has in research.....because not everyone is at the point of wanting/needing to do get a PhD. If they are at the 'research on the side' read moderately interested...I would suggest they go to an allopathic school....simply because there will be more opportunity there than the average DO school. If someone was choosing between say UMDNJ-nj med school MD/PhD and UMDNJ-SOM DO/PhD (I'd first assume they were gungho about doing research and perhaps wanting a career), I'd tell them they could expect the same level of education/opportunity for both degrees while in school, but afterwards because of whatever reasons they are more likely to have a tougher path as a DO/PhD....if they don't care...I'd say choose the place you feel most comfortable and at home. If they do, I'd advise them to go to the MD/PhD school. Supposing more freestanding DO schools start implementing joint degree programs (and I don't necessarily think this is a good idea), at this point, I'd have to direct my advisee to a MD/PhD program. DO schools that are not associated with a larger system of schools have not shown me that their commitment to even MINIMAL research is enough to sustain such a program granting a PhD. If the freestanding DO school partnered with a nearby established PhD program...it might be worthwhile. That's my take honestly.
 
"you DON'T think that DO's and osteopathic institutions have an ethical obligation to train physician-scientists or gather data on the validity of osteopathic approaches to patient care? Interesting..."

This just shows that there is little understanding of the goal of MSTP. What you have described here is evidence-based medicine, NOT basic science research. MD-PhD programs do not train students to excel in EBM, but rather the fundamental science of how things work. You do not need an advanced degree in EBM.
 
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Originally posted by tofurious
"you DON'T think that DO's and osteopathic institutions have an ethical obligation to train physician-scientists or gather data on the validity of osteopathic approaches to patient care? Interesting..."

This just shows that there is little understanding of the goal of MSTP. What you have described here is evidence-based medicine, NOT basic science research. MD-PhD programs do not train students to excel in EBM, but rather the fundamental science of how things work. You do not need an advanced degree in EBM.

I'm not talking about EBM. I'm trying to get you to clarify whether or not you believe that osteopathic institutions have an ethical obligation to their stakeholders (patients, donors, alumni, etc) to contribute to biomedical science? You have seemed to suggest in a previous post that they should not.
 
Do DOs have an ethical obligation to prove what they do is actually medically useful? Sure. I would like to see more clinical evidence that OMT improves patient health outcome. That's where EBM comes in. Do they have an ethical obligation to train physician scientists? IMO, no. As of now, basic biological science focuses on the detailed individual steps of biology and local interaction of systems rather than the (w)holistic interaction between distant body parts and distinct bodies. Wholistic hypotheses are difficult to prove because so much hand-waving is possible. PhD style thinking focuses on one testable question at a time to demonstrate the truth in a single hypothesis away from the "system", and in a way, in contrast with DO style thinking. Additionally, there should be no bias in PhD science. There is too much intrinsic bias among DOs to prove "OMT works". There are many MD and PhD types who show that their hypotheses are wrong. I would like to see DOs willing to accept the possibility that OMT does NOT work. Because of this, most people in the scientific realm have a hard time believing no bias can be introduced in any such research conducted by DOs.

I think it's truly misleading to confuse whether clinically-based, EBM-style questions should be asked among DOs with whether basic science programs such hard-core transgenic animal/second messengers should be introduced into DO curriculum broadly. I think the latter remains one of many giant distinctions between MD and DO schools, and to add that to DO schools would only contribute to the slippery slope of making DOs = MDs + OMT. It is also wrong to assume that just because NIH funds something it is worthy basic science research. There are clear distinctions between clinical and basic science research programs within NIH and amongst those familiar with research, and the assumption that one who is capable in one is proficient in the other shows fundamental lack of understanding of either science.

Perhaps it's time for the DO field to discuss amongst themselves whether they want to remain one unifying field or split into two - one MD, and one traditional DO. Obviously, AAMC would have a say in whether you get an MD degree even if you are MD-like. Perhaps that is truly the core of the issue here: more people wanting to be MDs while the supply of such degrees has not expanded for the increasing interests.
 
Tofurius,

You are obviously a very smart guy (and a fellow Cal alum--Go Bears!), but you have an incomplete understanding of osteopathic medicine. What do you think we learn at D.O. schools? Osteopathic medical education encompasses a standard MD education--second messengers and transgenic mice included!

The point is that osteopathic medicine does not SUBSTITUTE, rather it expands upon, the standard biomedical worldview. That's why it is in a powerful position to reform the US healthcare system. We train osteopathic neurosurgeons, orthopedic surgeons, immunologists, pathologists, psychiatrists, etc. And, that has been historically (and continues until today) to be the fundamental difference between DO's and other manual medicine practitioners (ie chiropractors, massage therapists, etc) It's not that DO's believe that OMT is a *BETTER* modality for low back pain than say traditional NSAIDs, PT, and exercise; we assert that it *ADDS* something to those other treatments.

Validating basic osteopathic concepts means employing both "top-down" and "bottom-up" thinking. It means not only looking at clinical outcomes in a rigorous, EBM-based way; but fundamentally (i.e. mechanistically) understanding the structural and functional characteristics of connective tissue, neurohormonal immune responses, neurophysiology, etc. I see no other way to accomplish this than to rigorously train DO/PhD scientists. Some DO/PhD may have research interests that have nothing to do with manual medicine per se, and that's okay because it helps raise the visibility (and credibility) of DO/PhD scientists as a whole.

It would be great if MDs would take an interest in doing manual medicine or osteopathic research and remove any bias from the equation. Incidentally, some do. But, if DO's have to wait around for MD's to prove what DO's do actually works or doesn't work, one can expect to wait indefinitely! And, it's not the job of the MD world to "clean our house."

Science is not a proprietary enterprise; it exists for the greater public good. As long as osteopathic physicians and institutions treat patients, own and operate hospitals and healthcare networks, and work to reform the United States healthcare system; then they should contribute meaningfully, and in proportion to their numbers, to the biomedical knowledge base.

I am still amazed that any science-minded person would disagree with that sentiment and not support the rigorous training of osteopathic physician-scientists. In one sense, and not to overdraw the analogy, your argument that DO/PhDs *SHOULD NOT* do so (ostensibly because they lack objectivity and would be testing difficult to disprove holistic hypotheses) reminds me of the reasons the southern segregatonists used to argue against teaching black share-croppers to read!
 
I think that's where we differ significantly: while you believe DOs encompass MD + OMT, I believe that the two systems should offer different (perhaps complementary) styles of health care. Rather than having DO schools teach MD curricula plus a little bit of distinction, I believe elements of traditional osteopathy should be the emphasis rather than the icing on the cake in DO education. That will create two education systems that really teach two sets of different philosophies rather than a two-tiered system, as MOST of us believe the system to be today.

I also disagree with your definition of what an osteopathic medical school should produce. You are right in saying that I do not know enough about osteopathy. Before I made my last post, I went to the pre-DO thread to read the sticky on what osteopathy is, and how it differs from allopathic medicine. The websites listed there SPECIFICALLY indicated that DO schools' goals are to train primary care providers, NOT the neurosurgeons and orthopods you have indicated. Therefore, I stick with my notion that the two systems should be distinct and remain distinct.

That said, I obviously took offense to the southern share cropper analogy. There is one fundamental difference: people have the CHOICE of going to an MD school or a DO school and STICKING with the philosophy, while the share croppers did not have a choice in this country. Even their choice to LEAVE this country was not granted until later. Any DO has the choice of entering osteopathy and leaving osteopathy to join an allopathic school of thoughts or institution. If you truly believe that your situation is similar to that of a Southern share-cropper, you are saying that you were forced into osteopathy not by choice but because of situation/necessity. If that is the case, I can understand why you would want DOs to be more like MDs. However, if that is the case, I go back to what I said at the end of my last post: perhaps those with DOs should decide whether one unifying direction should be the way of the future for American ostepathy.
 
One last thing about science as a non-proprietary enterprise: while the sentiment sounds nice, I disagree with your interpretation of such a statement. Medicine, similar to science, is not a proprietary enterprise and exists for the public good. Nevertheless, it is reserved for those with qualification and training. Similarly, today's practice of science and training of scientists are best reserved for institutions with great traditions and a critical mass of successful scientists. While the number of PhD granting institutions has gone up dramatically due to the lack of regulation in this country, the quality of top-notch research has not really declined because of self-regulation at the respected institutions, many of which are traditional allopathic medical schools. The absence of strict regulations against rise of unqualified PhD granting institutions should not be confused with the dequalification of science. When sufficient quack science populates our society as when medicine did 50-100 years ago, proper regulations will be necessary to limit the number of and harm done by "science-minded" charlatans.

On your top-down and bottom-up approaches: those are essentially scientific principles put into place over 100 years ago in the scientific revolution and do not argue for or against DO/PhD programs. However, once again, based on the principles of osteopathy listed in the pre-DO thread, basic science research is NOT in line with the practice of primary care, outcome driven osteopathic medicine. If the goal of DO/PhD programs is to demonstrate that DOs can do research, no funding agency in its right mind will significantly fund DO/PhD programs just to entertain this concept when large numbers of MD/PhD programs are well established for the purpose of training physician-scientists given the start-up costs and the necessary catch-up time. It is a simple matter of resource allocation. In order for funding agencies to give reasonable $$$ to DO/PhD programs, DO schools themselves must demonstrate - like I mentioned before - their scientific mindedness and lack of bias. This pre-requisite is really not possible for the following reason. MD scientists are willing to challenge the efficacy of their bread-and-butter therapies such as hormone replacement therapy, aspirin, antibiotic therapy, and even surgery and organ transplantation. If there is no demonstrated benefit, most MDs will STOP prescribing these things. Such a philosophy and track record ensure that no interpretation bias or bias at any other level exist in a *systematic* way in MD-driven basic science research among MD/PhDs. (PhD alone scientists are out of this debate altogether for clarity purposes) I sincerely doubt that DO scientists would be willing to stop practicing osteopathy if OMT has no demonstrated benefit. Plainly put, DOs have too much to lose given the high stakes surrounding their main distinction from MDs, and as a result the research on osteopathic philosophy will never have scientifically demonstrated grounds unless it is jointedly done by MDs and DOs (as MDs themselves are unlikely to spend their whole careers working on osteopathic principles).

In a way, respect for DO/PhDs will only be granted IF DO schools and believers are willing to accept the POSSIBILITY that OMT is no more effecacious than placebo. Given the fervor consistently demonstrated by DOs that OMT has benefits without any empirical evidence, that is just not likely in the near future. For the sake of science, however, I do hope that DOs will begin to accept the theoretical possibility what their predecessors did may not make any sense, as most MDs have done so already (with regards to historical medical practices).
 
I must also add that, small amounts of bad arguments aside, this thread has been one of the most informative and thoughtful in a while on this board. Kudos to everyone who has contributed so far.
 
While I love debating..I am passed the point because of the time it takes to formulate my responses. So, this will be my last post on this...basically I disagree with Tofurious..pretty much all around. And it seems you have not really posted anything to refute much of what _I_ have posted..but are going back and forth with Drusso. I think your opinion about what SHOULD be studied by osteopaths is backwards and I, as a black female, can slightly see the analogy to blacks being prevented from learning that Drusso brought up. Here's why: you have pigeon-holed osteopathic medicine into something its not and therefore have these huge generalizations about what they can and cannot study or rather what should and should not be funded. And as we all know funding is the backbone of research (and prestige for that matter) and if the powers that be feel the same as you, DOs WILL be forced to remain on the outskirts of the research community, even if they didn't want to. And that's where the CHOICE to be a DO AND be research-oriented (which as I outlined before is more than plausible) is taken away...

At any rate, I do agree with Tofurious about the usefulness of this thread. It has been quite interesting and its great to have a debate without folks becoming 'trolls' or getting 'flamed'. Goodluck to everyone in their future endeavors. I'll be lurking around the forum....
 
Tofurious,

You wrote too much to address and I can't cover all the bases because I'm tired and working on other outside (research) topics. Briefly:

1) A.T. Still did not intend to create a separate branch of medicine when we founded osteopathy. He intended to reform the current practice of his day. Early in the profession's history many struggled with the question of should osteopathy be a "limited practice" profession or a "full practice profession." Based upon the founder's original vision, the political zeitgiest of the time, and the health care needs of an emerging frontier nation osteopathy transformed itself into osteopathic medicine. That's the way it is and that's the way it will continue.

I think that you have the most conservative interpretation of osteopathy from anyone outside the profession that I have ever met! It's far more common (as was clearly articulated in the NEJM editorial a few years ago "The Paradox of Osteopathy") that most MD's are happy to accept, nay EMBRACE even, basic osteopathic precepts provided that DO's "show them the data." Your position is actually one that progressive DO's (like myself) have been fighting within the profession for decades---the argument that the osteopathic profession should be isolationists, should only focus on primary care, should stick with "tradition." I argue that the profession should gather data on the effectiveness of osteopathic modalities and join the mainstream scientific community and apply itself to making important biomedical and health policy contributions to our nation's healthcare system. In fact, I believe that it is the profession's moral obligation to do so and an obligation that has been shirked because of fears that "we won't be accepted," "we already know it works," "the deck is stacked against us (i.e. the MDs are calling the shots)," "it's too complicated to prove with science," etc.

If osteopathic medicine is to continue as a SOCIAL MOVEMENT in healthcare, then it logically follows that one cannot train osteopathic generalists without the input of osteopathic specialists. Would you prefer that your generalist learn to manage hypertension from another generalist or from a nephrologist? Similarly, scientists doing "osteopathic research" or "osteopathic relevant research" are required. An example of such research might be, "Is inflammatory cytokine production upregulated under states of chronic hypersympathotonia?" or "Is fibroblast mRNA synthesis attenuated by transmembrane pressure?" I know of few other ways to answer these kinds of questions than either to a) train PhD and MD/PhD investigators in the underlying precepts of osteopathy (this has been the traditional solution) or b) effectively train DO/PhDs.

2) I think that you underestimate DO's capacity to critically evaluate what we do. The profession does not define itself solely on the basis of OMT. In fact, less than 5% of DO's use OMT on more than 50% of patients (See Shirley Johnson, Jrnl of Am Osteo Assn, 1999 I believe). Manual medicine is not magic; nor do any DO's believe that it is a panacea. There are challenging and complex research issues involved in clearly demonstrating a mechanism of action for a manual intervention or describing complicated system interrelationships, but these things are not impossible just complex. 70 years ago the structure/function of DNA was beyond our imagination. Now look. Basic osteopathic research questions are fundamentally questions of structure and function. You may think that osteopathy is "beyond science" but a quietly emerging generation of DO's (with scientific training and "allopathic credentials") simply disagrees.

Finally, I can understand why you are confused with the "internal inconsistencies" that osteopathy presents. Are DO's MD's + OMT or are we truly unique physicians? Are we primary care oriented physicians or holistically oriented physicians who practice as "generalists first and specialists second"? Are osteopathic institutions more like technical/vocational schools or liberal arts colleges? But, confusion is the nature of social movements. Ideas and priorities are debated and competing interests bid for relevance. But, at the end of the day, I hope that we both agree that it comes down to what is right for the stakeholders (patients, payors, and participants) and what is in keeping with founding mission of the profession.
 
I am seeing a big difference in how we are arguing for our causes: you are presenting your arguments based on your ideal view and personal interpretation of osteopathy (perhaps progressive osteopathy as you call it), while I am basing my arguments on the textbook definition of osteopathy and the practical (including financial) reality of science. I go back to the AOA.net definition of what osteopathy is provided on this board (http://www.aoa.net/Consumers/whatdo01.htm):

* D.O.s comprise a separate, yet equal branch of American medical care. Together, D.O.s and M.D.s enhance the state of care available in America.

* Osteopathic medical schools emphasize training students to be primary care physicians

* D.O.s practice a "whole person" approach to medicine. Instead of just treating specific symptoms or illnesses, they assess the overall health of their patients including home and work environments.

* Osteopathic manipulative treatment (OMT) is incorporated in the training and practice of osteopathic physicians. With OMT, osteopathic physicians use their hands to diagnose injury and illness and to encourage your body?s natural tendency toward good health. By combining all other medical procedures with OMT, D.O.s offer their patients the most comprehensive care available in medicine today.

I find it rather paradoxical that so few DO physicians use OMT when it is one distinction between MDs and DOs one can put on paper to defend or destroy. Without reading the article myself, I imagine most DO physicians don't use it because of questionable appreciable benefits for the ailments they see, at least at a very general level. If you read all these guidelines of what osteopathy is, it truly sounds like what you are proposing to be progressive osteopathy is merely another step towards general MD medicine. I personally believe that if a school of thoughts has held for more than 100 years that something (OMT) works better than something else, people who CHOOSE to go into this field would be proud to use it and would be in a hurry to demonstrate its efficacy. And just to appease bullhorn since I have left her arguments to others on this board, if the GOAL of a PhD training in a joint degree program is to ADD to the medical practice rather than promoting basic science understanding of pathology, why then 1) should we create more PhD candidates to add to the already astronomical pool of PhD scientists who can readily answer the question you posed above without MD or DO affiliation? and 2) why should the FOCUS of ANY scientific research done by DO degree holders NOT be about the benefits of osteopathic treatments and philosophies?

I am sure I am not the only one to say that while we MD degree holders feel justified when DO degree holders want to practice allopathic medicine, we also find it unnecessary and somewhat inappropriate to transform osteopathy into something it's not meant to be. I really do not see much of what "progressive osteopathy" is that allopathic medicine is not. Similar to you labeling me a conservative, I would challenge the notion that even the majoirty of DOs are as "progressive" as you. I am sure many of them are proudly practicing OMT and distancing themselves from allopathy. "Separate but equal" is an AOA LISTED characteristic of osteopathy. If you choose to despise that quality as isolationism and distance yourself from it, I really question whether you should be representing osteopathy.
 
Also, there really shouldn't be any confusion between SCiENCE and SOCIAL MOVEMENT. I personally don't agree with your view that osteopathic medicine or even allopathic medicine should be a social movement, as the healthcare profession needs to maintain its neutrality and thus its sanctity. Similarly, SCIENCE is non-biased and only reports the facts. While the ramificiation of both science and health care could influence society, neutrality of both fields warrants that they themselves do not promote social movements of any sort. One could argue that AMA promotes social movements as much as any other lobbying group, but because of that reason AMA now represents less than 30% of American physicians, has lost much of its credibility and has become just yet another special interest group. If osteopathy is meant to be a form of social movement, that is one more reason why osteopathy and basic research should not mix.
 
I think I can answer tofurious's question.

It seems that the first train of thought in defining DO is now the dominating way (perhaps albiet the more backdoor "Fox-News" way) of thinking about osteopathy

Right now, DO degrees (as far as cirriculum) are not that much different from MD degrees-> implying, there is not that much difference between MD/DO period. The AOA "philosophical" etc etc is bull**** basically.

So, the purpose of DO/PhD programs reduce to the same purpose of MD/PhD programs. This further implies, a DO/PhD from, say Michigan State, is essentially equivalent to an MD/PhD from Michigan State, for obvious reasons. My judgement is, someone who can get into Michigan State or Oklahoma State's DO program probably would be able to get into, say, Finch...or Morehouse. DO schools are essentailly equivalent to "lower-tier" MD schools, which are also aimed primarily for primary care. But, there are always a few students in these schools who ****ed-up their undergrad/MCAT, but really want to shine later on, so DO/lower-tier MD (maybe + PhD) is their oppurtunity.

That's my intrepretation.
 
Originally posted by tofurious
Also, there really shouldn't be any confusion between SCiENCE and SOCIAL MOVEMENT. I personally don't agree with your view that osteopathic medicine or even allopathic medicine should be a social movement, as the healthcare profession needs to maintain its neutrality and thus its sanctity. Similarly, SCIENCE is non-biased and only reports the facts. While the ramificiation of both science and health care could influence society, neutrality of both fields warrants that they themselves do not promote social movements of any sort.

speaking of Renaissance...
 
I've been reading through all of these posts and am wondering what career(s) do you all have in mind with your DO/PhD or MD/PhD???
 
Listening to underqualified individuals whine about how they didn't get into joint degree programs because of ________ and how they got into joint degree programs because of ________.
 
Gee,

I used to believe in evolution. Now I wonder.

All of this bickering does very little to move us forward in medicine. Go read Hippocrates and Galen.

Or try, Roy Porter's, Short History of Medicine.

We are not evolving.
 
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