Is disinterest in OMM/OMT enough reason to not want to go DO?

[sylvanthus]

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I could actually care less what anyone thinks. As was stated before in this thread, it's really hard to conduct OMM research, there's so much bias involved that people often go on first person accounts.

Then don't assume the research is legit if the study design is poor. This not only discredits you, but the profession. Personal experience is not a substitution for research.

 

[cliquesh]

Then don't assume the research is legit if the study design is poor. This not only discredits you, but the profession. Personal experience is not a substitution for research.

Just to let you know, physicians do tons of stuff every day that isn't based on solid research or, in some cases, any research. Today, for instance, we gave lactulose to treat hepatic encephalopathy. Its a pretty common treatment for HE, but its effectiveness is questionable.

 

[sylvanthus]

Just to let you know, physicians do tons of stuff every day that isn't based on solid research or, in some cases, any research. Today, for instance, we gave lactulose to treat hepatic encephalopathy. Its a pretty common treatment for HE, but its effectiveness is questionable.

This is not an excuse, just because others have done it at certain times doesn't mean we should do it. Especially when OMT is essentially the only significant difference between DOs and MDs. We should strive to prove efficacy of treatments and not accept mediocrity. Otherwise, what in the world is differentiating us from MDs? Philosophy?

 

[cliquesh]

This is not an excuse, just because others have done it at certain times doesn't mean we should do it. Especially when OMT is essentially the only significant difference between DOs and MDs. We should strive to prove efficacy of treatments and not accept mediocrity. Otherwise, what in the world is differentiating us from MDs? Philosophy?

I don't disagree.

 

[donkeykong1]

Then don't assume the research is legit if the study design is poor. This not only discredits you, but the profession. Personal experience is not a substitution for research.

First off, I'm all for evidence based research. That's a core scientific principle. However it is quite difficult to conduct OMM research due to the obvious bias involved. This goes for some types of Rehab or Physical Therapy treatments in general. Furthermore, there is definitely constructive research being done on OMM at my future school's ohio muskuloskeletal and neurological institute:

http://www.oucom.ohiou.edu/omni/Research.htm

Finally the Virtual HAPTIC BACK PROJECT also in development at Ohio University HCOM which virtualizes palpation responses, could very well be instrumental in removing some of the bias involved.

http://www.ohio.edu/people/williar4/html/PDF/IMAGE03.pdf

Another example of legit OMM research: Can osteopathic manipulation treat sweat disorders?

http://www.oucom.ohiou.edu/news/press/Wilson2011/index.htm

Anyways, it really doesn't hurt to keep an open mind when it comes to OMM. We're often forced to lean on patient accounts, since we just don't have the technology to asses or even understand the science of manual medicine. Maybe this is a bad example but It's like how the NFL or the Army has a tough time scientifically assessing concussions. They often rely on patient responses, where a bias is existent (they can easily lie their way out of a diagnosis)..

 

[Joe the Plumber]

I think it's worth noting that MDs are not the impersonal, scientific, nerdy, hands-off cousins of DOs. Two of the MDs I shadowed were very touchy feely with patients, really wanting to find out was going on. And the DO I shadowed didn't dare get close to his pts. Mainly I'm looking forward to time with the S.O. and giving deep tissue massage during which I name each muscle I'm working on, and then things heat up from there. Gotta love that scientific dirty talk.

 

[sylvanthus]

First off, I'm all for evidence based research. That's a core scientific principle. However it is quite difficult to conduct OMM research due to the obvious bias involved. This goes for some types of Rehab or Physical Therapy treatments in general. Furthermore, there is definitely constructive research being done on OMM at my future school's ohio muskuloskeletal and neurological institute:

http://www.oucom.ohiou.edu/omni/Research.htm

Finally the Virtual HAPTIC BACK PROJECT also in development at Ohio University HCOM which virtualizes palpation responses, could very well be instrumental in removing some of the bias involved.

http://www.ohio.edu/people/williar4/html/PDF/IMAGE03.pdf

All well and good, but that does not prove that all those conditions you listed earlier can legitimately be treated with OMT. Do not pretend you are an authority on OMT when you have not yet even begun.

 

[donkeykong1]

All well and good, but that does not prove that all those conditions you listed earlier can legitimately be treated with OMT. Do not pretend you are an authority on OMT when you have not yet even begun.

ahhh I'm no authority, that list came straight out of my notes from OMM class last summer at OU. Good luck on your rotation

 

[sylvanthus]

ahhh I'm no authority, that list came straight out of my notes from OMM class last summer at OU. Good luck on your rotation

It may be wise to analyze these notes and look up the studies for yourself rather than just blindly trust your professors, you may be surprised.

 

[donkeykong1]

It may be wise to analyze these notes and look up the studies for yourself rather than just blindly trust your professors, you may be surprised.

Thanks for the advice. Besides for cranial techniques are there any conditions in particular in that list where the efficacy of OMM as a treatment option would be mediocre at best?

 

[sylvanthus]

Thanks for the advice. Besides for cranial techniques are there any conditions in particular in that list where the efficacy of OMM as a treatment option would be mediocre at best?

A quick cursory glance makes me focus on anything that just says "pain". There have been numerous studies that show that just the fact that a physician lays hands on a patient decreases their subjective pain level. Proving that pain decrease is due to OMT and not placebo is difficult to do and has not been proven in many of these conditions. Better studies are needed, plain and simple.

 

[somekindof]

There is active OMM research going on, but it's not as well funded as traditional areas of research. I'm sure it's not easy to get NIH grants from OMM research, and on top of that it's practically impossible to test every single area that OMM potentially treats. It's very broad.

My school, for example, has an Osteopathic Research Center: http://www.hsc.unt.edu/ORC/index.html
I believe it's the only center of it's kind in the nation.

 

[willen101383]

Its not even the OMM that turns me off that much. Its the chip on the shoulder isolationist policies of not only most OMM faculty but also the AOA. There are enough issues going on in healthcare right now, and maintaining a false distinction is absolutely ridiculous in the shadow of the massive issues looming over all of us as future physicians. If OMM were taught in limited fashion in conjunction with the typical clinical skills classes it would be one thing. But to force students to sit through an entire course that 95% of students wont even use is A. a waste of time and money and B. ludicrous. The time has come for OMM courses to be pared back to the absolutely useful things....because the majority of the OMM we are taught is absolutely worthless for the modern day DO grad (unless you go into a sole OMM/family med type practice). Ill leave it at that out of respect for my school although i could rant for hours about this.

 

[Vancomycin12]

Its not even the OMM that turns me off that much. Its the chip on the shoulder isolationist policies of not only most OMM faculty but also the AOA. There are enough issues going on in healthcare right now, and maintaining a false distinction is absolutely ridiculous in the shadow of the massive issues looming over all of us as future physicians. If OMM were taught in limited fashion in conjunction with the typical clinical skills classes it would be one thing. But to force students to sit through an entire course that 95% of students wont even use is A. a waste of time and money and B. ludicrous. The time has come for OMM courses to be pared back to the absolutely useful things....because the majority of the OMM we are taught is absolutely worthless for the modern day DO grad (unless you go into a sole OMM/family med type practice). Ill leave it at that out of respect for my school although i could rant for hours about this.

I could not agree more with you on this.

 

[SuperFOR]

Yes! It's definitely enough to consider waiting a year and going MD

 

[RichterBelmont]

I'm currently a first year DO student and several of my classmates were held back a year because they failed OMM. If you don't see yourself possessing the motivation/drive to practice and learn OMM (both the techniques and the theory behind it) it as much as your other basic and clinical science courses, I would not attend an osteopathic medical school.

 

[Kevin Baker]

I felt the same way going in but the OMM faculty have won me over. I didn't envision using it 12 months ago but if I end up in a certain field, I could see using a few techniques on very specific patient populations.

Really though, it's a few extra hours out of your week. Not too bad. 10 minutes of studying a night, plus ~4 hours a week in class isn't terrible. A slim majority of your fellow students will likely grin and bear it with OMM, ~1/4 will be hostile to it, and ~1/4 will really like it.

If we were revamping the curriculum, there are about half a dozen other annoying filler classes I'd get rid of before revamping the OMM component. Plus, it's good with chicks.

 

[DocEspana]

Legitimate thread with some good posts about to leap off the cliff of why you cannot create a good double blind model for OMM, while ignoring that the same thing can be said of surgery and we get past that by simply understanding anatomy and physiology of whatever we just pulled out/put in. (not that surgery = OMM. At all. Just pointing out a flawed argument)

 

[Dharma]

Legitimate thread with some good posts about to leap off the cliff of why you cannot create a good double blind model for OMM, while ignoring that the same thing can be said of surgery and we get past that by simply understanding anatomy and physiology of whatever we just pulled out/put in. (not that surgery = OMM. At all. Just pointing out a flawed argument)

Yep. 👍

 

[PhiPhenomenon]

My sentiments exactly. I'm shocked this thread is still alive (and honestly a little embarrassed about a few of the things I said).

That being said, I still don't have much interest in OMM/OMT. I'm also amazed at how very not alone I am. Outside of rapport building and getting a better understanding of human anatomy, and we can all use that, I really don't see much use for it.

 

[COMedic2Doc]

Legitimate thread with some good posts about to leap off the cliff of why you cannot create a good double blind model for OMM, while ignoring that the same thing can be said of surgery and we get past that by simply understanding anatomy and physiology of whatever we just pulled out/put in. (not that surgery = OMM. At all. Just pointing out a flawed argument)

Definitely and the ship going off the edge is definitely fitting for this thread.... 😀

 

[somekindof]

Legitimate thread with some good posts about to leap off the cliff of why you cannot create a good double blind model for OMM, while ignoring that the same thing can be said of surgery and we get past that by simply understanding anatomy and physiology of whatever we just pulled out/put in. (not that surgery = OMM. At all. Just pointing out a flawed argument)

I'm not a fan of OMM, but it's harder to "test" OMM's effectiveness because you can't really scientifically assess something like "feeling better" very accurately. The research that is done on OMM typically looks at physiological responses to treatment, like increased lymph flow and such, but I'm sure that's hard to definitely correlate with improved outcomes. Overall, I do agree that more research should be put into OMM so we can filter out what works and what doesn't. Then again, I can't say it matters to me personally because I highly doubt I'll use it in my practice.

 

[DocEspana]

I'm not a fan of OMM, but it's harder to "test" OMM's effectiveness because you can't really scientifically assess something like "feeling better" very accurately. The research that is done on OMM typically looks at physiological responses to treatment, like increased lymph flow and such, but I'm sure that's hard to definitely correlate with improved outcomes. Overall, I do agree that more research should be put into OMM so we can filter out what works and what doesn't. Then again, I can't say it matters to me personally because I highly doubt I'll use it in my practice.

The research that is done generally looks at self-reported pain levels, length of hospital stay, and frequency of return to hospital (no clue where youre saying lymph flow is the measurement. It probably exists, but I've never seen that be a metric). Those are the exact same metrics used in surgery. Surgery also uses measurement of how many people returned for the gold standard surgery after the experiemtal. Im sure that can be done for OMM too, but I've never seen it done.

Again. I;m not in any real way equating them. But they're both areas where the issue becomes "how do you measure something that has no/little effect on body chemistry, the most quantifiable measurement out there" and "how do you double blind something that requires an expert every time, would be malpractice if you did anythin but an effective procedure, and the patient is likely to recognize a dummy procedure"

note: the irony here. I dont like OMM except for casual muscle energy and HVLA for spinal pain. But I also dont like people who get information on stats/studies wrong. Its sort of my pet peeve. I'm a stats guy.

 

[donkeykong1]

I'm not a fan of OMM, but it's harder to "test" OMM's effectiveness because you can't really scientifically assess something like "feeling better" very accurately. The research that is done on OMM typically looks at physiological responses to treatment, like increased lymph flow and such, but I'm sure that's hard to definitely correlate with improved outcomes. Overall, I do agree that more research should be put into OMM so we can filter out what works and what doesn't. Then again, I can't say it matters to me personally because I highly doubt I'll use it in my practice.

I know that some counter-strain techniques help to ease lymph flow. But how would you measure lymph flow differential (before/after)? just curious

 

[somekindof]

The research that is done generally looks at self-reported pain levels, length of hospital stay, and frequency of return to hospital (no clue where youre saying lymph flow is the measurement. It probably exists, but I've never seen that be a metric). Those are the exact same metrics used in surgery. Surgery also uses measurement of how many people returned for the gold standard surgery after the experiemtal. Im sure that can be done for OMM too, but I've never seen it done.

Again. I;m not in any real way equating them. But they're both areas where the issue becomes "how do you measure something that has no/little effect on body chemistry, the most quantifiable measurement out there" and "how do you double blind something that requires an expert every time, would be malpractice if you did anythin but an effective procedure, and the patient is likely to recognize a dummy procedure"

note: the irony here. I dont like OMM except for casual muscle energy and HVLA for spinal pain. But I also dont like people who get information on stats/studies wrong. Its sort of my pet peeve. I'm a stats guy.

If I'm not mistaken, there are many OMM studies that use frequency of return, length of hospital stay, length of medication... etc. In fact, I've heard length of hospital stay cited as a big factor in alot of OMM research, and I don't exactly sit around reading OMM journal articles.

And for the lymph thing, I was just using that as an example of physiological things they can measure. The research was done at the Osteopathic Research Center and led by the professor who taught us the cardiovascular system. They used dogs as test subjects, but I can't remember how it was measured. The professor just sorta plugged it into the end of one of his lectures out of nowhere.

EDIT: I think this might be the research publication: http://ebm.rsmjournals.com/content/236/10/1109.long

 

[DocEspana]

If I'm not mistaken, there are many OMM studies that use frequency of return, length of hospital stay, length of medication... etc. In fact, I've heard length of hospital stay cited as a big factor in alot of OMM research, and I don't exactly sit around reading OMM journal articles.

And for the lymph thing, I was just using that as an example of physiological things they can measure. The research was done at the Osteopathic Research Center and led by the professor who taught us the cardiovascular system. They used dogs as test subjects, but I can't remember how it was measured. The professor just sorta plugged it into the end of one of his lectures out of nowhere.

I think this might be the research publication: http://ebm.rsmjournals.com/content/236/10/1109.long

I think you misread my comment. I was saying that I've never heard of the lymph study and would have no clue how its done (but appreciate the link), all the studies ive heard on OMM have used length of stay/etc/etc. which are all accepted measures, and you backed up that its what you've seen as well. I'm glad we agree, haha, though im sad I wrote it in a manner that you misunderstood and had to type all that out.

 

[Bacchus]

I know that some counter-strain techniques help to ease lymph flow. But how would you measure lymph flow differential (before/after)? just curious

I think there were canine studies done. The thoracic duct was cannulated and the lymph techniques were done on the dogs. There was an upregulation in lymph flow into whatever collection vessel was used.

 

[donkeykong1]

I think there were canine studies done. The thoracic duct was cannulated and the lymph techniques were done on the dogs. There was an upregulation in lymph flow into whatever collection vessel was used.

awesome. 👍

 

[Bacchus]

awesome. 👍

http://www.jaoa.org/content/105/10/447.full

 

[donkeykong1]

I think there were canine studies done. The thoracic duct was cannulated and the lymph techniques were done on the dogs. There was an upregulation in lymph flow into whatever collection vessel was used.

abdominal pump technique on a dog....so cool

http://www.jaoa.org/content/105/10/447/F1.large.jpg

 

[willen101383]

abdominal pump technique on a dog....so cool

http://www.jaoa.org/content/105/10/447/F1.large.jpg

Did you know all the dogs in that study were euthanized rather than adopted out post study? As someone who has 3 rescue dogs, and sheltered another 4 that really bothered me.

Sure guys, lets kill a bunch of dogs to prove that the miller pump actually stimulates lymphatic flow in the thoracic duct. Vomit. The only good thing about lymphatic pumps is that when you do the pedal pump in OMM lab the lab tables squeek and it sounds like teh secks is going on in there. Good for some giggles at least. Oh and it contributed to the main accomplishment osteopathic medicine has made to society: saving some people during the 1917/18 flu pandemic (that the OMMites still wont stfu about).

 

[donkeykong1]

Did you know all the dogs in that study were euthanized rather than adopted out post study? As someone who has 3 rescue dogs, and sheltered another 4 that really bothered me.

Sure guys, lets kill a bunch of dogs to prove that the miller pump actually stimulates lymphatic flow in the thoracic duct. Vomit. The only good thing about lymphatic pumps is that when you do the pedal pump in OMM lab the lab tables squeek and it sounds like teh secks is going on in there. Good for some giggles at least. Oh and it contributed to the main accomplishment osteopathic medicine has made to society: saving some people during the 1917/18 flu pandemic (that the OMMites still wont stfu about).

thanks for bringing it up. this issue is definitely prevalent in medical research in general.

yah the flu pandemic thing needs to go...it almost 100 years

 

[msmitra]

You could always do a masters program. There are many 1 year masters programs if you are worried about it taking too long. Most schools look at your GPA for your highest GPA for your highest degree earned. In other words, if you did well in a masters program they wouldn't care about your 3.1 undergrad GPA.

 

[msmitra]

apply to an MD school please.

 

[willen101383]

thanks for bringing it up. this issue is definitely prevalent in medical research in general.

yah the flu pandemic thing needs to go...it almost 100 years

Interesting they were able to surgically implant a flow transducer in there Ill admit it, but that really irked me they euthanized the subjects for no good reason when they were likely perfectly healthy afterwards (and maybe even flu free lol). This isnt even a study that really advances medicine, thats another reason it pissed me off.

 

[ChaiMeow]

You should absolutely not apply to DO school. I don't think you'll be happy in an environment where you think the medical education is illegitimate. I wont go into my reasons for wanting to be an osteopath, but to maintain the integrity of the profession I think we should only have students that really believe in the treatment philosophy and technique join our ranks.

 

[sylvanthus]

You should absolutely not apply to DO school. I don't think you'll be happy in an environment where you think the medical education is illegitimate. I wont go into my reasons for wanting to be an osteopath, but to maintain the integrity of the profession I think we should only have students that really believe in the treatment philosophy and technique join our ranks.

The problem and huge flaw in this is that you don't know what you believe until you experience it. I went in and actually gave OMT a shot and thought it would be an additional tool. That is until I experienced it and saw the research first hand and then realized many of the techniques are completely unfounded. Also, alittle premature to be talking about not allowed non-believers into "our ranks" when you haven't bloody started yet.

 

[ChaiMeow]

I have experienced it. I was a chronic pain patient for several years and OMT made a huge difference for my condition. I have also spent many hours working for a DO that exclusively practices OMM and count several graduated DOs as contemporaries. I apologize for upsetting you with a 3 month premature suggestion of joining your ranks. I simply gave my opinion that someone who has a huge issue with OMM should steer clear of becoming an osteopath. It seemed like a no-brainer. It also seems like you just want to pick a fight, so I'll just pipe down and let you ask others for an opinion you agree with.

 

[Drrrrrr. Celty]

You should absolutely not apply to DO school. I don't think you'll be happy in an environment where you think the medical education is illegitimate. I wont go into my reasons for wanting to be an osteopath, but to maintain the integrity of the profession I think we should only have students that really believe in the treatment philosophy and technique join our ranks.

Especially since studies show that less than 10% of DOs will ever use OMM.
Eh, you need to be comfortable with the fact that people will be attending your DO school because they want to be a physician, not an osteopathic physician. Not that there is any real difference, perceived or otherwise...

 

[toxicwombat]

the problem and huge flaw in this is that you don't know what you believe until you experience it. I went in and actually gave omt a shot and thought it would be an additional tool. That is until i experienced it and saw the research first hand and then realized many of the techniques are completely unfounded. also, alittle premature to be talking about not allowed non-believers into "our ranks" when you haven't bloody started yet.

Well said.

 

[Bacchus]

I hate for this to be about semantics, but it is OSTEOPATHIC PHYSICIAN... or just physician. Not osteopath. If you want to be an osteopath, don't take a spot from an American student; find a program overseas.

 

[fiznat]

http://www.jaoa.org/content/105/10/447.full

Yeah, did you guys read the article?

During OMM treatment: lymph flow went from 1.57 to 4.80 mL/min
Dog just walking on treadmill (control): lymph flow went from 1.47 to 5.81 mL/min

So, walking on the treadmill was MORE effective than the treatment.

Also, a quote:

"In the two canine subjects for which recovery data was gathered (ie, canine subjects 4 and 5), TDF levels quickly returned to baseline levels following the termination of manipulative intervention. Although this observation demonstrates the ability of researchers to measure changes in TDFs accurately, it also suggests that these OM techniques, when used in the clinical setting for OMT, may not have sustained effects after treatment is completed."


Here's another article, published in the Journal of the American Osteopathic Assoc.:

http://www.jaoa.org/content/101/1/21.full.pdf

"Our results suggest that TLP had little therapeutic advantage for enhancing the production of antibodies against influenza antigens in healthy, active, ambulatory individuals—young or aged."



There is another study that seems to have some positive results, although the sample size is small and I can't see the whole article (can anyone get it?).



The jury is still out on the lymph pump.

 

[Bacchus]

No, I didn't read it. Nor did I care to read it. It was for him to explain the process of the intervention measurement.

 

[fiznat]

No, I didn't read it. Nor did I care to read it. It was for him to explain the process of the intervention measurement.

I meant everyone. Sorry, I'm a bit keyed about about this subject in particular. The current president of the AOA recently came to our school and gave a speech which was a bit, ah, controversial with many of the students. He cited some of these studies in his talk as evidence for the expanded use of lymph pump (and OMM in general). That's why I happened to have them on hand....

 

[ChaiMeow]

SORRY again. I learned that from the DO I worked for who has been practicing since 1986. I'll be sure to school her in the correct way to refer to herself. You all are a snarky bunch.

 

[fiznat]

SORRY again. I learned that from the DO I worked for who has been practicing since 1986. I'll be sure to school her in the correct way to refer to herself. You all are a snarky bunch.

She can refer to herself however she likes. It is still solid advice for you though. As you become more deeply involved in this DO world of ours, you will find plenty of people who take offense to the title of "osteopath" because that term is also used abroad for healthcare providers who do OMM but are not physicians. For reasons I'm sure you can imagine, DOs can be very sensitive about being mistaken for anything other than full-fledged physicians.

It doesn't hurt, especially as you're just starting out in this profession, to know where the mines are.

 

[sylvanthus]

I meant everyone. Sorry, I'm a bit keyed about about this subject in particular. The current president of the AOA recently came to our school and gave a speech which was a bit, ah, controversial with many of the students. He cited some of these studies in his speech as evidence for the expanded use of lymph pump (and OMM in general). That's why I happened to have them on hand....

I hear ya, I have two half days each week of my OMT rotation where I look strictly at OMT studies and I am disturbed to say the least.

Study 1: Acute ankle sprain in the ED. Patients split into two groups, an OMT group and a control group. Both groups got standard treatment. They took a look at range of motion, pain, and edema after OMT treatment. But, then didn't compare it to the control.......Their conclusion? OMT in acute ankle sprain increased range of motion, decreased pain level, and decreased edema. Did I mention the researchers themselves did the measurements also and no measurements were done on the controls at the same time as the post-treatment omt group? Hello!? They all got pain meds, ice compression, elevation, etc! Of course pain went down! It probably did in the control group also, but they neglected to find out!

Study 2: Pneumonia patients were split into 3 groups, control, sham treatment, and omt. They concluded that the OMT group had a shorter length of stay, decreased length of antibiotic treatment, and decreased mortality. Whats the problem? There was no significant difference between the OMT group and the sham treatment group. Meaning, just laying hands on the patient had a positive effect. But, of course, they concluded that it was the OMT that made the difference.

Study 3: Pediatric Asthma patients post OMT treatment and measurement of peak flow values. First, the researchers did the measurements! How does this **** happen? Seriously, how likely is it that the researchers encouraged the OMT group to blow harder!? Or redo the measurement if it was lower than they expected?! Also, no control group again.....It can easily be reasoned that maybe just the fact that the kids took a deep breath in and out for the initial peak flow readings may have freed up their lungs a bit so that the next peak flow results may have been higher? Nawww, of course not, it had to be OMT that produced the results. But, how do you know when you don't compare it to a control!?!?!?

Ugh, sorry, these are just some of the bloody articles I am reading right now and it disgusts me.

 

[fiznat]

I hear ya, I have two half days each week of my OMT rotation where I look strictly at OMT studies and I am disturbed to say the least..

So do you have a journal club or something? ...An opportunity to discuss the articles? What happens then?

 

[sylvanthus]

So do you have a journal club or something? ...An opportunity to discuss the articles? What happens then?

Nothing so formal, I just discuss the articles with a faculty member. Unfortunately, she is big into cranial, so its not likely that we are going to have a good conversation about valid study design.

 

[DocEspana]

I was perhaps not clear enough the first time with my distaste for the strange strange turn this thread has taken.

Don't counteract skepticism and any critiques by declaring "then you're not allowed in our tree fort! Go climb a caribbean coconut tree. Build a fort there". No one appreciates OMM before they go into school. Almost no one appreciates it after graduation. The few people who do appreciate it before enrollment are the kind of people I avoid. People go into DO schools because they want to be physicians. Done deal. Case closed. Don't try to act like the forum is the exclusive club and you're the bouncer. Be more along the lines of this forum is a BJ's wholesale club or a Costco and you're the 82 year old lady with a toaster oven giving out samples. Warm. Friendly. Slightly Senile. Loved by everyone.