Why does DO exist?

[RNtoMD87]

From my understanding MD and DO are in essence the same thing. DO has manipulative therapy, but some MD programs teach this as well. Some DOs never utilize it, and some MDs implement it.


Why do separate licenses that do the same identical thing still exist? Just something I've wondered.

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[Lawpy]

Historical and political reasons on part of AOA and COCA.

 

[Goro]

Historical and political reasons on part of AOA and COCA.

And the AMA for refusing to recognize the profession for almost a century

 

[RNtoMD87]

Wow.

 

[Lawpy]

And the AMA for refusing to recognize the profession for almost a century

I think that’s because osteopathy was viewed as pseudoscience. Part of the reason why DOs became equivalent to MDs today is they essentially adopted modern medicine in their curricula and minimized Still’s importance. I don’t think the AMA is at fault here.

The residency merger is the first step in unifying the two fields together. COCA isn’t willing to give up money and power by surrendering accreditation powers to LCME. And it’s because of that, the two degrees remain separate even though everything should be integrated under MD and accreditated by LCME/ACGME.

I’m of the opinion that OMM should serve as a fellowship for medical graduates.

 

[Blanky]

I wonder what the chances are of DO and MD merging one day. It would be ideal for obvious reasons. Most of us want to be doctors and only later get twisted in the MD vs DO nonsense.

 

[Lawpy]

I wonder what the chances are of DO and MD merging one day. It would be ideal for obvious reasons. Most of us want to be doctors and only later get twisted in the MD vs DO nonsense.

If the LCME takes over accreditation, most DO schools would be forced to close because they would fail to meet the strict standards. The really strong DO schools would probably end up like UC Irvine.

 

[RNtoMD87]

Ah, so historically, DO was more into manipulation etc. and did not have the same hard science medical emphasis it has today?

Very interesting. I'm glad to see this merger. I believe in holistic medicine but I also like hard science to back it up. I do believe some things can not yet be explained by science due to a limitation on our knowledge and technology, but I don't believe it makes it "fake science". Aspirin was used for thousands of years before we even began to understand how it worked.

 

[Lawpy]

Ah, so historically, DO was more into manipulation etc. and did not have the same hard science medical emphasis it has today?

Very interesting. I'm glad to see this merger. I believe in holistic medicine but I also like hard science to back it up. I do believe some things can not yet be explained by science due to a limitation on our knowledge and technology, but I don't believe it makes it "fake science". Aspirin was used for thousands of years before we even began to understand how it worked.

History of Osteopathic Medicine

I support the use of OMM in specific contexts but I oppose having two separate degrees that are functionally equivalent. Unifying the two degrees is the best option but that results in most DO schools getting shut down for failing to meet strict LCME standards. This in turn results in students being left without a degree and forcing nearby schools to take them. The current DO expansion is only worsening the matters.

The AOA already lost its residency powers to the ACGME. I doubt COCA is willing to accept giving up the COMLEX and agreeing to a merger with LCME. Politics and logistics are what’s preventing the complete merger from happening.

 

[RNtoMD87]

The only reason I would really prefer MD over DO is I'm worried about patients not knowing what a DO is, and getting misinformation (seeing as many premed people even have misinformation). Most RNs I work with don't even know what DO is.

I'd get tired of telling people I wasn't an optometrist or a bone doctor

 

[Lawpy]

The only reason I would really prefer MD over DO is I'm worried about patients not knowing what a DO is, and getting misinformation (seeing as many premed people even have misinformation). Most RNs I work with don't even know what DO is.

I'd get tired of telling people I wasn't an optometrist or a bone doctor

That’s just general ignorance and you can correct them by saying you’re a physician. I wouldn’t use that as a factor to decide between the two pathways.

However, there are more important factors to consider, such as facing anti-DO bias in specialties during residency application, having to deal with COMLEX and DO shelves, dealing with weaker clinical rotations etc.

 

[RNtoMD87]

Oh don't get me wrong. Although Id choose MD over DO, Id be thrilled to be either one.

 

[MyGrainAura]

The only reason I would really prefer MD over DO is I'm worried about patients not knowing what a DO is, and getting misinformation (seeing as many premed people even have misinformation). Most RNs I work with don't even know what DO is.

I'd get tired of telling people I wasn't an optometrist or a bone doctor

The stigma exists amongst premeds and residency directors who’ve been alive since the ice age and still take notes with a stone tablet.

You’ve probably visited a DO physician in your lifetime and didn’t know it.

Tell me off the top of your head what license your dentist has: DDS or DMD?


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[Magus5454]

The stigma exists amongst premeds and residency directors who’ve been alive since the ice age and still take notes with a stone tablet.

You’ve probably visited a DO physician in your lifetime and didn’t know it.

Tell me off the top of your head what license your dentist has: DDS or DMD?


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DDS. Not hard

 

[RNtoMD87]

The stigma exists amongst premeds and residency directors who’ve been alive since the ice age and still take notes with a stone tablet.

You’ve probably visited a DO physician in your lifetime and didn’t know it.

Tell me off the top of your head what license your dentist has: DDS or DMD?


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I don't think so. I've only been to a handful of doctors. The only way it would've been possible is back in the late 80s-early 90s when I was a child. I've only went to a doctor for anything like 3 times since then, and it was an EENT, an endocrinologist, and a sleep doctor. All MDs. They don't have very many DOs in Louisiana. I know they exist here, but theyre very few compared to MDs.

I haven't been to a dentist in 6 years, but he was a DDS. Family friend.

 

[workaholic181]

Osteopathy was founded by an MD to be a separate medical degree that incorporated OMM and emphasized holism in the 1800s. That's why originally it was a separate thing. And as others have stated there were a ton of historical/political since then that have prevented a merger. IMO it's unlikely there would ever be some kind of degree merger.

 

[darklabel]

California had a brief stint with a merger but that fell through: History in CA of DOs to MDs, DO and MD association merger, etc.

There's too much money on the line and a lot of DO schools would close if the 2 degrees merged so it's unlikely to ever happen.

 

[Isoval]

California had a brief stint with a merger but that fell through: History in CA of DOs to MDs, DO and MD association merger, etc.

There's too much money on the line and a lot of DO schools would close if the 2 degrees merged so it's unlikely to ever happen.

Frankly, there might be a few that are forced to close after the residency merger if they are unable to place their grads in ACGME positions...

As schools improve to accommodate the higher standards required of applicants to snag an ACGME spot, I think the gap will further shrink as we move forward.

 

[MyGrainAura]

I don't think so. I've only been to a handful of doctors. The only way it would've been possible is back in the late 80s-early 90s when I was a child. I've only went to a doctor for anything like 3 times since then, and it was an EENT, an endocrinologist, and a sleep doctor. All MDs. They don't have very many DOs in Louisiana. I know they exist here, but theyre very few compared to MDs.

I haven't been to a dentist in 6 years, but he was a DDS. Family friend.

And do you make a significant distinction that he’s not a DMD. Although the difference may be clear in your mind most patients will have no clue.

Take for instance the deluge of chiropractic shills that parade as Dr. so-and-so taking advantage of public ignorance. They never try to market their alternative treatments making the distinction that they are chiropractors or even chiropractic physician. If you dig around their websites they will hide this information and their degree in the deepest recesses.

As a DO, you are a physician. If it will give you a complex or you want a competitive specialty then look elsewhere.


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[AnatomyGrey12]

Part of the reason why DOs became equivalent to MDs today is they essentially adopted modern medicine in their curricula and minimized Still’s importance. I don’t think the AMA is at fault here.

Ah, so historically, DO was more into manipulation etc. and did not have the same hard science medical emphasis it has today?

The AMA’s actions can’t be explained simply saying, “well back then DOs mainly did manipulation” seeing as schools of osteopathic medicine incorporated the same subjects as allopathic schools in the early 1900s...

Osteopathic medicine grew out of mainstream medicine in the late 1800s because that was a time when doctors were essentially killing patients by giving them “medicine” that they didn’t even know what it did, or by performing surgical procedures that killed more than half the patients that received it. Since then there is essentially no difference outside of DO schools teaching manipulation to every student for historical reasons and “holistic medicine” is simply good medicine and practiced by physicians everywhere.

I predict a full merger within 15 years.

 

[AnatomyGrey12]

If the LCME takes over accreditation, most DO schools would be forced to close because they would fail to meet the strict standards. The really strong DO schools would probably end up like UC Irvine.

If it was an abrupt change then yes but but you gave schools a 5 year window similar to the residency merger then I think more schools would make it than people think. There are probably 8-10 that could make it right now if they were given leeway with some of the research requirements.

 

[Lawpy]

I predict a full merger within 15 years.

If it was an abrupt change then yes but but you gave schools a 5 year window similar to the residency merger then I think more schools would make it than people think. There are probably 8-10 that could make it right now if they were given leeway with some of the research requirements.

But the DO expansion needs to stop. I don't know how the new schools would qualify for LCME accreditation.

 

[deleted103644]

I think that’s because osteopathy was viewed as pseudoscience. Part of the reason why DOs became equivalent to MDs today is they essentially adopted modern medicine in their curricula and minimized Still’s importance. I don’t think the AMA is at fault here.

The residency merger is the first step in unifying the two fields together. COCA isn’t willing to give up money and power by surrendering accreditation powers to LCME. And it’s because of that, the two degrees remain separate even though everything should be integrated under MD and accreditated by LCME/ACGME.

I’m of the opinion that OMM should serve as a fellowship for medical graduates.

No, osteopathy is pseudoscience.

It was better than medicine when AT Still created it, because it mostly does nothing and medicine in his day could be pretty harmful.

But.... it’s complete and utter bull****.

 

[GTown]

No, osteopathy is pseudoscience.

It was better than medicine when AT Still created it, because it mostly does nothing and medicine in his day could be pretty harmful.

But.... it’s complete and utter bull****.

Lol! I've actually had OMM done after a car accident and it actually helped and I was able to avoid a lot of pain meds.

That said, as far as competitive specialities (is anesthesia still considered one? Coz my husband hates it) Anyhow, one of my husband's former co-residents is a DO that is about to finish his pain fellowship. My husband actually had a lot of DO's in his anesthesia residency but then again we're on the east coast, very little bias here I believe.

 

[deleted103644]

Lol! I've actually had OMM done after a car accident and it actually helped and I was able to avoid a lot of pain meds.

That said, as far as competitive specialities (is anesthesia still considered one? Coz my husband hates it) Anyhow, one of my husband's former co-residents is a DO that is about to finish his pain fellowship. My husband actually had a lot of DO's in his anesthesia residency but then again we're on the east coast, very little bias here I believe.

People have great anecdotes about crystals too!

That’s not how science works.

Also, want to know a secret about pain medicine, particularly spine procedures?

A lot of that is pseudoscience too.

 

[AnatomyGrey12]

But the DO expansion needs to stop. I don't know how the new schools would qualify for LCME accreditation.

Agreed. I’ve held the opinion for a while that the AOA blew their chance to actually gain a lot of respect in the medical community. Before all this school expansion you only had about 25-30 schools, you had DO grads matching better and better, the entering stats were going up (with many schools approaching low tier MD level), and the overall product was getting better every. If they would have simply harnessed that momentum, they could have created more resources for those schools, improved on the GME, created better clinical opportunities, etc. Instead they decided to rapidly expand like rabbits and create a bunch of marginal, at best, new schools that are accepting poor applicants by the bunches that have no good clinical opportunities.

It’s insane.

 

[Durty-Trixxx]

Agreed. I’ve held the opinion for a while that the AOA blew their chance to actually gain a lot of respect in the medical community. Before all this school expansion you only had about 25-30 schools, you had DO grads matching better and better, the entering stats were going up (with many schools approaching low tier MD level), and the overall product was getting better every. If they would have simply harnessed that momentum, they could have created more resources for those schools, improved on the GME, created better clinical opportunities, etc. Instead they decided to rapidly expand like rabbits and create a bunch of marginal, at best, new schools that are accepting poor applicants by the bunches that have no good clinical opportunities.

I hate to kicksart another "Why We Hate LECOM" thread but wasn't LECOM like the first D.O. school to open in 25 years when it started in 1993? Then within 10 years of that another dozen D.O. schools open as well as them starting dental and pharmacy schools like crazy. Since when did you ever meet an "osteopathic dentist" or "osteopathic pharmacist"? Talk about confusing the public.

 

[CJhooper123]

The AMA’s actions can’t be explained simply saying, “well back then DOs mainly did manipulation” seeing as schools of osteopathic medicine incorporated the same subjects as allopathic schools in the early 1900s...

Osteopathic medicine grew out of mainstream medicine in the late 1800s because that was a time when doctors were essentially killing patients by giving them “medicine” that they didn’t even know what it did, or by performing surgical procedures that killed more than half the patients that received it. Since then there is essentially no difference outside of DO schools teaching manipulation to every student for historical reasons and “holistic medicine” is simply good medicine and practiced by physicians everywhere.

I predict a full merger within 15 years.

Agree with mostly everything you said. Didn't early osteopathy involve magnetic healing? Lol
The full merger prediction is bold. How will the new schools qualify for LCME accreditation?

People have great anecdotes about crystals too!

That’s not how science works.

Also, want to know a secret about pain medicine, particularly spine procedures?

A lot of that is pseudoscience too.

There are plenty of medical conditions and treatments we can't thoroughly explain. Medical pseudoscience will continue to exist until we can adequately measure and explain conditions/treatments.

 

[GTown]

People have great anecdotes about crystals too!

That’s not how science works.

Also, want to know a secret about pain medicine, particularly spine procedures?

A lot of that is pseudoscience too.

A lot of things are pseudoscience and don't quite always make sense. I'm coming to medicine from a car t-cell therapy background in pharma. It's a lot of hard science but I have seen instances where changing to a different manufacturer of a cytokine fixed a problem. Just like off-brand ibuprofen works for most people but not for others (I believe it's the variation in the delivery system and not the drug itself). That's what makes medicine so interesting to me, as much as you rely on numbers and facts - there is the ultimate human element that gives it a je ne sais quois. Some patients react well to the same experimental therapy and others get miserably sick. How do you explain it?

Do I think OMM helped me? At the time it certainly did. I also had to really search for a DO that actually did OMM. Right now I'm struggling with pregnancy induced sciatica and nothing is helping.

The spine procedures, I'll have to ask my husband. But I'm not planning on an epidural because as much as my husband will deny this - I know of too many friends left with long term back pain following an epidural. Pseudoscience.

 

[RNtoMD87]

So basically if we can't explain why something works- it's pseudoscience? Because there are many things we can't explain

 

[GTown]

Agreed. I’ve held the opinion for a while that the AOA blew their chance to actually gain a lot of respect in the medical community. Before all this school expansion you only had about 25-30 schools, you had DO grads matching better and better, the entering stats were going up (with many schools approaching low tier MD level), and the overall product was getting better every. If they would have simply harnessed that momentum, they could have created more resources for those schools, improved on the GME, created better clinical opportunities, etc. Instead they decided to rapidly expand like rabbits and create a bunch of marginal, at best, new schools that are accepting poor applicants by the bunches that have no good clinical opportunities.

It’s insane.

With the merger, won't these sub-par schools get filtered out? If their students can't match into anything, what else is the likely outcome after a few years of that except closing? People certainly wouldn't apply I hope, and even if they do - what's the point if you don't match.

Easy to get into DO schools have become a way for people that maybe shouldn't be doctors to become doctors. Can't the merger l my be a good thing in that case for everyone, DOs at good DO schools especially? I wish I'd looked a little more into the merger before choosing to go with my DO acceptance, but I'm also not worried too much about matching because my school matches more people into ACGME than AOA.

 

[Blanky]

With the merger, won't these sub-par schools get filtered out? If their students can't match into anything, what else is the likely outcome after a few years of that except closing? People certainly wouldn't apply I hope, and even if they do - what's the point if you don't match.

Easy to get into DO schools have become a way for people that maybe shouldn't be doctors to become doctors. Can't the merger l my be a good thing in that case for everyone, DOs at good DO schools especially? I wish I'd looked a little more into the merger before choosing to go with my DO acceptance, but I'm also not worried too much about matching because my school matches more people into ACGME than AOA.

Your logic isn't terrible, but take a look at Carib schools and the dropout and then reconsider mentioning that people might not attend those schools in your theory.

 

[MyGrainAura]

So basically if we can't explain why something works- it's pseudoscience? Because there are many things we can't explain

e.g. the mechanism of aspirin


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[deleted103644]

Agree with mostly everything you said. Didn't early osteopathy involve magnetic healing? Lol
The full merger prediction is bold. How will the new schools qualify for LCME accreditation?



There are plenty of medical conditions and treatments we can't thoroughly explain. Medical pseudoscience will continue to exist until we can adequately measure and explain conditions/treatments.

PLACEBO EFFECT

 

[deleted103644]

A lot of things are pseudoscience and don't quite always make sense. I'm coming to medicine from a car t-cell therapy background in pharma. It's a lot of hard science but I have seen instances where changing to a different manufacturer of a cytokine fixed a problem. Just like off-brand ibuprofen works for most people but not for others (I believe it's the variation in the delivery system and not the drug itself). That's what makes medicine so interesting to me, as much as you rely on numbers and facts - there is the ultimate human element that gives it a je ne sais quois. Some patients react well to the same experimental therapy and others get miserably sick. How do you explain it?

Do I think OMM helped me? At the time it certainly did. I also had to really search for a DO that actually did OMM. Right now I'm struggling with pregnancy induced sciatica and nothing is helping.

The spine procedures, I'll have to ask my husband. But I'm not planning on an epidural because as much as my husband will deny this - I know of too many friends left with long term back pain following an epidural. Pseudoscience.

Epidural for pregnancy is not pseudoscience.

TFESI for sciatica, kinda.

Also, cell based therapies rely on multiple complex pathways and small changes in things like reagents can have a dramatic effect on outcomes, even if it’s hard to figure out what the precise cause might be. This is more about complex systems than lack of a scientific basis for results.

 

[Oso]

I'm here waiting for the two degrees to just merge already.

Enough is enough.

I want my MO degree.

You know what they say, MO money, MO.... oh wait

 

[deleted103644]

So basically if we can't explain why something works- it's pseudoscience? Because there are many things we can't explain

Google RCT and PLACEBO.

We don’t have to know how something works to figure out whether or not it works, but you need to control for confounding variables.

 

[AnatomyGrey12]

How will the new schools qualify for LCME accreditation?

They won’t.

With the merger, won't these sub-par schools get filtered out? If their students can't match into anything, what else is the likely outcome after a few years of that except closing?

Do you really think COCA is going to close these schools down? And how would they? The schools wouldn’t be breaking any rules since COCA got rid of the placement rate requirement.

People certainly wouldn't apply I hope,

The Carib schools are proof your hope is in vain.

 

[DrMcCoyDO]

I wonder what the chances are of DO and MD merging one day.

I’d imagine this will happen in our lifetimes, but not for a long time.

 

[Isoval]

I’d imagine this will happen in our lifetimes, but not for a long time.

I also think this will be the case. Give it a few decades.

 

[Goro]

They won’t.


Do you really think COCA is going to close these schools down? And how would they? The schools wouldn’t be breaking any rules since COCA got rid of the placement rate

Probation will precede a shutdown. As will a mandatory reduction in class sizes.

 

[AnatomyGrey12]

Probation will precede a shutdown. As will a mandatory reduction in class sizes.

Honestly if every school opened with 50 students we probably wouldn’t be having the discussions we are now.

 

[GTown]

Epidural for pregnancy is not pseudoscience.

TFESI for sciatica, kinda.

Also, cell based therapies rely on multiple complex pathways and small changes in things like reagents can have a dramatic effect on outcomes, even if it’s hard to figure out what the precise cause might be. This is more about complex systems than lack of a scientific basis for results.

Certainly epidurals aren't pseudoscience, but people like my husband and his colleagues do think that post-epidural effects are minimal because there's no reason for it. He thinks my belief that it'll potentially cause me back pain is my own pseudoscience.

Cell therapy is great, finicky at times to get things to work and just beautiful at other times. The target makes a huge difference and stage of differentiation of the starting cells from what I work on. We don't question/dig too much when things work though until it's time to do regulatory filing lol . Same thing with RBC therapy or even just regular old biologics.

 

[Goro]

I see a lot of banter in threads like these about how LCME should take over the COMs, and how DO and MD should merge, and other wishful thinking. Actually, it's magic thinking. LCME doesn't give a rat's ass about the proliferation of DO schools, and obviously, COCA doesn't either. you should, though. After all, it's your profession.

And a lot of you who complain the loudest seem to have the least interest in helping your profession. Look, and I'm especially directing this to you residents. You see your MD colleagues and think "They're just like me and I'm just like them" And your MD colleagues think the same way (except for a few elitist dinguses, but you'll find those in any profession). You all realize that there is no magic lock on holism, you practice Medicine the same way, and whatever was different about the two professions 75-100 years ago is now pretty much gone.

The only way you're going to have any impact is by joining the AOA, rising to positions of power, and fixing the profession from the inside. Nobody is going to do it for you. YOU have to do it. Waiting for the current generation of True Believers to retire or die off means nothing gets fixed for another 20 years.

I have to give a shout out to muscle energy techniques. That's no placebo when I limp, crippled, into my pal Dr NO's office and within ten seconds she fixes me. For good. What we simply need is more research and none of this defensive "everybody's different so you can't test these techniques!" mindset.

 

[Lawpy]

I see a lot of banter in threads like these about how LCME should take over the COMs, and how DO and MD should merge, and other wishful thinking. Actually, it's magic thinking. LCME doesn't give a rat's ass about the proliferation of DO schools, and obviously, COCA doesn't either. you should, though. After all, it's your profession.

And a lot of you who complain the loudest seem to have the least interest in helping your profession. Look, and I'm especially directing this to you residents. You see your MD colleagues and think "They're just like me and I'm just like them" And your MD colleagues think the same way (except for a few elitist dinguses, but you'll find those in any profession). You all realize that there is no magic lock on holism, you practice Medicine the same way, and whatever was different about the two professions 75-100 years ago is now pretty much gone.

The only way you're going to have any impact is by joining the AOA, rising to positions of power, and fixing the profession from the inside. Nobody is going to do it for you. YOU have to do it. Waiting for the current generation of True Believers to retire or die off means nothing gets fixed for another 20 years.

I have to give a shout out to muscle energy techniques. That's no placebo when I limp, crippled, into my pal Dr NO's office and within ten seconds she fixes me. For good. What we simply need is more research and none of this defensive "everybody's different so you can't test these techniques!" mindset.

I generally agree with this but I completely oppose having two different degree pathways that lead to the same outcome. It's redundant. The only reason why the two pathways remain separate is there are financial and political interests involved on the COCA/AOA side that they don't want to give up. People thought the residency merger wouldn't happen since the ACGME didn't care, but ultimately, ACGME used a power move to force an acquisition of AOA residencies. The same thing can happen from LCME. There just may need to be a longer transition period and some relaxation of accreditation requirements just to ensure DO schools don't get wiped out.

 

[Goro]

I generally agree with this but I completely oppose having two different degree pathways that lead to the same outcome. It's redundant. The only reason why the two pathways remain separate is there are financial and political interests involved on the COCA/AOA side that they don't want to give up. People thought the residency merger wouldn't happen since the ACGME didn't care, but ultimately, ACGME used a power move to force an acquisition of AOA residencies. The same thing can happen from LCME. There just may need to be a longer transition period and some relaxation of accreditation requirements just to ensure DO schools don't get wiped out.

I doubt it since you'll be getting into restraint of trade issues. Frankly, what power does LCME have over AOA? ACGME had the fellowship card to play in the issues of residency and the merger.

 

[DrMcCoyDO]

I doubt it since you'll be getting into restraint of trade issues. Frankly, what power does LCME have over AOA? ACGME had the fellowship card to play in the issues of residency and the merger.

If ACGME said that only LCME certified schools could get into their residencies, DO schools would have to shape up or fold. However, I have no idea of how much crossover there is between LCME & ACGME there is, so I have no idea how likely this would be.

 

[Goro]

If ACGME said that only LCME certified schools could get into their residencies, DO schools would have to shape up or fold. However, I have no idea of how much crossover there is between LCME & ACGME there is, so I have no idea how likely this would be.

Two different professional bodies. Not gonna happen, especially since plenty of ACGME residencies are already OK with DOs.

 

[Lawpy]

I doubt it since you'll be getting into restraint of trade issues. Frankly, what power does LCME have over AOA? ACGME had the fellowship card to play in the issues of residency and the merger.

Two different professional bodies. Not gonna happen, especially since plenty of ACGME residencies are already OK with DOs.

Could ACGME require its residencies not to accept COMLEX? And basically require all applicants to take USMLE to apply?

 

[Goro]

Could ACGME require its residencies not to accept COMLEX? And basically require all applicants to take USMLE to apply?

They could, but then all COMs would simply require students to take USMLE. Historical precedents would favor a lawsuit against ACGME by the COMs if they pulled this, because people have been happy with COMLEX in the past.

But again, what I'm hearing is the desire for a Great White Hope to come fix things, when it has to be done internally.