Sunday, April 13, 2008

Conundrum of Osteopathic Medical Education

Hey Erik,
Nice to "meet" you and welcome on board!!

I can answer your question about why we aren't taught OMT treatments for every disease yet there seems to be a pharm treatment (albeit, even the pharm treatments are sometimes ridiculous by just throwing steroids at someone, etc). Research.

What I'm about to say is my pure conjecture, which should not hold any weight. Actually, I need to read more about the history of medicine/physiology/pathology.

It is my belief the original research deducing basic physiology was elegant yet simple, reproducible and irrefutable. Drugs may have been used to help prove a hypothesis, but they weren't used in excess. Concurrently, drugs were being used clinically without a clear rationale. For both of these reasons further research revolved more and more around drugs: how they changed the biochemical make-up of a disease model, their clinical effect, etc. Drugs are handy because you can do a well-controlled study where you have 2 parallel systems, the only difference being the addition of a drug. A researcher's dream. Not to mention the investment of pharm agencies in the funding of said research.

So, our instinct agrees with Dr. Still's idea that the body contains all the ingredients to heal itself, however, our ethical/societal obligation is to "buy" into the pharmacological approach to treatment of disease because that is how society says we should operate. If we don't follow standard recommendations, we could lose our licenses. Another influence in our education are the scientific sticklers (PhD professors) who blindly believe in the scientific method and EBM, shunning most OMT (especially cranial) for conditions other than pain syndromes because they lack clinical experience to valid the non-scientific ways of healing. Thus, these PhD folks want us to maintain our scientific credibility, which I can respect, however they limit us by not seeing what's possible. That leaves us with the clinicians to teach about the possibilities of OMT in the setting of disease, but how many of them are trained appropriately?

It really is a conundrum, which is why I am so thankful to people like Jonathan and Kelly and yourself who are as passionate about the topic as I am. The Osteopathic Integration website is a great start to give students that speck of hope regarding what MIGHT be possibility with OMT for treatment of disease. There are some excellent texts that SHOULD be cited in our course work, but those god damned PhD people believe that if students are interested, they would fine the resources theirselves. I about went through the roof when one professor told me that. Luckily, a DO stepped in and said she thought my request was reasonable.

On the topic of resources, have any of you heard that Ray Hruby and Mickey Seffenger recently wrote a book on EBM OMM?



Michelle, Bethany, Zach & James said...

Simply said, EBM talks. They are not going to teach it if they can't back it up. And there is simply more of it for pharmaceuticals. And why is there more for them and not for OMM?

1) Pharm companies have the money to do the research. What they research is a copyrighted brand that can make them more money - VS- OMM is not copyrighted, can not make anyone money, and there isn't an established company to fund it.

2) Research for drugs is honestly easier to do. Results are reproducible and objective -VS- OMM research can be quite difficult since it is nearly impossible to isolate the variables and most of the results are subjective qualities, like change in quality of pain.

Plus I am not at liberty to go into details, but there has been a history at DO schools for making claims without EBM in the OMM classes that went against what the students were learning in the IM classes. From what I hear, uh, things did not end well in that situation.

So do I think we need more OMM in the IM classes? YES. But is that easier said than done? YES. I almost think we should have an EBM class, where we could learn how to search effectively, but then also learn about the big trials, like the HOPE trial, well as the EBM for OMM. Its kinda sad I can't name a big OMM trial don't cha think? I think that would be so valuable, to learn the great research of OMM so we can justify what we are doing whenever an MD is kinda rolling their eyes while we give the patient a "massage."

I hope that book is real :)

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