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Larry Malerba, D.O.

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Are Osteopathic Physicians Real Doctors?

Posted: 04/30/2012 5:20 pm

After coming across what was in my opinion a rather biased and poorly-researched article at Forbes.com, "Osteopaths Versus Doctors" by Steven Salzberg, I felt compelled to set the record straight. As an osteopathic physician myself, I realize that there is a lot of misinformation out there about a variety of non-M.D. medical practitioners, but to question whether an osteopath is a qualified doctor strikes me as arrogant and ill-informed. Mr. Salzberg fancies himself a crusader against "pseudoscience," and he appears in this shamelessly-misleading article to lump osteopathic medicine in with other unconventional medical practices that he considers to be unworthy of his high-and-mighty standards. In any event, whatever your opinion about alternative medical practices, his portrayal of osteopathic medicine is both grossly out of line and irresponsible.

Let's review the facts: An osteopath is a Doctor of Osteopathy (D.O.) and is one of two types of physicians licensed to practice medicine and surgery in the Western Hemisphere. Osteopathic medical schools require the same prerequisite science courses and the same MCAT entrance exams that M.D. schools require. Like M.D. schools, the four-year curriculum consists of the same basic medical science coursework in addition to clinical rotations that provide direct patient care experience. There are currently 26 osteopathic medical schools in the U.S. and, like M.D.s, D.O.s do internships and residency training in all the standard medical specialties. D.O.s are fully-qualified physicians licensed to prescribe medications and perform surgery in all 50 states.

There are literally thousands of D.O.s who work in all medical specialties in hospitals and clinics all across the country. There are primary care physicians, obstetricians, endocrinologists, oncologists, neurologists, surgeons, and even psychiatrists that are D.O.s. Because they tend to wear the same white coats and stethoscopes that M.D.s do, I can understand why this may have fooled poor Mr. Salzberg. I would be willing to bet that he has worked side-by-side with D.O.s more than once, even though he may not have known it at the time. In fact, I myself did post-graduate clinical training at a hospital affiliated with an M.D. medical school.

Because of the initials, there is a tendency to sometimes mistake D.O. for O.D, which is the designation for a Doctor of Optometry, or an optometrist. And on occasion people have asked me if I'm a "bone doctor," whatever that is. The academic study of bones is called osteology. I suppose they may be confusing osteopaths with chiropractors or orthopedic doctors. Further confusion comes from the fact that D.O.s who practice in countries other than the U.S. are non-physician practitioners of manual therapy. They do not prescribe medication, diagnose disease, or perform surgery.

Now you may ask, why do the two professions have different degrees if they have the same training and responsibilities? This is because there are some small but significant differences between M.D.s and D.O.s. Most importantly, osteopathic training emphasizes family medicine and encourages its students to become primary care physicians. Many osteopaths work as family physicians, often in rural and underserved areas of the country. However, this does not preclude an osteopath from working in urban settings or entering the medical specialty of his or her choosing.

The other important distinction is that D.O.s are trained in one additional specialty that M.D. training does not include: osteopathic manual medicine (OMM). Sometimes called osteopathic manipulative therapy (OMT) or osteopathic manipulation, it represents both a specific type of somatic body therapy and a philosophical orientation toward whole person health and healing. The profession was founded in 1874 by Andrew Taylor Still, a physician who recognized the human body's innate capacity to heal itself. Dr. Still believed in the unity of body, mind, and spirit, and in the importance of the relationship between the structure and function of the body. He believed that an important role of the physician is to facilitate healing through therapeutic manual techniques that remove somatic dysfunction and restore physiological homeostasis.

The most obvious point of comparison that this brings to mind is that of chiropractic treatment. Although there are some similarities between osteopathic medicine and chiropractic medicine, there are also a number of differences in terms of philosophy, terminology, and practical approaches to healing. The biggest difference is that D.O.s are also licensed to prescribe conventional pharmaceuticals and perform surgery.

In this sense, D.O.s have all the advantages of M.D.s and chiropractors combined.

Although osteopathic practice is holistic in its stated philosophy, in practical actuality, many osteopaths are indistinguishable from M.D.s. I applied to osteopathic school because of this holistic reputation but ultimately found my medical training to be too conventional for my taste. In the spirit of full disclosure, my strong holistic leaning is not typical of the average D.O. and I am not, therefore, representative of the profession as a whole. Nevertheless, I am proud of my profession and believe it needs to be defended when it is mischaracterized by the likes of Mr. Salzberg. Likewise, when Mr. Salzberg uses Dr. Joseph Mercola as his example of an osteopathic physician, he is being disingenuous. Although I respect the great work that Dr. Mercola is doing, he is far from the typical osteopathic physician. By the way, I believe that the profession should be proud of mavericks like Dr. Mercola who have the courage to follow their convictions.

It is also my belief that the osteopathic profession is uniquely positioned to be the holistic representative of the conventional medical world, if only it would find the resolve to embrace that role. Unfortunately, just like chiropractic, osteopathy has had to weather a great deal of historical persecution and political pressure from mainstream medicine in order to achieve its current status as a respectable equal. As such, it is reluctant to jeopardize that position by embracing alternative practices. This is unfortunate, because I believe that it would make osteopathy an even more attractive medical option than it already is at present.

The future of medicine is very green indeed, and by this I mean that someday, in the not-too-distant future, the medical profession as a whole will eschew the type of fear-based, fundamentalist intolerance epitomized by medical witch hunters like Mr. Salzberg. And when that day comes, medical diversity and tolerance, in the name of providing the best care possible to those in need of healing, will be the norm.

References & Resources:

Steven Salzberg, "Osteopaths Versus Doctors" Forbes.com, 10/27/2010

American Association of Colleges of Osteopathic Medicine

Osteopathic Manipulative Medicine, Wikipedia


Andrew Taylor Still, TheNewMedicine.org

Larry Malerba, DO, DHt is a holistic physician, author, and educator. For more than 25 years he has been a trailblazer of new paradigm medical thinking. Along the way he has sought to build bridges between holistic healing, spirituality, and conventional medical science. Dr. Malerba is the author of "Green Medicine: Challenging the Assumptions of Conventional Health Care."

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