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DO vs MD

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Andrew Taylor Still MD, DO, the founder of osteopathic medicine, started a new model for treating patients after years as a practicing MD physician. He was driven to start a new model for medicine in the United States due to the rampant over-use of drugs like heroin and cocaine for the treatment of so many common ailments in the 1800’s. He was seeing so many people harmed (often permanently) by these chemical interventions that he strived to develop a more conservative model of healthcare delivery based on promoting homeostasis, supporting the body’s natural disease fighting abilities (immune system), and optimizing the structure-function relationship (anatomy) that underlies all of life. He had such positive results that he continued to develop his methods and started his own medical school where he taught these principles as an effective way to approach the treatment of disease. This conservative medical treatment method caught on and quickly grew into the second largest form of medicine in the US. However, it wasn’t until the US military started accepting DOs as military physicians did osteopathy become so integrated into US healthcare that MDs and DOs are nearly indistinguishable today.

AT still

The differentiating philosophy is simple: Osteopathic medicine approaches disease as a disruption of the body’s homeostasis; the whole body is affected, including the mind. Treatment aims to restore balance via structural/mechanical, emotional/spiritual, and chemical optimization (in that order). This unfortunately sounds different, odd, or interesting to those who are accustomed to the ‘mainstream’ model for medical treatment in the United States – that being allopathic medicine. Allopathy literally means to treat by opposites. If you are cold then I should warm you. If your blood pressure is high then I should lower it. If you have back pain then I should give you a pain killer. All of these treatments are opposite of the symptoms that are being treated. This often makes quite a lot of sense, but sometimes it avoids the main problem of why your body temperature is lower, why your blood pressure is high, and why your back is causing you pain. Osteopathic medicine, in its philosophy, approaches disease differently.


Differences that exist between MDs and DOs are few and far between, but some of the practical differences are:

1.) Philosophy: Osteopathic medicine attempts to achieve homeostasis by restoring and optimizing structure/function, treating pathology and physical disruptions in homeostasis, and by treating the whole person including the mind, body, and spirit.

2.) Manipulative Treatments – osteopathic physicians are trained in many different treatment modalities involving manipulating the musculoskeletal system. These include muscle energy, cranio-sacral, myofacial-release, counterstrain, and high-velocity low-amplitude (HVLA). Many of these techniques have well known and documented clinical benefits and are used by other practitioners (physical therapists and/or chiropractors). Many other treatment modalities are anecdotally beneficial at best. However, spending hundreds of hours manipulating the musculoskeletal system, touching patients, and mastering the art of palpation has undeniable benefits for the osteopathic medical student and therefore their future patients.

Mason back pain    DSC_1407_cropped-300x255


3.) Musculoskeletal system specialization – related to the manipulative treatments listed above, osteopathic physicians have additional coursework in manipulations involving the musculoskeletal system and spend hundreds of hours working on palpating, and manipulating the musculoskeletal system, learning to understand its motion, limitations, barriers, and functions. That being said, osteopathic physicians tend to be exceedingly knowledgeable about the musculoskeletal system and its role in health and disease processes.

4.) Research – unfortunately, until recently, osteopathic physicians were little involved in research. In the modern age of evidence-based medicine, this has resulted in a great disadvantage to what is referred to as ‘osteopathic medicine’ due to the lack of high-quality research studies on the efficacy of osteopathic medicine. However, this is beginning to change as many research studies are being conducted into osteopathic approaches to medical care. Additionally, research into all areas of medicine and science is being conducted at every osteopathic medical school in the country helping to support the evidence based practice of medicine.  Osteopathic medicine still remains a very practice-focused, primary care, and front lines type of medicine. Research definitely comes after treating people whereas many allopathic medical schools focus much time and energy on research and grant funding.

Qing Farewell 135

We are all studying medicine. Our curricula are the same, our professors are often the same, our training hospitals are the same, and now – at risk of being labeled a heretic among osteopaths – I suggest we are the same. While those aging osteopaths currently in power want to preserve the unique identity of osteopathic medicine as a distinct profession separate from allopathic medicine, I wonder why? Why fight to remain separate but equal when fighting for the same cause? We all want to learn, discover, apply our skills to better the lives of those who are ill. Why do we make something out of nothing and compare, argue, and over-analyze? Why not focus our energies toward bettering patient care? I think our two professions (or is it one profession?) have something to learn from one another. Our world would benefit greatly from the two modes of medical education coming together and becoming some sort of united front. Fortuntately, this is already beginning to happen as the DO and MD graduate medical education bodies have merged and become a single graduate medical education accrediting body, all under the ACGME. I think this is the beginning of a bright future of an advantageous partnership between the two routes of medical education in the US.

In honor of National Osteopathic Medicine week (although it has now passed) I wanted to share my understanding of osteopathic medicine and its unique attributes.  I hope everyone has a great week! Educate someone on osteopathic medicine this week!


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One thought on “DO vs MD

  1. Just wanted to bring some balance to the the subject of “Science” and its application in health care…..

    The Mythology of Science-Based Medicine
    The Huffington Post – Posted: 03/18/2010

    The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

    One side, mainstream medicine, promotes the notion that it alone should be considered “real” medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

    If a pill or surgery won’t do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.
    The British Medical Journal recently undertook a general analysis of common medical treatments to determine which are supported by sufficient reliable evidence. They evaluated around 2,500 treatments, and the results were as follows:

    • 13 percent were found to be beneficial
    • 23 percent were likely to be beneficial
    • Eight percent were as likely to be harmful as beneficial
    • Six percent were unlikely to be beneficial
    • Four percent were likely to be harmful or ineffective.

    This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial. This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”

    For those who have been paying attention, this is not news. Back in the late 70’s theCongressional Office of Technology Assessment determined that a mere 10 to 20 percent of the practices and treatment used by physicians are scientifically validated. It’s sobering to compare this number to the chances that a patient will receive benefit due to the placebo effect, which is between 30 percent and 50 percent, according to various studies.

    We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don’t submit bills in the tens of thousands of dollars.

    It would be one thing if any of these unproven conventional medical treatments were cheap , but they are not. Angioplasty and coronary artery bypass grafting (CABG) alone cost $100 billion annually. As quoted by President Obama in his drive to bring down medical costs, $700 billion is spent annually on unnecessary tests and procedures in America. As part of this excess, it is estimated that 2.5 millionunnecessary surgeries are performed each year.

    Then there is the myth that this vast expenditure results in excellent health care, usually touted as the best in the world (most recently by Rush Limbaugh as he emerged from a hospital in Hawaii after suffering chest pain). But this myth has been completely undermined. In 2000 Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans.

    In 2005 the Centers for Disease Control and Prevention reported that out of the 2.4 billion prescriptions written by doctors annually, 118 million were for antidepressants. It is the number one prescribed medication, whose use has doubled in the last ten years. You would think, therefore, that a remarkable endorsement is being offered for the efficacy of antidepressants. The theory behind standard antidepression medication is that the disease is caused by low levels of key brain chemicals like serotonin, dopamine, and norepinephrine, and thus by manipulating those imbalanced neurotransmitters, a patient’s depression will be reversed or at least alleviated.

    This turns out to be another myth. Prof. Eva Redei of Northwestern University, a leading depression researcher, has discovered that depressed individuals have no depletion of the genes that produce these key neurotransmitters compared to people who are not depressed. This would help explain why an estimated 50 percent of patients don’t respond to antidepressants, and why Dr. Irving Kirsch’s meta-analysis of antidepressants in England showed no significant difference in effectivenessbetween them and placebos.

    You have a right to be shocked by these findings and by the overall picture of a system that benefits far fewer patients than it claims. The sad fact is that a disturbing percentage of the medicine we subject ourselves to isn’t based on hard science, and another percentage is risky or outright harmful. Obviously, every patient deserves medical care that is evidence-based, not just based on an illusory reputation that is promoted in contrast to alternative medicine.

    We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders.

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