Osteopathic medicine: Encyclopedia II - Osteopathic medicine - Osteopathic Medicine Around the World

Osteopathic medicine - Osteopathic Medicine Around the World

There are two main schools of thought within the osteopathic world. They are so different in practice as to be separate professions, but there have been attempts in the last few years to enhance exchange and dialogue between them.

In the United States osteopathic medicine is practiced by those holding a Doctor of Osteopathic Medicine degree (D.O.). A doctor with a D.O. is a fully licensed physician, just like an M.D. (Doctor of Medicine). Many are unaware of the D.O. degree, yet those holding it serve as physicians and surgeons in all specialties from cardiothoracic surgery to family medicine. Since a doctor with a D.O. degree can prescribe the same medicines and perform the same surgeries as a doctor with an M.D., some have argued that the distinction between the two has become blurred. However, though the two degrees share a background in traditional Western medicine, a doctor with a D.O. strives for a more holistic, compassionate and community-minded approach to health care.

The international model of osteopathic medicine is significantly different. "Osteopaths", as they are often called, continue to rely on non-surgical, non-pharmaceutical approaches, and see themselves as a complete school of manual medicine or NMS specialists, complementary to most mainstream medical practices. Commonwealth osteopathic students may spend up to ten times as many hours training in osteopathic diagnosis and technique as their American counterparts. Because of this specialization, they have traditionally remained relegated to the fringe of health care alongside naturopaths, chiropractors and others. In Commonwealth countries, osteopaths have also had to compete with physiotherapists, many of whom have integrated manipulative therapy into their practice. Nevertheless, osteopathy is growing in size and mainstream acceptance in many countries of the Commonwealth and Europe. More and more osteopaths are now working alongside the mainstream in interdisciplinary settings, and osteopathic departments are now well-established in many public universities.

Osteopathic medicine - Osteopathic Medicine in the USA

Acceptance by traditional M.D.s and their institutions has been an issue for osteopathic practitioners.

In the 1960s in California, the American Medical Association (AMA) spent some $8 million to end the practice of osteopathy in the state. After passing a proposition backed by the AMA, D.O.s were granted an M.D. in exchange for paying $65 and attending a short seminar. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine, College of Medicine. However, the decision proved quite controversial. In 1974, primarily due to the efforts of Viola M. Frymann, D.O., FAAO, the California Supreme Court ruled that licensing of D.O.s in that state must be resumed.

This decision by the California Medical Association in the 1960s to grant D.O. physicians an M.D. license was one of two turning points for D.O.s in their struggle for acceptance, the other being the U.S. Army's decision to allow D.O.s to enter the military as physicians. The California Medical Association may have been attempting to eliminate the osteopathic competition by converting thousands of their physicians to M.D.s. While most Californian D.O.s did take the opportunity to become M.D.s, nationally it provided the osteopathic physicans the stamp of equivalency they desired. The last state to grant D.O.s equal practice rights as a fully licensed physician was Mississippi, in 1973.

Today in the USA, an osteopathic physician is sometimes described as a physician who, while practicing conventional medicine much like his or her M.D. colleagues, also maintains the ability to perform osteopathic manipulative medicine (OMM), also referred to as osteopathic manipulative treatment, or technique (OMT). It must be emphasized that manipulation, while very useful for certain disease states, is simply one tool that the D.O. employs in addition to traditional medical practice. Some D.O.s use OMT on a limited basis, while others use it more frequently.

The scientific merit of manipulative medicine continues to be a point of controversy. The American Osteopathic Association has made an effort in recent years to both support and promote scientific inquiry into the effectiveness of osteopathic manipulation as well as encourage D.O.s to consistently offer manipulative treatments to their patients.

There is no doubt that the American osteopathic medicine, as a progressive social movement, has had a significant influence on the practice of American medicine generally. Indeed, some US osteopathic medical schools have opened basic courses in osteopathic manual therapy for their MD cousins.

Osteopathic medicine - Osteopathic Medicine in the UK Australia Canada and NZ

In the United Kingdom osteopathy developed as a distinct profession. The first osteopathic college was established in the UK in 1917 by a Scot, Littlejohn, who had studied under Dr Andrew Taylor Still. Littlejohn altered the osteopathic curriculum to include the study of physiology. The UK school he founded, the British School of Osteopathy, was the first osteopathic education institution outside the USA, and it still exists today [3]. British osteopaths use manipulative techniques based on the philosophy of Dr Andrew Taylor Still, but are not medical doctors. Some medical doctors do undertake osteopathic training as a postgraduate interest. The profession is subject to statutory regulation following the passing of the Osteopathy Act in 1993. The General Osteopathic Council (GOsC) [4]was established by the act to regulate the profession, to protect the public by maintaining a register of practitioners, to investigate allegations of professional misconduct, and to ensure the quality of training. Since 2001, there has been graduate only entry to the register. There are currently seven approved training institutions in the UK. There are approximately 5000 registered osteopaths in the UK, a small but growing profession. For the sake of comparison there are approximately 36,000 physiotherapists. Most medical services in the UK are delivered through the state funded National Health Service, osteopathy is largely excluded from this with most osteopaths working in private practice. Several large studies in the UK have produced evidence of the cost-effectiveness and clinical effectiveness of manipulation in the management of low back pain, the latest being the UK Back pain Exercise And Manipulation (UK BEAM) trial, [5], [6]. There is an increasing interest in osteopathy amongst patients, but barriers remain to osteopathic provision within the state system; not the least being hostility from the orthodox medical profession and physiotherapists. Many UK osteopaths are also naturopaths, with one osteopathic college offering a dual training in osteopathy & naturopathy (the British College of Osteopathic Medicine) and another offering a post-graduate program (the College of Osteopaths).

In 2005 the General Medical Council of Great Britain announced that U.S.-trained D.O.s would be accepted for full medical practice rights in the United Kingdom. This decision was an important departure from the United Kingdom's long-standing tradition of exclusively manual, or "traditional" osteopathy. [7]

In Australia and New Zealand the profession has developed along the same lines, and until recently neither country trained its own practitioners and relied on UK graduates. Likewise, each country maintains a government-approved list of practitioners and private health insurance reimbursement is available for osteopathic treatment. Three publicly-funded Universities now offer osteopathic medical courses in Australia. Courses consist of a Bachelor's degree in clinical science (osteopathy) followed by a Masters' degree. Integration into the university system has given Australian osteopaths the opportunity to access public research funding, raised the credibility of the profession, and focused attention on refining the scope of practice through clinical trials and basic research.

In Canada osteopaths are trained along similar lines to those in Britain and other Commonwealth countries, although US-trained osteopathic physicians have unlimited scope of medical practice.

In all four countries osteopathy straddles the boundary between orthodox and complementary/alternative medicine, with a variety of approaches and philosophies being brought to the practice. The model of osteopathy employed is essentially a drug-free system of manual therapy. Osteopaths are trained in standard medical differential diagnosis and have diagnostic competencies similar to primary care physicians, but with a scope of practice limited mainly to musculoskeletal conditions and treatment of some other conditions by manual means. Osteopaths in all four countries do not have prescribing rights, although the British Government has included osteopathy in the list of professions allied to medicine that may be granted prescribing rights in the future. Unless separately qualified as a medical doctor or holder of a doctorate degree, osteopaths in New Zealand or the UK do not use the honorific title of Doctor. Contested by some osteopaths, there is a campaign to use the title Doctor anyway. Australian osteopaths routinely call themselves Doctor. There is a debate on what differentiates an osteopath from a chiropractor from a physiotherapist in these countries, rather than the DO/MD debate in the USA.

Osteopathic medicine - Osteopathic Medicine in the European Union

Within the European Union there is no standardized training or regulatory framework for the profession, although attempts are being made to coordinate the profession within the EU. At present there is a conflict between the principle of free movement of labor and right to practice osteopathy in different member states as there is little equivalency in training and regulation of the profession. Previously the practice of spinal manipulation by non-medically qualified practitioners was outlawed in many European countries. This led to the arrest and imprisonment of the osteopathic faculty in France in the 1960s, who on their release then sought refuge in the UK and established the European School of Osteopathy. The General Osteopathic Council, the UK osteopathic regulatory body, has issued a position paper on pan-European regulation of the profession[8]. However, formation in osteopathy is built up in very few states : UK, France and Switzerland are the only countries to already have a solid, well-shaped conception of the osteopathy they wish to defend. In the other states, osteopathy is studied in rare schools.

Adapted from the Wikipedia article "Osteopathic Medicine Around the World", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki