Dubious Aspects of Osteopathy

Stephen Barrett, M.D.

Osteopathic physicians (DOs) are the legal equivalents and, in most cases, are the professional equivalents of medical doctors (MDs). However, before deciding whether to use the services of a DO it is useful to understand osteopathy's history and the practical significance of its philosophy.

Cultist Roots

Andrew Taylor Still (1828-1917) originally expressed the principles of osteopathy in 1874, when medical science was in its infancy. He is commonly said to have had an MD degree, but Martin Gardner, one of the 20th century's leading science writers, concluded that "there is no evidence Still had any medical training other than helping his father, a Methodist missionary, take care of Shawnee indians." [1]

Still claimed that diseases were caused by mechanical interference with nerve and blood supply and were curable by manipulation of "deranged, displaced bones, nerves, muscles—removing all obstructions—thereby setting the machinery of life moving." His autobiography states that he caused a bald-headed man to grow hair three inches long in one week and that he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck." [2] He was antagonistic toward the drug practices of his day and regarded surgery as a last resort. Rejected as a cultist by organized medicine, he founded the first osteopathic medical school in Kirksville, Missouri, in 1892.

As medical science developed, osteopathy gradually incorporated all of its theories and practices [3] and achieved licensure in all 50 states. In 1901, California became the first state to license DOs; in 1989, Nebraska became the last. Today, the scope of osteopathy is identical to that of medicine except for additional emphasis on musculoskeletal diagnosis and treatment. However, the percentage of practitioners who do osteopathic manipulative treatment (OMT) and the extent to which they use it are not high.

Osteopathic Education

There are now 39 accredited colleges of osteopathic medicine and more than 100,000 osteopathic practitioners in the United States [4]. Admission to osteopathic school in the U.S. requires a bachelors degree based on four years of undergraduate work that includes specified numbers of hours in basic science courses. The doctor of osteopathy (DO) degree requires more than 5,000 hours of training over four academic years. Graduation is followed by a year of internship of residency at an approved teaching hospital. Specialization requires two to six more years of residency training, depending on the specialty. Between 50% and 60% of DOs enter primary care (family medicine, internal medicine, or pediatrics). The length of training for MDs is identical.

The American Osteopathic Association (AOA) recognizes about 100 specialties and subspecialties [5]. AOA membership is required for specialty certification, which forces some practitioners to belong to the AOA even though they do not approve of the organization's policies. Since 1985, osteopathic physicians have been able to obtain residency training in medical hospital programs, and the majority have done so. Since 1993, DOs who completed osteopathic residencies have also been eligible to join the American Academy of Family Practice, which had previously been restricted to MDs or DOs with training at accredited medical residencies [6]. In 2014, the the AOA, AACOM, and the Accreditation Council for Graduate Medical Education resolved to institute a unified accreditation system by July 1, 2020. The unification will go a long way toward recognizing the overlapping characteristics in the training and practice of MDs and DOs [7].

There are some differences, however, between osteopathic and medical education. In the United States, the admission standards—as reflected by grade point averages (GPAs) and Medical College Admission Test (MCAT) scores—are lower at osteopathic schools than at medical schools. Whereas students accepted by osteopathic schools tend to have equal numbers of A's and B's, those accepted by U.S. medical schools tend to average three A's for each B. For the MCATs, the median score is at the top 40% level for osteopathic enrollees and top 20% for medical school enrollees. In addition, the average number of full-time faculty members is much higher at medical schools. Osteopathic schools generate relatively little research, and some have difficulty in attracting enough patients to provide the depth of experience available at medical schools. In practical terms, this means that medical students will be exposed to a greater variety of sick patients and a greater depth of expertise among the faculty. Of course, as with medical graduates, the quality of individual graduates depends on how bright they are, how hard they work, and what training they get after graduation. Those who diligently apply themselves can emerge as competent.

Osteopathic Hype

Many observers—including me— believe that osteopathy and medicine should merge. But osteopathic organizations prefer to retain a separate identity and have exaggerated the minor differences between osteopathy and medicine and claimed superiority in their marketing. For example:

Claims that OMT promotes the body's natural tendencies toward health and self-healing are similar to the baloney chiropractors use to suggest that their attention to the spine will have positive effects on all body processes. Spinal manipulation may produce pain relief in properly selected cases of low back pain [13]. However, neither OMT nor chiropractic spinal manipulation has any proven effect on people's general health. Nor does its usage make DOs better doctors.

Curiously, OMT usage among DOs is not high, and many don't use it at all. In 1995, a one-page questionnaire was mailed to 2,000 randomly selected osteopathic family physicians who were members of the American College of Osteopathic Physicians. About half returned usable responses. Of these, 6.2% said they treated more than half of their patients with OMT, 39.6% said they used it on 25% or fewer of their patients, and 32.1% said they used OMT on fewer than 5% of their patients. The study also found that the more recent the date of graduation from osteopathic school, the lower the reported use [14]. In 1998, a two-page questionnaire mailed to 3,000 randomly selected DOs drew 955 usable responses. About half said they used OMT on fewer than 5% of their patients, and 30% said they used it on 5 -25%. The researchers expressed dismay that OMT was becoming a "lost art." [15]. I have been unable to find more recent quantitative data on OMT usage among DOs, but I see no reason to believe there has been an increase.

Despite all of the above, the American Osteopathic Association's web site still glorifies Andrew Still and asserts that osteopathic medicine has a "distinct philosophy." Its Web site currently states:

DOs believe there's more to good health than the absence of pain or disease. As guardians of wellness, DOs focus on prevention by gaining a deeper understanding of your lifestyle and environment, rather than just treating your symptoms. It makes a difference when your physician is trained to truly listen. To pay more attention to you than your chart. To look beyond the symptoms and take the time to get to know you as a whole person. Listening to you and partnering in your care are at the heart of our holistic, empathic approach to medicine. We are trained to promote the body's natural tendency toward health and self-healing. We practice according to the latest science and use the latest technology. But we also consider options to complement pharmaceuticals and surgery [16].

I consider it outrageous to imply that osteopaths are the only doctors who regard their patients as individuals, provide comprehensive care, or pay attention to disease prevention.

Questionable Practices

The percentages of DOs involved in cranial therapy, chelation therapy, clinical ecology, orthomolecular therapy, homeopathy, and several other dubious practices appear to be higher among DOs than among MDs. I have concluded this by inspecting membership and referral directories of groups that promote these practices. Cranial therapy is unique among these because it is historically connected to osteopathy, promoted by a major osteopathic group, and taught in many of the DO schools.

Cranial Therapy

Practitioners of cranial therapy (also called cranial osteopathy, craniosacral therapy, and biocranial therapy) claim that the skull bones can be manipulated to relieve pain and remedy many other ailments. They also claim that a rhythm exists in the flow of the fluid that surrounds the brain and spinal cord and that diseases can be diagnosed by detecting aberrations in this rhythm and corrected by manipulating the skull. Most practitioners are osteopaths, massage therapists, chiropractors, dentists, or physical therapists.

Osteopaths attribute the origin of craniosacral therapy to osteopath William G. Sutherland (1873-1954), who published his first article on this subject in the early 1930s. From the mid-1970s onward, the leading proponent was John E. Upledger, D.O., who founded the Upledger Institute of Palm Beach Gardens, Florida. Institute publications have claimed:

Another illuminating source that no longer appears to be posted was The Cranial Letter, published quarterly by the Osteopathic Cranial Academy, a component society of the American Academy of Osteopathy. The Summer 1993 issue stated that the Cranial Academy had 989 members. Other issues contained case reports stating that cranial therapy could cause knee pain to disappear within a week (Summer 1992), cure hives (Summer 1993), improve the mental condition of Down syndrome patients (May 1995), and correct crossed eyes (May 1996).

The Osteopathic Cranial Therapy Web site now states:

Just as the lungs breathe and the heart beats, the central nervous system also has its own involuntary rhythmic motion. There is also movement of the cerebrospinal fluid (CSF) around the brain, within the meninges. Because of the "blood brain barrier, brain cells require circulation of the CSF so that all cells can receive nourishment and oxygen. Osteopaths with specialty training in this area (the "cranial field") work with the bones of the cranium, the fascial coverings (meninges), the fluids, and especially the central nervous system (the brain) to access the whole person, for both treatment of dysfunction and improvement of health. Sometimes called cranial osteopathy, it is an additional set of skills gained by osteopaths to better address the whole body [19].

Other osteopathic web sites that espouse cranial therapy can be located by using Google's Advanced Search to look for "cranial osteopathy."

The theory underlying craniosacral therapy is erroneous because the cranial bones fuse by the end of adolescence and no research has ever demonstrated that manual manipulation can move the individual bones [20]. Nor do I believe that "the rhythms of the craniosacral system can be felt as clearly as the rhythms of the cardiovascular and respiratory systems," as was claimed by another Upledger Institute brochure [21]. The brain does pulsate, but this is exclusively related to the cardiovascular system [22]. Many years ago, three physical therapists who examined the same 12 patients diagnosed significantly different "craniosacral rates," which is the expected outcome of measuring a nonexistent phenomenon [23].

The percentage of osteopaths using cranial therapy is not high, but it appears to be deeply entrenched within the profession. Many of the osteopathic colleges teach it, and the American Osteopathic Association treats it as legitimate. At least 15 of the 88 items listed in the AOA's 1996 list of "Osteopathic Literature in Print" were written by Sutherland, Upledger, or others who appear to advocate cranial therapy [24]. And in 1998, the AOA's continuing education calendar listed a 40-hour cranial osteopathy course it cosponsored with the American Academy of Osteopathy, which is a practice affiliate of the AOA.

In 2002, two basic science professors at the University of New England College of Osteopathic Medicine concluded:

Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. Since no properly randomized, blinded, and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations [20].

In 2005, one of the professors reported that despite their persistent effort, craniosacral therapy was still taught in all of the DO schools in the United States and questions about it remained on DO licensing exams [25].

In 2016, a French research team that a comprehensive review of the scientific literature concluded: "Our results demonstrate, consistently with those of previous reviews, that methodologically strong evidence on the reliability of diagnostic procedures and the efficacy of techniques and therapeutic strategies in cranial osteopathy is almost non-existent." [26]

Since my article was posted, dozens of osteopathic students and faculty members have told me that they and many (or most) of the students in their schools regarded CST as preposterous. Its persistence mystifies me.

Chelation Therapy

Chelation therapy is a series of intravenous infusions containing EDTA and various other substances. Proponents claim it is effective against atherosclerosis and many other serious health problems. However, no controlled trial has shown that chelation therapy can help any of them [27]. Chelation therapy with EDTA is one of several legitimate methods for treating cases of lead poisoning, but the protocol differs from that used inappropriately for other conditions. To its credit, the AOA has had a negative position statement on chelation therapy since 1985.

The American Osteopathic Association does not endorse chelation therapy as useful for other than its currently Food and Drug Administration approved and as medical evidence supports. 1985; revised and reaffirmed 1990, 1995; revised 2000; referred 2005; revised 2006; reaffirmed 2011; reaffirmed as amended 2016 [28].

The 1998 member referral list of the American College for Advancement of Medicine (ACAM) , the principal group promoting chelation therapy, identified about 400 MD members and 121 DO members who list chelation therapy as a specialty. These numbers strongly suggested that the percentage of osteopathic physicians doing chelation therapy was about four or five times as high as the percentage of medical doctors doing it. Curiously, AOA's president in 1998 was an ACAM member who did chelation therapy. In 2009, the ACAM directory contained 221 MDs and 93 who offered chelation therapy, which means that the percentage of osteopathic physicians doing chelation therapy was five or six times the percentage of medical doctors doing it.

The Bottom Line

I believe that osteopathic organizations and many of the DO schools and their graduates are acting improperly by exaggerating the value of manipulative therapy, falsely claiming that osteopathic medical care is inherently superior to standard medical care, and failing to denounce cranial therapy. However, there are many competent DOs. If you wish to select a DO as your primary-care provider or for specialty care, your best bet is one who: (a) has undergone residency training in a medically accredited program; (b) does not assert that osteopaths have a unique philosophy or that manipulation offers general health benefits; (c) either does not use manipulation or uses it primarily to treat back pain; and (d) does not practice cranial therapy.

Objections to This Article

In 1998, I received a letter from the AOA's law firm objecting to certain passages in an early version of this article [29]. In response, I clarified some of the points they raised and added additional information and references. I also invited the AOA to submit a letter for posting and further discussion. Through their attorney, they agreed to do so, but none ever arrived.

Recently, a reader correctly pointed out that many MDs practicing in the U.S. acquired their degrees from medical schools in the Caribbean where the entrance requirements are lower than those required by osteopathic medical schools. As with DOs, graduates of these schools who are bright, work hard, and get good postgraduate training can still emerge as competent. I also recommend complete avoidance of all practitioners—regardless of their credentials, who practice what they describe as "holistic," "alternative," complementary," or integrative" medicine [30].

Additional Reading

References

  1. Gardner M. Fads & Fallacies in the Name of Science. Dover Publications, New York City, 1957, pp199-200.
  2. Still AT. Autobiography—with a history of the discovery and development of the science of osteopathy. 1897, pages 112, 181, and 360.
  3. Gevitz N. The D.O.'s: Osteopathic Medicine in America. Baltimore, 1982, The Johns Hopkins University Press.
  4. Osteopathic Medical College Information Book: Entering Class 2018. American Association of Colleges of Osteopathic Medicine, 2017.
  5. FAQs. Osteopathic Board Certification Web site, accessed Feb 7, 2018.
  6. Gugliemo WJ. Are D.O.s losing their unique identity? Medical Economics 75(8):201-213, 1998. (Clarification regarding AAFP membership published in Medical Economics 75(14):21, 1998.)
  7. Ahmed A-K H. Allopathic and osteopathic medicine unify GME accreditation: A historic convergence. Family Medicine 4:9374-377, -017.
  8. Osteopathic medicine: A distinctive branch of mainstream medical care. Undated brochure, distributed in 1987. Chicago: American Osteopathic Association.
  9. What is a D.O.? (Brochure) Chicago: American Osteopathic Association, 1991.
  10. Policy statement on end of life care. AOA Policy Compendium 2017, p 51.
  11. Tenets of osteopathic medicine. In AOA Policy Compendium 2017, p 209
  12. Osteopathic medicine definition. In AOA Policy Compendium 2017, p 152.
  13. Franke H and others. Osteopathic manipulative treatment for nonspecific low back pain: A systematic review and meta-analysis. BMC Musculoskeletal Disorders 15:286-303, 2014.
  14. Johnson SM et al. Variables influencing the use of osteopathic manipulative treatment in family practice. Journal of the American Osteopathic Association 97:80-87, 1997.
  15. Johnson SM and others. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Academic Medicine 76:821-828, 2001.
  16. AOA Web site, accessed Feb 10, 2018.
  17. Discover CranioSacral Therapy. Undated flier distributed in 1997 by the Upledger Institute.
  18. Upledger CranioSacral Therapy I. Brochure for course, Nov 1997.
  19. Osteopathy in the cranial field. Osteopathic Cranial Therapy Web site, accessed Feb 7, 2018.
  20. Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine 6(1):23-34, 2002.
  21. Workshop catalog. Upledger Institute, 1995.
  22. Ferre JC and others. Cranial osteopathy, delusion or reality? Actualites Odonto-Stomatologiques 44:481-494, 1990.
  23. Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Physical Therapy 74:908-16, 1994.
  24. Osteopathic literature in print, October 1996. In AOA Yearbook and Directory. Chicago: American Osteopathic Association, Jan 1997, pages 756-757.
  25. Hartman SE. Cranial osteopathy: its fate seems clear. Chiropractic & Osteopathy, June 8, 2006.
  26. Guillard A and others. Reliability of diagnosis and clinical efficacy of cranial osteopathy: A systematic review. Plos One, Dec 9, 2016.
  27. Green S. Chelation therapy: Unproven claims and unsound theories. Quackwatch, Nov 9, 2013.
  28. Policy statement on chelation therapy. In AOA Policy Compendium 2017, p 17.
  29. Prober, JL. Letter to Dr. Stephen Barrett, January 23, 1998.
  30. Barrett S. Be wary of "alternative," "complementary," and "integrative" health methods. Quackwatch, Oct 30, 2017.

Reader Comments

An osteopathic student complained about my criticism of the misleading statements the AOA makes about OMT on its web site:

The AOA is not reflective of the majority of osteopathic physicians. To begin with, if one ever hopes to achieve a leadership position in the AOA, one must complete both an osteopathic internship and an osteopathic residency, this effectively eliminates somewhere around 70% of DOs (at least that's the figure tossed around this campus). The remaining 30% of DOs unfortunately includes those who make many questionable claims about OMT. It also includes many excellent physicians. The DOs who continue to make these claims are a very vocal minority; most of us become a little embarrassed when we read this sort of thing.

I replied: I would suggest that you and your future colleagues who think that the AOA is making deceptive claims bring pressure on the AOA because it is the only publicly identified spokesperson you seem to have.

Another osteopathic student commented:

The cranial labs we have are very strange. Most of the time is spent with our fingers on our partners heads feeling for motion. We are told before even started what we should feel in descriptive terms. We are told the rate range and how our fingers should move specifically for specific dysfunctions. It seems as if much of what anyone may actually think they feel is brought on by the suggestions by the professors. The first cranial lab I found very funny. The professor warned that too much pressure by the student could bring on a severe headache. They also stated that what we motions we feel may change when felt by the professor. This is because just by palpating the skull we may actually fix the dysfuction that the patient had. Once during lab one student made a comment to one of the instructors that one of the professors lecture style was a little like a sermon. The instructor immediately became defensive and asked if the student was suggestion that cranial was not evidence based medicine. Another instructor then added that we would "believe" in it once we saw how it could take away a patients headache so quickly.
I find it very strange that I will be tested to see if I can correctly identify the basic motions of an actual persons skull. I am not sure how a person can be tested to see if they can find something that cannot be found or doesn't exist. I don't think even seminary students are asked to prove the existence of god.

Another osteopathic student commented:

I am greatly impressed by your web site. I found out about it from one of my Biochemistry professors who highly recommended it. (I am a first year student.) I am glad to see that you address some of my (and many of my classmates) concerns about the promotion of osteopathy by the AOA in your article. My class has had the usual slogans and propaganda, like "Osteopaths treat the patient not the disease," etc. (implying that the "allopaths" don't, of course) thrown at us from day one. Two members of my immediate family are M.D.'s, and they both find the not-so-subtle disparaging of allopathic medicine by the AOA and the hard-core osteopathic physicians rather amusing.

Another osteopathic student commented:

First and foremost, thank you for your vital and honest web site that I believe helps people navigate the legitimate as well as the questionable modalities available in health care today. With more acceptance of alternative medicine today, it is essential to have a source that holds practitioners accountable to the scientific method.

The following is my assessment of my fist year of osteopathic medical school. Before I begin, I want to make it clear that I believe most D.O.s to be dedicated and competent practitioners who are slightly embarrassed by a sub-section of the profession that overstate the value of OMM and underutilize the methods of modern medicine.

Before entering medical school I was a practicing physician assistant. Even as a top student in PA school I was rejected by all of the allopathic medical schools that I applied to. Because I was accepted to an osteopathic program, I feel that I owe the osteopathic community a debt of gratitude for recognizing my potential to be a great physician.

Within the first few weeks of the commencement of my training, I became more and more concerned with the lack of consideration for basic scientific principles. I was rather shocked when in OMM lab I found myself holding my hands inches above another students abdomen attempting to feel her "energy pulsations." I was amazed at the lengths the Osteopathic faculty would go to explain why data for the efficacy of OMM was so dismal. There were some truly paranoid responses to politely worded inquiries concerning lack of evidence in the literature for osteopathy’s benefits.

I find it disconcerting that I am graded on accurately diagnosing an "inhaled rib" or a slightly "rotated" vertebral body when AOA funded studies involving inter-operator reliability of residency trained OMM specialists can't achieve a significant kappa score.

I can draw more parallels to religion than to medical science in continuing to teach material that has failed to pass muster in controlled clinical studies. I believe that the osteopaths regard A.T. Still so much like a deity that they are unable to disregard any of his 150-year-old notions when they prove unreliable. I am not here to say that no single part of osteopathy is useful in some application; I am simply commenting on my observation that in an attempt to justify a completely separate branch of medicine, the osteopathic community has lost its objectivity.  Osteopaths are so focused on resisting the merging of osteopathy with the mainstream of medical practice that they are quickly losing their credibility as reasonable scientists. Sadly, this sentiment is reflected in the last words of A.T. Still before his death: “Keep it pure boys, Keep it pure.”

A former osteopathic medical school faculty member wrote:

I spent 12 years teaching basic sciences and 7 years as an associate dean at an osteopathic medical school. However, since the school's faculty came from institutions throughout the United States, I doubt that what I observed differed much from the situation at other osteopathic schools.

Students carried a heavy curriculum in osteopathic manipulative therapy (OMT), beginning in their freshman year. The department of manipulative medicine was completely segregated from the other departments, both in principles and in practice. The osteopathic faculty members in the standard medical departments neither practiced nor taught OMT. Nor did the OMT faculty practice or teach the standard forms of medicine. It was as if OMT was a freestanding form of health care—one that, unlike other departments, was not necessarily bound by scientific foundations. Being a basic science researcher, I have made attempts to set up an animal model to objectively test the claim that certain harmful forms of sympathetic nerve traffic could be altered by spinal OMT. However, I never received any support from the osteopathic faculty in seeing such a study completed. The general attitude of the osteopathic manipulation physicians was, "since we already know it works, why should we bother with proving it."

Cranial therapy was a large component of the manipulative medicine department, both for patient care as well as for teaching the medical students. Interestingly, while the other faculty accepted most forms of OMT even though they did not use them, they did not endorse the use of cranial therapy. Indeed, I heard many criticisms of the practice by the non-OMT faculty. Their objections were the same as mentioned on Quackwatch—that the cranial bones fuse early in infancy, after which no motion of these bones takes place. As you indicate, the alleged sensing of such motion forms the heart of cranial therapy.

I have never heard any attempt by an OMT practitioner to offer a tenable defense to such criticism. To me it almost seemed as if the OMT practitioner felt that the practice could not be defended with ordinary logic since its basis lay somewhere in the metaphysical and that only their gifted hands were able to "sense" the cranial motion.

But the seemingly metaphysical did not stop with the practice of cranial therapy. I know of one case in which a student with an undiagnosed illness consulted one of her OMT mentors who concluded that she had "a "hole in [her] aura."

David E. Jones, Ph.D.

An osteopathic physician in postgraduate training at a university medical center wrote:

I have found my osteopathic school training to be quite equal to that given to my great allopathic colleagues. One of the things I did find disconcerting in my training is what you have pointed out on your site. Osteopathic physicians in training are bombarded with the views that A.T. Still was some kind of god. Most of the people in my class pretty much saw through this and concentrated on the positive aspects of our medical training. I continue to be dismayed at the attitude of the AOA in maintaining a "separate but equal" status for D.O.s. This smacks of an "us versus them" mentality which most mature people have little time for. I and a number of other D.O. colleagues believe that it is time to merge the professions into one cohesive medical discipline. This would allow us to concentrate on caring for our patients with proven modalities as well as produce a stronger lobby for the real danger in medicine: quackery.

Another osteopathic physician wrote:

I just read your article regarding the Osteopathic profession. You are, obviously, ill-informed. It's too bad there are still allopaths like yourself who poke fun at our esteemed profession and who do not truly understand how the body works and how healing can be achieved, from within, through proper alignment of the bones, joints, blood vessels, and nerves. Perhaps further research and an open mind would serve you better.

An osteopathic physician from Texas wrote:

ANYONE IGNORANT ENOUGH TO QUESTION THE BENEFITS OF MANIPULATION THERAPY IN 1999 SHOULD HANG THEMSELVES IN THEIR UTILITY CLOSET. 95% OF DOCTORS THAT PRACTICE CHELATION THERAPY ARE M.D.s. CHELATION THERAPY IS 85-95% EFFECTIVE IN ALL PATIENTS THAT TAKE A FULL COURSE OF THERAPY. WHOEVER THE STUPID MOTHERFUCKER IS THAT MADE THIS WEB PAGE SUCKS DICKS AND DESERVES TO DIE OF THROAT CANCER. PLEASE USE ALL MAINSTREAM METHODS TO ATTEMPT TO CURE THE ESOPHAGEAL CANCER I HAVE JUST WISHED ON YOU. I TRULY HOPE THEY HAVE TO REMOVE YOUR MANDIBLE AFTER YOUR RADIATION THERAPY. DIE MOTHERFUCKER!!!!!

Another osteopathic physician responded to the above letter:

I am a double boarded D.O. who completed an M.D. residency. I have never practiced manipulation and agree with much on your web site regarding osteopathy. I am profoundly embarrassed by the above letter from an "Osteopathic Physician in Texas." I would hope that the author is not really a physician, but I fear that he is because of some of his statements. The letter is very inflammatory and does little to expose the frauds of "cranial therapy" and other outlandish practices. If possible, could you consider removing the letter? I feel discussion is needed and the letter will simply drive people away from meaningful discussion.

I replied: Thanks for your note. It's always nice to hear from a rational D.O. The writer identified himself and was listed in the AOA directory. I posted it because most responses I get from D.O.s and students are negative and about 20% are just as nasty.

Another osteopathic physician responded:

I read with interest your article on the dubious aspects of osteopathy. I was disturbed by your note, appended to a letter which, in its turn, responded to the inflammatory and profane comments by a Texas osteopathic physician. Although it disturbs me to hear that such a high percentage of responses by osteopaths are negative—even profane—I am not entirely surprised.

In what seemed to be an effort to build and maintain a separate identity, there was a considerable degree of indoctrination and propagandizing aimed at the students while I was in osteopathic medical training. It is not surprising, therefore, that you should receive such responses from what I would hope to be a vocal minority of the strongest adherents to the "osteopathic faith." For the record, I am in agreement with much of what you have written.

I am pleased that the education I received has enabled me to practice evidence-based Family Medicine alongside my medical peers for the last decade. Graduates of my school perform admirably in postgraduate training alongside graduates of M.D. schools.

Unfortunately, those osteopaths who practice and preach the cranial message and other dubious methodologies still influence students of medicine today, and there are always those who will embrace such things and prey on those searching for the elusive magic bullet.

I appreciate your website and the information you provide. I would have no objection to a merging of professions as mentioned in the article by yourself and others. I feel, biased as I may be, that I received an excellent medical education through my osteopathic medical training, and I hope that time will show that osteopaths as a group will become more respectable with the attrition of some of the older, more "dubious" influences on the profession. I hope, as the numbers of osteopathic practitioners increase, the percentage of those engaged in cranial and chelation nonsense will fall to more nearly match those of the medical profession as a whole (although one would wish it to fall to zero).

I note with professional gratitude that you do not paint all osteopathic practitioners with the quackery brush. I hope this feedback will improve the balance, reducing the percentage of negativity you receive from the osteopathic community. Please keep up the good work. Your site is a very useful tool for my own and my patients' education.

Kindest regards.

Note: Please do not post my name or location. I have the privilege of training osteopathic medical students, and I enjoy imparting reason and discernment in the matter of evidence-based medical practice. Being seen as a "heretic" would impair my ability to continue to serve in this manner.

This article was revised on February 11, 2018.

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