Rediscovering the classic osteopathic literature to advance contemporary patient-oriented research: A new look at diabetes mellitus

Patient care experiences represent opportunities for establishing theories, testable hypotheses, and data to assess the potential use of osteopathic manipulative treatment in various disease conditions. The re-analysis of Bandeen's 1949 raw data described herein summarizes the effects of osteopathic manipulative treatment involving pancreatic stimulatory and inhibitory techniques in diabetic and non-diabetic patients seen over a 25-year period of clinical practice. Bandeen's data demonstrate a reduction in blood glucose levels at 30 and 60 minutes following pancreatic stimulation in 150 diabetic patients, and an elevation in blood glucose levels at 30 and 60 minutes following pancreatic inhibition in 40 non-diabetic patients. Such patient-oriented research conducted during the classic era of osteopathy in the United States provides a foundation and data for generating hypotheses about the potential mechanisms of action of osteopathic manipulative treatment. Osteopathic investigators would be well-served to rediscover the classic osteopathic literature to help advance contemporary evidence-based medicine

Osteopathic Medicine and Primary Care: one journal, two audiences

Osteopathic Medicine and Primary Care (OMPC) enters its fourth year of operation in 2010 under the umbrella of BioMed Central. Osteopathic Medicine and Primary Care strives to promote and advance research and scholarly work within the fields of osteopathic medicine and primary care. In so doing, OMPC welcomes submissions from clinicians within both the osteopathic and allopathic medical professions, and from other professionals having interests in primary care, including health care delivery, public health, and evidence-based medicine. Osteopathic Medicine and Primary Care offers fair and expeditious peer review (mean time from submission to publication, 118 days), retention of copyright for authors, unlimited online distribution and access without charge to readers, indexing in PubMed, and archiving in PubMed Central. In 2010, there will be an increased availability of waivers or discounts of article processing charges via several mechanisms for eligible authors who submit qualified manuscripts, especially in the field of primary care

A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004

BACKGROUND: Osteopathic philosophy is consistent with an emphasis on primary care and suggests that osteopathic physicians may have distinctive ways of interacting with their patients. METHODS: The National Ambulatory Medical Care Survey (NAMCS) was used to derive national estimates of utilization of osteopathic general and family medicine physicians during 2003 and 2004 and to examine the patient characteristics and physician-patient interactions of these osteopathic physicians. All analyses were performed using complex samples software to appropriately weigh outcomes according to the multistage probability sample design used in NAMCS and multivariate modeling was used to control for potential confounders. RESULTS AND DISCUSSION: When weighted according to the multistage probability sample design used, the 6939 patient visits studied represented an estimated 341.4 million patient visits to general and family medicine specialists in the United States, including 64.9 million (19%) visits to osteopathic physicians and 276.5 million (81%) visits to allopathic physicians. Osteopathic physicians were a major source of care in the Northeast (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.42–6.08), providing more than one-third of general and family medicine patient visits in this geographic region. Pediatric and young adult patients (OR, 0.64; 95% CI, 0.45–0.91), Hispanics (OR, 0.63; 95% CI, 0.40–1.00), and non-Black racial minority groups (OR, 0.39; 95% CI, 0.18–0.82) were less likely to visit osteopathic physicians. There were no significant differences between osteopathic and allopathic physicians with regard to the time spent with patients, provision of five common preventive medicine counseling services, or a focus on preventive care during office visits. CONCLUSION: Osteopathic physicians are a major source of general and family medicine care in the United States, particularly in the Northeast. However, pediatric and young adult patients, Hispanics, and non-Black racial minorities underutilize osteopathic physicians. There is little evidence to support a distinctive approach to physician-patient interactions among osteopathic physicians in general and family medicine, particularly with regard to time spent with patients and preventive medicine services

Osteopathic research: elephants, enigmas, and evidence

BACKGROUND: The growth and acceptance of osteopathic physicians as conventional medical practitioners in the United States has also raised questions about the distinctive aspects of osteopathic medicine. Although the use of osteopathic manipulative treatment (OMT) and a focus on primary care are most often cited as rationales for the uniqueness of osteopathic medicine, an osteopathic professional identity remains enigmatic. DISCUSSION: The fledgling basic osteopathic research efforts of the early and mid-twentieth century have not been sustained and expanded over time. Thus, there is presently a scarcity of basic mechanistic and translational research that can be considered to be uniquely osteopathic. To be sure, there have been advances in osteopathic clinical trials, particularly those involving OMT for low back pain. Meta-analysis of these low back pain trials has provided evidence that: (1) OMT affords greater pain reduction than active or placebo control treatments; (2) the effects of OMT are comparable regardless of whether treatment is provided by fully-licensed osteopathic physicians in the United States or by osteopaths in the United Kingdom; and (3) the effects of OMT increase over time. However, much more clinical research remains to be done. The planning and implementation of a large longitudinal study of the natural history and epidemiology of somatic dysfunction, including an OMT component, represents a much-needed step forward. Osteopathic medicine's use of OMT and its focus on primary care are not mutually exclusive aspects of its uniqueness. The intersection of these fundamental aspects of osteopathic medicine suggests that the profession may successfully adopt a generic strategy of "focused differentiation" to attain a competitive advantage in the health care arena. While there are both requisite demands and risks for the osteopathic profession in adopting such a strategy, these are reasonable in relation to the potential rewards to be attained. To help promote an osteopathic identity, "omtology" and its derivative terms are recommended in referring to the study of OMT. CONCLUSION: The osteopathic profession should adopt a coherent strategy for developing and promoting its identity. Failure to do so will likely ensure that osteopathic medicine remains "stuck in the middle.

Osteopathic Medicine and Primary Care looks forward to 2009

Osteopathic Medicine and Primary Care, which enters its third year of operation in 2009 under the umbrella of BioMed Central, continues to promote and advance open access publishing through universal online access without charge, indexing in PubMed and archiving in PubMed Central, retention of authors' copyright, and expeditious peer review. Notable accomplishments during 2008 included a median lag time of four months from initial manuscript submission to publication, designation of eight articles as "highly accessed," and achievement of a balanced proportion of publications in our core topic areas of osteopathic medicine and primary care. In October 2008, Springer Science+Business Media, a major publisher of journals in science, technology, and medicine, acquired the BioMed Central Group. Our 2009 Editorial Board is presented herein, as well as a new mechanism for posting book reviews on the Osteopathic Medicine and Primary Care website. We continue to encourage manuscript submissions and reader comments on our articles. Waivers or discounts of article processing charges are available via several mechanisms for eligible authors who submit qualified manuscripts

Time for the osteopathic profession to take the lead in musculoskeletal research

Musculoskeletal conditions, such as low back pain, are prevalent in the United States. These conditions exact an enormous toll on society, both in terms of their detrimental impact on quality of life and on the costs of treatment and lost productivity. Osteopathic physicians, as common providers of primary care services and spinal manipulation, are ideally positioned to lead future research efforts in this field. The emergence of data and standards relevant to osteopathic manipulative treatment outcomes, refinement of research methodologies to enhance evidence-based medicine, and investments in developing osteopathic research infrastructure are all critical elements in moving this field of research forward

Osteopathic Medicine and Primary Care completes first year of publication

Osteopathic Medicine and Primary Care affords authors the opportunity for rapid and universal dissemination of their work. We are keen to receive author manuscripts and reader comments on articles during 2008. A journal fund has been established to offset the cost of article processing charges for eligible authors who submit qualified manuscripts

Osteopathic Medicine and Primary Care: a new journal for changing times

Osteopathic Medicine and Primary Care is dedicated to the rapid and universal dissemination of peer-reviewed research and scholarly work within its scope. It aims to bridge diverse professional communities by providing a common forum for the publication of research relevant to the clinical practice of primary care

Osteopathic manipulative treatment for pandemic influenza: many questions, few answers

Commentary o

Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain. METHODS: Computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen's d statistic and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, stratified meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and stratified meta-analyses. RESULTS: Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 – -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow-up. CONCLUSION: OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain