Where have all the osteopaths gone?

These days in the U.S., people often don’t know what an osteopath is(or was). This is because they are rare indeed. Certainly many Doctors of Osteopathy(D.O.) come out of schools every year. Probably more than ever before, but are they osteopaths as we used to know of them?

Andrew Taylor Still, MD, DO was the first to be called an osteopath.  It is fair to say that he is the first true alternative medicine physician in the U.S. He was a surgeon who realized that there was more to how the body worked and how the body could be treated than was taught in medical schools back in the late 1800s. He thought the musculoskeletal system played a role in disease. He was a reformer. He had fought against slavery and then he would fight against a medical community that still used substances like arsenic, castor oil, whisky and opium as medications. He founded the first school of osteopathy in 1892 hoping for a day when physicians would still use surgery but would also utilize manipulation of the musculoskeletal system and would be more prudent with the use of drugs.  He started a revolution.  There had been forms of manual therapy long before Dr. Still.  Hippocrates wrote of joint manipulation techniques more than 2000 years prior. But it had long since been a tool of the ‘bone setter’.  It remained outside of medical consideration passed from father to son without formal education or study.  A.T. Still brought it into the hands of physicians, with an intimate understanding of anatomy, who were accustomed to the scientific method and analytical problem solving. With the advancements and mentoring provided by A.T. Still, osteopaths would follow such as: Chapman, Sutherland, Mitchell, Jones to name a few who would continue to add newer and better ways to treat disease and dysfunction.  Osteopathic manual therapy(OMT) flourished.

But this holistic revolution would take a strange turn. Over time, the system of payment in America would cause this more holistic approach to medicine to decline. Insurance companies rewarded physicians who saw more patients per hour. The age of big pharmaceuticals and paperwork had arrived.  With the growing demands of insurance filing and payment management, front office staffs soon outnumbered physicians in most medical practices.  In such a system, the days of the physician sitting and talking with a patient and assessing and treating with his hands in the office were numbered. Writing a prescription for medication and therapy and then moving to the next room to see another patient was the predictable outcome.  How else could a practice run when it needed to support a giant staff and also pay tens of thousands of dollars in malpractice insurance premiums annually?

Osteopathic physicians found that they could keep the doors of the business open and make far more money if they devoted more time to: delivering babies, doing surgeries, prescribing medicines etc. and they put much of osteopathy in the closet.  Indeed, most osteopaths in the U.S. could be characterized as ‘oreopaths’ because they are osteopaths on the outside but MDs on the inside.  And the nation’s colleges of osteopathy have moved with the times. Manual therapy and A.T. Still’s approach to looking at the body have been put on that shelf by the very institutions built to produce the D.O.

But while some of the gains made by osteopaths may have been lost, there were osteopathic physicians who did not want to see true OMT disappear.  Other manual therapists such as physical therapists and chiropractors wanted to fill that void and a handful of osteopaths felt an obligation to give what they could of OMT to the next generation.  Below are a few of those osteopathic physicians that deserve credit for decades of work passing this torch.

Loren Rex, D.O.

In 1976, the D.O. known by his friends and students as ‘Bear’ started educating licensed healthcare practicianers and did so for nearly 40 years.  While some sought to simplify and compartmentalize the osteopathic approach, Bear sought to preserve and pass along as eclectic and esoteric a body of knowledge as possible. He stayed true to the embryological approach that he had learned and taught it.

Ed Stiles, D.O., FAAO

Dr. Stiles formed a bridge from the glory days of osteopathy to the present.  The grandson of A.T. Still, George Laughlin D.O., mentored him and passed along a powerful but elegant form of treatment known as functional indirect technique. He also worked beside Fred Mitchell Sr. DO.(founder of muscle energy technique). He helped to found Pikesville College School of Osteopathic Medicine and has published research findings showing the benefits of OMT with various disease states.  He has taught OMT in seminars to physical therapists and physicians in the U.S. and Europe since 1970.

Philip E Greenman, D.O., FAAO

Dr. Greenman was a charter faculty member of the Michigan State University College of Osteopathic Medicine where he served as Professor and Associate Dean between 1972 and 2004. In that time, the late Dr. Greenman advanced research in the field and was instrumental in establishing manual medicine seminars that spread OMT not only to osteopathic physicians but also to allopathic physicians(M.D.s), physical therapists and dentists.