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Defining what a “physician” is

The very concepts of “complementary and alternative medicine” (CAM) and “integrative medicine” (IM), the former of which “complements” science-based medicine with quackery and the latter of which “integrates” pseudoscience-based with science-based medicine are all about slapping a veneer of scientific legitimacy onto something that has failed to achieve such legitimacy through actual basic, translational, and clinical science. The reason I start out by saying this is to emphasize that CAM/IM is all about using language to persuade that pseudoscience is actually science-based. It’s far more about marketing than accurately communicating concepts. In CAM, everything is “holistic,” and doctors “care for the whole patient,” while “Western medicine” is “reductionistic” and “allopathic.” At the very heart of this language is a false dichotomy: That you must either embrace pseudoscience or that you somehow can’t provide care as compassionate and caring as what the quacks supposedly provide, nor are you able to provide for the emotional needs of your patients. There are two false dichotomies, actually, in that there is also the not-so-subtle implication in CAM that you can’t be truly “holistic” without—you guessed it—embracing the pseudoscience that is at the heart of many CAM/IM modalities.

This use and abuse of language for propagandistic purposes in CAM/IM is not limited to just these examples. In fact, the misuse of language infuses the whole enterprise of CAM/IM to the point that its adherents, not content with being mere “practitioners,” are trying to claim the very title of “physician” for themselves. I learned this from John Weeks, the main force behind the Integrator Blog, a blog dedicated to issues of CAM and IM. He’s the one who first let me know about Andrew Weil’s attempt to put together a board certification in IM. In particular, his reporting on the reaction of CAM/IM practitioners, both physicians and non-physicians, to this initiative by Andrew Weil was most illuminating to me. What was most telling was how further propagandistic use of the language focused on “dominance” by MDs, which in this case struck me as actually being closer to the truth than the usual CAM-speak is. In any case, Dr. Weil’s initiative does indeed appear to be more about taking control of CAM for physicians, his high-minded language about “establishing standards” notwithstanding.

This time around, Weeks has provided me with an education about how alternative/CAM/integrative practitioners now covet the title of “physician”. In the process, he also uses and abuses language in the same way that Andrew Weil and CAM/IM advocates do. This time around, it’s all about co-opting the title of “physician” for non-physician CAM practitioners. It’s bad enough to me when actual physicians are seduced by the pseudoscience of CAM, but this effort appears to be an intentional strategy designed to confuse the public by proclaiming as physicians practitioners who lack the essential skills to be a physician, such as acupuncturists, chiropractors, homeopaths, and naturopaths.

Weeks begins with the story of a non-physician (i.e., non-MD, non-DO) practitioner of CAM who distinguished chiropractors, naturopaths, and acupuncturists from physicians. To me, of course, that’s an utterly appropriate distinction (it’s not for nothing, after all, that I frequently refer to the naturopath’s ND title as meaning “not a doctor”), but to Weeks it’s “stepping into a militarized zone”:

A doctor level, non-MD academic friend from a conventional medical school who has expertise in complementary and alternative medicine inadvertently stepped into a militarized zone the other day. On a conference call with a multidisciplinary group of practitioners, he wished to make a distinction. He first offered a generalization about the roles of “chiropractors, naturopaths and acupuncturists.” Then he distinguished these from what he called “physicians.”

All of us knew that this studied academic was referring to licensed medical doctors, a.k.a. the kings (and queens) of the hill in U.S. medicine. At the same time, many of us were acutely aware by his comment that, while common and even professional usage of the term “physician” may connote MDs, legal realities are shifting. In fact, trends suggest that one endpoint of the movement toward integrative medicine is that “physician” will increasingly umbrella a rainbow of disciplines.

It turns out that there is a conscious effort under way by promoters of CAM/IM to appropriate the title of “physician” for themselves or, at least, to dilute it down so that it can mean either MDs or any of a number of other types of health care practitioners. Surprisingly, they’ve apparently even had some legislative and regulatory success. Weeks reports that the United States Department of Labor recently published something called O Net Online which replaces the Department’s Dictionary of Occupational Titles and that in that online dictionary there is reference to “naturopathic physicians” and “chiropractic physicians.” Worse, if you look under the sample of reported job titles for chiropractors, a synonym for chiropractor is apparently just “physician.” I also couldn’t help but notice that the descriptions of these jobs are pretty funny in a morbid sort of way, for example, listing one of the functions of a naturopath as administering “treatments or therapies, such as homeopathy, hydrotherapy, Oriental or Ayurvedic medicine, electrotherapy and diathermy, using physical agents including air, heat, cold, water, sound, or ultraviolet light to catalyze the body to heal itself.” Yes, it’s depressingly accurate, but it’s funny in that there is no recognition that homeopathy is quackery, as is much of what naturopaths do.

Even acupuncturists are apparently getting in on the act, trying to claim the title of “acupuncture physician” and even proposing an abbreviation of AP to describe themselves. In Florida, for instance, acupuncturists are legally entitled to work under this title, although “not through accredited, doctoral-level educational means.” Of course not. Acupuncturists are not physicians, nor should they ever be referred to as physicians unless they also have an MD or a DO degree. (And in that case I’d seriously question whether a physicians who has become an acupuncturist and practices acupuncture deserves the title of “physician” any more.) Somehow, apparently acupuncturists managed to get the legislature to give them the right to refer to themselves as “physicians,” and boy do they take advantage of it! Indeed, during my visit to Florida last week to present Grand Rounds at the Florida State University College of Medicine, Jann Bellamy and I discussed this very issue.

But it’s not just acupuncturists. Naturopaths have been getting in on the action, too. Indeed, naturopaths in 15 of the 16 states that license them are allowed to call themselves “physicians.” (Apparently California is the only holdout willing to put its foot down.) But in the case of naturopaths, it goes far beyond that. Besides wanting licensure in as many states as possible, naturopaths are pursuing in these licensing laws the right to be able to practice as primary care providers (even though they have zero expertise in primary care) and even as highly specialized practitioners, such as naturopathic oncologists, the latter of whom tack the abbreviation FABNO, which stands for ““Fellow of the American Board of Naturopathic Oncology.” Meanwhile, a couple of miles away from where I practice, across the border, Canadian naturopaths keep trying to get the right to be able to prescribe real medications, either as an admission that their woo is mostly useless or because they want to be considered “primary care physicians.” Maybe a little of both. Be that as it may, naturopaths in other states, such as New Hampshire, are clamoring for laws mandating that health insurance plans pay for their services:

Republican members of the House Commerce Committee bucked their leadership Thursday and voted 15-5 to endorse a health insurance mandate requiring insurance companies to cover people who use naturopathic practitioners as primary care physicians.

If the bill is approved, the insurance companies of patients of some 60 practices throughout the state will have to reimburse the visits.

“Patients have been begging us to push for this legislation,” said Dr. Jaclyn Chasse, president of the New Hampshire Association of Naturopathic Doctors. “We couldn’t be happier.”

I can’t help but notice how the New Hampshire organization is called the “New Hampshire Association of Naturopathic Doctors,” much as the national organization is called the American Association of Naturopathic Physicians (AANP), not to be confused with the American Academy of Nurse Practitioners. I also can’t help but note that a typical nurse practitioner is far more able to provide primary care services than any naturopath. Yet naturopaths keep trying to wrap themselves in the mantle of the term “physician.”

Weeks is shockingly (to me, at least) honest about the reason for this push by promoters of unscientific health care modalities to be able to call themselves “physicians,” using as an example chiropractors:

Success in claiming the physician title, linked to privilege, status and particularly third party payment – some insurers will only cover certain services if provided by a “physician” – figured heavily in an October 2, 2009 mailing to members from the American Chiropractic Association (ACA). The ACA credited its hard work for insuring that the title stayed in the language defining the Federal Employee Benefit Plan. Blue Cross Blue Shield, which manages the plan, attempted to demote chiropractors to a status as “other health care providers.” (6)

As I’ve said before, it’s all about the status. Chiropractors, acupuncturists, naturopaths, and other specialties of woo crave the respectability that comes with being a physician. They also have delusions of grandeur in thinking that they can do what physicians do, namely provide primary care services, even though none of them have adequate training in the administration of drugs or the science-based screening for cancer, heart disease, and other common diseases to function as primary care doctors, among other functions of primary care. Nor can they deal with common diseases, such as diabetes, hypertension, coronary artery disease, or others, at least not using science- or evidence-based guidelines. Unfortunately, this delusion of grandeur leads them to want to blur the line between real physicians and practitioners of pseudoscientific medicine.

Not surprisingly, Weeks is very unhappy at even quite reasonable attempts by physicians to protect the title of “physician” by opposing the licensing of naturopaths, as if it were a bad thing to prevent the state from putting its imprimatur on specialties that are not based in science and evidence. He also confirms something that I’ve always suspected about the near-obsessive use of the word “allopathic” to describe conventional MDs and DOs:

Then again, the AMA leaders in keeping “physician” out of reach of other professions are probably not as comfortable with the additional 2008-2009 language: “MDs are also known as allopathic physicians.” The modifier “allopathic” is a hole in the dike through which may flow naturopathic physicians, chiropractic physicians, perhaps more acupuncture physicians, and the first through, osteopathic physicians.

In other words, modifiers are the way to go, as far as letting non-science-based practitioners claim the title of “physician.” If physicians who practice science-based medicine are described not just as “physicians” but “allopathic physicians,” then they are lowered and other woo peddlers claiming the title of physician are elevated to approximate equality. Then you have various flavors of “physicians,” including “allopathic,” “naturopathic,” “chiropractic,” and “acupuncture” physicians. I do give Weeks credit, though, for mastery of deceptive language on par with the best propagandists. After all, if osteopathic physicians are now equivalent to MDs, even though 50 years ago they were viewed with extreme suspicion, then why not naturopathic or chiropractic physicians?

I’ll tell you why not.

The reason that DOs are now generally considered on par with MDs is because the way that osteopathic physicians (DOs) practice medicine, at least in the U.S., is usually indistinguishable from the way that MDs practice medicine. In essence, DOs became the equivalent of MDs by changing their education and practice to become like those of MDs. They now do the same residencies, are subject to the same standards and board certifications, and are licensed in the same way as MDs. In most osteopathic medical schools, osteopathy has been deemphasized to the point where it’s now, more than anything else, a historical vestige that continues to be taught more because of tradition than because of any continued enthusiasm for osteopathy. Indeed, very few DOs actually ever use it or practice it anymore once they graduate. Most, in fact, are rather embarrassed by these reminders of the chiropractor-like beliefs that used to be central to osteopathy. We can only hope that naturopaths go that way, but it’s highly unlikely, given the sheer extent of woo practiced by naturopaths, who are not only not embarrassed by their woo but downright proud of it. Remember, homeopathy is still considered an integral part of naturopathy, so much so that it is a major part of the curriculum of every school of naturopathy whose curriculum I’ve ever examined and is also a requirement on the naturopathic board examinations. (Don’t get me started on the very concept of a naturopathic board examination.)

Be that as it may, if you want to get an idea of how far Weeks and presumably his non-science-based holistic cohorts are willing to go to redefine what a “physician” is, look to the last part of Weeks’ post, where he actually invokes Webster (as in the dictionary) to convince his readers that physician should mean what he wants it to mean. He lists various definitions of “physician” that he’s found in different versions of Webster, picking the ones he likes, the ones that are seemingly most inclusive. In other words, he exercises one of the lamest arguments known to humankind. When you’re reduced to arguing based on dictionary definitions, you’ve sunk about as low as you can go.

My amusement at such lame arguments notwithstanding, I can’t resist pointing out Weeks’ one last envious broadside at physicians:

The physician term is power. Professions so denominated stand at the top of the hill, waving about highfalutin reasons why their recognition as such is in the public good. The sub-text includes the know motivator that the title lands one on the road to the bank.

I must conclude by saying again that I’m pleasantly surprised at just how honest Weeks is about the motivation for trying to redefine the term “physician” to include quacks. It has nothing to do with improving patient care, nor does it have anything to do with quacks being able to provide primary care that is equivalent to that provided by real physicians. Rather, it’s all about power, money, and prestige, and the quacks want as much of all three as physicians have. Never mind that they haven’t actually earned such prestige and power through proving the value of what they do to society and through validating their contributions to health care though science. They want it all anyway. Unfortunately, they appear to be succeeding in co-opting the term “physician,” diluting its value to the point of meaninglessness and in the process contributing to the corruption of language, all in order to achieve their goal of more power and prestige.

At least Weeks is pretty honest about his motivation.

But what about the argument that “naturopathic physicians” or “chiropractic physicians” or “acupuncture physicians” can function as primary care practitioners? What sort of argument against this nonsense might actually resonate among not just real physicians but legislators and the public? I can think of one. Just consider the effect on vaccination rates of letting naturopaths, chiropractors, acupuncturists, and all the other non-science-based specialties, the vast majority of which tend to be profoundly anti-vaccine, were allowed to claim the title of “physician” and to function as primary care physicians. Now that’s a truly scary thought.

Posted in: Chiropractic, Homeopathy, Naturopathy, Politics and Regulation

Leave a Comment (35) ↓

35 thoughts on “Defining what a “physician” is

  1. daijiyobu says:

    Re: “CAM/IM is all about using language to persuade that pseudoscience is actually science-based [...e.g.] ‘naturopathic physicians’ or ‘chiropractic physicians’ or ‘acupuncture physicians’”,

    I personally prefer calling them metaphysicians, as in not of applied science but of whatever archaic and sectarian metaphysical worldview.

    And I savor this usual naturopathic oxymorony: that it’s “a distinct system that blends.”

    What I find really odd is that even the medical school guides now are all ‘____pathic-obsessed’, dividing the ‘physician domain’ into allopathic, naturopathic, and osteopathic varieties when they’re primarily pseudoscience-o-pathic.

    -@naturocrit on Twitter

  2. ConspicuousCarl says:

    I have no medical training, but maybe I can be a physician of marketing. I will keep a 3-ring binder full of magazine ads, like some gag from an apocalypse movie. “Patient Max, M… general soreness and anxiety… I shall consult the wisdom of the ancients… I prescribe Motrin and Pall Malls.”

    Texas does not have naturopath licensing, but some hooligans have started the Texas Association of Naturopathic Physicians ( txanp.org). They use the word doctor too.

  3. My anthropological bias always leads me to suspect that these kinds of dustups revolve around status and power, as Weeks’ parting shot beautifully illustrates. It’s really interesting IMO that the same theme always bubbles to the surface in discussions about CAM, homebirth, vaccine refusal, etc etc. It’s always about someone who is explicitly not a doctor, either a patient or ND or whomever, casting MDs as offensive power-mongers who are always dismissive jerks in patient interactions. I think the not-doctors are just projecting their own insecurities and compensate by painting scientific expertise itself as personally offensive. It’s bizarre, and I find it amusing that other experts like auto mechanics don’t come under similar fire. Again with the status thing, I suppose…

    I read something awhile ago, maybe in NYT, about highly trained PhD nurses who don’t have MD degrees wanting to be called “Doctor.” If I remember correctly the argument was similar to that of calling DOs “Doctor.”

  4. Scott says:

    DOs became the equivalent of MDs by changing their education and practice to become like those of MDs. They now do the same residencies, are subject to the same standards and board certifications, and are licensed in the same way as MDs.

    Is there a particular reason the DO persists as something distinct from the MD, then? I could see it just being institutional inertia, but is there anything more profound?

  5. ConspicuousCarl says:

    At least one DO school might persist because, though the nonsense has been removed from the classroom and practice (I have to take everyone’s word on that), they still use it as appealing rhetoric to recruit students:

    http://www.pcom.edu/General_Information/Osteopathic_Medicine/Osteopathic_Medicine.html

    ” But DOs bring
    something extra to the practice of medicine.
    Osteopathic physicians practice a “whole
    person” approach to medicine, treating the
    entire person rather than just the symptoms.”

  6. Quill says:

    Dr. Gorski wrote:

    The reason I start out by saying this is to emphasize that CAM/IM is all about using language to persuade that pseudoscience is actually science-based. It’s far more about marketing than accurately communicating concepts.

    I think that is spot-on and deadly accurate. It’s exactly the same kind of thing Orwell wrote about in his famous essay “Politics and the English Language.” (If anyone is not familiar with this, please go here and read it for free: http://www.mtholyoke.edu/acad/intrel/orwell46.htm It is a brief yet very effective tool in understanding how CAM-isms and IM-words function to obscure meaning.)

  7. Someone please tell me that insurance companies, Medicaid, Medicare and the applicable existing licensing boards have a system for coping with what essentially appears to be job title inflation. It is almost inevitable that unqualified people will try to get the title of “physician” if it means they can make more money. But my question is, why would insurance companies (etc) let a self applied job title make a difference?

    Oh, I know, I probably shouldn’t expect sensible processes from bureaucracies, but what the heck.

    ——-
    Somewhat relate, unrelated side note, Just heard on NPR some rather large numbers for expected doctor shortages in the upcoming years, due to the new health care bill.

    It accured to me how doctor shortages might play into any Chiropractors, Naturopaths and Accupunturists wish to become primary care providers. If one was into being proactive rather than reactive, one might begin to contemplate some sort of plan to deal with the doctor shortage before there is an opportunity to take advantage of it.

    Just a, probably not very original, thought.

  8. Rabbit says:

    Anthropologist Underground:
    “I read something awhile ago, maybe in NYT, about highly trained PhD nurses who don’t have MD degrees wanting to be called “Doctor.” If I remember correctly the argument was similar to that of calling DOs “Doctor.”

    In the Canadian province where I live (Alberta), an RN holding a Ph.D. in nursing may use the title “Dr.” when acting professionally in an academic capacity, but may not use that title when acting professionally in delivering health care services. She is “Dr. X” when giving a lecture on nasogastric intubation at the local medical school, but becomes — as a matter of law — merely “Ms. X” the minute she performs that procedure on an actual patient.

  9. jschaum1499 says:

    David,

    Let me start by saying that I am not a doctor, but I have dealt with many doctors in my time, due to illness within my family and with friends. Based on my experience, I have to say that I do not have much faith in doctors.

    I do not solely blame doctors for this. I realize that for many years, pharmaceutical companies have been a major source of funding for medical schools and have had a significant influence on the way that medicine is taught and practiced. The problem I see with that is that pharmaceutical companies have no desire to cure anyone. As a matter of fact, they (and their investors) have a vested interest in making sure that no one gets cured. They “discover” medicines that may mask some symptoms of a particular disease and hope to keep patients alive as long as possible so that they can sell as much of it as possible to them. From a business perspective, this can be understood. My concern is that so many people, particularly physicians, turn a blind eye to this obvious situation. When was the last “cure” discovered for anything. As far as I can tell, Polio was the last disease for which a “cure” was found and that cure was found by a private group of scientists funded by private citizens. I do not believe that any pharmaceutical company has ever “cured” anything. I will admit that I may be wrong and would be interested in knowing of any true “cures” that have been discovered by pharmaceutical companies.

    There are some doctors that have championed the use of vitamins and natural foods to promote healing. They have been called quacks, but common sense should tell you that a persons diet is one of the main causes of their health or sickness. I realize that genetics can make someone more prone to a particular disease (and that a parents poor choices or inability to provides good food for oneself can affect the fetus to the extent of causing disease in a child) but I believe diet is also a major contributor to health and wellness. The fact that not much food of good quality is produced these days creates a major problem for most people. You have probably heard the term “garbage in, garbage out”. Well, I believe it that is applies to peoples diets. As a good reference source, see the movie “Super Size Me”.

    Before discounting the affects of what you call a holistic approach to healing, you should take some time to actually do some research and think about it a bit. I would recommend reading books such as “Good Calories, Bad Calories” by Gary Taube and “Doctor Yourself” by Andrew Saul, PhD.

    Sincerely,

    Jim Schaum

  10. wertys says:

    The worst part of this whole post is the use of the word ‘umbrella’ as a verb, and the use of ‘rainbow’ as a collective noun. Perhaps we should refer to a ‘rainbow of quacks’ from now on?

    *shudders*

  11. Cowy1 says:

    @jschaum

    Geeze man, tell me about it. At every lecture in med school we’ve got some smokin’ hot blondes teaching how we should try to string out treatments as long as possible, avoid curing patients so we can keep ‘em coming back for life (cough chiropractors cough) and encourage them to smoke, eat like crap and keep drinking cheap whiskey. Honestly, most of the time I can’t even pay attention so I just do everything according to those little prescribing packets they hand out.

    Actually, now that I’m in clinic, every patient I switch from generics (damn Wally World and those $4 scripts) to Crestor a rep from AstraZeneca throws me a benjamin. It’s pretty tight man.

  12. nybgrus says:

    @cowy1:

    lol. Welcome to the commentariat. If you happen to be down in the Southeastern US give a shout – I’ll be back down in that neck of the woods for med school in January and would love to buy you a beer.

    @jschaum:

    I realize that for many years, pharmaceutical companies have been a major source of funding for medical schools and have had a significant influence on the way that medicine is taught and practiced

    [citation needed]

  13. @cowy1: Smokin’ hot blondes?! So that’s where they were when I was in Anthropology school.

  14. lilady says:

    @jschaum: There is no cure for polio…there is a preventive vaccine however. Since the development and licensing of polio vaccine, many vaccines to prevent viral and bacterial diseases have been developed to protect children and adults from serious, often deadly, infectious diseases.

    No special diet in the world can prevent any infectious disease process, nor can any special diet cure an infectious disease. Some infectious diseases (common cold for example), do not require medications because the body is able to resolve those minor diseases. For other serious diseases, such as bacterial meningitis, bacteremia and tuberculosis, to name a few, you will require antibiotics. Advances have been made by scientists…not “nutritionists” to develop specific anti-viral medicines. You need to read up on antibiotics and antiviral medications.

    There is no miraculous cure for cancer in your food pantry or in a book. I suggest you visit the American Cancer Society for information about treatment modalities for the various types of cancer.

    A diet that is well balanced (See the American Dietetic Association website), may prevent the onset of coronary artery disease, hypertension, Type II diabetes and other disorders. If you are fortunate enough to have the “right” genes, you may leave this life without requiring prescribed medicine…most people don’t have the “right” genes.

    What makes you think that doctors, nurses and registered dieticians (not “nutritionists”), are unschooled in well-balanced diets and are unable to counsel their patients about diet, lifestyle changes and exercise to maintain health?

  15. Badly Shaved Monkey says:

    As a Brit, I’m curious about the apparent respectability of osteopaths in the USA and their near-equivalence to proper doctors. Their status in in UK is simply to be a branch of physical therapy, akin to physiotherapists and more respectable that chiropractors.

    Does a primary care DO deal in all sorts of disease (hypertension, acute gastroenteritis or whatever) or do they stick to musculoskeletal conditions?

  16. BillyJoe says:

    BSM,

    “Their status in in UK is simply to be a branch of physical therapy, akin to physiotherapists”
    Likewise in Australia.

    “Does a primary care DO deal in all sorts of disease (hypertension, acute gastroenteritis or whatever) ”
    Strange as it may seem, that apparently that is the case

  17. Yes, this dust-up is about power and authority. Beyond the interests of anthropologists, these terms translate into state-level regulation of who can do what, and bill for what.

    If a complemetary-and-alternate-medicine practitioner wants to be called ‘doctor,’ or ‘physician,’ AND starts wanting to do the sociological dis-assembly of the term, it is only because they also want the power and authority, and a slice of the pie.

    Anyone can buy a lab coat and a stethoscope.

    If you don’t like the way the term ‘doctor’ or ‘physician’ works in our society, go find your own term.

  18. nybgrus says:

    It is indeed very different in the US. The osteos here have essentially completely eschewed all the pseudo-science and woo and modelled their curriculum to be essentially the same as MD schools. They still have a tiny touch of reference to the osteopathic manipulations, but it really is a very small part of the curriculum that most grads are actually a tetch ashamed of. I would say that a final step would be to completely remove that, but I think the reason they may keep it around is for justification of maintaining a separate term for themselves and justifying their existence. But in Australia U Melbourne and U Queensland are changing their degree from MBBS to MD, so I don’t see why DO couldn’t do the same.

    But the real difference here in the States is that they take purely science based licensing exams and then go on to the exact same residency training as MDs. There is still a bit of a stigma associated with it, but that is decreasing since they are consistently demonstrating their ability to be science based and competitive in real medical fields.

    A naturopath, for example, could never pass an MD or DO licensing exam and would never be able to complete a medical residency, even if they were allowed to sit such exams. Same with a chiropractor or homeopath.

  19. rwk says:

    Any reader who wants to know about DOs should read for themselves past and present. Nybgrus is only giving his opinion.

    He says
    “The osteos here have essentially completely eschewed all the pseudo-science and woo and modelled their curriculum to be essentially the same as MD schools”

    Prove the first part please.

    “They still have a tiny touch of reference to the osteopathic manipulations, but it really is a very small part of the curriculum that most grads are actually a tetch ashamed of”.

    Prove that as well. If you go to CCOM or Kirksville College of Osteopathic medicine and check out the curriculum
    they get Osteopathic manipulation coursework in every quarter of the first 2 years.

    I suspect that any of Nybgrus’s DO friends that are a “tetch ashamed of” OMM are probably just plain no good at that skill, or only interested in being a specialist.

    Also you might note that a minimum 2.5 GPA at KCOM and 2.75 at CCOM are required to enter.

    Nybgrus, you’re quite the boffin about science and medicine but not about DOs.

    Oh, and if you ever come to Chicago Nybgrus, I’d be glad to buy you a beer or two as I’m a poor typist.

  20. Calli Arcale says:

    Badly Shaved Monkey:

    Does a primary care DO deal in all sorts of disease (hypertension, acute gastroenteritis or whatever) or do they stick to musculoskeletal conditions?

    In the US, yes, they do. I have sometimes seen an analogy made between the MD/DO distinction and the BS/BA distinction; I know the liberal arts school that I attended gave BA degrees in the sciences which were every bit as rigorous as a BS at a big university could be, and which were accepted as prerequisites for MS and PhD programs. In general, a DO is just like a doctor except they also get trained in osteopathic manipulation. (And MDs can get trained in that too. It’s just not a core part of the curriculum.)

    My second baby was actually delivered by an osteopath. My chosen doctor was an MD, but she was not qualified as a surgeon, and circumstances indicated a c-section. The OB on duty happened to be an osteopath. She was competent, and I actually didn’t know her title until about a week later (it was listed on the bill, which indicated the particular surgeon by name). She was very no-nonsense for my child’s delivery, staying calm and upbeat despite some dangerous indications, so as not to stress me out unduly. (It was done under spinal block, so I was fully alert.) She switched from transverse to lateral incision as soon as it became apparent that the lower part of the uterus was too constricted to allow the baby to pass through easily (which, unbeknownst to any of us, would have been a problem had we gone ahead with labor), and did an excellent job with both the external incision and with cleaning me up and stitching me together afterwards. The external scar nicely overlaid my existing one from the first c-section, and my recovery was surprisingly swift and uneventful.

    Not all osteopaths do a lot of osteopathic manipulation. It depends on what the situation calls for. I’ve also been treated by an opthamologist who was a DO. I don’t think there’s much call for the manipulation in that line of work; there certainly wasn’t in my case, as I was presenting with a whopper of a chelazion. He recommended a conservative approach, and unfortunately it didn’t work — I returned a month later to have it excised. (A different opthamologist performed that. I wasn’t picky about who did it. Coincidentally, this was while I was pregnant with the baby who would later be delivered by a DO, with my regular MD assisting.)

  21. Intraneural says:

    @rwk-

    Having worked with at least a hundred DO’s throughout my residency and fellowship I can tell you that not one of them actually practice osteopathic manipulation. I know one that will perform it on friends but for the most part osteopaths do not perform osteopathic manipulation in practice. I have no citation for this… yes it is anecdotal but it is not worth the time for a DO to perform because it does not bill well. Many of the DO’s that I know were some of the brightest residents that I worked with in my training. They for the most part follow science based medicine and complete mostly the same residencies, although in some states they are required to complete a DO internship instead of an MD/allopathic internship (the first year of training in residency).

    Osteopathic schools are more likely to emphasize the primary care speciatlies (family practice, internal medicine, pediatrics) and I would say that many of my friends in college that went to osteopathic schools had a strong conviction to be in primary care. A few were even more prone to SCAM but many of my “allopathic” classmates were too. It is common knowledge for medical school applicants that it is “easier” to get into an osteopathic school, and many applicants will apply to a few osteopathic schools as a “back-up”. This is not to say that osteopathic schools are worse than MD schools, but I would attribute it to the reputation and discrimination that DO’s experienced in prior generations. Having said that, like I stated earlier, some of the DO’s I know are the brightest physicians I know. However I did have some classmates in college that were accepted to DO schools that I would not let touch my worst enemy with a ten foot pole.

  22. David Gorski says:

    Indeed. I remember one DO who was the director of the surgical intensive care unit at one of the hospitals where I trained as a resident. He was among the most brilliant and caring physicians I’ve ever encountered. He taught me much of what I know (or knew, given that I no longer practice it) about critical care and trauma. I’ve also encountered many residents who were DOs; they do not appear to differ appreciably in their training or ability to practice from MDs, at least not to my ability to detect. I’ve known oncologists who were DOs. They were just as good as any MD oncologist.

    For the most part, in the U.S. these days DOs in the U.S. are indistinguishable from MDs. I realize that that is not true in the U.K. and Europe, which is why our readers from that part of the world are frequently left scratching their heads when I say that DOs in the U.S. are largely as good as MDs. But it is true here in the U.S., and that’s a good thing indeed.

  23. lilady says:

    I haven’t seen too many D.O.s practicing in my area, but my husband had three drug eluding stents placed in two of his coronary arteries in February, by a D.O. who is part of the large cardiac practice where my husband is a patient. (He has a h/o right and left atrial ablations 10 years ago and 3 years ago).

    I am fortunate to have had the opportunity to check the physician’s “record” because I live in a state where the State Health Department monitors patient outcomes by hospital and by the individual cardiologist (while hospitalized post procedure, 30 days out, and at one year post procedure).

    This particular physician does 800+ stent placement procedures a year and had the lowest morbidity and mortality rates in the State. No, I didn’t check up on him because he is a D.O., but because I wanted the very best physician to place the stents.

  24. nybgrus says:

    I actually don’t have a single friend who is currently in DO school, though I have worked with a few DO’s when I was working in the ER. They were critical care pulmonologists and stroke neurologists and were absolutely fine doctors.

    The point is that yes, they still have osteopathic training, albeit significantly limited and not the core focus. They can and do succeed in completing actual MD residencies and practice the same medicine I will be. Coming out of DC school you are not trained or knowledgeable enough to pass the USMLE or undertake an MD residency.

    So yes, I still do disparage DOs for having the osteopathy as part of their curriculum. But as a whole they have changed their curriculum, teaching, and testing standards to be almost entirely in line with science based medicine, and demonstrate the USMLE and COMLEX scores plus the success in actual residencies to back that up. DCs aren’t even remotely close.

  25. WilliamLawrenceUtridge says:

    @jschaum1499

    There are so many CAM talking points in your post it would take a fair-sized book to address them all thoroughly. You might be well-served by reading through the posts on SBM, since many are addressed already. That being said:

    - the lack of “cures” for many illnesses is a straw-man. The overall issue in most cases is that there is no cure. Bacterial infections can be treated by antibiotics (if no resistance has evolved). Viral infections have limited-effecitveness antivirals, but is mostly prevented (not “cured”) through vaccination. Chemotherapy works by preferentially killing rapidly-dividing cells, with the hope that the cancer dies before the body does. There are few cures, perhaps some treatments only, for many genetic disorder. The lack of “cures” is less likely “Big Pharma wants to keep prescribing” and more likely “there’s simply no way to prevent the body from aging”. Sometimes all you can do is mask symptoms because they haven’t figured out a way to eliminate them at the source.

    - While Big Pharma doubtless gets excited at something like insulin or statens, which must be taken for life, that doesn’t mean research has stopped on things like pancrease transplants or stem cells to regenerate damaged tissues. Just means that it’s hard (and Bush killed research on stem cells because of religious opposition, thus setting the US research community back by a good decade or more).

    - “Big Pharma” are companies staffed by people. People who indeed manage to cure a previously uncured disease would make lots and lots and lots of money, as well as fame and prestige – as would their company. “Big Pharma” is set up to reward any process that treats or cures illness. And as a counter-point, the vaccine for polio didn’t receive massive opposition from makers of iron lungs.

    - Employees of pharmaceutical companies are people who get sick or are related to people who get sick, and those people in turn are often connected to others who have the same chronic illness. Do you really think that in the interest of profit, if a company had a genuine cure, it wouldn’t get out?

    - The medical community is extremely aware of the COI issues presented by Big Pharma, it’s a topic of much research and education.

    - All doctors “champion” adequate diet and exercise. The fact that patients don’t follow their advice isn’t the doctor’s fault. The 66% of Americans who are obese are there mostly because of eating too much and exercising too little, not because their doctors told them to put down the weights and pick up the chips. In fact, if they were this fat a century ago, they would die much younger. Medicine (along with sanitation, herd immunity, vaccination, modern obstetrics and research overall) allows people to live longer in spite of poor diet, little exercise and deadly genes. A good diet is important, but the only thing it cures is acute deficiency of vitamins, minerals and macronutrients.

    - It’s amusing to point to “Super Size Me”. Did any of Morgan Spurlock’s doctors say “just keep eating McDonalds, and take these pills while you do it”? My recall is his doctors kept trying to convince him to end the 30 day experiment early.

    - Why, and how, would you treat a bacterial infection “holistically”? It’s a bacterial infection. Kill the bacteria and the infection goes away. Same questions for for type I diabetes.

    Before proclaiming people should “do some research”, you might want to brush up on something other than popular sources and films.

  26. GLaDOS says:

    The vestigial ceremonial vitalism present in DO schools makes their students a little more vulnerable to cultish vitalism, and I am starting to worry about what’s happening in those schools now, based upon some recent graduates promoting things like prolotherapy, thermography, chiropractic, metagenics, and the like.

    Also, “we treat the whole patient.” Hey, thanks for the insult, twatters!

  27. @Cowy1, way up thread. Okay, I was going to reprimand folks for picking on jschaum1499 who’s unfortunately bought into the natural news party line. I still have some hopes that some gentle respectful encouragement might shock such converts so much that they will reconsider their opinion. But your post was so funny… I just don’t have the heart to discourage such ironic talent.

  28. Cowy1 says:

    @michele AND nybgrus

    Thanks, I try. Stuck in Chicago for the time being, still digging through the slog of M3.

    Got a bunch of friends (including a number from undergrad) that go to CCOM, supposedly one of the higher rated DO schools (whatever that means). Apparently some of the faculty is pretty militant about the manipulation thing but all of the students and DOs I’ve met laugh it off as a silly historical artifact. In fact, one of my good friends is a 4th year DO student and the kind of skeptic that would put most of us to shame.

    I’ve had 2 rotations with DO students (1 with a bunch of DO residents/attendings too) and I couldn’t tell the difference between “us” MDs and them.

  29. nybgrus says:

    @Cowy1:

    One of my very good buddies is an M3 in Chicago (RFUMS). I’m sure over the next year or so I’ll find I chance to mosey on up there. If it becomes convenient a beer might be in order.

  30. radu says:

    You know, if the practitioners of voodoo medicine really want to be like physicians, then why not let them, but with the requirement that the ethical and legal responsibilities and obligation are the same? If the law sees them as equals, then all the tort laws about malpractice and so on will drive their insurance through the roof and will make them quite unable to get coverage for themselves. Malpractice court cases will drag them through through the meat grinder until a) some will stop practicing medicine; b) some will get actual medical education so as not to do harm; c) rest of them get discredited and marginalized.

    But allowing equivalence between voodoo medicine and scientific medicine, would go against the time-honored ethical principles of “do no harm” and would be equal to human sacrifice. The hypocrisy of voodoo medicine practitioners or VAMPS (pun intended) has all the signs of religious practice: church of latter day acupuncture, homeopathy witnesses, apostolic magnetoholics etc.

    Your blog post depressed me a bit and reminded me all the times when I have tried to make people see sense.
    They want to see the world through rose tinted glasses and to find easy answers (something internet based culture espouses). Luckily, many are used to the dichotomy between religion and science. I fear that only people who have recognized, even with reservations, this divide between science and religion, can be won over. Sadly willful ignorance is quite impervious to reason …

    In a way the legitimization of voodoo medicine can be compared to the attempts to make creationism a scientifically sound theory, but without the burden of decent evidence. But in the latter case, lives are not at stake.

  31. GLaDOS says:

    You know, if the practitioners of voodoo medicine really want to be like physicians, then why not let them, but with the requirement that the ethical and legal responsibilities and obligation are the same?

    One of the big lessons I’ve learned from watching Anonymous is, don’t go to court. The bad guys are half lawyers. They love going to court. They always make money there. And they know how to win even if it involves losing cases.

    Look at our friend in the UK, Ben Goldacre. He won, but his defense cost over $300,000 pounds. Good thing the Guardian was willing to back him.

    It is a serious flaw in our judicial system that we aren’t going to fix any time soon: going to court will hurt you. If you win your case, it will hurt you a lot less. But it will still hurt. You aren’t going to get those years back. And the shakes may never completely go away.

  32. DrRobert says:

    Oh my! I couldn’t even finish reading this article because I became infuriated!

    I simply refuse to call any of these quacks by any title. A naturopathy doctor? No. You are Mr. or Mrs. Whomever. A chiropractic? No, you are Mr. or Mrs. Quack too. If you want the Doctor title, you go to medical school, or you devote your life to studying real science. If you want to be a physician, you go to medical school.

    If anything, these CAM practitioners should be called Quackicians.

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