The History of Osteopathic Medicine

A new movement within medicine
Frontier physician Andrew Taylor Still, MD, DO, founded the American School of Osteopathy (now the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine) in Kirksville, MO, in 1892 as a radical protest against the turn-of-the-century medical system. A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease. He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were arsenic, caster oil, whiskey, and opium. In addition, unsanitary surgical practices often resulted in more deaths than cures.

He intended his new system of medicine to be a reformation of the existing 19th century medical practices he knew and imagined that someday "rational medical therapy" would consist of manipulation of the musculoskeletal system, surgery, and very sparingly used drugs. He invented the name "osteopathy" by blending two Greek roots osteon- for bone and -pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.

The new profession faced stiff opposition from the medical establishment at the time. The relationship of the osteopathic and medical professions was often "bitterly contentious" and involved "strong efforts" by medical organizations to discredit osteopathic medicine. Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a cult and osteopaths were seen as "cultist." The AMA code of ethics declared it unethical for a medical physician to voluntarily associate with an osteopath.

One notable advocate for the fledgling movement was Mark Twain. Manipulative treatments had purportedly alleviated the symptoms of his daughter Jean's epilepsy as well as Twain's own chronic bronchitis. In 1909, he spoke before the New York State Assembly at a hearing regarding the practice of osteopathy in the state. "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven't been able to sleep." Philosophically opposed to the American Medical Association's stance that its own type of medical practice was the only legitimate one, he spoke in favor of licensing for osteopaths. Physicians from the New York County Medical Society responded with a vigorous attack on Twain, who retorted with "[t]he physicians think they are moved by regard for the best interests of the public. Isn't there a little touch of self-interest back of it all?" "... The objection is, people are curing people without a license and you are afraid it will bust up business."

1916-1966, Federal recognition
Recognition by the US federal government was a key goal of the osteopathic medical profession in its effort to establish equivalency with its MD counterparts. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the US Military Medical Corps. On May 3, 1966 Secretary of Defense Robert McNamara authorized the acceptance of DO's into all the medical military services on the same basis as MD's. The first DO to take the oath of office to serve as a military physician was Harry J. Walter. The acceptance of osteopathic physicians was further solidified in 1996 when Ronald Blanck, DO was appointed to serve as Surgeon General of the Army, the first osteopathic physician to hold the post.

1962, California
In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $8 million to end the practice of osteopathic medicine in the state. In 1962, Proposition 22, a statewide ballot initiative in California, eliminated the practice of osteopathic medicine in the state. The California Medical Association (CMA) issued MD degrees to all DOs in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (DO) could obtain an MD degree; 86 percent of the DO's in the state (out of a total of about 2000) chose to do so." Immediately following, the AMA re-accredited the formerly-osteopathic University of California at Irvine College of Osteopathic Medicine as University of California, Irvine School of Medicine, an MD medical school. It also placed a ban on issuing physician licenses to DO's moving to California from other states. However, the decision proved to be controversial. In 1974, after protest and lobbying by influential and prominent DO's, the California Supreme Court ruled in Osteopathic Physicians and Surgeons of California v. California Medical Association, that licensing of DO's in that state must be resumed.

1969, AMA House of Delegates approval
In 1969, the American Medical Association (AMA) approved a measure allowing qualified osteopathic physicians as full and active members of the Association. The measure also allowed osteopathic physicians to participate in AMA-approved intern and residency programs. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur, MD sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of DO and MD professions. Today, a majority of osteopathic physicians are trained alongside MDs, in residency programs governed by the ACGME, an independent board of the AMA.

Non-discrimination policies
Recent years have seen a professional rapprochement between the two groups. DO's have been admitted to full active membership in the American Medical Association since 1969. The AMA has invited a representative of the American Osteopathic Association to sit as a voting member in the AMA legislative body, the house of delegates.

2006, American Medical Student Association
In 2006, during the presidency of an osteopathic medical student, the American Medical Student Association (AMSA) adopted a policy regarding the membership rights of osteopathic medical students in their main policy document, the "Preamble, Purposes and Principles."

2007, AMA
In recent years, the largest MD organization in the US, the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an MD or DO medical school.

In 2006, calls for an investigation into the existence of differential fees charged for visiting osteopathic and MD medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting DO and MD medical students at MD medical schools, it was found that one institution of the 102 surveyed charged different fees for DO and MD students. The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.



State licensing of practice rights
In the United States, laws regulating physician licenses are governed by the states. Between 1901 to 1989, osteopathic physicians lobbied state legislatures to pass laws giving those with a DO degree the same legal privilege to practice medicine as those with an MD degree. In many states, the debate was long and protracted. Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was California in 1901, the last was Nebraska in 1989.