Response
http://www.100md.com
《美国整骨期刊》
JAOA—Journal of the American Osteopathic Association Chicago, Ill, Downriver Cardiology Consultants Trenton, Mich
I thank all four letter writers for their provocative comments.
The tenets and principles of osteopathic medicine can be advanced through research, scholarly publications, education programs, and clinical practice. To that list, John B. Crosby, JD, executive director of the American Osteopathic Association (AOA), adds advocacy by the presidents of the AOA and public relations/marketing.
R. Paul Lee, DO, makes a plea for "connective tissue," as opposed to the musculoskeletal system, to be a defining element of osteopathic medicine. This suggestion from Dr Lee highlights a challenge we faced as an ad hoc committee charged with updating the tenets and principles of osteopathic medicine in 2002.1 Although we were tempted to make a statement of personal preference, our obligation was to present the dominant expression in philosophy and in clinical practice. The most prominent interpreter of osteopathic medicine in the 20th century was Irvin M. Korr, PhD, a member of our ad hoc group. Dr Korr often referred to the central role of the musculoskeletal system.2,3 Dr Lee reminds us of our founder's description of the fascia as the dwelling place of the soul. That description has a certain charm. It calls to mind the colorful language Andrew Taylor Still often used as well as the many "supremes" that he cited, which include the artery, nerves, the lymphatics, the diaphragm, and cerebrospinal fluid.4
Mark E. Rosen, DO, addresses an issue that is often a challenge for those who try to define the distinctiveness of osteopathic medicine. If one is restricted to those areas where osteopathic medicine is unique, the "definition" becomes a short statement and misses the comprehensive scope of our profession. Likewise, an emphasis on attributes of osteopathic medicine that may be shared with other healthcare providers (eg, a "whole person" approach, the patient as the focus for healthcare) risks the interpretation that an osteopathic physician is just another "good physician." Our group tried to capture the distinctive and comprehensive nature of osteopathic medicine with the proposed tenets and principles of osteopathic medicine,1 which updated the previous statement from 19535 and expanded it to define principles for patient care. Our work in 20021 represented the foundation for my May 2005 special communication.6
Douglas M. Goldsmith, DO, and Mr Crosby both mention the Osteopathic Research Center (ORC) based on the campus of the University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine. I did not want to emphasize the topic of research in my article6 because the focus of my piece was the advancement of the tenets and principles of osteopathic medicine through clinical practice, which I feel is a practical goal.
On the other hand, establishing a research center is a daunting proposition. Centers of excellence in research typically call for start-up costs of between $10 million and $40 million— or more. Furthermore, such centers need to develop in the context of a major institution-wide program of research that is much larger in scope. The ORC was established with seed money ($1.1 million over 4 years) from the AOA, the American Osteopathic Foundation, and the American Association of Colleges of Osteopathic Medicine. This seed grant allowed the ORC to take the first step to apply for additional funding so that it may become a center of excellence.
As a member of the external advisory committee to the ORC, I know they have made remarkable progress in a short period, conducting multiple clinical trials and winning a U19 grant from the National Institutes of Health (NIH). Since my last visit to the ORC in April 2005, they have secured a grant from the Osteopathic Heritage Foundation that will allow them to conduct a national search for a research chair to head the basic science program. The next step for the ORC is to obtain funding for an NIH program project grant ($5 million to $10 million). At that point, the ORC will have a center of excellence in osteopathic manipulative medicine, the only such center in the country.
Like Dr Goldsmith, I was a medical student at the Kirksville College of Osteopathic Medicine in Missouri and had the opportunity to work with John Stedman Denslow, DO, and Irvin M. Korr, PhD. That research program was unparalleled at the time and served in many ways as a model for the current ORC.
It is important to dispel the unfortunate impression that the ORC now meets the research needs of our profession, as might be inferred from Mr Crosby's comments. Osteopathic medicine is a complete school of practice. It is far too large for any one research center to establish a program to test our tenets and principles, much less to define our future growth and development.
References
2. Korr IM. Osteopathic research: the needed paradigm shift [review]. J Am Osteopath Assoc.1991; 91:156,161 –168,170,171.
3. Korr IM. An explication of osteopathic principles. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:12 –18.
4. Korr IM, Korr JM. The supremes of A.T. Still. J Am Acad Osteopath. 1991;1:7 –8.
5. Thompson M, for the Special Committee on Osteopathic Principles and Osteopathic Technic, Kirksville College of Osteopathy and Surgery. An interpretation of the osteopathic concept: tentative formulation of a teaching guide for faculty, hospital staff and student body. J Osteopathy. 1953;60:7 –10.
6. Rogers FJ. Advancing a traditional view of osteopathic medicine through clinical practice. J Am Osteopath Assoc. 2005;105:255–259. Available at: http://www.jaoa.org/cgi/content/full/105/5/255. Accessed February 21, 2006.(FELIX J. ROGERS, DO, Asso)
I thank all four letter writers for their provocative comments.
The tenets and principles of osteopathic medicine can be advanced through research, scholarly publications, education programs, and clinical practice. To that list, John B. Crosby, JD, executive director of the American Osteopathic Association (AOA), adds advocacy by the presidents of the AOA and public relations/marketing.
R. Paul Lee, DO, makes a plea for "connective tissue," as opposed to the musculoskeletal system, to be a defining element of osteopathic medicine. This suggestion from Dr Lee highlights a challenge we faced as an ad hoc committee charged with updating the tenets and principles of osteopathic medicine in 2002.1 Although we were tempted to make a statement of personal preference, our obligation was to present the dominant expression in philosophy and in clinical practice. The most prominent interpreter of osteopathic medicine in the 20th century was Irvin M. Korr, PhD, a member of our ad hoc group. Dr Korr often referred to the central role of the musculoskeletal system.2,3 Dr Lee reminds us of our founder's description of the fascia as the dwelling place of the soul. That description has a certain charm. It calls to mind the colorful language Andrew Taylor Still often used as well as the many "supremes" that he cited, which include the artery, nerves, the lymphatics, the diaphragm, and cerebrospinal fluid.4
Mark E. Rosen, DO, addresses an issue that is often a challenge for those who try to define the distinctiveness of osteopathic medicine. If one is restricted to those areas where osteopathic medicine is unique, the "definition" becomes a short statement and misses the comprehensive scope of our profession. Likewise, an emphasis on attributes of osteopathic medicine that may be shared with other healthcare providers (eg, a "whole person" approach, the patient as the focus for healthcare) risks the interpretation that an osteopathic physician is just another "good physician." Our group tried to capture the distinctive and comprehensive nature of osteopathic medicine with the proposed tenets and principles of osteopathic medicine,1 which updated the previous statement from 19535 and expanded it to define principles for patient care. Our work in 20021 represented the foundation for my May 2005 special communication.6
Douglas M. Goldsmith, DO, and Mr Crosby both mention the Osteopathic Research Center (ORC) based on the campus of the University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine. I did not want to emphasize the topic of research in my article6 because the focus of my piece was the advancement of the tenets and principles of osteopathic medicine through clinical practice, which I feel is a practical goal.
On the other hand, establishing a research center is a daunting proposition. Centers of excellence in research typically call for start-up costs of between $10 million and $40 million— or more. Furthermore, such centers need to develop in the context of a major institution-wide program of research that is much larger in scope. The ORC was established with seed money ($1.1 million over 4 years) from the AOA, the American Osteopathic Foundation, and the American Association of Colleges of Osteopathic Medicine. This seed grant allowed the ORC to take the first step to apply for additional funding so that it may become a center of excellence.
As a member of the external advisory committee to the ORC, I know they have made remarkable progress in a short period, conducting multiple clinical trials and winning a U19 grant from the National Institutes of Health (NIH). Since my last visit to the ORC in April 2005, they have secured a grant from the Osteopathic Heritage Foundation that will allow them to conduct a national search for a research chair to head the basic science program. The next step for the ORC is to obtain funding for an NIH program project grant ($5 million to $10 million). At that point, the ORC will have a center of excellence in osteopathic manipulative medicine, the only such center in the country.
Like Dr Goldsmith, I was a medical student at the Kirksville College of Osteopathic Medicine in Missouri and had the opportunity to work with John Stedman Denslow, DO, and Irvin M. Korr, PhD. That research program was unparalleled at the time and served in many ways as a model for the current ORC.
It is important to dispel the unfortunate impression that the ORC now meets the research needs of our profession, as might be inferred from Mr Crosby's comments. Osteopathic medicine is a complete school of practice. It is far too large for any one research center to establish a program to test our tenets and principles, much less to define our future growth and development.
References
2. Korr IM. Osteopathic research: the needed paradigm shift [review]. J Am Osteopath Assoc.1991; 91:156,161 –168,170,171.
3. Korr IM. An explication of osteopathic principles. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:12 –18.
4. Korr IM, Korr JM. The supremes of A.T. Still. J Am Acad Osteopath. 1991;1:7 –8.
5. Thompson M, for the Special Committee on Osteopathic Principles and Osteopathic Technic, Kirksville College of Osteopathy and Surgery. An interpretation of the osteopathic concept: tentative formulation of a teaching guide for faculty, hospital staff and student body. J Osteopathy. 1953;60:7 –10.
6. Rogers FJ. Advancing a traditional view of osteopathic medicine through clinical practice. J Am Osteopath Assoc. 2005;105:255–259. Available at: http://www.jaoa.org/cgi/content/full/105/5/255. Accessed February 21, 2006.(FELIX J. ROGERS, DO, Asso)