Perspectives in Biology and Medicine

In the second edition of The DOs: Osteopathic Medicine in America, Norman Gevitz extends and updates his assessment of the relationship between osteopathic physicians, their allopathic colleagues, and American society. The second edition continues to chronicle in detail a historical basis from the osteopathic [End Page 618] perspective as to its favorable relationship with the American public and its adversarial one with their allopathic colleagues. As he did in the first edition (1982), Gevitz draws a clear portrait of the founding philosophy and the founder, Dr. Andrew T. Still. Still was trained in orthodox medicine before the Civil War. He spent most of his training in an apprenticeship under a local doctor with didactic work for an unknown period of time in Kansas City. His faith in the orthodox medicine of the time faltered with the death of three of his children from meningitis after the war. Faith-based philosophy and open-mindedness led to his success as a physician and his ability to found the first American College of Osteopathy in 1892.

Clearly, the 21st-century osteopath has an inferiority complex, but even though the "orthodox" medical image and majority culture has maintained its dominance as mainstream medicine in America through breathtaking medical discoveries and great science, American capitalist culture, which thrives on choice, has rejected the notion that alternative medicine is quackery. A second edition should give readers an update on the medical society in which both osteopathy and allopathy operate. Gevitz cannot deliver this update because he is too mired in the osteopath's past feeling of inferiority to see that the initial divergence of the two medical cultures is now converging and that they are becoming more alike each day.

As you read The DOs, Still's success as a medical visionary and mentor is striking and parallels the remarkable success that Sir William Osler had in creating the standard for allopathic training at Johns Hopkins University Medical School. Unfortunately, The DOs fails to make obvious this parallel that ironically also provided the crux in North American medicine at the turn of the 20th century. The paths of osteopathy and orthodox medicine are, first and foremost, geographically divergent. The urban polish and academia of the East (including Europe) versus the survivalist rural frontier of the West provide the environs in which American medical society gestates as fraternal twins. It is in understanding this dichotomy not on an economic level but rather on a philosophical level that one can explain why osteopathy has and will continue to remain independent even as it incorporates aspects of orthodox and alternative medical science into its philosophy. Specifically, the question The DOs does not propose or answer is, on what platform would medicine investigate and treat disease at the start of the 20th century? Osler and colleagues, who received advanced training mostly in Europe, were for the most part focused on microbiology and investigating disease by attacking the specific pathology of organs. They had rich monetary support and equipment to practice their trade. Still and colleagues (mostly European doctors coming to learn from Still) were most interested in the entire human body as the platform by which disease and microorganisms can flourish. Still's group had very little monetary resources and doubtful even a microscope. They relied on their hands for diagnosis and care while on the frontier. These [End Page 619] two distinct philosophies are maintained today in the medical schools and define the main difference between the DO and MD degrees.

Without doubt the name osteopathy propagates further confusion and assimilates manipulation of the musculoskeletal system as the distinguishing expertise of the DO. But is it necessary, as Gevitz suggests, for all DOs to perform manipulation in their daily care of patients in order to maintain a separate identity? The osteopathic philosophy does not have to distinguish itself with manipulation, but at the same time it...