Osteopathic Medical Research Eugene Mochan, PhD,DO Associate Dean Primary Care Philadelphia College Osteopathic Medicine

Overview The Way it Was The Way it is Today New Research Directions

The Way it Was

The Early Years A.T. Still, MD –Limitations of allopathic medicine New Focus –Musculoskeletal –Holistic Approach –Patient-centered care –Seems to work –Pressure to prove mechanism World War II

Tenets of Osteopathic Medicine (A.T.Still, MD) First, do no harm. A thoughtful diagnosis should be made before exposing the patient to any potentially harmful procedure. Look beyond the disease for the cause. Treatment should center on the cause, with effect addressed only when it benefits the patient in some tangible way. The practice of medicine should be based on sound medical principles. Only therapies proven clinically beneficial in improving patient outcome should be recommended.

Tenets of Osteopathic Medicine(con’t) The body is subject to mechanical laws. The science of physics applies to humans. Even a slight alteration in the body’s precision can result in disorders that overcome natural defenses. The body has the potential to make all substances necessary to insure its health. No medical approach can exceed the efficacy of the body’s natural defense systems if those defenses are functioning properly. Therefore, teaching the patient to care for his own health and to prevent disease is part of a physician’s responsibility. The nervous system controls, influences, and/or integrates all bodily functions. Osteopathy embraces all known areas of practice.

Tenets of Osteopathic Medicine(1955) Body is a unit Body possesses self-regulatory mechanisms Structure and function are reciprocally interrelated Rational therapy is based on understanding how all of the above interact

The Way it is Today

Proposed New Tenets of OM Proposed Principles:Patient Care 1. A person is the product of dynamic interaction between body, mind and spirit. 1.The patient is the focus for healthcare. 2. An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease. 2. The patient has the primary responsibilty for his/her health.

Proposed New Tenets of OM Proposed Principles: Patient Care 3.Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness. 3.An effective treatment program for patient care is founded on these tenets (and incorporates evidence-based guidelines, optimizes the patient’s natural healing capacity, addresses the primary cause of disease, and emphasizes health maintenance and disease prevention.) 4.The MS system significantly Influences the individual’s ability to resist disease processes.

University of North Texas Health Science Center (UNTHSC) Osteopathic Research Center (2001) Nationwide collaborative research on the efficacy of OMM Fellowship Programs “Belongs” to osteopathic profession and research community ( –Glossary, clinical research database Primary care practice-based research network

New Research Directions

Setting a National Research Agenda At the 111 th Annual Meeting of the AOA Clinical and Scientific Meeting (2006), the AOA hosted the 50 th Annual Research Conference “Osteopathic Medicine in the American Health Care System” This meeting was very special for several reasons: –~100 presentations dealing with OMR ( OMM/OPP, clinical studies, basic science, medical education) -- over 50 DO residents/students were actively involved in the projects

What Have We Learned??

Disease Improvement with Decent Evidence Back pain (Level A) Acute ankle injuries Asthma Epicondylitis Otitis Media?

Suggestion of Some Disease Improvement with Marginal Evidence Bell’s palsy Cerebral palsy Headache Hepatitis Mononucleosis Premenstrual syndrome Rheumatoid arthritis Mononucleosis Epilepsy Heartburn Parkinson’s disease

Low Back Pain

Figure 2. Effect size for low back pain. CI denotes confidence interval; OMT, osteopathic manipulative treatment. Overall effect size, -0.30; 95% CI, – -0.13; P =

Summary Significant progress has been made in setting a national research agenda for primary care oriented osteopathic medical research