From Wikipedia, the free encyclopedia
Osteopathic medicine is a branch of medicine based on the premise that the primary role of the physician is to facilitate the body's inherent ability to heal itself. Though practiced mainly in the United States, osteopathic medicine shares a common historical origin with a type of complementary medicine practiced worldwide, known as osteopathy. Physicians who graduate from osteopathic medical schools are sometimes known as osteopathic physicians and hold a doctorate in osteopathic medicine (D.O.), while holders of a similar, but far more common M.D. degree are known as allopathic physicians. The existence of this distinction and of D.O.s as licensed physicians is not widely known.Gevitz N. Visible and recognized: osteopathic invisibility syndrome and the 2% solution. The DO. March 1997:23-4, 26-7. PMID 9107129Founded as osteopathy by frontier physician Andrew Taylor Still as a radical rejection of the prevailing system of medical thought of the 19th century, the profession gradually moved closer to mainstream medicine in its practices, and came to be called "osteopathic medicine" within the United States. Today, osteopathic medicine is "no longer considered alternative medicine"JD Howell, MD PhD. The Paradox of Osteopathy. N Engl J Med. 1999 Nov 4;341(19):1465-8. PMID 10547412 and the training of osteopathic physicians is "virtually identical" to that of M.D. physicians.Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. Chapter 10. Complementary and Alternative Medicine Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw Hill. Osteopathic physicians use all conventional methods of diagnosis and treatment but are trained to place additional emphasis on the achievement of normal body mechanics as central to maintaining good health.Lesho, Emil. An Overview of Osteopathic Medicine. Arch Fam Med. 1999;8:477-484. PMID 10575385 D.O. physicians receive training in Osteopathic Manipulative Medicine (OMM), a form of manual therapy shown to be of some benefit for patients with certain musculo-skeletal disorders.Osteopathic medicine. Intelihealth.com. accessed Dec 2007. However, this form of therapy is used by a minority of osteopathic physicians in actual practice.Johnson, SM, Kurtz, ME, Kurtz, JC. “Variables influencing the use of Osteopathic Manipulative Treatment in Family Practice.” J Amer Osteopathic Assoc, 1997;97:80-87. PMID 9059002 In the United States, osteopathic medicine is considered by some both a profession and a social movement.Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998.
Demographics From its inception, the osteopathic profession has been smaller in numbers than its allopathic counterpart.Morzinski J and Henley C.Aligning the Interests of Osteopathic and Allopathic Teachers of Family Medicine. Annals of Family Medicine 4:182-184 (2006) PMID 16569724 Currently, there are 25 accredited osteopathic medical schools in 28 locations in the United States and 126 accredited U.S. allopathic medical schools.
[thumb|left|310px|Physicians entering U.S. workforce by education, 2005.Cohen, Jordan. [http://www.aamc.org/newsroom/reporter/april05/word.htm A Word from the President: "Filling the Workforce Gap." AAMC Reporter: April 2005. ]]
Osteopathic principles In addition to the Hippocratic oath, Osteopathic medical students take an oath to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:
#The body is a unit, and the person represents a combination of body, mind, and spirit.
#The body is capable of self-regulation, self-healing, and health maintenance.
#Structure and function are reciprocally interrelated.
#Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
SignificanceThere are different opinions on the significance of these principles. Some note that the osteopathic philosophy is akin to the tenets of holistic medicine.Osteopathic medicine. Intelihealth.com. They suggest that osteopathic philosophy is a kind of social movement within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the primary care physician within the health care system.About Osteopathic Medicine. American Osteopathic Association. Accessed 30 Aug 2007. [http://www.osteopathic.org/index.cfm?PageID=ost_main]Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998. Stephen Barrett argues that the American Osteopathic Association's emphasis of the core principles amounts to a form of professional indoctrination, glorifying osteopathic principles while misrepresenting those of the allopathic community.Barrett, Stephen M.D. Dubious Aspects of Osteopathy. Quackwatch. 18 Aug 2003. Still others point out that there is nothing in the principles that would distinguish osteopathic from allopathic training in any fundamental way. One study, published in the Journal of the American Osteopathic Association found a majority of allopathic medical school administrators and faculty saw nothing objectionable in the core principles, and some would even endorse them generally as sound medical principles.
A new movement within medicineFrontier physician Andrew Taylor Still, M.D., D.O., founded the American School of Osteopathy (now Kirksville College of Osteopathic Medicine of A.T. Still University of Health Sciences) 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.Still AT. The Philosophy and Mechanical Principles of Osteopathy. Kansas City, Mo: Hudson-Kimberly Pub Co; 1902:9–20,185,210,270. Version 2.0. Inter Linea Web site. Accessed January 23, 2006. 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, castor oil, whiskey, and opium. In addition, unsanitary surgery often resulted in more deaths than cures.Hansen, G. Beyond OMT: Time for a New Chapter in Osteopathic Medicine? J Am Osteopath Assoc 2006 Mar;106(3):114-6. PMID 16585374] 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 osteopathic and allopathic professions was often "bitterly contentious"Cohen, Jordan. A Word from the President: "Filling the Workforce Gap." AAMC Reporter: April 2005. [http://www.aamc.org/newsroom/reporter/april05/word.htm] and involved "strong efforts" by allopathic organizations to discredit osteopathic medicine.Chapter 34: Complementary and Alternative Medicine. Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004. Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a cult and D.O.s were seen as "cultist." The AMA code of ethics made it unethical for an M.D. physician to voluntarily associate with a D.O.Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998.One notable advocate for the fledgling movement was Mark Twain. Manipulative treatments had purported 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's 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 "the 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 recognitionRecognition by the federal government was a key goal of the osteopathic medicine in its effort to establish equivalency with its allopathic counterpart. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the U.S. Military Medical Corp. On May 3rd, 1966 Secretary of Defense Robert McNamara authorized the acceptance of D.O.s into all the medical military services on the same basis as M.D.s. The first D.O. 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 Blank, D.O. was appointed to serve as Surgeon General of the Army, the first osteopathic physician to hold the post.
1962, CaliforniaIn 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 M.D. degrees to all D.O.s in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (D.O.) could obtain an M.D. degree; 86 percent of the D.O.'s in the state (out of a total of about 2000) chose to do so."Howell, JD. The Paradox of Osteopathy. N Engl J Med. 1999 Nov 4;341(19):1465-8. PMID 10547412 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 allopathic medical school. It also placed a ban on issuing physician licenses to D.O.s moving to California from other states. However, the decision proved to be controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled in Osteopathic Physicians and Surgeons of California v. California Medical Association, that licensing of D.O.s in that state must be resumed.
1969, AMA residencies open to DOsIn 1969, the AMA House of Delegates 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, M.D. sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of osteopathic and allopathic professions. Today, a majority of osteopathic physicians are trained alongside M.D.s, in residency programs governed by the AMA.
1976-1987, Principle 3 and Wilk v. AMAOsteopathic medical schools teach a form of manual therapy called Osteopathic manipulative medicine (OMM). In the past, the AMA considered manual therapy to be an unproven, unscientific method of treatment. Before 1980, Principle 3 of the AMA Principles of medical ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Also, up until 1974, the AMA had a Committee on quackery that openly challenged what it considered to be many unscientific forms of healing, including OMM and chiropractic medicine. The AMA changed its policies towards osteopathic manipulative medicine largely as a result of a court ruling regarding chiropractic medicine, the Wilk case. In that case, the AMA was convicted of unlawful conspiracy in restraint of trade.Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987 Following the ruling, Principle 3 was removed from the AMA statement of medical ethics.
Non-discrimination policiesRecent years have seen a professional rapprochement between the two groups. D.O.'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.Wilson, Jennifer Fisher. [http://www.acponline.org/journals/news/nov97/osteopat.htm Osteopathic medicine's growing pains]. American College of Physicians Observer. November 1997.
2006, American Medical Student AssociationIn 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, AMAIn recent years, the largest allopathic organization in the U.S., the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an allopathic or osteopathic medical school.AMA policy H-295.876 [http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-295.876.HTM] In 2006, calls for an investigation into the existence of differential fees charged for visiting osteopathic and allopathic medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting osteopathic and allopathic medical students at allopathic medical schools, it was found that one institution of the 102 surveyed charged different fees for osteopathic and allopathic students.Thomas MK (presenter). Recommendation on Equal Fees for Osteopathic and Allopathic Medical Students. Council on Medical Education, American Medical Association. Report 6-A-07. The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.
Practice Rights from the StatesIn 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 D.O. degree the same legal privilege to practice medicine as those with an M.D. 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.Gevitz N. The D.O.s: osteopathic medicine in America''. Baltimore: Johns Hopkins University Press, 1982.
Education and trainingAccording to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and board certification."Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. Chapter 10. Complementary and Alternative Medicine Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw Hill.DO-granting U.S. medical schools have curricula identical for the most part to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine. Upon graduation, osteopathic medical physicians may opt to pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating internship at a hospital approved by the American Osteopathic Association (AOA). Osteopathic physicians may apply to residency programs accredited by either the AOA or the Accreditation Council for Graduate Medical Education (ACGME). Currently, osteopathic physicians participate in more ACGME programs than in programs approved by the American Osteopathic Association (AOA).
Manipulative therapyWithin the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. However, a 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like allopathic physicians in every respect—few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment.Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76:821 –828. PMID 11500286] The American Osteopathic Association has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation as well as to encourage D.O.s to consistently offer manipulative treatments to their patients. However, the number of D.O.s who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist Norman GevitzZuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998. cites poor educational quarters and few full-time OMM instructors as major factors for the decreasing interest of medical students in OMM. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction," and he claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students.Gevitz, Norman. Center or Periphery? The Future of Osteopathic Principles and Practices. J Am Osteopath Assoc. 2006 Mar;106(3):121-9. PMID 16585378]At the same time, recent studies show an increasingly positive attitude of patients and physicians (allopathic and osteopathic) towards the use of manual therapy as a valid, safe and effective treatment modality. One survey, published in the Journal of Continuing Medical Education, found that a majority of physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe, and over half (56% of physicians and 59% of patients) felt that manipulation should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM.Stoll ST, Russo DP, Atchison JW. Physicians and patients' attitudes toward manual medicine: implications for continuing medical education. J Contin Educ Health Prof. 2003 Winter;23(1):13-20. PMID 12739255 Another small study examined the interest and ability of allopathic residents in learning osteopathic principles and skills, including OMM. It showed that after a 1-month elective rotation, the M.D. residents responded favorably to the experience.James D. Leiber. [http://www.stfm.org/fmhub/fm2005/November-December/James693.pdf Allopathic Family Medicine Residents Can Learn Osteopathic Manipulation Techniques in a 1-month Elective'']. Fam Med 2005;37(10):693-5. PMID 16273444
Professional attitudesRecent years have seen an increasingly cooperative climate between the osteopathic and allopathic professions. In 1998, a New York Times article described the increasing numbers, public awareness, and mainstreaming of osteopathic physicians, but said that "some aspects of osteopathic practice can still raise eyebrows among conventional doctors." "Leaders of conventional medicine may no longer use the word quack, but many still look askance at the osteopathic system of medical thought, which they feel lacks the intellectual rigor and the scientific underpinnings of their own practice."Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998. In 2005, during his tenure as president of the American Association of Medical Colleges, Jordan Cohen described climate of cooperation between allopathic and osteopathic practitioners. Elsewhere, he has remarked that osteopathic manipulative medicine (OMM) can be an aid to the physician in fostering a relationship with the patient, while also a source of "skepticism on the part of the allopathic world." In particular, he noted that suggestions that OMM could be used to treat diseases other than back problems, "reinforces lingering feelings among proponents of conventional medicine that osteopathy is simply a less intellectual field all around."Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998.
International practice rightsEach country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the U.S. Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States.Notices. Federal Register. Vol. 70, No. 190. 3 Oct 2005. Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained D.O.s are currently able to practice in 45 countries with full medical rights and in several others with restricted rights.The Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) is an independent board of the American Osteopathic Association. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained D.O.s. Towards this end, the BIOMEA works with international health organizations like the World Health Organization (WHO), the Pan American Health Organization (PAHO) as well as other groups. International. American Osteopathic Association. DO-online.org [https://www.do-online.org/index.cfm?PageID=lcl_main&au=A&SubPageID=lcl_interntnl]The procedure by which international countries consider granting physician licensure to foreigners varies widely. For U.S. trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, M.D. or D.O.AOA International License Summary. American Osteopathic Association. Council on International Osteopathic Medical Education and Affairs.[http://www.tugsa.net/InternationalDO.pdf] Many countries recognize US-trained M.D.s as applicants for licensure, granting successful applicants them "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained D.O.s similarly to their allopathic counterparts, with some success. In 44 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council of Great Britain announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath."DOs around the World. American Osteopathic Association.[http://www.osteopathic.org/index.cfm?PageID=ost_dogoblobal] The American Medical Student Association strongly advocates for U.S.-trained D.O. international practice rights "equal to that of Allopathic physicians."Principles Regarding Osteopathic Medicine. Preamble, Purposes and Principles. American Medical Student Association.
Criticism Traditional osteopathic medicine, specifically OMM, has been criticized for unproven techniques such as cranial and cranio-sacral manipulation. Some question the therapeutic utility of osteopathic manipulative treatment modalities. A Harvard medical school reviewed website cites numerous studies demonstrating that there are some ailments for which the benefit of manipulative therapy has "firmly established" scientific support.~st,8513|~r,WSIHW000|~b,
Future of osteopathic medicine
Maintaining distinctivenessThere is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within U.S. health care.Gevitz, Norman. Center or Periphery? The Future of Osteopathic Principles and Practices. J Am Osteopath Assoc. 2006 Mar;106(3):121-9. PMID 16585378Tatum, William O, IV. AOA Needs to Reach Out More. J Am Osteopath Assoc. Vol 106 No 8 p442-443. August 2006.Mychaskiw, George. Will the Last DO Turn Off the Lights? Journal of the American Osteopathic Association. Vol 106 No 5 May 2006. 252-302. PMID 16717365Steiner, Kenneth. Time to Accept Allopathic Physicians Into AOA-Approved Residencies? Journal of the American Osteopathic Association. Vol 106 No 5 May 2006 250-252. PMID 16717364Tosca M. Future of osteopathic medicine depends on investing in graduate medical education. J Am Osteopath Assoc. 106(6):319. June 2006. PMID 16790537 JD Howell, author of The Paradox of Osteopathy, notes claims of a "fundamental yet ineffable difference between allopathic and osteopathic physicians" are based on practices such as "preventive medicine and seeing patients in a sociological context" that are "widely encountered not only in osteopathic medicine but also in allopathic medicine."Howell, JD. Correspondence. New Engl J Med. Volume 342:817-820 Number 11. 16 March 2000. Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a D.O. from an M.D.Johnson SM, Kurtz ME. Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts. Soc Sci Med. 2002; 55:2141 –2148. PMID 12409127Licciardone, JC. A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004 Osteopath Med Prim Care. 2007 Jan 12;1:2. PMID 17371578 Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.
For-profit medical educationThe accredidation of RVUCOM generated some controversy before the school held its first class. Like all osteopathic medical schools, RVUCOM is accredited by a board of the American Osteopathic Association (AOA). Unlike the other 28 osteopathic and 126 allopathic medical colleges in the U.S., RVUCOM is organized as a for-profit corporation.Croasdale, Myrle. First for-profit med school nears approval. American Medical News. 1 Oct 2007. Critics claimed the AOA's approval of a for-profit school "erodes creditability" of osteopathic medical schools, especially in comparison to their allopathic counterparts.Mychaskiw G. COM Accreditation: the Flexner Report revisited. J Am Osteopath Assoc. 2007 Jul;107(7):246-7; 277. PMID 17682109 The Liaison Committee on Medical Education, which accredits the M.D.-granting (allopathic) U.S. medical schools, has banned for-profit schools.Mychaskiw G. Future of DO. powerpoint presentation. accessed 7 Nov 2007. School officials insist the for-profit status of the school will not compromise the integrity of its educational mission.Martin RB. RVUCOM: Striving to Meet the Needs of the Osteopathic Medical Profession J Am Osteopath Assoc. 2007 Oct;107(10):426-8. PMID 17956994 AOA president Peter Ajluni responded, "there are many socially minded for-profit companies that contribute time, resources, and profits to their communities" and "for-profit institutions like RVUCOM can further the cause of osteopathic medicine in the United States."Ajluni PB. Nonprofit and For-Profit COMs: Investing in the Future of Osteopathic Medicine. J Am Osteopath Assoc. 2007 Oct;107(10):425-6. PMID 17956993]
This article is based on an article from Wikipedia, the free encyclopedia and is available under the terms of GNU Free Documentation License.
In the Wikipedia there is a list with all authors of this article available.