698 • JAOA • Vol 101 • No 12 • December 2001 New & noteworthy/Letters
sponsible for communicating with IRBs/IECs,
for ensuring that the approved procedures of
obtaining informed consent are followed, for
determining that protocols are followed, and for
reporting adverse events.
IRBs/IECs are responsible for scrutinizing
proposed research and ascertaining that both the
work and the workers comply with agreed-upon
standards, and for monitoring ongoing studies for
safety and responsible conduct.
Academic institutions must act responsibly in
allocating appropriate funding for the protection
of human subjects, and by providing IRBs/IECs
and other institutional bodies with the stature,
authority, and resources required to do the job.
The unfortunate events described in this
report remind us that ongoing vigilance and
effort and continuing education are all required,
here in the United States and in overseas set-tings,
to protect those who volunteer to partici-pate
in clinical research.
Terrie E. Taylor, DO
Professor, Internal Medicine
Michigan State University College of
Osteopathic Medicine
East Lansing, Michigan
References
1. Stevens J. As drug testing spreads, profits and lives
hang in balance. Washington Post. December 17, 2000;
The Body Hunters series, No. 1. Health section:A1.
2. Stevens J. Doctors say drug trial’s approval was
backdated. Washington Post. January 16, 2000; Health
section:A01.
3. Malakoff D. Nigerian families sue Pfizer, testing the
reach of US Law. Science 2001;293:1742.
4. Kolata G. Johns Hopkins death brings halt to US-financed
human studies. New York Times. July 20,
2001.
5. Bren L. Human research reinstated at Johns Hopkins,
with conditions. FDA Consumer [serial online]. Septem-ber-
October 2001;35(5):doc 1. Available at: http://www.
fda.gov/fdac/features/2001/501_john.html. Accessed
November 8, 2001.
6. Shalala D. Protecting research subjects—what must
be done. N Engl J Med 2000;343:808-810.
Guide OPTI
development beyond
organizational differences
To the Editor:
From the onset, the osteopathic postgrad-uate
training institution (OPTI) concept has
been hailed as an innovative approach to
graduate medical education in a strongly
competitive environment challenged by
shrinking resources. Through several years
of careful, tedious, and sometimes strained
collaboration of osteopathic constituent
stakeholders, the OPTI was born. The first
OPTI was accredited in 1998, and as of
today, 18 OPTIs are accredited and opera-tional.
It has not been without difficulty,
and the OPTI, now in its infancy, must be
nurtured and continuously improved to
affect excellence in osteopathic graduate
medical education.
All would agree intellectually that OPTI
is about quality osteopathic graduate med-ical
education. However, as the major orga-nizations
who ultimately determine the
OPTIs’ success have divergent ideas on
implementation and the path to achieving
quality, OPTI development is sometimes
unclear. These differences result in part
from organizational perceptions and mis-understandings
about the other major con-tributing
organizations in terms of finan-cial
resources, tuition utilization, and re-sponsibilities
of the hospitals or colleges.
Under the leadership of James E. Zini,
DO, who has prioritized the OPTIs’ devel-opment
during his presidency, the leadership
of constituent stakeholders are urged to put
their best foot forward. It is clear that the
Association of Osteopathic Directors of
Medical Education, the American Osteo-pathic
Healthcare Association, the Ameri-can
Association of Colleges of Osteopath-ic
Medicine, Osteopathic Specialty Colleges,
and the American Osteopathic Association
are sincere and dedicated, all wanting suc-cess
for our profession. Regional, state, and
program needs must be recognized and con-sidered
as we all progress toward the same
goal.
It is up to us to ensure quality osteo-pathic
graduate medical education—through
OPTI—that will provide our students with
distinct and excellent opportunities in osteo-pathic
medicine. The future of our profes-sion
is at stake.
R. Michael Gallagher, DO
Vice chair
Council on Postdoctoral Training
American Osteopathic Association
Careless abandonment
of osteopathic identity
or lack of instillation in
medical school?
To the Editor:
Addressing the need for osteopathic medi-cal
schools to foster a sense of identity,
Robert Fogel, DO, stated that, “our stu-dents
have thrown out the baby with the
bath water in an endeavor to completely
emulate the practices of their allopathic
counterparts” (JAOA 2001;101:330). From
a student’s perspective, one could easily
make the argument that the baby is never in
the possession of the osteopathic student
and therefore cannot be thrown out.
In the first year of osteopathic medical
school, osteopathic medicine is presented
as a separate entity from other classes, such
as anatomy and biochemistry. Due to this
lack of integration, the campus Osteopath-ic
Manipulative Medicine office is quickly
assumed to have a separate ideology.
Because faculty who lack knowledge of
Letters
Letters JAOA • Vol 101 • No 12 • December 2001 • 699
osteopathic medicine teach classes, they do
not give students an osteopathic education.
As classes become more clinical, few clini-cians—
most of whom are osteopathic physi-cians—
bring little, if any, osteopathic out-look
to lectures. When there is an attempt
to teach or instill an osteopathic identity
over the 2 classroom years, the students
have already dismissed it. Is it any wonder
that fewer than 30% of third- and fourth-year
students have adequate exposure to
osteopathic manipulative treatment (OMT)
in clinical rotations?1 Is it obvious why 90%
of residents and interns report rarely incor-porating
OMT in their practice?2 In a vi-cious
cycle, these students become interns,
residents, and attendings who then present
the same osteopathic education they received
to their students.
The school and its curriculum cannot
be solely at fault. Dr Fogel states: “Our
prescient notions of holistic care and the
importance of the primary care physician in
healthcare delivery have been accepted by
insurance companies.” It is hard to agree
with this statement when insurance com-panies
exert pressure to turn over large
numbers of patients in a short time, and
OMT is not always reimbursed. Manipu-lation
is the first to go because of the time
and money constraints placed on the physi-cian.
The current system makes it hard for
osteopathic physicians to practice the
medicine they once dreamed of providing to
patients.
Beyond speculating about who is to
blame for the lack of osteopathic identity,
one must look at what the osteopathic iden-tity
is and why it is so important to prop-agate
it. Fogel says that the osteopathic
identity can be provided by “demystifying
osteopathic medicine and presenting its
principles and practice as the art of ambu-latory
orthopedics.” Unfortunately, this
would not demystify the identity but would,
in fact, change it into something it is not.
Osteopathic manipulative medicine treats
more than musculoskeletal problems; it uses
the neuromusculoskeletal system to treat
and affect the entire body, whether through
high-velocity thrust techniques or osteopa-thy
in the cranial field. Osteopathic manip-ulative
treatment goes beyond treating low
back pain, headaches, and chest pain from
a cough and can be used alone or in con-junction
with other modes of therapy
because it treats the whole body. There-fore,
students should not be limited to diag-nosing
and treating a few selected condi-tions.
Instead, students should learn how to
use OMT and practice it as the art that it is
for every condition and for the entire body.
We dismiss this approach because medicine
is becoming more specialized, but osteo-pathic
medicine, when practiced correctly,
is a holistic approach from which a modal-ity
of treatment has sprung. Students need
to use their knowledge of applied anato-my,
physiology, pharmacology, and pathol-ogy
to give patients the best possible care,
because it is this knowledge combined with
current modes of therapy, technologies, and
manual medicine that provides a way to
see how pathologic processes affect physi-ologic
mechanisms and anatomy. This then
becomes the art of osteopathic medicine
and the basis of the osteopathic identity.
Approaches to fostering the osteopath-ic
identity should be grounded in preserving
the osteopathic identity as it was envisioned
by its founder, A. T. Still, MD, DO, rather
than changing it to accommodate current
conditions. For this to happen, the osteo-pathic
identity must be taught to the stu-dent—
who then realizes that he or she has
the baby and, hopefully, will never have
reason to throw it out.
Brian Acunto, MSII
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania
References
1. Fry LJ. Preliminary findings on the use of
osteopathic manipulative treatment by osteo-pathic
physicians. JAOA 1996;96:91-96.
2. Shlapentokh V, O’Donnell N, Grey MB. Osteo-pathic
interns’ attitudes toward their education
and training. JAOA 1991;91:786-796, 801-802.
All opinions expressed in JAOA are those
of the authors and not necessarily those
of the editors, the AOA, or the institution
with which the authors are affiliated. Let-ters
may be e-mailed to JAOA@aoa-net.
org or they may be mailed to the Let-ters
Editor, AOA, 142 E Ontario St,
Chicago, IL 60611. No unsigned letters
will be considered for publication.
