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Osteopathic medicine (formerly known as osteopathy) is "a complete system of medical care with a philosophy that combines the needs of the patient with current practice of medicine, surgery and obstetrics. The emphasis is on the interrelationship between structure and function, and has an appreciation of the body’s ability to heal itself." ^[1] Outside the United States, "osteopathic medicine" is often used interchangeably with "osteopathy".

Doctors of Osteopathic Medicine, or D.O.s, are trained to apply the philosophy of treating the whole person (a holistic approach) to the prevention, diagnosis and treatment of illness, disease and injury using conventional medical practice such as drugs and surgery, along with manual therapy (Osteopathic Manipulative Medicine or OMM).

As with Doctors of Medicine (M.D.s), D.O.s educated in the United States are fully licensed physicians and surgeons who practice the full scope of medicine. Currently, there are 27 accredited osteopathic medical schools^[2] in the United States and 125 accredited U.S. allopathic medical schools.^[3]

D.O. and M.D.-granting U.S. medical schools have similar curricula. 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, both D.O. and M.D. physicians may opt to pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also be required to complete a one-year rotating internship at a hospital approved by the AOA - the American Osteopathic Association. Osteopathic medical physicians also have the opportunity to pursue allopathic residency programs, however, the converse is not currently permitted. Within the U.S., osteopathic medical physicians practice in all medical specialties including, but not limited to, internal medicine, emergency medicine, dermatology, surgery, and radiology. There is no difference in compensation between allopathic and osteopathic physicians. Physician salaries do differ among the various medical specialties.

Osteopathic medical physicians educated in countries outside of the U.S. do not follow the same curriculum as U.S.-trained D.O.'s. Their scope of practice is limited mainly to musculoskeletal conditions and treatment of some other conditions using OMM and various alternative medicine methods.

Osteopathy was founded by Andrew Taylor Still M.D. (1828 - 1917) in reaction to what he perceived as inadequate medical treatment of his day. Specifically, he believed that other conventionally trained physicians over-prescribed to patients harsh and often toxic medications. He invented the name "osteopathy" by blending two Greek roots osteon- for bone and -pathos for suffering in order to communiciate 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. 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.

Osteopathic medical practice began in 1874 in the US. From its very inception, early practitioners embraced the movement's philosophy and theories to varying degrees. Some held steadfastly to its core tenets while others were more apt to blend features of osteopathic medicine with other conventional or competing schools of medicine. Early in the twentieth century, the American osteopathic profession adopted the use of medicine and surgery. As biomedical science developed, osteopathic medicine gradually incorporated all its proven theories and practices. D.O.'s have been admitted to full active membership in the American Medical Association since 1969. Today, except for a stronger primary care emphasis in most osteopathic medical schools and additional education in musculoskeletal diagnosis and treatment, the training and scope of osteopathic medicine practiced by D.O.'s in the United States is identical to that of allopathic medicine as practiced by M.D.'s.

Because of the initial varying degrees of acceptance of osteopathic theories and principles among early practitioners, there are two divergent scopes of practice within the osteopathic community. Though they are so different as to be considered two separate professions, there have been attempts in the last few years to enhance exchange and dialogue between them. In other parts of the world, especially Australia, and New Zealand, D.O.s have a narrower scope of practice limited to manual therapy.

In the United States D.O.s are medically-trained physicians. Because only 6% of physicians in the U.S. are D.O.s, many patients are unaware of the distinction between the D.O. and the M.D. degree or that the D.O. degree is the legal and professional equivalent of the M.D. degree. Acceptance by traditional M.D.s and their institutions was once an issue for osteopathic physicians. Today, D.O.s and M.D.s work side by side in the health care setting and regard each other as medical and professional peers. Osteopathic medicine's historical clashes with allopathic medicine has been an occasional point of contention between the fields.

In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $ 8 million to end the practice of osteopathy in the state. With considerable financial support from the AMA, a state-wide referendum was passed (Proposition 22) ending the practice of osteopathic medicine in California. California D.O.s were offered the M.D. degree in exchange for paying $65 and attending a short seminar. The California Medical Association may have been attempting to eliminate osteopathic competition by a process of amalgamation by converting thousands of D.O.s to M.D.s. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine, College of Medicine. However, the decision proved quite controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled that licensing of D.O.s in that state must be resumed.

College of Osteopathic Physicians and Surgeons in Los Angeles, c.1920s. From California College of Medicine Records, AS-027 The osteopathic college was eventually absorbed into the University of California system following a state-wide ballot referendum and become the UC Irvine Medical Center.

This decision by the California Medical Association in the 1960s to grant D.O. physicians an M.D. license was one of two turning points for D.O.s in their early struggle for parity; the other being the U.S. Army's decision to allow D.O.s to enter the military as physicians. These two turning points provided the osteopathic community with the stamp of equivalency they desired.

There is no doubt that osteopathic medicine, as a progressive social movement, has influenced the general practice of American medicine. Indeed, some osteopathic medical schools in the U.S. have opened basic courses in osteopathic manual therapy to their M.D. colleagues. Many continuing medical education programs in osteopathic manipulation are also offered to M.D.s and physical therapists.

The majority of osteopathic medical school graduates go on to specialize in family medicine, a trend that has resulted in osteopathic medical schools being criticized for being less focused on research and scientific discovery and more focused on practical application than allopathic medical schools. More recently, osteopathic medical schools have consciously worked toward becoming more research-focused. Critics also have noted the fractionally lower average undergraduate academic attainment of students who matriculate to osteopathic medical schools -- GPA, 3.46 for osteopathic vs 3.64 for allopathic matriculants, and MCAT scores, an average of 24.6 for osteopathic vs 30.4 for allopathic matriculants.^{[4] [5]}

Osteopathic medicine has been both criticized and applauded for offering non-traditional and alternative therapies such as cranial and cranio-sacral manipulation along with traditional medical treatment options. This expanded scope of practice has lead to some question as to the therapeutic utility of osteopathic manipulative treatment modalities. The scientific merit of all manipulative therapies continues to be controversial. Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. The American Osteopathic Association has made an effort in recent years to both support and promote scientific inquiry into the effectiveness of osteopathic manipulation as well as 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. The reasons for this are not known, but are believed to be related to changes in the general financing and delivery of health care, fewer D.O.s training in exclusively osteopathic post-graduate residency training programs, and a lack of perceived relevance to a number of specialties and sub-specialties pursued by D.O.s.

In Greek and Roman mythology, the gods Hermes and Mercury carried a staff with two serpents. In contrast, the Roman god of healing, Aesculapius, carried a staff with a single snake. Snakes were sacred to Aesculapius because it was believed that they could renew their youth by shedding their old skin and growing a new one.

The D.O. caduceus is entwined with a single serpent.

Over 120 years after its founding, the field continues to evolve. While it interfaces, cooperates, shares its philosophy, and allies itself with the biomedical enterprise and industries, it simultaneously retains its own distinct professional identity.

Osteopathic medicine first developed its unique and proprietary treatment modalities in the early 19th century as a distinct alternative to allopathic medical practice. Indeed the founder of osteopathic medicine was Dr. Andrew T. Still, a conventional M.D. who had grown dissatisifed with the restraints of allopathic medicine and wanted to expand the scope of practice to include additional therapies. His original modalities moved through stages of discovery, development, refinement, and translation in order to be integrated into a modern biomedically-oriented osteopathic medical educationa curriculum. This curriculum was instituted in largely free-standing educational institutions, community hospitals, and clinics that were relatively isolated from the established scientific and medical training centers of the time.

Osteopathic medicine, including its professional organizations, colleges, and specialty societies, continues to define itself in terms of its holistic system of diagnosis and treatment. Critics point out that such a definition implies that the field is somehow separate from mainstream medicine and question if this definition is in reality a false distinction. Most view the field of osteopathic medicine as being a part of and complementary to mainstream medicine by offering a form of patient care and health services that encompasses and extends standard medical practice.

Given its recent unprecedented growth and expansion, osteopathic medicine is embarking on a new phase in its social evolution. It has tenuously positioned itself as a bridge between medical care that is conventionally considered evidence based medicine versus complementary and alternative medicine. It has developed and implemented a network of colleges, post-graduate training institutions, professional organizations, federally-recognized professional certification standards, hospitals and health care networks in order to deliver a package of health services based on a distinct worldview of patient care. In the United States as of January 2007 there are currently over 55,000 practicing osteopathic medical physicians and 24 osteopathic medical schools graduating over 4,000 students every year.

In order to secure its relevance in a modern, integrated health care system, its success will depend upon conscientious organizational leadership, the stewardship of its academic community, and continued long-term investment in research infrastructure. This will be needed in order to demonstrate cost-effective, positive treatment effects for the services it provides. In order to sustain and perpetuate itself as a social movement within medicine and the health care industry, it will need to attract and garner the support of recent osteopathic medical graduates comprising a generation of osteopathic medical physicians who have benefited from widespread acceptance, unrestricted practice opportunities, and post-graduate training and mentorship that has occurred, to an increasing degree, outside of the osteopathic medical profession.

• List of osteopathic medical schools in the United States
• List of medical schools in the United States
• Medicine
• Osteopathic Manipulative Medicine

• The DOs: Osteopathic Medicine in America, Norman Gevitz, 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0-8018-7834-9 (An excellent review of the history and development of ostepathic medicine and medical education in the United States)
• Science in the Art of Osteopathy: Osteopathic Principles and Models, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
• An Osteopathic Approach to Diagnosis and Treatment , Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5

• American Academy of Osteopathy
• American Osteopathic Association (Website)
• American Association of Colleges of Osteopathic Medicine (Website)
• International Osteopathic Alliance
• Student Osteopathic Medical Association (U.S. students)
• The (American) Council of Osteopathic Student Government Presidents
• The Cranial Academy
• U.S. Osteopathic State & Regional Associations
• American College of Osteopathic Emergency Physicians
• American College of Osteopathic Surgeons
• American Osteopathic Academy of Orthopedics
• American Osteopathic College of Family Physicians
• American College of Osteopathic Internists
• American Osteopathic Academy of Sports Medicine
• American Osteopathic College of Radiology
• American Osteopathic College of Pathology
• American Osteopathic College of Anesthesia

• Chiropractic & Osteopathy An online journal published by BioMed Central
• International Journal of Osteopathic Medicine
• Journal of the American Osteopathic Association The official journal of the American Osteopathic Association
• Osteopathic Medicine and Primary Care An online journal published by BioMed Central

• Cranial Osteopathy - Myth or Science? - Supportive article on Cranial Osteopathy
• Osteopathic medicine and back pain
• Osteopathic Research Information - On Vienna School of Osteopathy website
• Osteopathy: Art of Practice
• The History of Osteopathic Medicine - (American Osteopathic Association)
• The Osteopathic Center For Children (U.S.)
• Understanding Osteopathy
• The Paradox of Osteopathy - New England Journal of Medicine
• Dubious Aspects of Osteopathy - Quackwatch