Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Osteopathic Medicine

Episode Date: October 16, 2020

Doctors of Osteopathic Medicine (D.O.s) have been thrust into the spotlight recently when one was tasked with caring for the world's most famous COVID-19 patient. Some even went so far as to dismiss the president's D.O. for those two letters following his name. But is that fair?This week on Sawbones: Do D.O.s do what M.D.s do?Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, Miskite in Medicine. for the mouth. Hello everybody and welcome to Saul Bones, a middle tour of misguided medicine.

I'm your co-host, Justin McElroy. And I'm Sydney McElroy. Oh, I put the emphasis on I'm. No one else is claiming to be Justin McElroy. Yeah, I don't know if he's fighting you for that. Except for CBC Canadian Justin McElroy. But he's not claiming, he is. Well, is he?

Yes. I mean, he's Justin McElroy, but is he Justin McElroy, you know, with that? I don't know if he would say it like that. Probably not. You know, that might just be you. Justin, I like on this show sometimes when I have the opportunity to dispel misinformation. I don't know if you've noticed that. Mm-hmm. Mm-hmm. You didn't intend to take what someone described as delight in it. Recently in the news, I have been very dismayed

to see the way that some of my colleagues in the medical profession, specifically D.O.'s, doctors of osteopathic medicine are being treated. I forgot for the intro for this episode, I wanted to be, I wanted to say, Sydney, are you ready to do this episode? Oh, and like DO. Is that really the, that was, or did you just come up with that and then you wanted to try to? I thought of it two days ago and I decided not to do it.

Yeah. And why that I think I have an extra organ in my body that makes me say the jokes I shouldn't. I think you should have listened to Justin from two days ago. Yeah. Can we call him in here and do the show? I don't know why I'm having a flare up of my my bed. My bed. in here and do the show. I don't know why I'm having a flare up of my bed, my bed joke, my third kidney that makes me do bad joke.

So anyway, a lot of people have written in to ask about osteopathic medicine and osteopathic physicians. What is the difference? Is there a difference? What does it mean? You may have seen recent reports about this because the president's doctor, while he was admitted to the hospital, Dr. Conley, I believe, is an osteopathic physician. And there has been a lot of question as to not being able to fully decipher what the doctor

was communicating, I think, to reporters during press conferences. He has been accused of kind of being cagey with some of his answers. And all that, I have nothing to say about any of that. I mean, frankly, I don't know this fellow. I know nothing of his credentials training or communication ability. Is he a fellow or is he just an attending physician? I was just calling him a fellow. Oh, like, you know, fellow, fellow.

Feller, fellow. You gotta say, fellow. I don't know, and personally, and I'm not talking about him, but whatever all that aside, the fact that he's an osteopathic physician should have nothing to do with your opinion of him. That is the, that is why I wanted to address this. Because a lot of people, I think, kind of looked into him, Googled some stuff, got the wrong idea. They're not a hot take all in the chamber. Yeah.

Yeah. I mean, there were journalists, there were celebrities, there were a lot of just random people on social media who were insulting this person based on the fact that they are not an MD but a DO physician. And as we go through the history of osteopathic medicine and I seek to explain the difference and lack of difference in a lot of ways between the two, please keep in mind that the number one thing I want you to understand is there is nothing there is not there is really no fundamental difference in the care you're going to receive from an MD or a DO and there is no reason that you should be dissuaded

from seeing a physician because they are a DO. They are wonderful. I have reached out to some of my DO colleagues and some of our listeners that I want to thank Caitlin and Matthew and Jennifer and Audrey and Anita for giving me some more information since I understand osteopathic medicine, I did not attend osteopathic school

and so they help me get a little more insight into what the current thought is. So these will you talk to your attendings? No. What are you? That was another one. That was another one.

You're all over the place here. I've actually spoken now with students, residents, fellows, and attendings. How do you like that? Wow, that is great, Sydney. All levels of training as What about an associate? What about an associate? What about amateurs? Amateur Dio's no, I would not recommend an amateur doctor whatever initials follow their name

That's you included I still looking for college. Give me that honorary doctorate by the way. If anybody can do that for me, let me know. I'll do anything at this point. Not anything. So, whatever nasty thesis you need for me, if you listen to this show regularly, you know that medicine wasn't always

good. Competent. We went through a lot of phases in medical history where we would just try things. And if it worked, we would keep doing it. If it didn't work, we might keep doing it anyway. But the idea that we've always had it figured out, I think you know, is flawed. It's taken us a long time and there's still things we're figuring out. That's just the nature of human knowledge and scientific inquiry. Back when Dr. Andrew Still, who we're going to talk a lot about, the founder of osteopathic medicine, back when he became a physician, he was originally an MD during the American Civil War, there was a lot to be desired.

And that was Dr. Still's main problem with medicine at the time. Is there were a lot of things that he was learning. His father was actually a physician. He studied an apprentice under him. He worked as a hospital steward and then would, the way that that would go is you would like start out like giving out medications and things and then eventually you would be caring for the sick and then eventually you'd be doing surgery. So just yeah, it's an accelerated track we have here. Exactly. And so as he, as he went through these different levels of responsibility and areas of medicine, he slowly was becoming more and more kind of

disenchanted with the state of medical knowledge at the time. Okay. There were a lot of treatments that were just as likely to harm people as they were to help people. And he kind of, he felt like he started to get the inkling that there has to be a better way. There has to be a better way. And and what really, what really motivated him to start finding that in his mind, better way was after the war, he, he very tragically lost his wife and children to meningitis. It's terrible.

And after that, he really decided, you know what, there's a lot we haven't figured out. Which is true. And a lot of the treatments that we're using are really dangerous. And we need to kind of go back to basics and see, are we going at this the wrong way? When we start bleeding people or giving them mercury

or arsenic or whatever was fashionable at the moment, what are we doing? What are, have we really gone down the wrong road? Okay. And so, Dr. Stil went back and after a lot of thought and kind of contemplation based on his own knowledge as a physician. He came up with this concept that most disease gets back to sort of like mechanics.

It's a problem of bones and muscles at the end of the day. And I think the fact that he also understood a lot about like machines kind of makes all this as I'm trying to envision him as a person and how his mind worked. He wants patented a butter churn so nice. That's the way his brain worked and so mechanics as a way of understanding the human body kind of made sense to him. Which is accurate, it's just what scale, right? Right, well, I mean, I think there is a, there are certain things you can apply this to for sure. And you'll see that this persists in osteopathic medicine. But when it comes to other physiological processes,

this probably doesn't pay out. Yeah, not the most helpful metaphor. But he decided that he was going to kind of restructure medicine with this new theory that he called osteopathy. Ocio is a reference to bones. Hey, you got that. Path is like roads are different ways you can go. So these are different ways your bones can go. No, it's a reference to suffering. Like pathology.

Path, path, bone suffering, like pathology. Bone suffering. Pat, Pat. Bone suffering, suffering of the bones. Got it. But it wasn't just about like the bones are the problem. It was more about the idea that the way that we could fix things, the way that we could treat disease, is really through hands-on manipulation of the bones, the muscles, the tissues to treat underlying disease processes. Okay.

And he founded the first school of osteopathy based on this idea, and it was called the American School of Oceopathy, it is now AT Still University in Missouri. And this was back in 1892 when this all started. And you know, if you look into like this period in history, and we've talked about this a lot on the program, there were a lot of other medical schools of thought

popping up here and there. So this idea was not, you know. The thought that you'd come up with a new kind of medicine to do was not that you know. The thought that you'd come up with a new kind of medicine to do was not that wild back then. Right. So all of it, in this period, we see a lot of people. I think we have a, we start to have like a groundwork without necessarily the best applications

for all of it. And you start to see people like, well, we can all agree basically this is the way things are going in there. So maybe this is the way that we address it. Yeah. And I think that's some of this obviously distrust in the medical system that existed. Like I feel like I went to the doctor

and I ended up worse than before, which sometimes was unfortunately true. We didn't know everything, well we don't know everything now, but we didn't know as much yet. But some of it gave rise to things that we know that didn't work like homeopathy. some of it gave rise to things that we know didn't work, like homeopathy. And then you get like groups like we've talked about like the collectics and the Tom

Sonians who bordered on some things and then there were a lot of other things that didn't work. So you get this kind of time period where a lot of different medicines going a lot of different directions as a reaction to I don't and probably like based on the previous heroic era of medicine when if it you know if you're going to die anyway we may as well do whatever. A bunch of weird stuff. Yeah.

So anyway his initial plan was to teach people everything he knew in three months. That was the that was the medical school. You can learn this in three months anybody can learn it and in three months. That was the medical school. You can learn this in three months. Anybody can learn it and take three months. He eventually realized that you probably need a little more time. Four months. Final offer. He also, I think at his worth noting, he taught both men and women, which is pretty revolutionary at the time, like from the beginning, that was fine. And this main difference, I think, when we talk about, like, in a current climate, what is the difference between a DO and an MD in terms of their training, this was sort of codified in this beginning.

Still taught, Dr. Still taught something called osteopathic manipulative medicine, OMM, or osteopathic manipulative treatment, some people, OMT. But the idea is that this is a way of treating disease by manipulating and moving the body around. It is a hands-on, laid out on this table, I'm going to touch you and move you and make things better, right? Right. And it's based on an understanding of anatomy.

It includes movement of the bones, the muscles, the tendons, the fascia, which is a layer of tissue, a thin, strong layer of tissue that overlies the muscles. You have to work with tension in all those areas and dysfunction in those areas to manipulate them to take you back to health wellness. Now that sounds, if you're listening to this as a sort of a lame and that might start to sound kind of like massage therapy.

There's, when you, if you've ever, well, I have had OMT performed, if you haven't, I will tell you that it, it for someone who has not been trained in it, it would remind you of somewhere between like massage therapy and I have never been to a chiropractor, but I know there are some similarities between just some pieces, they are not the same thing by any stretch, but some pieces, and even a little bit of physical therapy. It's somewhere in the middle there.

I found it. You get an example of one one manipulation that's so people have an idea of like what we're talking about. Oh honey I wasn't trained in it. I know the like, neither were the lame but you had it done to you, right? Yes. When I had it done a lot of what I was pregnant with our first child and I was having a great deal of pelvic pain, especially in the front part of my pelvis, the pubic synthesis, and it was very tender and sore. And so one of my colleagues who was trained in osteopathic medicine would,

a lot of it had to do with just like, I was laying down and she would, I don't know what these, I know there are probably deos listening going, I don't know what these, I know there are probably Dio's listening going, I know what maneuver that is. And she would like flex my leg up and over to the side and provide like tension against the way that, you know, I mean like, it was a lot of just like.

So stuff like maybe if you need a reference point, something like you'd see in like physical therapy also. Sort of like that sort of, like that idea. So, it doesn't, when you're seeing it, a lot of the time it looks a lot like just stretching or massage, it looks like that from the lay person's view on the outside.

The reason I'm drilling down on it is, if you don't know what it's talking about, it can sound, it sounds made up. If you don't know that, like what were sort of, like, well, how would that have anything to do? I mean, these are legit, serious, like, you're doing something, right? Well, and when I talk about energy and tension, I am not talking about a philosophical concept. Right.

I am talking about, like, physics, like, you're, you're finding points where there are contracted muscles and there are actually inflamed tenths parts of tissue and working against the counter-energy of that. Like that, I'm talking physics here, not, this is not conceptual. Does that make sense? Absolutely. Okay.

And like I said, the initial idea was that anything could be treated this way Like anything So that's kind of where maybe the problem right right and I and again, I want to get into like How this has evolved and but before we kind of as you have already alluded to before you start thinking like well This doesn't sound real It's important remember a few things. Dr. Still was against a lot of pharmaceuticals for the most part.

He thought that we were probably evolving in a direction with medicine where the vast majority of illness, disease, could be treated by OMM. Some people will need surgery and there will be maybe a handful of like pharmaceutical like therapeutics that could be helpful in the future. He did not feel like those necessarily existed in his time. And when people were being given like opium and arsenic, that's not, I mean, that's not a wild thought to say, like, I don't think these things are really helpful. I think that there were probably some who would argue, well, yeah, but like we're moving in the direction and medicine will play a big part.

And he thought that actual, like, drugs would play a much smaller role in the future of medicine. Thought they would or thought they should. Should if things evolved the way he felt they should. Would if things evolved the way he felt they should. And in addition to this, he was the first physician who pushed really strongly on the idea of preventative medicine, that really comes, Dr. Stowe really focused on the idea that like we're so

We're so interested in treating pathology, but why aren't we putting this much energy into keeping people well? So that we don't have to treat the since we're really bad at treating pathology Why don't we try to prevent that from getting there? Which was you know is an incredibly important idea in medicine and doctor still was one of, you know, is an incredibly important idea in medicine, and Dr. Stowe was one of the, you know, four runners of this idea. I want to talk about how, if that is the origin of osteopathic medicine, which I would say at the time was alternative medicine, certainly back then, to what was considered the mainstream alopathic medicine.

How did that evolve into what I am arguing now is indistinguishable? I don't know. I'm going to tell you. Oh, good. But first, I want to take you to the Billing Department. Ah! That one, actually, you got me on that one. That one, you got me.

Let's go. Okay. The medicines, the medicines that ask you make my car for the mouth. All right, Sid, where should I say tricky, Sid? Cause you tricked me. Oh, I like that. Trick me in the commercialism. Okay. Not me. I'm not. I would. If it were up to me, folks, no room for capitalism on this show is. Hey, oh, don room for capitalism on this show. It's. Oh, don't even I long for a day where we have to rename the billing department because it

no longer makes sense. Oh, yeah. We have to name it like waiting six hours for a death panel, right? Oh, my God. High five. Oh, how about you're high five, it'd be so hard. How about? No, how about time time to pay your taxes,

which are totally reasonable because you don't have to pay healthcare premiums or deductibles anymore? I like mine, I think mine's a little catcher. Neither of them are the Garg Gray. Anyway, no, we'll, we'll, we'll workshop that. We're gonna work together. We, we, we probably, thank you, sir. We probably have plenty of time to find something else.

Unfortunately, so as I was saying things definitely were going to evolve because the pharmaceutical industry the way that we make drugs, study drugs, prove if drugs work or not, you know, because for in the beginning like that wasn't really necessary, right? Eventually we said, you know what, we should we should regulate this stuff so that you're not, this is that snake oil is not the default. And so the pharmaceutical industry started to grow, the FDA was created. We started to come up with our idea of standard ways of proving if a medicine works, right? Right. You know, placebo controlled randomized controlled trials, double blind study, all

that stuff became sort of the way that you know if something works. Well, what got harder to study in that model are things like osteopathic manipulative medicine. It doesn't fit as well into this method of studying as a drug does, right? It's a lot easier to control, like, well, you give them a sugar pill and you give them the medicine and then that's it, right? That's a lot harder when you're talking about this type of treatment to come up with what we call a sham treatment, meaning it looks and feels like I might be doing OMT on you, but I'm not really to see. That's really hard to do, right?

And so it was hard to prove that any of these treatments worked in the same way. You also have people doing it slightly differently, because you're introducing another human being into the, you know, you're giving me 20 CCs of rubbing. It was a lot harder to prove that it worked you know, so I get you're giving you 20 CCs of rubbing. It was it was a lot harder to prove that it worked and that it was definitely operator dependent. The more you did it, the more practice you were in it, probably the

better effects you were going to have. And you know, also a lot of studies were being done on students, like we'll practice on the DO students who might not necessarily not have any problem. And so how much better did it make you if you weren't having any issues to begin with? So it was really hard to have it kind of codified into our treatment protocols the same way that drugs are a lot easier to do. And this also, as we evolved, this also went into how things get paid for. You know, insurance companies like to pay for things

that are standard standards of practice, and it's harder to put these things into standards of practice when they're not being studied the same way. Anyway, all of this moved like it put pressure on osteopathic schools to move closer to MD schools in sort of their training. And this is what happened. A lot of the DO schools started to move in that direction doing things like adding pharmacology to their curriculum, you know, which was

kind of against what Dr. Still initially, you know, thought medicine would be like and the school started to evolve and say, well, but we have to change with the times and medicines work now. We have good ones. And so students were trained in that. Their curriculum was expanded from three to four years eventually, which is the same as MD school. And you get to a point as you move through like the 1900s up to the 60s and 70s, where DO school is becoming pretty much MD school. With the addition of this osteopathic manipulative medicine that is still being taught, but all the other stuff in D's are learning, D.O.'s are also learning.

And so along with that, the D.O.'s had to start lobbying to be recognized as physicians, because initially they weren't called doctors of osteopathic medicine. Well, where are they? Osteopaths. It was removed from the concept of doctor. That sounds like you have a psychic connection to bones, like you can talk to them. So like a Jennifer Love Hewitt series. I had to learn this because it's weird.

I initially, I have used those terms interchangeably. Like, well, they're an osteopath, meaning they're a Dio, meaning they're a doctor of osteopathameticin. But apparently, there was a time period where that's all, because it was like intentional. So you're diminishing them? Well, I didn't, no, I didn't mean to, I didn't know that. Oh, just cause you didn't mean to.

Now I think they are all used the same way because they're doctors, we know this. Do you have anything in alipacit medicine in your alipacit training that you would equate these maneuvers to stuff that like, people don't really do that much, but it is part of your training just for like tradition or some people still have faith in it. Is there anything like similar to that? I wouldn't say there is like a body of knowledge that's similar to that. But there are definitely pieces of medicine scattered throughout. And my deocolleges learned this stuff too, so they would probably agree with

all this. There are things we do in various medical disciplines for treatment that have been done, like back when we first thought that they would work and that since then evidence has not really borne them out to be incredibly effective, but we maybe don't have anything else and maybe we think it might work occasionally and it's not harmful and so it continues to be done. And as you're learning these things, sometimes your professor will mention that or the person you're preceptor will mention that, but then tell you to do it anyway. You know, okay, here's something similar. The way that we prescribe steroids for various disorders

has changed dramatically since I have been in practice. And that's because a lot of what we were first trained to do when I became a resident was just like, we don't really know how long to give people steroids or how much to give them for different things. So we just sort of do this. Now, evidence has evolved and we have better ideas now. But when I first entered training, like, how long do you put somebody on steroids for a COPD exacerbation, it depended on which doctor you were working with. I mean, it really did. And everybody kind of knew that.

So definitely, I mean, medicine's always evolving and changing. And there are things that you continue to be taught because it's the best we know right now, but we expect that we'll know better, different, more in the future. That's just the nature of science. Anyway, so as Dio started to lobby to be recognized as physicians, one area, they wanted to be able to serve in the military as physicians. They were pushing very hard for that. A lot of what was happening against this were the AMA was fighting back. The American Medical Association was fighting to not allow D.O.s to kind of become doctors

during the ranks of M.D.'s. And there was even for a while, the AMA said that it is considered unethical for an M.D. to associate with a D.O. That's how strong this divide was. But the DOs proved through, you know, turning out good physicians who knew what they were doing, that by the 60s that the R doctors, and they are worthy of that title, and there were even, there was a series of legal battles in California throughout like the 60s and 70s that finally had to put it into it. They were making all D.O.'s also go get MD licenses, which basically was sort of a racket.

It was just money. You had to go pay to get one. And anyway, after all of this legal stuff, after that time period, the two were seen as both pathways to becoming a physician equal but slightly different in a little bit of that one aspect of the training. It's interesting too because when you talk about like the philosophical underpinnings of the two, because that's the other thing. So what is the difference in the training?

A DO will learn OMM, I will not as an MD. The there is this focus on preventive medicine that came from DO's, I would say that in MD school, that has become part of our training as well. And so while that was a difference, it's probably not so much a difference now. And then the other thing that is often cited is this sort of holistic viewpoint that Dio's were trained to look at people as like a whole human, a mind, body, spirit, connection that has to be treated. You can't just, you know, do a surgery or give a pill and make a person well. You might say you treat the illness you win. You lose Treat the patient

You win every time. It's funny because that concept and also like the idea that you cannot Extricate the human that you're treating from their sort of social situation like They exist within a context and you have to consider all of those things when you take care of a person. Like on house, like maybe they had mold growing in their bathroom so you had to consider that. Well, okay, yes, that. But also things like, do they have a home? Do they have money to pay for things? What kind of foods do they have access to?

What kind of social connections do they have? All these different things, which it's interesting because as a family doctor, all of this stuff feels like, well, yeah, I mean, that's like, of course, that was part of my training. Of course, that's part of what I think about as a physician. So I really don't think all of these ideas

are that different from where medicine evolved naturally for a lot of us. I mean, maybe not everybody thinks of all these things, but I don't think these differences are as stark as maybe they were in the origins of this back in the late 1800s, right? The misunderstandings, I think, come from a couple areas. One, I think the initials MD have just somehow become a shorthand for like doctor, they're an MD. And so not everybody is as familiar with DO. I just think that there's a familiarity. It's like, get the name out there and people recognize it more readily. Just

recognition. So I think that's just part of it. It's like, well, I don't know what DO means. Well, here's what it means. They're a doctor. It's fine. Everything's fine. I think the other misunderstandings come from things like, Dr. Still did not specifically focus on cranial osteopathy, which

is like osteopathic manipulation of the cranium of the skull, the bones of the skull. But Dr. William Sutherland, who was a physician who kind of followed in his footsteps, he did. And his theory on this is that if you look at the places where the bones of the skull connect, the sutures, we call them, they look, I mean, they look that way. They look like sutures. They look, he thought they look like gills. And he thought that it indicated that there might be some slight movement there, like breathing

almost, respirations there. And so he felt like you could fix. In a little weird, but I'm trying to hang in there. He felt like you could fix problems through very gentle subtle manipulations of the bones of the skull and that you could fix like the underlying cerebral spinal fluid and the membranes underneath and like a lot of things could be treated by manipulation of the skull Now as I've alluded to if

if it's hard to come up with the same kind of like exact 100% proof positive evidence for OMT in general, it's even harder, I would say, to prove that this works in our general scientific sense. And so, because he would feel these like rhythmic movements, like feel the skull and that you could feel this rhythm. And I've talked to some of the D.O.'s that I've reached out to and they say it's kind of like, it's one of those things where you learn it and then it is not necessarily a large part

of their training in school. It was not returned to a lot. And there are certainly people who go on and do specialized extra training in this specifically. Is there real? Here is what I think. There are DOs who are trained in this, who have done specialized training in this,

who have spent many, many hours learning these techniques, who have seen improvement in patients. One thing that some of the DO.O.'s I talked to you mentioned specifically was for headaches, who can do some of these manipulations and help with headaches. What I have seen through reading about it that has arisen from this is that there's

craniosacral therapy, which is kind of building, it's like the extension of cranial osteopathy. And craniosacral therapy is practiced by a lot of people who are not deos, who did not go through all of this rigorous medical training, who did not go to medical school. They're just squeezing your head. Yeah. And I would, here is what I would say, do not go to those people. If someone is not a licensed DO, I would not let them do osteopathic manipulative, treatment on me, and I wouldn't let them do

any sort of cranial therapy on me. I didn't find evidence that it's dangerous per se because it seems a lot of like very gentle manipulations. It would be so subtle you wouldn't even know necessarily what was happening if you were watching. And again, I have talked to DOs who say that this does work in the proper hands. This is helpful for some of those conditions. But if it's just like Larry and a strip mall who does like Crenius' sacral therapy and also has a variety of tinctures that he's made on his own that he will sell you and I don't know. Has a degree in something totally other. I would not let him touch your head.

Is that fair? That's fair. That's fair. I got it. If it says DO at the end, do go to them. Yes, yes. And again, a lot of the, that's the other thing about OMM that's really interesting.

So not all DOs practice it. Many don't. Many go on to practice medicine the same as an MD because they even though they learned this stuff in medical school, it did not become part of their practice. And it also has to do with what residency you attend. If you attend a residency where you're not working with other DO.O.s, you won't continue to practice these techniques. And so they'll probably fall by the wayside. And you might just not use them anymore. And that is true for many osteopathic physicians is they just don't continue to do OMM.

The ones who do really seek out additional training and do the hours to make sure that like I said, it's operator dependent that you actually receive benefit from what they're doing. So a DO who does this on a regular basis can do this effectively. Just some guy who read a book about it or girl probably can't, let's not put it probably there. Can't do it. Yeah. The principles, like I said, the principles today of osteopathic medicine are laid out basically,

I would say they actually did a survey of MDs from medical schools and said do you agree with these concepts? The body is a unit, the person is a unit of body, mind, and spirit. Yes. The body is capable of self-regulation, self-healing and health maintenance. Fair.

Structural and function are reciprocally, reciprocally. Reciproc, wow. It's a hard word to say. Reciproc, probably. Oh my gosh. Interrelated. Interrelated, let's skip to that. They. We're super crumbly. Oh my gosh. Interrelated. Interrelated.

Let's skip to that. They should have put that in a different way. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function. These are all, I mean, like that, yes. None of these things are untrue. Like an MD would agree with all these things. It is, I think think it is the natural extension

of practicing medicine in the real world is you would have some people, especially, that's the other thing about osteopathic physicians. The original mission was really primary care. The original goal was to create a lot of primary care physicians. The thought was, as a primary care physician, you really need to understand your patient as a whole.

You're going to spend time with them, their whole life, maybe. And you need to know not just like what is wrong with a piece of their body, but their whole situation, to help them feel better, get to wellness and stay there. Like, that's not a wild idea, that's a good idea. That patient-centered idea is really the way that all medicine has moved.

So in some ways, Dr. Stil was kind of ahead of his time saying that because that is the way that, I mean, an MD school, those same principles are taught. I would say that they are very much focused in primary care And I am probably biased to say that I learned a lot of that because I went to a family medicine residency and We talked about this stuff constantly. I mean these ideas were very much ingrained in my training that you have to See a person as a whole to take care of them. You can't just Take care of their wrist or whatever.

You're saying sort of... Oh no, again. I'm sorry, stop misquoting patch atoms, and I won't have to give you the correct patch atoms quote. This is a very patch show today. But like MD school, even though I went into primary care, which is, and especially family medicine, I think we have this reputation as being a little like,

you know, touchy feeling, that yes, that is who I am, I would say, I will own that. There are DOs who go into every medical specialty, just like MDs. So there are DOs who go into the not so touchy-feeling medical specialties of radiology or pathology or anesthesiology or whatever sub-specialties or sub-specialties you can think of.

You will find DOs in all of them. They are completely qualified to do all of those things just the same as an MD. Whatever helps you make a decision as to like, who should be your doctor? I mean, because, you know, it is important to think about what matters to you and like, a good fit. I've said that many times on the show, you got to find somebody that's a good fit for you. Whether they are an MD or a DO should not have anything to do with your decision, unless you really want OMT in which case you should go to the DO because I don't know how to do it. I did say I have

I have had it done on me. I did find it. This is anecdotal though. I'm just I did find it helpful. I won't say that all of my pain vanished but it did make the pelvic pain. I was having a lot more bearable. I have seen it work. I refer patients to DO colleagues to do OMT for like chronic pain issues and things like that. I've seen it work for those issues. I've had patients need less medication because they're having that done similar to, you know, patients who go to physical therapy or massage therapy or some other form of hands-on manipulative therapy that helps them move their body in ways and manipulate their tissue in ways where they have less pain. Which is a good thing.

I want to speak frankly for a moment if I'm a... Because I can tell that you are... If I was a listener, I feel like I would be sort of a little bit confused at this point. And let's talk about the central issue with doing this. That was the thing that has been challenging to you is that a lot of the arguments you could make against OMM are arguments that we have made against therapies that are fake, right? Yeah. And it becomes hard.

Like Sydney has just provided anecdotal evidence for this, right? Which is something that we have cautioned against on this program, innumerable amounts of times. But what you're up against with with this is one, like you said, hard to do a study and have a, a sham treatment. Also, not as, I mean, there's not the pharmaceutical levels of money in proving the efficacy, right? Now flip, flip that around. That is also the same argument that's made about filling the blank CBD or whatever.

But, and there's not like a, so this is the explanation of it. This is just in talking to you about it. This has been sort of the back and forth struggle. If you feel like I'm, you know, saying it correctly. I don't want to do it. I do think that we were making an exception for, you know, the scientific method of breathing treatment is effective,

you know, except in this one regard, the system of that situation. No, and I think what I have seen through reading osteopathic journals and talking with osteopathic physicians is that this conversation is happening within that community. Like, DOs are talking about this. I read articles from osteopathic physicians arguing that cranial osteopathy should not be taught anymore, because it does not have a solid evidence base. I read arguments from other physicians saying,

well, but we can't study it in the same way. And I have spent many, many hours devoted to learning it appropriately, and I can do it appropriately, and I have seen it work, and I have evidence that it works because, you know, these studies are ongoing and whatnot. And so, like, I think it is still an area that is being studied and understood, and you will find people who are D.O.s on both sides of that.

So it's not without critical thinking. It's not. And I think that's a huge difference. Because in that way, it's the same as alipathic medicine. It's the same thing. We have many things that we are developing our ideas of. You're watching it in real time with COVID, right? With medications that we think work and then don't or didn't think work. And then my, we're seeing that happen in real time right now. And that happens in allopathic medicine. So certainly it is still happening in osteopathic medicine as well.

It's sort of what we're talking about as the difference between, and I don't know, this is exactly it turns, but like supportive versus alternative therapies, right? Yes. It started as an alternative therapy, which now is more of a supportive therapy in working in conjunction or in concert with Alec. And it's hard because I'm not, I mean, I think I've been clear. I'm not a pragmatist. I do not just feel like, well, if it works, then go for it.

That's never been my line. And so me saying, I felt like I received benefit from OMT. I do not believe is enough foundation for me to know holds barred, recommend it to everybody all the time. Right? I do not believe that. I believe in finding evidence for things. And I think that that, in this case, the evidence is just

going to be really hard to accumulate in the same way that we study pharmaceuticals. You're just not going to see it that way. But when you have these therapies, and I mean massage therapy is the same. And a lot of people receive a lot of benefit from massage therapy without a huge body of evidence that says, you know, it can definitely do these things. But if we're talking about like a whole person, risk-versed benefit, all those other things that go into practicing medicine in the real world, and not just in a lab, then these therapies

can help some people. And I would always go to a DO who is practiced in them. I would never have somebody who wasn't a DO do these things to me or you, please don't. But I think at the end of the day, the main thing I wanted to get across is there is no reason a DO can't provide you all the services that an MD can.

I, my mentor in residency is a DO can't provide you all the services that an MD can. I, my mentor in residency was, is a DO physician who is incredible. One of the best doctors I've ever worked with and was the model for the kind of doctor I wanted to be and I learned a ton from. So, um, there, him and patch, you would say her, her and patch. You just assumed it was a dude there, did you? I thought it was the guy you worked with. I was just confused you worked with. I was just confused about your talk.

Sorry. She was my chief. But anyway, the point is my DO colleagues have gotten so much crap over this one doctor who took care of Trump. And it's not fair. They're great. There is no reason to ever consider a DO less competent than an MD.

They are wonderful and that ad for scrubs that figs put out. Sydney, you are making a reference to something as though everybody knows what you're talking about when a very swell subsection of humanity is that you're talking about. Well, then I won't talk about it. No, you're going to give me a very quick summation of the issue. There are these highlights.

There are these scrubs that you can get these that are called figs. And I own some, I own some, they're, they're, they're nice product, but they put out an ad unfortunately of a female physician dressed in their scrubs holding a book called Medical Terminology for Dummies upside down wearing a name tag that said DO. And they have apologized since, but should be careful. Don't be like this, people. That was, I mean, it's just not fair. There's net deals are

Wonderful caring competent physicians and they have done nothing to deserve that and Please spread the word. Yeah, do MD that part does not matter. They are both completely capable of taking care of you Best way to spread the word. I think just show quick lingerie to this episode Collects going as long as you're clicking stuff. I would like to humbly ask that if you enjoy video games, you check out my video game program, The Besties. It's a Spotify original. You can only find it there, but you can get it for free on Spotify. If you search for the besties, it's me, my brother Griffin, and our friends, Chris and Russ, as we talk about a new video game every week. It's fun, it's lighthearted.

You'll hear about all the latest and greatest in home interactive entertainment. And it's called the besties and it's on Spotify. So please go check that out if you would be so kind. Also, I want to thank the taxpayers for these. There's some medicines as the intro and outro of our program. Hey, we got a new delightful horseshoe crab shirt up at McElroyMerch.com. It's a lovely blue shirt that says, have you thanked a horseshoe crab today? Of course, for their contribution to making sure vaccines are safe.

That's right. I love horseshoe crabs. Thanks, horseshoe crabs, not a horseshoe, not a crab. But this has been an episode of Sovons, and that will do it for us for this week. So until next time, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright! Maximumfun.org

Comedy and Culture Artist Oat? Audience supported. Hi, I'm Taylor Smirl and I know what you're thinking. This music does not sound like neat boozcast and you're right, it does not. That's because this is an all new neat boozcast. Now I'll still be here, Taylor Smurl, pro-New York bartender. I will be serving you knowledge as well as cocktails, but I will also have a new co-host.

Hi, that's me, Tommy Smurl. I'm Taze Dad. While I'm not a bartender, I do have almost 50 years of experience drinking, as well as learning its history and trivia. So, well, we might sound a little different. We will still be the boozcast that you've come to up. So, join us every Thursday on... ...Nate! I'm calling this round two. Drink it with my dad. On... Meet!

I'm calling this round, too. Drink it with my dad. Cheers! You like that? Yeah! Alright. you