“He calls himself Mr. because he has not acquired the privilege of giving a certificate when a patient dies on his hands”. Mark Twain in praise of his osteopath.
In the UK, most osteopaths are very comfortable with being a Mister (or Ms). None of us are Dr, unless we are also actually a Doctor of Medicine or a PhD. So it is a surreal experience to be moving to a country where most osteopaths call themselves Doctor, and to consider whether I should do the same.
In order to become a doctor, something has to change! And for me, nothing has changed. I should point out that Mark Twain’s osteopath worked in London. And in England, for a medical practitioner to be called ‘Mr’ is a mark of distinction. Even so, I am not a medical practitioner, so perhaps a little bit of history is in order.
The point of it all
The term ‘osteopathy’ was first used by Andrew Taylor Still in around 1860. At that time he perceived medicine as a disaster, and devoted his life to finding a better way of restoring health, without the drugs that he thought were so abominable. The approach he developed was such an enormous clinical success, it was apt to rival and even threaten pharmaceutical medicine commercially. In short, the osteopathy of 1900 was better than medicine at curing disease, and for that reason Still wanted to keep it as an entirely separate discipline. He had no reason to merge it with medicine.
However, with success comes rivalry and politics. Medicine has always enjoyed immense political power, and the industry pushed for significant healthcare reforms in America between 1910 and 1919. The result was pharmacology’s near-complete supremacy as an accepted therapeutic. Thousands of medical schools in the USA went under for simply being not good enough. But many of them surely were good enough, they were just unwilling or unable to reform in order to fit in.
Chiropractic and Osteopathy survived, but not unscathed. And within a few decades, the paradigms of pharmaceutical medicine – everything AT Still had rejected – had thoroughly taken over the training of our discipline. Chiropractic was the victim of a dirty tricks campaign that was clearly intended to close it down altogether. This was so blatant that a court actually ruled against the American Medical Association and ordered them to desist in this activity. Similar well-funded campaigns continue today, under various guises, and with claims to the moral high ground of science and rational thought, when in fact they are an absolute disgrace to science.
Regulate – in the right way, for the right reasons – or do not regulate
What remained of the original osteopathy survived mainly by moving overseas, to England initially and then beyond. However, calls for regulation usually follow sooner or later, based on a self-evident (unproven) assumption that the public will automatically be better off that way. Government policy calls for standards, medicine is the model, professional administrators translate that into regulation. Practitioners themselves like the exclusivity that regulation bestows, and so the turkeys usually vote for Christmas.
[A warning to places where osteopathy is not yet regulated: the grass may look greener on the other side, but once regulated you can never get unregulated. Your destiny will be forever after influenced by people who do not understand your work, including publishers, insurers, doctors, bureaucrats, to mention a few.]
So it is always a matter of time before osteopathy is forced to change itself in order to appear acceptable – by the wrong measure. Naturally this leads to a loss of potency, which drives further call for change, and so on. Inevitably this spiral forms us into physiotherapists in all but name. There is nothing wrong with physiotherapy, it just has very little relation to osteopathy, and is a very poor model for what we do.
To cut a very long story short, osteopathy is not a branch of medicine, a version of medicine or an adjunct to medicine. In its purest form it is supposed to be a distinct alternative to medicine, a total reformation from the ground up. But it has always been medicine that has reformed us. Over the last century our identity has been considerably diluted, and we need to work actively to keep osteopathy ‘osteopathic’.
Solutions looking for problems?
And so the big issue we should be examining is how much bearing medicine has on the development of osteopathy. I am not against regulation – oh no. I am in favour of the common law principle of a sound evidential basis for change. For example, are the public really at risk without certain standards? Or do we just assume this, and then mire ourselves in solutions where there is not really a problem?
There is a distinct lack of evidence that the bottom line – clinical outcome – has improved one iota thanks to regulation. It may have, but because everybody assumes it must have, nobody is checking. The evidence I see is that osteopaths have always had a great many satisfied customers, a low insurance risk, and no trail of bodies: nothing has changed. If we are to improve on that it is not by following medicine’s lead.
The pros and cons of working alongside medicine
Now, I am realistic, and modern medicine has brought us some incredible gifts. If I am hit by a bus, then take me to a modern hospital right away – please. Because the one thing medicine is extremely good at is dealing with acute emergencies. Where mainstream medicine is not so good – for the most part hopeless in fact – is in reversing chronic and degenerative disease. From the common cold right on through, symptom-management is really all pharmacology has to offer. And it does not cure anything, because it is against the laws of physics to make somebody healthier by poisoning them.
And that realisation is dawning on more and more people all the time. The only cure for anything is to raise health. And that is slow, painstaking, mundane work, with unpredictable results, and it won’t take us to many swanky conferences in five-star hotels. When it works best it can easily go unnoticed, as presenting complaints melt slowly away. There may be nothing at all to show for success: how do we count the numbers of patients who have avoided sickness and injury with our help? We can’t. So there is a lot of appreciation for what we do but very little fanfare.
Compromise can be costly
But what needs pointing out is that no therapy has ever joined forces with medicine and survived intact. This is why I am against homoeopathy and osteopathy in the NHS – not because they don’t work, but because they do work; but only when you are working for the patient and not for a bunch of desk-bound administrators trying to fit one size of everything to every case. With the best of intentions, the NHS will ruin what is left of our therapies if we get too cosy. And then all the skeptics will come out and say “we told you so, alternatives don’t work”.
And don’t get me wrong – I am all for cooperation between disciplines, but not for its own sake. Modern diagnostics, anaesthetics, surgery, antibiotics, imaging are of fantastic benefit – when they are used in the right way. To have a big system full of experts and tools to call on for support is essential from time to time.
But when the case is under control it is better, for a competent generalist to keep a grip on things, working with the whole picture in completeness, rather than doing lots of things in different departments. Very few state medical systems, if any, are ever likely to let osteopaths work that way. They will offer us a foot, or a shoulder, while somebody else is given the stomach, the glands, the blood vessels etc. And we will thereby be physiotherapists, seeing certain bits of the body through our own area of interest, instead of raising health through the holistic vision we claim is our expertise. We will be mixing a toxic therapy with an anti-toxic one.
I have seen patients on whole cocktails of drugs referred to an osteopath AND a chiropractor at the same time! I don’t wish to be rude to the well-meaning professionals who direct these schemes, but if this sort of eclectic mish-mash doesn’t immediately illustrate the absurdity of the philosophy, then a whole series of articles is urgently needed: because it ain’t holism. It may get some sort of result: but the body doesn’t actually work like that, it totally lacks an evidence-base, and it isn’t osteopathy. It is like having a team of navigators steer a ship to several destinations at once without a common map between them. Not only is it harder to get the patient better that way, frankly it can explain why they remain so chronic: the ship remains forever at sea.
And most of all I believe it arises out of a lack of awareness of osteopathy’s actual potential and of what it means to be holistic.
Going the way of the Barber Surgeons?
But we might take a lesson from the barber-surgeons. For a long time doctors had very little to do with surgery. They considered it pretty horrible work I would think. And because it was so incredibly dangerous it must have been terrible for ones public image. It may seem extraordinary to us now that hairdressers would have done a bit of suturing, or offered “a bit of product?” while setting a fracture. But that is because they were not always cutting hair – for seven centuries barbers were the experts in surgery.
And then medicine took it all over, and the barbers were faced with a stark choice – go to medical school or stick with hair-dressing.
The Royal College of Surgeons will tell us that all surgeons in the UK are called ‘Mr’ (or Ms etc, but not ‘Dr’) because of tradition, an historical artifact. Could it be they refused to surrender their identity for so long that they actually forgot why? “I may have to join your club, Doctor, but please don’t call me ‘Doctor’, Doctor…”
Sour grapes is not a very good reason to do things I suppose, but the fact is we are not doctors, and I for one don’t wish to be. I trained as an osteopath in order to do something different, for some very good reasons. I simply wish to offer an alternative viewpoint and an alternative therapy option for people who are – maybe literally – sick of the limitations of the standard model and want something else. This is a service many people value most highly in its pure form. It has been all but lost, and may disappear entirely if we forget what it is that makes us osteopaths different.
But in case nobody has noticed, osteopathy is in a slow-moving crisis. We are now at the same crossroads as the barber surgeons, and very soon our choice will be between medical school and relaxing massage. Any clinical arguments for reforming medieval surgery certainly don’t apply to osteopaths, but the lessons from history certainly do. So I think it healthy to have a little reminder in the professional title that we were never meant to be doctors, we were meant to be something else. As long as it is legal to touch another human being with the aim of making them feel better, that something can survive: but not if we forget what it is.