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Division of Social Sciences Truman State University, Consultant, Northeast Missouri Health Council Inc Kirksville, Mo

It is with pleasure that I respond to the letter to the editor by John B. Crosby, JD, regarding my editorial in the May 2005 special focus issue of this JOURNAL(JAm Osteopath Assoc. 2005;105:241–244). As the executive director of the American Osteopathic Association (AOA), it is appropriate and consistent with Mr. Crosby's position to call readers' attention to the profession's recent responses to the topics addressed in that issue of JAOA. The initiatives, themes, and examples Mr Crosby cites are all valid and accurate.

The AOA's role in the founding and ongoing support of the Osteopathic Research Center (ORC), located on the campus of the University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine, is indeed an important step toward developing a culture of research within the osteopathic medical profession.^1–3 The promotion of the Clinical Assessment Program (CAP) is, likewise, a major step in promoting structured documentation of the distinctive dimensions of osteopathic patient-centered care.^4,5 Similarly, just we applauded the vision of George Thomas, DO,⁶ during his 2004–2005 term as AOA president in his campaign for "Patient-Centered Quality Care," we join current AOA President Phillip L. Shettle, DO,⁷ in taking "Pride in the Profession." All of these measures are very positive, should receive the ongoing support of the entire profession—and should have been included in my editorial.

Mr Crosby's letter, however, confirms and reinforces the main points of the editorial and the articles by Leonard H. Calabrese, DO,⁸ Robert Orenstein, DO,⁹ and Felix J. Rogers, DO.² All the initiatives and efforts Mr Crosby notes are recent.

On its Web site, the ORC describes itself as "a relatively new organization, founded in 2001."¹⁰ Although CAP was piloted in 1999, Dr Thomas' vision,⁶ which expanded the applications of the program from osteopathic medical residency programs only^4,11 to private clinics,^5,6 date from his 2004–2005 presidency.

Within the historical context of a profession that is over 110 years old, the examples cited by Mr Crosby are, indeed, quite recent. The fact remains that the profession has yet to develop a culture of scholarly endeavor that will help to more closely align reality with rhetoric.

The intent of my May 2005 editorial, consistent with its title, "Taking osteopathic distinctiveness seriously: historical and philosophical perspectives," was to emphasize this broader context and encourage thoughtful reflection. The intent of the entire issue was to stimulate wider discussion. I am pleased that, from this perspective, we appear to have succeeded.

Since the issue's publication, I have had numerous interesting conversations with fellow osteopathic physicians on the topics addressed in that issue of the JAOA. I have also been engaged in one particular, ongoing conversation with a medical historian at Pennsylvania State University (University Park). However, these many discussions most frequently turn to the comparison made by Dr Orenstein⁹ of Kirksville, Mo, with Rochester, Minn.

Many have speculated what the town of Kirksville might look like today if the leadership of Kirksville College of Osteopathic Medicine had developed a tradition consistent with the "Mayo model." Many of these conversations have been characterized by bewilderment as to why a "parallel and distinctive"¹² culture of research and inquiry did not develop expeditiously during the rapid expansion of the colleges of osteopathic medicine after 1969.

It is always interesting and vitally important to reflect on the lessons of history in a critical and unflinching manner. It is even more important to use these lessons to inform the present and actively shape the future. Mr Crosby's thoughtful and well-crafted letter reflects the importance of recent efforts by the AOA in shaping the future of the osteopathic medical profession. With the support of us all, that future will look even brighter.

References
1. Pagaduan MA. Osteopathic Research Center announced at AOA annual convention [press release]. Chicago, Ill: American Osteopathic Association; October 22, 2001. Available at: http://www.osteopathic.org/index.cfm?PageID=mc_orcpr. Accessed August 31, 2005.

2. Rogers FJ. Advancing a traditional view of osteopathic medicine through clinical practice. J Am Osteopath Assoc. 2005;105:255–259. Available at: http://www.jaoa.org/cgi/content/full/105/5/255. Accessed March 27, 2006.

3. Crosby JB. ORC funding. AOA Daily Reports [serial online]. American Osteopathic Association Web site. July 13, 2005. Available at: http://www.do-online.osteotech.org/blog/index.php?itemid=728. Accessed August 31, 2005.

4. Thomas G, Snow RJ, Levine MS, Harper DL, McGill SL, McNerney JP; Agency for Healthcare Research and Quality. Clinical Assessment Program to evaluate the safety of patient care. Storming Media [serial online]. 2005. Available at: http://www.stormingmedia.us/89/8964/A896434.html. Accessed August 31, 2005.

5. Tunanidas AG, Burkhart DN. American Osteopathic Association commitment to quality and lifelong learning. J Am Osteopath Assoc. 2006;106:404–407. Available at: http://www.jaoa.org/cgi/content/full/105/9/404. Accessed March 27, 2006.

6. Year of the Patient page. American Osteopathic Association Web site. Available at: http://www.osteopathic.org/index.cfm?PageID=aoa_yrpatient. Accessed March 27, 2006.

7. Pride in the Profession page. American Osteopathic Association Web site. Available at: http://www.osteopathic.org/index.cfm?PageID=aoa_yrpride. Accessed March 27, 2006.

8. Calabrese LH. Sir William Osler then and now: thoughts for the osteopathic profession. J Am Osteopath Assoc. 2005;105:245–249. Available at: http://www.jaoa.org/cgi/content/full/105/5/245. Accessed March 27, 2006.

9. Orenstein R. Andrew Taylor Still and the Mayo brothers: convergence and collaboration in 21st-century osteopathic practice. J Am Osteopath Assoc. 2005;105:251–254. Available at: http://www.jaoa.org/cgi/content/full/105/5/251. Accessed March 27, 2006.

10. ORC: The Organization page. Osteopathic Research Center Web site. Available at: http://www.hsc.unt.edu/orc/about/default.asp. Accessed March 27, 2006.

11. Pagaduan MM. Osteopathic medical profession launches Clinical Assessment Program this summer [press release]. Chicago, Ill: American Osteopathic Association; August 1, 2003. Available at: http://www.osteopathic.org/index.cfm?PageID=mc_caplaunchpr. Accessed March 27, 2006.

12. Gevitz N. `Parallel and distinctive': the philosophic pathway for reform in osteopathic medical education. J Am Osteopath Assoc. 1994;94:328–332. Available at: http://www.jaoa.org/cgi/reprint/94/4/328. Accessed December 22, 2005.

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