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LETTER |
North Palm Beach, Fla
To the Editor: After reading the supplement to the April 2005 issue of JAOA—The Journal of the American Osteopathic Association on the topic of headache, three words come to mind: symptomology, symptomology, symptomology. Andrew Taylor Still, MD, DO, must once again be rotating in his grave knowing what has happened to the profession he founded.
The title of the editor's message, "As the `circle turns round' back to neurovascular basis in migraine," by Frederick G. Freitag, DO,1 is applicable. It describes perfectly what has happened to osteopathic principles and practice. As a profession, we are now more "allopathic" than are the MDs. I have no argument with the medical treatment modalities prescribed for adults in the publication. I do, however, take exception to the hierarchy in which the diagnoses and treatment modalities are presented.
Before treating any patient with medication, my training dictates that I ask questions and screen the patient for the cause or major contributing factors in the pathophysiology of the reported symptoms. Dr Freitag, as the supplement editor, and the authors of the articles appearing in the JAOA supplement2-5 advocate that physicians investigate and treat symptoms rather than seek the actual cause of the complaint and treat patients for that cause. In my patients, I have found psychosocial and musculoskeletal causes for most complaints of headaches. Why do the authors of this JAOA supplement acknowledge these causes as an afterthought rather than as a primary cause?
It is interesting and revealing that David M. Biondi, DO, addresses cervicogenic headache.4 Articles such as his illustrate perfectly how osteopathic medicine has been convoluted into allopathic philosophy. I was surprised to read that Dr Biondi went as far as to consider the shoulders to be a possible contributing factor. Why not go one step further (thus thankfully abandoning the realm of "allopathic osteopathy") and underscore that somatic dysfunction anywhere in the body can show up in the neck and then cause the symptom of headache? I also believe that the allopathic model (treating the symptom not the cause) is the reason that most osteopathic research fails. We use the allopathic model of treating where it hurts, when osteopathic principles clearly state that we should seek the cause rather than the effect. Until this fundamental principle is applied in practice and research, we will continue to have mixed results in the effectiveness of osteopathic manipulative medicine, as in the study of OMT after hip arthroplasty by Licciardone et al.6 Patients receiving OMT had longer hospital stays but used less medication than patients not receiving OMT.
Finally, prescribing any of the powerful medicines used in adults for children constitutes off-label use in the pediatric population and may, as a result, leave a physician open to litigation.
This letter may anger some, but I feel compelled to address these issues. I do not contest the intelligence or hard work put into the April 2005 JAOA supplement by the authors. My question is simply, "Why have we come this far to be no different in practice than the MDs?" The topic of headache is well covered, and the same information is available in JAMA. Why not put all this effort and energy into a different approach to patient care? Many patients are abandoning "conventional healthcare" for complementary alternative medicine modalities because of dissatisfaction with overall treatment.7-9
References 2. Hershey AD, Winner PK. Pediatric migraine: recognition and
treatment. J Am Osteopath Assoc. 2005;105 (4 suppl 2):S2–S8.
Available at:
http://www.jaoa.org/cgi/content/full/105/4_suppl/2S.
Accessed June 27, 2006. 3. Nissan GR, Diamond ML. Advances in migraine treatment. J Am
Osteopath Assoc. 2005;105(4 suppl 2):S9–S15. Available at:
http://www.jaoa.org/cgi/content/full/105/4_suppl/9S.
Accessed June 27, 2006. 4. Biondi DM. Cervicogenic headache: a review of diagnostic and
treatment strategies. J Am Osteopath Assoc. 2005;105(4 suppl
2):S16–S22. Available at:
http://www.jaoa.org/cgi/content/full/105/4_suppl/16S.
Accessed June 27, 2006. 5. Silberstein SD. Chronic daily headache. J Am Osteopath
Assoc. 2005;105(4 suppl 2):S23–S29. Available at:
http://www.jaoa.org/cgi/content/full/105/4_suppl/23S.
Accessed June 27, 2006. 6. Licciardone JC, Stoll ST, Cardarelli KM, Gamber, RG, Swift JN Jr,
Winn WB. A randomized controlled trial of osteopathic manipulative treatment
following knee or hip arthroplasty. J Am Osteopath Assoc.
2004;104:193–202. Available at:
http://www.jaoa.org/cgi/content/full/104/5/193.
Accessed June 27, 2006. 7. Astin JA. Why patients use alternative medicine: results of a
national study. JAMA.1998; 279:1548
–1554. 8. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR,
Delbonco TL. Unconventional medicine in the United States: prevalence, cost,
and patterns of use. N Engl J Med.1993; 328:246
–252. 9. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and
alternative medicine use among adults: United States, 2002. Adv Data.
2004(338):1–19. Available at:
http://www.mbcrc.med.ucla.edu/PDFs/camsurvey2.pdf.
Accessed May 12, 2006.
1. Freitag FG. As the "circle turns round" back to
neurovascular basis in migraine [editor's message]. J Am Osteopath
Assoc. 2005;105(4 suppl 2):cover 2–S1. Available at:
http://www.jaoa.org/cgi/content/full/105/4_suppl/1S.
Accessed June 27, 2006.
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