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The Osteopathic Research Center, Fort Worth, Tex

To the Editor:

We commend Michael B. Clearfield, DO, and colleagues on their medical education article¹ and accompanying editorial² in the November 2007 issue of JAOA—The Journal of the American Osteopathic Association. In their medical education article, the authors¹ concluded that accruing a "critical mass" for teaching, service, and administration within a college of osteopathic medicine (COM) was necessary for realizing a productive research program, and that future growth of research was essential for expanding the evidence base relating to the unique aspects of osteopathic medical practice. Specifically, they cited The Osteopathic Research Center (ORC), which resides at the University of North Texas Health Science Center—Texas College of Osteopathic Medicine in Fort Worth, as a successful research funding initiative in osteopathic manipulative medicine (OMM) with regard to the profession's return on investment.¹

In the accompanying editorial,² the authors addressed the difficult issue of research growth at the COMs, suggesting that the American Osteopathic Association, the American Osteopathic Foundation, and the American Association of Colleges of Osteopathic Medicine fund additional, regionally based osteopathic research centers (RBORCs). According to their proposed model, each RBORC would be affiliated with a COM and encouraged to focus on its own unique aspect of OMM research.² We agree with the authors on this approach to integrating other RBORCs into the osteopathic medical profession during the next 2 decades. However, we wish to emphasize that funding for The ORC will remain critically important in maintaining and expanding the osteopathic medical profession's research portfolio as these fledgling RBORCs grow.

The rationale for continued profession-wide support of The ORC is provided by the Expert Panel Review of the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM) Research Centers Program.³ Therein, the following two lines of reasoning pertain to osteopathic medical research:

• Substantial funding is needed to maintain research infrastructure within an established research center, such as The ORC.
  
• There are formidable lag times before research centers, such as RBORCs, emerge as viable research enterprises in their own right.
  

The NCCAM Expert Panel Review³ indicated that research centers need to have adequate infrastructure support, typically at the level of $1 million to $1.5 million annually—an amount that is considerably greater than has heretofore been provided from osteopathic professional organizations to The ORC. Furthermore, unlike research centers at prestigious universities that can quickly focus existing financial resources on new areas of research, emerging RBORCs will likely have to develop and maintain research resources that did not previously exist to any substantial degree. A deceleration in osteopathic research productivity would almost surely ensue for years to come with any curtailment of funding to The ORC because other RBORCs would not yet be positioned for a compensatory contribution to the osteopathic research enterprise. Worse yet, such a loss in momentum for osteopathic research would come at a critical juncture—when calls for evidence-based support of all clinical practices are being increasingly voiced internationally.⁴

Research activities conducted at The ORC, including six major projects funded by the National Institutes of Health, are being increasingly cited and recognized within the international scientific community.^5,6 In addition, The ORC has taken on coordination responsibilities for the Osteopathic Collaborative Clinical Trials Initiatives Conference series to support other researchers in the osteopathic medical profession and to foster development of an "osteopathic research consciousness."

The ORC remains committed to the key aspects of research recommended in the NCCAM Expert Panel Review,³ including:

• maintenance of a basic science research agenda
  
• performance of exploratory and pilot research studies
  
• provision of necessary research support and infrastructure to investigators and collaborators
  
• development of osteopathic manipulative treatment approaches for large-scale studies
  
• provision of career development opportunities for clinicians, junior faculty, and osteopathic medical students
  
• conduct of health services research in osteopathic medicine
  

We look forward to the continued support of the osteopathic professional organizations as we move forward with these research initiatives.

References
1. Clearfield MB, Smith-Barbaro P, Guillory VJ, Cavalieri TA, Wood DL, Sharp GF, et al. Research funding at colleges of osteopathic medicine: 15 years of growth. JAm Osteopath Assoc. 2007;107:469-478. Available at: http://www.jaoa.org/cgi/content/full/107/11/469. Accessed July 3, 2008.

2. Clearfield MB, Smith-Barbaro P, Guillory VJ, Cavalieri TA, Hahn MB. How can we keep research growing at colleges of osteopathic medicine [editorial]? J Am Osteopath Assoc. 2007;107:463-465. Available at: http://www.jaoa.org/cgi/content/full/107/11/463. Accessed July 3, 2008.

3. National Center for Complementary and Alternative Medicine. National Center for Complementary and Alternative Medicine (NCCAM) Research Centers Program Expert Panel Review. Bethesda, Md: National Center for Complementary and Alternative Medicine, National Institutes of Health; 2002. Available at: http://nccam.nih.gov/about/plans/centers/expertreview.htm. Accessed July 3, 2008.

4. Oxman AD, Lavis JN, Fretheim A. Use of evidence in WHO recommendations. Lancet.2007; 369:1883 -1889.[Medline]

5. Lucas N. To what should we attribute the effects of OMT? Int J Osteopath Med.2005; 8:121 -123.

6. McClune T. Beyond spinal manipulation. Int J Osteopath Med. 2007;10:1 -2.

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