Osteopathy

History

The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still, MD, DO. Still was a physician and surgeon, a Kansas state and territorial legislator, a free state leader, and one of the founders of Baker University. He lived near Baldwin City, Kansas at the time of the American Civil War and it was there that he founded the practice of osteopathy.

Andrew Still held a view common to early 19th century proponents of alternative medicine, supporting the idea that the body's natural state tends toward health and inherently contains the capacity to battle any harmful threats to health in the body. This view was opposed to that of the orthodox practitioner, which held that intervention by the physician was necessary to restore health in the patient. The division between irregular medicine, also known as unorthodox medicine, and regular medicine that resulted because of these differing views was a major conflict for decades before Still established the basis for osteopathy. The foundations of this divergence may be traced back to the mid-18th century when specificity in physiology became the central study that pointed to the cause and nature of disease. Diseases began to be localized to organs and tissues, and doctors began shifting their focus from the patient to the internal state of the body, resulting in an issue labeled as the problem of the "vanishing patient." A stronger movement towards experimental and scientific medicine was then developed. In the perspective of the unorthodox physicians, the sympathy and holism that was integral to medicine in the past were left behind. Heroic medicine became the convention for treating patients, with aggressive practices like bloodletting and prescribing chemicals such as mercury, becoming the forefront in therapeutics. Alternative medicine had its beginnings in the early 19th century, when gentler practices in comparison to Heroic medicine began to emerge. Homeopaths, Thomsonians, and hydropaths practiced unconventional forms of healing that may have had strong appeal to patients due to their more attenuated practices. As alternative medicine grew to include more followers, orthodox medicine continued to rebuke and seek to invalidate the “irregulars,” as termed by the orthodox practitioners in Heroic medicine. As each side sought to defend its practice, a schism was presented itself in the medical marketplace, with both the irregular and regular practitioners attempting to discredit the other. The irregulars—those that are now referred to as Alternative Medicine practitioners—argued that the regulars practiced an overly mechanistic approach to treating patients, treated the symptoms of disease instead of the original causes, and were blind to the harm they were causing their patients. Regular practitioners had a similar argument, labeling unorthodox medicine as unfounded, passive, and dangerous to a disease-afflicted patient. This is the medical environment that pervaded throughout the 19th century, and this is the setting that Still entered when he began developing his idea of osteopathy.

After experiencing the loss of his three daughters to spinal meningitis and noting that the current orthodox medical system could not save them, Still may have been prompted to shape his reformist attitudes towards the conventional medicine. Still set out to reform the orthodox medical scene and establish a practice that did not so readily resort to drugs, purgatives, and harshly invasive therapeutics to treat a person suffering from ailment, similar to the mindset of the irregulars in the early 19th century. Thought to have been influenced by spiritualist figures such as Andrew Jackson Davis and ideas of magnetic and electrical healing, Still began practicing manipulative procedures that were intended to restore harmony in the body. Soon, Still attracted support for his medical philosophy that disapproved of orthodox medicine, and shaped his philosophy for osteopathy. Components of this philosophy included the idea that structure and function are interrelated and the importance of each piece of the body in the harmonious function of its whole.

Still sought to establish a new medical school that could produce physicians trained under this philosophy, and be prepared to compete against the orthodox, or allopathic physicians. The American School of Osteopathy was established on May 20, 1892, in Kirksville, Missouri. Twenty-one students made up this first class.

Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions." While the state of Missouri granted the right to award the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree. In the early 20th century, osteopaths across the United States sought to establish law that would legitimize their medical degree to the standard of the allopathic medic. The processes were arduous, and not without conflict . In some states, it took years for the bills to be passed. Osteopaths were often ridiculed and in some cases arrested, but in each state, osteopaths managed to achieve the legal acknowledgement and action they set out to pursue.

In 1898 the American Institute of Osteopathy started the Journal of Osteopathy and by that time four states recognized osteopathy as a profession.

Osteopathy worldwide

The osteopathic profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice osteopathic physicians. These groups are so distinct that in practice they function as separate professions. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In Australia, the UK, and New Zealand the non-physician manual medicine osteopaths are regulated by statute and practice requires registration with the relevant regulatory authority. The Osteopathic International Alliance has a country guide with details of registration and practice rights and the International Osteopathic Association has a list of all accredited osteopathic colleges.

Several international and national organizations exist relating to osteopathic education and political advocacy. Similarly, there is also an international organization of organizations for national osteopathic and osteopathic medical associations, statutory regulators, and universities/medical schools offering osteopathic and osteopathic medical education, known as the Osteopathic International Alliance (OIA).

The following sections describe the legal status of osteopathy and osteopathic medicine in each country listed.

Australia

Osteopaths work in private practice, and the majority of private health insurance providers cover treatment performed by osteopaths. In addition, treatment performed by osteopaths is covered by the public healthcare system in Australia (Medicare) under the Chronic Disease Management plan.

Osteopaths in Australia undertake a minimum of five years' university training in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques to be eligible to practice.

Osteopathy Australia (formerly the Australian Osteopathic Association) is a national organization representing the interests of Australian osteopaths, osteopathy as a profession in Australia, and consumers' right to access osteopathic services. Founded in 1955 in Victoria, the Australian Osteopathic Association became a national body in 1991 and became Osteopathy Australia in 2014. and is a member of the Osteopathic International Alliance.

The Osteopathy Board of Australia is part of the Australian Health Practitioner Regulation Agency which is the regulatory body for all recognized health care professions in Australia. The Osteopathic Board of Australia is separate from the Medical Board of Australia which is the governing body that regulates medical practitioners. Osteopaths trained internationally may be eligible for registration in Australia, dependent on their level of training and following relevant competency assessment.

Canada

In Canada, the titles “osteopath” and “osteopathic physician” are protected in some provinces by the medical regulatory college for physicians and surgeons. As of 2011, there were approximately 20 U.S.-trained osteopathic physicians, all of which held a Doctor of Osteopathic Medicine degree, practicing in all of Canada. As of 2014, no training programs have been established for osteopathic physicians in Canada.

The non-physician manual practice of osteopathy is practiced in most Canadian provinces. As of 2014, manual osteopathic practice is not a government-regulated health profession in any province, and those interested in pursuing osteopathic studies must register in private osteopathy schools. It is estimated that there are over 1,300 osteopathic manual practitioners in Canada, most of whom practice in Quebec and Ontario. Some sources indicate that there are between 1,000 and 1,200 osteopaths practicing in the province of Quebec, and although this number might seem quite elevated, many osteopathy clinics are adding patients on waiting lists due to a shortage of osteopaths in the province.

Quebec

Beginning in 2009, Université laval in Quebec City was working with the Collège d'études ostéopathiques in Montreal on a project to implement a professional osteopathy program consisting of a bachelor's degree followed by a professional master's degree in osteopathy as manual therapy. However, due to the many doubts concerning the scientific credibility of osteopathy from the university's faculty of medicine, the program developers decided to abandon the project in 2011, after  2 ¹⁄₂ years of discussion, planning, and preparation for the program implementation. There was some controversy with the final decision of the university's committee regarding the continuous undergraduate and professional graduate program in osteopathy because the Commission of studies, which is in charge of evaluating new training programs offered by the university, had judged that the program had its place at Université Laval before receiving the unfavourable support decision from the faculty of medicine. Had the program been implemented, Université Laval would have been the first university institution in Quebec to offer a professional program in osteopathy as a manual therapy.

European Union

There is no universal regulatory authority for the practice of osteopathy or osteopathic medicine within the European Union; it is on a country-by-country basis. The UK's General Osteopathic Council, a regulatory body set up under the country's Osteopaths Act 1993, has issued a position paper on European regulation of osteopathy.

France

Osteopathy is a governmentally recognized profession and has title protection, autorisation d'utiliser le titre d'ostéopathe. The most recent decree regarding osteopathy was enacted in 2007.

Germany

Germany has both osteopathy and osteopathic medicine. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.

Physiotherapists are a recognized health profession and can achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)." Non-physician osteopaths are not medically licensed. They have an average total of 1200 hours of training, roughly half being in manual therapy and osteopathy, with no medical specialization before they attain their degree. Non-physician osteopaths in Germany officially work under the "Heilpraktiker" law. Heilpraktiker is a separate profession within the health care system. There are many schools of osteopathy in Germany; most are moving toward national recognition although such recognition does not currently exist. In Germany, there are rules (at the country level) under which persons (non-physicians) may call themselves osteopaths.

New Zealand

The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003 which came into effect on 18 September 2004. Under the Act, it is a legal requirement to be registered with the Osteopathic Council of New Zealand (OCNZ), and to hold an annual practicing certificate issued by them, in order to practice as an osteopath. Each of the fifteen health professions regulated by the HPCA Act work within the "Scope of Practice" determined and published by its professional Board or Council. Osteopaths in New Zealand are not fully licensed physicians. In New Zealand, in addition to the general scope of practice, osteopaths may also hold the Scope of Practice for Osteopaths using Western Medical Acupuncture and Related Needling Techniques.

In New Zealand a course is offered at Unitec. Australasian courses consist of a bachelor's degree in clinical science (osteopathy) followed by a master's degree. The Unitec New Zealand double degree programme is the OCNZ prescribed qualification for registration in the scope of practice: Osteopath, Australian qualifications accredited by the Australian and New Zealand Osteopathic Council are also prescribed qualifications.

Osteopaths registered and in good standing with the Australian Health Practitioner Regulation Agency – Osteopathy Board of Australian are eligible to register in New Zealand under the mutual recognition system operating between the two countries. Graduates from programs in every other country are required to complete an assessment procedure.

The scope of practice for US-trained osteopathic physicians is unlimited on an exceptions basis. Full licensure to practice medicine is awarded on an exceptions basis following a hearing before the licensing authorities in New Zealand. Both the Medical Council of New Zealand and the Osteopathic Council of New Zealand [OCNZ] regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.

United Kingdom

The practice of osteopathy has a long history in the United Kingdom. The first school of osteopathy was established in London in 1917 by John Martin Littlejohn a pupil of A. T. Still, who had been Dean of The Chicago College of Osteopathic Medicine. After many years of existing outside the mainstream of health care provision, the osteopathic profession in the UK was accorded formal recognition by Parliament in 1993 by the Osteopaths Act. This legislation now provides the profession of osteopathy the same legal framework of statutory self-regulation as other healthcare professions such as medicine and dentistry.

The General Osteopathic Council (GOsC) regulates the practice of osteopathy under the terms of the Osteopaths Act 1993. Under British law, an osteopath must be registered with the GOsC to practice in the United Kingdom. The General Osteopathic Council has a statutory duty to promote, develop and regulate the profession of osteopathy in the UK. It fulfills its duty to protect the interests of the public by ensuring that all osteopaths maintain high standards of safety, competence and professional conduct throughout their professional lives. In order to be registered with the General Osteopathic Council an osteopath must hold a recognized qualification that meets the standards as set out by law in the GOsC's Standard of Practice. This Act provides for "protection of title" A person who, whether expressly or implication describes him- or herself as an osteopath, osteopathic practitioner, osteopathic physician, osteopathist, osteotherapist, or any kind of osteopath is guilty of an offence unless they are registered as an osteopath. There are currently more than five thousand osteopaths registered in the UK.

Osteopathic medicine is regulated by the General Osteopathic Council (GOsC) under the terms of the Osteopaths Act 1993 and statement from the GMC. Practising osteopaths will usually have a B.S. or M.Sc. in osteopathy. Accelerated courses leading to accreditation are available for those with an M.D. and physiotherapists. The London College of Osteopathic Medicine, teaches osteopathy only to those who are already physicians.

United States

Those who practice Osteopathy, that is "Osteopathic practitioners," are trained only in manual osteopathic treatment, generally to relieve muscular and skeletal conditions. Medical licensing of these practitioners is not permitted in the United States and they are legally restricted from referring to themselves as "Osteopaths." This is to avoid confusion with "Osteopathic physicians" who are medical doctors trained and certified to practice in the branch of scientific medicine called osteopathic medicine.

The American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine recommend using the terms osteopathic physician (U.S.-trained only) and osteopathic medicine in reference to osteopathic medicine as practiced in the United States. Osteopathic physicians earn the degree of Doctor of Osteopathic Medicine (D.O.), a degree equivalent, though different in certain aspects, to that of Doctor of Medicine (M.D.).

Osteopathic medicine in the United States has always meant a physician trained in and entitled to the full scope of medical practice. Osteopathy or osteopath as written in some U.S. state and federal laws refers only to osteopathic medicine or osteopathic physicians, respectively. With the increased internationalization of the profession, these older terms have fallen out of favor as generally accepted use due to the confusion they may cause.

Egypt and the Middle East

Hesham Khalil introduced osteopathy in the Middle East at a local physical therapy conference in Cairo, Egypt in 2005 with a lecture titled “The global Osteopathic Concept / Holistic approach in Somatic Dysfunction”. Since then he has toured the Middle East to introduce osteopathy in other Middle Eastern and North African countries, including Sudan, Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman. In December 2007 the first Workshop on Global osteopathic approach was held at the Nasser Institute Hospital for Research and Treatment, sponsored by the Faculty of Physical Therapy, University of Cairo, Egypt. On August 6, 2010, the Egyptian Osteopathic Society (OsteoEgypt) was founded. OsteoEgypt promotes a two-tier model of osteopathy in Egypt and the Middle East. The event was timed to coincide with the birthday of A. T. Still.