Building miracles with research
In the 100th volume of The Journal of the American Osteopathic Association, Associate Editor Michael M. Patterson, DO, wrote that “By any measure, A.T. Still was the osteopathic medical profession’s first researcher.” Our founder embodied the quest for truth that underlies all scientific research, according to Barbara Ross-Lee, DO, the vice president for health sciences and medical affairs at the New York Institute of Technology. Thanks in part to Dr. Still’s passion for inquiry, we do things in medicine today that would have been called miracles not too long ago—restoring hearing to deaf children, sending deadly cancers into remission, repairing grave injuries with life-saving surgeries.
The great thing about the osteopathic medical profession is that we have the ability to make miracles happen. We do it through research, built through collaboration on a foundation of science. The AOA is advancing research through several bold new initiatives, but the fact remains: We can, and should, do much more.
Advancing osteopathic research
Over the course of my AOA career, I have personally observed “miracles” evolve from research conducted by DOs. The Multicenter Osteopathic Pneumonia Study in the Elderly evaluated the efficacy of osteopathic manipulative treatment in treating elderly patients with lower respiratory infections. Terrie E. Taylor, DO, distinguished professor of internal medicine at the Michigan State University College of Osteopathic Medicine in East Lansing, continues her efforts to eliminate malaria in the African nation of Malawi. Diabetes care is being transformed in Appalachia thanks to research led by Jay H. Shubrook Jr., DO, at the Ohio University Heritage College of Osteopathic Medicine in Athens, while the research of Leonard H. Calabrese, DO, in Cleveland breaks new ground on the benefits of empathetic care provided by DOs.
But these rigorous efforts will be threatened unless the AOA and rest of the profession support them. The AOA Council on Research is taking the lead on a strategic direction for osteopathic research. The council drafted a 10-year strategic plan for the profession’s research through multi-stakeholder discussion and teamwork, which was approved by the AOA Board of Trustees in March.
The council’s plan makes recommendations, suggests strategies, identifies responsible parties, and defines a timeline for advancing osteopathic medical research over the next 10 years. Everything depends on funding, however. Should it receive funding, the plan envisions several outcomes, including cultivation of active research cultures on our medical school campuses, publication of hundreds of peer-reviewed original manuscripts, and establishment of our profession as a leader in investigating manual medicine and in coordinating and disseminating such research.
Teamwork with AOA official family
Clearly, the AOA by itself cannot accomplish the goals of the council’s strategic plan. Thankfully, we have many supporters, including the Osteopathic Heritage Foundation in Columbus, Ohio, which for years has provided generous funding for AOA grants, enabling several published research projects. We hope to work further with the foundation in the coming years. The American Academy of Osteopathy (which has developed its own strategic plan for research) and the AOA have formed a small task force to discuss how we might collaborate.
Such collaboration is critical, as we know the impact osteopathic medical research can make when funded and well-done. An example is a trial led by John C. Licciardone, DO, that was published in the March/April issue of Annals of Family Medicine. Conducted at the Osteopathic Research Center in Texas and funded by the National Institutes of Health—National Center for Complementary and Alternative Medicine and the Osteopathic Heritage Foundation, the trial examined OMT and ultrasound therapy in the treatment of 455 adults with chronic low back pain. Patients who received ultrasound therapy did not see any improvement, but patients who received OMT saw significant improvement in pain, used less prescription medication and were more satisfied with their care. Dr. Licciardone’s team published three substudies of their trial in The Journal of the American Osteopathic Association. These substudies will be recognized with the AOA’s George W. Northup, DO, Medical Writing Award during AOA’s annual business meeting in July.
Federal initiatives and challenges
We are also heavily involved with the national Patient-Centered Outcomes Research Institute (PCORI), an agency created by the Affordable Care Act. AOA President Ray E. Stowers, DO, encouraged DOs to apply for PCORI research funding. We have also been invited to provide feedback on PCORI priorities. A DO was selected for first PCORI workshop in October 2012. The AOA National Osteopathic Advocacy Center in Washington, D.C., has hosted meetings of the PCORI/Partnership to Fight Chronic Disease. And this is just one of many federal entities we support and work with to expand research.
Yet as I’ve said, we as a profession must do much more. The profession’s lack of research spills over into payment issues. Carriers often do not properly reimburse OMT because they are not familiar with our modalities and the great benefits they provide to patients. Without an evidence base, OMT may not be included in essential benefits packages under the Affordable Care Act.
The AOA is not blameless. We allocate only 3% of our budget to research funded by the Osteopathic Research and Development Fund—nowhere near enough to support the amount of research we need. This is a problem. We must increase the fund’s corpus to support new osteopathic research projects as we did in the 1990s, when the AOA instituted a $50 assessment on all members on top of their dues. Another goal of the Council on Research’s strategic plan is to have $3 million to $9 million available annually within 10 years to support research within the osteopathic medical profession. My calculations (I’m a lawyer, not a statistician) show we could raise the first $3 million in three years with a $25 assessment. Is it time to do this again?
Making miracles happen
While OMT and the benefits it provides to patients might not seem like a miracle at first glance, anything that can help save a life, relieve chronic pain, or prevent a life-altering condition might be viewed by that patient as miraculous. And what better way to “Provide compassionate, quality care to my patients,” as the Osteopathic Pledge of Commitment calls us to do, than through research and advancement.
In 1915, Dr. Still urged the osteopathic medical profession to “stand behind all legitimate research institutes and give them your support.” We must come together as a profession to expand our research base, to prove the efficacy of what we do, and to ensure that the osteopathic medical profession can survive in the future health care world of comparative effectiveness, essential benefits and quality measurement. I call upon the AOA to put our money where our mouth is and institute a research assessment by 2015. We can DO it!