The Rise of Osteopathic Medicine in the United States: A Foucauldian Perspective

Abstract

Those who wish to obtain the title of “physician” in the United States have only two options before them: the Doctor of Medicine (MD) degree or the Doctor of Osteopathic Medicine (DO) degree. These two degrees correspond with allopathic and osteopathic medicine, respectively. Allopathic medicine consists of what might be described as traditional Western medicine. Osteopathic medicine, though, is relatively new. It was developed over the 19th century by American physician Andrew Taylor Still in response to what Still perceived to be the inefficacy and corruption of the medical field at that time. Still posited that the body contained everything it needed to cure itself, and the physician’s job was to facilitate the body’s natural healing processes through “manual medicine”—that is, physical manipulation of the musculoskeletal system by the hands (“Osteopathy”). He objected to the use of drugs and invasive procedures like surgery, endorsing prevention rather than treatment through a holistic approach to the human body. Today, DOs have all of the same rights and privileges as MDs—they can prescribe medication, perform surgery, and diagnose illnesses. Medical education is virtually identical, too: osteopathy students spend four years taking all the same classes as allopathic students, with the addition of manual manipulation. Next, they obtain a residency for several years, where they work alongside MDs doing the same jobs.

Eventually they may opt to specialize in everything from family medicine to neurosurgery (“Doctor”). Osteopathic and allopathic physicians today are virtually indistinguishable. This hasn’t always been the case. Initial opposition to osteopathy and osteopaths by mainstream medicine was, in fact, quite vehement. Allopathic medicine did everything it could to discredit osteopathy’s voice in the discourse of medicine.1 Osteopathy was officially considered by the American Medical Association (AMA) to be a “cult” and DOs “cultists” (“Sword,” 283). The American Medical Association’s Code of Ethics went so far as to forbid MDs from voluntarily associating with DOs (283). Acceptance by mainstream medicine and the American public came only after a long uphill battle. And even today, mainstream acceptance, far from being a victory for osteopathy, suggests at least partial defeat: DOs and MDs are now virtually indistinguishable—but doesn’t this interchangeability imply that the original elements and contributions of osteopathy are no longer in effect? Ultimately, this question can be framed in Foucauldian terms: mainstream medicine exerted a great deal of power in the United States, and osteopathy offered a basis for resistance to the authority and perceived dangers of medicine. But has osteopathy succeeded in changing the status quo, or does its eventual merger with mainstream medicine signify its defeat?

The lengthy struggle of osteopathy against standard medicine can be divided into three parts: first, its origin as a reaction against the prevailing practice of medicine in the United States, which held a monopoly on medical discourse; second, its resistance to institutionalized medicine throughout the 20th century; third, its gradual co‐optation by allopathic medicine, which resulted in the diminished authority of many original osteopathic principles but also, importantly, in the increased influence of osteopathic medicine and a significant change in the overall practice of medicine in the United States.