The Battle Between Politics and Science Is Costing Us a Timely Victory Over the COVID-19 Pandemic.

Against the backdrop of the COVID-19 pandemic, the author discusses what he views as a persistent tension between the nature and aims of politics vs science. He outlines a call to action for osteopathic physicians to stand with science, advocate for best practices, undertake dialogue with local and state health authorities, and act as role models for colleagues and patients alike.

Interprofessional education can help close the gap in behavioral health workforce.

Of the health profession workforce shortages projected over the next 10 years, none is more dire than behavioral health. It's estimated that by 2020, mental health and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.

A new pathway for medical education.

Physician education in the United States must change to meet the primary care needs of a rapidly transforming health care delivery system. Yet medical schools continue to produce a disproportionate number of hospital-based specialists through a high-cost, time-intensive educational model. In response, the American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine established a blue-ribbon commission to recommend changes needed to prepare primary care physicians for the evolving system. The commission recommends that medical schools, in collaboration with their graduate medical education partners, create a new education model that is based on achievement of competencies without a prescribed number of months of study and incorporates the knowledge and skills needed for a twenty-first-century primary care practice. The course of study would occur within a longitudinal clinical training environment that allows for seamless transition from medical school through residency training.

Accreditation standards of osteopathic and allopathic medical schools: could they affect educational quality?

Accreditation of medical schools in the United States is the province of the Liaison Committee on Medical Education (LCME) for MD-granting schools, and the Commission on Osteopathic College Accreditation (COCA) for DO-granting schools. One of the functions of accreditation is to provide medical schools an opportunity for critical self-analysis, which leads to improvement in quality. In some quarters, there are perceptions that the quality of osteopathic education, and therefore the graduates of DO medical schools, are of a lower quality than is the case with MD schools. To examine that assertion, the authors delved into certain aspects of accreditation across the two professions, particularly the structure of the two accrediting bodies, as well as a comparative analysis of certain select accreditation standards, to determine whether these elements demonstrate any differences that could lead to educational quality dissimilarities.The basic structures of the two accrediting bodies are functionally similar except in the way the members are chosen. Also, the LCME has student representation and COCA does not. However, the authors did not think these differences have significant quality implications. In the areas of governance, the major difference is that a for-profit osteopathic school has now been approved, while the relevant LCME standard states that a medical school should be not-for-profit unless there are extraordinary and justifiable circumstances that preclude full compliance with the standard.Relative to academic environment, LCME standards are more expansive, possibly leading to environments where that may enhance student learning. Comparative analysis of several other standards demonstrates some variation, but not enough to conclude that accreditation is a factor in any quality issues across the two professions.

The National Osteopathic Research Center at the University of North Texas Health Science Center: inception, growth, and future.

The osteopathic profession has long recognized the need to carry out research in order to improve clinical care. Osteopathic physicians have a particular obligation to carry out research in areas, such as osteopathic manipulative medicine (OMM), that are unique to osteopathic medicine. OMM is similar to manual therapy that is performed by other types of practitioners, but it has some distinctive characteristics. Osteopathic doctors also use OMM to treat infectious disease-not just musculoskeletal disorders.In 2001, several osteopathic professional organizations agreed to jointly fund a national osteopathic research center at one of the osteopathic medical colleges. Five osteopathic colleges submitted research proposals in response to a request for applications. The University of North Texas Health Science Center (UNTHSC) was chosen to be the site for the Osteopathic Research Center (ORC) and was funded for four years with $1.1M. Between 2002 and 2007, the ORC received an additional $11M in research support from multiple sources including federal funds. With this support, it has made substantive contributions to science. These include oversight of the recently completed four-year, $1.5M multicenter study on the efficacy of OMM as a treatment for pneumonia in the elderly and a three-year, $1.9M National Institutes of Health-funded developmental research center to perform mechanistic studies of some OMM actions.The authors discuss the long-term costs, benefits, and sustainability of the national ORC at UNTHSC in the contexts of research accomplished, the training of new medical osteopathic researchers, and an effort to develop other successful regional osteopathic research centers.

Research funding at colleges of osteopathic medicine: 15 years of growth.

CONTEXT: Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years. OBJECTIVES: To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999. METHODS: Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases. RESULTS: Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years. CONCLUSIONS: The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once "critical mass" for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.

Management of intrathecal catheter-tip inflammatory masses: a consensus statement.

OBJECTIVES: In a companion article, we synthesized current clinical and preclinical data to formulate hypotheses about the etiology of drug administration catheter-tip inflammatory masses. In this article, we communicate our recommendations for the detection, treatment, mitigation, and prevention of such masses. METHODS: We reviewed published and unpublished case reports and our own experiences to find methods to diagnose and treat catheter-tip inflammatory masses in a manner that minimized adverse neurological sequelae. We also formulated hypotheses about theoretical ways to mitigate, and possibly, prevent the formation of such masses. RESULTS: Human cases have occurred only in patients with chronic pain who received intrathecal opioid drugs, alone or mixed with other drugs, or in patients who received agents that were not labeled for long-term intrathecal use. Most patients had noncancer pain owing to their large representation among the population with implanted pumps. Such patients also had a longer life expectancy and exposure to intrathecal drugs, and they received higher daily doses than patients with cancer pain. Clues to diagnosis included the loss of analgesic drug effects accompanied by new, gradually progressive neurological symptoms and signs. When a mass was diagnosed before it filled the spinal canal or before it caused severe neurological symptoms, open surgery to remove the mass often was not required. Anecdotal reports and the authors' experiences suggest that cessation of drug administration through the affected catheter was followed by shrinkage or disappearance of the mass over a period of 2-5 months. CONCLUSIONS: Attentive follow-up and maintenance of an index of suspicion should permit timely diagnosis, minimally invasive treatment, and avoidance of neurological injury from catheter-tip inflammatory masses. Whenever it is feasible, positioning the catheter in the lumbar thecal sac and/or keeping the daily intrathecal opioid dose as low as possible for as long possible may mitigate the seriousness, and perhaps, reduce the incidence of such inflammatory masses.