The Aging Elephant

For some people reading this essay, 2004 may seem like just yesterday. For me, it seems like an eternity ago. I have certainly felt the pull of time increase its velocity with each passing year, but 16 years is still a long time. I won’t give away my age, but I will say I was still in Piaget’s “preoperational” stage of development when Dr. Bryan E. Bledsoe wrote his now-famous article “The Elephant in the Room: Does OMT Have Proved Benefit?”. In his essay, he succinctly describes a system of medical education that I have come to know very well. It is a system that attempts to indoctrinate belief in a set of “techniques” that have, in almost all cases, no credible evidence. It is a system that has been allowed to bastardize the term “evidence-based medicine” so shamelessly, it has scarred me from trusting even the most basic medical claims made by my colleagues. I understand that humans are capable of two opposing behaviors, the “duality of man (or woman),” as the saying goes. Our species is notoriously capable of preaching rationality with one hand and believing what makes us feel good with the other, but enough is enough.

We cannot continue to allow the existence of a system that takes advantage of the trust our country has in physicians. A system that peddles unsubstantiated claims as scientific fact, and worst of all, charges patients for these beliefs under the guise of evidence-based medicine. A system that year after year encourages students to invent “mechanisms” for therapies without even a shred of evidence. A system where an infinite number of techniques and mechanisms are acceptable as long as they can fit into the osteopathic models and as long as they sound plausible. A system where medical students are expected (forced) to “diagnose” and “treat” somatic dysfunction in a woman who can barely afford clothes. A system where I am expected to act like I have delivered uncontroversial medical care to this unfortunate woman before sending her off to billing, even though I know she doesn’t have insurance. A system where faculty member after faculty member tells me, “we know it is insane, but you just have to play along to graduate.” Your choices are either sit passively by and look the other way or risk getting kicked out of school for being critical.

Immanuel Kant had a concept that it doesn’t matter what the results of your actions are; what matters is whether the actions you take are moral or not. In other words, it doesn’t matter that in this instance, I have chosen to sit passively by for my four years in medical school, and society didn’t crumble. What matters is that in a different set of circumstances, my decision to legitimize a system I knew was not based in reality could have meant the atrocities of the second world war or the Tuskegee study. I don’t entirely agree with Kant’s moral system, but the thought experiment is deeply troubling. I understand that the number of physicians in our society doing full-time OMM is minuscule. I know that the number of DO’s who practice OMM in any form is minute. That is probably the reason nothing has changed in 16 years.

The history of medicine is the story of ridiculous ideas persisting as the status quo for hundreds and hundreds of years. We have discovered more about the human body and how to heal it during the last century than we did in humankind's entire history. The reason for this anomalous progress is simple, we as a profession of physicians and scientists all agreed nothing was acceptable except that which has been proven. Sometimes in medicine, the efficacy comes before the mechanism; sometimes, it’s the opposite. But, within the realm of American medicine, in no instance is there a complete lack of convincing evidence on either, except in the case of OMM.

The aging elephant remains till we are bolder.
So conspicuous and at least as big as a boulder.
Will the elephant first have to die and rot?
Before he is even given a thought?
The elephant in the room is getting older.