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Allopathy

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Allopathy is a term, coined in the late 18th century by Samuel Hahnemann, a German physician and scholar who was the founder of homeopathy. Derived from the Greek (ἄλλος, állos, other, different + πάϑος, páthos, suffering), "allopathy" describes the Hippocratic principle contraria contrariis curantur:

Diseases which arise from repletion are cured by depletion; and those that arise from depletion are cured by repletion; and in general, diseases are cured by their contraries.[1]

The term, of which a common variant was allopathic medicine, was meant to be contrasted to Hahnemann's own theory of "homeopathy", whose underlying concept was similia similibus curentur, "let like cure like", and was based on "the principle of similars". Allopathy, therefore, according to Hahnemann, because it was based on "the principle of opposites", was intended to characterize a wide range of medical theories and applications. The word "homeopathy", also Hahnemann's creation, which is in widespread use to this day, was derived from the Greek hómoios (similar) and páthos (suffering).

The term "allopathy" was used frequently throughout the first half of the 19th century, particularly in the United States, to describe various forms of conventional medicine, even by non-homeopathic practitioners themselves. By the turn of the 20th century, the term had fallen into disrepute. medicine derived from the increasing use of scientific models of biology and treatment simply did not use a concept of opposites.

Forty years later, during which time conventional medicine had begun to adopt a firmly scientific basis, the 1941 printing of the Encyclopedia Britannica, had, in its 23-volume set, a one-page article on homeopathy, 34 pages devoted to "Medicine" and "Medical" off-shoots, but no article at all about allopathy. Even its index, comprising an entire volume of 978 pages, made no mention of it. For historical reasons, it continues to be used to distinguish fully accredited undergraduate medical schools that grant the Doctor of Osteopathy degree, and graduate medical education in historically osteopathic institutions, from accredited in non-osteopathic institutions.

Some practitioners of alternative medicine do use "allopathy" for practitioners that do not use their models of health, models that often are not based on generally accepted ideas of biologically based medicine.

Conflict based on alleged "opposites" paradigm

The term, however, is still used occasionally today, generally in a disparaging fashion, by some practitioners of alternative medicine to characterize what others call conventional medicine. A reason that it is considered derogatory is that mainstream medicine is not based on a theory of opposites. In many cases, medical therapy either helps replaced a failed body system (e.g., administering insulin in Type I diabetes, when the body no longer makes its own), or with drugs to reduce the acquired insulin resistance of body cells in Type II diabetes. Many new therapies directly reinforce or regulate physiologic mechanisms operating at a molecular level.

Similarly, vaccination uses weakened forms of the microbiological pathogens (bacteria and viruses) to artificially induce the immune response. This is certainly not 'allopathic', but isopathic, similar to homeopathy itself.

Current usage in medical education

Sir William Osler, first professor of medicine at Johns Hopkins, whose textbook of medicine [2] is now in its 23rd edition, was quoted in the Flexner Report:

A new school of practitioners has arisen which cares nothing for homeopathy and still less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new."(Flexner report, page 162)

Osler saw medicine as neither allopathic nor homeopathic, but the Flexner Report did accept some osteopathic medical schools as scientifically based. Contemporary usage, which is not considered derogatory and respects historical tradition, is used to distinguish between U.S. osteopathic medical schools that grant the Doctor of Osteopathy (D.O.) degree versus "allopathic" medical schools that grant the degree Doctor of Medicine (Latin Medicinae doctorum, or M.D.). Both types of programs are under the aegis of the Accreditation Council for Graduate Medical Education (ACGME).[3] The ACGME glossary defines "Applicant" as "An M.D. or D.O. invited to interview with a GME program"; note that no distinction is made.

For some time, there has been reciprocity in graduate medical education programs. In the ACGME and other certification discussions, the M.D.-granting schools are frequently called allopathic to distinguish them from osteopathic; no one seems to mind. Emergency medicine had some problems in creating jointly accredited programs, due to an earlier lack of an American Osteopathic Associated emergency medicine board, so faculty often had a different board certification. Emergency medicine, as one primary care specialty, now routinely accepts D.O. or M.D. residency candidates.[4]

A new trend has been creating reciprocity in clerkships, which are clinical rotations for students still in undergraduate medical education (i.e., working toward the M.D. or D.O. degree).[5] In the U.S., both types of medical schools are recognized as "mainstream"; the osteopathic schools teach additional musculoskeletal manipulations but the core curricula are otherwise identical. In the U.K., "osteopaths" are trained only in manipulations. Graduates of osteopathic schools tend to be more likely to go into primary care than from non-osteopathic schools; it has been suggested that the osteopathic schools are more holistic and less specialty/research oriented with the same general body of knowledge.[6] There are also combined family medicine residencies approved by the graduate medical organizations of both traditions.[7]

References and notes

  1. Hippocrates, Aphorisms, Section II, Aphorism #22
  2. William Osler, The Principles and Practice of Medicine (First Edition ed.)
  3. Accreditation Council for Graduate Medical Education (ACGME)
  4. Accreditation Council for Graduate Medical Education (ACGME), Emergency Medicine Guidelines
  5. Henry Tulgan, MD; William J. DeMarco, DO; Michele P. Pugnaire, MD; Boyd R. Buser, DO (May 2004), "Joint Clinical Clerkships for Osteopathic and Allopathic Medical Students: New England's Experience", Journal of the American Osteopathic Association 104 (5): 212-214
  6. John C Licciardone (January 12, 2007), "A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004", Osteopath Med Prim Care 1 (2), DOI:10.1186/1750-4732-1-2.
  7. St. Luke’s Hospital & Health Network, Bethlehem, PA, Family Medicine (Allopathic/Osteopathic) Residency Program
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