Not long after he set up a family practice in the late 1970s, Dr. Larry Silverberg learned that local physicians were saying disturbing things about him: that he was not, in their opinion, "a real doctor."
Never mind his Maryland medical license, his years in the U.S. Public Health Service and residency at the University of Miami School of Medicine, where he went on to teach.
He was a doctor of osteopathy, or D.O. - licensed to practice medicine but schooled in a holistic philosophy whose 19th-century roots can appear exotic and arcane. "For a long time, D.O.s were shunned by everybody," Silverberg said.
But as Silverberg's practice in Ellicott City blossomed over time and conventional doctors grew to accept him, osteopathic medicine has undergone a renaissance.
Many laymen still believe that osteopathic physicians are "bone doctors," a misunderstanding based on the discipline's original premise that hands-on manipulation of the spine and muscles can fix much of what ails you.
But as today's osteopaths branch into standard medical specialties and fill the demand for primary care doctors, many patients don't realize they're seeing a D.O. until they see the initials on a nameplate. They also might notice that the doctor is asking as many questions about their diet, exercise habits and family life as their physical symptoms.
"It's a concept of osteopathic medicine that you take care of the person, not the problem," said Dr. Tyler Cymet, an osteopathic physician in charge of family medicine at Sinai Hospital.
Since 1990, the number of osteopaths in the United States has more than doubled, to 61,000, although they still represent a fraction of the nation's 690,000 licensed physicians. Even in Maryland, with no homegrown schools of osteopathy, their ranks have more than tripled, from 182 to 680, with osteopaths practicing and teaching in the Johns Hopkins and University of Maryland medical systems.
"Now, D.O.s are accepted by the medical profession on equal footing," said Silverberg. In fact, he worries that osteopathy has become so mainstream that it is losing its identity.
This year, applications to osteopathic medical schools hit a record high, with 11,650 students competing for 4,462 first-year spots. New osteopathic medical schools have sprouted, including three in rural areas of Kentucky, Virginia and Tennessee that have had trouble attracting doctors.
"There is still a need and desire for people to become physicians in society, and to some extent, the D.O. schools are meeting the needs of the community," said Dr. Steve Shannon, a Maryland native who heads the American Society of Colleges of Osteopathic Medicine.
The discipline has come a long way since the 1870s, when a former Civil War doctor who lost three family members to meningitis rebelled against a medical establishment that he felt had failed them.
Laying on hands
Andrew Taylor Still believed that illnesses could be treated by laying hands and applying force to a patient's bones and muscles. "Osteopathic manipulation" was designed to relieve back pain and other orthopedic problems, and infections and emotional ailments as well.
In the early 1900s, progressive reformers drove many osteopaths and their schools out of business in their zeal to eliminate quackery. But as the century progressed, osteopaths began to embrace conventional medicine, blending it with the traditional practices that had made them outsiders.
In 1969, the American Medical Association - which once branded osteopaths as "cultists" and forbade members from associating with them - allowed D.O.s to join its ranks. State boards licensed osteopaths to practice the full spectrum of medicine - a privilege granted to no other group except M.D.s.
Like M.D.s, osteopaths prescribe drugs and recommend tests and surgery. They learn the same principles of scientific medicine as M.D.s, but also learn to consider diet, exercise and family dynamics when evaluating ailments.
To Sinai's Cymet, this means encouraging lifestyle changes and helping patients understand the disease behind their symptoms. It can mean less emphasis on the prescription pad and a greater willingness to consider acupuncture and other alternative treatments. The bottom line: promoting the body's innate, if imperfect, ability to heal itself.
`No, I'm a doctor'
Still, like many colleagues, Cymet rejects the "alternative medicine " label. "No, I'm a doctor," he said. "I take care of people. I use science as a guiding principle, but it doesn't answer all my questions."
Raised in Florida and Israel, Cymet came from a family that debated issues and challenged conventions. Among his cousins were three chiropractors who brought their alternative view of the medical universe to the table.
At Emory University, he studied psychology, anthropology and Hebrew. He began medical school at Northwestern University but dropped out after a semester.