Osteopaths seek more slots on federal research panels

State of play: There are just two D.O.s among the 462 experts serving on national advisory councils for the National Institutes of Health, compared with 213 M.D.s, per an analysis the American Association of Colleges of Osteopathic Medicine shared with Axios.

• NIH is the largest funder of biomedical research in the world. Its national advisory councils review research grant applications and provide input to more than two dozen research institutes and centers on policy development and program implementation.
• Committee members are chosen by Health and Human Services leadership based on such factors as the quality of their research, scientific journal publications and other professional accomplishments. A doctoral degree or equivalent is typical but not always required, per an NIH selection criteria memo.

The small number of D.O.s on NIH advisory councils put osteopathic medical schools at a disadvantage for getting research funded, said David Bergman, AACOM's senior vice president of government relations and health affairs.

• This is becoming a bigger problem for D.O. students, Bergman said.
• Since 2020, osteopathic and allopathic medical students with M.D.s have competed for the same residency slots. Research publications are increasingly important factors for earning a residency match, especially in competitive specialties.

Congress has weighed in on the lack of osteopathic physicians — which currently make up 11% of the physician workforce — in NIH committees several times.

• Most recently, the House of Representatives in July expressed its concern in the report to a fiscal 2025 spending bill covering federal health agencies, including NIH.
• The report cites "NIH's failure to respond to requests to create an action plan to address the agency's chronic underfunding of osteopathic research and underrepresentation of osteopathic scientists on NIH National Advisory Councils and study sections."

The other side: NIH understands the importance of creating opportunities for physician-scientists with osteopathic degrees, it said in a statement to Axios, adding it doesn't analyze its advisory committee members by degrees.

• 19 osteopathic doctors and 46 other osteopathic medical school employees sat on other types of NIH expert panels in 2021, including those attached to the All of Us precision medicine initiative, according to a budget document the institute sent to Congress in response to questions on osteopathic medical school research funding.
• NIH currently funds $55.6 million in active research at osteopathic medical schools, including a $2.4 million grant to Heritage College of Osteopathic Medicine in Ohio for skeletal muscle research.
• That's compared with the nearly $23 billion currently funding research projects at M.D.-granting schools.

Zoom out: The underrepresentation of osteopathic physicians on federal committees goes beyond NIH, Bergman said. Approximately 17 D.O.s sit on federal advisory committees overall, per AACOM's analysis.

• Nearly 250 committees actively advise HHS on a wide range of topics from childhood immunizations to arthritis to health information technology, and other federal agencies have health-related advisory boards, as well.

Osteopathic medical programs, which have been around since 1892, emphasize holistic care and non-pharmacological pain management. More than half of D.O.s go into primary care.

• Historical bias against osteopathic doctors may contribute to their low numbers on these committees, even if it's not intentional, Bergman said. In the early 20th century, the medical establishment shunned D.O.s — the American Medical Association called them "cultists."
• That sentiment has faded. But D.O.s are still less likely to work at large academic medical centers that often feed into these advisory committees.
• That creates a negative feedback loop that leaves D.O.s out of crucial conversations as their ranks grow, especially in rural and underserved communities, Bergman said.

The bottom line: Holistic care that relies less on pharmaceuticals "is permeating the practice of medicine, but nevertheless, we were leaders in that," said Thomas Cavalieri, dean of the Rowan-Virtua School of Osteopathic Medicine in New Jersey.

• Cavalieri has served on three non-NIH federal advisory committees. He was the only D.O. on each of the committees at the time he served, he said.
• "I do think these committees and the health of the nation and the research would benefit more with more inclusion of D.O.s in these committees," he added.