Epigenomics and Osteopathic Medicine: Why Right Now is the Ideal Time for Osteopathic Manipulative Medicine (OMM) to shine at the Forefront of Genetic Research
Gabriela Perez, OMSI1,2 and Rafael Guerrero-Preston2, PhD, MPH
1Kansas City University of Medicine and Biosciences, Kansas City, MO
2Johns Hopkins Sidney Kimmel Cancer Research Center, Baltimore, MD
Current trends in healthcare are moving in a direction focused more on wellness, preventive care, and “health” care rather than what is practiced now, disease management and “sick” care. The trend towards a holistic approach to health care is especially important to physicians trained in osteopathic medicine, Doctors in Osteopathy (DOs). According to the American Osteopathic Association (AOA), osteopathic physicians apply the philosophy of treating the whole person to prevent, diagnose, and treat illness, disease, and injury3. DOs are trained to support the body’s innate mechanisms to heal itself using osteopathic manipulative medicine (OMM)3 and are one of the fastest growing segments of healthcare professionals in the United States (US)4.
It is hypothesized that holistic medicine approaches, such as OMM, complementary/alternative medicine (CAM), and therapies that induce a relaxation response may be beneficial to prevent and treat chronic diseases14. However, there is a lack of quantitative evidence to support this hypothesis. In fact, many of these approaches are criticized or negated due to a lack of scientific evidence7,13. Evidence-based care in holistic medicine could greatly benefit from molecular research that looks at the effects of OMM, CAM, and the relaxation response on the genome and the epigenome.
Epigenomic research is one of the most vibrant fields of research in medicine and public health today. Epigenomics is the study of heritable changes in gene expression that are not associated to changes in DNA sequence and regulate cellular processes through the life-course and in subsequent generations. Diet, life-style, environmental exposures and disease dynamics interact with the genome and the epigenome to regulate gene expression and impact the equilibrium between health and disease.
To parallel the increasing amount of work being done in epigenetics8, there has been an increasing number of trained, practicing physicians in the field of osteopathic medicine4. The lack of data with respect to epigenomic and holistic therapies could be due to a lack of clinician-researchers, or PhDs with interest in this topic and lack of funding,. The National Institutes of Health (NIH) recently published a Request For Applications (May 2013) to evaluate the role of epigenetics in social, behavioral, environmental, and biological relationships throughout life span and across generations11. I would argue that if we examine the impact of CAM and OMM in health care today we would unveil currently unknown beneficial cellular effects in multiple body compartments that improve health care delivery quality and lower health care costs.
It is not rare for patients to self-report increased quality of life after implementing therapies such as OMM, yoga, acupuncture, and/or change of diet. A study could be performed to see if any of these CAM practices have genomic/epigenomic effects by using serum samples taken before, during, and after these holistic practices, and after long-term follow up. It could then be determined if a statistical significance exists between holistic therapies and genomic/epigenomic changes. If so, primary care physicians could recommend these practices to their patients with similar symptoms and osteopathic physicians could additionally practice OMM on these patients. This would increase quality of life in patients undergoing chemotherapy or with similar acute or chronic symptoms.
It is evident that epigenomic studies, at the forefront of current biomedical research, may provide quantitative evidence to support primary care physicians, especially osteopathic physicians. Research should be conducted evaluating the epigenomic alterations that may occur in response to OMM, CAM, and therapies that induce the relaxation response. Case studies evaluating small numbers of patients and their individual responses to holistic therapies should eventually lead to randomized studies, that evaluate the genomic and epigenomic changes that modulate the response to these therapies and that can be used as biomonitors of their effectiveness.
13