Instead of dashing out of class to celebrate the end of Anatomy I, the 100 first-year medical students remained seated, heads bowed, while their professor led them in a solemn prayer.
For a brief moment, culminating a grueling term of lab work and lectures, they paid final tribute to the 26 cadavers they had dissected during the course.
Although such practices might be laughed out of another medical school, not even a smirk registered at the College of Osteopathic Medicine of the Pacific in Pomona.
"It is wholly appropriate that we highlight the dignity of the human being in this special way," O. J. Bailes, vice president and dean of academic affairs, said of the February service. "It is a true reflection of the osteopathic philosophy of caring and sensitivity in all our dealings with life and death."
Unique approaches to medical training have been the trademark of this tiny Pomona college ever since it became a part of the quest 10 years ago to resurrect the practice of osteopathic medicine in California.
Osteopathy, a century-old form of health care emphasizing the body's muscular and skeletal structures, was virtually condemned to extinction in California with the passage in 1962 of a referendum that banned further licensing of osteopathic physicians. At the time, existing doctors of osteopathy were given the option of hanging on to their osteopathic degrees or trading them in for medical degrees. Most chose the latter route.
The college was founded in 1977, shortly after the state Supreme Court overturned the ban. In the last decade it has struggled to bring back osteopathy as a credible alternative to traditional medicine.
Promoting the profession's distinctive holistic approach and hands-on spinal techniques, COMP, as the college is known, has grown from 36 students to 400. During that time, the number of osteopaths practicing in California has jumped from about 70 to 850.
Symbol of Resurgence
Today, as the school celebrates its 10th anniversary in a former J. C. Penney building on the downtown Pomona mall, many hail it as a symbol of osteopathy's resurgence, a kind of phoenix risen from the profession's demise.
Fully accredited and privately funded, it is the newest of the nation's 15 osteopathic colleges and the only such school west of the Rockies.
"COMP is the future of osteopathic medicine," said Matt Weyuker, executive director of Osteopathic Physicians and Surgeons of California, a Sacramento-based organization representing the state's osteopaths. "It shows that we're back, and stronger than ever."
Partly because of their non-traditional approach, osteopaths, who represent about 5% of the country's physicians, have long suffered from the stigma that they are second-class "bone doctors" practicing on the fringes of modern medicine. Often, they are confused with chiropractors, who perform some of the same musculoskeletal manipulations but are neither trained nor licensed to provide a full range of medical care.
Osteopaths are fully licensed physicians, trained to prescribe drugs and perform surgery. Having achieved a kind of peaceful coexistence, osteopaths and medical doctors routinely work together on hospital staffs with the same privileges and teach together in a variety of postgraduate medical programs.
Osteopaths, however, like to claim that they offer "something more, not something else." Although they subscribe to many of the same medical principles as traditional physicians, osteopaths put special emphasis on the body's muscular and skeletal structures in the diagnosis and treatment of disease. By massaging muscles, rotating limbs and realigning vertebrae, osteopaths believe they have an extra tool for remedying a wide range of ailments, from headaches to circulation problems to severe back pain.
The belief that body structure affects body function has also engendered a holistic philosophy among osteopaths, so that they advocate looking at the entire patient, not just at an isolated disease or symptom.
Even in instances where their remedies may not differ much from those of traditional physicians, osteopaths take pride in this people-oriented approach, which, they claim, makes them more humanistic, sensitive physicians.
"We put our hands on people," said Ethan R. Allen, a Norwalk osteopath and one of COMP's founders. "It means a lot to patients if you can touch the spot that hurts."
The stormy history of osteopathic medicine began nearly 100 years ago, when a traditionally trained Missouri doctor named Andrew Taylor Still proposed that the body's muscular and skeletal structures form an interconnected web that regulates a patient's health.
Limited at first to hands-on drug-free therapy, the discipline was branded a "quackish system" by the American Medical Assn. at the turn of the century. Because of this stigma, osteopathic physicians were denied the right to serve as medics in World Wars I and II.
Later, as the quality of osteopathic training improved and the practice came to include a full range of medical treatments, traditional physicians gradually began to concede that osteopaths are, in fact, "real" doctors with nearly identical backgrounds.
"The difference now is very slight, and the training they get is parallel," said James G. Magnall, a retired physician who recently finished a four-year term on the state Board of Medical Quality Assurance. "It's more of a doing the same thing but approaching it from a little different philosophical angle."
It was this new-found acceptance, ironically, that was largely responsible for the profession's demise in California in the early 1960s.
In an effort to establish "one single, high standard of care," leaders of the California Medical Assn. offered to incorporate osteopathic physicians within the ranks of traditional medicine. The unification, they reasoned, would upgrade the quality of medicine in California and eliminate confusion among the public about the differences between the two fields.
Most osteopaths readily agreed. The proposed merger was, after all, the long-awaited recognition that their qualifications and skills were equal to those of their traditionally trained counterparts.
With both osteopaths and medical doctors supporting the concept of a merger, California voters overwhelmingly approved a 1962 referendum that banned new osteopaths from being licensed. Proposition 22 gave practicing osteopaths the choice of keeping their doctor of osteopathy degrees or acquiring medical doctor licenses.
For a $65 fee, the large majority of California's 3,100 osteopaths accepted the offer to be relicensed as medical doctors. As part of the merger, the board of trustees of the College of Osteopathic Physicians and Surgeons in Los Angeles voted to convert the institution to a traditional medical school.
"It was my opinion that the people of California would receive better medical care if we combined the two philosophies," said Forest J. Grunigen, a retired Newport Beach urologist who traded in his osteopathic license for a medical license 25 years ago.
For a handful of determined osteopaths, including Allen, however, the merger represented a compromise of the distinctive osteopathic philosophy.
Along with a small group of die-hards, he led a 12-year fight to overturn the referendum and restore California's osteopathic profession to its former status as a separate medical field.
The battle eventually led to the state Supreme Court, whose justices ruled in 1974 that the ban was unconstitutional. The court ruled, in a case brought by eight out-of-state osteopaths, that the referendum had violated the equal protection provisions of both state and federal constitutions because it prohibited the outside osteopaths from practicing in California.
"I hate to say this, but the merger was kind of a blessing in disguise," said Viola M. Frymann, director of COMP's Osteopathic Center for Children in La Jolla. "It began a revival in the profession, so that the teaching of true osteopathic principles and practice is vastly stronger today than it was at the time."
Nowhere is that revival stronger than at COMP's five-building campus in Pomona.
Besides receiving the same four-year training as traditional physicians, COMP students are required to take 300 to 500 more hours of study in osteopathic curriculum, according to national figures supplied by the Chicago-based American Osteopathic Assn.
Students take all the standard courses in anatomy, biochemistry and pathology, and they meet for special classes, including musculoskeletal manipulations, known as palpations.
In a course called "Literature in Medicine," students are assigned to read Tolstoy, Camus and Kafka because, according to COMP President Philip Pumerantz, "patients are people with feelings, dreams and fears, and it is essential that their doctors have a sensitivity to their social and psychological needs."
The college also has a drama group, hailed as the only osteopathic theatrical troupe in the country. "We are training medical students who are well-rounded and sensitive human beings, whose gentle and caring spirits will make them the very best of osteopathic physicians," Pumerantz said.
The Wellness Club, a student organization, was formed on the premise that health is more than merely the absence of disease and can be promoted by developing a person's physical, mental and spiritual capacities.
"If a student graduates from an osteopathic medical school, he's grounded in all the scientific paraphernalia that one needs, but he also has a philosophy that makes him more humanistic, that makes him sensitive and caring, that makes him people-oriented," Pumerantz said. "It's not done by mistake. We educate them that way on purpose."
The typical COMP student, according to admissions director Curt Clauss, tends to be somewhat non-traditional, a bit older--the average age is 29--and to have work experience. The college, which charges an annual tuition of $13,250, last year received 1,200 applications for its 100-student freshman class.
Most tend to have "good people skills," he said. Statistics show that, nationwide, about 85% of osteopaths provide primary care, such as general practice, internal medicine or pediatrics.
"Other doctors forget that everything is interrelated," said Mark McManigel, 30, an osteopathic student who recently finished his second year at COMP. "We deal with the whole body. It's more holistic, and that fit my philosophy of what I thought medicine should be."
The result, osteopaths say, is that they are uniquely trained to recognize and treat certain health problems that would stymie some medical doctors.
'Enhance the Healing'
Although the difference may not be noticeable when it comes to removing tonsil here or fighting an infection there, osteopaths say their special skills make them particularly qualified to treat a wide range of muscular and skeletal disorders.
"Rather than letting the injured part sit stagnant while it is healing, we are accomplishing strength, flexibility and circulatory improvements during that healing process," said Lee Rice, an osteopath and team physician for the San Diego Chargers football team.
"By using hands-on manipulative diagnosis and treatment, we . . . in fact, enhance the healing process," he added. "I would hate to practice sports medicine without my osteopathic background."
Often, osteopaths say, it is simply a matter of being trained to recognize subtle malformations of the body's structure.
Last fall, for example, a prison guard showed up in Allen's Norwalk office with an excruciating backache, apparently the result of a scuffle with an inmate. Another physician, a medical doctor, had given the guard, 28, a painkiller and told him to change jobs.
Allen discovered that one of the man's legs was about three-quarters of an inch shorter than the other.
Although the feuds of earlier years between medical doctors and doctors of osteopathy have largely ended, traditionally trained doctors challenge the premise that osteopaths have a monopoly on caring or sensitivity. Medical officials contend that the fundamental differences between the two fields are negligible.
To that end, the California Medical Assn. still officially supports a unified standard of medical care. Since the 1974 state Supreme Court ruling, the association has made several unsuccessful attempts in the state Assembly to establish one licensing board and regulatory agency for both osteopaths and medical doctors.
The American Medical Assn. also supports unifying the licensing process, but it has not made any organized effort toward that end.
"I see no reason for two schools of medicine," said Robert M. Garrick, a top California Medical Assn. official who heads a group that was created 25 years ago to represent former osteopaths who accepted medical degrees.
"Osteopathic medicine is here to stay," Pumerantz said.
Nationally, officials credit the success of COMP with helping boost the profession, which has grown from 15,000 osteopaths a decade ago to more than 25,000.
'Times Have Changed'
From a personal perspective, no one knows the shifting of the tides better than Elliot Harris, a former osteopath who opted to become a medical doctor after the 1962 ban.
A Canoga Park family practitioner, Harris said he was "pleased as hell" when his 27-year-old son decided to enroll at COMP last fall.
"Times have changed. I think it's a lot easier for the osteopathic student now," Harris said. "But he'll still be walking toward the wind all the time. He'll have to lean a lot heavier.
"It's like any other minority, though," he said. "You have to say what you are and be proud of what you are, or you get lost in the crowd and die."