When Nancy Nichols began her osteopathic practice 15 years ago, no hospital in her town of Mesa, AZ, would grant her privileges. Today, she's welcome to practice at all of them.

To Nichols, that represents real progress for her profession. Long considered pseudo-doctors by the medical establishment, osteopathic doctors are in fact licensed physicians who can do surgery and prescribe drugs but have added training in manipulative therapy. It's the manipulation part of the practice that has earned them a reputation as "alternative" practitioners.

But only 6.2% of osteopathic physicians currently practice manipulation on the majority of their patients, leading many to worry that their profession will soon have nothing that distinguishes D.O.s from M.D.s. "It?s sort of like being the victim of our own success,?? says Eugene Oliveri, DO, president of the American Osteopathic Association.The November 4, 1999 issue of the New England Journal of Medicine warned osteopaths that they are losing something valuable.

The journal reported a study by researchers at Rush-Presbyterian-St. Luke's Medical Center and the Chicago College of Osteopathic Medicine that compared osteopathic manipulation to treatment of the type practiced by orthopedists for low back pain. The researchers randomly assigned 178 patients to receive one or the other type of treatment. After 12 weeks, both groups of patients were equally satisfied with the care they received. The only significant difference was that the osteopathic patients used fewer drugs and paid less for their treatment.

In an accompanying editorial, Joel Howell, M.D., Ph.D., of the University of Michigan warned that the practice is in a "precarious position.''

"Today, osteopathic medicine has moved close to the mainstream -- close enough that in general it is no longer considered alternative medicine," he wrote. "The long-term survival of osteopathic medicine will depend on its ability to define itself as distinct from and yet still equivalent" to the medicine practiced by M.D.s.

Osteopathy was a concept of healing developed in 1864 by Andrew Taylor Still, a Kansas doctor whose conventional treatments failed to save his three children from spinal meningitis. Still came to believe that the body is capable of healing itself, and he developed a way to manipulate the spine and organs that he believed would allow for better blood flow, flushing out disease.

Marilyn Wagner is one patient who didn't need a peer-reviewed study to know that osteopathy works. The 63-year-old Berkeley, CA, woman has a lifelong history of asthma and back problems from severe scoliosis (curvature) of the spine.

"When I got up in the morning, I would be bent double," Wagner says. "It would take a couple of hours before I straightened up." She had been to numerous medical doctors for her respiratory and back problems and had seen a chiropractor for her back without lasting effect.