It seems that in the U.S. it is becoming a lost art, I go to an office that is run by three Osteopaths and they may as well be MD's. They communicate little even if you are prepared and they are on a financial success program to time their client's time to 10 minutes. I fear the manipulation & alignment that they are famous for is becoming a thing of the past, rather write a quick script for drugs. If they do not want to do hands on anymore maybe they could pass it on to nurses or other modalities?
Ha! Big subject, and too easily open to sweeping generalisations!
However, whilst we might say American Osteopaths have become more like MD's, they might say British ones have become more like physiotherapists.
In fact both have moved away from our roots. Osteopathy was conceived as a complete re-think of medical principles and practice. At the time medicine was perceived to be a colossal failure (discuss), and this was intended to be its reformation from the ground up.
It was based on the idea that the body is self-regulating, coordinated, and totally self-repairing, providing its basic needs are met. One of those fundamental needs is structural and postural ease. There are many levels to interpret that, but hence the emphasis on manual adjustment.
In America, it was seen as pragmatic to maintain the scope of practice but to incorporate pharmacology, in Britain the pragmatic approach was to remain largely a manual therapy but deal only in 'structural conditions'. Both shifts mark changes so significant that osteopathy as it was conceived is certainly missing. The jury is out on whether it is now something better than it was.