How is a DO more than MD + OMT?

bones · Nov 18, 2004

hey all

glad i could give a different perspective on things.

To answer your questions dpw,
1) yes
2) virtually all Family med programs "allow" OMT- but almost none will train you (or at least train you well). the real question is- will you be competent to use it effectively given little time per patient and no supervision? I'm not sure where you are in your education- but honing your skills as early as possible is what its all about. if you end up in a cash practice for family med or OMM, your OMT skill is (or seriously should be) directly proportional to how much you make for your time. generally if you are doing a chiropractors work of cracking a back here and there for the endorphin rush- you get chiropractor wages. If on the other hand you are preventing surgeries, getting patients safely and permenently off their expensive pain meds, and curing lifelong medical conditions on a regular basis... well then you do a little better- more like an anesthesiologist (and will get lots of referrals). People will pay out of pocket to get well. I would if it were me.

If you work in an insurance based family med program, your challenge will be to do general management + OMT within your alloted 10 minutes. You can still make permanent changes in this little time, however... if your skill is there. resist the temptation to just pop a few prominent segments to make them feel better and save time. Instead: get really good at finding the key lesion- and if you treat that alone it wont take long and you can really effect long term change.

adios,
bones

Evilcaterpillar · Nov 18, 2004

Thee's a book by Norman Gevitz called "The DO", you can find it at Barnes and Noble.com. It's a great way to get background information on the DO philosophy and it's history. It also attempts to explain the main differences between MD and DO.

medic170 · Nov 18, 2004

Evilcaterpillar said:
Thee's a book by Norman Gevitz called "The DO", you can find it at Barnes and Noble.com. It's a great way to get background information on the DO philosophy and it's history. It also attempts to explain the main differences between MD and DO.

Yes, that has been mentioned several times.

BamaAlum · Nov 18, 2004

bones said:
Miss me?

allright. I see a few unanswered criticisms and comments to field from since I was last on here.

so the point of my previous posts were to tell you the difference between DO's and MD's as per the topic of the thread- not to defend the validity of the DO profession or the efficacy of OMM. but lets take a detour.

To be fair, if "rational, modern" DO's ran the AOA (as in wanna-be MD's who don't use OMM), then our profession is as good as finished. It has no reason to exist. Just give us all MD degrees at that point. I am sorry if you slacked off or go to a doc-diploma-mill DO school and feel that your osteopathic skill is inadequate and cannot integrate it- again this is a failing of the education process, and not the art of osteopathy. Sadly, this is a very common story. your best option in such a place is to seek out specialists in private practice in your city who can be role models for you. make the best of the situation.

http://www.academyofosteopathy.org/findphys.cfm
look up neuromuscular medicine and osteopathic manipulative medicine specialists in your town for shadowing in the first 2 years, and get a rotation or two with them 3rd and 4th year. And USE it all 3rd and 4th year. If you don?t use your skills on a variety of patients under a variety of clinical situations you have lost the art and will probably not apply it effectively in your practice.

Try to follow as many different osteopaths as possible... as with any type of doc- there are awesome ones and crappy ones. I don?t doubt that some are so lousy that their benefit to patients is minimal. And then you see the ones that change lives left and right and you realize why we?re DO?s. if you can develop some of that skill and apply it to your specialty you will be unique in your profession, able to help those patients that nobody else can.

A big failing of the osteopathic profession is that our current AOA leaders (zealots, as you say- and rather stupid ones) let these new random DO schools surface all over with severely inadequate OMM faculty, when we barely have enough skilled osteopathic faculty at our core schools. Thus, the common story of the inadequate DO becomes even more common... and not only does nobody integrate functional anatomy into their practice, but probably the majority of DO's today don't even know anything about osteopathy. Its like having a bunch of MD's who have had a few chiropractic lessons (shudder). or they are zealots who are essentially chiropractors that couldnt save a life in the ER if it was their mothers... no offense you chiros, but most of you are taught to crack backs and charge a bill- without understanding key lesion mechanics and functional causes. fix the key lesion and it never comes back... but if you don't you'll be cracking the same vertebrae for years. If you also understand the visceral anatomy you can address all sorts of conditions, not just sloppy vertebrae.

a real osteopath integrates... learn anatomy and phys REALLY well, and then NOTHING is left to "belief". whats all this crap about "i want to believe". its like you're some freaking Jehovas witness bible nazi. osteopaths are scientists and artists, not religious fanatics (well... maybe a few are, but they need to keep it quiet). the reason it is a science is that its all built on a rock-solid foundation of knowns- anatomy, physiology, and pathophyisiology.

and to that "show me the functional anatomy studies" parrot... wake up. read your textbooks. read doctor Willards work from NECOM. now read it again. functional anatomy isn't clinical- its basic science. perhaps more complicated anatomy than you were taught, but critical to understanding OMM.

Now as far as the clinical efficacy of individual techniques, yes
I agree that our profession needs a TON of research. we are under-researched for a number of reasons:

1)osteopathy treats the whole patient... thus, no two patients with the same condition are treated in the same way. just try setting up a good pneumonia study when every single patient needs a different treatment from the ground up based on their structural strains and systemic stresses.

2) OMT is NOT a double-blind tool. how can a skilled practicioner do a practicioner-blind sham treatment? at BEST you can do single blind... and even then you are pushing it (massage the right place and you'll get benefit, sham it too hard and its obvious to the patient).

Now imagine proving to me that surgery works. hmm??? there are virtually NO double blind or placebo-controlled studies for the surgeries we use every day. Should we stop performing all of these surgeries due to insufficient evidence? The results are "self evident"... right? well no... I would actually love to see a double blind study for surgery on pancreatic cancers, cholecystectomies, and appendectomies, but it just aint gonna happen, now is it?

At best you can do outcome studies... but guess what? there are some good outcome studies for OMM out there. I would love EBM double blind OMM research too, but it just ain't happening.

3) DO's dont know how to do research. a failing of the education. we have virtually no research education or publication requirements in DO schools. Thus, once we graduate we write some truly pitiful papers... and some of these make it into JAOA since there is such a small pool of papers to choose from.

4) resources. Most DO schools dont even have PhD programs. very little funding for research facilities. it shows the emphasis of those ever-wise AOA leaders.

so after all this, you see only a few good OMM papers. surprised? i'm not at all. BUT there ARE a few good ones out there. you just have to look.
http://ostmed.hsc.unt.edu/ostmed/index.html

so there isn't much data (though more than for most common surgeries), and unless you do the research yourself there wont be more anytime soon. the only way to understand the value of OMM is to understand functional anatomy and the clinical pathophysiology of disease way better than most of your colleagues... or to see outcomes from skilled specialists. its not enough to read case studies since they can be exaggerated or distorted. That said I have dozens of my own cases that i could share with anyone who is interested, and im still just a student. Believe nobody's case study though. see it for yourself. Understand it for yourself. yes that answer sucks, but deal with it, since thats the best you'll get.

And if you think OMM is a joke but went DO anyway... its your own damn fault for going DO. quit your bitching... some of us are proud osteopaths with very happy and now very well patients!

cheers,
bones

Yeah, Ole Doc Jones says it works. So, I believe him. Even though Ole Doc Jones has never picked up a journal or done any research on his own. He wrote a textbook once, though. His anecdotal evidence is overwhelming.

You lost all credibility when you defended the current AOA establishment. You can't seriously believe that they have our best interest at heart.

You are still giving the AOA party line, man. Let me guess you are applying to DO Family Med programs. How are you going to get on here and criticize those of us who want to know why and how OMM works and if certain techniques work? Maybe you should have studied a little harder and spent some time in a research lab to learn how the scientific method works. A heavy dose of skepticism is a great attribute for a physician to have, instead of following like sheep.

I atend one of the oldest DO schools and our OMM department is fairly strong. You still fail to give any credible sources or background for your claims. You innudate us with 'you should follow so and so' and 'practice your art.' Forgive me and others who want a little more substance to our claims. Don't get me wrong I believe that OMM is beneficial for certain conditions, but I want to know why and how. Just as i want to know how and why and for what conditions certain drugs are indicated. Granted most OMM techniques definitely won't hurt the patient(although cervical manipulations carries a 2% risk of vertebral artery dissection) and are certainly worth trying as an adjunct, but you act like they are proven entities and should be first line therapy. I actually agree with some of your claims. I do think that lymphatic treatments for pneumonia patients is beneficial and can help speed recovery. I don't agree, however that their pneumonia was a result of functional anatomy disturbances precisely because I do know my pathophysiology.

I will most likely never use OMM in my career since I am going into Pathology (which I guess makes me a bad DO since I didn't choose to do FM), but I would like to see our profession be able to say this works and here is why, or we thought this technique worked but after studying it we determined that it didn't. What is wrong with that?

medic170 · Nov 18, 2004

BamaAlum said:
Yeah, Ole Doc Jones says it works. So, I believe him. Even though Ole Doc Jones has never picked up a journal or done any research on his own. He wrote a textbook once, though. His anecdotal evidence is overwhelming. You lost all credibility when you defended the current AOA establishment. You can't seriously believe that they have our best interest at heart.

You are still giving the AOA party line, man. Let me guess you are applying to DO Family Med programs. How are you going to get on here and criticize those of us who want to know why and how OMM works and if certain techniques work? Maybe you should have studied a little harder and spent some time in a research lab to learn how the scientific method works. A heavy dose of skepticism is a great attribute for a physician to have, instead of following like sheep.

I atend one of the oldest DO schools and our OMM department is fairly strong. You still fail to give any credible sources or background for your claims. You innudate us with 'you should follow so and so' and 'practice your art.' Forgive me and others who want a little more substance to our claims. Don't get me wrong I believe that OMM is beneficial for certain conditions, but I want to know why and how. Just as i want to know how and why and for what conditions certain drugs are indicated. Granted most OMM techniques definitely won't hurt the patient(although cervical manipulations carries a 2% risk of vertebral artery dissection) and are certainly worth trying as an adjunct, but you act like they are proven entities and should be first line therapy. I actually agree with some of your claims. I do think that lymphatic treatments for pneumonia patients is beneficial and can help speed recovery. I don't agree, however that their pneumonia was a result of functional anatomy disturbances precisely because I do know my pathophysiology.

I will most likely never use OMM in my career since I am going into Pathology (which I guess makes me a bad DO since I didn't choose to do FM), but I would like to see our profession be able to say this works and here is why, or we thought this technique worked but after studying it we determined that it didn't. What is wrong with that?

So do explain why you believe in surgery like bones was saying. I'm not being a jerk, either, I seriously want to see your logic.

Idiopathic · Nov 18, 2004

BamaAlum said:
although cervical manipulations carries a 2% risk of vertebral artery dissection

Dont spit this rhetoric out unless its accurate please. 2 out of 100 cervical manipulations will cause VA dissection? Gimme a ****ing break. I did 30 or so just practicing on classmates, and probably 2000 were done when we were learning and during clinicals. Also, if a stat like this were true, chiropractors would be out of business, as they probably do about 50 necks a week, which would mean 1 out of those patients would end up in the ER or dead as a result. This is an absolutely ridiculous statement to make (unless you are being sarcastic).

BamaAlum · Nov 18, 2004

Idiopathic said:
Dont spit this rhetoric out unless its accurate please. 2 out of 100 cervical manipulations will cause VA dissection? Gimme a ****ing break. I did 30 or so just practicing on classmates, and probably 2000 were done when we were learning and during clinicals. Also, if a stat like this were true, chiropractors would be out of business, as they probably do about 50 necks a week, which would mean 1 out of those patients would end up in the ER or dead as a result. This is an absolutely ridiculous statement to make (unless you are being sarcastic).

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11805635

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10547013

I read a similar study last year and I thought I remembered the increase incidence was 2% but I could have been mistaken. You're right it probably isn't this high, but in the particular study I read they quote either 1 or 2%. Nevertheless, it is associated with an increased risk of dissection. Although, the frequency of such dissections is not agreed upon. Also, some of these case may have had tortuous vessels or other risk factors which led to dissection. My point is that it is not without risks.

Idiopathic · Nov 18, 2004

"Approximately 117 cases of postmanipulation cerebrovascular ischemia have been reported in the English language literature"

2% risk my ass. I dont like HVLA of the C-Spine and I dont do it on patients, but the risk of dissection is a fraction of 2%. How many cases of C-Spine HVLA have been done in the last year? If you exclude the teaching sphere (which I dont see how you can), I would say that between DC's and DO's, it was probably done upwards of 250K times just last year. Even if there were all 117 cases of CV ischemia in one year, it wouldnt even be 0.05% The risk is there, and yes, if you look retrospectively at Px with CV ischemic injuries you will find some who have had HVLA, but to say that the risk is 2% is simply wrong, and borders on irresponsible. A quality clinician should know the signs to look for (i.e. when not to Rx with HVLA) and should also carefully follow his/her HVLA Px, especially when this is a consideration. In my mind, it goes with the territory, and this is actually a reason that I dont/wont do it.

But 2%? Sheesh...

edit: I dont mean to attack you or harp on this. But anything over 1% for a supposedly benign procedure, to me, is a HUGE risk. Clinicians could not justify performing this procedure if the risk of likely death was that high.

BamaAlum · Nov 18, 2004

medic170 said:
So do explain why you believe in surgery like bones was saying. I'm not being a jerk, either, I seriously want to see your logic.

Because I have been in the path lab and have seen fungating adenocarcinomas removed by surgery. Which would explain the patients lower GI bleeding. I have seen appendices removed with fecaliths and massive inflammatory changes. This would explain the patient's symptoms and their elevated white count. The patient presents with an elevated white count, tenderness over McBurney's point. The appendix is removed the white count gradually goes down, the patient recovers. Cause and effect. It is called Occam's Razor. I had a case two weeks ago where the patient had a dissected thoracic aorta. He had an identifiable lesion on MRA, went to surgery had the dissected portion removed, replaced with a porcine graft and subsequently recovered. That is why I believe in surgery.

medic170 · Nov 18, 2004

BamaAlum said:
Because I have been in the path lab and have seen fungating adenocarcinomas removed by surgery. Which would explain the patients lower GI bleeding. I have seen appendices removed with fecaliths and massive inflammatory changes. This would explain the patient's symptoms and their elevated white count. The patient presents with an elevated white count, tenderness over McBurney's point. The appendix is removed the white count gradually goes down, the patient recovers. Cause and effect. It is called Occam's Razor. I had a case two weeks ago where the patient had a dissected thoracic aorta. He had an identifiable lesion on MRA, went to surgery had the dissected portion removed, replaced with a porcine graft and subsequently recovered. That is why I believe in surgery.

Cause and effect: you perform OMM, and the pneumonia patient recovers faster, their white count returns to normal, ans s/s disappear, and the bacteria is erradicated at a faster rate than a control group. I posted a similar study about otitis media from JAMA.

BamaAlum · Nov 18, 2004

Idiopathic said:
"Approximately 117 cases of postmanipulation cerebrovascular ischemia have been reported in the English language literature"

2% risk my ass. I dont like HVLA of the C-Spine and I dont do it on patients, but the risk of dissection is a fraction of 2%. How many cases of C-Spine HVLA have been done in the last year? If you exclude the teaching sphere (which I dont see how you can), I would say that between DC's and DO's, it was probably done upwards of 250K times just last year. Even if there were all 117 cases of CV ischemia in one year, it wouldnt even be 0.05% The risk is there, and yes, if you look retrospectively at Px with CV ischemic injuries you will find some who have had HVLA, but to say that the risk is 2% is simply wrong, and borders on irresponsible. A quality clinician should know the signs to look for (i.e. when not to Rx with HVLA) and should also carefully follow his/her HVLA Px, especially when this is a consideration. In my mind, it goes with the territory, and this is actually a reason that I dont/wont do it.

But 2%? Sheesh...

edit: I dont mean to attack you or harp on this. But anything over 1% for a supposedly benign procedure, to me, is a HUGE risk. Clinicians could not justify performing this procedure if the risk of likely death was that high.

Dude, no offense taken. You are right and I probably misspoke. But also there are most certainly some patients that had manipulation that resulted in dissection that weren't caught. So to say that there were 250K manipulations done last year and only 117 REPORTED cases fails to recognize that some of the dissections weren't caught and certainly weren't reported. I totally agree with you though. The risk is probably infinitely small and I wish I hadn't quoted a paper I didn't have on hand and represents a small sample size. I still wonder if the risk of cervical manipulation is worth it, though.

Idiopathic · Nov 18, 2004

BamaAlum said:
I still wonder if the risk of cervical manipulation is worth it, though.

No matter what the risk, and even without personal experience of bad outcome, I wont do it because it scares me. If I felt 100% comfortable with my technique, maybe...but who can honestly say that about something that is so based in subjectivity?

BamaAlum · Nov 18, 2004

medic170 said:
Cause and effect: you perform OMM, and the pneumonia patient recovers faster, their white count returns to normal, ans s/s disappear, and the bacteria is erradicated at a faster rate than a control group. I posted a similar study about otitis media from JAMA.

I don't disagree. I read the study on otitis media and I think that it is valid. My point wasn't that it wasn't efficacious, it was that you can't show me a quantifiable lesion. You can't demonstrate to me that the OMM treatment group and the control group had an identifiable lesion that was resolved through OMM and not through the control group. I can show you an inflammed appendix with a fecalith that was cured through surgery, though.

medic170 · Nov 18, 2004

BamaAlum said:
I don't disagree. I read the study on otitis media and I think that it is valid. My point wasn't that it wasn't efficacious, it was that you can't show me a quantifiable lesion. You can't demonstrate to me that the OMM treatment group and the control group had an identifiable lesion that was resolved through OMM and not through the control group. I can show you an inflammed appendix with a fecalith that was cured through surgery, though.

Ok, I get what you are saying.

BamaAlum · Nov 18, 2004

Idiopathic said:
No matter what the risk, and even without personal experience of bad outcome, I wont do it because it scares me. If I felt 100% comfortable with my technique, maybe...but who can honestly say that about something that is so based in subjectivity?

Also, I don't know about you, but at my school they made almost no comment on certain risk factors in the literature that may predispose to dissection. Definitely wouldn't do it on someone with bad atherosclerosis.

bones · Nov 18, 2004

BamaAlum said:
Also, I don't know about you, but at my school they made almost no comment on certain risk factors in the literature that may predispose to dissection. Definitely wouldn't do it on someone with bad atherosclerosis.

I wouldnt either genius. If your school didnt teach you those contraindications there is something seriously wrong.

bones · Nov 18, 2004

well hellooooo mr kansas city. LMFAO. I dont know how i can dumb this down for you any more. In the future I?d suggest you read my post before replying.

BamaAlum said:
You lost all credibility when you defended the current AOA establishment. You can't seriously believe that they have our best interest at heart.

If you read what I posted, you'd see that yes the AOA is a bunch of doobers that need their cage rattled. They are either corrupt, have poor judgment, or maybe some of both. Our profession is getting run into the ground due to lack of innovation in teaching techniques, lack of qualified OMM faculty and proper integration, and yet they allow all these new schools to open up which just add to the problems we have. Plus they let people like you into their schools who like to write a lot but don?t read first.

There are some great MD?s out there, and who knows, maybe you?ll be great at what you do one day. Prove to me that you are different enough from MD?s to deserve a different title. If you have nothing to say to that, then you?re an allopath. Brand his forehead!

But really, why bother going to a DO school or being an osteopath unless you master the functional anatomy- and see and understand the functional interrelationships between anatomy, physiology, and pathophysiology.

BamaAlum said:
Let me guess you are applying to DO Family Med programs. How are you going to get on here and criticize those of us who want to know why and how OMM works and if certain techniques work? Maybe you should have studied a little harder and spent some time in a research lab to learn how the scientific method works. A heavy dose of skepticism is a great attribute for a physician to have, instead of following like sheep.

OHH how clever you are. :laugh:

For people who really want to know how OMM works- I JUST GAVE IT TO THEM ON A SILVER PLATTER. For the rest of you pigheads- go do the research yourself and stop bitching. Or at least read those decades of OMM research articles in the link I sent you.

I will probably be applying to neurology programs. However, I do consider primary care fields honorable and challenging work and i wouldn?t insult primary care doctors for their choice. One of my friends was 3rd in his class and chose family practice... and for very good reasons.

BamaAlum said:
Because I have been in the path lab and have seen fungating adenocarcinomas removed by surgery. Which would explain the patients lower GI bleeding. I have seen appendices removed with fecaliths and massive inflammatory changes. This would explain the patient's symptoms and their elevated white count. The patient presents with an elevated white count, tenderness over McBurney's point. The appendix is removed the white count gradually goes down, the patient recovers. Cause and effect. It is called Occam's Razor. I had a case two weeks ago where the patient had a dissected thoracic aorta. He had an identifiable lesion on MRA, went to surgery had the dissected portion removed, replaced with a porcine graft and subsequently recovered. That is why I believe in surgery.

WAIT WAIT WAIT!!!!!!
So you mean? because of your personal experience? you expect us to believe in these so- called surgeries??? I don?t believe it for a second. Show me your double blind studies that those techniques provided any benefit to the patient! PROVE it. Who cares if they go from excruciating agony with high white counts one day to feeling normal the next eh? No proof. Maybe they would have gotten better anyway. Or maybe it was the ibuprofin they were taking. I mean? I WANT to believe? but how can I without proof?

UM? duh. SOMEtimes that kind of talk is just pigheaded and ******ed eh? Its always nice to see the studies, but when you see something for yourself, and the results are so dramatic that there isn?t the slightest shred of doubt in your mind? well maybe you should learn what obviously freaking works and worry about the proof later (after all, for surgery and OMM what are you going to see except outcome studies anyway? and for OMM many of those have been done).

Aaah some people are just fun to mess with. seriously though. If you actually care about anything you?re arguing? try reading my post again. You totally missed the whole boat there.

BamaAlum · Nov 18, 2004

bones said:
well hellooooo mr kansas city. LMFAO. I dont know how i can dumb this down for you any more. In the future I?d suggest you read my post before replying.

If you read what I posted, you'd see that yes the AOA is a bunch of doobers that need their cage rattled. They are either corrupt, have poor judgment, or maybe some of both. Our profession is getting run into the ground due to lack of research, lack of innovation in teaching techniques, lack of qualified OMM faculty and proper integration, and yet they allow all these new schools to open up which just add to the problems we have. Plus they let people like you into their schools who like to write a lot but don?t read first.

There are some great MD?s out there, and who knows, maybe you?ll be great at what you do one day. Prove to me that you are different enough from MD?s to deserve a different title. If you have nothing to say to that, then you?re an allopath. Brand his forehead!

But really, why bother going to a DO school or being an osteopath unless you master the functional anatomy- and see and understand the functional interrelationships between anatomy, physiology, and pathophysiology.

OHH how clever you are.

For people who really want to know how OMM works- I JUST GAVE IT TO THEM ON A SILVER PLATTER. For the rest of you pigheads- go do the research yourself and stop bitching. Or at least read those decades of OMM research articles in the link I sent you.

I will probably be applying to neurology programs. However, I do consider primary care fields honorable and challenging work and i wouldn?t insult primary care doctors for their choice. One of my friends was 3rd in his class and chose family practice... and for very good reasons.

WAIT WAIT WAIT!!!!!!
So you mean? because of your personal experience? you expect us to believe in these so- called surgeries??? I don?t believe it for a second. Show me your double blind studies that those techniques provided any benefit to the patient! PROVE it. Who cares if they go from excruciating agony with high white counts one day to feeling normal the next eh? No proof. Maybe they would have gotten better anyway. Or maybe it was the ibuprofin they were taking. I mean? I WANT to believe? but how can I without proof?

UM? duh. SOMEtimes that kind of talk is just pigheaded and ******ed eh? Its always nice to see the studies, but when you see something for yourself, and the results are so dramatic that there isn?t the slightest shred of doubt in your mind? well maybe you should learn what obviously freaking works and worry about the proof later (after all, for surgery and OMM what are you going to see except outcome studies anyway? and for OMM many of those have been done).

Aaah some people are just fun to mess with. seriously though. If you actually care about anything you?re arguing? try reading my post again. You totally missed the whole boat there.

I read your post, but I just didn't find much substance to it. I prefer to base my treatments on evidence but if you want to continue to blindly accept what good Ole Doc So and So feeds you, be my guess. I believe in surgery because of millions of documented cases that show that disease A was cured by procedure B. You got that kind of documentation to back up your claims?

I never said that OMM is not efficacious, I just would like to see how and why. I believe that all things in medicine should be rigorously tested. Why should OMM be any different? If studies came out that showed that certain OMM modalities didn't work would you stop using them? Probably not because Doc Johnson said they worked.

Yeah, thanks for dumbing it down for us. It's obvious that you are living out on the cutting edge of biomedicine. I'm sure NIH is knocking down your door.

And I'm sure you test everyone for lipid disorders, get a sed rate and do MRAs of their vertebral arteries before doing cervical HVLA.

medic170 · Nov 18, 2004

BamaAlum said:
I read your post, but I just didn't find much substance to it. I prefer to base my treatments on evidence but if you want to continue to blindly accept what good Ole Doc So and So feeds you, be my guess. I believe in surgery because of millions of documented cases that show that disease A was cured by procedure B. You got that kind of documentation to back up your claims?

I never said that OMM is not efficacious, I just would like to see how and why. I believe that all things in medicine should be rigorously tested. Why should OMM be any different? If studies came out that showed that certain OMM modalities didn't work would you stop using them? Probably not because Doc Johnson said they worked.

Yeah, thanks for dumbing it down for us. It's obvious that you are living out on the cutting edge of biomedicine. I'm sure NIH is knocking down your door.

And I'm sure you test everyone for lipid disorders, get a sed rate and do MRAs of their vertebral arteries before doing cervical HVLA.

Actually, NIH is funding a lot of OMM research, a long list was posted earlier. Also, OMM has a 100 year history of positive effects that are documented (just like surg), I think bones posted some links earlier, and I am sure he can show you plenty of documented outcome studies, I have seen many myself, but since I am a rookie, I'll let someone else further opine.

You are correct though that OMM needs further scrutiny and study to continue to prove its legitimacy in medicine.

BrooklynDO · Nov 18, 2004

BamaAlum said:
I read your post, but I just didn't find much substance to it. I prefer to base my treatments on evidence but if you want to continue to blindly accept what good Ole Doc So and So feeds you, be my guess. I believe in surgery because of millions of documented cases that show that disease A was cured by procedure B. You got that kind of documentation to back up your claims?

I never said that OMM is not efficacious, I just would like to see how and why. I believe that all things in medicine should be rigorously tested. Why should OMM be any different? If studies came out that showed that certain OMM modalities didn't work would you stop using them? Probably not because Doc Johnson said they worked.

Yeah, thanks for dumbing it down for us. It's obvious that you are living out on the cutting edge of biomedicine. I'm sure NIH is knocking down your door.

And I'm sure you test everyone for lipid disorders, get a sed rate and do MRAs of their vertebral arteries before doing cervical HVLA.

Yes, im sure he gets a sed rate on everyone .. because its the most specific and significant lab test you can think of? LOL
Im not going to go through the research now mainly because i dont have the info on my home comp but basically as far as most reported incidents of complications of hvla, most were not the result of manipulation by licensed people... they were usually self hvla. As for safety...I somehow fail to see why surgery is safer than a noninvasive procedure.
as for evidence... read up on just how many cases Mcburney used to publish his article on appendicitis? the one that became the major source of research for the appendectomy for quite a while.

as far as not using things that a study said didnt work : go to a few journal clubs with surgeons, or go to a few of their M&M's, then tell me if any of them base their decisions on one or even 3 or 4 major studies say the same thing. It usually takes a lot more for them to stop doing surgery their way... and they usually base what they do on THEIR specific experience, and "scew what everyone else thinks because im the one doing the cutting and taking the patient to the OR"

As for NIH knocking on doors, DRrusso posted several currently NIH funded OMM research projects on another thread in this forum...look at it

BamaAlum · Nov 18, 2004

BrooklynDO said:
Yes, im sure he gets a sed rate on everyone .. because its the most specific and significant lab test you can think of? LOL
Im not going to go through the research now mainly because i dont have the info on my home comp but basically as far as most reported incidents of complications of hvla, most were not the result of manipulation by licensed people... they were usually self hvla. As for safety...I somehow fail to see why surgery is safer than a noninvasive procedure.
as for evidence... read up on just how many cases Mcburney used to publish his article on appendicitis? the one that became the major source of research for the appendectomy for quite a while.

as far as not using things that a study said didnt work : go to a few journal clubs with surgeons, or go to a few of their M&M's, then tell me if any of them base their decisions on one or even 3 or 4 major studies say the same thing. It usually takes a lot more for them to stop doing surgery their way... and they usually base what they do on THEIR specific experience, and "scew what everyone else thinks because im the one doing the cutting and taking the patient to the OR"

As for NIH knocking on doors, DRrusso posted several currently NIH funded OMM research projects on another thread in this forum...look at it

No, a sed rate is not the most specific test I could think of, but it is commonly used for screening for vasculitides such as giant cell arteritis, etc.. The definitive tests for such diseases is biopsy. The literature has many cases of dissection by licensed practitioners. Anyway, my point was that OMM deserves the same scrutiny as all other modalities. I never said that NIH didn't fund OMM research. My point was that we need to be skeptical of all therapies. Apparently, wanting more research is considered blasphemous around here. I guess my school's effort to increase research really pisses off the powers that be at the AOA. Whatever. I more interested in cell and molecular research myself.

BrooklynDO · Nov 18, 2004

i never meant to suggest that there shouldnt be more research, there should always be more, but how much can 20 schools produce? anyway a lot of people that complain about omm say "oh there is no proof there is no research" but when people like drrusso post research they never reply...that annoys me

bones · Nov 18, 2004

BrooklynDO said:
i never meant to suggest that there shouldnt be more research, there should always be more, but how much can 20 schools produce? anyway a lot of people that complain about omm say "oh there is no proof there is no research" but when people like drrusso post research they never reply...that annoys me

don't be annoyed. He's just a troll.

if you saw what i posted and his reply- he didn't address any of my points- made up random stuff that he thought I said- and then just posts his same silly tirades which we've already taken apart. :laugh:

He has the whole osteomed OMM research database to puruse at his pleasure when he finds the time. http://ostmed.hsc.unt.edu/ostmed/index.html

don't waste any more energy on him.

BamaAlum · Nov 18, 2004

bones said:
don't be annoyed. He's just a troll.
if you saw what i posted and his reply- he didn't address any of my points- made up random stuff that he thought I said- and then just posts his same silly tirades which we've already taken apart.

He has the whole osteomed OMM research database to puruse at his pleasure when he finds the time. http://ostmed.hsc.unt.edu/ostmed/index.html

don't waste any more energy on him.

Yeah dude, you're so enlightened.

daveyboy · Nov 18, 2004

bones said:
don't be annoyed. He's just a troll.
if you saw what i posted and his reply- he didn't address any of my points- made up random stuff that he thought I said- and then just posts his same silly tirades which we've already taken apart.

He has the whole osteomed OMM research database to puruse at his pleasure when he finds the time. http://ostmed.hsc.unt.edu/ostmed/index.html

don't waste any more energy on him.

That is seriously hard core. :scared:

daveyboy · Nov 18, 2004

BamaAlum said:
Yeah dude, you're so enlightened.

I think you may want to lay low for a few weeks, maybe get an unlisted address and phone number. I feel a lynch mob coming on.

BamaAlum · Nov 18, 2004

daveyboy said:
I think you may want to lay low for a few weeks, maybe get an unlisted address and phone number. I feel a lynch mob coming on.

Not too worried. I think I can hold my own.

bones · Nov 18, 2004

BamaAlum said:
Not too worried. I think I can hold my own.

BamaAlum · Nov 18, 2004

cooldreams said:
yes bama, an old DO school, but he comes from kcom, guess where that stands...

just as you said " granted most OMM techniques definitely won't hurt the patient" why would you then say "you act like they are proven entities and should be first line therapy" ????? are you saying that you should use the mose unknown, unreliable treatment first, something that MAY hurt the patient?? omm is awesome, something that could tell you so much about a patient, possiblly even help their problem, and you dismiss it as worthless.

odd "I don't agree, however that their pneumonia was a result of functional anatomy disturbances precisely because I do know my pathophysiology." im not in medical school yet, but even i know that if you are constantly laying/sleeping in the wrong position you can get pneumonia. you are right that your anatomy does not cause the problem which is the result of bacteria or viruses or w/e... just like the swan necked flasks used to show the beef broth would not get spoiled because the bacteria could not get to it.... but the anatomy in play may provide a "path" to allow the lungs to get infected.

"How are you going to get on here and criticize those of us who want to know why and how OMM works and if certain techniques work?" easily... i think he has already done it, but just wondering - why complain about ppl doing research and then turn around and complain about a lack of research? where is your research??

VPDcurt · Nov 18, 2004

Plinko said:
Hopefully this trend will continue to a point where one day we won't even have to answer such questions as to what is the difference between a DO and an MD.

I am just reading this thread and I don't meant to start any arguments here, but this quote just caught my eye. It seems that many of you DO students seem to be proud of your status and education. Doesn't this contradict what most others are saying? It sounds like you guys appreciate the difference between MDs and DOs, so convergence would be a bad thing, right?

cooldreams · Nov 18, 2004

VPDcurt said:
I am just reading this thread and I don't meant to start any arguments here, but this quote just caught my eye. It seems that many of you DO students seem to be proud of your status and education. Doesn't this contradict what most others are saying? It sounds like you guys appreciate the difference between MDs and DOs, so convergence would be a bad thing, right?

some do, some dont. i appreciate the difference, and i would like to see a world where ppl actually know what a do is. however, i dont mind explaining it. i think this stuff is cool, and really, that alone makes it worth it to me.

cooldreams · Nov 18, 2004

bones said:
please dont quote aoa propoganda when trying to figure out what DO's are all about. Go read philosophy and mechanical principles of Osteopathy by AT Still if you can find a copy.

okay, so here it is:

Functional Anatomy.

Osteopaths (at least the good ones) draw from a tremendous base of knowledge of functional anatomy, which is critical in both diagnosis and treatment. We use this, along with- as Dr Still put it... "intelligence" to figure out treatments for serious disease.

Unfortunately there are probably quite a few DO's who never learned this stuff- and thus they ARE just MD's + OMT... but not osteopaths. AT said so himself.

Bones MSIV
OMM Fellow
KCOM

daveyboy · Nov 18, 2004

cooldreams said:
davey, why dont you make one of your great comebacks to bama? bones is obviously more knowledgable, by your reasoning, since he is in a more advanced year, so again by your reasoning, just that alone makes bama wrong....

In a deeper sense, I think that they are both right. I support them both.

cooldreams · Nov 18, 2004

daveyboy said:
In a deeper sense, I think that they are both right. I support them both.

thas deep dood.... like,.... well deep....

daveyboy · Nov 18, 2004

cooldreams said:
thas deep dood.... like,.... well deep....

I support you, too, Coolie-D!

Elysium · Nov 19, 2004

bones said:
A big failing of the osteopathic profession is that our current AOA leaders (zealots, as you say- and rather stupid ones) let these new random DO schools surface all over with severely inadequate OMM faculty, when we barely have enough skilled osteopathic faculty at our core schools. Thus, the common story of the inadequate DO becomes even more common... and not only does nobody integrate functional anatomy into their practice, but probably the majority of DO's today don't even know anything about osteopathy. Its like having a bunch of MD's who have had a few chiropractic lessons (shudder). or they are zealots who are essentially chiropractors that couldnt save a life in the ER if it was their mothers... no offense you chiros, but most of you are taught to crack backs and charge a bill- without understanding key lesion mechanics and functional causes. fix the key lesion and it never comes back... but if you don't you'll be cracking the same vertebrae for years. If you also understand the visceral anatomy you can address all sorts of conditions, not just sloppy vertebrae.

cheers,
bones

Since you've appointed yourself expert of all things OMM (as a 4th year, no less!) you might want to check some of your facts before you spew a bunch of bullsh1t on the internet. I'm at one of those "diploma mill DO schools" (thanks for the support, since we will one day work in the same profession) and this is the head of our department. He was last at PCOM, which still has his bio listed. He was an editor and contributing author of FOM and was even a dean at your esteemed school! He also worked directly with the original Dr. Jones (you might have heard of counterstrain, right?) and is incredibly well published in the field. Or is that not adequate enough for you?

http://www.pcom.edu/Department_Web_...c_Mani/John_Jones__D_O_/john_jones__d.o..html

My god, man, you should listen to yourself. Your haughty superiority is absolutely nausating. If you can't objectively say that some of OMM is a bit suspect then you're just as bad as the zealots in the AOA you claim to abhor. Do you buy cranial in adults? Do you buy energy medicine? For the love of christ, if I have to watch another "I'm taking the bad energy away and shaking it off! There's no paper towels in the bad energy world!" from an OMM "expert" I'm going to throw up. These are your peers, brother. These are people that have graduated from OMM residencies from top ranked DO schools like TCOM (I'm not referring to Dr. John Jones, btw, who's an intelligent and articulate physician). These are your "OMM fellows". And we wonder why we don't get respect from people in the allopathic world.

We absolutely need more research and we absolutely need to have something irrefutable to acknowledge that OMM techniques work. The ones that CAN'T be proven should be eliminated from practice and from osteopathic medical education. Starting with that energy medicine bullsh1t. It's a goddamned embarrasment. I cringe everytime I see it or hear it done. Or can you produce a study about bad energy?

bones · Nov 19, 2004

Elysium said:
Since you've appointed yourself expert of all things OMM (as a 4th year, no less!) you might want to check some of your facts before you spew a bunch of bullsh1t on the internet. I'm at one of those "diploma mill DO schools" (thanks for the support, since we will one day work in the same profession) and this is the head of our department. He was last at PCOM, which still has his bio listed. He was an editor and contributing author of FOM and was even a dean at your esteemed school! He also worked directly with the original Dr. Jones (you might have heard of counterstrain, right?) and is incredibly well published in the field. Or is that not adequate enough for you?

http://www.pcom.edu/Department_Web_...c_Mani/John_Jones__D_O_/john_jones__d.o..html

My god, man, you should listen to yourself. Your haughty superiority is absolutely nausating. If you can't objectively say that some of OMM is a bit suspect then you're just as bad as the zealots in the AOA you claim to abhor. Do you buy cranial in adults? Do you buy energy medicine? For the love of christ, if I have to watch another "I'm taking the bad energy away and shaking it off! There's no paper towels in the bad energy world!" from an OMM "expert" I'm going to throw up. These are your peers, brother. These are people that have graduated from OMM residencies from top ranked DO schools like TCOM (I'm not referring to Dr. John Jones, btw, who's an intelligent and articulate physician). These are your "OMM fellows". And we wonder why we don't get respect from people in the allopathic world. We absolutely need more research and we absolutely need to have something irrefutable to acknowledge that OMM techniques work. The ones that CAN'T be proven should be eliminated from practice and from osteopathic medical education. Starting with that energy medicine bullsh1t. It's a goddamned embarrasment. I cringe everytime I see it or hear it done. Or can you produce a study about bad energy?

feel the love.

Jones is great. BUT do you have a 1 board certified OMM doc to 6 student ratio in your labs? do you have at least 1000 hours of well taught and well-integrated OMM lab in your first 2 years as it was in the 1970's? I suspect the answer is no... probably more like 1 doc to 20 students, and perhaps 100-200 hours. Do you really honestly think you can learn OMM well enough like that to change peoples lives?? ...perhaps. but it will take a TON of work outside of class. see my point??? even the core schools can't make these commitments, but the new ones -on the whole- are even worse. So why the hell are we opening up new schools every year??? spreading skilled OMM faculty thinner and thinner. Perhaps there are a few exceptions... and maybe your school is perfect- but the decision to open it was still wrong unless they really have some way to improve on this system.

The reason there are new DO schools is that the allopathic world has limited the number of new schools, yet with the demand for new docs, and no restrictions on the DO side- BOOM demand is supplied. These are not people -on the whole- who are dying to be osteopaths... and we have room for the truly dedicated at the core schools. Thus you have an influx of new DO phyisicians who dont know or care about osteopathy.

your other off the cuff comments about cranial in adults and energy medicine... where the heck did that come from? Energy medicine is not osteopathy... its something entirely different. I dont know why you attach that to OMM any more than Family med or cardiology. As far as cranial in adults- I am reserving judgement. yes I've cut out a few migraines mid-stride with it (very cool), and yes it seems to have a very calming effect on patients, stops tremors, that sort of thing. I can't tell you if it does more than that in adults- I suspect much more, but as I have no proof, my claims stop there for adult cranial (changes still potentially explainable just with its calming effects). with children, of course, the results are quite dramatic. beats pediatric neurosurgery for reshaping heads, no? also beats months of screaming baby for mothers that want colic cured.

what does any of this have to do with my prior points?

sorry if you feel i ragged on your school. It wasn't your school in particular- it is the decision to spread osteopathy even thinner than it already is that I despise.

bones

Elysium · Nov 20, 2004

bones said:
feel the love.

Jones is great. BUT do you have a 1 board certified OMM doc to 6 student ratio in your labs? do you have at least 1000 hours of well taught and well-integrated OMM lab in your first 2 years as it was in the 1970's? I suspect the answer is no... probably more like 1 doc to 20 students, and perhaps 100-200 hours. Do you really honestly think you can learn OMM well enough like that to change peoples lives?? ...perhaps. but it will take a TON of work outside of class. see my point??? even the core schools can't make these commitments, but the new ones -on the whole- are even worse. So why the hell are we opening up new schools every year??? spreading skilled OMM faculty thinner and thinner. Perhaps there are a few exceptions... and maybe your school is perfect- but the decision to open it was still wrong unless they really have some way to improve on this system.

The reason there are new DO schools is that the allopathic world has limited the number of new schools, yet with the demand for new docs, and no restrictions on the DO side- BOOM demand is supplied. These are not people -on the whole- who are dying to be osteopaths... and we have room for the truly dedicated at the core schools. Thus you have an influx of new DO phyisicians who dont know or care about osteopathy.

your other off the cuff comments about cranial in adults and energy medicine... where the heck did that come from? Energy medicine is not osteopathy... its something entirely different. I dont know why you attach that to OMM any more than Family med or cardiology. As far as cranial in adults- I am reserving judgement. yes I've cut out a few migraines mid-stride with it (very cool), and yes it seems to have a very calming effect on patients, stops tremors, that sort of thing. I can't tell you if it does more than that in adults- I suspect much more, but as I have no proof, my claims stop there for adult cranial (changes still potentially explainable just with its calming effects). with children, of course, the results are quite dramatic. beats pediatric neurosurgery for reshaping heads, no? also beats months of screaming baby for mothers that want colic cured.

what does any of this have to do with my prior points?

sorry if you feel i ragged on your school. It wasn't your school in particular- it is the decision to spread osteopathy even thinner than it already is that I despise.

bones

More bullsh1t from you. Where do you get your data from? From the secret OMM cranial society? We have a class of 78 and have 6 board certified faculty in OMM. Our class is divided in half for OMM, so that's 36 students for 6 faculty. Which is...hmm...what, 6 students for 1 faculty member? Also, we actually do more counterstrain than ANY DO school in the entire country! Including fabulous KCOM!

We spend our entire first semester first year doing counterstrain ONLY. Our last block we learned the treatment and location for 118 tenderpoints alone. I have to get the exact numbers about the amount of hours we spend in OMM (I would hate to post a bunch of lies on the internet, after all). And how are we going to create more quality OMM faculty if we don't have more oseopathic physicians? It's a pickle, ain't it?

I specifically said adult cranial because I can theoretically see how cranial could work in young children (whose skull bones can...move! :idea:

). Even DOs that do cranial in kids say that adult cranial is a bunch of bullsh1t. If you don't think that energy medicine is a tangential part of OMM you're living in fantasy land. It's part of the hocus pocus crap that encourages people to think that that OMM is ridiculous.

People like you are part of the reason I want to distance myself from OMM. Now go find some actual data before you spread more lies on SDN. Thanks.

OnMyWayThere · Nov 20, 2004

Elysium said:
More bullsh1t from you. Where do you get your data from? From the secret OMM cranial society? We have a class of 78 and have 6 board certified faculty in OMM. Our class is divided in half for OMM, so that's 36 students for 6 faculty. Which is...hmm...what, 6 students for 1 faculty member? Also, we actually do more counterstrain than ANY DO school in the entire country! Including fabulous KCOM! We spend our entire first semester first year doing counterstrain ONLY. Our last block we learned the treatment and location for 118 tenderpoints alone. I have to get the exact numbers about the amount of hours we spend in OMM (I would hate to post a bunch of lies on the internet, after all). And how are we going to create more quality OMM faculty if we don't have more oseopathic physicians? It's a pickle, ain't it?

I specifically said adult cranial because I can theoretically see how cranial could work in young children (whose skull bones can...move! ). Even DOs that do cranial in kids say that adult cranial is a bunch of bullsh1t. If you don't think that energy medicine is a tangential part of OMM you're living in fantasy land. It's part of the hocus pocus crap that encourages people to think that that OMM is ridiculous.

People like you are part of the reason I want to distance myself from OMM. Now go find some actual data before you spread more lies on SDN. Thanks.

Hey "bones", she has just clearly proven your statements on this thread completely unreliable. Give it up.

cooldreams · Nov 20, 2004

OnMyWayThere said:
Hey "bones", she has just clearly proven your statements on this thread completely unreliable. Give it up.

wow where is the love guys??? hehe

bones · Nov 20, 2004

OnMyWayThere said:
Hey "bones", she has just clearly proven your statements on this thread completely unreliable. Give it up.

oh my. thats a big ego for a pre-med.

now for your cheeky friend who doesn't read... "sorry if you feel i ragged on your school. It wasn't your school in particular- it is the decision to spread osteopathy even thinner than it already is that I despise."

I don't even know what school you go to. yours might be the one that got the formula right, but that doesnt change that my friends at 10 of the top osteopathic schools all agree that the teaching is spread way too thin, and a few of these schools are the ones that are now expanding to florida, atlanta and las vegas. if the original didnt have enough faculty, how are the satellites meant to find faculty. If you dont have enough faculty, very few of the students graduating will be competent to teach. Its a simple formula.

KCOM went from 1400 hours in the 1970's to 195 today, and yet it still has more hours than most DO schools (no, not all). Fortunately KCOM has some great faculty- but I don't care who is teaching you... its just not enough contact hours.

I'm not sure how memorizing 118 counterstrain points would make you a better osteopath, but more power to you. other than all that memorization instead of focus on principles that make it clinically sound- it sounds like her school has their act together (at least in her mind). That is very good if its true... but her rants about osteopaths who do energy medicine (how many really? i've never had an OMM preceptor that throws energy around the room with their hands and I've worked with dozens) ...and this general disrespect she seems to have for our profession- It makes me wonder how good her education really was.

Dr. jones jr wasn't dean at KCOM, that would be Dr Kuchera. "the kuch" as we affectionately refer to him. if you go to PCOM you have 250 students per class (last i heard), and only 6 listed faculty (one of the best of which... dr crow, is leaving to florida i hear). you do the math (even if they split the lab)

:laugh:

yes I'm "just" a 4th year, but that doesnt mean i don't know dr kuchera and dr crow personally. Kuchera was a huge proponent of increasing contact hours at KCOM too, by the way.

I'd love to play some more hardball but it will have to wait till after thanksgiving. Have a great break all! don't bloody yourselves up too much.

OnMyWayThere · Nov 20, 2004

bones said:
oh my. thats a big ego for a pre-med.

Give it up... you sure seem to think you know a lot about all these schools as a med student.. and she already proved you wrong. My ego is not large due to that.

bones said:
I don't even know what school you go to. yours might be the one that got the formula right, but that doesnt change that my friends at 10 of the top osteopathic schools all agree that the teaching is spread way too thin, and a few of these schools are the ones that are now expanding to florida, atlanta and las vegas. if the original didnt have enough faculty, how are the satellites meant to find faculty. If you dont have enough faculty, very few of the students graduating will be competent to teach. Its a simple formula.

You're wrong again. It's in Las Vegas that there are 6
students to 1 faculty in OMM. Read what you wrote above and how much truth there is to it - not much. Just give it up, please already.

bones said:
KCOM went from 1400 hours in the 1970's to 195 today, and yet it still has more hours than most DO schools (no, not all). Fortunately KCOM has some great faculty- but I don't care who is teaching you... its just not enough contact hours.

I'm not sure how memorizing 118 counterstrain points would make you a better osteopath, but more power to you. other than all that memorization instead of focus on principles that make it clinically sound- it sounds like her school has their act together (at least in her mind). That is very good if its true... but her rants about osteopaths who do energy medicine (how many really? i've never had an OMM preceptor that throws energy around the room with their hands and I've worked with dozens) ...and this general disrespect she seems to have for our profession- It makes me wonder how good her education really was.

Dr. jones jr wasn't dean at KCOM, that would be Dr Kuchera. "the kuch" as we affectionately refer to him. if you go to PCOM you have 250 students per class (last i heard), and only 6 listed faculty (one of the best of which... dr crow, is leaving to florida i hear). you do the math (even if they split the lab)

yes I'm "just" a 4th year, but that doesnt mean i don't know dr kuchera and dr crow personally. Kuchera was a huge proponent of increasing contact hours at KCOM too, by the way.

I'd love to play some more hardball but it will have to wait till after thanksgiving. Have a great break all! don't bloody yourselves up too much.

Thanks for the all the valuable info and Happy Thanksgiving.

healthydawg · Nov 21, 2004

my this thread has gotten interesting since i last read it.

as much as i wanted to pass it by, i couldn't help myself... so here it goes.

bones, first thanks for your enlightening messages, especially the one that quoted my message from a while back. we seem to agree on a couple of points; osteopathy needs more research, the yahoos that run our profession don't seem to pay this much heed and many osteopaths aren't really osteopathic at all.

that's where the agreement ends, i think.

in my original post, i argued that amongst other things, the profession has done a pitiful job of engaging in research either in osteopathy or basic science. your links notwithstanding, i stand by that statement. let's divide the world into three parts, yes? part one is osteopathy as a system of medicine. part two, omm. and finally part three, the rest of basic medical science.

most, if not all of the research into the first two parts to date has consisted of small empirical studies. you essentially made the point that if the surgeons can get away with that sort of thing, why can't the osteopaths? surgery is a poor choice to compare with, don't you think? the foundation of MEDICINE, and in particular EVIDENCE BASED MEDICINE is science. it's the science that allows us to posit theories, test them, reach conclusions and incorporate them appropriately into practice. it's science that's driven medicine forward from the days of calomel and bleeding to what it is now (regardless of how you feel about what it is now). and to defend surgery for a bit, while it's true that many surgeries cannot and have not been tested by double blind studies, many have. what's more, at the core of modern surgery is a lot of science as well. surgeons these days rarely if ever operate in a vacuum; instead they rely on a team of internists, pathologists, radiologists and such to guide them. who do those guys rely on? the basic scientists who identify the disease processes at play and come up with treatments that can be tested.

osteopaths, on the other hand, rely on their ten fingers, strong backs, a bunch of small studies that were often poorly done, a bunch of books by sutherland, glover, yates, et al that are often poorly edited, and the common belief that, "i know it works. i've SEEN it." oh yes, i forgot the learning at the hands of a master part. all of that is really sad and your defense of it is worse. another poster commented on your arguing the party line...with all the defensiveness of your posts and the same tired old reasoning, i couldn't agree more. you know the stuff...the "you guys aren't real osteopaths", "the schools don't teach it correctly", "there are tons of studies" (all published in obscure journals, of course) bullsh*t. save it bro, i've heard all of it and more from people who have gone a lot farther than being an omm fellow. i've learned from the guys who wrote your books, and even interned with the queen herself. i'm that kind of believer. but, the type of nonsense you are spouting not only won't save the profession, it will sink it for sure.

incidentally, in spite of all of the above, yes, i DO want to believe. you seem to think that's a statement of religious fanaticism. i think not. i want to believe because i like the osteopathic philosophy, i use it and i would like to use more OMM too. i'm happy i learned the philosophy, but i'm not as happy with OMM. i won't use more OMM backed up simply by faith alone; as far as i'm concerned, treating simply on faith (especially as a first approach) contradicts what Still taught. i need more than faith and some crappy books and studies. bones, i guess you don't. your countless years of training, learning at the hands of masters, research, not to mention curriculum development, etc., have lifted you above scepticism. good for you, good for your patients. for the rest of us mortals, a bunch of well thought out, well run trials would be nice. not too much to ask for in a 100+ years, is it? btw, if you want to read some real fanaticism, try the cranial bowl. in fact, try any of the classic treatises on cranial. why don't you quote some of them here for all of us? they are very spiritual works and this is the season.

finally, i'll move on to point three from above, research in basic sciences. i argued earlier that we as a whole have done little to advance the basic medical sciences. i refered to a total research budget of all osteopathic schools that is laughably small. another poster asked how much can 20 schools do anyway? i say a lot if they made it part of their culture to do so. but in 100+ years of existence they are only now coming around to that way of thinking. this week i spent 40 hours (40!) on call mostly taking care of ONE pt with what turned out to be pleural tb. of course, he didn't show up in the ER with a card saying, "hi, i have pleural tb." he just showed up in v-tach. anyway, guess what i spent many of those hours doing? scouring journals trying to figure out what the hell this guy had, how to work it up, etc. fortunately, i found out a lot, and YES, that research has guided my treatment of this case.

can i do the same sort of thing with OMM? if this were a case where i considered OMM as a first line therapy, could i find a paper to support that treatment? could i say "i thought it would work" to the lawyer suing my ass off after the guy died and expect to get off? no. AFTER 100+ YEARS THE ANSWER TO ALL OF THESE QUESTIONS IS STILL NO. AND THE ANSWERS TO WHY IT'S THAT WAY (DESCRIBED ABOVE) ARE 100+ YEARS OLD. it's really time to step off that kind of thinking. i'm not sure if i can think of ANY serious acute illness that i would use OMM for as monotherapy. i wish it weren't that way. bones, you're the expert in functional anatomy...perhaps you could describe an acute case in which you WOULD use OMM or osteopathy especially as monotherapy, that would end up with a treatment plan significantly different than anyone else's.

how far would osteopathy be today if only we had listened to Still and made science a real part of our profession? today what we need are anatomists, biochemists, geneticists, molecular biologists, etc. looking into the basic processes behind somatic dysfunction. we also need epidemiologists, health service scientists, economists and the like to examine whether osteopathy as a system really benefits patients more than any other system. guess how we get those people? we develop a culture that encourages research in these fields at large - that equals research programs. eventually some of those folks will turn their eyes to the stuff we're interested in as a profession (or for you bones, as a specialty). right now, we rely on everyone else to do science for us. and then we scream about why no one takes us seriously. they don't because we don't contribute jack back. we just take. here's what we don't need: another 100+ years of osteopaths in old shoe, kansas publishing studies in the JAOA about their "i saw it work on two patients" techniques (or better yet, god revealed to me that it moves like the gills of a fish, toes of a hamster, neck of a crane, etc.) and then writing shi*ty books about them. oh yes, and becoming heads of omm departments and osteopathic colleges.

ok, i'm done. what a tirade. i'll be interested to see if this generates any replies, although i'm not sure if i'll reply back. i'll try if i get the chance. patients first, right? with that, i'll sleep now. happy tg everyone, hope y'all were entertained by this post.
healthydawg

medic170 · Nov 21, 2004

healthydawg said:
"there are tons of studies" (all published in obscure journals, of course) bullsh*t. save it bro,

Well, since you said "ALL published in obscure journals" I wanted to know, since when in JAMA an obscure journal. I know of a few studies in JAMA and I even posted the one on otitis media. Careful witht he blanket statements or what you say can't be legitimate either.

Elysium · Nov 22, 2004

medic170 said:
Well, since you said "ALL published in obscure journals" I wanted to know, since when in JAMA an obscure journal. I know of a few studies in JAMA and I even posted the one on otitis media. Careful witht he blanket statements or what you say can't be legitimate either.

I think healthydawg's point is that studies published in well respected journals like JAMA are the exception to the rule, certainly not the norm. Just how many OMM studies have been published in journals such as JAMA? I'm sure someone on here will find a link to 2 or 3 studies and that will be about it. Does that not suggest something about the lack of data that has been compiled regarding the efficacy of OMM? It's highly suspicious at best that in 100 years of osteopathy that so few studies have been conducted in journals like JAMA (not the JAOA).

medic170 · Nov 22, 2004

Elysium said:
I think healthydawg's point is that studies published in well respected journals like JAMA are the exception to the rule, certainly not the norm. Just how many OMM studies have been published in journals such as JAMA? I'm sure someone on here will find a link to 2 or 3 studies and that will be about it. Does that not suggest something about the lack of data that has been compiled regarding the efficacy of OMM? It's highly suspicious at best that in 100 years of osteopathy that so few studies have been conducted in journals like JAMA (not the JAOA).

Yeah, I know, I was just pointing out that he said "All" which is not true, and at least some of OMM is proven with respectable research. However, I do agree with you. I only know of four JAMA studies, and it seems JAOA publishes more experience related articles than actual research. I think schools like MSU and KCUMB (I think) are finally beginning to do more now that NIH is willing to fund it.

BackTalk · Nov 22, 2004

Bonehead, I find it fascinating how someone who didn't go to chiropractic school seems to know what chiropractic education entails. Obviously you have no clue as to a chiropractor's education. In DO school you learn more about pushing pills than pushin on backs. You should have been a chiropractor.

visceral anatomy you can address all sorts of conditions, not just sloppy vertebrae.

I love that one!....Hehe....a straight osteopath...that's great! I wish there were more doctors in your profession just like you. :laugh:

virtually all Family med programs "allow" OMT- but almost none will train you (or at least train you well). the real question is- will you be competent to use it effectively given little time per patient and no supervision? I'm not sure where you are in your education- but honing your skills as early as possible is what its all about. if you end up in a cash practice for family med or OMM, your OMT skill is (or seriously should be) directly proportional to how much you make for your time. generally if you are doing a chiropractors work of cracking a back here and there for the endorphin rush- you get chiropractor wages. If on the other hand you are preventing surgeries, getting patients safely and permenently off their expensive pain meds, and curing lifelong medical conditions on a regular basis... well then you do a little better- more like an anesthesiologist (and will get lots of referrals). People will pay out of pocket to get well. I would if it were me.

This is great! :laugh:

Hey bonehead, if you want to be the best at manipulative therapy then go to chiropractic school.

If you work in an insurance based family med program, your challenge will be to do general management + OMT within your alloted 10 minutes. You can still make permanent changes in this little time, however... if your skill is there. resist the temptation to just pop a few prominent segments to make them feel better and save time. Instead: get really good at finding the key lesion- and if you treat that alone it wont take long and you can really effect long term change.

The subluxation is the key just remember that.

bones · Nov 30, 2004

backtalk,

I mean no disrespect to your profession, and you're right that i didn't go to chiro school- however i have friends that have.

The biggest difference is in diagnosis. You guys see a so-called vertebral "subluxation" and pop it back in place (note- ACTUAL subluxations are very rare, involving a shearing force of one vertebrae on another due to serious instability). The problem here is that even though you guys get tons of hours in lab, you do not get the hours of anatomy, pathophysiology, general medicine, or even musculoskeletal diagnosis to appreciate how somatic dysfunction relates to the eventual complicated symptom pictures the patients present with (which may actually include serious diseases as well as musculoskeletal problems).

If you only treat what you see while not knowing what to look for based on the above knowledge- anything you fix will likely come back in only a couple days... leading to the chiros out there who treat patients multiple times a week for months, years or until their money and patience wears out.

this is much like leaving patients on the same medicine for years without even attempting to diagnose and treat the underlying mechanical or even psychological causes of these symptoms. Thus you manage your patients rather than curing them. No, we can't cure everything- but we should certainly do our best to try. Do you know any chiro classmates that can cure chronic whiplash in 3 treatments? I have done so as just a student of osteopathy. what about post surgical complications? Pneumonia? GERD? Acute back spasm? These are not patients you can just shotgun thrust on and expect to get better. And yet they do get better with correctly applied osteopathy. Back spasms that could lay someone out easily for 1-3 weeks even on pain meds and muscle relaxants could instead be fixed by simple counterstrain- I helped one such patient walk on her own with minimal discomfort within 20 minutes of treatment just yesterday. Its not even that big of a deal for those of us that do these things every day- since we see it all the time.

If you don't believe my experience in this profession is possible- I suggest you shadow a skilled osteopath sometime (or if you're not willing to invest the time and just want to bitch, shut up and take your trolling elsewhere). If you think you can do all this yourself as a chiropractor- I would be very impressed. you should then apply to DO school so you can legally manage these patients both outpatient and inpatient with the skills you have- and get paid appropriately for your skill and medical knowledge. Perhaps you could choose a medical specialty to apply your skills to then as well.

We are in a wonderful profession. I openly encourage any who have their hearts in the right place to join us as osteopaths.

best,
Michael

xxyyzz · Dec 1, 2004

bones said:
Do you know any chiro classmates that can cure chronic whiplash in 3 treatments? I have done so as just a student of osteopathy.

Wow, listen to yourself man. I've been reading your posts and you absolutely think of yourself as a god. It's that kind of superiority complex that gets people pissed off at you. And this..coming from a 4th year MEDICAL STUDENT. Sheesh. I've also trained with some leading OMT figures around, including the aforementioned "Queen" herself as well as some leading European osteopaths. And though they may have similar philosphies as you do, they don't portray themselves as superior egomaniacs like yourself.

BTW, you as an "OMM Fellow" should know of all people that YOU DO NOT CURE people. Remember, the body has the inherent ability to heal itself (with a few exceptions). You are merely assisting the body heal itself.

Just thought I would remind you of your mortality.

xxyyzz, D.O.

bones · Dec 1, 2004

xxyyzz said:
Just thought I would remind you of your mortality.

my what??? :scared:

Outspoken confidence and egomania is sometimes difficult to distinguish.
egomania is actually far more fun, but unfortunatly most OMM specialists that I know are better at their trade than me and I must openly acknowledge their skill as such. Don't you see that was the point? I am just a student- and I get great results. All the better for those who are docs out in practice and have decades of experience.

While i LOVE talking about myself...

We could make a thread dedicated to judging me if you like, but till then lets discuss the topic of this thread.

The curing topic is actually very relevant.
In the first sentance of AT Still's introduction to Research and Practice he states that it is "a treatise on diseases" and "their cause and cure from an osteopathic standpoint." He uses the word cure all over the place in his writings.

Cure is for something that is totally resolved. A cured infection is an infection in which the individual returns to the health of the standard population. One of the few conditions mainstream medicine can cure today is infection, since we presumably treat its cause (assuming there wasn't a cause of lowered immunity which allowed the infection- which, often there is). In osteopathy, however there are as many cures to be had as there are diseases with sources we can find and target.

WHO does the curing is up for debate. You could argue its physician, the patient, Elmo, Joseph Smith, the Buddha, or some moth who flapped its wings at just the right moment on the other side of the world. Does it matter? The doc is a catalyst, but the patient's own system is ultimately what heals, lives or dies. I don't think anyone can take credit, but the modality used and the physician are ultimately responsible for outcomes.

How is a DO more than MD + OMT?

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