What do you think of this article "Dubious Aspects of Osteopathy"?

I had a whole long response then my computer froze.

I will respond after my exam on Monday.

I believe the motivation behind Stephen Barrett's attack on osteopathy is similar to the motivation that some high school jocks have when they pick on other people. They do it in order to feel better about themselves. It's true that many MDs also treat their patients as entire individuals and in a holistic way as an osteopathic education stresses, but it's also true that a MD education does not stress on that fact as much as an osteopathic education would.

They are both fine systems of education that happens to be different in philosophy. And why does it have to be "hype" or "marketing strategy" when DO schools emphasize on their philosophy? why can't DO schools talk about their philosophy in a positive way? Why does Stephen Barrett think that just because DO schools speak of themselves positively, they are also looking down on MD in a negative way?

I imagine when Stephen Barrett was a student in school, he must have hated when his classmates came up to him and told him that they were good in sports, did well on the exam, or had a good hair day, because in Stephen Barrett's insecure mind, he must have thought they were telling him that he was bad in sports, did poorly on the exam, or had ugly hair.

Well said, Kim. That article is really old news.

I actually thought that the article was very well written, and I agreed with the vast majority of his statements. The voice of the last "comment" is almost mirroring my own.

Q, DO

I also agree with most of the author's comments.

You can tell he has some disdain for the profession in the way he phrases things, but most of what he says is right on.

I started surfing through the references section of the article and ran across this: http://www.upledger.com/news/twins.htm
I read a paper everyday hoping to get an update on these kids.

I agree with the author and think the website provides a great public service.

quackwatch.org??? where do you all find the time to look this stuff up?

Jhug-
They're not raising 1 year old triplets while studying for our massive GA test on Monday.
See you in lab.

For the record, Barrett is actually married to a D.O. He's kinda like any good sports or political writer... make a strong opinion and guaranteed you'll have people come visit your site.

Take what he says with a deep breath, he's just trying to get an audience, by whatever means are necessary.

The funny thing is, he lumps all D.O.s into the complimentary medicine genre, but in reality there's many, many more MDs practicing alternative and complimentary medicine than D.O.s. Our Complimetary and Alternative Med class at nycom was taught almost exclusively by MDs.

first of all, oceandoc, welcome back. how is third year treating you? nycom is kicking my first year ass.

i recently saw on the news a story about a doctor on LI who is using cranial therapy for kids with all kinds of chronic problems and having a lot of success. at the time, i tried to post it but the link wouldn't paste. it was local eyewitness ch7 news with Dr.jay something. i found it on the archives. obviously, this is not THE medical science source but it was nice to see this therapy used w/some success.

I agree 100%. Most of what jammed down our throats during my 1st two years was complete snake oil -- pure crap.

It really pisses me off that for some reason the whacko, manipulation-will-save-the-world crowd is so unwilling to accept scientific scrutiny.

How odd...one minute I'm at a mandatory lecture on the importance of evidenced-based medicine, and the next I have some weirdo wearing mocasins telling me to feel for the cranial impulse.

Don't get me wrong, I believe that there is a place for some OMM...but crap like cranial...this is the stuff that makes us the subject of criticism. We as the next generation of osteopathic physicians need to decide to embrace evidenced-based medicine...and that applies to OMM.

I don't see why OMM gets a free ride. They're always telling us how OMM is like any drug, i.e. you have to give the appropriate medication, the appropriate dose, etc. So, if its just like a drug, then how come its not scrutinized like drugs are.

Give me a break.

Sore subject.

I start a 2-week OMM rotation tomorrow.

Woo Hoo!

I have always thought that someone should circulate a petition at each school asking the AOA or the AACOM to instruct its member institutions to stop teaching cranial until some peer reviewed research is produced that demonstrates its efficacy and/or mechanism of action. I, too find it odd that OMM is the only modality taught in our schools that is granted a pass when it comes to research. Why not teach those modalities with proven efficacy and cull those modalities that have not shown to be efficatious and/or have no demonstrated MOA? We expect and demand this of pharmaceuticals, surgical procedures and invasive modalities. Why should OMM be exempt from such scrutiny?

As the future leaders of our profession, I believe that we have a responsibility to not only become competent, compassionate physicians, but to also ensure that all of the techniques at our disposal have undergone rigorous scientific testing and are a proven benefit to our patients. A lack of peer reviewed research runs the risk of relegating OMM to the category of "alternative medicine" in the dubious company of chelation therapy, and the like.

Bama Alum,
I could not have said it better myself.
Disco Dave

Originally posted by BamaAlum
I have always thought that someone should circulate a petition at each school asking the AOA or the AACOM to instruct its member institutions to stop teaching cranial until some peer reviewed research is produced that demonstrates its efficacy and/or mechanism of action. I, too find it odd that OMM is the only modality taught in our schools that is granted a pass when it comes to research. Why not teach those modalities with proven efficacy and cull those modalities that have not shown to be efficatious and/or have no demonstrated MOA? We expect and demand this of pharmaceuticals, surgical procedures and invasive modalities. Why should OMM be exempt from such scrutiny?

As the future leaders of our profession, I believe that we have a responsibility to not only become competent, compassionate physicians, but to also ensure that all of the techniques at our disposal have undergone rigorous scientific testing and are a proven benefit to our patients. A lack of peer reviewed research runs the risk of relegating OMM to the category of "alternative medicine" in the dubious company of chelation therapy, and the like.

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WORD!

first, I'm shocked how many anti-OMM students there are out there... (Quinn?)

Now that I have experienced and done OMM first hand I have forced myself to form an opinion on and I must say I consider it's benefits to be 40% physiological and 60% placebo effect. While the points the author made in his article are cogent, they miss a larger point: the mind has powers we don't understand.

I have an undergraduate degree in neuroscience and I'm telling you we know very little about how the brain "REALLY" works. We know OF certain cells, chemicals, afferent and efferent paths with a swirl of neurochemistry but when it comes to these interactions with the rest of the body I think there is much to be learned. I know there are experienced physicians out there that have seen mentally miserable people "make" themselves sick and conversely very sick people pull out of an illness just by keeping optimistic.

OMM is a two pronged attack, fix the misalignments and improve patient morality.

You may all say that mind healing/controlling the body's health state is pish-posh but I'd like to think that even if it is at least you helped someone enjoy their last few days or suffer a little less even if it didn't "do" anything for that patient physically.

Is asking for OMM to hold the same standards as every other area of medicine really an anti-OMM stance?

first, there ARE articles with "scientific evidence" on certain procedures...

I think you will see a lot of articles coming from the faculty, staff and students of EV VCOM in the next few years, when I interviewed there dean expressed a strong desire to perform much needed research on things such as OMM and it's clinical impact.

I'm willing to take that leap of faith that the techniques we learn have never done nothing for noone and are actually helping people. There's a reason we're learning it, there's a reason it's been done for years and years and there's a reason many think it's useless; stop being so jelous you didn't come to DO school ;-)

You are right, there is published, peer reviewed research on certain OMM techniques. See a recent Pediatrics article on OMM and its benefits in otitis media. My point is this: Why not teach those procedures that have proven efficacious in controlled trials and refrain from teaching those that have not until research shows that they are a benefit. You certainly wouldn't want to be taught about a certain pharmaceutical that 'we have empirical evidence that this works, but we are not sure why and we have no demonstrated clinical trials to show that it does.' Why should OMM be given this pass? If we as future DO's are sure that certain OMM techniques work, why are we so afraid of testing them to determine how and why they work?

because no one wants to write, read, edit, publish a research article for a scientific journal on SUBOCCIPITAL RELEASE just because some MD student thinks it's worthless without ever even having it done to him/her. But according to your logic suboccipital release should not be taught or used without scientific proof it's effective... It's a stretch for an example but it's the point I'm trying to make that matters.

You keep citing pharmaceuticals as your defense and offense against OMT however unlike those drugs the patient can't (generally) overdose, misuse, abuse, or die from them.

You may argue that OMT can be deadly and dangerous, you're right, ever try eating an entire bottle of extra strength advil?

Um, Reality check, I go to a DO school. How about checking my signature, Ace. Suboccipital release or other myofascial techniques are hardly the modalities we are discussing. More specifically, techniques such as cranial therapy are the ones that shouldn't be taught, because they have yet to show any efficacy. A paper from faculty at UNECOM demonstrates evidence that the entire premise is false and they recommend their school stop teacjing it. Try looking up Viola Frymann's abuse of cranial therapy sometime.

You are right, for the most part OMM is not going to harm the patient (maybe some slight chance of vertebral artery dissection with cervical HVLA in a recent study, but nonetheless). However, you seem extremely accepting of all OMM based on empirical evidence alone. Based on your logic any procedure that doesn't harm the patient should be fair game. Since harm to the patient is tested in early phases, this approach would totally eliminate the latter phases of drug trials which demonstrate efficacy of the drug vs. placebo. My point has been and always will be that we should only be taught those techniques that have shown efficacy and/or a MOA. The osteopathic community should conduct randomized, multicentered trials on various modalities. Keep the ones that work, cull the ones that don't. I am not anti-OMM in any sense. I just believe that OMM should be held to the sames standards of scientific inquiry that all other medical procedures are held to.

Psychiatrists are all quacks!!! Can you belive that they use psychotropics to treat illnesses with little to no knowledge or scientific evidence as to how they work? (Hint: Tone = Sarcasm)

Lithium, for example, is given to patients with Bipolar Disorders; we know it works - or think we do because patients claim to feel better - and yet, have little understanding of the underlying mechanism of action.

I have a close friend that recently suffered a severe head injury. He underwent minor surgery and now experiences a constant headache. His team of doctors have given him meds (which have no effect), and told him that his headaches may last months or years and that there is nothing more they can do for him.

He was successfully treated several years ago for chronic back pain by an osteopath and will be returning next week to begin treatment. He is HOPEFUL.

Why do we fear learning and defending the tools of our trade that offer hope and a potential cure, with little to no physical harm. Science complements medicine - however, in the interest of good clinical practice we recognize the need to use treatment moalities in the absence of having a definitive understanding of how they work.

I would rather heal a suffering patient in ignorance (without the knowledge of how the method works) than lack the tools to even make the attempt.

MS-I COMP

We do have lots of studies that show lithium does work; the mechanism isn't all that important. We do NOT have many studies showing that gentle targeted pressure "usually no greater than the weight of a nickel" on certain parts of the head has the same sort of efficacy.

Those who promote pseudoscience almost always defend their beliefs through some supposed mechanism of action. They've got to do this; they're not going to get a whole lot of converts from results, so a supposedly plausible explanation has to take its place.

Well, of course dowsing works. It's been done for thousands of years...you don't think that the great tradition of dowsing would still be alive if it didn't get results? What, you want to see results? Well, let me tell you about this great dowser I knew back home who took care of that dry well problem for us. Oh, you want to know exactly how a forked stick can locate water hundreds of feet underground? Well, we don't really have articles on it because the scientific establishment looks down on us. But it has to do with these very subtle radiation fields underground. With just the slightest amount of pressure, the dowser is able to detect and in some cases manipulate these fields...What? You say you can't do it? Well, don't worry. It's as much an art as science; I personally practice my dowsing skills a few hours a day, and if you don't you probably aren't going to get results. Besides, you're not going to hurt anyone trying, so why not learn it?

Good one... luke... made me smile (needed it after 4 trauma alerts in the last 30 minutes of my 12 hour shift).

I am not anti-OMM. I use some manipulation on my family and friends (mostly soft tissue, ME, and some thoracic HVLA). Not because it cures their ills, but that it makes them feel better. I know that the human touch can "cure" a lot of things... as well as just making someone feel cared about...

However, I am angered by a lot of osteopaths who do OMM exclusively to "cure everything" from diabetes to htn. OMM is a cash business... just like chelation therapy. It behooves those to use it as a broad-spectrum treatment. That I have issues against. I will likely never use OMM in the practice of Emergency Medicine. It not only goes against the standard of care, but is also almost completely indefensible in court. That is why I am somewhat negative about OMM. Does it work? Maybe. Should I be ostracized from the Osteopathic community because I choose not to perform it on 10% of my patients? Hades NO.

Where are you DOSouthpaw?

Q, DO

Originally posted by borg
WOW!

Is OMM really not held to the same scientific/ evidence based standards as other areas of medicine?

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Let's get real, it obviously isn't really held to the same standards. It could be, it should be, and it will be b/c of exceptionally responsible DO students like me, but for now it ain't.

*apathy sets in*

who cares....

I'm someone who's not in DO school yet (2004), but as I understand, the main reasons are:

1) Most "respected" research is conducted by certain institutions and certain organizations, and those are mainly allopathic medicine-oriented, and won't waste their time (and money) doing research in osteopathic methods.

2) Many people claim that OMM is hard to test because many people perform OMM differently and therefore it would be hard to be consistent. It's easier when all you're doing is giving people the same pill. Also, it's claimed that it would be difficult to create a "placebo" OMM technique as a control. With drugs, just give the same drug but with the active ingredient removed. As I understand, modalities such as acupuncture have this problem also.

I'm sure knowledgeable current DO students will have more information.

I will try to keep this brief, but I feel the urge to respond. As probably one of the few DO students out there who is actively working on OMT research, let me assure you that there are many difficulties with quantifying this field to everyone's satisfaction. My current research is in OMT for chronic low back pain, an area which has seen little primary research - big suprise right! And why exactly is that? First, has anyone out there ever tried to find funding for OMT research? Let me tell you something folks. I am at one of the only DO schools associated with a major research university in a state that has a very strong DO population, and one of my faculty members is probably one of the five most recognized osteopathic manipulative medicine practitioners in the country - and you know what, money is not easy to get. Believe it or not, there is no pharmaceutical company willing to pay me thousands of dollars to prove that manipulation works better than their NSAIDs, so we struggle on. Second, many OMT faculty are not interested in the tedious process of research - now don't jump on your soap box just yet - I realize this is no excuse. However, we as a profession need to make an effort to bring our younger OMT faculty into mainstream research. For decades OMT was used by DOs to alleviate and cure a variety of ailments; of course thousands of collected anecdotes of positive outcomes collected over the 100+ years of osteopathy's existence means little in comparison to one craftily designed RCT published in JAMA. Yet many OMT docs use this history and their personal experiences as proof enough that OMT works, so they do no research.
I hope this will soon change. I also hope you read with some sarcasm the previous few sentences, because I believe there is something to be learned from past experiences, but as a researcher myself, I also know the value of evidence-based medical science. Which brings me to my third point - has anyone out there ever tried to design a damn OMT research project. There are tons of variables to control for and as of yet, we have very few mechanisms for the collection of objective data - unless of course you count Oswestry and McGill Pain and Dysfunction questionnaires, but hell anyone can lie to a researcher. It is with these thoughts in mind and 6 months worth of personal research headaches that I urge those of you out there who are so quick to admonish the "fringe practices" of osteopaths who manipulate to actually help further the profession. Hey, it may turn out that none of this stuff does a damn thing - I'll be surprised if that's the case - but it will take forever to evolve our profession if the only ones willing to put in the leg work are those of us who already interested in OMT.

As for the validity of some of the major research into manipulation, I read a very interesting review in the Annals of IM (a rather well-respected journal) this summer that basically stated that through a meta-analysis of 60 or so studies that there was no efficacy in manipulative treatment in Low Back Pain. But, after spending two hours starting at their inclusion/exclusion criteria and references, I found that only 2 studies which used DOs as the manipulative practitioners were referenced, and not one of them were used in the meta-analysis. The study was basically a meta-analysis of PT and Chiropractic treatment. This is not to say that their techniques are inferior, but come on, a little fair play would be nice. Check it out:
Assendelft WJ, et al. Spinal manipulative therapy for LBP, Annals of IM 2003;138:871-881.

Another thing, while I'm being less brief than I had hoped. I have found that at our school, and I'm guessing this is endemic to DO schools, the OMT professors (and the other professors as well) do a poor job of directing students to the few shreds of recent primary OMT research that actually do exist. I think that the only modern texts that make any attempt to provide a fair and balanced (I hate FOX news) view of OMT are those written by Leon Chaitow, a British osteopath. Maybe since OMT is all they do, the Europeans have more time to write and research. I am guessing however, that they too get very little pharmaceutical money for their efforts. Check out his books, or at least read some of his references.

Sorry to take up so much time, but I often feel that there are only about four of us on SDN that ever make a meaningful comment on the positive aspects of OMT. I realize that many people read this and I particularly fear that first year DO students and even pre-DO students are unnecessarily given an unbalanced opinion on OMT.

So, points I'm willing to concede:
1.DOs need to make a concerted effort to put OMT into hard data.
2.This is especially needed in areas such as Cranial (there is more research out there than you think)
3.There are a lot of DO students/physicians who will never use OMT - Why did you come to a DO school again? Sorry another topic.

Challenges:
1.Help do the damn work. If you like OMT help find out if it works. If you think its total **** then do the research prove the null hypothesis and, damn it, cut off the vestigial organ that is OMT.
2.Make better use of your OMT studying time. I find that at our school, the ones who hate OMT are the ones that do nothing outside of the lab. Sometimes you have to read things that aren't on the syllabus and learn things that don't just come from your school's respective Guru.

One last side note, and then I will leave you all in peace. Someone mentioned that OMT is a cash only practice. Well, that's partly true, many are cash only, but just try to get money out of the insurance companies for manipulation. In ten years, even if we do have a great deal of research backing OMT, reimbursement for OMT services will still be minute.

Well, I hope someone manages to make sense of my ramblings.
Time to go pray to my big marble statue of A.T. Still (Jesus, I'm kidding....I know someone will think I'm serious)

money is not easy to get. Believe it or not, there is no pharmaceutical company willing to pay me thousands of dollars to prove that manipulation works better than their NSAIDs, so we struggle on.

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Yes! It never occurred to me that OMT will actually infringe on drug companies' cash cows. Well, maybe someone can convince a drug company to slash down their TV advertising budget by a few million dollars and give that to osteopathic schools for research....Yeah, right.

Cool point of view from someone in the "trenches". Thanks.

By the way, where can I get a marble A.T. Still statue?

Buddhist:

Excellent post. I do have a question that I'm sure there's a good answer to, but I haven't heard it yet:

In the absence of research, how do you think the osteopathic community should distinguish between valid and invalid methods of treatment?

From your post, it seems as if you'd at least partly rely on the test-of-time thing, but that would seem to have the double disadvantage of giving too much weight to quackery that's been around for awhile and too little weight to new and truly useful methods of treatment.

While methods like HVLA have pretty clear advantages, I simply find it tough to take seriously any modality that relies on mysticism more than science. Here's a quote from the physician who developed cranial:

"Within that cerebrospinal fluid there is an invisible element that I refer to as the 'Breath of Life.' I want you to visualize this Breath of Life as a fluid WITHIN this fluid, something that does not mix, something that has potency as the thing that makes it move. Is it really necessary to know what makes this fluid move?"

There may be research supporting cranial (and if it's compelling, I'll certainly be compelled of its usefulness), but there's also research supporting creationism, the Hare Krishnas' position that the moon is 94 million miles away, etc. One gets the sneaking suspicion when looking at certain citations of osteopathic research that the researchers are doing their best to prove, rather than to disprove their hypothesis.

So if there's a good scientific test to determine what and how to research, and what to abandon, I'm sold. If there's not, and certain techniques rely mainly on tradition and word of mouth, then they may make a fine club activity, but I'm not so sure that they're worth the couple hours of study time sacrificed for them.

To briefly respond to your last point asking why one would choose osteopathy if not sold on OMM: Aside from the obvious reason (that osteopathic schools are more forgiving in their admissions, and may be the only route for some to become a doctor), osteopathy is surely more than OMM. I chose osteopathy because it was the most effective path to practicing comprehensive primary care. The OMM is a nice touch, but I do think much (though not all) of OMM has been supplanted by better methods of treatment. If people insist on defining osteopathy by OMM, it will be at best a hollow dogma that students recite but don't believe, and at worst the poorly-respected niche practice it was for the better part of the century. It's not saying anything new, but if osteopathy is to gain even more respect, it needs to be defined by its methods rather than by its tricks and boutique appeal.

Goofy thoughts:

Okay.
Not to pick on you Ohiobuddhist, but your statements typify the arguments of OMT advocates so much that it is convenient for me to quote you.

"Believe it or not, there is no pharmaceutical company willing to pay me thousands of dollars to prove that manipulation works better than their NSAIDs, so we struggle on." - Ohiobuddhist

Goofy: Of course not. Why should they. They sell pharmaceuticals, not OMT. Likewise, an OMT researcher shouldn't be expected to investigate the efficacy of drugs.

"Second, many OMT faculty are not interested in the tedious process of research - now don't jump on your soap box just yet - I realize this is no excuse. However, we as a profession need to make an effort to bring our younger OMT faculty into mainstream research. For decades OMT was used by DOs to alleviate and cure a variety of ailments; of course thousands of collected anecdotes of positive outcomes collected over the 100+ years of osteopathy's existence means little in comparison to one craftily designed RCT published in JAMA. Yet many OMT docs use this history and their personal experiences as proof enough that OMT works, so they do no research.
I hope this will soon change. I also hope you read with some sarcasm the previous few sentences, because I believe there is something to be learned from past experiences, but as a researcher myself, I also know the value of evidence-based medical science."- Ohiobuddhist

Goofy: Touche. Of course we learn from past experience. But anecdotal evidence isn't evidence at all. For every positive outcome you hear of, there are neutral or negative outcomes that you will never hear of or read about. Has an OMT practitioner ever told you about all the times his/her treatment didn't seem to help at all? I haven't. I often hear that "Science doesn't have all the answers." This is true, but as humans with only five senses, it's all we have to go on. I feel like 'science' has become some kind of a dirty word. People mistrust it. But science, however imperfect, is the best tool we have. It is simply a way of observing the world using our senses, but TAKING PRECAUTIONS AGAINST FOOLING OURSELVES (ie, randomized, double-blinded, blah blah blah studies.) That is what people forget, and what anecdotal evidence ignores. I hear stories of babies with misshapen heads and the enormous benefits that cranial has on these kids. What you don't hear is that the head would have returned to the normal shape with or wihout it. I hear stories of GERD "cured" with Chapman's points. The fact that this disease often waxes and wanes and goes into spontaneous remission of course doesn't matter. Need I continue?

"Sorry to take up so much time, but I often feel that there are only about four of us on SDN that ever make a meaningful comment on the positive aspects of OMT. I realize that many people read this and I particularly fear that first year DO students and even pre-DO students are unnecessarily given an unbalanced opinion on OMT." - Ohiobuddhist

The opinion may be unbalanced, but is it not representative? Considering that most D.O.'s don't use OMT on most of their patients (check some recent issues of the JAOA) is it any wonder that there is little interest in research on this topic?

"So, points I'm willing to concede:
1.DOs need to make a concerted effort to put OMT into hard data.
2.This is especially needed in areas such as Cranial (there is more research out there than you think)"

I agree that we need hard data. I keep hearing "the research is coming." Where? When? Isn't a hundred+ years long enough?

"3.There are a lot of DO students/physicians who will never use OMT - Why did you come to a DO school again? Sorry another topic."

Yes, another topic indeed. This sounds like another one of those "doubters of the faith" arguments (Heretic!!!!). Just because I chose to attend D.O. school doesn't mean I have to blindly accept whatever a professor tells me. F.Y.I.: when I started school, I was very positive about OMT. Perhaps I was a bit naive and hadn't "done my homework" on the subject. After going through a year+ of OMT instruction and reading literature on the subject, I have begun to doubt many of the applications of OMT. Isn't a person entitled to change their mind?

"Challenges:
1.Help do the damn work. If you like OMT help find out if it works. If you think its total **** then do the research prove the null hypothesis and, damn it, cut off the vestigial organ that is OMT."

Sorry, but your thinking is flawed here. The burden of proof is upon the claimant. People do research on a hypothesis that they believe to be true. Doubters don't have to disprove anything. On the contrary, the claimant must prove their hypothesis to be true.


"2.Make better use of your OMT studying time. I find that at our school, the ones who hate OMT are the ones that do nothing outside of the lab. Sometimes you have to read things that aren't on the syllabus and learn things that don't just come from your school's respective Guru."

I'm not sure what your point is, but devoting more time to learning something doesn't make it more valid. Perhaps you are advocating the position that "Once you feel the cranial rhythm, you will be a believer," or similar?

Other thoughts:

I could care less what the mechanism of action is for OMT, or for a pill. What I care about is:
1. Is it going to help my patients?
2. Is it going to help my patients enough to warrant using it in place of or as an adjunct to standard medical care?
3. Do the benefits outweight the time/cost.

It may surprise you that I don't claim to know that answers to these questions, and I have not jumped to any conclusions about OMT.

I have read several studies on OMT. But I only hear about the ones that "prove" it works, and little about the ones conclude that it is ineffective. Some of the studies that I have seen have been truly laughable, with ridiculous setups. One major flaw I have seen in most studies is the lack of control models using therapeutic touch in place of OMT.

I suspect that there is real value in OMT, but the fact that the studies are so shaky and the evidence that I have seen so far is so weak that I think it will wind up being placed in the categor of accupuncture (ie. maybe it works a little, but it's nearly impossible to prove or disprove, and is likely mostly placebo effect and isn't worth the time in most [not all] situations).

Finally, I must ask the obvious question: Would we, as a profession, be so insistent on 'proving' the (likely minimal) effectiveness of OMT if we didn't feel the need to find something, anything, that makes us feel that we are 'different' from the M.D. profession?

I feel that if we worried less about OMT and more about making the most outstanding medical schools that we possibly can, then there is no reason we can't coexist with and outperform M.D. schools without having a fundamentally different philosophy than they do.

I think I'm going to troll over to the MD forums and see how many pill-pushers I can piss off...

Whats the matter you can bring it but you can't take it...

Sorry, but your thinking is flawed here. The burden of proof is upon the claimant. People do research on a hypothesis that they believe to be true. Doubters don't have to disprove anything. On the contrary, the claimant must prove their hypothesis to be true.

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Although I agree with Goofyone on this point, I believe that by virtue of attending an osteopathic college there's some implied "burden of proof" that falls on your shoulders. If DO students aren't going to do the research, then who? Certainly not MD students! It doesn't make sense for someone to go to DO school with the mindset of "I don't think OMT works but I'm going to be a DO anyway, and it's up to other people to prove or disprove the efficacy of OMT." There are many allopathic researchers that don't believe a therapeutic approach is effective and go ahead and set up a study to try and prove that. Why not the same with OMT?

Unfortunately, I have a nagging feeling that the higher-ups at the AOA will not let any part of OMT disappear, whether proven effective or not. The AOA is a big proponent of the "equal but distinctive" approach, and without OMT, there would be no real reason for osteopathic medicine to be a separate entity (besides the so-called "holistic approach" which is somewhat intangible and not necessarily the domain of osteopathic medicine).

A difficult position indeed. I think the AOA would freak out if someone at, say TCOM, was granted a lot of money to study the effectiveness of cranial therapy and JAMA would be willing to publish the results when finished. What do you think?

Originally posted by borg
As someone who believes in osteopathy, Why does not the AOA get involved and fund studies to prove OMT?

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It sure would be a lot more helpful internally than that cutesy and costly "I can D.O. anything!" campaign.

It sure would be a lot more helpful internally than that cutesy and costly "I can D.O. anything!" campaign.

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I totally agree! Those ads are silly.

There's a funny story associated with those ads. Apparently they paid a woman's magazine to run the ad (Woman's World? I don't remember which one). The same issue that ran the ad also contained an article about women's health and spoke of various health issues. In that article they spoke not very highly of the osteopathic profession, even saying something like "if you're basically healthy then it's OK to see a D.O.". Boy was the AOA mad about that one! Kind of funny if you think about it.

that sucks. did they say how they came to that conclusion aboit DOs? taht's the first time i have heard of bad press for DOs, i have seen a lot of positive articles.

I don't remember who wrote the article in the magazine. I tried locating the link to the news item at the AOA website, but it appears they don't keep an archive with old news. I'll keep searching...

There will never be significant OMT research because there is no incentive to do it. Pharmaceutical companies won't fund it because there is no money it, government won't fund it(much, it has recieved a little cash) because it's utility, even if it worked, is limited and expensive to administer(1/2hr OMT=$100, A couple of advil<$.50). Additionally, the powers that be in the DO community have no interest in research, and why would they, so it can be all proved BS? Many people in the DO community make their living and have built their professional reputations on OMT, why mess with it? I think if you are a skeptical DO student(as I am) that's fine but you have to suck it up, smile, and learn the stuff. Be grateful you are being given an opportunity to be a doc and make a great living doing something cool. If it was not for the back crackin, head massaging voodoo doc's that came before me, I'd be working at Starbucks.

Originally posted by bigmuny
There will never be significant OMT research because there is no incentive to do it. Pharmaceutical companies won't fund it because there is no money it, government won't fund it(much, it has recieved a little cash) because it's utility, even if it worked, is limited and expensive to administer(1/2hr OMT=$100, A couple of advil<$.50). Additionally, the powers that be in the DO community have no interest in research, and why would they, so it can be all proved BS? Many people in the DO community make their living and have built their professional reputations on OMT, why mess with it? I think if you are a skeptical DO student(as I am) that's fine but you have to suck it up, smile, and learn the stuff. Be grateful you are being given an opportunity to be a doc and make a great living doing something cool. If it was not for the back crackin, head massaging voodoo doc's that came before me, I'd be working at Starbucks.

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Yeah! You are totally right. Let me grab my leaches!

*hides ICEWOMAN voodoo doll behind back*

what? voodoo? us? naaaahhh....

I don't know of anyone with very strong opinions against OMT at my school, but maybe they are there and just keep it to themselves.

I look at OMT as a way to get in a little extra anatomy (never a bad idea) and to learn some basic skills that I might be able to pull out of my black bag now and then. I will probably not do a lot of OMT in my practice, but I want to be proficient enough in the basics that I am not afraid of putting my hands on a patient if I feel it can help them and if they are willing.

Plus the additional palpation practice can't hurt, either.

Will I be a back-cracking voodoo doc? Probably not. But anything extra I can learn about the human body, I figure can't hurt, and it might help....and if it keeps me away from the wrong side of the counter at Starbucks, I am all for it.

I swear to the voodoo OMT god if one more person diss's Starbucks there's going to be voodoo dolls as far as the eye can see...

Borg,
Some students believe OMT to be voodoo, others don't. The truth of the matter is OMT is no more voodoo than physical therapy. However, some of the more traditional osteopaths believe it's utility extends beyond treating sore backs, sprains ect..There is also a very small population of osteopaths who believe in some forms of OMT that is considered by most to be voodoo. It is sort of like in psychiatry, there are still some oldtime shrinks who believe in Freud. Also as was said before learning OMT does have certain benefits like additional anatomy study time, honing palpation and musculoskeletal exam skills, and it forces you to get comfortable touching patients quick.