Article on Skepticism

[47alphatango]

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Here is the link to the article. Any thoughts?

 

[Jrsharp70]

http://en.wikipedia.org/wiki/Ideomotor_effect

The ideomotor effect is well documented, similar to a placebo effect. Never underestimate the power of suggestion.

Any rational individual shares the opinion of the author, and any rational individual must also examine the possibility that they must concede that their own senses can fail them.

Only controlled, repeated, double blind trials will convince me that cranial manipulation is effective. Most MD and DO physicians I know see benefits of many OMM techniques, and I am glad to be learning/using it.

 

[JaggerPlate]

Here is the link to the article. Any thoughts?

Not a bad piece honestly (and I 100% assume you, yourself, wrote it). To be honest, I feel like majority of individuals involved with the profession on a generation X/Y level share your feelings towards cranial. To me, it seems like there is a small majority of individuals who are passionate about it, and, like it or not, these same individuals have a lot of clout in the DO community. Personally, I don't think this mentality can last forever because, as you pointed out, we are the future of Osteopathic medicine ... and this skepticism isn't exclusive to you alone. Frankly, I would like to see cranial strictly reviewed, researched, and, likely, moved to (like you said) some sort of elective or small history lesson in an OMT course. However, I personally want to do this because I am an OMM fan and would love to see it used more frequently by DO graduates and accepted more universally by the medical community. However, like you pointed out, much more research, streamlining, and proof (not anecdotal 'evidence') is needed for this to occur.

 

[SFO-IST]

Here is the link to the article. Any thoughts?

I am on vacation in a country that seems to block access to that site, can you paste it in this forum please? Thanks.

 

[bones]

Here is the link to the article. Any thoughts?

Warning: radical content

The average person in this world is flawed. many have a lack of discernment (The blind fool), while many have a lack of openness to new ideas (the blind skeptic). Blind skeptics disbelieve anything that does not fit with their belief system until they are beaten over the head with proof- and sometimes that beating never comes. Such people are very slow to learn new things and often they never learn. Blind fools on the other hand believe anything they are told and end up believing many false things and proporting them as truth. They live in a world of delusion. Neither approach leads you to truth or new understanding.

AT Still was very clear that the goal of the DO student was to master anatomy and physiology and pathophysiology- and to believe no unproven theory on the road to being an osteopath. With mastery comes the ability to understand and deduce, and build testable theories of health and disease for individual patients as well as groups of patients.

Unfortunately over the years very few people understood what he was saying.
I applaud your questioning of the foolishness within the osteopathic profession. Just dont take it so far that you miss what is real that osteopathy has to offer- including treatment of the head (which does not necessarily require believing anything, despite what your department might be selling you).

-bones

 

[babdoc]

Only controlled, repeated, double blind trials will convince me that cranial manipulation is effective. Most MD and DO physicians I know see benefits of many OMM techniques, and I am glad to be learning/using it.

First, I'm not convinced that cranial field OMT works. But, it's impossible to do a double blind controlled study on OMT. Just like you can't double blind surgery.

 

[preDoGuy24]

First, I'm not convinced that cranial field OMT works. But, it's impossible to do a double blind controlled study on OMT. Just like you can't double blind surgery.

Why not ? I was at a presentation by an orthopedic surgeon who participated in a clinical trial on vertebral replacement vs spinal fusion ( i believe, was two years ago) in which he didn't know which procedure he would perform until he had the patient on the table. Just saying it is possible in some circumstances to double blind surgery. I agree that their is very little aka no evidence of cranial OMT effectiveness that I (or anyone else?) can muster though.

 

[bones]

Why not ? I was at a presentation by an orthopedic surgeon who participated in a clinical trial on vertebral replacement vs spinal fusion ( i believe, was two years ago) in which he didn't know which procedure he would perform until he had the patient on the table. Just saying it is possible in some circumstances to double blind surgery. I agree that their is very little aka no evidence of cranial OMT effectiveness that I (or anyone else?) can muster though.

Excuse me here, but that isn't double blind, nor placebo controlled. To be double blind the surgeon would need to not know what group the patient was in even during the procedure... you can see how that would be a challenge. For placebo trials they would have to just open the patient up and then close them again. At best in surgery they can do single blind (patient blind) outcome based studies. These are rarely done, and you can see why. Almost everything surgeons do is unproven scientifically to the standard you are holding OMM. They base their techniques on patient and physician perspectives of outcomes and case studies, which is largely what is done in OMM. It is quite the challenge to go past this, but certainly it can be done.

 

[preDoGuy24]

Excuse me here, but that isn't double blind, nor placebo controlled. To be double blind the surgeon would need to not know what group the patient was in even during the procedure... you can see how that would be a challenge. For placebo trials they would have to just open the patient up and then close them again. At best in surgery they can do single blind (patient blind) outcome based studies. These are rarely done, and you can see why. Almost everything surgeons do is unproven scientifically to the standard you are holding OMM. They base their techniques on patient and physician perspectives of outcomes and case studies, which is largely what is done in OMM. It is quite the challenge to go past this, but certainly it can be done.

I stand corrected.

 

[bones]

I stand corrected.

Actually, there are some surgery studies where they keep the patient blind as to their group, as well as everyone involved in pre post op care. This is probably equivalent to double blind... and there ARE a couple of studies where they just opened and closed patients in the placebo groups- though those studies are very rare... so yes it is theoretically possible to do the equivalent of surgical studies to this level of quality research (i just talked my way out of winning the argument...). If you look at the surgeries we do however i think you'll find that double blind placebo controlled evidence is nowhere to be found.

To do this with cranial however you'd have to knock them out with anesthesia just as you do with surgery so they wouldnt know their grouping. You could then just not treat the placebo group. Thats as close as i've come to figuring out how to pull it off with cranial. Im not sure that would fly with the funding agencies or with patients, but it might just work.... but i hope you can appreciate the difficulty of doing studies in the manner of which you speak.

Also, if I can consistently make a full blown migraine go away completely within 2-5 minutes of treatment, I dont need to sell that it works to my patients or myself. Its only students and physicians that dont know how to do it and have never seen it work like this that remain skeptical- and of course this is the vast majority. Until we can teach in a more balanced way with less crazy anecdotes and theory and more practical and obvious results seen by every student in the class we're gonna have a lot of skeptical students- as it should be. We as faculty should take full responsibility. Shadowing someone who is competent and sane should be your recourse if you're curious and want to know for yourself if it works and whether you want to actually invest the time to learn it.

 

[babdoc]

Also, if I can consistently make a full blown migraine go away completely within 2-5 minutes of treatment, I dont need to sell that it works to my patients or myself. Its only students and physicians that dont know how to do it and have never seen it work like this that remain skeptical- and of course this is the vast majority. Until we can teach in a more balanced way with less crazy anecdotes and theory and more practical and obvious results seen by every student in the class we're gonna have a lot of skeptical students- as it should be. We as faculty should take full responsibility. Shadowing someone who is competent and sane should be your recourse if you're curious and want to know for yourself if it works and whether you want to actually invest the time to learn it.

That would be nice! It seems like a hard sell to even the most devoted student. Sitting in the lab for a few hours trying to feel a bone move 200 microns isn't an adequate way to learn it. There's a retired doc that hangs out for our labs and helps out that said it took him years to feel it, then years to treat.

Whether or not it works, I don't know. I don't know if I even feel anything. Just by that, I'm skeptical because it's not tangible. But, if a patient feels like it works, then I can't criticize a doctor for using it as a treatment or adjunct. Either way, the 8 hours of instruction we got could only serve to give us an idea of what it is. I feel that if I tried to do cranial on someone, it would do nothing but further verify the placebo effect.

 

[bones]

That would be nice! It seems like a hard sell to even the most devoted student. Sitting in the lab for a few hours trying to feel a bone move 200 microns isn't an adequate way to learn it. There's a retired doc that hangs out for our labs and helps out that said it took him years to feel it, then years to treat.

Whether or not it works, I don't know. I don't know if I even feel anything. Just by that, I'm skeptical because it's not tangible. But, if a patient feels like it works, then I can't criticize a doctor for using it as a treatment or adjunct. Either way, the 8 hours of instruction we got could only serve to give us an idea of what it is. I feel that if I tried to do cranial on someone, it would do nothing but further verify the placebo effect.

I must admit when I first took a cranial class I didnt feel much either- and what I did i was convinced i was imagining. It frustrated me that some attendings didn't seem to care about whether what they were saying was true- just that students needed to know it. It is clear the model we are using for cranial is far from complete and based on a lot of theory we haven't verified yet.

This said, the ability to treat the head is very important. I use the subtle stuff from lab to screen what needs to be treated, but i'll often use substantially more force for the actual treatment- sometimes up to 20LBS of force- more akin to what students call BLT on other areas of the body. This isn't subtle movement- and it works very quickly, and when I re-screen the findings and symptoms are often substantially changed. using gross motion like this the head is actually quite easy to treat head problems effectively, and I do wish this was emphasized in class over the more subtle stuff that so many students struggle with and rightly question given their lack of ability to validate it. I think they do this to try to prevent students from having serious issues as their partner is learning how to do things.

I have had substantial success with severe migraine patients that have suffered for years- even decades (targeting strain through the sphenoid- CN5 irritation), vertigo (temporal bone- CN8 irritation), sleep disturbance (likely a general cranial circulation issue) and GERD (temporal/occiput/OA- CN10 irritation).

If you are interested in learning more you should see cranial in action with real patients with real conditions before you knock it or "believe" something about it, and i strongly encourage you to see it early in training so you dont waste your Cranial class only to find out later you wish you had paid attention.

 

[siliso]

First, I'm not convinced that cranial field OMT works. But, it's impossible to do a double blind controlled study on OMT. Just like you can't double blind surgery.

You could easily do single-blind with sham treatments and have a blinded observer rate the response. Has that been done?

 

[bones]

You could easily do single-blind with sham treatments and have a blinded observer rate the response. Has that been done?

You are correct that this could be done, given properly trained practitioners who understand research in a small enough geographic area and who have enough time on their hands. Some people have attempted this, but most of the studies have been very small and very poorly designed. If this is an interest of yours i am sure the funding is out there- even NIH. You just need to design the study and put the docs and patients together.

 

[Jrsharp70]

You are correct that this could be done, given properly trained practitioners who understand research in a small enough geographic area and who have enough time on their hands. Some people have attempted this, but most of the studies have been very small and very poorly designed. If this is an interest of yours i am sure the funding is out there- even NIH. You just need to design the study and put the docs and patients together.

Silso has a good understanding of experimental design.

In "magic NIH money land" with funding for this, and "magic time-not-spent-studying" land, I'd design a single-blind with a sham treatment for chronic X sufferers. However, it would have to be done so that a D.O. who KNEW the technique intentionally performed it wrong. There couldn't be some random person probing your head, otherwise the patient would be likely to feel the lack of intention/confidence.

I'll say that it may also be difficult to have someone who is sufficiently experienced to partake in this imaginary study, since it would be best performed by someone who has a vested interest.

Good thread people. Great to see that the future of the profession will be in the hands of people with this kind of enthusiasm for the truth. I have found many techniques we are doing to be beneficial and logical (of course). But the heart of science is constant self-examination to always have the greatest confidence in the knowledge we have.

 

[dozitgetchahi]

Good thread people. Great to see that the future of the profession will be in the hands of people with this kind of enthusiasm for the truth. I have found many techniques we are doing to be beneficial and logical (of course). But the heart of science is constant self-examination to always have the greatest confidence in the knowledge we have.

Of course. After all, medicine in general is laden with techniques and treatments that seemed beneficial and logical (digoxin for CHF/post-MI, flecanide post-MI, tonsillectomies for everyone, etc) but actually turned out to be useless, counterproductive, or even dangerous.

OMM treatments should not be held to any lesser standard.

 

[Jrsharp70]

Of course. After all, medicine in general is laden with techniques and treatments that seemed beneficial and logical (digoxin for CHF/post-MI, flecanide post-MI, tonsillectomies for everyone, etc) but actually turned out to be useless, counterproductive, or even dangerous.

OMM treatments should not be held to any lesser standard.

Thank you for canceling out the Jersey Shore show in my mind!