Cranial Osteopathy - What is your take on it?

[Dies Irae]

---

Members don't see this ad.

???

 

[Boomer]

Cranial....I feel a sneeze coming on....

Ah, ah, buul......llllll.........sssssssssssssssshi......

 

[old blue]

pure crap

 

[jonb12997]

not to feed the fire or anything, but have you had TMJ problems and been treated with it? I have, and I have to say it seems to somewhat works...

 

[235750]

Hi everyone,

I'm an incoming DO student and normal OMM sounds great for back pain, pain management, etc, but the concepts and theory behind cranial osteopathy has me worried. Now I'm not a doctor, but I do know that the adult skull is made of fused bones. So, already it seems to clash with my basic beliefs of the human body.

I was excited to see that some of cranial's biggest critics come from osteopathic medical schools. Two UNE professors wrote some great articles/reviews of the practice.

That's what evidence medicine is all about, right? We use the best forms of medicine available and then change our techniques/treatments when new results come out. So, my thinking is, cranial osteopathy was used because we thought it worked, but now that we know it doesn't we should move on and stop using it.

My question to you DO and DO students out there: does this mean that DOs are going to change and dump this practice? What's the attitude about cranial osteopathy at your institution or place of practice?

Oh yes, the articles I was referrencing are here and here . You may need to be at a campus with eletronic journal access for that second link

 

[Buckeye(OH)]

The people that believe in and teach cranial are the OMM faculty and the OMM fellows. Everyone else looks the other way.

 

[Buckeye(OH)]

I dont see an option to vote, but Id vote that its bogus.

 

[Styria]

I'm an incoming DO student and normal OMM sounds great for back pain, pain management, etc, but the concepts and theory behind cranial osteopathy has me worried. Now I'm not a doctor, but I do know that the adult skull is made of fused bones. So, already it seems to clash with my basic beliefs of the human body.

I'm an incoming DO student too, but I've been able to palpate the movement of those bones and show others too. You just need to be willing to slow down, be patient, and learn. Fused bones are the frontal bone in 90% of people (the rest retain two with the metopic suture between them), or the clavicle which can set on its own in a day. The cranium just behaves differently, and the sutures look like very jagged, multiple failed attempts at fusion. You even get lambdoid bones or other little floaters in the sutures that don't fuse. Why?

 

[TexasTriathlete]

I think that it is great, and it is the only kind of medicine that should be practiced by anyone.

 

[235750]

I dont see an option to vote, but Id vote that its bogus.

This thread is 4 years old so I think the voting stopped a long time ago! I just wanted to be a good SDN participant and talk about my concerns by using a relevant, pre-existing thread

I was not trying to elicit inflammatory responses. My question is, is cranial osteopathy still taught? And is it actually used?

I saw articles dated 6 years ago that claimed that cranial manipulation is on the COMLEX exams. Is this true? How much cranial is there?? Here's an example COMLEX test question I saw from years ago:

"A 33-year-old female presents to the emergency department with pain in the back of the head after being struck by her spouse. Cranial osteopathic examination reveals no true sphenobasilar flexion/extension, only a monophasic rocking motion. The most likely cranial diagnosis is
(A) right lateral strain
(B) inferior vertical strain
(C) left sphenobasilar torsion
(D) sphenobasilar compression
(E) right sidebending rotation”

I've worked in the ED for quite some time, had the pleasure of working under many doctors, DO and MD alike, and I have never heard of or seen such a diagnostic test for traumatic injury. When I see a head trauma I think 'CT scan', not "let's get some cranial osteopathy in here". And whilst I've heard crazy medical jargon before, I think I would remember a diagnosis of cranial 'monophasic rocking motion' 😕

Again, I'm not a doctor, I have never seen this stuff practiced, but I can read journal articles. I can't find one good paper that backs up this practice, and by 'good' I mean a fairly large double-blind clinical trial, not 7 people who know what treatment they're getting.

It just seems to be an scientifically unproven and unverified tool...I'm hoping the above comlex question are old remnants of a changed system.

 

[235750]

I'm an incoming DO student too, but I've been able to palpate the movement of those bones and show others too. You just need to be willing to slow down, be patient, and learn. Fused bones are the frontal bone in 90% of people (the rest retain two with the metopic suture between them), or the clavicle which can set on its own in a day. The cranium just behaves differently, and the sutures look like very jagged, multiple failed attempts at fusion. You even get lambdoid bones or other little floaters in the sutures that don't fuse. Why?

You obviously know a bunch about this stuff and I don't, I'm just reading what over people wrote. But if it's such a great thing, why aren't there any decent aticles written about it?

I'm hoping it's not really taught anymore, or at the minimum not emphasized.

If not, hopefully it's the case that cranial osteopathy is actually an effective, well kept secret that DOs hide from journals to keep it for themselves. In which case, well played Buckeye, but your cover has been blown!

 

[Buckeye(OH)]

Well played what? Im about to graduate from a DO school. Its still taught, and its still bogus in my opinion.

 

[BobBarker]

Read the JAOA article on the intraexaminer reliability of cranial. It is pretty much 0.

 

[mentulbloc]

have there been any articles published that say OMM even for back pain reduces morbidity, or improves long term outcome...🙄

the biggest problem with osteopathy as a field, as a profession, and as a philosophy is that it is not routed in current scientific doctrine. Where are the quotable papers, cohorts and so on. If there was evidence that it worked, why not let MD doc's practice it as well......... This is going to be problematic in the future as more insurance companies move to a pay for performance sort of reimbursement. If it there is no evidence you won't get paid for it, unless out of pocket. And if patients are paying for it out of pocket, doesn't it reduce the field to a kind of hocus pocus unrecognized sort of medicine.

Has anyone considered that the reason there is no evidence is because maybe it is no more effective then NSAIDs, Chiropractics and the such. where is the *&*%$ evidence...

 

[bigDinLV]

I haven't seen it work, so I lean more towards BS.. The people that believe in it, believe that patients benefit from it a ton. Maybe they have seen first had results and that is what has them sold. Heck, maybe if I saw these amazing results I would be a believer too???

But there is also the possibility that sometimes you find exactly what you are looking for. So their belief in cranial leads them to find amazing results in patients that I might not see..

I guess I don't know, I don't discredit anything.. But I do like evidence that things work. If only someone could convince me...

 

[JaggerPlate]

have there been any articles published that say OMM even for back pain reduces morbidity, or improves long term outcome...🙄

the biggest problem with osteopathy as a field, as a profession, and as a philosophy is that it is not routed in current scientific doctrine. Where are the quotable papers, cohorts and so on. If there was evidence that it worked, why not let MD doc's practice it as well......... This is going to be problematic in the future as more insurance companies move to a pay for performance sort of reimbursement. If it there is no evidence you won't get paid for it, unless out of pocket. And if patients are paying for it out of pocket, doesn't it reduce the field to a kind of hocus pocus unrecognized sort of medicine.

Has anyone considered that the reason there is no evidence is because maybe it is no more effective then NSAIDs, Chiropractics and the such. where is the *&*%$ evidence...

-MDs can and do practice it with additional courses. There is an OMM clinic in my city with two DOs and one MD
-Insurance will cover it, but a lot of people charge out of pocket because it is very profitable
-Insurance will also cover Chiro
-I don't think a lot of people consider all of it completely bogus ... but many people do feel like they won't use it, and don't take much with them outside of med school courses.

edit: I'm not talking about cranial, I'm talking about OMM in general.

 

[Pony46]

I have had cranial work done before and in my opinion there is something to it.

I have also read a bit about, a book by the man who invented it and I have to say that it really sounds dated. I MEAN really! Not only that but it is written for a person who has gone through medical school which I have yet to do.

And looked over some of the negative studies. While I am not denying that there is little hard cold science to back it up- I am not educated enough yet to say that it is bogus. But I am curious...very ...about it.

Two things I think are important though-

I dont think the fusing of cranial bones is hard cold fact and remember reading somewhere that they do not fully fuse until your 30's if then... but i do not know for certain.

(It was also considered a scientific fact that neurons do not regrow in the brain..but that territory has gotten considerably more gray in recent years.)

There is an article about OMM and how a physician must keep up its practice in order to develop the palpatory( word?) sensitivity needed for the breadth of Dr. Still's OMT to become apparent.

Yet most do not have the time or the interest and let the techniques go...

.02

I am excited to find out more when I start school.

 

[Hurricane95]

LOLZ!!

roflcopters

 

[Hurricane95]

Cranial sounds like something one of my psychotic patients would have come up with this morning on rounds....the same patient who believes he has a miniature married woman growing from his thigh, and whenever her husband comes to have sex with her at night, he gets a nosebleed (in reality the nosebleed is from his chronic cocaine habit).

 

[Styria]

You obviously know a bunch about this stuff and I don't, I'm just reading what over people wrote. But if it's such a great thing, why aren't there any decent aticles written about it?

I'm hoping it's not really taught anymore, or at the minimum not emphasized.

If not, hopefully it's the case that cranial osteopathy is actually an effective, well kept secret that DOs hide from journals to keep it for themselves. In which case, well played Buckeye, but your cover has been blown!

I have a family history in it. My grandfather was a president of the Cranial Academy. So I get stories, like him reshaping the heads of mentally handicapped children, and learned a few things about practice from him (adults' he would gently pull apart and let go back into place on their own, while children's cranial bones could be set in place more directly). Though he didn't teach me any; I tried palpating it on my own later.

Go visit the anthropology department at your undergrad. They'll have skulls you can check out. Some will be disarticulated and you can see the sutures from top to bottom - it looks like several random rows of teeth. Sure, there will be skulls there too with some (but not all) fused sutures. I want to know whether the typically open sutures are the ones more often used in cranial.

COMLEX has a greater proportion of cranial questions than other OMT areas. Whether or not it's emphasized in every DO school, you'll still be responsible to know the mechanisms behind it in order to do well.

However, if you want to read about cranial osteopathy and hidden secrets, here's a book claiming they're associated with the Illuminati and mind control and absolutely asserting that true practicioners know what they're doing. 😉 Take it as you will.

HTML: http://educate-yourself.org/mc/deeperinsightsbook.shtml
PDF: http://www.forgenerations.net/documents/vol2-maybe.pdf

 

[metalmd06]

My friend at school calls the breath of life " the smoke of life," because it's like blowing smoke up your ass. Cranial, and PINS for that matter, is bull. Counterstrain, ME, myofascial and FPR work. Like the MDs on campus say, "it's just another tool in your toolbox."

 

[danzman]

It is crap. 1/3 of all OMM is crap, 1/3 only works for 100 yr old grannies who can't get out of bed, and 1/3 is probably a little effective. Trouble is, the 1/3 that is effective is just glorified massage therapy/physical therapy. If I give a patient a ****job, they feel good and it may be good for them (hell there is even research to back that up), but that don't make it medicine. Still, the chiro's of the world have learned that selling hope is more profitable than selling medicine. I heard a story of a surgeon who does a pedel pumps everyone for twenty seconds and bills them for it. Easy money.

 

[funshi baba]

cranial is like religion. Only does that believe in it, feel and see the effects.

its a hard sell

 

[funshi baba]

Cranial....I feel a sneeze coming on....

Ah, ah, buul......llllll.........sssssssssssssssshi......

That's f*king hilarious

 

[235750]

While I am not denying that there is little hard cold science to back it up- I am not educated enough yet to say that it is bogus.

Here's the thing: if there isn't any evidence to back it up, then why practice it? The default is not to accept it as a legitimate treatment. We fail to reject the null until we have evidence otherwise

No one has answered my questions yet: is cranial on COMLEX? If so how much? Is is emphasized less now?

 

[cyclohexanol]

No one has answered my questions yet: is cranial on COMLEX?

Unfortunately, yes.

If so how much?

I'd say that about 10% of the test is OMT. Maybe 2-5% of all of the questions on COMLEX Step 1 have something to do with cranial. Maybe another 2% for 'regular' OMT questions, and the remaining 3-6% are crap like chapman's points, and viscerosomatic reflexes.

Is is emphasized less now?

Seems to be about the same.

 

[235750]

Unfortunately, yes.


I'd say that about 10% of the test is OMT. Maybe 2-5% of all of the questions on COMLEX Step 1 have something to do with cranial. Maybe another 2% for 'regular' OMT questions, and the remaining 3-6% are crap like chapman's points, and viscerosomatic reflexes.


Seems to be about the same.

Wow, 2-5% is a lot!! That's crazy. I guess I understand know why some programs want the step 1 USMLE instead of the COMLEX...it's not that they're anti-DO, they probably just think the test is not very good

Thanks for answering my question Mr T!

 

[JaggerPlate]

Wow, 2-5% is a lot!! That's crazy. I guess I understand know why some programs want the step 1 USMLE instead of the COMLEX...it's not that they're anti-DO, they probably just think the test is not very good

Thanks for answering my question Mr T!

It's probably because they are unfamiliar with the scaling, what makes a good score vs a bad score, etc. Not because they think it's a bad test. From what I've heard, most people think USMLE is a 'better' test, but I've never heard your theory.

 

[funshi baba]

It's probably because they are unfamiliar with the scaling, what makes a good score vs a bad score, etc. Not because they think it's a bad test. From what I've heard, most people think USMLE is a 'better' test, but I've never heard your theory.

based on my experience after taking both COMLEX 1 and USMLE 1, i do feel COMLEX is a much straight-forward exam. Stem of question provides history and finding on physical exam and ask you for the diagnosis or treatment.

While USMLE gives you similar question format, the choices require you to be able to apply your knowledge in almost a non-conventional, weird way. e.g interpreting a graph based on ur knowledge of drug availability and metabolism (just a random example)

So in my opinion, i think USMLE test more of ur critical thinking capacity while COMLEX is more of your memory.

my 2cents.

 

[cyclohexanol]

based on my experience after taking both COMLEX 1 and USMLE 1, i do feel COMLEX is a much straight-forward exam. Stem of question provides history and finding on physical exam and ask you for the diagnosis or treatment.

While USMLE gives you similar question format, the choices require you to be able to apply your knowledge in almost a non-conventional, weird way. e.g interpreting a graph based on ur knowledge of drug availability and metabolism (just a random example)

So in my opinion, i think USMLE test more of ur critical thinking capacity while COMLEX is more of your memory.

my 2cents.

Is this supposed to be a good characteristic of the COMLEX?

 

[funshi baba]

Is this supposed to be a good characteristic of the COMLEX?

I think it makes it more of an easier exam to study for. So in a way, good for us the test taker. For the PDs and outside world, dont really know.

 

[cyclohexanol]

I think it makes it more of an easier exam to study for. So in a way, good for us the test taker. For the PDs and outside world, dont really know.

So in comparing COMLEX to USMLE, tests which supposedly serve as some benchmark for determining if you should be granted a license or not, you think that a test which is 'easier to study for' and 'good for the test taker' is a good thing? A test which, in your words, tests memory? Seriously? I hope that I'm wrong in interpreting your post.

Don't get me wrong, I agree with you that it is more of a test of memory vs. critical thinking skills. It's a ****ing joke.

If the benchmark for licensure is being able to memorize a bunch of ****, then yes, COMLEX is a superior test.

Medical licensing tests should be difficult. They should test critical thinking abilities. When you get your license, your patients (and their lawyers) don't care about how much **** you memorized, they care about how you interpret data and formulate a proper differential, assessment and plan. Before getting a license, I want to make sure they can do that. If a licensing exam can't do that, it's worthless. Compared to the USMLE, the COMLEX is worthless in that sense.

My $0.02.

 

[235750]

It's probably because they are unfamiliar with the scaling, what makes a good score vs a bad score, etc. Not because they think it's a bad test. From what I've heard, most people think USMLE is a 'better' test, but I've never heard your theory.

It makes sense that if 2-5% of the exam is BS (ie unverified treatment therapy, or 'cranial') then PDs would perfer not to use it when judging applicants. I've seen this theory before, but I'm just using my own powers of deductive reasoning here. It makes sense if you think about it.

Knowning how to scale the exam is easy: you can find bell curves with scores on the internet with a simple google search. All you really need is the mean, median, and SD and you're good, or a simple percentile score which ERAS gives.

Anyway I hope they remove the cranial portion soon...

 

[funshi baba]

So in comparing COMLEX to USMLE, tests which supposedly serve as some benchmark for determining if you should be granted a license or not, you think that a test which is 'easier to study for' and 'good for the test taker' is a good thing? A test which, in your words, tests memory? Seriously? I hope that I'm wrong in interpreting your post.

Don't get me wrong, I agree with you that it is more of a test of memory vs. critical thinking skills. It's a ****ing joke.

If the benchmark for licensure is being able to memorize a bunch of ****, then yes, COMLEX is a superior test.

Medical licensing tests should be difficult. They should test critical thinking abilities. When you get your license, your patients (and their lawyers) don't care about how much **** you memorized, they care about how you interpret data and formulate a proper differential, assessment and plan. Before getting a license, I want to make sure they can do that. If a licensing exam can't do that, it's worthless. Compared to the USMLE, the COMLEX is worthless in that sense.

My $0.02.

The only way you can argue that point is by showing that MDs are better physicians than DO or even better critical thinkers, and i don't think that's the case.

I do agree with you that USMLE is a superior exam in terms of testing the test-taker depth of knowledge and critical thinking.

 

[Buckeye(OH)]

So in comparing COMLEX to USMLE, tests which supposedly serve as some benchmark for determining if you should be granted a license or not, you think that a test which is 'easier to study for' and 'good for the test taker' is a good thing? A test which, in your words, tests memory? Seriously? I hope that I'm wrong in interpreting your post.

Don't get me wrong, I agree with you that it is more of a test of memory vs. critical thinking skills. It's a ****ing joke.

If the benchmark for licensure is being able to memorize a bunch of ****, then yes, COMLEX is a superior test.

Medical licensing tests should be difficult. They should test critical thinking abilities. When you get your license, your patients (and their lawyers) don't care about how much **** you memorized, they care about how you interpret data and formulate a proper differential, assessment and plan. Before getting a license, I want to make sure they can do that. If a licensing exam can't do that, it's worthless. Compared to the USMLE, the COMLEX is worthless in that sense.

My $0.02.

Word. Back in the day when I took Step 1/Level 1, I took them two days apart. I took USMLE first, and basically breezed through Level 1. Had it been the other way around and I would have tried to cruise through the USMLE...I would have failed, undoubtedly.

The COMLEX should be renamed, the CRAPLEX.

 

[JaggerPlate]

It makes sense that if 2-5% of the exam is BS (ie unverified treatment therapy, or 'cranial') then PDs would perfer not to use it when judging applicants. I've seen this theory before, but I'm just using my own powers of deductive reasoning here. It makes sense if you think about it.

Knowning how to scale the exam is easy: you can find bell curves with scores on the internet with a simple google search. All you really need is the mean, median, and SD and you're good, or a simple percentile score which ERAS gives.

Anyway I hope they remove the cranial portion soon...

1. I highly doubt any PD knows that 2-5% is cranial ... they probably have no ****ing clue what's its about, ergo why they don't want it.
2. Lol I don't trust your deductive powers -> making sense if I think about it argument.
3. PDs aren't going to take the time to google COMLEX scores when they have 200 applicants to go through. Do you think that if 199 people have USMLE, they know what means, what is good/bad etc, and 1 person has COMLEX that a PD is going to take an hour out of going over applications to find a bell curve, figure it out, compare your score to the curve - knowing nothing about what the test really comprises - and then decide to inverview you or not??? Use you're deductive powers ... you'll see it doesn't make sense if you think about it.

Trust me, I doubt ACGME PDs know at all about the 2-5% cranial ... they probably just know nothing about the exam and don't care/have the time to figure it all out.

 

[235750]

1. I highly doubt any PD knows that 2-5% is cranial ... they probably have no ****ing clue what's its about, ergo why they don't want it.
2. Lol I don't trust your deductive powers -> making sense if I think about it argument.
3. PDs aren't going to take the time to google COMLEX scores when they have 200 applicants to go through. Do you think that if 199 people have USMLE, they know what means, what is good/bad etc, and 1 person has COMLEX that a PD is going to take an hour out of going over applications to find a bell curve, figure it out, compare your score to the curve - knowing nothing about what the test really comprises - and then decide to inverview you or not??? Use you're deductive powers ... you'll see it doesn't make sense if you think about it.

Trust me, I doubt ACGME PDs know at all about the 2-5% cranial ... they probably just know nothing about the exam and don't care/have the time to figure it all out.

ERAS gives a percentile for your COMLEX score, so you don't have look anything up. All they need is your application

You're right, they probably don't know the composition of the COMLEX, but I bet they know OMM is on it. Nuff said

 

[235750]

..

 

[Pony46]

Here's the thing: if there isn't any evidence to back it up, then why practice it? The default is not to accept it as a legitimate treatment. We fail to reject the null until we have evidence otherwise

I think that the major debunking was the failure to be able to find a definitive cranial rhythm between different practitioners- like one can find a heartbeat.

This what I have read and heard about.

I just dont think this study is enough to debunk it entirely due to the many, albeit anecdotal, stories about help received from cranial.

If you speak to someone who has practiced it and has a thriving practice using it they do not think that it is fake, they have many recovery stories- are these not real because of a study? One study?

And how is chalking it up to placebo means for dismissal?
Placebo can be bad- as in when you think you are well but you are not and then when you in fact heal naturally from something which has yet to make scientific sense. Meaning we don't understand the mechanism!

I do know that it is hard to get funding for studies involving non-tertiary care, as well to have hard cold scientific studies when you are involving a practitioner.

I am not a researcher, nor am I saying that I think one way or the other, I just wonder sometimes if science( even though it is the best that we have for analysis) is not also a limited form of assessment based on the level of understanding which the society has... and that therefore it might be possible at times to throw the baby out with the bath water.

Again I am waiting to make any definitive decisions until I get my medical education.

 

[JaggerPlate]

Nuff said

For sure.

 

[235750]

I think that the major debunking was the failure to be able to find a definitive cranial rhythm between different practitioners- like one can find a heartbeat.

I believe you are right, the underlining theory behind the entire practice is not been shown to be replicable, meaning until proven otherwise it is rubbish. That was mentioned in the articles I posted. I'm glad you agree.

And how is chalking it up to placebo means for dismissal?

There is not one good study supporting cranial. Not one! I put two links up that were critical reviews of all literature available. Read the articles. And please post a decent article that supports cranial if you can

You sound like a supporter of intelligent design, aka creationism. There is zero evidence to support your viewpoint. The burden of proof is on the supporters of the theory. Again, the default is that the intervention is not effective. This is basic science

And how is chalking it up to placebo means for dismissal?

Am I feeding a troll by responding to this?

We don't use therapies that are placebos because they are a waste of resources and potentially harmful. I'm no doctor, but again, this is pretty basic stuff.

Would you pay £1000s for a therapy that's been shown to be just as good as doing nothing?

Right.

Again I am waiting to make any definitive decisions until I get my medical education.

You can look for well-written articles now about this practice. Just because you aren't a doctor yet doesn't mean you can't evaluate the evidence put forth by cranial practitioners. All you need is a basic understanding of clinical trial design and biostatistics, and you're fine.

 

[Pony46]

I believe you are right, the underlining theory behind the entire practice is not been shown to be replicable, meaning until proven otherwise it is rubbish. That was mentioned in the articles I posted. I'm glad you agree.



There is not one good study supporting cranial. Not one! I put two links up that were critical reviews of all literature available. Read the articles. And please post a decent article that supports cranial if you can

You sound like a supporter of intelligent design, aka creationism. There is zero evidence to support your viewpoint. The burden of proof is on the supporters of the theory. Again, the default is that the intervention is not effective. This is basic science

I do not support intelligent design, I am not trying to sound like this either. I do understand your premise. However, It is hard for me to discount an experience that I had with cranial OMT, so it makes it hard for me to discredit it entirely.

It helped me, does that mean that I am the victim of fake medicine? That I really did not get help from this form of therapy?

Am I feeding a troll by responding to this?

Please please dont call me a troll, I am not. I know that we are just typed words and computer screens, so misinterpretation is easy, but I just am trying to keep an open mind- not a blind open mind. Simply one which takes my experiences into account.

We don't use therapies that are placebos because they are a waste of resources and potentially harmful. I'm no doctor, but again, this is pretty basic stuff.

Actually many doctors have said that most of what they end up giving to their patients is placebo.

But, I was not looking at it from this point of view when I was talking about it and I understand your point.

However, if there is an internal mechanism which can be triggered to help the body to heal and this is what we sometimes call placebo then a form of therapy which can effectively trigger this without harmful side effects seems to be interesting to me.

Would you pay £1000s for a therapy that's been shown to be just as good as doing nothing?

I dont think that placebo is as good as doing nothing all the time. The tricky thing about placebo is that sometimes it is harmful ( aka patient thinks he/she is better but they are not and over exert themselves doing more harm) it is also sometimes good( patient actually, inexplicably gets better)
THERE IS A FINE LINE HERE and I KNOW IT.

I am not endorsing no antibiotics, and no vaccines or any sort of non-sensical illogical medicine. So please try not to assume that that is where I am coming from, although I bet it is easy- since you believe that cranial is illogical non-sensical medicine.

Right.

You can look for well-written articles now about this practice. Just because you aren't a doctor yet doesn't mean you can't evaluate the evidence put forth by cranial practitioners. All you need is a basic understanding of clinical trial design and biostatistics, and you're fine.

I cannot find your links to articles please repost ?
I am interested. Yet I can read all of the scientific articles that I want to still until I go through medical school and learn about the human body and mind from that level of thinking and interacting with patients/people- I am keeping an open mind.

But please dont call me a troll, if you want me to stop posting my thoughts on cranial than just ask and I will- I just want to understand it better, that is all.

 

[Tenacious DO]

While mulling over some of my favorite Karl Sagen quotes, I thought that these 2 encompassed the debate over cranio.
For:
“Absence of evidence is not evidence of absence.” – Keep an open mind
Against:
“Extraordinary claims require extraordinary evidence.” – If cranio is so great, prove it

In my own opinion:
In the end, as US Physicians, we are charged with providing treatments that have a foundation in accepted scientific reasoning and tested by evidence based research...to the best of our abilities

 

[Lokhtar]

However, It is hard for me to discount an experience that I had with cranial OMT, so it makes it hard for me to discredit it entirely.

Anecdotal evidence is irrelevant.

It helped me, does that mean that I am the victim of fake medicine? That I really did not get help from this form of therapy?

It means that unless you were part of a tightly controlled double blind study, the results mean nothing. It could be a placebo effect, it could be you getting better on your own, or a hundred other things. I can find random n=1 to prove homeopathy, reiki, and anything else you want.

I cannot find your links to articles please repost ?

Just search pubmed about interexaminer reliability of cranial. It's nonexistant.

 

[Bleurberry]

Anecdotal evidence is irrelevant.

I can't wait until you tell your first patient their history is irrelevant.
Did you learn in any of your classes that there's no such thing as
science of the individual? How are you going to work in a clinical environment with your current disposition?

 

[Lokhtar]

I can't wait until you tell your first patient their history is irrelevant.
Did you learn in any of your classes that there's no such thing as
science of the individual? How are you going to work in a clinical environment with your current disposition?

Are you serious?

You treat the individual based on evidence of efficacy from a proper controlled trial. That means, statistically, the treatment has shown to be beneficial for people with your condition. That doesn't mean it will always work on everyone, but statistically, that's the patients best chance of getting better based on the current knowledge. I try my best to stay as far away from doctors as possible from doctors who think otherwise.

I'll give you one guess why doctors don't prescribe reiki for a bacterial infection. Yes, anecdotal evidence is not admissible in science. It's that simple. The only thing you can use it for is to form a hypothesis which can lead to a proper study to actually test that hypothesis out.

 

[Bleurberry]

Kathryn Montgomery authors How Doctors Think: Clinical Judgment and the Practice of Medicine, and makes a compelling case of how young evidence based medicine advocates are mistakenly trying to stamp out rational clinical judgement, when it's erroneous and impossible to succeed in doing so. It's like trying to shut down the narrative aspect of cognition. It's not feasible to extract from a person's unique history and situation and symptomology an answer from EBM, or computers would be doing it for us. It requires synthesis on the part of the clinician. This isn't a science, and it's not an art, it's rational judgement. Science is a foundation in that process of synthesis. That's what I'm getting at. What are your thoughts now that I've articulated?

Are you serious?

You treat the individual based on evidence of efficacy from a proper controlled trial. That means, statistically, the treatment has shown to be beneficial for people with your condition. That doesn't mean it will always work on everyone, but statistically, that's the patients best chance of getting better based on the current knowledge. I try my best to stay as far away from doctors as possible from doctors who think otherwise.

I'll give you one guess why doctors don't prescribe reiki for a bacterial infection. Yes, anecdotal evidence is not admissible in science. It's that simple. The only thing you can use it for is to form a hypothesis which can lead to a proper study to actually test that hypothesis out.

 

[Lokhtar]

Kathryn Montgomery authors How Doctors Think: Clinical Judgment and the Practice of Medicine, and makes a compelling case of how young evidence based medicine advocates are mistakenly trying to stamp out rational clinical judgement, when it's erroneous and impossible to succeed in doing so. It's like trying to shut down the narrative aspect of cognition. It's not feasible to extract from a person's unique history and situation and symptomology an answer from EBM, or computers would be doing it for us. It requires synthesis on the part of the clinician. This isn't a science, and it's not an art, it's rational judgement. Science is a foundation in that process of synthesis. That's what I'm getting at. What are your thoughts now that I've articulated?

You are arguing a different point. Clinical judgement, in terms of which therapy is best suited to a patient's specific condition, is different from choosing a therapy that has no evidence to support it and no known scientific principles that can possibly explain how it can work.

The reason doctors go through rigorous scientific training is that in the absence of a clear mandate for a patients condition, the physician can use his or her scientific knowledge to come up with a treatment based on scientific principles. For example, in the case of a complex patient with multiple problems, treatment for which is not clear based on evidence, the doctor can apply scientific principles to come with a solution that makes scientific sense, and why it may work. That's clinical judgment - formulating an acceptable hypothesis in the absence of a clear mandate from the scientific literature.

That is completely different from prescribing treatment with no scientific basis, or worse, treatment repeatedly shown not to have any effect. If, through their 'clinical judgment', a doctor prescribed homeopathy, that is not a rational decision because the treatment itself is not rational. There is no scientific principle that they've learned that would lead them to use this method. It's the reason why a doctor would get into trouble if, through his 'clinical judgment', he told the patient to skip the antibiotics and use crystal healing for a bacterial infection. That physician would likely lose his license (and if the patient sues, would win), and rightfully so.

Cranial is the same way. This is the difference between medicine and quackery.

 

[Bleurberry]

I like the point you make and I'm not sure why I confused the two points.
I think I was just itching to talk about Kathryn Montgomery's book. I'm really digging it. I encourage everyone to check it out.

But Lokhtar, isn't a case report published in a peer reviewed journal by a physician antecdotal by definition? Would you discount these when considering treatment? If the treatment poses no harm, but antecdotally can produce benefit, what's the harm in utilizing it? I mean you have to admit cranial isn't on the top of the list in importance for studies to be conducted, so why not take the case reports seriously? After all, it's not like a UFO sighting, it's a professional documenting and submitting for peer review.
What's your take?

You are arguing a different point. Clinical judgement, in terms of which therapy is best suited to a patient's specific condition, is different from choosing a therapy that has no evidence to support it and no known scientific principles that can possibly explain how it can work.

The reason doctors go through rigorous scientific training is that in the absence of a clear mandate for a patients condition, the physician can use his or her scientific knowledge to come up with a treatment based on scientific principles. For example, in the case of a complex patient with multiple problems, treatment for which is not clear based on evidence, the doctor can apply scientific principles to come with a solution that makes scientific sense, and why it may work. That's clinical judgment - formulating an acceptable hypothesis in the absence of a clear mandate from the scientific literature.

 

[Lokhtar]

But Lokhtar, isn't a case report published in a peer reviewed journal by a physician antecdotal by definition?

Yes.

Would you discount these when considering treatment?

If other proven options were available, yes. And if the treatment did not make any scientific sense on top of it being unproven via evidence based medicine, then I would completely discount it in all cases.

If the treatment poses no harm, but antecdotally can produce benefit, what's the harm in utilizing it?

Depends: is it being utilized in lieu of a proven treatment? Is it being advertised as anything other than an unscientific, short in the dark modality only when there are no other options left? Is the provider making claims regarding its mechanism that are highly unscientific? The answers to these questions (and I'm sure a few others that I've missed) would determine if it ought to be used.

Homeopathy is harmless (just diluted water), and people can publish plenty of case studies on it. That doesn't make it a valid practice that ought to be peddled by modern physicians.

it's a professional documenting and submitting for peer review.

Because its still n=1, and there are no controls. Case studies are useful only to form initial hypothesis, which must then be verified by a proper experiment.