A few comments (DO student):
1. I do agree that some of the issues with OMM is that a lot of people want to chalk it up to more than it is. OMM is a useful, interesting, helpful modality for MSK issues, but I think it's when people (OMM professors, lol) start reaching with it's usefulness that others get turned off and don't want to hear the anecdotes.
However, as a modality for MSK issues, especially things like low back pain - which, from what I've read, is one of the top reasons people seek primary care, it seems quite effective.
Now, even as I type that, I definitely see the fallacy of my argument - 'it seems quite effective.'
Great ... that's not how science works, and it needs to be backed with objective research and empirical data before acceptance.
I'm definitely not going to sit here and argue that OMM is well researched, because frankly, it's 120 years old and the research is absolutely lacking, however, I do think there are a few important points to consider here:
1. It's a difficult thing to research because, like I said before, it really isn't a cutting-edge modality that requires extensive research and NIH funding. It's a useful therapy for MSK dysfunction, and because 98% of it is just based on anatomy and physiology, it just isn't something people are bursting out of their seat to prove.
Additionally, and unfortunately, many of the individuals who really utilize OMM a lot prefer to fall back onto anecdotes and very outdated studies while practicing the modalities, but not researching and proving it themselves.
2. It does not lend itself to a double blind modality well ... at all. I took a research course one time and wrote a big report on hypothetically researching OMM, and had a much harder time than I thought I would trying to come up with effective, non-biased, randomized, double blind studies.
It's just unfortunate that any practitioner is going to know whether they are giving a sham or real OMM treatment (it's not the same as handing two people identical pills, one a sugar placebo, the other the trial drug) and even worse that the potential sham treatment could have actual effect (either positive or negative, but more than a simply psychological, placebo effect).
3. The research is out there, but, like I said earlier, people aren't dying to fund and publish studies on OMM, so a lot of it is very poorly funded and most of it is published in JAOA (which people immediately dismiss). The Osteopathic Research Center in Texas is doing some pretty interesting things, and there was the recent article (last year I believe) in the Journal of OB/GYN that demonstrated it was effective for pregnancy related back pain, so hopefully studies like this in more academically respected sources will continue
Now, having said all that, it's still not an excuse, and if we want to push OMM more into the main stream (and see IM residents, for example/as Old Grunt said) utilize it in clinical settings without raising eyebrows, then proper research and publications are necessary.
2. With regards to the numbers of individuals who use OMM in practice ...
The numbers I've usually seen thrown around SDN seem to arise from a singular study (more of a survey) I actually reviewed during the previously mentioned research course. Essentially, what this study did was look at NOT the number of practitioners who utilize OMM, but the percentage of people who use it + the percentage of patient they use it on. For example ...
Less than 5% of DOs reported that they used OMM on 50% or more of their patients. From here, we can't really extrapolate that only 5% of DOs use OMM in general, but what we can say is that less than 5% of DOs use it (roughly) on every other patient they treat. However, the number practitioners who use it on lower numbers of patients, 10%, 5%, 2%, etc is higher than 5 or 10% (if I remember correctly). Which means that although it's being utilized in small numbers, it is still being used by practitioners.
3. With regard to why it isn't used by more doctors ...
Frankly, OMM, for those who aren't the hardcore 'osteopaths,' really only lends itself to certain primary care, outpatient, office settings (in my opinion). It's not that it has no validity in areas like IM (some of the counterstrain techniques and soft tissue manipulation would probably actually be much appreciated - for whatever that's worth), but you aren't going to whip out a table and ask a sick patient to lay prone and receive OMM in the middle of the ICU when you still have to round on GOD knows how many patients that hour. It doesn't make sense ... even in the most 'Osteopathic' of training programs.
However, in a comprehensive, outpatient, private practice, primary care setting, it definitely has a place.
4. As far as some of the 'voo doo,' 'witch doctor' comments are concerned ...
I'd say that 98% of OMM is based in very simple anatomical and physiological principles. This is out of place, it's, therefore, affecting these tissues (which can be palpated), ergo by performing this technique you place this back, affect this, recheck here and BOOM ... done. No magic behind it, no real need (again, not an excuse) for a NIH funded study ... just manipulating the simple basics we learn via modalities that are widely adapted and used in fields like physical therapy, PM&R, etc, etc.
However, I think the 2% of OMM that's 'out there' is what gives the modality, in general, a black eye (I'm looking at you cranial). When you have 98% of something that's sound, boring, and mundane and one little BLIP that claims to do wild things and really doesn't rest (or flat out denies) upon sound, scientific principles, other scientists are going to take notice and extrapolate from here.
As physicians (and future physicians) we should really be strict with ourselves, review the treatments, and cut the ones that are outdated and flawed (which again, I personally believe are a very small amount). To be honest, it seems like a very small, aging, and vocal minority LOVES these treatments ( I don't even know why, but start talking about cranial with a hardcore cranial OMM guy and it's like mentioning 'Han shot first' to a hardcore Star Wars fan), and their adherence to these traditions without any real proof (and quite a bit of evidence to the contrary) isn't acceptable. Streamlining OMM by removing techniques like this would, in my opinion, help make it more universal in practice as well.
5. The way it's taught ...
This won't mean much to the MD students, but I know a lot of DO students take issue with the way OMM is taught and get really turned off/have no intention of utilizing it further because they don't like the curriculum (and therefore don't understand it, feel like it's valid, etc) when it's first presented. If you hated Pathology during pre-clinical, it's unlikely you'll be very interested in path when it's time for residency selection and practice, you know?
Again, just some thoughts. I actually really like OMM and plan on using it as much as I can (and when appropriate), but just some arguments for both sides/things I've personally noticed ... I guess. Sorry for the novel.
