AOA Response to Nassar and LA Times

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Spectreman

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In case you don't get the AOA emails...
Link to LA Times Article: Dr. Larry Nassar was not a doctor
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Actual DOs ought to go into the comments of that LA Times article and set things straight. I'd do it but as a pre-med, I've got zero credibility.

The "historical context" about OMT being almost like child abuse was terrible and irrelevant. One could give "historical context" on pretty much every aspect of medicine and find some crazy, outdated practices.
 
Larry Nassar is a pig! How this case has brought into question the validity of an entire profession is beyond me. Health Care workers are often placed in circumstances that involve a lot of patient vulnerability. Larry Nassar might have been an MD, PT, Nurse, CNA, PA, chiropractor (not a dentist since its a long way from the teeth..) or whatever other field! He would have used his profession as a means to abuse these women. The Author of the article has something against the Osteopathic Degree. This scenario with Nassar is just another opportunity for the few that love to bash the DO degree.

I'm calling any D.O. that has ever had miss Virginia Heffernan (author of the LA Article) as a patient to send her a personal email and remind her of the excellent quality of healthcare you provided her. With the growing amount of DO's in the country, I'm confident that once or twice she was unaware that her provider was an angelic visitor.

However, it is time for the AOA and any governing body to revise their practices. The current climate should be warning to all healthcare professions. Over dated practices should be abolished.
 
osteodoc7 said:
Larry Nassar is a pig! How this case has brought into question the validity of an entire profession is beyond me. Health Care workers are often placed in circumstances that involve a lot of patient vulnerability. Larry Nassar might have been an MD, PT, Nurse, CNA, PA, chiropractor (not a dentist since its a long way from the teeth..) or whatever other field! He would have used his profession as a means to abuse these women. The Author of the article has something against the Osteopathic Degree. This scenario with Nassar is just another opportunity for the few that love to bash the DO degree.

I'm calling any D.O. that has ever had miss Virginia Heffernan (author of the LA Article) as a patient to send her a personal email and remind her of the excellent quality of healthcare you provided her. With the growing amount of DO's in the country, I'm confident that once or twice she was unaware that her provider was an angelic visitor.

However, it is time for the AOA and any governing body to revise their practices. The current climate should be warning to all healthcare professions. Over dated practices should be abolished.
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Re: the bolded, you've clearly not seen Horrible Bosses 1 or 2.

All joking aside, I'd agree with most of this post. In addition, I'll be the first to say I'm unsure if the AOA response and email are a bit on the anemic side or the smart move. Time will tell, I guess.
 
Spectreman said:
In case you don't get the AOA emails...
Link to LA Times Article:]

Correct. This is another case of LA times FAKE NEWS. Add it to the list! Some woman talking out of her ass because she was given some sort of fake platform that is put out in the public to see so dumb ignorant people believe it......next time you hear someone talk about “fake news” this is the exact feeling they’re talking about lol
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Correct. This is another case of LA times FAKE NEWS. Add it to the list! Some woman talking out of her ass because she was given some sort of fake platform that is put out in the public to see so dumb ignorant people believe it......next time you hear someone talk about “fake news” this is the exact feeling they’re talking about lol
 
What's "OPP"?
 
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studentdoct4281 said:
Correct. This is another case of LA times FAKE NEWS. Add it to the list! Some woman talking out of her ass because she was given some sort of fake platform that is put out in the public to see so dumb ignorant people believe it......next time you hear someone talk about “fake news” this is the exact feeling they’re talking about lol
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Robin-jay said:
The LA times giving inaccurate information? What a shock.

The whole article was depressing. One of the worst representations of the profession of DO I've ever heard.
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The LA Times article is an opinion article written by a columnist. It is not a news article.
 
Lawper said:
The LA Times article is an opinion article written by a columnist. It is not a news article.
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Whatever the f*ck it is.

Her opinion means jack ****.

Even if I have an opinion on something that is out of my field or expertise, I atleast read up on it so I don't sound like a total ******* when I'm talking to others about it.

OR atleast be open to learning about it.

But nope. Too hard for this sad excuse of a "columnist" to understand.

Like I said.

F*CK her and her entire writing career and everything and anything her stupid a** stands for.

Lock her up with Nassar for all I care.

Freaking idiot she is.

ARGH!
 
Yeah I agree. The oped was terribly written. If someone made a thread on SDN expressing similar anti-DO sentiments, that member would be banned for trolling.

The AOA condemnation is appreciated, but columnists should realize they need to research their topic thoroughly before writing articles. And they should stop demonizing others.
 
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Lawper said:
The LA Times article is an opinion article written by a columnist. It is not a news article.
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That's a little better, but still...an opinion should at least have valid facts behind it.

When she says "Osteopathic medicine focuses on the joints, muscles and spine", she is almost insisting that OMM is actually the "only" thing DO's do. She is basically saying they are glorified chiropractors. Its a mess.
 
Robin-jay said:
That's a little better, but still...an opinion should at least have valid facts behind it.

When she says "Osteopathic medicine focuses on the joints, muscles and spine", she is almost insisting that OMM is actually the "only" thing DO's do. She is basically saying they are glorified chiropractors. Its a mess.
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You can thank your trusty AOA and their brillant marketing PR campaigns for causing this situation. "Separate but Equal" brought by the AOA does nothing but make everyone associate us with chiropractors/mid-levels/quacks. It took us further away from being thought of as physicians in the public eye.
 
Robin-jay said:
When she says "Osteopathic medicine focuses on the joints, muscles and spine", she is almost insisting that OMM is actually the "only" thing DO's do. She is basically saying they are glorified chiropractors. Its a mess.
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I think the article is trash, but I don't really understand the points you are making. A lot of OMM pretty much is glorified PT/chiropractic, and much of it is widely rejected by the vast majority of physicians as a valid form of medical treatment. Also, osteopathic medicine does have a very intense focus on biomechanics (at least at the educational curriculum level). She isn't insisting that OMM is all DOs do. She's pointing out a key difference between osteopathic and allopathic. The osteopathic "part" of medical practice done by DOs does indeed have a focus on joints, muscles, and spine. Did she express herself with dignity? No, the article is condescending and written at a high school level.

For the record, again, I think the article is complete trash. Though, I did laugh at the insulting references to AT Still. I actually enjoyed those.
 
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I think it would be hypocritical of me to criticize this article, since I've said worse things about osteopathy every week in OMM lab.

It was very poorly researched though.
 
Calm down.

Not only does she do a terrible job "researching" her article (did she even research it?), she also is just a poor writer. That said, you don't need to go off on her with such vitriol. Its not the first time someone writes an article like this about DOs (I guess you never read that Forbes article), and it won't be the last.

Also, we've gone over this a million times, but a lot of OMM is actually accepted by modern medicine in the fields of PM&R, PT and OT. My ears bleed when I hear things like PT is "widely rejected by the vast majority of physicians as a valid form of medical treatment", because we sure as hell send a lot of patients to PT... like everyone with pain... ever.
 
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Is this response a condemnation of Nassar? If not, in the same response they mentioned that he’s convicted but yet they can’t comment on legal matter.

Why won’t they condemn someone who is legally convicted?

EDIT: the only appropriate response is immediate condemnation of Nessar and any sort of intravaginal technique unless they are proven by RCT to be better than the current first line for whatever they are treating.
 
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DrfluffyMD said:
Is this response a condemnation of Nassar? If not, in the same response they mentioned that he’s convicted but yet they can’t comment on legal matter.

Why won’t they condemn someone who is legally convicted?
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Because they legally can’t until all legal proceedings are done apparently.
 
AnatomyGrey12 said:
Because they legally can’t until all legal proceedings are done apparently.
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Sure. But sure can they condemn intravaginal techniques. I still remember people posting on this very forum asking if those techniques are actually used technique in OMT and some posters mentioned yes. It’s chilling to think about.

If those techniques for MSK indication don’t have RCT backing them up, why are they acceptable, especially in today’s political enviroment? The AOA can only hurt themselves by refusing to condemn those techniques.
 
Because they likely do have a small role in a very small subset of patients for which they were intended.

This isn’t about the techniques themselves as he probably wasn’t even doing those techniques but flat out sticking his hand in places for sick pleasure without any sort of consent or therapeutic purpose. I think to demand RCT for specific types of MSK related manaual manipulative therapy is likely going to be disappointing as there’s no financial incentive for a large trial.

Are you in the same breath demanding RCTs for other mainstream medical/drug therapies that are commonly used with poor data behind them?

Again, the issue here is a sick man did sick things and needs to go to jail for a very long time. He was doing these things even before he was a DO. If his local school happened to be an allopathic school do you think any of this would have been different?
 
nlax30 said:
Because they likely do have a small role in a very small subset of patients for which they were intended.

This isn’t about the techniques themselves as he probably wasn’t even doing those techniques but flat out sticking his hand in places for sick pleasure without any sort of consent or therapeutic purpose. I think to demand RCT for specific types of MSK related manaual manipulative therapy is likely going to be disappointing as there’s no financial incentive for a large trial.

Are you in the same breath demanding RCTs for other mainstream medical/drug therapies that are commonly used with poor data behind them?

Again, the issue here is a sick man did sick things and needs to go to jail for a very long time. He was doing these things even before he was a DO. If his local school happened to be an allopathic school do you think any of this would have been different?
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The issue here is more than that. There are reason we don’t demand RCT for medical procedures/therapies

1. Modality is clearly useful. For example, paracentesis, stuff bleeding nose with tissue paper

2. Modality is deeply ingrained in the culture of medicine / commonly practiced in medicine: physical exam such as rectal exam or vaginal exam, even when routine exam may or may not be beneficial. Patients are familiar with it and it’s not necessarily seen in a sexual light.

I have never heard of vaginal OMT technique until I read about the thread that was later revealed to be related to Nessar. I have never read about, seen or heard from any patients who benefited from those modality. The science is dubious and possibly nonexistent. The procedure itself is extremely invasive and violating. Those are the kind of hallmark that demand a high burden of proof for its effectiveness.

As long as DOs are still practicing those types of OMT, accusations about them will continue to be made. Why defend those practices?
 
The AOA needs to openly condemn intra-pelvic OMT procedures. The social risks associated with performing "pelvic floor therapy" far outweigh the (scientifically unproven) benefits for patients.

The AOA isn't going to protect the DO profession by arguing with journalists all day. They need to face reality and start making changes to the scope of OMT.
 
Osminog said:
The AOA needs to openly condemn intra-pelvic OMT procedures. The social risks associated with performing "pelvic floor therapy" far outweigh the (scientifically unproven) benefits for patients.

The AOA isn't going to protect the DO profession by arguing with journalists all day. They need to face reality and start making changes to the scope of OMT.
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Agreed. In fact, some of the more passionate responses in this thread toward journalism, including “fxxk her and her entire career” or “lock her up with nassar” absolutely does not paint those purported DO student posters or even the DO profession in a good light.

Appropriate response here would be to emphasize with those women who have been harmed, condemn the criminal and remove those inappropriate procedures from practice if there is no evidence to back them up.
 
There are physician therapists who specialize in pelvic floor physiotherapy and use it in diagnosing and assisting with therapy for various pelvic floor dysfunction syndromes and urinary incontinence. Are you saying to throw all this out because some twisted doc decided to abuse his role?

I don’t know much about any of these techniques as they weren’t taught to us during med school and I presume you only got exposure if you went on to pursue additional training on your own or within your related field.

Again, my point is that just because someone abuses a modality (albeit very limited and specialized one) doesn’t mean we throw it out. It’s very likely that these modalities weren’t even indicated for what he was supposedly treating so to base your assumptions on these based on what this one guy did is a little short sighted in my opinion.
 
nlax30 said:
There are physician therapists who specialize in pelvic floor physiotherapy and use it in diagnosing and assisting with therapy for various pelvic floor dysfunction syndromes and urinary incontinence. Are you saying to throw all this out because some twisted doc decided to abuse his role?

I don’t know much about any of these techniques as they weren’t taught to us during med school and I presume you only got exposure if you went on to pursue additional training on your own or within your related field.

Again, my point is that just because someone abuses a modality (albeit very limited and specialized one) doesn’t mean we throw it out. It’s very likely that these modalities weren’t even indicated for what he was supposedly treating so to base your assumptions on these based on what this one guy did is a little short sighted in my opinion.
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So how often do those physician therapist utilize INTRAVAGINAL technique? Your point isn’t valid until you can present evidence that INTRAVAGINAL technique work. Hell, how about even patient testimonial or case reports?

I have learned about pelvic floor dysfunction in my med school. None of my faculty proceeded to insert their finger into their patient’s vagina for this reason.
 
I’ve long since gotten rid of any OMT related textbooks I may have had as I just don’t use it in my field.

Any DO students here still have one? Would be interested to see what it says about any sort of intravaginal related techniques and if that lines up with what I see mentioned in the physiotherapy and urology relms.
 
DrfluffyMD said:
Your point isn’t valid until you can present evidence that INTRAVAGINAL technique work.
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Lol i don’t disagree with getting rid of crap that doesn’t work (ie a lot of OMM) but this isn’t the argument for it. There are a ton of things that are “standard medical procedure” that don’t work and have no evidence for their efficacy that are plenty invasive. Should we debate the efficacy of having patients undergo the risks of surgery so we can scope their knee to no benefit? Or how about vaginal exams? Rectal exams? You can’t say “but those are accepted” and then use the argument “there isn’t any evidence.” There is either evidence or there isn’t, and unfortunately a lot of what modern medicine has no evidence backing it up.

Just to be clear, Nassar deserves to rot in prison and OMM has a few practices that should be eliminated immediately, I have no argument with either of those points.
 
DrfluffyMD said:
So how often do those physician therapist utilize INTRAVAGINAL technique? Your point isn’t valid until you can present evidence that INTRAVAGINAL technique work. Hell, how about even patient testimonial or case reports?
Click to expand...

I have no idea, look it up. It’s so far outside my field’s scope that I have no exposure to it. In a quick 30 second google search I just did I saw various physical therapy related sites discussing it in the context of helping to assess and teach pelvic floor muscle exercises for urinary incontenence and chronic pelvic pain syndromes. I even saw some patient pacing websites from patient advocacy type groups including a menopause society list in among various modalities.

In the setting of proper informed consent for treatment of likely very limited and specific clinical scenarios with a chaperone present I would consider it a vary cheap, and low risk therapeutic option of which we usually have a low threshold for utilization and no need for strict randomized data.

In the setting of a sick individual, without consent with likely no indication to begin with then yea of course it’s inappropriate.
 
AnatomyGrey12 said:
Lol i don’t disagree with getting rid of crap that doesn’t work (ie a lot of OMM) but this isn’t the argument for it. There are a ton of things that are “standard medical procedure” that don’t work and have no evidence for their efficacy that are plenty invasive. Should we debate the efficacy of having patients undergo the risks of surgery so we can scope their knee to no benefit? Or how about vaginal exams? Rectal exams? You can’t say “but those are accepted” and then use the argument “there isn’t any evidence.” There is either evidence or there isn’t, and unfortunately a lot of what modern medicine has no evidence backing it up.

Just to be clear, Nassar deserves to rot in prison and OMM has a few practices that should be eliminated immediately, I have no argument with either of those points.
Click to expand...

You are missing my point. Scoping the knee or vaginal exam (which is public, common knowledge) is far, far different from “intravaginal manipulation” that most practioner do not practice or in fact, never heard of.
 
DrfluffyMD said:
By physical therapy. Is this related to the AOA or OMT by any means?
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That first link was a physics therapist and second link the ACOG site which also mentions physician therapy as a treatment option.

OMT itself shares basically same conceptual basis and some of the same techniques employed by physics therapists in regard to stretching, joint mobility maneuvers and treating muscular tender points.

So if the AOA/OMT materials discuss intravaginal massage techniques like this to treat local muscle spasms similar to what those links say then that’s fine. If they discuss widespread intravaginal techniques to treatment something like cranial dysfunction or paralyzed diagraphm then yea obviously that’s a problem. Someone with an OMT text should look it up and let us know.
 
nlax30 said:
That first link was a physics therapist and second link the ACOG site which also mentions physician therapy as a treatment option.

OMT itself shares basically same conceptual basis and some of the same techniques employed by physics therapists in regard to stretching, joint mobility maneuvers and treating muscular tender points.

So if the AOA/OMT materials discuss intravaginal massage techniques like this to treat local muscle spasms similar to what those links say then that’s fine. If they discuss widespread intravaginal techniques to treatment something like cranial dysfunction or paralyzed diagraphm then yea obviously that’s a problem. Someone with an OMT text should look it up and let us know.
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Just so we are clear, I am talking about AOA needing to condemn intravaginal OMT. You are talking about intravaginal physical therapy which are appropriate when performed by physical therapist.

And you don’t have an OMT text or able to cite any example regarding intravaginal OMT.

I rest my case.
 
A lot of OMT is the same as what a physician therapist would do, just done by a physician. I don’t see why they need to condemn an accepted modality, one you didn’t even know existed.

So if you are accepting that this is an accepted therapeutic technique for vulvodynia then how would it not be appropriate for use by a physician who is specifically trained in that modality?
 
nlax30 said:
What if he was a physical therapist who used his position to do these same abuses? Would you be calling for the physical therapy association to denounce that technique because one of their own used their position to perform inappropapte therapies in an inappropriate way?
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Can you find a source to me that intravaginal OMT is the same as physical therapy? The exact thing? Because right now we are talking about two different entities. One has science behind it, the other doesn’t.
 
Who cares. The point is that this virginia girl should lose her job for writing FAKE sorority talk.

What about the female high school teachers molesting and VAGINALLY RAPING little teenage boys? Not finger penetrating, actual vaginal rape.

Larry Nassar may have been a pedophile sicko or he may have been doing legit OMM techniques. It does not matter. Larry got 160 years and these vaginal rapist teachers get maybe 7 years. What’s up with that
 
DrfluffyMD said:
Can you find a source to me that intravaginal OMT is the same as physical therapy? The exact thing? Because right now we are talking about two different entities. One has science behind it, the other doesn’t.
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I’m a DO. I’ve done various OMT techniques in school and rotations. One particular technique involves myofascial type ‘massage’ and point treatment of trigger points which is what is described in some of these physical therapy references. I don’t have to point you to a source to say that me as a physician abducting a shoulder is essential the same movement as a therapist abducting a shoulder.... it’s common sense.

Intravaginal OMT is a vague ‘blanket’ statement, of which I’m sure there are a couple, ? Few, specific techniques described. But based on my past knowledge of other OMT techniques in other regions this is certainly reasonable in the right clinical setting and after proper informed consent like any other medical procedure. If this is something that you’ve never heard of then feel to research it yourself and/or give some sort of benefit of the doubt to the folks who do properly train with it and properly use it since you are not familiar with it.

If a physical therapist use counter strain to treat a muscle spasm then do I as a physician have to have completely separate data showing a physician can use the technique as well....
 
studentdoct4281 said:
Who cares. The point is that this virginia girl should lose her job for writing FAKE sorority talk.

What about the female high school teachers molesting and VAGINALLY RAPING little teenage boys? Not finger penetrating, actual vaginal rape.

Larry Nassar may have been a pedophile sicko or he may have been doing legit OMM techniques. It does not matter. Larry got 160 years and these vaginal rapist teachers get maybe 7 years. What’s up with that
Click to expand...

Not really sure what you’re talking about or what it has to do with this particular thread.

And Nassar was a pedophile sicko AND NOT doing legit OMM techniques.
 
This is like taking the history of something like lobotomy and calling doctors quacks because something in their past was dark.

Or saying that because there were Nazi doctors, all doctors must be bad.

Totally unfair and sensationalist article.
 
nlax30 said:
I’m a DO. I’ve done various OMT techniques in school and rotations. One particular technique involves myofascial type ‘massage’ and point treatment of trigger points which is what is described in some of these physical therapy references. I don’t have to point you to a source to say that me as a physician abducting a shoulder is essential the same movement as a therapist abducting a shoulder.... it’s common sense.

Intravaginal OMT is a vague ‘blanket’ statement, of which I’m sure there are a couple, ? Few, specific techniques described. But based on my past knowledge of other OMT techniques in other regions this is certainly reasonable in the right clinical setting and after proper informed consent like any other medical procedure. If this is something that you’ve never heard of then feel to research it yourself and/or give some sort of benefit of the doubt to the folks who do properly train with it and properly use it since you are not familiar with it.

If a physical therapist use counter strain to treat a muscle spasm then do I as a physician have to have completely separate data showing a physician can use the technique as well....
Click to expand...

Again, you have NO IDEA what are you talking about. You are talking about OMT technique of the shoulder. This has nothing to do with what I am talking about (intravaginal OMT techniques) which the AOA seem to have problem condemning. You are not personally familiar with the technique.

For example, just because it’s appropriate to place a large drain into an abscess cavity, doesn’t mean it’s appropriate to use the same technique to drain an intra aortic abscess. Just because you can do OMT for a shoulder injury, doesn’t mean OMT performed intravaginally is indicated or have evidence behind it or is useful at all.

I don’t have skin in this game. I am not a DO nor do I practice OMT. Why is it up to me to research this “technique”?

Honestly, some of the comments in this thread demostrate a lot of insensitivity and is quite appalling.
 
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