“Quackery in Medical School: Chapman Points” article

[FlyerScribe]

One of my docs said it the best, we're going to school to become doctors, not scientists. We are learning how to treat people and help them out. Scientists are trying to prove theory. The "theories" behind the treatment are just theories and they may be crap and completely wrong (OMM doc said this mind you) but they help people and they know that it does because they have seen it work. And that is why we learn it so we can treat and help people.

I will preface this all by saying, I will not be removing a gall bladder, appendix or putting a heart cath in based solely off visceral "restriction" (and those will not be a large portion of my medical decision making process)

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[EmilKraepelin55]

One of my docs said it the best, we're going to school to become doctors, not scientists. We are learning how to treat people and help them out. Scientists are trying to prove theory. The "theories" behind the treatment are just theories and they may be crap and completely wrong (OMM doc said this mind you) but they help people and they know that it does because they have seen it work. And that is why we learn it so we can treat and help people.

Not sure that scientists are out to “prove” as much as attempt to falsify particular natural propositions. I also highly dislike “theory” being used colloquially in this sense. Scientific theories are not hunches, but the current best explanation for observed phenomena based on an independent preponderance of evidence instead of merely empiricism which gung-ho OMM practitioners (cranial peeps etc.), ND’s, and other quacks base their entire practice on.

 

[FlyerScribe]

I would have told him to email me those peer reviewed journal articles.

Hahahahahahahahaha yeah right you would say that. You might be going into the wrong field if what you think you're about to practice for the next few decades is science. That's funny. You know what the IM doc said when I asked about choosing the right DM medications or the right antidepressant for a patient. You just see what works best. Medicine = science might be the funniest thing I heard all day.

 

[SomaticDysfunk]

One of my docs said it the best, we're going to school to become doctors, not scientists. We are learning how to treat people and help them out. Scientists are trying to prove theory. The "theories" behind the treatment are just theories and they may be crap and completely wrong (OMM doc said this mind you) but they help people and they know that it does because they have seen it work. And that is why we learn it so we can treat and help people.

This is a horrible approach not only to osteopathy, but medicine in general. The sentiment that there need not be evidence to support a treatment is antithetical to Still’s original philosophy and practice. If you don‘t believe that, you’ve clearly never read anything he wrote. He says in his first book Philosophy of Osteopathy, “Truth is only a hopeful supposition unless it is supported by results.” That sentiment is echoed throughout his work. Pseudoscience and quackery of allopathic medicine and the “homeopathy crowd” of the late 1800s is exactly why Still adopted his own philosophy and discovered the practice of osteopathy.
To speak to some of the techniques mentioned above in the thread... Remember Southerland spent 40 years studying cranial mechanics and experimenting with treatments before he ever published a book about his work. Chapman and Miller share similar stories. If you have written off cranial manipulation, etc. as BS because you haven’t been able to get these treatments to work for you after a few hours of instruction as an MS1 or 2, consider that at this stage it’s far more likely that you have no clue what hell you’re doing than it is that these treatments don’t actually work.

 

[AnatomyGrey12]

This is a horrible approach not only to osteopathy, but medicine in general. The sentiment that there need not be evidence to support a treatment is antithetical to Still’s original philosophy and practice. If you don‘t believe that, you’ve clearly never read anything he wrote. He says in his first book Philosophy of Osteopathy, “Truth is only a hopeful supposition unless it is supported by results.” That sentiment is echoed throughout his work. Pseudoscience and quackery of allopathic medicine and the “homeopathy crowd” of the late 1800s is exactly why Still adopted his own philosophy and discovered the practice of osteopathy.
To speak to some of the techniques mentioned above in the thread... Remember Southerland spent 40 years studying cranial mechanics and experimenting with treatments before he ever published a book about his work. Chapman and Miller share similar stories. If you have written off cranial manipulation, etc. as BS because you haven’t been able to get these treatments to work for you after a few hours of instruction as an MS1 or 2, consider that at this stage it’s far more likely that you have no clue what hell you’re doing than it is that these treatments don’t actually work.

Or....... the bones don't move and that they have literally cut histology slides of "chapman's points" and have NEVER found anything. It has been repeatedly shown that the results aren't there. Osteopathy needs to either die a quick death or do actual studies instead of the "n=7" garbage that currently exists and show some results. It's been over 100 years of no provable results.

 

[SomaticDysfunk]

Or....... the bones don't move and that they have literally cut histology slides of "chapman's points" and have NEVER found anything. It has been repeatedly shown that the results aren't there. Osteopathy needs to either die a quick death or do actual studies instead of the "n=7" garbage that currently exists and show some results. It's been over 100 years of no provable results.

I think you are exactly right. Our treatments should rest on evidence--which there is plenty of. You can look through the literature yourself. The golgi tendon organ, myofascial strain patterns, somato-visceral and viscero-somatic reflexes, compensation of musculoskeletal structure due to trauma, movement of CSF, lymph, blood etc. are well documented in both allopathic and osteopathic literature. The treatments Still, Southerland, Chapman, Miller, etc. used are based on the anatomy--they are not voodoo. Most of it is really elegantly simple--"bone is sticking out, I will push it back in," "the fascia is tight here, I will stretch it out," "the lymph is stuck, how can I get it to move." The concepts aren't that hard to understand--the actual hands-on ability to make those things happen requires some skill. That said, I think it is difficult to create valid osteopathic studies for several reasons: it is difficult to procure funding--there is no real financial incentive to study osteopathy, also there is a massive difference in skill level between practicing osteopathic physicians making it hard to standardize an approach.

 

[AnatomyGrey12]

I think you are exactly right. Our treatments should rest on evidence--which there is plenty of. You can look through the literature yourself. The golgi tendon organ, myofascial strain patterns, somato-visceral and viscero-somatic reflexes, compensation of musculoskeletal structure due to trauma, movement of CSF, lymph, blood etc. are well documented in both allopathic and osteopathic literature. The treatments Still, Southerland, Chapman, Miller, etc. used are based on the anatomy--they are not voodoo. Most of it is really elegantly simple--"bone is sticking out, I will push it back in," "the fascia is tight here, I will stretch it out," "the lymph is stuck, how can I get it to move." The concepts aren't that hard to understand--the actual hands-on ability to make those things happen requires some skill. That said, I think it is difficult to create valid osteopathic studies for several reasons: it is difficult to procure funding--there is no real financial incentive to study osteopathy, also there is a massive difference in skill level between practicing osteopathic physicians making it hard to standardize an approach.

The literature is garbage and there is no evidence for the majority OMM. Best case scenario is that most of it is as good as placebo.

 

[deleted936470]

placebo is powerful though

 

[Neopolymath]

This is a horrible approach not only to osteopathy, but medicine in general. The sentiment that there need not be evidence to support a treatment is antithetical to Still’s original philosophy and practice. If you don‘t believe that, you’ve clearly never read anything he wrote. He says in his first book Philosophy of Osteopathy, “Truth is only a hopeful supposition unless it is supported by results.” That sentiment is echoed throughout his work. Pseudoscience and quackery of allopathic medicine and the “homeopathy crowd” of the late 1800s is exactly why Still adopted his own philosophy and discovered the practice of osteopathy.
To speak to some of the techniques mentioned above in the thread... Remember Southerland spent 40 years studying cranial mechanics and experimenting with treatments before he ever published a book about his work. Chapman and Miller share similar stories. If you have written off cranial manipulation, etc. as BS because you haven’t been able to get these treatments to work for you after a few hours of instruction as an MS1 or 2, consider that at this stage it’s far more likely that you have no clue what hell you’re doing than it is that these treatments don’t actually work.

This is an A+ parody account. Bravo

 

[Angus Avagadro]

Below is from a post I put up in January 2020. I believe it is worth reposting in this thread. These articles are from mainstream peer reviewed journals, some of the top in their specialty. Many more exist in the JAOA file. Noll, et al, has studies on pneumonia with N's in the 200's.





I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.

Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.

American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.

Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.

Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.

These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest

 

[Goro]

Or....... the bones don't move and that they have literally cut histology slides of "chapman's points" and have NEVER found anything. It has been repeatedly shown that the results aren't there. Osteopathy needs to either die a quick death or do actual studies instead of the "n=7" garbage that currently exists and show some results. It's been over 100 years of no provable results.

This is a horrible approach not only to osteopathy, but medicine in general. The sentiment that there need not be evidence to support a treatment is antithetical to Still’s original philosophy and practice. If you don‘t believe that, you’ve clearly never read anything he wrote. He says in his first book Philosophy of Osteopathy, “Truth is only a hopeful supposition unless it is supported by results.” That sentiment is echoed throughout his work. Pseudoscience and quackery of allopathic medicine and the “homeopathy crowd” of the late 1800s is exactly why Still adopted his own philosophy and discovered the practice of osteopathy.
To speak to some of the techniques mentioned above in the thread... Remember Southerland spent 40 years studying cranial mechanics and experimenting with treatments before he ever published a book about his work. Chapman and Miller share similar stories. If you have written off cranial manipulation, etc. as BS because you haven’t been able to get these treatments to work for you after a few hours of instruction as an MS1 or 2, consider that at this stage it’s far more likely that you have no clue what hell you’re doing than it is that these treatments don’t actually work.

You know, both of you are correct!

Design a decent experimental protocol, write an IRB protocol, and set up the logistics to carry it out and the AOA can cough up $100K to fund this.

Then there's always the Alternative and Complementarity Institute, which has funded far worse.

More thoughts later.

 

[sab3156]

Hahahahahahahahaha yeah right you would say that. You might be going into the wrong field if what you think you're about to practice for the next few decades is science. That's funny. You know what the IM doc said when I asked about choosing the right DM medications or the right antidepressant for a patient. You just see what works best. Medicine = science might be the funniest thing I heard all day.

Are you trying to troll or are you serious?

Usually when OMM trolls come in here, they try to say that OMM is based on scientific rigor or they say that their anecdotes = enough evidence. You're taking an interesting but equally dishonest and ignorant approach, which is to suggest that medical science is actually not really science, therefore trying to point the finger in the opposite direction. Unfortunately for you, people here aren't as dumb as you think - no one is going to take your posts seriously, especially when you "hahahahahahaha" right before saying such delusional things. Some of the people here are participating in field changing scientific research while you're sitting on SDN demonstrating huge holes in your knowledge. Right now, your credibility is below the scale. It's going to take a while before you can bring it up again.

In any case, I applaud your bravery and the ability to speak your mind.

 

[hallowmann]

Are you trying to troll or are you serious?

Usually when OMM trolls come in here, they try to say that OMM is based on scientific rigor or they say that their anecdotes = enough evidence. You're taking an interesting but equally dishonest and ignorant approach, which is to suggest that medical science is actually not really science, therefore trying to point the finger in the opposite direction. Unfortunately for you, people here aren't as dumb as you think - no one is going to take your posts seriously, especially when you "hahahahahahaha" right before saying such delusional things. Some of the people here are participating in field changing scientific research while you're sitting on SDN demonstrating huge holes in your knowledge. Right now, your credibility is below the scale. It's going to take a while before you can bring it up again.

In any case, I applaud your bravery and the ability to speak your mind.

There are a lot of things done in medicine with poor or even negative evidence (knee arthroscopies anyone?). That said, I overall agree with you, because the examples that poster used are ridiculous. While yes, many docs may just roll the dice, both in the case of DM meds and antidepressants, there are lots of reasons to choose one over the other in real clinical practice for individual patients.

 

[Cath Up]

I think you are exactly right. Our treatments should rest on evidence--which there is plenty of. You can look through the literature yourself. The golgi tendon organ, myofascial strain patterns, somato-visceral and viscero-somatic reflexes, compensation of musculoskeletal structure due to trauma, movement of CSF, lymph, blood etc. are well documented in both allopathic and osteopathic literature. The treatments Still, Southerland, Chapman, Miller, etc. used are based on the anatomy--they are not voodoo. Most of it is really elegantly simple--"bone is sticking out, I will push it back in," "the fascia is tight here, I will stretch it out," "the lymph is stuck, how can I get it to move." The concepts aren't that hard to understand--the actual hands-on ability to make those things happen requires some skill. That said, I think it is difficult to create valid osteopathic studies for several reasons: it is difficult to procure funding--there is no real financial incentive to study osteopathy, also there is a massive difference in skill level between practicing osteopathic physicians making it hard to standardize an approach.

Why aren't Chapman points viewable on ultrasound or histology?
Could you explain the pathophysiology behind these points?

Why does the palpated CRI rate line up so darn well with respiratory rate?

 

[NurWollen]

There are a lot of things done in medicine with poor or even negative evidence (knee arthroscopies anyone?). That said, I overall agree with you, because the examples that poster used are ridiculous. While yes, many docs may just roll the dice, both in the case of DM meds and antidepressants, there are lots of reasons to choose one over the other in real clinical practice for individual patients.

At least the things we do in medicine with poor evidence bases are based on plausable physiology. Chapman's points on the other hand are a total joke and I'm disappointed more of my DO colleagues can't see it.

Sent from my SM-G930V using SDN mobile

 

[hallowmann]

At least the things we do in medicine with poor evidence bases are based on plausable physiology. Chapman's points on the other hand are a total joke and I'm disappointed more of my DO colleagues can't see it.

Sent from my SM-G930V using SDN mobile

I honestly don't know anyone beyond OPP staff that have tried to convince me Chapman's points or cranial exists. Maybe you meet a lot more, but those are basically the most fringe aspects of OMM.

 

[sab3156]

Why aren't Chapman points viewable on ultrasound or histology?
Could you explain the pathophysiology behind these points?
View attachment 297852
Why does the palpated CRI rate line up so darn well with respiratory rate?

 

[deleted947265]

Pretty bold of him though because I wouldn't count on DO adcoms not finding this article.

Meh. I've done nothing wrong and as Goro has mentioned, adcoms don't really cyber-search applicants until late really late in the process. Is this really going to be a dealbreaker for them? If that's a dealbreaker for them, it's their loss. You want someone who will be a good doctor, I fit the bill. I don't care what the letters next to my name say. We're not going to see eye to eye on everything, and we don't have to.

I am glad to have OMM 100% past me. The other DOs in my residency program all seem to love it though so I wonder what the actual percentages are of DOs who are skeptics vs true believers. I suspect the DOs here in SDN and on Reddit, etc kind of self select as skeptics.

Actual true believers? I think it's actually very low but SDN and reddit aren't real life. The issue is that the true believers seem to have all the power. I think ditching OMM entirely would be a huge boost for the AOA. Their new marketing strategy could be "Hey, we have nothing to do with the AAMC". The AOA marketing is just so cringey. What I want to know is how many premeds get sucked in by that stuff.

 

[bananafish94]

Below is from a post I put up in January 2020. I believe it is worth reposting in this thread. These articles are from mainstream peer reviewed journals, some of the top in their specialty. Many more exist in the JAOA file. Noll, et al, has studies on pneumonia with N's in the 200's.





I have been listening to medical students trash OMM for a couple years now without any feedback. Remember pre meds read SDN and might actually think you know what you are talking about. It is not all pseudoscience. Mainstream journals aren't in the habit of publishing pseudoscience.

Annals of Internal Medicine: 2004, 141; 432-439
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain;
Gert J.D. Bergman, et al.

American Journal of Obstetrics and Gynecology, (ACOG Green Journal), Am J Obstet Gynecol 2010; 202:43.e1-08
Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during pregnancy: a Randomized Controlled Trial
John C. Licciardone, D.O. et al.

Annals of Internal Medicine; 21 December 2004; Vol 141: Number 12; pp. 920-928.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study
Maj John D. Childs, PhD, et. al.

Annals of Thoracic Surgery: 2017 Jul;104(1): `45-152. doi: 10.1016/j.athoracsur.2016.09.110. Epub 2017 Jan18
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.
Racca V, et. al.

These are some articles published in peer reviewed mainstream journals showing positive correlations with OMT. These articles don't represent a cure for cancer or for the common cold, but suggest OMT was beneficial in their study and like anything, more work is needed. Students having trouble wrapping their arms around cranial and Chapmans points is understandable. Too many students have very firm opinions about OMT and should reserve them until they have actually treated patients, not classmates, with OMT. Once again, these mainstream journals are not in the habit of publishing pseudoscience. Whew, got that off my chest

Honest question: do you have any studies that are actually double-blinded and account for the placebo effect? Reading those papers, it's not unreasonable to think that in any given population if you do usual care + OMT the expectation would be that the subjects receiving OMT would perceive an additional intervention and the placebo effect could very well account for the differences reported. The closest of those papers to a placebo-controlled experiment is the Green Journal paper but even in that study some subjects undergo OMT and some undergo "sham ultrasound," which would be a completely different experience than receiving seven 30-minute OMT sessions. Shouldn't the onus be on the investigator to account for the placebo effect? I'm confused because in these studies, I imagine it would be very simple to introduce some kind of sham OMT that would greatly enhance the internal validity so I'm confused why the investigators would just opt to do usual treatment +OMT vs. usual treatment.

That said, I fully admit that I know absolutely nothing about OMT and I happened to stumble across this thread. Just trying to continue the dialogue.

 

[Angus Avagadro]

Honest question: do you have any studies that are actually double-blinded and account for the placebo effect? Reading those papers, it's not unreasonable to think that in any given population if you do usual care + OMT the expectation would be that the subjects receiving OMT would perceive an additional intervention and the placebo effect could very well account for the differences reported. The closest of those papers to a placebo-controlled experiment is the Green Journal paper but even in that study some subjects undergo OMT and some undergo "sham ultrasound," which would be a completely different experience than receiving seven 30-minute OMT sessions. Shouldn't the onus be on the investigator to account for the placebo effect? I'm confused because in these studies, I imagine it would be very simple to introduce some kind of sham OMT that would greatly enhance the internal validity so I'm confused why the investigators would just opt to do usual treatment +OMT vs. usual treatment.

That said, I fully admit that I know absolutely nothing about OMT and I happened to stumble across this thread. Just trying to continue the dialogue.

You pose a a well thought out question. Most OMT studies divide into 3 groups. Read the Am Journal of OB GYN I mentioned. One group on that study was Usual OB care. Next group usual OB care + OMT. I believe third group was Usual OBbcare + Sham Ultrasound treatment with the transducer unplugged. Other groups use sham touching for the third group. Some studies show improvement with sham treatment over usual care and that should identify the Placebo group.