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http://www.ncbi.nlm.nih.gov/entrez/...oa.org/cgi/pmidlookup?view=long&pmid=15537794
"The Elephant in the Room: Does OMT Have Proved Benefit?
Bryan E. Bledsoe, DO, FACEP
Midlothian, Texas
To the Editor:
I would like to congratulate John C. Licciardone, DO, MS, et al on another high-quality study, "A Randomized Controlled Trial of Osteopathic Manipulative Treatment Following Knee or Hip Arthroplasty," evaluating the efficacy of osteopathic manipulative treatment (OMT) (J Am Osteopath Assoc. 2004;104:193-202). The results of this randomized controlled trial indicate that OMT in the setting of postoperative knee arthroplasty is ineffective. Further, on one outcome measure, OMT actually decreased rehabilitative efficiency.
This study is an important contribution to osteopathic medicine's knowledge base. It has findings similar to those of Dr Licciardone and colleagues' earlier study that showed no added benefit of OMT over sham treatment for chronic low back pain.1 The earlier study, also a randomized controlled trial, was published in a predominantly allopathic medical journal and has not been openly discussed in the osteopathic medical literature.
In the last paragraph of his article, Dr Licciardone and colleagues state what many osteopathic physicians have come to believe: Healthy patients derive more benefit from OMT than those who are ill or injured. This seems intuitive and supports the hypothesis that OMT has a minimal effect. Such an effect may be all that is needed for people who are healthy; people with injury or illness, however, are not as likely to receive significant benefit from OMT. Moreover, one could argue that when OMT does have an effect, it is little more than the classic placebo effect. It certainly offers some Pygmalion effect; however, which occurs when a persistently held belief becomes a perceived reality
This begs the question of why members of the osteopathic medical profession continue to teach an outdated and ineffective system of healthcare to undergraduate osteopathic medical students.
It is important that osteopathic medical students know the history of osteopathic medicine and the ideas that A. T. Still, MD, DO, professed. But Still lived in the preantibiotic and presurgical era. His findings, though important at that time, are of little more than historic interest today. He did the best with what he had. Likewise, practitioners such as Christian Friedrich Samuel Hahnemann, MD, the founder of homeopathy, did the best with what they had as well. But under the scrutiny of the scientific method, such antiquated practices as homeopathy and magnetic healing have fallen by the wayside.2 It seems that OMT will and should follow homeopathy, magnetic healing, chiropractic, and other outdated practices into the pages of medical history.
I received an excellent undergraduate medical education and am proud to be a DO, but I cannot continue to support an antiquated system of healthcare that is based on anecdote or, in some cases, pseudoscience. As a medical school student, I was taught to critically analyze problems and practice evidence-based medicine. When it came to courses in osteopathic principles and practices, however, my peers and I were asked to put aside our critical, evidence-based medical skills and accept the tenets of OMT on faith. When we questioned such esoteric practices as craniosacral therapy and energy field therapy, we were told that "we needed to believe." Likewise, when less than 5% of the class "felt" the craniosacral rhythm, the rest of the class was derided for a lack of faithto the point that ejection from the medical school was threatened. When we complained that some students were using barbeque strikers to stimulate invisible "energy fields," we were told that in time, we would come to understand and believe.
In osteopathic medical school, OMT courses were so steeped in history, tradition, and anecdote that a question included on a final examination asked the name of the mascot of the American School of Osteopathy in 1906, a query without any clinical relevance whatsoever. When my classmates and I inquired into the science of OMT, we were given copies of studies that were little more than statements of faith published in the Journal of the American Osteopathic Association more than 50 years ago. As Mark Twain wrote in his book, Following the Equator, "Faith is believing what you know ain't so."
How can the osteopathic medical profession deliberately seek the brightest college graduates to become osteopathic physicians and at the same time, ask those students to believe in and practice modes of therapy that have little or no proved effect? Likewise, how can osteopathic physicians, with a straight face, ask those students to believe that the fused bones of the skull move in a magic rhythm that mainstream researchers have never been able to document?3-6 (Perhaps the findings of these researchers would be different if they had "faith.") How can we ask students to believe that the body has an energy field that cannot be seen or objectively measured or ask students to believe that providing myofascial release will cause the tissues to "remember" the trauma that caused their injury? This is what we were taught; it did not make sense then and makes even less sense now.
Therefore, I express my congratulations to Dr Licciardone and his colleagues. I hope they continue to ask and answer the hard questions. The testament to osteopathic medicine as a profession will be whether it responds to accumulating scientific evidence and modifies its practices accordingly or simply reverts to a call for faith. Osteopathic medicine has found a niche in modern medicine, not one of a medical specialty that practices OMT, but as a medical specialty that produces well-rounded primary care physicians. The future of osteopathic medicine is bright. But, the future is in the continued graduation of competent and compassionate primary care physicians and not in the historic dogma of OMT."
As we are all applying to DO schools, it is obviously important that we consider the implications of accepting OMT on "faith" as a method of treatment for our (future) patients. On the one hand, I have personally seen (and experienced) OMM in practice and its percieved benefits (placebo effect?). I cannot help but wholeheartedly agree with this author's pride in the founding osteopathic principles (holistic approach, emphasis on primary care, compassioniate doctor-patient relationship, etc.); however, I also cannot help but agree with him that we need to consider leaving behind the antiquated, unscientifically-backed aspects of OMM/OMT in order to advance with 21st century medicine and provide the best treatment for our patients (see knee manipulation study). Can we leave the ineffective methods of OMM behind, or is the state of academic osteo. medicine too resistant to change to accept this? Can we (students and future docs) change this? Or is it best just to "accept" it and move on? (I have serious issues with this-- I would have no problem attending classes on OMM etc, but I would definitely voice my opinion (in an appropriate manner- outside of class))...
I realize this is a controversial issue and that it will probably draw some heat from DOs, med students, OMM fellows etc, and that some will tell me to use the search function, stop beating a dead horse, etc. However, as we are the future of osteopathic medicine, I feel that it is an important consideration that should be discussed and dealt with.
"The Elephant in the Room: Does OMT Have Proved Benefit?
Bryan E. Bledsoe, DO, FACEP
Midlothian, Texas
To the Editor:
I would like to congratulate John C. Licciardone, DO, MS, et al on another high-quality study, "A Randomized Controlled Trial of Osteopathic Manipulative Treatment Following Knee or Hip Arthroplasty," evaluating the efficacy of osteopathic manipulative treatment (OMT) (J Am Osteopath Assoc. 2004;104:193-202). The results of this randomized controlled trial indicate that OMT in the setting of postoperative knee arthroplasty is ineffective. Further, on one outcome measure, OMT actually decreased rehabilitative efficiency.
This study is an important contribution to osteopathic medicine's knowledge base. It has findings similar to those of Dr Licciardone and colleagues' earlier study that showed no added benefit of OMT over sham treatment for chronic low back pain.1 The earlier study, also a randomized controlled trial, was published in a predominantly allopathic medical journal and has not been openly discussed in the osteopathic medical literature.
In the last paragraph of his article, Dr Licciardone and colleagues state what many osteopathic physicians have come to believe: Healthy patients derive more benefit from OMT than those who are ill or injured. This seems intuitive and supports the hypothesis that OMT has a minimal effect. Such an effect may be all that is needed for people who are healthy; people with injury or illness, however, are not as likely to receive significant benefit from OMT. Moreover, one could argue that when OMT does have an effect, it is little more than the classic placebo effect. It certainly offers some Pygmalion effect; however, which occurs when a persistently held belief becomes a perceived reality
This begs the question of why members of the osteopathic medical profession continue to teach an outdated and ineffective system of healthcare to undergraduate osteopathic medical students.
It is important that osteopathic medical students know the history of osteopathic medicine and the ideas that A. T. Still, MD, DO, professed. But Still lived in the preantibiotic and presurgical era. His findings, though important at that time, are of little more than historic interest today. He did the best with what he had. Likewise, practitioners such as Christian Friedrich Samuel Hahnemann, MD, the founder of homeopathy, did the best with what they had as well. But under the scrutiny of the scientific method, such antiquated practices as homeopathy and magnetic healing have fallen by the wayside.2 It seems that OMT will and should follow homeopathy, magnetic healing, chiropractic, and other outdated practices into the pages of medical history.
I received an excellent undergraduate medical education and am proud to be a DO, but I cannot continue to support an antiquated system of healthcare that is based on anecdote or, in some cases, pseudoscience. As a medical school student, I was taught to critically analyze problems and practice evidence-based medicine. When it came to courses in osteopathic principles and practices, however, my peers and I were asked to put aside our critical, evidence-based medical skills and accept the tenets of OMT on faith. When we questioned such esoteric practices as craniosacral therapy and energy field therapy, we were told that "we needed to believe." Likewise, when less than 5% of the class "felt" the craniosacral rhythm, the rest of the class was derided for a lack of faithto the point that ejection from the medical school was threatened. When we complained that some students were using barbeque strikers to stimulate invisible "energy fields," we were told that in time, we would come to understand and believe.
In osteopathic medical school, OMT courses were so steeped in history, tradition, and anecdote that a question included on a final examination asked the name of the mascot of the American School of Osteopathy in 1906, a query without any clinical relevance whatsoever. When my classmates and I inquired into the science of OMT, we were given copies of studies that were little more than statements of faith published in the Journal of the American Osteopathic Association more than 50 years ago. As Mark Twain wrote in his book, Following the Equator, "Faith is believing what you know ain't so."
How can the osteopathic medical profession deliberately seek the brightest college graduates to become osteopathic physicians and at the same time, ask those students to believe in and practice modes of therapy that have little or no proved effect? Likewise, how can osteopathic physicians, with a straight face, ask those students to believe that the fused bones of the skull move in a magic rhythm that mainstream researchers have never been able to document?3-6 (Perhaps the findings of these researchers would be different if they had "faith.") How can we ask students to believe that the body has an energy field that cannot be seen or objectively measured or ask students to believe that providing myofascial release will cause the tissues to "remember" the trauma that caused their injury? This is what we were taught; it did not make sense then and makes even less sense now.
Therefore, I express my congratulations to Dr Licciardone and his colleagues. I hope they continue to ask and answer the hard questions. The testament to osteopathic medicine as a profession will be whether it responds to accumulating scientific evidence and modifies its practices accordingly or simply reverts to a call for faith. Osteopathic medicine has found a niche in modern medicine, not one of a medical specialty that practices OMT, but as a medical specialty that produces well-rounded primary care physicians. The future of osteopathic medicine is bright. But, the future is in the continued graduation of competent and compassionate primary care physicians and not in the historic dogma of OMT."
As we are all applying to DO schools, it is obviously important that we consider the implications of accepting OMT on "faith" as a method of treatment for our (future) patients. On the one hand, I have personally seen (and experienced) OMM in practice and its percieved benefits (placebo effect?). I cannot help but wholeheartedly agree with this author's pride in the founding osteopathic principles (holistic approach, emphasis on primary care, compassioniate doctor-patient relationship, etc.); however, I also cannot help but agree with him that we need to consider leaving behind the antiquated, unscientifically-backed aspects of OMM/OMT in order to advance with 21st century medicine and provide the best treatment for our patients (see knee manipulation study). Can we leave the ineffective methods of OMM behind, or is the state of academic osteo. medicine too resistant to change to accept this? Can we (students and future docs) change this? Or is it best just to "accept" it and move on? (I have serious issues with this-- I would have no problem attending classes on OMM etc, but I would definitely voice my opinion (in an appropriate manner- outside of class))...
I realize this is a controversial issue and that it will probably draw some heat from DOs, med students, OMM fellows etc, and that some will tell me to use the search function, stop beating a dead horse, etc. However, as we are the future of osteopathic medicine, I feel that it is an important consideration that should be discussed and dealt with.
