Research behind OMM

[zachjm2]

So I have applied to a number of DO schools and will likely be attending a DO school over an MD school. What I am wondering about is the clinical effectiveness of OMM and how much scientific research there is supporting the use of OMM. I understand the tenets of osteopathic philosophy and they make sense in theory, but to me it looks like a lot of DO schools are more practice-oriented than research-oriented. So who is conducting research on the effectiveness of these techniques? Does anyone have any books I could read or links to research studies?

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[DuxburyPembroke]

Honestly, just stop thinking about it for now. You won't get a straight answer here - and, really, there is no straight answer to give. Don't look into it, don't try to find research about OMM, it'll just be frustrating and may get you a bad name at school if you pester the teachers with questions. Your time will be much more profitably spent studying for your classes. If, after your second year, you are still interested, then maybe look into it on rotations. Not trying to be a jerk, just giving honest and friendly advice.

 

[willen101383]

Honestly, just stop thinking about it for now. You won't get a straight answer here - and, really, there is no straight answer to give. Don't look into it, don't try to find research about OMM, it'll just be frustrating and may get you a bad name at school if you pester the teachers with questions. Your time will be much more profitably spent studying for your classes. If, after your second year, you are still interested, then maybe look into it on rotations. Not trying to be a jerk, just giving honest and friendly advice.

Couldnt have said it better. Dont ask about OMM research. Either you will get A. a horribly designed study or B. "we dont need research we know it works already." Thats the state of current affairs...at least at my school. Teach us techniques without any "tie together" and dont provide any sort of actual evidence that any of this actually works. I sort of feel like the DO profession is at a crossroads here....or maybe thats just wishful thinking.

 

[Black Adder]

Honestly, just stop thinking about it for now. You won't get a straight answer here - and, really, there is no straight answer to give. Don't look into it, don't try to find research about OMM, it'll just be frustrating and may get you a bad name at school if you pester the teachers with questions. Your time will be much more profitably spent studying for your classes. If, after your second year, you are still interested, then maybe look into it on rotations. Not trying to be a jerk, just giving honest and friendly advice.

Follow above advise.

I gave up trying to find logical explanations to this stuff a long time ago. Nowadays, I simply turn my brain off when I enter OMM lab and just relax for 3 hours every week and play simon says with the man on the tv screen .....

 

[donkeykong1]

Your question is something I came across early in researching osteopathic medicine. NYU's medical center which has a huge number of DOs on site, I think best answers this question with the following:What Is the Scientific Evidence for Osteopathic Manipulative Therapy?

"There is little evidence as yet that OMT is helpful for the treatment of any medical condition. There are several possible reasons for this, but one is fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like OMT.
Only one form of study can truly prove that a treatment is effective—the double-blind, placebo-controlled trial . (For more information on why such studies are so crucial, see Why Does This Database Rely on Double-blind Studies? ) However, it isn't possible to fit OMT into a study design of this type. What could researchers use as a placebo OMT? And how could they make sure that both participants and practitioners would be kept in the dark regarding who is receiving real OMT and who is receiving fake OMT? The fact is, they can't.
Because of these problems, all studies of OMT fall short of optimum design. Many have compared OMT against no treatment. However, studies of that type cannot provide reliable evidence about the efficacy of a treatment: If a benefit is seen, there is no way to determine whether it was a result of OMT specifically or just attention generally. (Attention alone will almost always produce some reported benefit.)
More meaningful trials used fake osteopathy for the control group. Such studies are single-blind because the practitioner is aware of applying phony treatment. However, this design can introduce potential bias in the form of subtle unconscious communication between practitioner and patient.
Still other studies have simply involved giving people OMT and seeing if they improve. These trials are particularly meaningless; it has long since been proven that both participants and examining physicians will think, at least, that they observe improvement in people given a treatment...."

 

[HealingDoc]

The following articles are broken into categories- I have been referring to many of these studies on rotations when explaining OMT to preceptors and patients. There is no doubt that the very nature of OMT makes it impossible to perform a double blind randomized control trial. That said, we do not discount the results of surgical studies with similar design. The leaders of the profession have deemed these studies below to be excellent support for OMT. More research is currently being done around the nation. We're finally reaching a saturation point where there are enough people performing this research to justify funding for it. Look out for many more OMT studies in the near future with larger N, multi-site, etc. It is a very exciting time for the profession.



Evidence Based Medicine for OMT in Musculoskeletal System Complaints:
• Gunnar B.J. Andersson, M.D., Ph.D., Tracy Lucente, M.P.H., Andrew M. Davis, M.D.,
M.P.H., Robert E. Kappler, D.O., James A. Lipton, D.O., and Sue Leurgans, Ph.D. A
Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain N Engl J Med 1999; 341:1426 1431
• John C. Licciardone, DO,* Scott T. Stoll, DO,† Kimberly G. Fulda, MPH, David P. Russo, DO,‡ Jeff Siu, BA,† William Winn, DO,§ and Jon Swift Jr, DO Osteopathic Manipulative Treatment for Chronic Low Back Pain A Randomized Controlled Trial SPINE Volume 28, Number 13, pp 1355–1362
• RUSSELL G. GAMBER, DO; JAY H. SHORES, PHD; DAVID P. RUSSO, BA; CYNTHIA JIMENEZ, RN; BENARD R. RUBIN, DO Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: Results of a randomized clinical pilot project J AOA • Vol 102 • No 6 • June 2002
• JANICE A. KNEBL, DO, MBA; JAY H. SHORES, PHD; RUSSELL G. GAMBER, DO; WILLIAM T. GRAY, DO; KATHRYN M. HERRON, MPH Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: A randomized, controlled trial JAOA • Vol 102 • No 7 • July 2002


Evidence Based Medicine for OMT in Pulmonary and Infectious Disease:
• Donald R. Noll, DO; Brian F. Degenhardt, DO; Christian Fossum, DO (Norway); and
Kendi Hensel, DO Clinical and Research Protocol for Osteopathic Manipulative
Treatment of Elderly Patients With Pneumonia JAOA • Vol 108 • No 9 •
September 2008
• Peter A. Guiney, DO; Rick Chou, DO; Andrea Vianna, MD; Jay Lovenheim, DO
Effects of Osteopathic Manipulative Treatment on Pediatric Patients With
Asthma: A Randomized Controlled Trial JAOA • Vol 105 • No 1 • January 2005
• Brian F. Degenhardt, DO, Michael L. Kuchera, DO Osteopathic Evaluation and
Manipulative Treatment in Reducing the Morbidity of Otitis Media: A Pilot Study
JAOA • Vol 106 • No 6 • June 2006


Evidence Based Medicine for OMT in Cardiology:
• Albert H. O Yurvati, DO; Michael S. Carnes, DO; Michael B. Clearfield, DO; Scott T.
Stoll, DO, PhD; and Walter J. McConathy, PhD Hemodynamic Effects of
Osteopathic Manipulative Treatment Immediately After Coronary Artery Bypass
Graft Surgery JAOA • Vol 105 • No 10 • October 2005
• Patricia A. Gwirtz, Jerry Dickey, David Vick, Maurice A. Williams, and Brian
Foresman Viscerosomatic interaction induced by myocardial ischemia in conscious
dogs J Appl Physiol 103: 511–517, 2007.
• E. Marty Knott, OMS V; Johnathan D. Tune, PhD; Scott T. Stoll, DO, PhD; and H.
Fred Downey, PhD Increased Lymphatic Flow in the Thoracic Duct During
Manipulative Intervention JAOA • Vol 105 • No 10 • October 2005


Evidence Based Medicine for OMT in OB-Gyn/Urology:
• John C. Licciardone, DO, MS, MBA; Steve Buchanan, DO; Kendi L. Hensel, DO,
PhD; Hollis H. King, DO, PhD; Kimberly G. Fulda, DrPH; Scott T. Stoll, DO, PhD
Osteopathic manipulative treatment of back pain and relatedsymptoms during
pregnancy: a randomized controlled trial JANUARY 2010 American Journal of
Obstetrics & Gynecology
• Marx S, Cimniak U, Beckert R, Schwerla F, Resch KL. Chronic prostatitis/chronic
pelvic pain syndrome. Influence of osteopathic treatment a randomized
controlled study Urologe A. 2009 Nov;48(11):1339 45.
• Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial
cystitis and the urgency frequency syndrome. J Urol. 2001 Dec;166(6):2226 31.


Evidence Based Medicine for OMT in Surgical Patients:
• W. Thomas Crow, Lilia Gorodinsky Does osteopathic manipulative treatment
(OMT) improves outcomes in patients who develop postoperative ileus: A
retrospective chart review International Journal of Osteopathic Medicine 12
(2009) 32e3
• JM Radjieski; MA Lumley; and MS Cantieri Effect of osteopathic manipulative
treatment of length of stay for pancreatitis: a randomized pilot study J Am
Osteopath Assoc, May 1998; 98: 264.
• Frederick J. Goldstein; Saul Jeck; Alexander S. Nicholas; Marvin J. Berman; and
Marilyn Lerario Preoperative Intravenous Morphine Sulfate With Postoperative
Osteopathic Manipulative Treatment Reduces Patient Analgesic Use After Total
Abdominal Hysterectomy J Am Osteopath Assoc, Jun 2005; 105: 273 279.

 

[Styria]

Your question is something I came across early in researching osteopathic medicine. NYU's medical center which has a huge number of DOs on site, I think best answers this question with the following:What Is the Scientific Evidence for Osteopathic Manipulative Therapy?

"There is little evidence as yet that OMT is helpful for the treatment of any medical condition. There are several possible reasons for this, but one is fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like OMT.
Only one form of study can truly prove that a treatment is effective—the double-blind, placebo-controlled trial . (For more information on why such studies are so crucial, see Why Does This Database Rely on Double-blind Studies? ) However, it isn’t possible to fit OMT into a study design of this type. What could researchers use as a placebo OMT? And how could they make sure that both participants and practitioners would be kept in the dark regarding who is receiving real OMT and who is receiving fake OMT? The fact is, they can’t.
Because of these problems, all studies of OMT fall short of optimum design. Many have compared OMT against no treatment. However, studies of that type cannot provide reliable evidence about the efficacy of a treatment: If a benefit is seen, there is no way to determine whether it was a result of OMT specifically or just attention generally. (Attention alone will almost always produce some reported benefit.)
More meaningful trials used fake osteopathy for the control group. Such studies are single-blind because the practitioner is aware of applying phony treatment. However, this design can introduce potential bias in the form of subtle unconscious communication between practitioner and patient.
Still other studies have simply involved giving people OMT and seeing if they improve. These trials are particularly meaningless; it has long since been proven that both participants and examining physicians will think, at least, that they observe improvement in people given a treatment...."

This is a false argument because it doesn't hold OMT to applicable standards. OMT is a procedure, not a medication. No surgeon is ever blinded as to whether he is performing a surgical procedure or doing a fake surgery during their research.

 

[LifeTake2]

Ok, nobody else has the guts to ask so I will.....

To those of you who have replied so harshly: WHY ARE YOU PURSUING A D.O. if you clearly have so much disdain for the basic tenets?

You are the reason so many pre-meds consider DO a backup, because you obviously did not apply because you agreed with osteopathy.

I would expert this response in the pre-allo forum, but I expected better of DO students

 

[Drrrrrr. Celty]

Ok, nobody else has the guts to ask so I will.....

To those of you who have replied so harshly: WHY ARE YOU PURSUING A D.O. if you clearly have so much disdain for the basic tenets?

You are the reason so many pre-meds consider DO a backup, because you obviously did not apply because you agreed with osteopathy.

I would expert this response in the pre-allo forum, but I expected better of DO students

Same reason that you'll have disdain towards your surgery rotation when you want to be an IM doctor{Arbitrary example}. Anyways.. the fact is you're getting a D.O because you want to be a doctor.. not a marytr for the AOA or A.T. Still or a philosophy which overall is at odds with even 20th century germ theory of disease. I don't particularly think it is a back up really in the sense that it is an equal playing field medical school which can be compared to MD schools. It's not an alternative like Caribbean schools, it is simply medical school.
Furthermore... CRANIAL
/thread

 

[donkeykong1]

This is a false argument because it doesn't hold OMT to applicable standards. OMT is a procedure, not a medication. No surgeon is ever blinded as to whether he is performing a surgical procedure or doing a fake surgery during their research.

I'm not sure if i really understand your point since comparing OMT to surgery is like comparing apples to oranges. both are vastly different in use. lastly, in my opinion after reading a bunch of these OMT research papers, i think omt should be regarded as a rehab tool at best, and cranial well who the hell knows...,

yet, as serenade pointed out, just b/c some of us don't agree with the efficacy of some osteopathic techniques, this doesn't mean that we should throw the entire osteopathic philosophy under the bus. for me at least,the DO approach is definitely something that appeals to me even with some of these discrepancies. perhaps in the future, research findings will clear these discrepancies and lead to a newer understanding of OMT, OMM or NMM (whatever u like to call it).

 

[DocEspana]

Evidence Based Medicine for OMT in Surgical Patients:
• W. Thomas Crow, Lilia Gorodinsky Does osteopathic manipulative treatment
(OMT) improves outcomes in patients who develop postoperative ileus: A
retrospective chart review International Journal of Osteopathic Medicine 12
(2009) 32e3
• JM Radjieski; MA Lumley; and MS Cantieri Effect of osteopathic manipulative
treatment of length of stay for pancreatitis: a randomized pilot study J Am
Osteopath Assoc, May 1998; 98: 264.
• Frederick J. Goldstein; Saul Jeck; Alexander S. Nicholas; Marvin J. Berman; and
Marilyn Lerario Preoperative Intravenous Morphine Sulfate With Postoperative
Osteopathic Manipulative Treatment Reduces Patient Analgesic Use After Total
Abdominal Hysterectomy J Am Osteopath Assoc, Jun 2005; 105: 273 279.

I condensed your quote for the sake of "it's f***ing huge"

I want to point out two things in support of what you posted (as its the only two I can talk about). 1) Joan Radjieski, author of the study on length of stay in pancreatitis was one of our OMM docs. She is as pure of a cat woman as there ever was and is clearly out of her mind... but... she is a hardcore researcher of OMM and has a huge amount of research on the efficacy of OMM in increasing surgical outcomes due to post-op treatment. Not just lowering scarring and strictures, but in controlling inflammation, pain and avoiding rather serious negative consequences such as wound reopening

So I'd give her article there some creedance that it's likely a well designed study because she did spend much of her free time doing studies instead of actually practicing (she was a bit crazy, as I said before)

And also the MD heads of surgery of Staten Island University Hospital and (probably) St. John's Hospital in Queens are following up on Crow's studies on post-operative ileus (as they felt it didnt go far enough) and having a large scale study done with the osteopathic students rotating there performing OMM on the abdominal surgery patients vs no OMM treatment and recording the values when n= a big number.

Obviously, as said before, procedural treatments that are *believed* to be effecacious by the practitioner can, at best, be single blind. But any surgical study where a treatment of anecdotal success (as opposed to 'theoretical superiority of treatment') will never be any better than single blind either. The surgical world is okay with this and we've got (at least) two MD surgery chairs tossing their name on an OMT study. I think thats something worth noting

 

[donkeykong1]

I condensed your quote for the sake of "it's f***ing huge"

I want to point out two things in support of what you posted (as its the only two I can talk about). 1) Joan Radjieski, author of the study on length of stay in pancreatitis was one of our OMM docs. She is as pure of a cat woman as there ever was and is clearly out of her mind... but... she is a hardcore researcher of OMM and has a huge amount of research on the efficacy of OMM in increasing surgical outcomes due to post-op treatment. Not just lowering scarring and strictures, but in controlling inflammation, pain and avoiding rather serious negative consequences such as wound reopening

So I'd give her article there some creedance that it's likely a well designed study because she did spend much of her free time doing studies instead of actually practicing (she was a bit crazy, as I said before)

And also the MD heads of surgery of Staten Island University Hospital and (probably) St. John's Hospital in Queens are following up on Crow's studies on post-operative ileus (as they felt it didnt go far enough) and having a large scale study done with the osteopathic students rotating there performing OMM on the abdominal surgery patients vs no OMM treatment and recording the values when n= a big number.

Obviously, as said before, procedural treatments that are *believed* to be effecacious by the practitioner can, at best, be single blind. But any surgical study where a treatment of anecdotal success (as opposed to 'theoretical superiority of treatment') will never be any better than single blind either. The surgical world is okay with this and we've got (at least) two MD surgery chairs tossing their name on an OMT study. I think thats something worth noting

well, we will see how it goes. staten island university hospital is like 600+ bed so yeah i guess the n will be large unlike other studies.

 

[JaggerPlate]

I think what Healing is referring to with regard to the surgery comments is that OMT research suffers from some of the same basic design problems that designing a study to research a 'control versus variable' surgical situation faces.

In the same vein that you can't have an OMT practitioner who is blind to which therapy is being offered - the variable or control/placebo, you also can't have a surgeon who isn't sure whether he/she is performing a real surgical operation or just cutting a patient open and rustling things about. It's not the same as a drug study where a doc hands a participant a sugar pill versus the experimental drug and neither knows which is which.

Additionally, surgical studies is comparable on another level as 'sham' treatments are either a. impossible or b. could actually have some unknown side effect besides a psychological placebo effect. This is why these types of modalities are, in many instances, just based off pure results.

Maybe I'm confused as to what people were saying though.

 

[DocEspana]

Additionally, surgical studies is comparable on another level as 'sham' treatments are either a. impossible or b. could actually have some unknown side effect besides a psychological placebo effect. This is why these types of modalities are, in many instances, just based off pure results.

Maybe I'm confused as to what people were saying though.

There is a certain field of thought that justifies the ability to have a double blind surgery trial due to the fact that someone may have come up with a good idea in an academic situation. AKA: this looks like it will work better on paper than what we currently do in practice.

It's considered an effective double blind because the surgeon can do the procedure and not be certain that this procedure is actually effective/better than current treatment despite performing a real procedure. If they have only theoretical knowledge that the treatment *might* work, they dont technically bring a treatment bias into it.

The limit of this is that 'they' (whomever the 'they' is in academia) don't feel that you can be double blind once enough people have done this procedure to have anecdotal positive evidence. It is at this point where OMM sits. All these techniques, unless you make one up on the spot using existing theory, have been done before and your teachers are telling you anecdotes of their success. Because of this we can never perform a double blind study the way surgery can have a 'technical' double blind.

This entire thing is how it was explained to me by a member of our OMM staff. They basically said that this is the best we can hope for, being single blind. The unstated addendum is that surgeries constant advances in academia leads to the ability to perform double blind while OMM seems to have made very few new additions which would fit this criteria for double-blind credibility.

 

[wittyalias]

There is a certain field of thought that justifies the ability to have a double blind surgery trial due to the fact that someone may have come up with a good idea in an academic situation. AKA: this looks like it will work better on paper than what we currently do in practice.

It's considered an effective double blind because the surgeon can do the procedure and not be certain that this procedure is actually effective/better than current treatment despite performing a real procedure. If they have only theoretical knowledge that the treatment *might* work, they dont technically bring a treatment bias into it.

The limit of this is that 'they' (whomever the 'they' is in academia) don't feel that you can be double blind once enough people have done this procedure to have anecdotal positive evidence. It is at this point where OMM sits. All these techniques, unless you make one up on the spot using existing theory, have been done before and your teachers are telling you anecdotes of their success. Because of this we can never perform a double blind study the way surgery can have a 'technical' double blind.

This entire thing is how it was explained to me by a member of our OMM staff. They basically said that this is the best we can hope for, being single blind. The unstated addendum is that surgeries constant advances in academia leads to the ability to perform double blind while OMM seems to have made very few new additions which would fit this criteria for double-blind credibility.

Trying to redefine what double blind means does not make these types of studies an "effective double blind". The bias exists in the first place because you "think something might work". Compared to a placebo there will always be a bias towards the treatment, however experimental it might be. If you were testing a new pharmaceutical you wouldn't have any luck arguing that you don't need to test against a placebo because clinicians think your drug is more "experimental" than other drugs that have been tested.

 

[DocEspana]

Trying to redefine what double blind means does not make these types of studies an "effective double blind". The bias exists in the first place because you "think something might work". Compared to a placebo there will always be a bias towards the treatment, however experimental it might be. If you were testing a new pharmaceutical you wouldn't have any luck arguing that you don't need to test against a placebo because clinicians think your drug is more "experimental" than other drugs that have been tested.

hey take it up with the ~7% of all doctors who are surgeons. They use the term double blind and no one complains. I'm not defending OMM usage, i'm actually pointing out why OMM can't use it (if that wasnt clear). But how things like surgery can use it and no one has had an issue. There is a difference, but its subtle.

 

[wittyalias]

Just as sham procedures can be used for controls for some types of surgery, it seems that something similar could be used to test aspects of OMM. For a placebo control, why couldn't a DO apply a similar but unrelated OMM technique that should not result in symptom relief (but patient wouldn't know) and then afterward have the patient be evaluated by a different physician that didn't know which technique was used?

Testing a diagnostic OMM technique for which there is another definitive diagnostic available would also be an easy way to confirm the validity of the OMM version of the diagnostic with minimal bias. If it is faster, cheaper, and more effective than everyone should be doing it. But if there are treatments that are impossible to properly test for efficacy what is the point in using them?

 

[DocEspana]

Just as sham procedures can be used for controls for some types of surgery, it seems that something similar could be used to test aspects of OMM. For a placebo control, why couldn't a DO apply a similar but unrelated OMM technique that should not result in symptom relief (but patient wouldn't know) and then afterward have the patient be evaluated by a different physician that didn't know which technique was used?

Testing a diagnostic OMM technique for which there is another definitive diagnostic available would also be an easy way to confirm the validity of the OMM version of the diagnostic with minimal bias. If it is faster, cheaper, and more effective than everyone should be doing it. But if there are treatments that are impossible to properly test for efficacy what is the point in using them?

They do that all the time. If you read the one about pancreatitis recovery time, that is exactly what was done. And the main way that study was attacked (by the students at least. It was well respected from what I have heard by the academia) is that it wasn't double blind as the DOs knew who was getting real abdominal treatment and who was getting random massage techniques.

Same way using sham procedures in surgery is not double blind. 'Double blind;' surgical studies require the doctor to not know if the procedure is effective. Surgery with sham techniques is the same as OMM with related techniques. It can at best be single blind. If you *have* to use 'sham techniques vs tested technique' instead of a 'usual treatment vs new treatment' then you have eliminated the ability for the doctor to be blinded. He will know which one *should* be more effective. They will realize a sham treatment and the theory is that a patient (even a knocked out one) will read subtle clues from the doctors body language that they got the sham technique. If its truly believed that the doctors dont have a clear opinion as to wether the technique will be more effective, then it can be double blind by surgical standards.

the downfall here is that OMM rarely comes up with new techniques. Which mean 99% of OMM students will fall into techniques the doctor believes will work being compared to either a control treatment or sham treatment (same thing here). the doctor's belief that the OMM works, and knowledge of what a sham treatment would be, ruins the test. It's the same way how studies where surgeons perform sham operations are only single blind (sorry to repeat, but i want it drilled home), and are only 'double blind' when the surgeon legitimately does not know which treatment should be more effective, but believes both will work (though one might not. Its for this reason that only new procedures without a lot of hype and awareness can really ever fit this bill).

And as for why osteopathic physicians cant train physical therapists to do two techiques and not tell them which one is the real one? I actually think that could be done. But I hear it argued otherwise, that since many OMM inherantly *could* do some injury if done to someone who doesnt need it, they defend it the same way a surgeon would never let a non-surgeon be "trained" to do the job for experimental purposes.

 

[wittyalias]

A sham procedure can still be double blind. If the doctor who assess the patient and records the treatment's effectiveness is not the same doctor who did the surgery (or performed OMM) than they can be completely blind to whether the procedure was real or sham. The surgeon can be as biased as he wants to because he knows which procedure he is doing, but if neither the patient or the assessing physician know which happened, a surgical procedure (or OMM) could be truly double blind.

If the physican making the assessment after the procedure knows which procedure was performed, there is clearly going to be a bias so this is not a good substitute. In some cases, this may be difficult to test if there is danger to the patient etc. but it would sure be nice to see more real double blind studies. The results are pretty difficult to argue with if they are done properly and they are certainly feasible in many cases even with OMM.

 

[DocEspana]

A sham procedure can still be double blind. If the doctor who assess the patient and records the treatment's effectiveness is not the same doctor who did the surgery (or performed OMM) than they can be completely blind to whether the procedure was real or sham. The surgeon can be as biased as he wants to because he knows which procedure he is doing, but if neither the patient or the assessing physician know which happened, a surgical procedure (or OMM) could be truly double blind.

If the physican making the assessment after the procedure knows which procedure was performed, there is clearly going to be a bias so this is not a good substitute. In some cases, this may be difficult to test if there is danger to the patient etc. but it would sure be nice to see more real double blind studies. The results are pretty difficult to argue with if they are done properly and they are certainly feasible in many cases even with OMM.

The issue is not *really* in the doctor knowing. Its not like the doctors will (often) make incorrect assessments. Its that the patient during the procedure, no matter the knowledge basis of whomever assesses them, deals with a trained professional for the treatment itself who does know the difference. Its some unconscious subtle hint that a patient might pick up at that moment that ruins the double blind. I don't mean to be anal retentive in the specificity, but that is the reality. Their issue is with the fact that you interact with a conscious patient when performing the technique, and a conscious patient can pick up subtle cues from the treating physician even if he is not the assessing physician and those cues can distort the placebo effect.

An example of the insanity is I heard someone (not on here, in real life) with strong credentials argue that surgery fails the double blind test here too, *even if the patient is under general anesthesia for the procedure*. People are crazy about trying to punch any hole they can in the validity of a study.

 

[wittyalias]

Sure, accidental giveaways can occur in any double blind study. i.e. if the medicine has a distinctive taste or very frequent side effects that are a giveaway to the clinician or patient. But that doesn't mean it shouldn't be attempted. Narrowing your error down to some patients possibly being clued in by nonverbal clues from the caregiver is a heck of a lot better than not having any controls, or letting the same physician who is performing the treatment be the one who interprets whether it was effective.