Why is it hard to do research for omm?

[Onigiri]

Hello Sdn,

I was wondering why it is hard to do research for omm. I remember reading possibly in Norman Gevitz book about dislocating or relocating rat bone structures to standardize the experimental set up.

Someone also said that somehow omm impedes the double blind system.

What are all the criterias for a science experiment to be valid and what makes them or who decides that this is the most objective path to follow?

Do you think some of these scientific criterias are not neccessary for all types of studies and are biased for more drug based phenomena?

Thanks in advance. I'm thinking of going into omm research later.


Maybe we can debunk some, find new approaches,and further solidify others with quality, accepted research.

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[kenjixshadow]

You can do research on magic? Btw, you may want to rethink of your career choice.
Your question is answered on post #3 and 14: http://forums.studentdoctor.net/threads/omm-question.1125806/

 

[MannysB]

Because are you really going to leave a patient with otitis media hanging with a study with OMM vs placebo? Look up that lady with the multiple lawsuits for practicing OMM only. I forget her name. A pioneer.

 

[Drrrrrr. Celty]

Because are you really going to leave a patient with otitis media hanging with a study with OMM vs placebo? Look up that lady with the multiple lawsuits for practicing OMM only. I forget her name. A pioneer.

Viola Frymann I imagine? She was a negligent osteopath and nearly killed patients. I honestly believe many experts in OMM even find her a subject of scorn.

You can produce an experiment where all parties are given antibiotics and only half are given OMM and measure recovery time, quality of life, etc. That's not a limitation of the study. The limitation is the lack of capacity to explain mechanism and a clear foundation for explaining the foundation of lympathic drainage techniques or gallbrath in models. Which btw has not been established despite a wonderful study using 'mongrel' dogs...

 

[Drrrrrr. Celty]

There are a myriad of problems associated with researching OMM that go beyond double blind studies ( You can't double blind surgery either, but we have plenty of research on it). To begin there's a poor foundation of literature explaining what OMM is particular focused on doing, what the logic or mechanism is for many techniques, and generally evidence for why it should be researched to begin with as a whole. Likewise it's less discrete on a particular condition or opperationalized around outcomes and what not.

But, likewise and the biggest crux is that very few doctors are going to be interested in the findings anyways. You have research coming out describing how to cure Hep C, keep HIV patients healthy, reverse diabetes, treat cancer and etc. And then you're going to have research showing that rubbing someone's leg helps them feel less pain and walk better after 3-6 sessions. It's not to say that helping people regain mobility is not important, but it's not attention grabbing and most doctors were doing something of the sort of advising patients to do remedies themselves at home before that OMM research proved it ( Ex. my friend says she was doing pretty much the same thing to treat her foot problems before she ever was taught it formally, etc). Which gets back to the previous comment I made, OMM research is less opperationalized and many times it's a whole bunch of well duh findings.

Personally I would love to see good research on OMM happen. And I would like to see it used to potentially enhance the teaching and training of family practitioner doctors. But there are major barriers to it and they aren't going to be going away any time soon.

 

[ninjaman22]

Somebody research up how cranial techniques can cure learning disabilities

 

[AlbinoHawk DO]

It's hard because then the truth will come out. Can't have that happen and keep the cash cow while not becoming another BS alternative medicine degree.

 

[235009]

It's pretty straight forward. OMM vs. sham OMM. You can blind the patients and a research assistant who administers the surveys. Can be easily done for back pain for instance. Use a validated questionnaire for pain and functional status.

The only reason this hasn't been done is because a negative result would be very financially detrimental.

 

[hossle12]

What? Anecdotal case stories told by our OMM faculty don't count?
It's concerning how many students gobble up everything said in the lab

 

[tux4]

With OMM research the investigators already have their "answer" and just conduct studies that try to prove what they already believe is true.


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[Drrrrrr. Celty]

With OMM research the investigators already have their "answer" and just conduct studies that try to prove what they already believe is true.


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I'm pretty sure most studies are conducted to prove their hypothesis. The issue is whether or not the research methods and the findings are reproducible and applicable.

 

[IslandStyle808]

It's pretty straight forward. OMM vs. sham OMM. You can blind the patients and a research assistant who administers the surveys. Can be easily done for back pain for instance. Use a validated questionnaire for pain and functional status.

The only reason this hasn't been done is because a negative result would be very financially detrimental.

The reason why I see so many retrospective studies instead...

 

[235009]

The reason why I see so many retrospective studies instead...

They require way fewer or no resources and it's a lot easier to either manipulate the data (ie do incorrectly) or sweep under the rug if it doesn't come out the way you had hoped.


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[Drrrrrr. Celty]

They require way fewer or no resources and it's a lot easier to either manipulate the data (ie do incorrectly) or sweep under the rug if it doesn't come out the way you had hoped.


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Lets also admit that regardless of the outcome of the findings, it'll either only have neutral effects if positive. I sincerely doubt it'll ever be even moderately adopted by the general medical field even in MD FM training. It'll at best simply remain a field that we're happy exists, but are happy that someone else does instead of us because I really doubt that even if I did OMM that a single minor session could really have long term relief.

 

[JustaDO]

The counter-argument by the believers would be:

A. Technique was done wrong or the wrong one was chosen - Ask any 2 OMM instructors how to do a technique, and you learn 5 ways to do the same one.
B. Misdiagnosis of a "somatic" dysfunction - See above, rinse and repeat.

 

[JustPlainBill]

Ah, yes, the inevitable OMM research question ---

1) I found it rather interesting that an OMS3 who was a D.O./Ph.D candidate set up the only experiment I know of while at TCOM --- it involved inducing coronary vessel occlusion into canines and having various different OMM professors palpate the spine looking for changes -- there were some interesting results that got published in the American Journal of Physiology; Now, what's interesting about that one is that an unpaid OMS3 set up and ran the experiment (to my knowledge) while all these paid ORC "investigators" were sitting around looking over previously done research.....and left it at that...

 

[Drrrrrr. Celty]

Ah, yes, the inevitable OMM research question ---

1) I found it rather interesting that an OMS3 who was a D.O./Ph.D candidate set up the only experiment I know of while at TCOM --- it involved inducing coronary vessel occlusion into canines and having various different OMM professors palpate the spine looking for changes -- there were some interesting results that got published in the American Journal of Physiology; Now, what's interesting about that one is that an unpaid OMS3 set up and ran the experiment (to my knowledge) while all these paid ORC "investigators" were sitting around looking over previously done research.....and left it at that...

That's actually mildly interesting.

But is it clinically significant? I mean someone has so and so tart finding. Not like you're not going to run an EKG or etc when a pt comes in with chest pain.

 

[JustPlainBill]

That's actually mildly interesting.

But is it clinically significant? I mean someone has so and so tart finding. Not like you're not going to run an EKG or etc when a pt comes in with chest pain.

Agreed-- the point I was trying to make was that in spite of the money poured into the ORC with highly respected researchers, the best that could be produced (at least up until that time) was a canine model for TART (thank you, forgot the term) changes associated with coronary vascular occlusion --- and it was done by an OMS3 student, not a full time, paid researcher ---- just ridiculous in my opinion....

 

[Goro]

Frankly, it's not hard. OMM as an efficacious treatment for X is a testable hypothesis. Yeah, you can't do double blinds, but that still doesn't mean you can't test it and compare it to a control.

I suspect that my OMM/OMT colleagues do NOT want to test out their techniques for fear that they'll be shown to have no effect. Unfortunately, too many of them are prone to confirmation bias, and for a few, it's a belief system. They ignore the scientific idea that if something doesn't work, you throw it out and try something different. I've had enough OMM done on me to accept that it has efficacy, and no, it's no placebo effect either.

Next year I'm going to be a collaborator in a study testing OMM on a fairly significant clinical condition, and look for the biomarkers to prove it.

Hello Sdn,

I was wondering why it is hard to do research for omm. I remember reading possibly in Norman Gevitz book about dislocating or relocating rat bone structures to standardize the experimental set up.

Someone also said that somehow omm impedes the double blind system.

What are all the criterias for a science experiment to be valid and what makes them or who decides that this is the most objective path to follow?

Do you think some of these scientific criterias are not neccessary for all types of studies and are biased for more drug based phenomena?

Thanks in advance. I'm thinking of going into omm research later.


Maybe we can debunk some, find new approaches,and further solidify others with quality, accepted research.

 

[Goro]

Interesting reading!

http://www.quackwatch.org/11Ind/frymann3.html

Because are you really going to leave a patient with otitis media hanging with a study with OMM vs placebo? Look up that lady with the multiple lawsuits for practicing OMM only. I forget her name. A pioneer.

 

[Drrrrrr. Celty]

Agreed-- the point I was trying to make was that in spite of the money poured into the ORC with highly respected researchers, the best that could be produced (at least up until that time) was a canine model for TART (thank you, forgot the term) changes associated with coronary vascular occlusion --- and it was done by an OMS3 student, not a full time, paid researcher ---- just ridiculous in my opinion....

There's a lack of research on it simply put. The research was interesting, but it's mystified in poorly understood mechanisms and wide generalizations, i.e T so and so = the heart. Well ok, there are changes, great, i'm not sure whether this is subclinical or acute or your heart just being angsty for a minute, etc.

 

[Drrrrrr. Celty]

Frankly, it's not hard. OMM as an efficacious treatment for X is a testable hypothesis. Yeah, you can't do double blinds, but that still doesn't mean you can't test it and compare it to a control.

I suspect that my OMM/OMT colleagues do NOT want to test out their techniques for fear that they'll be shown to have no effect. Unfortunately, too many of them are prone to confirmation bias, and for a few, it's a belief system. They ignore the scientific idea that if something doesn't work, you throw it out and try something different. I've had enough OMM done on me to accept that it has efficacy, and no, it's no placebo effect either.

Next year I'm going to be a collaborator in a study testing OMM on a fairly significant clinical condition, and look for the biomarkers to prove it.

I think most will find some minor significance. However compare P values between say meds, other treatments ( ex. Physical therapy), yoga, bed rest, etc on restoring motion or dealing with pain and then we end up with issues. But then again, remember we live in a world where we still learn sacral and cranial and chapman points.

 

[Goro]

If we replace the pseudoscientific "cranial manipulation" with the more accurate "cranial tactile stimulation" or "cranial palpation", you still have a valid hypothesis to test. Pick some condition..PTSD? Migraines? Sinusitis? All testable.

Chapman's points? Unproven claims, at best. Until someone shows me a histo slide of one of them, they don't exist.

I think most will find some minor significance. However compare P values between say meds, other treatments ( ex. Physical therapy), yoga, bed rest, etc on restoring motion or dealing with pain and then we end up with issues. But then again, remember we live in a world where we still learn sacral and cranial and chapman points.

 

[Goro]

Agree 100%. Also, for some, it's a belief system. The sooner we can extirpate that attitude, the better.

It's pretty straight forward. OMM vs. sham OMM. You can blind the patients and a research assistant who administers the surveys. Can be easily done for back pain for instance. Use a validated questionnaire for pain and functional status.

The only reason this hasn't been done is because a negative result would be very financially detrimental.

 

[doczebra]

Agree 100%. Also, for some, it's a belief system. The sooner we can extirpate that attitude, the better.

Will never happen. AOA and OMM faculties are run by militant nutcases. Now if anyone thinks this is a generational problem with the last generation having nutcases and reform coming in the future, it wont. Our class also puts out 4-5 OMM nutcases every year that will go on to continue AOA's legacy of quackery.

Best anyone in this thread can do is hide the D.O. and just advertise themselves as Dr. Name AIBM/ABFM/etc

 

[235009]

Interesting reading!

http://www.quackwatch.org/11Ind/frymann3.html

Oh my god! That reads like a horror story. Wtf was that "doctor" doing?! I'm no pediatrician or FM doctor but i was getting palpitations reading through the symptoms.

 

[Drrrrrr. Celty]

Will never happen. AOA and OMM faculties are run by militant nutcases. Now if anyone thinks this is a generational problem with the last generation having nutcases and reform coming in the future, it wont. Our class also puts out 4-5 OMM nutcases every year that will go on to continue AOA's legacy of quackery.

Best anyone in this thread can do is hide the D.O. and just advertise themselves as Dr. Name AIBM/ABFM/etc

I think the curriculum will change, chapman points for example is almost universally seen as voodoo and will be removed for example from the curriculum.

 

[doczebra]

I think the curriculum will change, chapman points for example is almost universally seen as voodoo and will be removed for example from the curriculum.

Have you seen the members of AOA? They're out to add more chapman point to gain a higher position in AOA.

 

[bowjangles]

OMM vs sham OMM is an ignorant over simplification of the techniques. Studies are always going to be lacking because there will never be a standardized course of care for any somatic dysfunction. Each individual person will be proficient in particular techniques and not others, thus approaching each dysfunction differently than the next. This has been the main flaw in all studies regarding OMT. This is no surprise for an entirely subjective finding that is somatic dysfunction (just like any other finding in a physical exam, DO or MD taught). Medicine still practices empirical courses of care that have absolutely no data to back it up. Picking on OMT, particularly if you never utilized it yourself over a legitimate course of time to grow a proficiency, is childish.

 

[Drrrrrr. Celty]

OMM vs sham OMM is an ignorant over simplification of the techniques. Studies are always going to be lacking because there will never be a standardized course of care for any somatic dysfunction. Each individual person will be proficient in particular techniques and not others, thus approaching each dysfunction differently than the next. This has been the main flaw in all studies regarding OMT. This is no surprise for an entirely subjective finding that is somatic dysfunction (just like any other finding in a physical exam, DO or MD taught). Medicine still practices empirical courses of care that have absolutely no data to back it up. Picking on OMT, particularly if you never utilized it yourself over a legitimate course of time to grow a proficiency, is childish.

You don't really need to create a model to internally evaluate OMM. OMM v.s Physical Therapy v.s Massage therapy v.s pain meds and compare quality of life, ROM, etc at the end of 1 day, 1 week, 1 month. None of these therapies should in theory be standardized and everyone should probably address the problem differently. Likewise you can in theory evaluate multiple techniques as different treatment groups as well pending that you obtain a large enough group size.

There are viable ways to create research methodologies for OMM.

 

[dozitgetchahi]

One big problem (didn't read everything above, sorry if this is a repeat) is standardizing the actual treatment under experimental conditions.

One of my classmates went to OMED one of the years we were in DO school and saw a huge setup from another DO school for OMM research- it literally involved an specialized OMM table fitted with hundreds of pressure sensors in a room that had hundreds of different cameras and other sensors to determine exactly how much force was applied in each plane at any given moment in time during OMM treatment. They stated that when they observed actual OMM treatments being performed under these conditions, the inter-practitioner variability (and inter-treatment variability) was absurdly high. Basically nobody is doing exactly the same 'treatment' every time they attempt to do HVLA etc.

Another anecdote is this. When one of those early 'automatic CPR' machines was approved, it had to get through clinical trials comparing it to manual chest compressions. Standardizing manual CPR for these studies turned out to be a rather difficult task. IIRC, the paramedics involved in the study went through all sorts of courses and specialized training on pressure-sensitive tables to demonstrate that they were doing CPR consistently. Then, they had to do monitored real life CPR sessions with instructors where their real-life CPR was critiqued. If they slipped below a certain threshold level, they had to go back and do the computerized training again. It turned out that CPR was so tricky to standardize that these paramedics required almost nonstop coaching to perform it consistently under real-life conditions. Some of these paramedics had to do the computerized training over and over again to get consistent enough to be in the study.

If chest compressions - which are very straightforward - are this hard to do consistently, you can imagine how much of a nightmare it is to make sure HVLA, muscle energy, etc is performed exactly the same way every time by every different practitioner for a study.

 

[Drrrrrr. Celty]

One big problem (didn't read everything above, sorry if this is a repeat) is standardizing the actual treatment under experimental conditions.

One of my classmates went to OMED one of the years we were in DO school and saw a huge setup from another DO school for OMM research- it literally involved an specialized OMM table fitted with hundreds of pressure sensors in a room that had hundreds of different cameras and other sensors to determine exactly how much force was applied in each plane at any given moment in time during OMM treatment. They stated that when they observed actual OMM treatments being performed under these conditions, the inter-practitioner variability (and inter-treatment variability) was absurdly high. Basically nobody is doing exactly the same 'treatment' every time they attempt to do HVLA etc.

Another anecdote is this. When one of those early 'automatic CPR' machines was approved, it had to get through clinical trials comparing it to manual chest compressions. Standardizing manual CPR for these studies turned out to be a rather difficult task. IIRC, the paramedics involved in the study went through all sorts of courses and specialized training on pressure-sensitive tables to demonstrate that they were doing CPR consistently. Then, they had to do monitored real life CPR sessions with instructors where their real-life CPR was critiqued. If they slipped below a certain threshold level, they had to go back and do the computerized training again. It turned out that CPR was so tricky to standardize that these paramedics required almost nonstop coaching to perform it consistently under real-life conditions. Some of these paramedics had to do the computerized training over and over again to get consistent enough to be in the study.

If chest compressions - which are very straightforward - are this hard to do consistently, you can imagine how much of a nightmare it is to make sure HVLA, muscle energy, etc is performed exactly the same way every time by every different practitioner for a study.

I think standardizing and trying to get things to move exactly the same or happen exactly the same inherently negates naturalistic validity in the setting of patients. I think the best study would be to observe and reflect on how doctors actually practice OMM in their clinics and to then see outcomes. Sure, not everyone will do it the same, just like I doubt every PT or any doctor does anything. We do not need to be so reductionist that we become detached from reality.

I think the best choices for proceeding with OMM research are in showing that it has validity in the settings that it is used significantly, ex. FM clinics. Ex. Have patients come in with common complaints and be treated with OMM, OMM + Analgesic, OMM + life style changes, etc. And then you rank quality of life and ROM changes. If OMM is comparable or more linked to improvement that offers insight into its possible validity as a treatment in said setting.