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Osteopathy in the NICU: False Claims and False Dichotomies

I would like to preface this post by stating that I have worked with many DOs (Doctors of Osteopathy), and I have helped train many pediatric residents with DO degrees. I have found no difference in the overall quality of the training these students have received, and some of the very best clinicians I have ever worked with have been DOs. I would never prejudice my assessment or opinion of a physician based on whether they have an MD or a DO after their name.

Now, on to the discussion at hand.

I recently stumbled upon an article entitled, “Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial”. There is nothing particularly exciting or interesting about this study, as there have been many published on the use of osteopathic manipulative therapy (OMT) in children. There aren’t that many RCTs, however, and this particular one, although published in the open-access BioMed Central Pediatrics (impact factor 1.98), was chosen to be included in AAP Grand Rounds. AAP Grand Rounds is a publication put out by the American Academy of Pediatrics (AAP) to help pediatricians “Stay current and save time with monthly critical, evidence-based summaries of clinical content from nearly 100 journals.” Because the AAP found this important enough for mention in this widely read publication, with a distribution of 19,000 (source: AAP, 2014), I thought it would be interesting to take a closer look at it. I am also interested in the very odd existence of the two, distinct paths to becoming a physician in this country, osteopathic and traditional medical school training. The distinction between the two is rarely discussed, even within the halls of academia or in our health care centers. That’s not to say that the topic isn’t discussed at all (in fact it was highlighted very recently right here on SBM), it has just remained a somewhat politically incorrect subject, sliding mostly under the radar. Having worked with and trained pediatricians with osteopathic degrees, I can tell you that discussions about this are considered taboo. This is primarily because osteopathic physicians have become mainstreamed over time (see below), and discussing the validity of the existence of their “specialness” is an awkward proposition. After taking a look at the paper in question, I’ll address this issue some more as I think it deserves additional attention.

Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial.

This was a single-blinded RCT conducted at Santo Spirito Hospital in Pescara, Italy to explore whether OMT could shorten the length of stay among premature infants in their neonatal ICU (NICU). Secondary outcomes studied were the differences in daily weight gain and total cost of the NICU stay.

I’ll discuss the methods in a moment, but first let’s review the results.

Results

Infants who received OMT in addition to an osteopathic evaluation were found to have a significantly shorter NICU length of stay (LOS) than those in the control group who received only an osteopathic evaluation, without OMT. The mean average LOS was 26.1±16.4 days for the study group and 31.3±20.2 days for the control group (p<0.03). This was found to be true even after accounting for likely confounders using linear regression analysis. In terms of the secondary outcomes measures, there was no significant difference in daily weight gain between the two groups, but the authors found an almost 3 000 (~$4 100) savings in hospital costs for the study group, related to the shortened LOS.

Methods

Now let’s look at how this study was conducted. A total of 101 preterm infants were included in the study. Infants were randomly assigned to one of two groups:

  1. Osteopathic evaluation only
  2. Osteopathic evaluation and OMT

Here’s where it gets silly, and I’d like to briefly step away from the article to review the fundamentals of osteopathy before moving on.

Osteopathy is a pseudoscientific belief system developed in 1874 by the physician Andrew Still. The fundamental premise of osteopathy is the inter-relatedness of mind, body, and spirit. Still believed that this tripartite system had intrinsic, self-healing and self-correcting capabilities. He believed that disease states were caused by misalignments or obstructions of various structural elements of the body (bones, muscles, fascia, nerves, blood vessels, lymphatics), and that specific corrective manipulations could facilitate the body’s innate ability to heal. Like many wacky medical belief systems of this era, osteopathy was not any worse than much of the prevailing thought and practice of the day. Today, the practice of osteopathy varies considerably within the profession, as does the degree of adherence to the fundamentals of the original dogma preached by Dr. Still. I will revisit this at the end of the post and discuss how it pertains to the current training and practice of osteopathic physicians in this country. Now, let’s return to the study.

The authors of the study define osteopathic practice much the way AT Still described it in the 1800s:

Osteopathic practitioners use a wide variety of therapeutic manual techniques to improve physiological function and restore homeostasis that has been altered by somatic (body framework) dysfunction…Osteopathic practitioners use their understanding of the relationship between structure and function to optimize the body’s self-regulation and self-healing capabilities. This holistic approach to patient care and healing is based on the concept that a human being is a dynamic functional unit, in which all parts are interrelated and possesses its own self-regulatory and self-healing mechanisms.

This definition is so rife with fantasy and meaninglessness that it is difficult to discuss rationally or with a straight face. But we shall try. First, it assumes there is some specific physiologic function that needs to be restored. Now, we can go along with this since pretty much every pathologic state, by definition, has some physiologic basis. But osteopathy then assumes that a detectable structural dysfunction lies at the center of this physiological “imbalance”, much the way many chiropractors claim that fictional spinal “subluxations” are the cause of myriad disorders. We know this is whole-cloth fantasy, since not one shred of evidence supports this claim. However, the entire concept of osteopathy is predicated on this fantasy. But the definition gets even stranger. It then claims that osteopaths use their understanding of this relationship between a specific structural disequilibrium/obstruction/misalignment/lack of homeostasis (pick and choose) and a specific, corresponding physiologic dysfunction to design an effective manipulative fix. These manipulations then allow the body to resume its innate, self-healing magic to restore the body to health. I still can’t figure out why, if the body has innate self-healing abilities, these manipulations are required, and what they are supposed to be doing.

Now, recall the two groups of infants in the study, Group A (the control group) and Group B (the study group). All infants received 10-minute osteopathic evaluations by one of four Group A osteopaths. The study group infants additionally received a 10-minute evaluation and a 10-minute OMT session from one of four Group B osteopaths who visited the infants at a different time. After the group A osteopaths performed their evaluations, they remained standing at the bedside for an additional 10 minutes, supposedly as a form of “blinding”. Let me repeat this in table form for clarification:

Group A (control) Group B (intervention)
Group A osteopaths 10 minute evaluation +
10 minutes of standing by the bedside
10 minute evaluation +
10 minutes of standing by the bedside
Group B osteopaths 10 minute evaluation +
10 minutes of OMT
Total time at bedside 20 minutes 40 minutes
Group A and B osteopaths entered the NICU at different times of the day.

The authors explained blinding as follows:

NICU staff was blinded to patients allocations, since all infants were at least touched by osteopaths from group A and B and osteopaths spent the same amount of time in front of incubators and/or beds. Moreover osteopaths were unaware of study design and outcomes.

I read the methods over and over again and this explanation is either untrue or there is an error somewhere. Infants were not at least touched by osteopaths from each group. The control subjects were touched only by group A osteopaths, who then stood by the bedside (doing what, we don’t know) for an additional 10 minutes. Study subjects had this same evaluation and bizarre “standing” gimmick, and then at another time had an additional evaluation by group B osteopaths followed by an OMT session. I don’t see how group A osteopaths standing by the bedside for ten additional minutes after their evaluation accomplishes anything, since the study infants will again be visited by a second osteopath. NICU staff would certainly see that two different osteopaths were visiting the study infants. There is no blinding here as far as I can tell. The authors describe further “blinding” as follows:

Osteopaths from group A and B entered to the NICU in different hours of the schedule days, to provide blinding and to avoid possible confounding.

Even if there were different NICU staff working at these times, they could easily discuss their observations with one another. Again, this is not blinding. Of course, the treating osteopaths could not have been blinded.

So we know the methods are flawed and prone to producing biased and confounded results, but let’s discuss the intervention, which itself defies all Bayesian rules of logic. For those of you not familiar with the precepts of osteopathy, the fantasy is rich:

The aim of the structural examination is to locate the somatic disfunction [sic]. In newborns the structural exam is usually performed with the infant lying down on the table. Diagnostic criteria for somatic disfunction [sic] are focused on tissue texture abnormalities and tone. Areas of asymmetry and misalignment of bony landmarks are evaluated. The quality of motion, its balance and organization are noted.

If this sounds to you like hocus-pocus, you are not alone. Structural, anatomic assessment is obviously important for detecting a wide array of newborn problems and is, of course, performed every time an infant is examined. But the osteopathic evaluations described above purport to detect subtle findings reflecting complex, systemic, physiologic processes. They claim to detect vague alterations of texture, tone, and alignment indicative of the overall physiologic state of these premature infants – a tidy package of physiologic dysfunction that is somehow contributing to their need to remain hospitalized. As with other forms of CAM, there is a drastic oversimplification at play here, of phenomena that are very complex. To claim that a premature infant’s hospital stay may be prolonged by physiological “imbalances” that can be predictably detected by an osteopath’s trained, hands-on assessment, and which can then be treated with simple manipulations, is not just fantastical and wishful thinking, it is a massive simplification of a very complex physiological reality. A reality over which no “traditional” practitioner would ever claim such mastery and control. Because these telltale stigmata do not actually exist, inter-rater reliability for osteopathic evaluations would be expected to be poor or non-existent, as has been shown in the few studies that have looked at it (Giles, 2011, Wirth-Pittullo et al., 1994, Pattyn et al., 2013). The “dysfunctions” identified by the evaluators in this study are not stated but are presumed to be related to significant and complex issues keeping these infants in the NICU, since the manipulations concocted to relieve them resulted in an improved LOS. Several hypotheses for how OMT may be working here are put forth in the discussion section of the paper. These include possible anti-inflammatory effects, and bringing “balance to the sympathetic and para-sympathetic inputs, creating an improvement of newborns clinical condition.” I will not be discussing the evidence for the benefits of touch and massage on newborns in the NICU (there is some interesting data on this), but this has nothing to do with the imaginary structure-function claims of osteopathy. Even if the hands-on interventions of the osteopaths in this study did truly improve the LOS for these infants (and this cannot be assumed from the evidence in this study), it in no way validates the mechanistic claims of osteopathy. If there is benefit to hands-on touch and massage in neonates, that’s one thing, and that is an interesting and potentially valuable thing to study. But it says nothing about and does not require the existence of osteopathy, which is based on non-existent relationships and false assumptions about anatomy and physiology.

Osteopathy today

There are large regional and individual differences in the ways in which osteopathic providers practice OMT. Different countries have their own regulations and even definitions of osteopathy. Though individuals trained as osteopaths in the 19th and first half of the 20th century practiced in a fashion closely aligned with Still’s original dogma, osteopathic training and practice in the US over the last half century has changed dramatically, coming to resemble traditional modern medical training and practice in nearly every respect. In the United States, there are two types of medical schools that confer degrees bestowing equivalent privileges to practice medicine and surgery. The DO curriculum in the US is now indistinguishable from that of the MD curriculum of traditional medical schools, with one glaring distinction. A vestigial, non-trivial remnant of osteopathic teaching has been retained and remains, at least for the sake of appearances, at the heart of the mission of these schools. While osteopathic schools also claim distinction by focusing on a “holistic” approach to health and on disease prevention, this is a false distinction as traditional medical schools place this approach at the core of their missions as well. Despite the one true distinction between traditional and osteopathic medical school (the focus on osteopathic manipulative therapy), a minority of DOs continues to practice OMT once they finish their training (Johnson et al., 2001). My experience working with many DO students and graduates is that most do not choose this path to a medical degree because of the DO component of the training, but because of the less competitive nature of the admissions requirements. The traditional DO student body has tended to be older and have lower GPA and MCAT scores than that of traditional medical schools. Probably a plus, it has also tended to be comprised of students with more diverse, non-traditional backgrounds. These distinctions, however, have grown smaller as traditional medical schools have broadened their perspective about what characterizes a good candidate. More and more, medical schools are seeking individuals with broader, more well-rounded backgrounds, often looking toward the liberal arts for their prospective students. So other than a lower admissions standard and the focus on a pseudoscientific belief system, there is no difference between the two educational systems. So why should this two-tiered system even exist? It is time to rid ourselves of this pre-scientific, dual system of medical education. It is time to acknowledge that there is no such thing as osteopathy, and focus our efforts on improving our science-based approach to medicine.

Posted in: Clinical Trials

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243 thoughts on “Osteopathy in the NICU: False Claims and False Dichotomies

  1. Stephen H says:

    I suggest there are some warning words to look out for whenever someone it discussing a field of endeavour. These will include:

    - Quantum
    - Holistic
    - Natural
    - Inter-related
    - Disfunction
    - Balance
    - Energies
    - Asymmetry
    - Healthful or healthfulness
    - Midichlorians.

    While most of these terms have valid uses, they tend to be over-represented in certain areas of quackery. They have been misappropriated, and do not mean what the utterers think they mean.

    Please feel free to add to this list.

  2. windriven says:

    “More and more, medical schools are seeking individuals with broader, more well-rounded backgrounds, often looking toward the liberal arts for their prospective students.”

    And this is a good thing … why? Someone with a degree in Art History is unlikely to have a particularly well grounded understanding of science. Not impossible. But not likely. They are not going to be given a well grounded introduction to and appreciation of science in medical school; so much to learn, so little time. Is this how we end up with MDs offering aromatherapy and mind-body spiritual healing? I don’t know. But I don’t think these often come from the ranks of molecular biologists and physical chemists.

    1. DerBlutendeRabe says:

      If ever there was a degree course that should be banned outright its the Liberal Arts degree.

      Whats the point of learning a smattering of subjects, which were considered important in ancient Greece. You’d be better off taking one of the components of Liberal Arts as a hobby, rather than waste 4 years of your life in college.

      I’d love to see a liberal arts student try to survive a professional degree course such as medicine.

      1. goodnightirene says:

        That’s just about the most insulting thing (personally and academically) that I have ever read. My guess is that you are too young to remember a time when people got a broad and diversified education in order to be–educated. There was a time when education was separate from job-training.

        A liberal arts major has to take science courses (most places) just as a science major has to take English and some other non-science courses. In spite of the that, I agree whole-heartedly with Windriven. A liberal arts major should NOT be a med school candidate unless he or she has a solid grounding in at least one physical science. I would include Anthropology because it includes a thorough grounding in the History Of Science, the life and work of Darwin, and a basic study of Human Biology with a good deal of critical thinking taught throughout the curriculum, especially in Archaeology and Physical Anthropology. I am aware there is a movement to dumb down my field by diluting the best science aspects of it. I fervently hope this doesn’t take hold or spread.

        I have encountered DO’s at my large regional medical center/teaching hospital and haven’t made a fuss, but I keep my woo-antenna up. I try to assume that he or she really wanted to be a doctor but just couldn’t get into regular medical school for some “unfair” reason, but, but that may only be tooth fairy logic! These days, however, I remain fairly skeptical of any medical practitioner until I know otherwise. Sad.

      2. PB says:

        Obvious troll is obvious.

      3. Chris says:

        “I’d love to see a liberal arts student try to survive a professional degree course such as medicine.”

        Then get a copy of Dr. Hall’s autobiography, Women Aren’t Supposed to Fly. Her undergraduate degree is in Spanish:
        http://www.sciencebasedmedicine.org/editorial-staff/harriet-hall-md-associate-editor/

        1. Harriet Hall says:

          And my med school classmates included a classics major, a music major, and an English major. The English major became a pulmonary specialist, an academic, and did research that was published in the New England Journal of Medicine.

          Remember that the med school admission requirements include plenty of undergraduate science, enough to constitute a solid scientific foundation.

          1. nancy brownlee says:

            Lewis Thomas wrote an eloquent argument for just this- even for the elimination of “pre-med” as an undergraduate major. I don’t remember in which of his several collections of essays it appeared – maybe in ‘The Youngest Science’. That book is still a wonderfully articulate and accessible history of twentieth-century medicine, from the perspective of a fine physician who was the son of a ‘country doctor’.

          2. Chris says:

            Rats! My comment disappeared.

            Short version: There are a series of podcasts put out by a professor of virology at Columbia University. They are “This Week in Virology”, TW in Microbiology and TW in Parasitology. They mostly consists of four folks talking about papers, news, etc. But they often have guests (like Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases of NIH).

            When there are guests they ask how they got their start. And sometimes the researchers started in humanities, and switched. I think one was a concert pianist. Dr. Fauci’s dad had a pharmacy in Brooklyn.

            (I had two links in the comment that disappeared, so I am not doing that again)

            1. windriven says:

              Chris,
              You still seem to be plagued with posting issues and I still wonder if it isn’t related to your login. Might be worth trying one through gmail just for grins.

              BTW, I signed up for TWIV last night.

              1. Andrey Pavlov says:

                I spent an afternoon with the web guru at SBM running tests to get the posting thing sorted out. We thought we had it taken care of – it seemed to work for me. Is anyone else besides Chris still having significant issues?

              2. Chris says:

                I am using gmail!

              3. Chris says:

                It was one comment, and it had two links. One of them to the TWiV website.

      4. weing says:

        “Whats the point of learning a smattering of subjects, which were considered important in ancient Greece.”

        I don’t know. I had a liberal arts education. Major in psychology and minors in chemistry and biology. I don’t look at any of my courses as being a waste. There is a culture that is passed on, without it we may just get degrees without the Western culture and end up with something like the educated Islamists with degrees but without our values.

        1. Andrey Pavlov says:

          I agree with you weing. I did say that I think a science curriculum is indeed vital and it strikes me that a double minor in chem and bio would be plenty solid a foundation. But I absolutely do not discount LA type classes. I used to, but as I have learned more I’ve grown to really appreciate their value. They must be taught well, but that goes for the sciences also.

      5. WilliamLawrenceUtridge says:

        Whats the point of learning a smattering of subjects, which were considered important in ancient Greece.

        Because the roots of Western culture run deep into the myths, legends and thinking of the Romans, Greeks and even further back.

        Because roots are worth exploring, independent of where you come from or whether you share those roots.

        Because even if you solved every technical problem in medicine and engineering, there would still be wonders and experiences to amaze us in the infinite inventiveness of the human mind.

        Because I ended up in a profession that bears no resemblance to my education, and I regret nothing about either.

        Because we need something to balance out the accountants and lawyers.

        1. Calli Arcale says:

          Well said, WLU, well said.

          I went to a liberal arts college that is reknowned for many different disciplines, but particular for its chemistry program. It turns out a huge number of students who go on to medical school. My father was one of them, double-majoring in biology and chemistry.

          My own degree is in English, with a minor in Computer Science. I was originally going for an English/Chemistry double-major, but fell in love with the computers and that was the end of that. ;-) It did leave me a little more time for electives, at least, and I wouldn’t trade it for anything.

          Bottom line: the quality of the degree program is more important than the actual letters it bestows.

          1. weing says:

            I was under the impression that a good liberal arts education gave one the tools to properly learn anything they chose to. Whether they had studied it before or not.

            1. WilliamLawrenceUtridge says:

              I have to disagree here, at least in terms of pure practicality. I’ve edited wikipedia, a lot. Much as people mock it, editing wikipedia is a fantastic way to learn about a topic, particularly when it is already a well-developed article. This task drove home to me just how difficult it is to master a topic, let alone a discipline. While a good liberal arts education may in theory give you the “tools to learn”, what is really needed is at least an undergraduate degree in the topic at hand which will give you the cognitive tools needed (in the form of the facts and paradigms of the discipline). Wikipedia drove home Dunning-Kruger, it was a lesson in humbleness.

              While one may master a discipline, even two, ultimately the limitations of humans are far to vast to ever allow one to learn about anything one chooses to, unless you are talking about a very, very small number of areas. People like Jared Diamond and Noam Chomsky stand out because they manage to contribute original research in more than one area.

              The kind of detailed, multi-faceted background one needs to really learn about a discipline essentially mandates at least an undergraduate level of learning – and I would venture that 50% of the value found there is from being forced to work through problems (i.e. homework) that is not found outside of some sort of schooling. I think it’s hubris for someone to say that they “learned to learn” in school and thus can master any topic from there – be they an engineer (speaking of disciplines that foster arrogance – not all probelms have a mathematical solution) or a liberal arts major. At some point you run into the limits of time and neural capacity. At best we can be a master of two, and a dilettante in many.

              As I try to expand my reading to cover more areas, I am forced to recognize that if I wish to sip at the knowledge found therein, I must perforce leave off the reading of primary sources that one must read in order to drink deeply.

          2. Andrey Pavlov says:

            Bottom line: the quality of the degree program is more important than the actual letters it bestows.

            Agreed.

    2. PB says:

      Keep in mind that all schools have pre-requisites for admission related to taking necessary biological/chemistry/physics coursework. It’s a bit silly to suggest that simply because someone wants to major in art that they don’t have the mentality to handle serious science. In fact, most schools are now requiring students to have coursework related to social sciences – psychology and sociology, specifically.

      It seems like you would want a physician who was well-rounded in his educational background – assuming they had the medicine bit down.

      1. goodnightirene says:

        “assuming they had the medicine bit down.”

        That’s the key. As increasing numbers of MD’s embrace pseudoscientific practices, you have to wonder just how science is being taught, to science or non-science majors. So perhaps the single most important question should be: What is your critical thinking score?

        1. weing says:

          “So perhaps the single most important question should be: What is your critical thinking score?”
          In some universities, critical thinking is covered in the English department.

        2. Guess what guys, modern medicine, in the clinical setting, requires very little critical thinking, it is all push button. I am glad to see more school incorporating CAMs which allows them to thinking out of the box and use their brains.

          Gee the push button aspect of medicine can be set up in a kiosk in walmart or 7-11 and in a lot of cases a good idea.

          1. WilliamLawrenceUtridge says:

            modern medicine, in the clinical setting, requires very little critical thinking

            Perhaps the way you practice it.

            I’m sure much of modern medicine is based on repetitive interactions and diagnoses. That doesn’t mean all of them are. Doctors are primarily there for when it’s not a horse, but a zebra.

            How is using a whole bunch of improbable modalities “using their brains”? I mean, you have to actively avoid thinking about the mechanism, or not know a damned thing about it. Not that it matters, since most are inert, bar herbal medicine and the risk of organ puncture or infection with acupuncture. CAM is the very opposite of using one’s brain, it’s the suicide of reason and the abandonment of several centuries of carefully-acquired knowledge about the human body, virology, bacteriology and more. CAM is nothing but nonsense invented before people knew anything about the body brought into modern times and applied without critical reflection.

            Geez Stephen, your day must be so hard. You have to think about where to put the needle (not that it matters) and whether or not you’ve swabbed the site with alcohol.

            1. @WilliamLawrenceUtridge, You have just exposed the fact that you are unfamiliar with Acupuncture or CAMs or OMM. What type of work do you do? Are you a regular contributor to this site? Maybe you should just focus on your speciality, like I do?

              Acupuncture is safe in a well trained person, (not even a doctor or nurse, anybody can be schooled in the basics as long as they understand the basic admonitions).
              The needles are non-traumatic as oppose to a huge 20-18g needle used to do a biopsy or intraperitoneal study. These little needle will glide thru a blood vessel or nerve without trauma.
              I use them around the eyeball in the sockets with ease.

              NO need to clean the skin unless the person works in a slaughterhouse or cleans up poop for a living. I do wipe and clean the feet if someone has a foot problems and comes in wearing open sandals.I have used tens of thousands of needles and no injections.

              I’ve been in medicine for 30 yrs, seen thousands of patient with tens of thousand patient encounter … My light is still on, my level is plumb and my elevator goes up to the top floor. I’ve duped by my own logic and have been duped by cases and caught with flat footed many times. That is the world of clinical medicine.

              You false assumptions:
              Any nurse with a few extra hours of training can see 80% of what a primary care provider handles. It is mostly roth and vending machine. (This is good actually because we need more providers.)

              Naturopaths do not ignore modern medicine, we combine the best of both world and discard the crappy stuff. We don’t take chances with peoples lives and we rule out all of the dangerous stuff.

              1. WilliamLawrenceUtridge says:

                Why do my qualifications matter? Is it because you find it frustrating that you can’t reply to the substance of my points and are looking for a reason, any reason, to dismiss them?

                The needles are non-traumatic as oppose to a huge 20-18g needle used to do a biopsy or intraperitoneal study.

                The difference, of course, is the recognized benefits that come with using those “huge needles”. Unlike acupuncture.

                NO need to clean the skin unless the person works in a slaughterhouse or cleans up poop for a living.

                That’s terrifying.

                Naturopaths do not ignore modern medicine, we combine the best of both world and discard the crappy stuff. We don’t take chances with peoples lives and we rule out all of the dangerous stuff.

                So you’re a naturopath? That explains your embrace of nonsense and hostility to real medicine.

                So where’s that definition of acupuncture you said you had? I’m very intrigued to know how I’m getting it wrong, despite apparently know a lot more about the scientific and historical foundations of the practice than you do. Please, enlighten me. Enlighten us all.

              2. Sawyer says:

                NO need to clean the skin unless the person works in a slaughterhouse or cleans up poop for a living.

                followed by

                We don’t take chances with peoples lives

                I’m speechless. I want to explain the absurdity of these two sentences, but no words in the English language can match the ridiculousness SSR has already provided.

                SSR, for your own sake and for the future of acupuncturists everywhere, please stop posting. You’re only making things worse.

              3. windriven says:

                It isn’t going to happen, Sawyer. SSR celebrates his delusions and wants to share his credulity. Like a flasher he is eager to expose what little that he has, then mistakes the slack-jawed horror of onlookers for awe.

              4. Gee, from my view you guy are “nobodies” “avatars” with no credibility. Yes you guys are trapped in a self imposed dream.

                As for Acupuncture and acceptance; it will not happen unless it is displayed in reality and not stuck in the ancient mythology. There is truth to needles but not what you may think.

              5. windriven says:

                @Sawyer

                Told ya so ;-)

              6. WilliamLawrenceUtridge says:

                Gee, from my view you guy are “nobodies” “avatars” with no credibility.

                Meanwhile, having a picture next to your name somehow grants credibility to your claims, despite them being little more than “in my experience”.

                Yes you guys are trapped in a self imposed dream.

                And you’re trapped in a self-confirming loop.

                As for Acupuncture and acceptance; it will not happen unless it is displayed in reality and not stuck in the ancient mythology.

                On that point we can agree; the issue is then what standard is an acceptable one against which to judge. For you, as long as your patients report feeling better, it’s enough. For most of the contributors and commentors, it is careful research and scientific controls that are convincing. That’s why you are continually ridiculed here.

      2. windriven says:

        PB,
        I was quite careful, or tried to be, to indicate that a liberal arts education (Oberlin boy here) does not preclude an understanding of science – only that in many liberal arts programs it is if anything an afterthought.

        And I NEVER said or suggested that “someone [who] wants to major in art [doesn't] have the mentality to handle serious science.

        But science is not just a class or a series of classes. It is an approach to understanding reality. Like art history or French Romantic literature it requires both specific knowledge and a broad and fairly deep context in which to place it. It is not as simple as, as Ted Kaptchuk once proclaimed, “i needed to be a scientist so I became a scientist.”

    3. bluedevilRA says:

      windriven, do you have any evidence that liberal arts degree students are more likely to subscribe to woo than science majors? I know plenty of quacky science majors and plenty of science-based humanities majors. I was a history major with bio and chem minors (for pre-med) and I feel that history taught me a lot more than my science classes about critical thinking. History classes are about digging through primary sources and weighing them against each other based on reliability. This is no different from what I do when I search pubmed.

      1. windriven says:

        “windriven, do you have any evidence that liberal arts degree students are more likely to subscribe to woo than science majors?”

        Nope. Nor did I claim any.

        “History classes are about digging through primary sources and weighing them against each other based on reliability. This is no different from what I do when I search pubmed.”

        And you make at least part of my point for me. I have particular interest in the presidencies of Thomas Jefferson and Theodore Roosevelt. I have read quite widely on both and believe that I have a good understand of these men, their presidencies, and their legacies for an amateur. I would never begin to presume my knowledge or understanding of TR to be remotely in the same league as Edmund Morris or Doris Kearns Goodwin. I have many of the specific bits of data, but I lack the broader context and the professional’s grounding in historical analysis.

        1. bluedevilRA says:

          “Is this how we end up with MDs offering aromatherapy and mind-body spiritual healing? I don’t know. But I don’t think these often come from the ranks of molecular biologists and physical chemists.”

          You seemed to be speculating that liberal arts degrees predispose one to quackery, which is why I asked if you have any evidence. To be fair, I have nothing but anecdotes to offer in return.

          I’m unclear on your last point. As an amateur historian you do not feel you have same level of context as an expert? I feel like that’s to be expected, right? A first year med student does not have the same level of context for medicine as an attending, but I feel it has little to do with the person’s undergraduate major. Everyone has to take a minimum of 8 science courses (2 semesters each of general chemistry, organic chemistry, physics and biology) to go to med school. I don’t think someone that takes 15 or even 20 science courses in undergrad is better trained to interpret clinical studies. As someone else pointed out, science courses have become more about rote memorization rather than critical thinking. What we need to do is teach critical thinking (both in undergrad and in med school).

          1. windriven says:

            My point, bluedevilRA, was that a scientific footing is not gained in a class or two, that it is an approach to reality that is not necessarily cultivated in liberal arts programs.

            “As someone else pointed out, science courses have become more about rote memorization rather than critical thinking.”

            I don’t know this to be true. It certainly isn’t true in my experience. But then my formal education is decades old.

            “What we need to do is teach critical thinking (both in undergrad and in med school).”

            Here we agree in totality.

            1. bluedevilRA says:

              Yeah I think we agree overall, we just have different personal experiences. My liberal arts experience was very pro-critical thinking, but I can easily see where classes would be devoid of scientific literacy. An art history class isn’t meant to teach science, after all. I think the lack of science teaching in science classes is also true to some extent, but it’s hard to say. Stupid limitations of personal experience…

              My dream job is to be clinical faculty while teaching a critical thinking course (probably tied into a biostats/journal club course) at a med school. Just gotta get through residency and find a place that’ll hire me to teach :)

              1. Andrey Pavlov says:

                I tend to side with you on this discussion bluedevilRA. I think it is perfectly possible to have liberal arts degrees teach excellent critical thinking and science degrees teach very poor critical thinking. I also am unaware of any data to definitively answer any form of the question “Are liberal arts majors more prone to woo than science majors.” So everything we discuss should be recognized as speculative and anecdotal.

                That said, my speculation is that it seems reasonable to think LA degrees would tend to attract more woo-prone thinkers than science degrees, if nothing else than for the PR that each gets. Sciences are “hard” and “rigorous” and “stuffy.” LA is “creative” and “free” and “expressive.” Obviously I am not doing the ideas justice, but hopefully you grok my point.

                Things have undoubtedly changed since windriven and Dr. Hall went through their educations. On all fronts, I would argue, education has become more plentiful and with this plenty, much of it has become watered down garbage. Much of it is still excellent. My own education is the prime example of it and I have discussed it many times so I won’t bore everyone again.

                All that said, my argument for a requirement of an actual science degree to get into med school rather than just any bachelor’s degree plus the requisite science coursework is twofold. First, based on my speculation above, one is more likely to have a more critically thinking candidate pool. Once again, not because LA is inherently less critically thinking but because I believe it tends to attract those that are either afraid of or dislike science in addition to those who want to approach it critically and academically.

                Second, is that there is a lot of science to know. While the above is a lot of speculation (and while I am comfortable making the speculation would have a very low threshold for changing my opinion with evidence), it is not speculation that understanding medicine requires knowledge of science. Science is built on foundations. One is not very likely to learn those foundations in med school very well and even less likely later in their careers. My Bernoulli principle example is one of myriad I could lay out (anecdote, I know). To be good at anything you must focus on that thing. I agree with the idea of mandating a minimum number of sociology/humanities/philosophy/ethics/whatever courses as part of the requirement for applying to med school. But it does not seem to make sense to me to have an entirely different degree and focus then suddenly change over to medicine. And yes, you must take those courses, but to say that they provide a really solid foundation of science is a stretch. They are, IMHO, an absolute barest minimum. And most doctors don’t actually remember or apply any of the organic chemistry they learned – it is just something to get through for the requirement, the MCAT, and then forget it. I have actually used my old ochem skills to demonstrate to everyone why a certain test we were doing on a particular patient in the ICU would be expected to fail (it was a drug test and nobody – not even the lab techs – could answer definitively whether suboxone would be picked up by it. I got the manual for the test from the lab, read it in detail, and then drew out chemical structures to demonstrate that no, it could not possibly pick up suboxone).

                Are these sorts of things absolutely necessary to be a physician? No. You can be a perfectly decent physician without that sort of in depth knowledge. The problem is that while we should technically know this, most in our field are viewed as and view themselves as experts on the science of medicine as well. And I would argue that you cannot be an expert on the science of medicine without extensive science background and training – specifically in the relevant sciences. Yes, you can have an LA degree and be a pulmonologist published in the NEJM, but that is the exception not the rule (or, these days, because peer review standards are dropping). This is compounded by the fact that the US degree of “MD” is considered equivalent to a doctoral PhD and they are not the same. An MD, strictly speaking, is a vocational degree not a doctorate. Which is perfectly fine and necessary, and you don’t need a PhD to do science (I don’t have one), but then you get the likes of Dr. Oz, Weil, Guarnieri, etc who feel that they have the authority to speak on such things when they don’t. Or at least it sure seems like they don’t.

                What I am getting at is that just an MD is a technical degree, not a scientific one. Yet we treat it like it is a scientific one. Which, in many cases, would be like asking a certified auto mechanic how to design an engine.

                My friend with the LA background is an excellent critical thinker and knows he is not a scientist. He does research, but doesn’t lead it. He defers to actual experts and doesn’t pretend to know better and buck the consensus.

                I guess it all ends up boiling down to proper education (regardless of field) and humility to know what your limits are. But I’ve seen many colleagues get very puffed up over holding an MD and think that means they are experts on the very science of medicine when they don’t even properly understand what a P-value actually is.

                Requiring a degree in science would help in many respects, but is obviously not a miracle solution. As one of my attendings said, a duck with a PhD is still a duck.

              2. Harriet Hall says:

                “an MD is a technical degree”

                I didn’t want just training in a vocation; I wanted a college education. I wanted to learn about history, literature, foreign languages, philosophy, art, music, etc. as well as every branch of science. I was interested in everything: when I first looked at the college catalog I wished I could take every course. I wanted to be a cultured, well-rounded, well-educated person with a broad fund of knowledge who could carry on an intelligent discussion and command respect in any setting. I wanted to be “that” kind of MD, not just a competent technician whose knowledge was limited to science. My Phi Beta Kappa key may not have made me a better technician or a better scientist; but I think it made me a better human being and a better clinician.

                And by the way, I remembered Bernoulli from my physics class.

              3. StaphofAesclepius says:

                A little bit of a rant here. If we’re all throwing around “anecdotal evidence” and speculation about LA majors, I’d like to put in my perspective. I despise “tooting my own horn” because I think medicine is rife with egocentric people that have lost the skill to listen and always know better than everyone else, but I am an example of what apparently is someone more likely to be a woo-leaning medical student simply because of what I chose to study in undergrad.

                I was a foreign language major. FL is about interacting with people much different than yourself. I enjoyed it, lived abroad, and had a decent time in college. I like to think that it helps me interact with patients, but who knows. I took the same prerequisites everyone else took to get in to medical school. I took the same MCAT that everyone takes, unless you’re a student at the Icahn SOM at Mt. Sinai (and that school produced Scott Weingart – show me someone who is more evidence based and more critical thinking than that LA major?) I competed for the same spots as every hard science major, biology major, etc., and by some miracle I was found to be a better fit than the others vying for that spot in the inconsistent magical quagmire of medical school selection.

                Medical school isn’t a continuation of undergraduate science courses. I can say that none of my undergraduate courses in science did much to prepare me for medical school, and I don’t think the current pre-requisite and undergraduate education model is very good (I am speaking for the US alone, I know our undergrad system is different than many other countries). My MCAT performance compared to others in my class has not determined who is most successful at the academic curriculum, or who has the best bedside manner. It was a hoop I had to jump through to get in and start learning things that actually matter (sometimes). The information is more dense, more intense, and the volume is much higher. Having everyone be a science major or minor doesn’t add anything to the pool of physician candidates and doesn’t mean that they are going to be better critical thinkers. I have yet to meet someone that said “wow, I am so happy I decided to get a degree in because it has made me such a better doctor.”

                Success in medical school, and who you are/will be as a physician has more to do with your personality and motivation. The same is true for critical thinking. Critical thinking isn’t easy- it’s not something you can just lazily apply unconsciously and expect to get results. Many of my classmates came from hard science backgrounds, had much higher scores, went to much “better” schools than where I went, yet it has not made them better students or performers. The same science majors, with impressive pre-med CVs including research at the NIH, that apparently would make better candidates than me are the ones who believe in alternative medicine or the power of acupuncture. Not because they were taught it in undergrad, but because they either don’t care and think it funnels not-sick people away from real medicine and it “probably doesn’t hurt” (shruggies), or because they are prone to believe the hype without applying their “superior” scientific knowledge base.

                Your education is what you make it. I am in the top 10% of my class because I work hard, I am motivated to be a competent physician, not because I took x and y chemistry classes in undergrad or have a piece of paper on my wall that said I earned a degree in science. I am involved in clinical research, and many extracurriculars because it is important to me that I make the most of my education and stay well-rounded, even if it is now just in the narrow confines of medicine. Am I a scientist? I don’t know what that means other than a vaguely broad job title, but I am becoming a physician that utilizes critical thinking because that’s part of my personality, not because I was or wasn’t “taught” it in undergrad. Can it be taught? Sure, but I doubt that that is the focus of any undergrad science or liberal arts degree.

              4. weing says:

                @StaphofAesclepius,
                Well said.

              5. Andrey Pavlov says:

                @Dr. Hall:

                I feel the same way. That is why I ended up getting a BA and a BS and I graduated with way more units than I needed for either. In fact, if I’d hung out for one more year and taken the right classes I could have had a 3rd undergrad degree.

                But the reality is that medicine as a profession began as and was modeled as a vocational occupation. It has changed, quite a bit, but that fundamental model is still there. If you read the autobiography of Gene Stollerman it is pretty clear – the clinicians were extremely separate from the scientists and he was breaking the mold by being both.

                I also think that being a well rounded individual with actual life experience makes for a better physician. I actually know a guy who, as an intern – an actual doctor! – celebrated his 22nd birthday. Nice guy, but even he lamented about how difficult it was for him to relate to patients and have a conversation with them.

                The point is that there is no perfect solution to any of this, but that we do have a legacy in our profession that has bearing on the reality of the situation. There is no one single point that is “wrong” and can be “fixed” (whatever that would even really mean). But I have been observing – and in my current discussion with the Christian Scientist Karen can see it – that if you have “MD” after your name suddenly you have authority to speak on the science of things. And if you say “science is this way” then your words carry weight in a way that a certified auto mechanic saying “engines should be built this way” would not get. And yet, the curriculum of med school does not actually train you to actually have the expertise needed for that authority. That is not to say that you can’t get it yourself – I feel like I am working towards that myself. But it means that you are not required to have it upon graduating from med school. Which is why we have “clinician-scientist” pathways. And why in every country but our own, “MD” is a different degree with different meaning and different requirements than “MBBS” which is the basic medical degree. In Australia they call MBBS a “Level 7″ professional degree and the MD a “Level 9″ and there are different requirements of research and scientific training that are closer to that of a PhD than what we call an MD.

                Which, once again, is fine. We do not need (or even perhaps want) all physicians to also be scientists. But many of us still fancy ourselves that way and can thus make profoundly stupid claims that carry too much weight and undeserved authority.

                StaphofAsclepius makes some excellent points. And yes, I’ve already said multiple times that it doesn’t matter what discipline you come from you can still be a sloppy thinker. Obviously we see Francis Collins and it is very, very clear that in certain aspects he is a very uncritical and sloppy thinker. So no, having a science background is not entirely necessary nor a guarantee of anything.

                But when people say things like StaphofAsclepius that:

                Medical school isn’t a continuation of undergraduate science courses. I can say that none of my undergraduate courses in science did much to prepare me for medical school, and I don’t think the current pre-requisite and undergraduate education model is very good (I am speaking for the US alone, I know our undergrad system is different than many other countries). My MCAT performance compared to others in my class has not determined who is most successful at the academic curriculum, or who has the best bedside manner. It was a hoop I had to jump through to get in and start learning things that actually matter (sometimes). The information is more dense, more intense, and the volume is much higher. Having everyone be a science major or minor doesn’t add anything to the pool of physician candidates and doesn’t mean that they are going to be better critical thinkers. I have yet to meet someone that said “wow, I am so happy I decided to get a degree in because it has made me such a better doctor.”

                I’m befuddled. For me, medical school was a continuation of my undergrad science education. I used all those principles I learned every single day to better learn the material, how it applies in humans, and how medicine actually works. The MCAT was just a hoop to jump through? It tested concepts that I invoke regularly in my understanding of medicine. I still read up on evolutionary biology and find that it helps me understand and remember medicine better. I can say, unlike Staph, that a great many of my undergrad courses very, very much prepared me for medical school and made my studies a lot easier. And I could see the contrast with friends who were not from a science background. A concept that would take me 5 minutes to fully understand and remember took hours of me explaining background information – from my undergrad classes! – so that they could understand it. So while I can understand how you don’t need those classes in order to do well and succeed in medical school and as a physician, I just don’t understand how one can say that their undergrad (science) classes didn’t do much to prepare them for medical school.

                It is actually well documented that MCAT score correlates strongly with both Step 1 performance and grades in the pre-clinical years of med school and to a lesser degree with clerkship grades. That doesn’t mean a high MCAT guarantees success or a low MCAT precludes you from it, so folks like Staph can certainly be on the edges of the distribution there. But to imply that is has little bearing and is just a hoop to jump through… I disagree.

                Particularly to say that then you can “learn things that actually matter…” I think that knowing how steric hindrance can affect molecular receptor and ligand affinity matters. I think that Bernoulli’s principle matters. And I think that these often matter just as much as anything you learn in medical school.

                So I really disagree that a science degree doesn’t add anything to being a physician.

                And StaphofAsclepius, let me say hello and ““wow, I am so happy I decided to get a degree in [evolutionary biology] because it has made me such a better doctor.” Now you’ve met at least one.

                Success in medical school, and who you are/will be as a physician has more to do with your personality and motivation. The same is true for critical thinking. Critical thinking isn’t easy- it’s not something you can just lazily apply unconsciously and expect to get results. Many of my classmates came from hard science backgrounds, had much higher scores, went to much “better” schools than where I went, yet it has not made them better students or performers. The same science majors, with impressive pre-med CVs including research at the NIH, that apparently would make better candidates than me are the ones who believe in alternative medicine or the power of acupuncture. Not because they were taught it in undergrad, but because they either don’t care and think it funnels not-sick people away from real medicine and it “probably doesn’t hurt” (shruggies), or because they are prone to believe the hype without applying their “superior” scientific knowledge base.

                I agree with this fully. But that does not mean that a science degree doesn’t add anything to your ability to be a physician. Yes, there are plenty of physicians I know who say that their undergrad science did nothing for med school and that what they learned in the first two years of med school they don’t even remember and it doesn’t even matter. First off, I call BS on that. You may be successfully ignoring a lot of it, but you must be using a lot of what you learned. But in any event, I find it appalling when physicians say that. It is an implicit argument that medical school can be a two year program straight out of high school.

                As for those classmates who come from science degrees and did NIH stuff… yeah, that is a failing of their education and their personalities. It is also a prime example of Dunning-Kruger and the danger of knowing a lot but not enough. That isn’t an indictment of the principle of science education adding to being a physician, it is a demonstration of how hubris can make you look like a fool.

                Once again, yes – LA degrees are valuable in their own right. They can and do produce critical thinkers and excellent physicians. The real discriminator is your own personality, motivation, and ethos regarding critical thinking. No doubt whatsoever. But to try and argue that undergrad science does not add to your ability to be a physician, that the MCAT is just a hoop to jump through to go learn “what really matters,” is precisely why I had a group of 80 students who could not understand dynamic airway closure because for them, learning the physics of fluid dynamics was “a hoop to jump through” for the MCAT which they promptly purged from their memories afterwards.

                So no, I vehemently disagree that undergrad science and MCAT is just a hoop to jump through and that med school (or at least the process of learning medicine) is not a continuation of (and expansion on) undergrad science classes (it is also, IMHO, a continuation and expansion of my humanities and anthropology classes as well). That doesn’t mean that I think they are necessary to be an excellent physician or that LA degrees are useless and foster sloppy thinking.

    4. Kultakutri says:

      I have a degree in art history. I find your statement mildly offensive; while there is different methodology and apporaches than in ‘hard’ sciences, one damn well has to know what they are doing and why they are doing it. I admit that I met quite a few wooey types back at school but this blog is a proof that even M. D.s are not woo-resistant.

      1. Stephen S. Rodrigues, MD says:

        Most physicians that are in the vending machine family are only following a script dictated by the governing boards. This is what the science of medicine has provided for all of us.

        In about 20-30% of everyday office base cases people will NOT get better in spite of what doctors will do. This is where the art of medicine has to guide the provider. I use the try and see approach. Believe it or not the process is where you put the trust. Guessing is the norm.

        While the traditionalist will continue with the trial and error approach. They will rigidly offer more complex and dangerous combinations of medications until the patient dies, goes to the ER and the ICU or gets well anyway. (most get well anyway)

      2. Andrey Pavlov says:

        @kultakutri:

        Not sure if this comment was directed at me?

  3. PB says:

    As a current American DO student I can vouch for pretty much everything Dr. Snyder says with regard to how most DO students feel about OMM. Some students do/did fall for the “we’re special” woo/propaganda that DO schools spout in recruiting students, but the vast majority of us just want(ed) to be good physicians and pursued getting into whatever school we could.

    If you pushed most of us hard enough, I’m sure you could get a large chunk of students and practicing DOs to admit that there’s really no sense in having separate pathways to becoming a physician. Further most would also probably agree that, at best, OMM is really nothing more than stretching, massage, and joint popping – physical therapy type stuff, really. However, it’s only a minority of us that really do feel quite a bit of active frustration about the non-scientific nature of most of OMM. Most are just “shruggies” about OMM and the whole false dichotomy/woo portions of the “osteopathic philosophy.” The bit quoted by Dr. Snyder really sets itself up for ridicule by using flowery language, even though portions of it make quite a bit of sense, medically (structure-function relationships pertaining anatomy, innate physiological healing processes, the power of “touch” – i.e. placebo responses).

    Even among my DO/PhD peers (my school has a well-supported dual degree program and I’m a sixth year student working on my PhD, currently) there’s quite a bit of hostility toward the notion that most of the “osteopathic philosophy” is really not special or that OMM is either the stuff of physical therapy or completely bogus. We actually had Dr. Gorski come give a lecture about SBM to our DO/PhD and MD/PhD student body (our university has both DO and MD programs) and the brief appearance of “osteopathy” on a slide with other pseudoscientific beliefs had several people up in arms.

    It really is true that it’s quite taboo to talk about these topics. I’m pretty sure that doing so vocally, around the wrong people (i.e. the docs running the show), would probably get one ostracized from the DO community, which in my state is quite tightly knit.

    I could go on, but I think the message generally stands. I hope we can get some other DO students and practicing DOs to comment here as well. I’ll check back periodically if folks what to pose questions to me, specifically.

    1. goodnightirene says:

      I would like to ask your school why they continue to dress up PT as something else?

      Thanks you for commenting. It sounds like you will be a good doctor and doctor.

      1. PB says:

        OMM is essentially the only thing that separates DO from MD trainees in the US. I suspect it survives primarily out of its historical roots and because so many DOs either think OMM works the way it is proposed to (keeping in mind there are many different OMM modalities) or are just “shruggy” about it.

        1. OMM works and will alway be a part of medicine because of why it works.

          1. WilliamLawrenceUtridge says:

            How does it work Stephen? Can you explain it? Isn’t it, at best, musculoskeletal manipulation (then gone horribly wrong as it is applied to non-muscle, joint and bone conditions)?

            1. Your assumption is that we are using one alternatives blindly and doggedly inspite of the other, using OMM and traditional medicine you get a much better outcome in some cases. Especially the cases that don’t fit the push-button paradigm. In the non-vending machine cases you have to treat the entire person with all the many organ systems that should be in harmony. Muscle memory has a significant effect on health and wellbeing.

              I hope you are not asking me to explain OMM in a few paragraphs, it takes weeks of study to absorb the concepts.

              1. WilliamLawrenceUtridge says:

                OMM and traditional medicine you get a much better outcome in some cases

                What, in your opinion? How do you know the patients wouldn’t have gotten better on their own? Most low back pain patients see their back pain go away, even without intervention, over the course of months. My doctor happily wrote me a prescription for massage and physiotherapy to address my back pain.

                Why should we dogmatically accept your word as Truth? Why not John Sarno, who insists back pain is purely psychological? He also criticizes mainstream medical care, does that mean we have to accept him at his word?

              2. Stephen S. Rodrigues, MD says:

                Don’t take my word but take the word of patients who is the primary reason why we have a healthcare system.

                Oh … forgot hard core scientists don’t take the word of the patient’s as valid evidence!

                So why even ask???

  4. Dave says:

    Windriven, I tend to agree with you. I think the medical schools are trying to get more “well rounded” students because they are hearing the criticism that modern medicine is cold and uncaring. They are also swallowing the stereotype of the scientist as cold and uncaring. While it is true that when doing research scientists must not let their own feelings affect the results of the experiments, I know of no evidence that physicists or astronomers are less compassionate than English literature teachers, historians or business majors, nor that more liberal arts education makes you a better doctor. It might make you more likely to accept magical therapies in your curriculum.

  5. bluedevilRA says:

    The official terminology for a DO trained in the US is a “Doctor of Osteopathic Medicine.” Some get a little prickly when called “osteopaths” because that is the term used to describe European-trained “diplomates of osteopathy.” These are more like chiropractors or physical therapists as they are restricted in their scope of practice and can only manipulate.

    Also, there was a proposed merger of osteopathic and MD residency training programs just this past year. It seemed like a win-win. MD students would gain access to residency programs previously off limits to them and DOs would be one step closer to true equality. But of course the AOA (American Osteopathic Association) pulled out because they felt the merger did not do enough to preserve “osteopathic distinctiveness.” They seem to have to hard time defining what that really means though.

    http://www.osteopathic.org/inside-aoa/Pages/acgme-frequently-asked-questions.aspx

    1. PB says:

      Ugh. That whole thing was so frustrating. I have no intentions of doing a DO residency because I want to go into one with a strong research background (which is virtually absent in most DO residencies). We (my DO/PhD peers and I) were really pulling for this to work out. Hopefully the AOA will get it’s head out of its rear-end and go back to the table with more reasonable expectations.

      1. bluedevilRA says:

        Yeah, I share your frustration. The majority of DO students were in favor of joint accreditation, but that just goes to show you how out of touch the AOA really is.

    2. Thor says:

      I might add that in Germany there are osteopaths (more like our PTs and strictly limited to manual manipulation), and osteopathic physicians (more like our DOs). It is now required for osteopaths to pass the rather rigorous heilpraktiker exam in order to practice. Heilpraktikum is the German version of naturopathy. An acquaintance who had been practicing for years, complained that all he wanted to do was OMM, but was forced to study homeopathy, herbology, TCM, etc. He had to study on his own as he had not received ‘education’ in those subjects. He finally passed on his third try, but it was time-consuming and expensive, and a complete waste as he was not planning on implementing those aspects into his practice.

  6. Andrey Pavlov says:

    PB said it well, I think. And I’ve often commented myself that the vestigial OMM stuff just needs to be dropped, the AOA and ACGME merged, programs put under a single common standard, and everyone benefit from a larger unified science based medical workforce. But, ego often gets in the way.

    I too have worked with many DO’s from my pre-med school days as a trauma tech and all through med school. I’ve never seen one even mention OMM, let alone actually perform it on a patient.

    One thing to remember, as was also pointed out, is that osteopathy in the US is very different from pretty much anywhere else in the world. In the US it is very science based with just that vestigial OMM hanging around. In Australia they are rank quacks, right up there with chiros, homeopaths, naturopaths, and the rest. This study was done in Italy – I am not sure if their DO’s are science based like ours, but based on this study I am going to guess not. The fact that the AAP got duped into publicizing this particular study is a very poor reflection on the organization.

    As for windriven’s comments about liberal arts curricula and PB’s comment that certain classes are required for entry regardless of degree earned….

    I’m a bit torn. It is perfectly possible and indeed often the case that liberal arts (LA) type students are just as critically thinking as science students. As always, there is likely more in-group variance than between-group variance. Now, it may be reasonable to argue that those who pursue an LA degree tend to be self selected and thus less likely to be critically thinking and understand the application of science. Anecdotally this is certainly true, in my experience, for whatever that is worth. But of course, having a degree in science does not guarantee critical thought either – I hold a degree in evolutionary biology and did very rigorous science courses, acing my organic chemistry and physics courses, yet I still believed that homeopathy had legitimacy and the “East” vs “West” medicine dichotomy was real. Obviously when I got deeper into it, I was able to see how false that was.

    My point is that it is not so much the subject matter that is integral to people learning and exhibiting critical thinking skills. It is how one is taught. I was taught science reasonably well, but anthropology extremely poorly. Most of my classmates from non-science backgrounds struggled mightily in med school. Most of them didn’t lack critical thinking – they just didn’t know better when a bad idea was proposed to them. A sadly large number did espouse magical thinking. One in particular, however, is a dear friend and extremely critical thinker who knows the limitations of his knowledge. So it is, I think, unfair to simply say that someone with an LA degree will be ill prepared to be a good science based physician.

    However, I think that the idea that these are self selected groups has some credence to it. I think it may be confounded by the fact that some people want to get into medicine because they like the woo-ey side of it and go through science degrees because they know that is typically their best shot at getting in. In any event, we don’t really have a better discriminator and until we do, the importance of having a very solid science background warrants reconsideration of the current admissions criteria. I once gave a lecture on respiratory physiology to a room of about 80 medical students. Understanding dynamic airway closure requires understanding Bernoulli’s principle. Not a single person in the room knew it by name. Only a few knew it once I described it. None were able to explain the application of it to respiratory physiology.

    If we want to live up to the argument we make that a computer can’t replace us, then we need to do better than just memorizing a whole bunch of random facts and regurgitating them. Go beyond pattern recognition to slot our patients into an algorithm. We need to understand why things are happening, what it could mean, why certain treatments may or may not work, and why certain treatments absolutely will not work. Otherwise IBM’s Watson will indeed handily replace what the average physician is becoming – a highly trained mechanic who can follow complex algorithms. The problem is that there is so much to know in medicine that unless you come into it with a solid background in all the relevant sciences, you will be forced to just learn free-floating facts. Not only is this harder to do, but it leaves one “fact” just as valid as another. So when someone says to you that OMM or acupuncture or reiki or whatever “works” then you don’t have the cognitive toolset to argue against that. You don’t have your understanding of respiratory physiology anchored in the fundamental physics and physiology so the idea that acupuncture may actually help asthma doesn’t seem so ludicrous to you.

    So the real fix is a fix in how we educate people. For the most part, the focus becomes on learning facts rather than learning how to learn and understand facts. How to evaluate them and reality check them. We need to know facts. But there is a balance to be had. I, for some reason, still remember that oxygen coupling to heme moves the histidine residue by 0.79 angstroms. That is a useless fact and we need to learn less of those. But the idea of cooperative coupling and why that happens (shifts of histidine residues changing the 3D conformation and decreasing steric hindrance) is important. How do we accomplish this shift in education and learning? That is well outside my expertise. But until we do, I tend to feel that coming from a strong science background is likelier to yield a person who will think more critically and is important in and of itself because med school does not afford you time to learn science and medicine.

    At some point I will likely be sitting on an adcom for residency and maybe medical school. I won’t outright discriminate based on degree, but I will ask questions on the interview to evaluate the candidate’s critical thinking capacity and ability to reality check; to work through why a claim they’ve never heard of may or may not be real and how to find out. Because never getting duped is impossible, but knowing how to correct yourself is vital.

    1. Harriet Hall says:

      “I will ask questions on the interview to evaluate the candidate’s critical thinking capacity and ability to reality check”

      In my interview they asked me “What if you get married?” “What if you get pregnant?” That was 1966.

      1. I wouldn’t have the nerve to ask you anything like that. What was your response ?

        1. Harriet Hall says:

          You couldn’t legally get away with asking me that today. I don’t remember what I said. Probably that getting married wouldn’t change my career plans and that I would use birth control.

    2. goodnightirene says:

      I am sorry to hear about the Anthropology component of your education. My own was highly scientific and until recently, I had assumed that to be universal.

      I read your comment all the way through (I often skim them as many are rebuttals to arguments I don’t have a big dog in) and found it to be as relative as the post. It might be time for Dr. Pavolov to join the stars of SBM, no?

      1. Andrey Pavlov says:

        @Irene:

        Thank you for the kind words. Yes, my anthropology degree was a veritable mish-mash. My general anthropology and cultural anthropology courses were actually very good. A little bit too much cultural relativism, but not at all egregious. My religious studies and medical anthropology, on the other hand… oh my. My med anthro classes were as much post-modern, anti-scientific medicine, “evil reductionist” spouting, gobbledy gook as you can imagine. One of my professors has this as part of her bio:

        The second project investigates alternative ways of thinking, doing and being human. It begins with an exploration of how Daoism and especially its insistence on “oneness” not only provide the conceptual underpinning for traditional Chinese medicine, but can also serve as an immanent, sideways analytic that suspends practices of bifurcation in modern knowledge production.

        I’ve read that many times and I can’t begin to understand what the heck it actually means. Can you? (and I mean that seriously)

        As for joining the stars of SBM… I have actually co-authored a couple of posts here and am considered an active contributor. My issue is cranking out regular posts. I don’t know why, but I am much better at responding and editing than creating de novo. But moreso, my life is currently rather tumultuous (both in good and bad ways) and I am scattered enough that it isn’t particularly feasible at this point. Eventually, however, I’d like to get into a groove and be a more regular contributor here.

        1. nancy brownlee says:

          I think this may be a reference to the construct of Sir Terry Pratchett, the “trousers of time”. Possibly made even before he constructed it.

        2. WilliamLawrenceUtridge says:

          My guess is that it is talking about mind-body dualism.

    3. agitato says:

      Andrey Pavlov: You wrote above: “But of course, having a degree in science does not guarantee critical thought either – I hold a degree in evolutionary biology and did very rigorous science courses, acing my organic chemistry and physics courses, yet I still believed that homeopathy had legitimacy and the “East” vs “West” medicine dichotomy was real. Obviously when I got deeper into it, I was able to see how false that was.”

      I enjoy reading your comments but this has me mystified. How could you ever have thought homeopathy had legitimacy? It’s such obvious nonsense.

      1. WilliamLawrenceUtridge says:

        If you don’t know much about it, homeopathy basically sounds like that most probable of CAM approaches, herbalism. You have to scratch the surface, with knowledge of “mother tinctures”, “succussion” and “serial dilution” to realize just how loony-tunes far it is from a sprig of tarragon in alcohol to a white sugar pill in a bottle. As far as the average consumer goes, the difference between a mg dose of a drug (really, so small as to be invisible) versus something diluted several times, isn’t that much.

      2. Sawyer says:

        I don’t know how long ago WLU had his conversion, but remember back in the good ol’ days of the internet you couldn’t just go to wikipedia to find out the details about a particular type of pseudoscience. It was very easy to hear bits and pieces about a topic without really discovering the fatal flaws. While I never bought into homeopathy, it certainly passed under my radar for years despite a pretty rigorous science curriculum in college.

    4. Acupuncture does help many traditional illness but not how you might think. You will have to review my post to understand the mechanic of the needles.

      Magnesium helps Asthma too … all old idea tested in the 70-80s.

      1. WilliamLawrenceUtridge says:

        Why not explain it here, with references?

        1. You have to do some leg work! I’m just stating what we did in the 80′s. I still use lots of magnesium in pain therapy. Google it, I don’t need the proof anymore, I see it in the office.

          1. WilliamLawrenceUtridge says:

            Personal experience isn’t proof, it’s self-justifying bias.

            I’ve done considerable legwork, I’ve read lots of information on the history, efficacy and problems regarding acupuncture and research on the same. If your knowledge base is found in the 80s, that might be part of the problem. Once retracting needles were developed in the 1990s and you could control for skin penetration, the evidence base for acupuncture eroded significantly. That’s why I keep saying that it doesn’t matter whether you penetrate the skin or not – as long as patients think the needle is penetrating the skin, results are identical.

            And of course, needling location doesn’t matter, nor does “diagnosis”.

            Why are you so reluctant to give your definition of acupuncture? Why take the schoolyard approach of “nyah-nyah, I’m not telling”? Why not be a grownup and simply state what you believe to be true? Then we can break it down to its foundations and see if any of them can support any of your claims?

        2. qetzal says:

          From SSR’s website:

          First, let me explain how this all-natural process works.

          1. The thin flexible solid stainless steel needle is inserted into the skin and muscle and causes microscopic tissue injury. That injury triggers a healing cascade of repair. The injury is repaired and any local secondary injury is also repaired.
          2. The stainless steel wire, once it enters the muscle, will trigger a muscular re-polarization and the muscle twitches. After the twitch, the muscle will relax. The relaxed muscle will be a little longer and less tense and tight.

          Note: Depending on how dense the problem is within the tissues will dictate on how much effort you have to put into the needle to trigger both of these events.
          Note: One key assumption underlying the problem is that muscle tightness is what is causing a lot of pain and electrical malfunction in the body. The goal is to treat the tight, dry, stiff, firm muscle tissues so that healing occurs and all goes back to normal levels of suppleness.

          So there you have it. Acupuncture works, according to SSR, by triggering local healing, and by relaxing tense muscles. I don’t buy the “local healing” part, especially given all the studies that have found no difference between inserted vs. retracted needles. But I’m happy to believe that acupuncture works (if at all) through the simple relaxation achieved by the overall process (e.g. lying quietly on a table for 30 min, hearing soft music, hearing the practitioner say soothing things, etc.).

          And, to SSR’s credit, he basically only claims that it works for pain (see lower down at the same link).

          The real question, of course, is why bother with acupuncture? Since needle insertion does nothing per se, why not just get a relaxing massage?

          1. windriven says:

            “Since needle insertion does nothing per se, why not just get a relaxing massage?”

            Because SSR doesn’t get paid by patients who just get a relaxing massage.

            1. Actually I don’t charge for the Acupuncture. It is complemented into an office visit.

              I kinda figured out that yall are pissed that alternative will be part of the ACA and you don’t want to pay for someone else massage.
              Dang it I don’t want to pay for someone’s needless knee replacement!

              Relaxing is very therapeutic and is recommended to all my patient as part of the home care program.

              In some cases the patient can not relax without the benefit of the needles.

              Read my other post.

              1. WilliamLawrenceUtridge says:

                I kinda figured out that yall are pissed that alternative will be part of the ACA and you don’t want to pay for someone else massage.

                Damned skippy. Paying for useless treatments will drive up the premiums for everybody involved. All that money could, and should, have been spent on a genuine health care system, not this poor substitute of insurance reform. Not to mention all the poorly-trained acupuncturists causing lung collapses, nerve damage, bruising and infections. Sure, the risk of each is small. But when the benefit is zero, why take even a tiny risk?

                I’ll also point out that Stephen’s descriptions of how acupuncture “works” is a hypothetical. He may be right, but at this point the evidence doesn’t support the assertions he clings to dogmatically.

                In some cases the patient can not relax without the benefit of the needles

                Don’t you see that as problematic? Why not teach your paitents a skill set that allows for progressive relaxation through conscious control? Why force your paitents to return to you repeatedly for what is essentially a surgical procedure rather than teaching them a little self-care? Is it because acupuncture is easier for you, and you don’t want to take the time to teach them?

              2. windriven says:

                “Read my other post.”

                Why? They all say the same thing.

                When are you going to take the challenge? Every time I bring it up you slink off. Now here you are, back slinging your same tired delusions.

                Your ten most important disease entities that acupuncture – or whatever you want to call your particular woo – has mastered and in doing so transformed the human condition. Gotta be factual. Then I’ll name my ten for medicine. You can count to ten, right? After a thousand years or whatever – you must have hundreds to choose from. But we just want to see your best ten.

          2. You would have a conniption fit if I told you what can be accomplished with needles. Macular Degeneration and frozen shoulder gee for that matter you can use them to open the jets on a carburetor.

            1. MadisonMD says:

              gee for that matter you can use them to open the jets on a carburetor.

              Wow, SSR! Last month you couldn’t even get a mechanic to repair your car. I suggested you try needles.

              I’m glad that worked for you. Do you want to thank me now? ;)

    5. “In Australia they are rank quacks, right up there with chiros, homeopaths, naturopaths, and the rest. ”

      This is the reason why we are so low in the world rankings for clinical outcomes and quality of healthcare.

      We need a better balance in hands-on care and high-tech care.

      1. WilliamLawrenceUtridge says:

        Nope, the US is at the bottom of the rankings because of a lack of a national health care system that precludes preventive care for most of its citizens and encourages them to only seek care when it is critical.

        And despite this, the average lifespan has crept up for decades.

  7. daedalus2u says:

    As I understand, the Osteopathic “Evaluation” consists of lots of touching and feeling.

    All this is showing is that a single daily episode of 10 minutes of touching and feeling labeled “evaluation” and 10 minutes of standing around (given twice per week) isn’t as “therapeutic” as two episodes of touching and feeling labeled as “evaluation”, a 10 minute episode of touching and feeling labeled “therapy”, and 10 minutes of standing around (given twice per week).

    All newborns require lots of touching and feeling. It isn’t a surprise to me that 30 minutes of touching and feeling is more effective than 10 minutes of touching and feeling.

    A better “control” would be for non-osteopaths to do episodes of touching and feeling, as in cuddling the infants. My hypothesis is that random women (who are mothers and have experience cuddling and holding infants) would work better than osteopaths. I think it would be shown to be cost effective to hire unemployed women at $15 per hour just to hold premature infants and cuddle and rock them all day long. This might be something that retired grandmothers could do.

    There was no comparison with “usual treatment”. Both legs of the study had evaluation by osteopaths, which involved touching and feeling.

    1. Young CC Prof says:

      Daedalus2u, I totally agree with you. There’s quite a bit of research showing that babies respond well to touch, and in fact quite a few hospitals have recruited mothers and grandmothers as volunteer cuddlers, especially for the “boarder babies” who couldn’t go home with their own mothers and hadn’t found foster care yet.

      (Of course, female sex is not a prerequisite for baby cuddling skills, but there may be a statistical association there, especially in the older generation.)

  8. Frederick says:

    What also funny about the study, No control group or normal medicine group. If they wanted to demonstrate that osteopathy is more efficient than Normal medicine, they should have compare them. But i guess the people who designed that study knew that. The result would have been different, showing it is bogus, they probably know that their osteopathy is a scam, but, money is money.
    Now believers can say ” There have been a study” . that’s the only purpose of bogus study like that.

  9. Thor says:

    I live in one of the most woo-infested areas of the country—Sonoma County in the SF bay area. This ‘cultural’ milieu attracts people of all stripes who thrive in the comfort of being surrounded by this particular mindset. This includes the spectrum of CAM practitioners. And most definitely includes DOs. The osteopaths here are the top dogs, kings and queens of all ‘healers’. Their degree lends authority and legitimacy to any mode of practice they choose. Most DOs here focus almost exclusively on the use of CAM modalities. Like with NDs, nothing is off limits, especially craniosacral therapy, and various ‘energy’ modalities. Business is flourishing, as most residents subscribe to various forms of magical thinking vis a vis ‘the healing arts’. So even though Andrey hasn’t seen DOs mentioning or performing OMM, in these parts that is pretty much exclusively what they do. Keep in mind that most insurance covers osteopathy, whereas this isn’t the case for naturopathy et al.

    1. Andrey Pavlov says:

      Yes, of course, my sample size is pretty small. But I would imagine that yours is also a rather self selected group. The DO’s that want to practice more woo will go to areas where that is known to be more tolerated, even accepted and desired. Same goes for MDs and there are plenty of those in SF Bay Area as well.

      1. Thor says:

        You’re absolutely right, Andrey. Just wanted to mention how prevalent the woo side of osteopathy can be, and is. I only know about OMM DOs here, although there must be others. Most MDs here are definitely NOT in the CAM camp despite the tolerant environment, but there are certainly many MDs practicing what they term as holistic medicine. Same principle: Being an MD gives credibility to anything that can be pulled out of a hat. There is on offer ‘integrative neurology’, containing a large ‘pharmacy’ of nutraceuticals, botanicals and supplements right in the facility. Also, an MD/ND, with a pharmacy in the office, and numerous MDs practicing chelation therapy, live blood cell analysis, etc. All are selling their products along with the ‘treatments’.
        (Oh, and holistic veterinary medicine offering acupuncture!)

  10. Sastra says:

    My family physician for over 25 years recently transferred from family practice to emergency medicine and I had to find another one. I wanted to use the same local clinic. So I watched the introductory doctor videos and read their “about me” profiles and when push came to shove the two who were available seemed evenly matched — with one slight distinction. One of them was an M.D. and the other was a D.O.

    All other things being equal, I picked the M.D.

    It was a matter of playing the odds.

  11. angorarabbit says:

    Thanks for the review, John. I also find the study underwhelming. They start with 55 infants in each group but have 8 drop outs in the treatment group and only one in the controls. The authors did not reanalyze the population characteristics of those who completed the trial – one concern is that the high drop out rate in the treatments biased them toward only studying infants who were healthier. We need to rule out that potential explanation.

    My other concern is that the treatment group was evaluated twice daily and the controls only once. Thus the treatment group has greater inspection for potential health concerns that might require intervention. I would argue that their higher drop out rate is a reflection of this bias. Thus the authors can’t eliminate that the doubled evaluation time is what shaped the treatment group’s “improved” outcome.

    Finally, am I really supposed to believe that 26.1 +/- 16.4 is significantly different from 31.3 +/- 20.2? That variance is ginormous (as my students say). I can’t believe they are massaging significance out of a variance that is 50% to 60% of the average.

    1. Daniel says:

      So it looks like touch therapy may be the underlying mechanism involved because the treatment group got four times as much touch as the nontreatment group. (two 10 minute evaluations and two 10 minute OMT treatment sessions) vs (one 10 minute evaluation and one 10 minutes of finger twiddling).

      If I were designing a (better) study, the last thing I would think to do is double the number of evaluations and have doctors (or maybe they were using students in the nontreatment group?) stand around, wasting precious time.

  12. steney01 says:

    I would’ve loved to see the AOA/ACGME merger go through. Although I’ll be a first year DO student in the Fall, frankly I’m embarrassed by the continued promotion of OMM, as well as the false claim that DOs are the only ones who recognize a connection between mental and physical health and that DOs are the only practitioners who promote preventive medicine. We all need to be in this together. And by “this”, I mean science-based medicine that provides real benefits for patients. Time to move on from ol’ Dr. Still.

    1. Adam says:

      As a 2nd year DO student, I completely agree with you. It’s time we move on from trying to be different and put patient care first. Studies have shown that 80% of DO’s don’t use OMM in their practice. So, why is it so important to teach us OMM in the first 2 years? Contrary to what some might think, most of my classmates think along the same lines.

  13. David Weinberg says:

    There is another glaring problem with the study: The dropout rate imbalance.

    In the osteopathic manipulation group, there were 8 patients (14.5% if the group) who “dropped out” of the study because they were transferred to another hospital. Patients were transferred for the following reasons: genetic disorders (3), bacterial infection complications (2), cerebral hemorrhage (1), and convulsions (1), and cerebral hypoxia (1). In contrast only one patient (2% of the group) dropped out of the control group (for cerebral hemorrhage).

    The best I can tell, the patient who “dropped out” were excluded from the analysis.

    It appears that the patients in the manipulation group had more patients severe medical outcomes, yet these patients, who would likely have prolonged hospitalizations were excluded from the analysis of length of stay. Ditto for cost analysis.

    Just for fun, I ran a Fisher’s exact test to see of the difference in rate of dropout due to hospital transfer was statistically significant. The P value was .03.

    1. Daniel says:

      Another thought… perhaps the OMT itself caused some of the reasons for the dropouts? It’s plausible that prolonged contact could lead to increased likelihood of bacterial infection and associated complications. Meanwhile, spinal and cranial manipulation could lead to cerebral hemorrhage, convulsions, and hypoxia.

      1. David Weinerb says:

        It is as plausible that OMT caused the adverse events as it is that it shortened length of stay, but either proposition seems unlikely.

  14. Chet says:

    I’m confused about osteopaths. Are there osteopathy students who only applied to osteopathy schools because they see a difference and wanted to become osteopaths? Or, are they in osteopathy schools because they couldn’t get in to a traditional medical school ? What percentage of freshman osteopathy students are there because they couldn’t make the grade to enter tradition medical school ? If these osteopaths go on to merge with MDs later, then why on earth do we continue to have two degrees? Now I ask this question out of ignorance… I don’t know: if entering osteopathic students largely do not make the grade to enter into traditional medical school, is there a quality issue that the public needs to at least know about? If that’s not the case then fantastic… Just asking.

    1. John Snyder says:

      As I wrote in my post, most DO students do not pursue this path because of the OMM component, and very few go on to practice it when they’re done. The vast majority take this path because it is far easier to get into a DO school than an MD school. Most of the time it’s as simple as that.

      1. I wish they would use the OMM skills that would help our high-tech dependant healthcare system.

        1. WilliamLawrenceUtridge says:

          …completely missing the point that we don’t know if low-tech OMM will actually help patients. Perhaps rather than using the expensive time of highly-trained doctors, the equivalent benefits could be provided by unemployed day labourers in fleecy long-sleeves. That would be an even lower-tech solution. Unfortunately, we can’t tell from this research because they totally failed to control for an incredibly obvious confound.

          1. windriven says:

            @WLU

            I apologize for using this forum off-topic but … Nurmi at SfSBM is trying to engage with the powers that be in Quebec. My recollection is that you live in Quebec. If you are a member of SfSBM could you reach out to her? I will certainly offer any help that I can to her but I am neither Quebecois nor Canadian so I am at a disadvantage.

            If you are a member, please friend me or otherwise let me know so that I can contact you through that more appropriate forum. I am at SfSBM as windriven and as James Thomas.

            1. WilliamLawrenceUtridge says:

              Nope, that ain’t me. I don’t live in Quebec. I also can’t friend, I’m not on facebook, for the same reason as Betty White. There was a commentor who was from Quebec around here, but I don’t recall the name, sorry :(

              1. windriven says:

                @WLU – I’m not on FB either. I meant on SfSBM. But if you think of the name of the Quebecer please let me know.

            2. brewandferment says:

              there’s a fellow named Alain over at Dr. G’s not so secret other blog, I thought I saw him mention it sometimes, and I get the impression he speaks French. On here, there’s a new French speaking guy named Frederick.

    2. Skeptismo says:

      To address the quality issue, I think it’s important to illustrate how competitive med school admissions actually are. The students accepted into DO schools are not low performing students who barely squeaked through their undergraduate programs. The difference between MD vs DO admission often comes down to a few gpa points(3.8 vs 3.5) in undergrad, or a few points on the MCAT, the med school admissions test. And that margin has grown even slimmer over the years. The avg scores of accepted students now are several points higher than they were just ten years ago. The average med student 10-20 years ago (now practicing physicians) would have a much harder time getting any acceptances, were they applying this year.
      I just wanted to point out that the the margin is much slimmer than a lot of people assume. When tens of thousands of students apply for a limited number of MD or DO spots, <100 at most schools, many students who would make excellent physicians will be excluded.

  15. JohnMcC says:

    I’m an Australian ED CCRN (Critical Care Registered Nurse) and I don’t know what a DO is, but I have met many MDs and RNs who are into woo. Problem is they are all convinced they are right. Does anyone have any suggestions to show them the error of their ways? It seems like trying to argue about their religion, since they believe BECAUSE they believe, like anti-vaccine parents.

    1. James says:

      Error in our way? Most DO’s don’t practice OMM (>80%). Also, osteopathic techniques are an adjunct to our practice. We don’t try to cure bacterial pneumonia with OMT. We still treat with antibiotics but use OMT as a method to enhance healing. None of the neonates in the article described were denied standard of care. Many of the techniques we use have been adapted and are used in respiratory therapy and treating lymphedema. A tension headache is a tension headache and if some soft tissue techniques can ease a patient’s suffering along with some tylenol then why not try.

    2. Andrey Pavlov says:

      @JohnMcC:

      In Australia osteopaths are rank quacks. It is very different than here in the states.

      As for what to do about legit practitioners who are into woo? Tough and good question. You are absolutely right that it is like a religion. I’ve been particularly fascinated by both and the similarities are stunning.

      The best tack I have been able to come up with is to not go out and crusade to individuals, but to also hold no quarter for magical thinking. If you see a practice that you know is not supported by the evidence, don’t let it go by uncontested. Demand evidence and bring your own to the table. This is tricky, because it tends to require you really know your stuff, particularly when challenging a superior. But, done right, is highly effective. The second is to be plain, clear, and straightforward when asked about CAM in general and specific modalities. Do not mince words when you say “It doesn’t work.” Don’t be mad, aggressive, or condescending. Just say matter-of-factly “Nope, it is a load of bollocks” or something to that effect. Now the ball is in the other person’s court. If there is any chance of meaningful conversation they will begin it. If not, they will back away. From there, keep lobbing the ball back in their court. Never forget that the burden of proof is on them, and keep it there while asking questions to justify their stance. Even if you know all the reasons they are wrong, keep it minimal. Respond succinctly to their points and then ask question you already know the answers to, in order to make them think about it and have to defend their view.

      It is difficult to do, because it requires both a knowledge of the relevant medicine and science and a knowledge of logical fallacies and why certain things are fallacious. But if you know it well enough you can make people work through it themselves in a Socratic way. It is not guaranteed to work, but it is, to my knowledge, the best likelihood of success.

    3. Dr Robert Peers MBBS [UniMelb] says:

      Hi there, ED RN,

      I’m in Melbourne. Where is this Aussie woo happening? Woomelang? Woolongabba? Wooloomooloo? Tell us more about it. By MD do you mean MBBS? The new MD is not rolling yet [Doctors without Doctorates?]

      Cheers, Rob

      1. Andrey Pavlov says:

        USyd has been offering the MD for a while now. I believe Melbourne is planning on it. And i know UQ will be starting theirs next year.

  16. James says:

    It is amazing how ignorant medicine has become. Allopathic medicine has simply become a practice of treating a number (e.g. bp) and getting it to a target range. Along the way best practices are developed which many are found to be more harm than good (e.g. ACE/ARB combo). Science is inept as it only allows for what is 100% known and what we assumed is known may turn out to be wrong and what we presume to be wrong sometimes turns out to be right. Medicine is an art. Its true practice involves thought and allowing for our own observations and experience to assist in our care of the patient. When did we stop treating the patient and simply treat numbers? This is a problem with medicine as a whole. Best practices this and best practices that without looking out the patient. I am an osteopathic medical student in which all my preceptors have been MDs. This article knocks osteopathic medicine on what basis? It challenges its methods in the aforementioned article but I can guarantee any article in any journal including NEJM, JAMA etc… can have its methods challenge, and often do, they even have to retract some (e.g. the article put out on genomic testing for ovarian ca). So can we call all articles that have their methods challenged “Pseudoscience”? I doubt the gentleman who wrote this article has ever put his hands on patients with the intent to help heal. My goal is not cure with my hands but my intent is assist in the healing process. I don’t use OMT in practice but I do in my home life and with friends who ask. I don’t buy into many aspects of osteopathic practice, but I can’t knock them either because I have not tried them in practice.

    If we want to talk about “pseudoscience”, let us talk about “pseudomedicine”. The practitioner who places the stethoscope on the patient while talking and doesn’t even listen for half a breath cycle. Or worse, marks it down as complete without even doing it.

    Just to clarify, my scores on USMLE are in the top tenth and I train along many allopathic medical students and have outperformed them as per evaluations. I have also been told by numerous allopathic residency directors that they love their DOs and they usually rise to the top. I myself am on my way to a allopathic surgical residency. I will also note that just because someone has a MD behind their name does not make them more significant or they had better GPA/grades to get a MD. That MD could have come from another country or they may have gone to the Caribbean which has much lower standards. You should hear the Caribbean schools radio commercials down here.

    The hypocrisy and the ignorance that has pervaded through medical practice is unbelievable. This is just another article that is high on provocation and low on sustenance.

    1. Sawyer says:

      I doubt the gentleman who wrote this article has ever put his hands on patients with the intent to help heal

      There’s a lot to pick apart from your rant, but with this statement it doesn’t look like you’re going to be interested in an actual conversation. Please check out the “Contributors” tab under “About SBM” before unloading whoppers like this.

      Dr. Snyder must be a sly devil indeed if he’s gone two decades in pediatrics without ever helping heal a child.

      1. John Snyder says:

        @Sawyer: Thanks. I was going to grace this person’s remarks with a response, but I appreciate your comment.

    2. WilliamLawrenceUtridge says:

      Wow, that’s quite the rant.

      This is just another article that is high on provocation and low on sustenance.

      I think you mean “substance” there champ. The rest of your discussion is either “in my experience” stuff, which can’t be verified, or straw man (blarg, doctors only care about science, they ignore the unique needs of their patients!), ignoring the fact that doctors are well aware of the need to adapt guidelines to reality.

      And the realty is – MDs and DOs are basically the same. Thank the FSM, because the last thing we need is another useless SCAM profession bitching about how “allopaths” don’t care about their patients or preventive medicine”. Except vaccines.

      1. James says:

        No I mean sustenance. As in nutrition for the brain. When I stated “put hands on the patient with intent to heal” I meant I doubt he has himself tried OMT. If you boil this article down you have a practitioner whose field is opening up to new ideas and he is rebelling against this. He takes a single article tears into hits methods and then calls a field pseudoscience without spending anytime in an OMM clinic. As DO’s we are trained to heal with standard of care and manual techniques. I would challenge the field of medicine to ask itself why are so many turning to non-traditional practices of medicine? I am sure they would say because they are uneducated or they read hocus online. I would argue it is because the general public has lost faith in medicine because we have become too narrow minded and blow off patients concerns and too quick to stick them into an algorithm. As they shuffle specialist to specialist with no clear diagnosis or true discussion on what is going on they lose faith. For example, I helped resect a colon tumor who had developed an obstruction with large liver metastases. This unfortunate lady had been blown off for 2 years by 3 different providers whom she continuously told she had rectal bleeding. The sad thing is that this is the second tumor I helped resect this month with a very similar story.
        What is the harm of OMT? I know many practitioners who use it to ease pain and suffering. It has helped many get off the nasty opiods we so commonly prescribe patients. Have patients had some bad outcomes from OMT in the past? Yes But I guarantee they are not as severe as the some of the side effects seen in opioid use. Patients wouldn’t come back if they didn’t think it would help. Placebo? Who knows but if we are talking about science based medicine then what about SSRI’s which have been shown to be no better than a placebo that causes similar side effects, but we continue to prescribe them.

        We must remember that what is evidence today is often proven false tomorrow.

        1. weing says:

          “I would argue it is because the general public has lost faith in medicine because we have become too narrow minded and blow off patients concerns and too quick to stick them into an algorithm.”
          Do you have any studies showing this? If doctors are blowing off patient concerns, they are not doing their job. What’s preventing them from doing it? Not being able to find a specialist to do a colonoscopy on someone without insurance would be one barrier. A high copay for the procedure would be another. Prior authorization with the insurance carrier, still another. Lack of family member to pick them up after the procedure. We should be looking for ways to allow physicians to do their jobs more easily. Unfortunately, I don’t see that being the case in the US. I maintain that these are the types of barriers to the efficient practice of sound, science-based medicine that is leading to dissatisfaction. The old lady with the colon cancer you mentioned, what was the non-traditional way that finally diagnosed her condition?

          1. @weing. Yes todays doctors blow off patients like they are flies or gnats. It is a travesty and unjustified and needs to be corrected. Patients get caught in the vending machine of high technology and get chew up and then spit out.

            The discovery of a tumor is alway a shock whether it is a centimeter or 8 inches. Both of which are missed on a daily bases.

            Oh yes, modern doctors are still taking out perfectly good appendixes too. Is this malpractice or is this just the reality of how imprecise modern medicine is still even in 2014.

            1. WilliamLawrenceUtridge says:

              Stephen, you deliberately attract to your practice those patients who have the money and time to pay for extra care. Your appreciation for the average patient interaction is horribly biased because you see all the ones who seek boutique treatment for difficult to treat and frustrating conditions like complex pain.

              Criticizing modern medicine for being imprecise is pretty rich coming from someone who has repeatedly failed to ever even note the failings of one of their preferred interventions, acupuncture. Of course, you claim you define acupuncture on your website. That’s great, a definition is a lovely starting point. How much research have you conducted on that definition? How precisely do you control for each factor?

              Decrying the failings of specifically American medicine doesn’t magically justify, or make disappear, the failings of CAM. And it ignores most of the structural factors that contribute to many of the horrible outcomes found in the US.

            2. MadisonMD says:

              Yes todays doctors blow off patients like they are flies or gnats.

              … and, worse, you claim to blow away 15% of your patients like pigs or rabbits.

        2. WilliamLawrenceUtridge says:

          Well then I’m going to call you out for being low on sustenance and substance. “You should try it “is right up there with “in my experience” as a skeptical no-no. Personal experience doesn’t matter, careful observation and control does. Bloodletters were very convinced by their experience – fevers dropped, agitated patients calmed, and sleep deepened. From their perspective, halving a person’s blood volume did wonders. Trials like this, but with control groups that aren’t nonsense, should have been done decades ago to determine if OMT has unique benefits (beyond what is already taught in medical school, or to physiotherapists for that matter). Teaching it now because of a historical rather than a scientific justification, is stupid.

          I read Dr. Snyder’s post as criticizing the article and the OMT technique, and he goes out of his way to point out that he has worked with excellent DOs who were equivalent to MDs. And for good reason he is critical, if this is the kind of thing used to justify OMT, it’s shoddy and poorly-thought-out. How would you feel if this were a drug trial and the drug was given by injection after a 40-minute interview while the placebo was given by pill, dispensed by a machine? That’s a bit of a trick question as it depends on how much you know about placebo effects.

          New ideas should be welcomed as long as they are probable and are being researched. OMT follows neither stricture particularly well.

          As for your question about why so many are turning to CAM – first, are you sure they are? The actual rates of CAM use are still pretty low, and increasing only slowly (though this may change as quackademic medicine continues to infiltrate academia and medical schools). And further, CAM approaches tend to be cheaper, and deliver a lot more one-on-one attention than most medical appointments, unless you’ve got a lot of money. I see it as the reflection of a structural problem, one that should be alleviated by the United States having a real federally funded health care system, not this sham of healthcare reform (and possibly training more doctors). I have a federal health care system, and let me tell you – it’s fantastic. Happily do I pay my taxes to cover it. And regards your anecdote of the woman with a tumor – what was her insurance like, do you know?

          As for what’s the harm – well, it’s corrosive to clinical thinking, particularly if it seems to support magical thinking. It can waste time (expensive, precious time, for both doctor and patient in this time of managed care). It can lead doctors and patients into the slippery embrace of CAM (and if you don’t believe me, search this site for that festering fistula, Stephen Rodrigues). Patients would absolutely come back for compassion alone, even in the face of ineffective care. Have you ever heard of homeopathy?

          You can’t point to another treatment with empirical flaws in its evidence base and say it justifies OMT. That’s a logical fallacy (false dilemma). You should be ashamed of doing so by the way, because at its root, you are saying “my medicine doesn’t have to be improved until all medicine is perfect”, a tautological and overall stupid statement when examined. Also note that as the evidence base changes for SSRIs, their uses and up-to-date guidelines are also changing, an example of the self-correcting nature of science. Something certain doctors of osteopathy* could learn from.

          *You, and the authors of the article that Dr. Snyder criticized.

          1. Here I am!!!!!

            Gee I don’t ge notification and I a little busy.

            So how is my group of blinded souls from all the dogmas and the profound and radical religion-like believes in EBM!

            1. WilliamLawrenceUtridge says:

              I don’t care, as I mentioned above, I consider you little more than a pus-filled sore that refuses to close.

              Asking for evidence before believing is the very opposite of dogma and religion Stephen. The very opposite.

            2. windriven says:

              Back, like a bad dream.

        3. weing says:

          @james,
          “Along the way best practices are developed which many are found to be more harm than good ”
          That was not a best practice based on science. It was not developed by scientific testing but by speculation. Oh, it makes sense that an ACEI/ARB would be better. It was scientific testing that showed otherwise. The moral of the story is. If you have what sounds like a good idea, test it first and see whether it really works. It’s when medical practice strays from the science-based practice that people get hurt.

        4. Dave says:

          Standard of care for rectal bleeding is colonoscopy, followed by staging workup if cancer is found, then definitive therapy depending on the stage. To do otherwise is NOT science based or evidence based medicine. I know a lot of physicians, NP’s and PA’s. NONE of them would ignore rectal bleeding.

          I’ve also seen patients who come to me saying they were “blown off” by other practitioners. Often when I get the records or speak to the other practitioner I find that was not the case. It’s VERY hard for me to believe that a woman would go to “two or three” providers, complaining of continual rectal bleeding, and be totally ignored.

          1. Andrey Pavlov says:

            There have been many points where I would have failed an exam, failed medical school, or failed my boards if I had “blown off” rectal bleeding. Heck, I’ve had exams where I could have failed if I didn’t ask about it to make sure it wasn’t happening if the patient didn’t volunteer the information! It is part of the Review of Systems!

    3. william says:

      @James
      Excellent. Most of those in this little “chat” group won’t like your comment though.
      We can come up with lots of other little stories. But then we’d be accused of committing some sort of ” logical error” .

      1. weing says:

        “But then we’d be accused of committing some sort of ” logical error” .”
        Learn a little logic and try not to commit them then.

      2. Dave says:

        Using ACEI/ARB’s as an example of the problem with SBM is more than a logical error. Years ago it was found that patients with CHF treated with an ACEI do better. Many patients cannot tolerate ACEI’s, usually due to coughing. ARB’s work physiologically on the same pathway as ACEI’s and were also discovered to help people with CHF. It was logical to inquire whether the combination has an additive effect. It was tested. It did not. The expert recommendations are not to use the combination. A good case of EBM/SBM in action, almost a poster child for it.

        A better example would be the use of postmenopausal estrogens. Early observational studies suggested that women taking these has fewer cardiac events. Given that women get cardiac disease later than men do age-wise, it made sense that maybe the estrogens would be cardioprotective, but the groups were not controlled for smoking etc. For a while practitioners were advised to put women on postmenopausal estrogens as a result of these observations. However, when a controlled trial was done there was not found to be a cardioprotective effect and an increase in thrombotic events. As a result the recommendations changed. Another case of EBM/SBM in action.

        It is unfortunately true that the history of medicine has many instances of a intervention making logical sense (endarterectomies for the treatment of coronary lesions being a very old example – they work in the neck but not in the heart), being put into practice before the proper studies are done, and then when the study results come out they are found not to work. The medical profession has realized this problem and I think things are improving, but we have a ways to go. This is one of the things that science based medicine is working to prevent. So why rant about it on an SBM blog? Half the posters here dont seem to distinguish between malpractice, standard practice, or even seem to be aware of the various categories of strength of the guideline recommendations. They lump all of this into the “mainstream medicine has lots of problems and SBM is part of mainstream medicine so let’s bash it” idea.

        If you want to bash SBM don’t gripe about problems that are not part of SBM, IMHO.

        1. Dave says:

          One further comment. Frequently physicians are faced with problems both now and more frequently in the past when clear cut tested solutions are not available. In those cases it makes sense to use what we do know to arrive at a reasonable treatment until the solution is available. Physicians in the past. for example, used antacids by the gallon and a milk-and-cream diet for duodenal ulcers. It made sense at the time, more effective medications were not available and the link to H pylori had not been discovered. You can either sneer at these doctors for their ignorance, or realize they were doing the best they could with the information they had at the time. Hopefully much of what you, James, are doing will once belong to a similar story, if medical knowlege keeps advancing and treatments keep improving.

          Also, James, in the trenches where I work and live whether a doctor is an MD or a DO matters not a whit.

          1. Harriet Hall says:

            We forget that the older ulcer treatments worked too, just not as well as the new ones.

    4. windriven says:

      ” Science is inept as it only allows for what is 100% known and what we assumed is known may turn out to be wrong and what we presume to be wrong sometimes turns out to be right.”

      It is rare to find so much stupidity swept into a single pile. It’s author claims for himself monumental intellectual achievements yet his words betray a braying ass.

      Science claims to know 100% of very little. And the process of reevaluating and testing and reformulating ever bringing us closer to that 100%, our correspondent offers as a signature of ineptitude.

      How much easier and more certain to cling to hoary myths and rituals. As science has transformed the human condition, still we have shamans and conjurers cursing the light and bowing low to fear and superstition.

      Bray on james. Urinate boldly into the gale of scientific progress. Cling like a frightened child to the unshaking pillars of ignorance set deep in the floors of tradition.

  17. JohnL says:

    I applied to DO schools because I was 33, had a BA in history, minor in psych (Seton Hall ’75, Go Pirates), and was told that I probably didn’t stand a chance of getting admitted to any MD program. I also was working as a research assistant at a local hospital at the time, and my boss (MD), who taught at the local MD school, told me that the DO school at the same university offered a better education in his opinion.

    For what it’s worth, I find no difference between my MD and DO colleagues’ propensity to reject current SBM practices. Just sayin’

  18. RE: MDs, DOs, and SBM readers Beware: OMT without “comparable TMC” is clearly biased — or “blinded” — by the 19th-century Still’s preconceived notions of Osteopathy — while without incorporations of our modern Neurobiology, Anatomy, Physiology, issues, etc!?

    Several hypotheses for how OMT may be working here are put forth in the discussion section of the paper. These include possible anti-inflammatory effects, and bringing “balance to the sympathetic and para-sympathetic inputs, creating an improvement of newborns clinical condition.” I will not be discussing the evidence for the benefits of touch and massage on newborns in the NICU (there is some interesting data on this), but this has nothing to do with the imaginary structure-function claims of osteopathy. Even if the hands-on interventions of the osteopaths in this study did truly improve the LOS for these infants (and this cannot be assumed from the evidence in this study), it in no way validates the mechanistic claims of osteopathy. If there is benefit to hands-on touch and massage in neonates, that’s one thing, and that is an interesting and potentially valuable thing to study. But it says nothing about and does not require the existence of osteopathy, which is based on non-existent relationships and false assumptions about anatomy and physiology.

    Although John Snyder has presented a clear but confusing case of OMT efficacy in the NICU-RCTs, he clearly raised and concluded some very pertinent and relevant clinical observations and queries (as quoted above) that I think certainly warrant further consideration and discussion:

    First of all, I thought that the OMT-RCT above is clearly flawed, and biased, on the premise that it was scientifically subpar with the modern biomedical RCT design and methods: as it was primarily designed so as to accentuate the preconceived notions of OMT efficacy alone, while without ruling out a “[control] evidence for the benefits of touch and massage [or TMC] on newborns in the NICU”!?

    Specifically, the control Group A babies should have had received a comparable “10 minute evaluation + 10 minutes of [TMC]” (by nurses alone or it must be any non osteopaths as Daedalus2u suggests above) as a control or sham OMT maneuvers — and not been short changed by daily negligence of 20 minutes, without OMT nor TMC, at all!?

    Furthermore, that silly nilly “10 minutes of standing by the bedside” protocol should have had been eliminated — as been irrelevantly or inconsequentially included as clinically designed in the flawed OMT-RCTs above, it certainly has had confused the wit out of both Snyder and SBM readers alike!?

    Thus, with this revised (OMT vs TMC) RCT protocol, I would anticipate that the difference in LOS for Groups A and B babies, will certainly diminish significantly — showing the fact that exercising touch, massage, and/or caress babies alone, will also help bringing or stimulating the homeostatic development and/or “balance to the sympathetic and para-sympathetic inputs, creating an improvement of newborns clinical condition [especially the growing, developing, neuro-immuno-cardio-endocrine homeostatic system(s) and network(s), etc since fetal development and before preterm birth happenstance].”

    Best wishes, Mong 2/1/14usct1:19p; practical science-philosophy critic; author “Decoding Scientism” and “Consciousness & the Subconscious” (works in progress since July 2007), Gods, Genes, Conscience (iUniverse; 2006) and Gods, Genes, Conscience: Global Dialogues Now (blogging avidly since 2006).

    1. WilliamLawrenceUtridge says:

      The same flaw immediately jumps out to most people – it’s like comparing acupuncture to “usual care”. There’s a massive difference in terms of placebo effects, they simply aren’t comparable. If nothing else, all CAM scientific trials should involve some aspect of “health psychotherapy”, the chance for the participant to discuss their health status, including physical examination, with a compassionate listener for an equivalent amount of time. Homeopathy spends considerable amounts of time attempting to “suss out” symptoms, acupuncture has a lengthy diagnostic interview including tongue examination and pulse measurement, and my one consultation with a naturopath was a full hour. That’s a lot of careful, compassionate attention that’s not usually available in most managed care facilities.

  19. Rob Cordes, DO says:

    Interesting conversation.
    I am one of those majority DO’s who do not use much OMT.
    I have heard of it stopping asthma attacks. Specifically high velocity / low amplitude ( crunching) to the thoracic spine.
    I as a resident I tried it for several patients with success.
    Mechanism? Stimulation of sympathetic nerves? Efficacy vs albuterol – I have no idea.

    I think it is needed for those that promote teaching and use of OMT do legitimate studies to show if it works and if so what techniques for which patients and coniditions.
    This is likely a complex question. It might be like asking do antibiotics help sick patients? Which antibiotic for which illnesses and patents. No antibiotics help viral URI.
    PCN treats strep but is not useful if a person is PCN allergic.
    The there is the technician dependant nature.

    As for philosophic approach to patent care I see that I as a DO have a different approach to my patents than my MD partners.

    Personally I did a DO internship after med school planned on a DO family practice residency and a late change lead to an allopathic pediatric residency that is now has a DO tracked residency also.

    One has to wonder what would happen if DO’s were offered MD degrees again as happened in California in the 1960′s.

    1. WilliamLawrenceUtridge says:

      Dr. Cordes, have you seen the discussion on this website of the paper by Ted Kaputchuk that noted the effects of acupuncture on asthma? It’s worth looking up. Have you assessed actual lung function on patients before and after? Because the thrust of Kaputchuk’s paper was that acupuncture was effective at making patients feel better, without changing any of the objective measures that indicate actual improvement in the ability to breathe. This is a problem, particularly given that it can cause patients to over-estimate their recovery, thus putting themselves at risk of dying of asthma because they genuinely feel better.

      Systematically delivering untested advice can be dangerous; witness Dr. Spock’s recommendation for babies to sleep on their bellies to avoid choking, versus deaths from SIDS.

    2. william says:

      @ Rob Cordes
      I agree. DOs think differently.

  20. This is a good example of a badly flaw and poorly thought out study. Then everyone attempting to make sense out of the nonsense.

    I am not sure if any definitions were given, what techniques were employed, what about comparing the set manual care to set or totally random manipulations.

    It is very difficult to design and implement a study when you do not know what the mechanism of action of a discipline maybe.

    OMT is a valid therapy even fake or random manipulations.

    The same with Acupuncture! No one here can define Acupuncture with any clarity, so how can you study something that has no definition. A philosophy or a tradition is not a definition.

    Acupuncture is a valid therapy even if it is done by a nurse with and instruction book.

    I see everyone is still juggling around ideas, dogma and egos.

    1. WilliamLawrenceUtridge says:

      The same with Acupuncture! No one here can define Acupuncture with any clarity, so how can you study something that has no definition. A philosophy or a tradition is not a definition.

      Can you provide such a definition?

  21. MadisonMD says:

    I am not sure if any definitions were given, what techniques were employed, what about comparing the set manual care to set or totally random manipulations.

    You’ve also have never given definitions of acupuncture and Acupuncture– although you say they are somehow distinct.

    OMT is a valid therapy even fake or random manipulations.

    If the treatment is ‘fake’ you are now saying there is no specific effect. This is what is generally meant by placebo.

    1. To discover any placebo effects is much more difficult to determine with hands-on or needle therapies. Only the truly dogmatic, blinded, and myopic of researchers would attempt to suggest this notion.

      Why do you need to prove a therapy is valid when OMM and Needles have been around for many centuries.

      What we need are some opened minded scientist who will do all the due diligence to help clarify the mechanism of actions.

      1. WilliamLawrenceUtridge says:

        Bloodletting was around for many centuries.

        In terms of “mechanism of action”, there is still no definitive proof that either OMM or acupuncture actually work beyond placebo, so claiming a mechanism is premature. Or, more accurately, claiming a mechanism beyond placebo and nonspecific effects is still unnecessary.

        In terms of acupuncture, the needling location, needling manipulation, needle penetration and practitioner enthusiasm have all been tested, and only the latter has been found to matter. It doesn’t matter where you put the needle, it doesn’t matter if you penetrate the skin, but it does matter if the patient thinks they are getting “real” acupuncture, and whether the acupuncturist is enthusiastic or not. So really, what is left?

        And of course, there is no evidence that qi exists, so that mechanism is clearly out the window.

      2. weing says:

        “Only the truly dogmatic, blinded, and myopic of researchers would attempt to suggest this notion.”
        If you want to call your studies scientific, you need to follow the rules of science. If you want to do wishful thinking or whatever else, you don’t have to.

        “Why do you need to prove a therapy is valid when OMM and Needles have been around for many centuries.”
        This is an example of dogma.

        1. Dogmas and BS will not help people feel better. They will disappear and be disregarded if people had to pay out of pocket for what they determine to be valid. It is not perfect but when combined with traditional medicine both would add up to the best medicine of all worlds.

          An example of a dogma would be if we still perform prefrontal lobotomies or vagus nerve resections. Gladly we don’t! Those went out of vogue just a few decades ago.

          I advocate for needles and OMM primarily for pain and dysfunctions. We always will away use them to treat pain.

          This issue here are who will pay for such therapy in this present system.

    2. Defining Acupuncture in a few paragraphs would be difficult especially in an attempt to explain it to anyone who has a set vision of anatomy and physiology. Especially in this group, it may be futile.

      1. WilliamLawrenceUtridge says:

        So your vision of anatomy and physiology changes? How do you still have a license to practice medicine?

        Claiming you can’t define acupuncture, particularly for this group, really makes it sound like those Christians who say atheists don’t believe because they’ve never experienced the wonder of true faith. It’s a neat little vesicle of logic from which there is no escape, and it makes it look like you can’t justify it.

      2. PMoran says:

        I suspect most ancient medical theories derived from attempts to tie together certain clinical observations with the causes of illness. Once simplistic basic concepts developed, the numerous illusions of daily, seat-of-the-pants medical practice and cross-fertilisation with other cultures would lead to constant adjustments, ending up with quite complicated theories and practices.

        It can be regarded as a primitive form of science, with hypotheses being formulated, tested out, and modified, but under essentially impossible conditions, given the intellectual tools and knowledge of the times. From my understanding of Chinese culture and medicine the Chinese would have been at a disadvantage through cultural taboos against examination of the dead and even some of the living, so that basic anatomy was ill-understood until comparatively late, and it Chinese medicine became prone to rather pointless means of diagnosis such as examination of the tongue and pulse.

        We have seen much the same process in more modern times in the unwary and some who should know better, with the evolution of the quite complex cancer theories of Revici, Gerson Gonzales and others, and in some of the meanderings of naturopathy and homeopathy..

        A very old example is the “four humors” theory. “Black bile”. “yellow bile”, blood and “phlegm” were all observable materials that would be seen issuing, sometimes dramatically from the body in various illnesses. It was inevitable that theories would be woven around them.

        Whence acupuncture? It seems unlikely that the acupuncture points and all those lines on the old medical dolls and diagrams were wholly a fiction of fertile minds.

        I have pointed out before here that I suspect that the ancient Chinese would have seen a lot of streptococcal infections on arms and legs, from work in the rice paddies. The lymphangitis would produce those remarkably straight lines on the limbs, and the painful swollen regional glands would point to those anatomical locations being of importance, and the lumps likely signs of blockage of something? , where matter could build up, and sometimes be discharged, either spontaneously or from the insertion of something sharp.

        1. You went way back into Chinese history. 5000 yrs is a long time to try to BS millions of people. They were true alchemist, metaphysicist, scientist, engineers, mathematician, artisans and philosophers. They were about truth and harmony, not dogmas and capitalism. They figured out how to ignite healing and we are just now piecing the puzzle together.

          You also show that you are not well informed of acupuncture and all of it variations.

          Please you do not have to use the distant past as an example to justify our stupidity today. Just go back a few yrs.

          1. WilliamLawrenceUtridge says:

            So age and popularity determine if a treatment is effective or not? Really? Fascinating. So I assume you also pray to the ibex-headed Egyptian god of medicine, since it is older than acupuncture and was used universally by all Egyptians then-extant.

            Now, I assume that you must use stone lancets and bodkins, because acupuncture with filiform steel needles didn’t exist until the 19th century or so. And the earliest mention of acupuncture doesn’t date back 5,000 years, but at best 2,000 years to the Yellow Emperor’s Inner Canon. And what is described there is not acupuncture with needles that are left stuck in the body, but rather something much closer to bloodletting where the blood vessels of the body are gashed open to drain blood from.

            And of course, political affiliation or desire to do good do not justify medical practice. It doesn’t matter if your doctor is a capitalist or a communist. Mother Theresa, widely considered saintly, took in hundreds of millions of dollars to fund facilities that were essentially murder-by-neglect facilities where Hindus were religiously raped and force-converted to Christianity on their death beds. Many of them were sick with diseases that were curable with a few dollars worth of antibiotics, but the Missionaries of Charity were not a medical treatment facility – oh no, they were a well-funded place for the poor and non-Catholic to go to be blessed, in secret, before they died.

            Stephen, it’s amazing to me how much poorly-thought-out nonsense you manage to pack into every single post. How each one is filled with buzz words and nonsense which makes things sound so simple, unless one has just the slightest bit of common sense or knowledge about how real medicine works. It’s like you’ve been spoon-fed your rhetoric by acupuncturists and you never managed to think your way through what you were saying.

        2. Andrey Pavlov says:

          @pmoran:

          Whence acupuncture? It seems unlikely that the acupuncture points and all those lines on the old medical dolls and diagrams were wholly a fiction of fertile minds.

          Ben Kavoussi has documented quite well that acupuncture stemmed from bloodletting practices and that meridian lines map well to veins. There is not much need for conjecture, though your idea about the strep infections could certainly have been part of it as well.

  22. yogalady says:

    I have practiced yoga all my life and I know that the body can suffer from imbalance and chronic muscle tension. Correcting these problems does allow the body’s natural healing ability to restore health.

    It should be obvious to anyone that the body naturally heals itself as much as possible. We have all had the experience of healing, even it it’s only a superficial cut in the skin.

    Sometimes natural healing is obstructed and disease results. There is nothing nonsensical about these claims.

    This study may not have been completely blinded, but that does not necessarily explain away the positive results. Blinding can be very difficult when you are not studying drugs and can’t give a placebo.

    1. Yoga lady you are on to the basic ideas of health and wellness. Self Care is vital and you do not need a degree or a scientist to accomplish that.

      1. WilliamLawrenceUtridge says:

        You don’t need a naturopathic degree to recommend self care either. Proper diet and exercise are core recommendations of all scientific practitioners. If you’re claiming doctors don’t recommend them, you’re simply lying. If you’re taking credit for these recommendations, you’re deluded.

        Proper diet and adequate exercise are not alternative recommendations, they are heavily mainstream. It is not the fault of doctors and public health officials that the majority of the populace do not follow them. Stop blaming doctors for the failings of patients.

        1. madness says:

          Really? This is not the case some of the diets recommended by mainstream are appalling. I don’t know what planet you come from Mr Utridge but it certainly is a deluded one.

  23. william says:

    @ john snider,
    you do talk a good game !
    Do you think your palpation skills are equal to that of a D.O. who actually is a D.O.?
    How many children could you treat if the electricity went out, the pharmacies were closed and your team of nurses,staff weren’t around? Just you.

    1. Sawyer says:

      How many children could you treat if the electricity went out, the pharmacies were closed and your team of nurses,staff weren’t around?

      So now we’re judging modern medicine based on how well it would work WITHOUT ELECTRICITY!?!?

      This is kind of like Dr. Snyder criticizing osteopaths for not being able to treat patients without using their hands.

      1. weing says:

        “How many children could you treat if the electricity went out, the pharmacies were closed and your team of nurses,staff weren’t around?”

        As many as you and with the same success rate.

    2. Dave says:

      There are many doctors who volunteer on relief missions to third world countries. They scarf up all the supplies they can take with them and hope the clinic they are going to has some resources. The docs I’ve spoken to who have done this relate stories of people walking a hundred miles and waiting days in line to be seen, often to find that the clinic can’t help – something as simple as antibiotic or lubricating eyedrops may be lacking, and ocular problems are a big deal when you live in a dusty area and cook with an open fire.

      I’ve seen a lot of posts here lamenting the fact that doctors use drugs to treat people. Well, a lot of disorders require drugs. If you have hypothyroidism, you need a thyroid replacement. If you have diabetes, you need insulin or another hypoglycemic agent. If you have pulmonary emboli, you need blood thinners. If you have an underlying condition that increases the risk of dying early, such as uncontrolled hypertension, you can take drugs to modify that risk You can also refuse to take the drugs, which a lot of people do. For all the angry posts here about chemotherapy, every patient who gets chemotherapy signs a consent form that they desire to have the treatment administered.

      I suspect that the hostility comes from the high cost of some meds, the fact that some drugs are not as effective as we would like, and the fact that there are some disease (amyotrophic lateral sclerosis, chronic fatigue syndrome or Alzheimer’s disease come to mind) for which there are very marginal therapies.

    3. John Snyder says:

      My palpation skills are just fine, thank you. And, I don’t have to make s**t up…

    4. WilliamLawrenceUtridge says:

      Well obviously modern medicine would be essentially crippled if it lacked electricity.

      Not that this in any way justifies the use of osteopathic manipulation. Nor does it magically make an evidence base for osteopathic manipulation appear. I can bloodlet without electricity, I can pray to Thoth without electricity, but that doesn’t make either of them effective.

  24. Paul Spence says:

    Interesting article. I was educated in the UK at a time when osteopaths were regarded as quacks and not licensed to practise (as far as I recall). When I moved to the US I was quite literally shocked to find out that DOs were regarded pretty much the same as MDs. As the quackademic foundation of osteopathy is so absurd this troubled me deeply. I personally could never consider being treated by a DO for this reason.

    I’m a great fan of science based medicine and have spent a career pursuing its goals, even though I haven’t seen the inside of an operating theatre since 1985 – too much cutting and stitching.

    1. nancy brownlee says:

      @Paul Spence
      “When I moved to the US I was quite literally shocked to find out that DOs were regarded pretty much the same as MDs. As the quackademic foundation of osteopathy is so absurd this troubled me deeply. I personally could never consider being treated by a DO for this reason.”

      Yes. My state, Texas, and my city, Fort Worth, have been centers for this ‘alternative’ for many decades, and FW is still home to a large osteopathic school. I’m sure there must be DOs who are as competent as most MDs, but my experience (sorry, that may be an unacceptable criterion, but sometimes it’s all we’ve got to go on) with DOs is that they are badly trained – and are defensive about it. That defense largely takes the form of, “It’s just like being an MD! We all get the same training now!” Questionable on so many levels… and when I read the hysterical defenses of manipulation on SBM- by DOs and osteopathic students- I am even more certainly doubtful of any osteopathic move toward genuine medical science.

      1. PB says:

        I’m pretty sure there was only ONE rabid DO student (and one rabid MD) on here “hysterically” defending OMM.

        1. nancy brownlee says:

          I’m sure you’re right – at least, when considering only the responses to this particular entry. I wasn’t.

  25. Rob Cordes, DO says:

    To reply to the question about my experience using OMT for acute asthma:
    I did this a medical student around 1991.
    A patient would be complaining of asthma type symptoms and my exam would find wheezing on listening to their lungs.
    I would perform HVLA manipulation to the t spine and immediately listen to their lungs again finding a decrease or resolution to the wheezing and the patients expressed subjective improvement.
    Only twice did I have the chance to do objective measurements using a peak flow meter pre and post manipulation. One patient had an immediate improvement in peak flow and improved exam findings the other a decrease in peak flow and increased wheezing on exam. The one who decreased was a smoker that is the one significant variable I remember.
    The thing was I could never get a DO attending physician to help me set up a study.
    So I think there is a possibility that some forms of manipulation may have physiologic effects. The problem I see is those of promote its use are not doing the studies.

    Until such time as there is good evidence of beneficial effects my wheezing asthmatic patients will continue to get albuterol. Which I could developer via MDI and spacer without electricity.

    1. Harriet Hall says:

      Have you considered that reassurance and relaxation might be responsible for what you observed? Peak flow measurements are effort-dependent, and a hyperventilating patient can be calmed down and their respiratory rate reduced by simply talking to them.

      1. Rob Cordes, DO says:

        That is an idea, but from what I remember there was not much converstation between my initial lung exam and the OMT and follow up lung exam.
        Can a short conversation create enough relaxation to effect brochospasm?
        I will not object to the idea that as a 3rd yr med student my bed side manner was good enough to effect acute asthma.

        Either way something I did had an effect on the patients. Enough effect I think it worthy of legitate study.

        Here is a basic example of the tehnique I used.
        http://www.youtube.com/watch?v=Rj4Y5JGNPZs

        1. Harriet Hall says:

          It might not have been anything you said or anything about your bedside manner, but simply the fact that you were doing a hands-on manipulation and the patients had high expectations of its effectiveness. Have you ever wondered why DOs have been doing it for over a century without ever having established its effectiveness in legitimate studies?

          1. Rob Cordes, DO says:

            I wonder about that a lot.

            1. WilliamLawrenceUtridge says:

              A properly-controlled clinical trial would mean you no longer have to wonder :)

  26. Madness says:

    An interesting interpretation of this paper. Shame it shows such a poverty of understanding of the relationship between pathology and physiology. Shame on your church like belief structures. These belief structures are for people who have personally disorders so if this kind of stuff floats your boat, please do the world a favour and seek professional counselling.

    1. WilliamLawrenceUtridge says:

      Naw, the shame is on the authors for using such a shoddy, easily-recognized problem with the control group. With flaws like this, the article is borderline-useless, a waste of time and resources during a time of scarcity. It’s not enough to show a hypothetical relationship between pathology and physiology; that kind of faith is characteristic of the church you so disparage, requiring only a theoretical link. What is really necessary is a carefully-controlled study that isolates each potential factor and accounts for it. That is how real science is done. While churches may demand faith in the absence of empirical evidence, science demands the very opposite.

      1. madness says:

        Hypothetical link between pathology and physiology, you believe there is no relationship. I guess you think pathology happens independently of physiology or are you saying we need to study if one effects the other?

  27. Jason Hartman says:

    Keep writing those scripts to fill the pharmaceutical companies pockets…then tell me the mechanism of action of every medication you write for. Until then:

    There is nothing wrong with allowing for the possibility that some osteopathic techniques work, unless perhaps it challenges your fragile ego and your pockets that are lined with the by-product of the 10 minute medical model.

    We can embrace both sides of medicine, the wellness model and the disease model; the holistic and reductionist, the surgical and preventative. And those of us who do will be more successful, have better relationships with our patients, and be open to the possibility of something greater than your point of view.

    If you do not like it…Too Bad! Continue to slander and hide behind that which you know and when your child is sick our your back is aching and we can help. We will do it gladly, with a smile. Why? because we are busy applying old ideas in new ways and not afraid to think outside of the box that you know. So while you are busy writing your little “blog” justified by your superior training we will be seeing your patients that you have failed because your brand of medicine offers a piece of paper with a drug on it as an excuse for caring.

    1. windriven says:

      @Jason Hartman

      Hmmm… A veritable Noah’s Ark of false dichotomies paraded two by two.

      1. Woo Fighter says:

        It should be noted that Dr. Hartman’s wellness clinic also sells reiki and cupping services alongside chiro and acupuncture.

        Of course he also peddles a wide assortment of supplements, vitamins, enzymes, amino acids, protein powders and “paleo” products. I’m sure all of his clients are eventually referred to his supplement store with a list of products they need to buy.

    2. WilliamLawrenceUtridge says:

      See Jason, the mechanism of action is a bonus, if known. One doesn’t need to know the mechanism of action to know if a treatment is effective – merely careful counting. When controlling for the effectiveness of a medication, one needs merely to remove the medication for the control group. For physical interventions, something more sophisticated is required – and they didn’t have it. Want to control for physical manipulation in infants? Control for touch. Which they didn’t.

      Nobody here is afraid to “think outside the box”. They merely ask that one does not substitute that thought for evidence. It’s not enough to hypothesize a link or explanatory framework – one must verify one’s hypothesis is correct.

      Modern medicine is holistic – it examines body and mind (spirit is a hypothetical construct). It is preventive – vaccination, genetic testing, diet and exercise are all important, mainstream tools in the medical toolbox. It also treats back pain, generally through the instructions to stay active, take painkillers, and recognize that it will go away on its own in a relatively short time.

      Medicine isn’t flawed merely because it doesn’t embrace your favoured form of quackery; that’s a flaw in your favourite form of quackery because it is either untested, or practitioners refuse to recognize that the quackery failed the tests.

    3. John Snyder says:

      I do believe I detect a bit of hostility in your remarks. You know it’s funny, I too adhere to both a wellness and a disease model in my practice of medicine. That’s the one and only similarity it seems between the two of us, because I require evidence for the treatments I provide.

  28. I’m sure you guy have this disease Dogma Science Phase Locked Syndrome.

    Science Set Free: 10 Paths to New Discover
    Sheldrake offers the “ten dogmas of science” that he thinks need to be treated with more suspicion than they currently are:
    That nature is mechanical.
    That matter is unconscious.
    The laws of nature are fixed.
    The totally amount of matter and energy are always the same.
    That nature is purposeless.
    Biological inheritance is material.
    That memories are stored as material traces.
    The mind is in the brain.
    Telepathy and other psychic phenomena are illusory.
    Mechanistic medicine is the only kind that really works.
    http://www.amazon.com/o/ASIN/0770436706/thedailygrail

    1. yogalady says:

      Yes I agree with Sheldrake on most things. Unfortunately mainstream science will continue to ignore him.

      In the UK, his book is called The Science Delusion. Mainstream western science really has become delusional.

      And mainstream medicine is obsessively focused on drugs and surgery. Mechanical and electrical aspects of the body, for example, are mostly ignored.

      The big drug companies fund a lot of the medical research, so of course drugs are what gets studied. How do you expect osteopaths and chiropractors to get funding for big RCTs?

      1. Harriet Hall says:

        “How do you expect osteopaths and chiropractors to get funding for big RCTs?”
        The NCCAM funds such studies. All they need to do is present a well-thought-out proposal.

        1. yogalady says:

          You really think NCCAM has as much money as Big Drug?

          1. Harriet Hall says:

            No, but then Big Drug studies a lot more different drugs. The question was whether funding could be obtained for large studies on chiropractic and/or osteopathic manipulation. It can, and they are receptive to such research proposals. Consider some of the less plausible studies they have funded, like the Gonzalez study of coffee enemas, etc. to treat pancreatic cancer.

          2. Sawyer says:

            No, but they shouldn’t NEED as much money as “Big Drug”.

            One of the things that continues to amaze me about alt med fans is not only their lack of scientific acumen, but their inability to manage resources (both financial and human) efficiently. Yes, large scale RCTs are more expensive than crappy pilot studies, but they aren’t obscenely expensive for most CAM treatments. You don’t have anywhere near the same level of manufacturing, regulatory, or intellectual property barriers that pharmaceutical researchers have to deal with on a daily basis. I know there are still overhead costs to deal with, but this stuff is insanely cheap compared to what other medical research labs are doing.

            Instead of funding dozens of different small studies, have top-notch researchers submit grant proposals for extremely rigorous RCTs. Focus on treating non-specific, non-self limiting symptoms. Or go the other direction – stop doing trials completely and dump all funding into basic biochemistry and anatomy research to discover the underlying mechanisms behind your treatments.

            The FY 2013 NCCAM budget was $128 million. If the quacks can’t allocate this money correctly maybe they need to hire better accountants.

    2. Harriet Hall says:

      Sheldrake has a lot of weird ideas, is not an authority, and does not understand science. Those 10 items are not dogmas at all; they are provisional conclusions based on the best available evidence, and are open to revision if better evidence comes along. Sheldrake believes he has evidence, but he doesn’t. He only has pseudoscience, gullibility, and speculation.

      1. Andrey Pavlov says:

        Sheldrake is a complete quack. In fact, TED finally put their foot down and enforced some standards and kept him out. Now if only they would do the same for Chopra…

        In any event, invoking Sheldrake is one of a few very good litmus tests. Denying evolution, being a YEC, or invoking Chopra are some others. They tell me all I need to know about the person – that they are unreachable and that they are strongly anti-science. Except in the rarest of circumstances people like these do not share a language with people like us. Trying to convince them of anything would be like trying to hold a conversation where you spoke in English and they in French, with each of you knowing only a smattering of words here and there. Oui? Oui!.

        Invoke Sheldrake and you lose. Or, more accurately, you were never really playing in the first place and tried to bring your invisible ball of aura to a football game and complained when nobody was using your ball and playing your game.

      2. yogalady says:

        Did you ever read his book A New Science of Life?

        Sheldrake is an educated intelligent person and his ideas are at least worth considering. It is not scientific to dismiss someone just because you find their ideas unsettling.

        1. Andrey Pavlov says:

          It is not scientific to dismiss someone just because you find their ideas unsettling.

          You are absolutely right. But it is scientific to dismiss his ideas because they are ridiculous, have no evidence to support them, and plenty of evidence against them. Which is why his ideas are rejected by the scientific community.

          1. Anyone who is not open minded and who realizes that the standard-of-care is flawed and does irreparable harm to many unsuspecting people, will see the list and think honestly and deeply.

            Then if you have alternative therapy that will catch some of those who fall through those cracks, you have confirmation of what evil men will do for profits and fame.

          2. yogalady says:

            ” it is scientific to dismiss his ideas because they are ridiculous, have no evidence to support them, and plenty of evidence against them. Which is why his ideas are rejected by the scientific community.”

            There is no evidence against his ideas, and there is plenty of evidence for them.

            His ideas are rejected by the scientific community because mainstream science has become devoutly materialist. Without, by the way, ever explaining what “matter” is.

            Mainstream science rejects the possibility of life energy or life fields. Why? No special reason, the ideas just don’t fit their materialist preconceptions.

            Sheldrake, and alternative science in general, accepts and studies life energy and life fields. These ideas have been held by people in all times and places. Why? Because people are gullible and stupid? I don’t think that is why. But that is how scientific materialists see it.

            1. MadisonMD says:

              @yogalady

              Mainstream science rejects the possibility of life energy or life fields. Why? No special reason, the ideas just don’t fit their materialist preconceptions.

              Not quite. Electromagnetism is an example of a “life field” that science accepts. Electromagnetism is used to transmit signals through nerves and to make heart and muscles contract.

              Do you mean something else? I’m prepared to accept the possibility– if you can demonstrate it. Any ideas on how you can see, feel, or measure another “life energy” or a “life field?”

            2. Andrey Pavlov says:

              There is no evidence against his ideas, and there is plenty of evidence for them.

              Perhaps you’d care to reference that evidence?

              Mainstream science rejects the possibility of life energy or life fields. Why? No special reason, the ideas just don’t fit their materialist preconceptions.

              I suppose you are right, that it is for no special reason. It is just a regular ol’ reason, really. The reason being that there is, despite extensive testing, absolutely zero evidence that these fields exist (save the ones MadisonMD pointed out, which we can detect, but no others). Oh yeah, and that funny thing about the Higgs boson and the Standard Model of physics. See, the Higgs filled in the last biggest empirical piece of the Standard Model. So what that means is that if there are any forces yet to be discovered (and there are) then the distance of action of said force must either be on quantum scales if the force is strong, or must be incredibly weak. Which means there are no forces left which can act on human physiology that we have not described.

              Which means if we haven’t detected that force – that field – then it either doesn’t exist (most likely) or is absolutely inconsequential to human life.

              Oh, and of course, none of this even remotely posits the need for anything non-material (whatever that would mean, anyways).

              Why? Because people are gullible and stupid?

              Well, to put it bluntly, yes. Well, that’s not entirely fair. They really didn’t know better back then. We do now. So for modern people to still think such things, I suppose gullible and stupid are probably accurate most of the time.

              I don’t think that is why. But that is how scientific materialists see it.

              Want to guess why we see it that way? Because there is stupendously overwhelming evidence that it is the case. That and the philosophical underpinning of science is that of methodological naturalism.

              1. yogalady says:

                “the philosophical underpinning of science is that of methodological naturalism.”

                No it is not. And what is “naturalism” anyway? What is “natural?” The things you already know about and are able to detect? Anything else that might exist is impossible?

                Life energy and life fields exist, although not accepted by current mainstream science. They are researched in alternative science.

              2. MadisonMD says:

                @Yogalady

                Life energy and life fields exist

                How do you know they exist? It is quite simple. All you need to do is demonstrate them and it will be accepted by “mainstream medicine.” Please provide citation or evidence.

                Thank you.

              3. Andrey Pavlov says:

                No it is not. And what is “naturalism” anyway? What is “natural?” The things you already know about and are able to detect? Anything else that might exist is impossible?

                Then you should go take that up with the philosophers and the millennia of epistemological underpinnings of the scientific method.

                In other words, you quite simply have no idea what you are talking about.

                No, not limited to the things we already can detect, but limited to the things we can detect in principle. If you want to claim that the mechanism of action of aspirin is be spontaneously generating millions of tiny unicorns that attack the COX enzyme and destroy it, but that they are generated and destroyed so rapidly they can never be detected, then you have left the realm of science.

                Life energy and life fields exist, although not accepted by current mainstream science.

                And what evidence do you have for this? Can you demonstrate it to me? If “mainstream science” can’t detect it, how can you? What method are you using to detect these fields and assert that they exist?

                They are researched in alternative science.

                So? They haven’t been established to exist. And have plenty of evidence that they don’t (enough, in fact, that the book really is closed on it, albeit somewhat recently).

                But the point still stands – you can “research” anything and get data and write papers. Our own Dr. Hall called that – very aptly – tooth fairy science. You can study the tooth fairy, how much money she brings for what kind of teeth, whether different countries get different rates, etc. But you haven’t established that the tooth fairy exists in the first place.

                There are people that study god. Specific gods. Allah vs Yawheh vs Ganesh. Does the fact that they are studied – and have papers written about them by people who dedicated their lives to it – mean that they exist also? Because then we have a problem since all gods would exist and we know that can’t be true.

                So you can study “life energy” without it actually existing. Which is precisely what these “alternative science” people are doing.

              4. weing says:

                ““the philosophical underpinning of science is that of methodological naturalism.”

                No it is not.”

                What is it then?

                “The things you already know about and are able to detect? Anything else that might exist is impossible?”

                Do you mean like the Higgs boson? We were just recently able to detect it. Until recently it was postulated to exist in real science. Ever hear of dark matter and dark energy?

                In an alternate universe, alternative science has developed flying carpets and telepathy. Here, real science has only airplanes, TV, internet, etc.

        2. Harriet Hall says:

          I don’t dismiss Sheldrake’s ideas because I find them unsettling. I find them unsupported by evidence and incompatible with the rest of scientific knowledge. And some of them have been debunked by other researchers. See http://www.richardwiseman.com/resources/psychicdogreply.pdf

    3. WilliamLawrenceUtridge says:

      Stephen, you keep decrying “dogma” in medicine. “Dogma”, as I have said repeatedly, is “belief without evidence”. For instance, your ongoing assertions to believe your personal experience without scientific evidence to back up your opinion? That is a call to dogma.

      Refusing to believe your claims about the medical system and human biology is not dogma, it’s a recognition that much of what you say is contradicted by evidence.

      You want people to believe you? Stop demanding they believe you merely because you find your own opinion convincing. Do some research. Read some research. Reconcile your opinion with the research.

      What you’re doing now is a call-back to the huckster snake oil salesmen of a century ago, who asked their customers to believe them, trust them, and above all – hand over their money.

      1. Dogma is certainty of a belief or an idea whether it is true or not.

        1. WilliamLawrenceUtridge says:

          Yes, which is why scientist and skeptics are not dogmatic. Because we ask for evidence to justify our beliefs.

          That’s ever been the problem, you believe because of your uncontrolled experience. We look at that, compare it to the carefully-controlled scientific studies of acupuncture, and quite reasonably conclude that the evidence does not favour your claims of specific effects.

          That’s what you don’t get.

  29. madness says:

    It would be funny, if it wasn’t frightening that the writers knowledge on health and disease is phenomenally poor. The understanding that the human organism is self healing is not just an osteopathic idea, but now also medically accepted, otherwise cuts and bruises would never heal or we would die from a common cold. He should really go and get an education and some counselling.

    1. yogalady says:

      Yes of course the body is self-healing. How could anyone think otherwise?

      1. Sawyer says:

        Sorry for being rude, but are these parody accounts?

        You recognize there is a difference between normal operation of the lymphatic/nervous/endocrine systems and the magical, spiritual, I-can-reverse-MS-with-my-immune-system version of self-healing, right?

        No one else here seems to have any trouble making this distinction.

    2. John Snyder says:

      Oh, thanks so much for that important piece of information about sefl-healing. I hadn’t realized that the body can heal cuts and bruises. I guess I’ll have to re-think everything now.

      You either did you read my post at all, or you simply have a penchant for stating non-seqitors. I never said the body doesn’t have innate defenses and repair mechanisms, just that there is no evidence, or even plausibility for the benefit of OMM.

      1. Dave says:

        It is truly amazing that alt-enthusiasts seem to think doctors are unaware the body has a capacity to heal. Some of the most harrowing conditions we deal with are when that capacity is damaged – trying to get patients through a septic episode when their wbc count is zip being one example. Some of our work is also mainly to support the patient until the body can heal. We have no effective therapy for the disorders of hantavirus or ARDS, for example. Treatment involves supportive care, usually with ventilatory support, iv fluids and medications to support the blood pressure, until the body heals.

        Nature is not benign. If a tick could think it would probably thank a deity that human beings were put on earth for it to feed on, and the lyme bacteria, erlichiosis or rocky mountain disease rickettsia it carried would heartily agree.

        1. @dave are you the same dave from Nat. Pain Report?

          1. Dave says:

            No. I belong to no organization.
            I got interested in this stuff because I think SBM is important, more actually for helping out mainstream medicine than for combatting alternative therapy. For centuries people have been treated with therapies that have been used because of tradition, recommended by experts (eminence-based medicine), based on flawed theories, based on glowing anecdotes, or even based on good theories, but later often shown not to work. Until the recent past this was the history of mainstream medicine. Even now it occurs – we still will see a study come out touting some treatment, (such as very tight control of blood sugars in ICU patients) that has multiple confounding problems (early use of TPN, for example), only to find on later studies that the treatment doesn’t pan out. I regard SBM as the best way out of this morass. The use of many medications have been curtailed because of controlled studies, the poster child being flecainide and encainide from the CAST trial, and some surgical techniques have been reduced due to it – full radical mastectomies as an example – when did you last see one of those? How in the heck do you find out if something works or not unless you study it, and then repeat the study (very important! Otherwise we’d still be doing expensive, useless, dangerous and futile bone marrow transplants on breast cancer patients, but the initial study out of South Africa looked great)? The older medical textbooks are full of treatments that people believed in unconditionally based on individual experience which were later found to be useless. We know that individual experience and anecdotes are good for postulating that a treatment works, but it takes further work to determine if it really is effective. And, damn it, the patients deserve this! And so do the doctors delivering the care! I’ve felt really betrayed when a treatment I was taught was effective turned out later to not be.

            And yes, there are problems with RCT’s and EBM. These are talked about HEAVILY in the mainstream medical journals. It’s a work in progress. Unfortunately, I can’t see anything better out there.

            1. I referring to this dave:
              Dave says: February 3, 2014 at 7:35 am
              John- Yes we agree- it is up to people in pain to trouble the sleep of politicians and medicine in America when it comes to improving pain care. And it will take quite a lot of effort to trouble their sleep for they do not wish to be troubled.
              http://americannewsreport.com/nationalpainreport/nation-pain-americas-hidden-epidemic-8822896.html#comments

              I agree with the stand-of-care protocols forced into our psyches by drug reps and CME meeting. I still have to go to them to maintain and to get a kick out of the responses when I talk alternatives. It falls on deaths ears but at least I try to change the dialogues.

              The needles allow the provider to ignite innate healing to actually auto-miraculously solve a lot of medical conundrums without harm and with fewer drugs. I still use traditional meds (the tried and trues) sparingly with much better outcomes. (in my observations)

  30. Vicki says:

    So acupuncture is the belief that matter and energy are not conserved, individual atoms are conscious, you are telepathic, and neither memory nor biological inheritance are part of the actual physical world?

    In that world model, I don’t see why anyone bothers with medicine, acupuncture, exercise, or even food: surely the non-material mind and memory don’t have any significant connection to the body, or need it.

    The mere fact that someone can list ten nonsensical things that most scientists–and most other sensible people–would say are false doesn’t make any of those things true. Go sacrifice a goat to Asclepius, and maybe say a few prayers to Apollo, god of medicine, mice, and music.

    1. This is what this site advocates are human sacrifices.

      Animal sacrifices have devolved into actual human sacrifices by political leaders or religious radicals. Dogmatic stubborn narrow minded scientific or physicians will also allow failed medical cases to languish in misery and pain until they “die by cop” or heroin or OD or MVA or GSW.

  31. (some of you who are not versed in the practice of low-tech pain therapy will not get all of these)
    Dogmas as a result of material science and denial of myofascial pain and dysfunction:
    @we can fix it.
    @we can medicate it.
    @if you fail therapy, it’s the patients tough luck or fault that they did something worn to mess things up.
    @we can see where your pain is with our x-ray or mri
    @if we rely on high tech we will solve all illnesses.
    @doctors know what is best for you.
    @if it is not detectable you are a hypochondriac.
    @pain will not kill you.
    @pain that is not the dangerous is ok to ignore and neglect.
    @pain will not spread.
    @pain can’t be coming from the muscles.
    @pain is not coming from the TrPs.
    @TrPs can not cause nerve or vascular problems.
    @Those simple TrPs can not cause dysfunction.
    @TrPs will just disappear all by themselves.
    @TrPs have to fit the standard definitions.
    @TrPs will give a twitch response
    @TrPs just need a shot of steroids.
    @All TrPs need steroids.
    @one shot will treat a TrP.
    @just treat the TrP and all is well. no worries about the PT.
    @just treat the primary TrP.
    @Don’t worry about the secondary TrPs.
    @a knee is a joint.
    @pain in a joint radiates outwards … so it can’t radiate into the joint.
    @pain that feels like is is in the bone must be in the bone.
    @the biscuit analogy is bunk.
    @If we keep trying to fix a bad back we will get it right sooner or later.
    @Long term opiates is OK by me and the medical community.
    @The long term dangers of drugs are OK.
    @All trials are valid and complete, no need to update them or repeat overtime or continue over an extended time.
    @All researcher are completely without bias or faults or errors.
    @Stats don’t lie.

    1. WilliamLawrenceUtridge says:

      Stephen, “dogma” is the belief in things without evidence.

      What you are describing are areas of uncertainty and within the scientific literature, community and research processes. They are complicated, fraught with difficulty and in many cases controversial. Yes, we lack strong scientific results in many of these areas and further research is needed. Yes, individual practitioners will fall short, will dismiss patients and will give suboptimal care.

      That doesn’t mean that your assertions are automatically right. That doesn’t mean that your opinions are truth. That doesn’t mean that your experience is beyond question.

      Yes, trigger points are a possible solution for pain (TrP, for everyone who doesn’t have an intimate understanding of the inside of Stephen’s mind, are trigger points). Paul Ingraham, a long-time support person for this site, discusses the scientific evidence for (and lack of evidence for) trigger points as sources of pain. His website, saveyourself.ca, manages to do this while engaging deeply with the scientific evidence, including the evidence that acupuncture isn’t effective. He does this without claiming conspiracy or incompetence, and while acknowledging the complexities of the area.

      You might learn something from him. You might try engaging with the scientific evidence, rather than setting up a straw-man caricature of science and medicine just so you can knock it down.

      Merely because real medicine is imperfect doesn’t mean you are automatically right. You could be right, but proving it requires hard work and dedication – not merely mouthing off. Criticizing real medicine is like masturbation – you may please yourself, but you accomplish nothing.

      1. Those are all truths and will be forever! i know they are difficult to ingest in one bite, so take them one at a time.

        Your friend Ingraham is Myofascial tissues knowledgeable has an “almost” complete understanding of how to treat MF chronic pain and dysfunction.

        He should read C. Chan Gunn, MD who helps to links MF issues into 2 groups; 1. Those that can be treated with hands-on kneading, adjustments and unwinding. AND 2. Those where the muscles have to be rebooted electro-mechanically with a wire.(as per Cannon’s Law) In this case, the “internal muscle electrical program” is locked-down and will not release without a “reboot.” These muscles are locked because of a magnesium-calcium imbalance corrupting the muscle into an autonomously/independently death grip. http://www.ncbi.nlm.nih.gov/pubmed/7286246

        So MF release therapy comes in 2 forms, hands-on + leverage and with needles.
        Here are some clues that will allow you to think about the wire reboot:
        No improvement despite intensive hands-on care.
        The patient has autonomic discombobulation with erratic pulse, digestion and temperature.
        Above and below the waste misery.
        More than usually stiffness and decreased ROM.
        The person’s back or muscle feels like leather or balsa wood.
        The skin is thickening due to intramuscular blockage of lymphatics.
        etc.

        1. WilliamLawrenceUtridge says:

          Those are all truths and will be forever!

          So you assert dogmatically without evidence. Merely because we don’t know the answer now doesn’t mean we will never know the answer.

          Your friend Ingraham is Myofascial tissues knowledgeable has an “almost” complete understanding of how to treat MF chronic pain and dysfunction

          I’m sure he’ll find that quite comforting. The thing is, if your grasp of myofascial issues is as rock-solid as you claim it to be, by subjecting it to controlled tests you could do tremendous service to humanity and science. By claiming you have all the answers and don’t need to test anything, you’re just being an arrogant, dogmatic douchebag.

          Actual truths have no fear of well-controlled tests. Actual tests require development beyond a single article from 1981. Only horribly arrogant doctors would insist they are right solely on the basis of their experience and in the absence of evidence, and pointing out that absence of evidence isn’t dogma. It’s merely critical thinking.

          Maybe cite something a little more recent than 33 years ago?

    2. Harriet Hall says:

      Congratulations! What a tour de force! I have never seen so many straw man fallacies listed in one place.

      1. Andrey Pavlov says:

        Honestly Dr. Hall, it never ceases to boggle my mind when I see comments like SSR’s. That wall of “@…” is just… impressive. I hate being overly speculative or assign my own values and thoughts to others, but I have trouble fathoming what kind of mind besides a deeply troubled one could generate such dreck.

        1. I figure some of you would not be able to comprehend the vastness of my insights now that I can see through the fog!!

          Read my author and you 2 will be enlightened. Otherwise I would be taking and conversing to brick walls.

          1. Andrey Pavlov says:

            Delusional much?

            1. Delusions and illusions are all in one’s mind.

              I know where the flaws are in mechanical science and medicine. I know what pain is and is not, I know what alternatives are and are not … same for (A) acupuncture.

              My mind and insights are clear and fluid!

              1. MadisonMD says:

                Delusions and illusions are all in one’s mind.

                Particularly in yours.

              2. windriven says:

                Put up or shut up Rodrigues. Quit running from the challenge you coward.

          2. MadisonMD says:

            Otherwise I would be taking and conversing to brick walls.

            Your logic may be more persuasive to brick walls. What have you got to lose?

    3. Dave says:

      Honestly, this is really over the top.

      There are some conditions medicine can “fix”. Most of the conditions doctors deal with however are chronic conditions which occasionally resolve but often afflict the patient for his or her life. They cannot be “fixed”. This is like lecture #1 in medical school.
      These diseases must be managed. Some will be fatal without treatment (insulin for insulin-dependent diabetes) but for most the patient’s life will be much better for having the disease treated (ACEI, beta blockers and diuretic for chf for example).
      There are side effects to medications. These side effects may be “ok” if the benefit of the medication outweighs the risk or the aggravation of the side effects. If unacceptable side effects occur the meds should be changed (from an ACEI to an ARB for example) or stopped. A comment made to my freshman medical school class by Dr Richard Vilter, head of the IM program where I trained and President of the American College of Physicians – “The darn thing about medicines is that they don’t just do what we want them to do, they do everything they’re capable of doing”. Any doctor worth her salt knows this and has a healthy respect for side effects.

      Some diseases have no effective treatment and some are painful. That is where the concept of PALLIATIVE CARE comes in. It’s a big deal. We have a separate department in my hospital dealing with it. Hospice care is a major part of palliative care but palliative care is broader.

      Palliative care may involve pain medications, muscle relaxants, anti-anxiety agents, oxygen, the initiation of hospice, home health visits, home aid, etc.

      Not all treatment involves drugs. I cannot tell you how many grab bars. toilet seat risers. shower benches, canes, walkers, wheelchairs etc I’ve ordered in my life. It would fill a warehouse. Ditto with referrals to physical therapists and occupational therapists or dieticians.

      Some of your other comments, such as mri’s being regarded as perfect in defining what’s hurting, don’t merit a response.

      It seems your big deal is refractory back pain. The other physicians on this blog may correct me if I am wrong, but I think the standard approach with a back pain patient is first to make sure there’s no life threatening problem such as discitis, metastatic disease, cord lesions or even a dissection. If these are ruled out most patients, including those with herniated discs will recover with whatever treatment given enough time. The studies have shown equal outcomes at six months for all modalities. Six months is a long time. The remainder of patients have a really difficult problem. You claim to have a miraculously effective therapy, but so far you haven’t given a definition of it or produced any evidence other than your word that it works, when there are numerous studies on the effectiveness of accupuncture which have been related ad nauseum in this blog. If your treatment is as good as you say you really should do the study and get it verified. I personally would be ecstatic if we had better therapy for chronic low back pain, but I think we should have the same evidence your therapy works that we would have for a new drug or surgical technique, certainly more than your word alone.

      You also have a beef with chronic opioid use. I think most doctors, if asked, would say that the treatment of chronic unrelenting pain in patients with non-malignant conditions is one of the thorniest problems in medicine. Twenty years ago narcotics were rarely used for chronic non-cancer pain. The push came from certain experts based on the results of short term studies, without longterm trials (the kind of thing that SBM should help prevent from happening), resulting in the present situation. This is one condition where treatment needs to be individualized and the risk/benefit issue needs to be continually re-examined. You hate to have a patient suffer continually with pain but the meds have many adverse and dangerous side effects. The most recent CME I’ve done on this stresses increased function as the primary goal since total pain relief is not often possible, and recognizes the dangers of chronic opioids. Again, if your treatment helps these people, do the work and get it verified so it can become mainstream.

  32. madness says:

    If your so convinced micromanagement of RCT’s is the way ahead why not have a look at this;

    Richard Smith: Medical research—still a scandal
    31 Jan, 14 | by BMJ

    Twenty years ago this week the statistician Doug Altman published an editorial in the BMJ arguing that much medical research was of poor quality and misleading. In his editorial entitled, “The Scandal of Poor Medical Research,” Altman wrote that much research was “seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.” Twenty years later I fear that things are not better but worse.

    Most editorials like most of everything, including people, disappear into obscurity very fast, but Altman’s editorial is one that has lasted. I was the editor of the BMJ when we published the editorial, and I have cited Altman’s editorial many times, including recently. The editorial was published in the dawn of evidence based medicine as an increasing number of people realised how much of medical practice lacked evidence of effectiveness and how much research was poor. Altman’s editorial with its concise argument and blunt, provocative title crystallised the scandal.

    Why, asked Altman, is so much research poor? Because “researchers feel compelled for career reasons to carry out research that they are ill equipped to perform, and nobody stops them.” In other words, too much medical research was conducted by amateurs who were required to do some research in order to progress in their medical careers.
    Ethics committees, who had to approve research, were ill equipped to detect scientific flaws, and the flaws were eventually detected by statisticians, like Altman, working as firefighters. Quality assurance should be built in at the beginning of research not the end, particularly as many journals lacked statistical skills and simply went ahead and published misleading research.

    “The poor quality of much medical research is widely acknowledged,” wrote Altman, “yet disturbingly the leaders of the medical profession seem only minimally concerned about the problem and make no apparent efforts to find a solution.”

    Altman’s conclusion was: “We need less research, better research, and research done for the right reasons. Abandoning using the number of publications as a measure of ability would be a start.”

    Sadly, the BMJ could publish this editorial almost unchanged again this week. Small changes might be that ethics committees are now better equipped to detect scientific weakness and more journals employ statisticians. These quality assurance methods don’t, however, seem to be working as much of what is published continues to be misleading and of low quality. Indeed, we now understand that the problem doesn’t arise from amateurs dabbling in research but rather from career researchers.

    The Lancet has this month published an important collection of articles on waste in medical research. The collection has grown from an article by Iain Chalmers and Paul Glasziou in which they argued that 85% of expenditure on medical research ($240 billion in 2010) is wasted. In a very powerful talk at last year’s peer review congress John Ioannidis showed that almost none of thousands of research reports linking foods to conditions are correct and how around only 1% of thousands of studies linking genes with diseases are reporting linkages that are real. His famous paper “Why most published research findings are false” continues to be the most cited paper of PLoS Medicine.

    Ioannidis’s conclusion as to why so much research is poor is similar to that of Altman’s: “Most scientific studies are wrong, and they are wrong because scientists are interested in funding and careers rather than truth.” Researchers are publishing studies that are too small, conducted over too short a time, and too full of bias in order to get promoted and secure future funding. An editorial in the Lancet collection on waste in research quotes 2013 Nobel Laureate Peter Higgs describing how he was an embarrassment to his Edinburgh University department because he published so little. “Today,” he said, “I wouldn’t get an academic job. It’s as simple as that. I don’t think I would be regarded as productive enough.” Producing lots of flawed research trumps a few studies that change our understanding of the world, as Higgs’s paper did.

    Chalmers, Glasziou, and others identify five steps that lead to 85% of biomedical research being wasted. Firstly, much research fails to address questions that matter. For example, new drugs are tested against placebo rather than against usual treatments. Or the question may already have been answered, but the researchers haven’t undertaken a systematic review that would have told them the research was not needed. Or the research may use outcomes, perhaps surrogate measures, that are not useful.

    Secondly, the methods of the studies may be inadequate. Many studies are too small, and more than half fail to deal adequately with bias. Studies are not replicated, and when people have tried to replicate studies they find that most do not have reproducible results.

    Thirdly, research is not efficiently regulated and managed. Quality assurance systems fail to pick up the flaws in the research proposals. Or the bureaucracy involved in having research funded and approved may encourage researchers to conduct studies that are too small or too short term.

    Fourthly, the research that is completed is not made fully accessible. Half of studies are never published at all, and there is a bias in what is published, meaning that treatments may seem to be more effective and safer than they actually are. Then not all outcome measures are reported, again with a bias towards those are positive.

    Fifthly, published reports of research are often biased and unusable. In trials about a third of interventions are inadequately described meaning they cannot be implemented. Half of study outcomes are not reported.

    The articles in the Lancet collection concentrate constructively on how wastage in research might be reduced and the quality and dissemination of research improved. But it wouldn’t be unfair simply to repeat Altman’s statement of 20 years ago that: “The poor quality of much medical research is widely acknowledged, yet disturbingly the leaders of the medical profession seem only minimally concerned about the problem and make no apparent efforts to find a solution.”

    I reflect on all this in a very personal way. I wasn’t shocked when we published Altman’s editorial because I’d begun to understand about five years’ before that much research was poor. Like Altman I thought that that was mainly because too much medical research was conducted by amateurs. It took me a while to understand that the reasons were deeper. In January 1994 at age 41, when we published Altman’s editorial, I had confidence that things would improve. In 2002 I spent eight marvellous weeks in a 15th century palazzo in Venice writing a book on medical journals, the major outlets for medical research, and reached the dismal conclusion that things were badly wrong with journals and the research they published. I wondered after the book was published if I’d struck too sour a note, but now I think it could have been sourer. My confidence that “things can only get better” has largely drained away, but I’m not a miserable old man. Rather I’ve come to enjoy observing and cataloguing human imperfections, which is why I read novels and history rather than medical journals.

    Competing interest: RS was the editor of the BMJ when it published Altman’s article. Doug Altman and Iain Chalmers he counts as friends (they might even make his funeral), and he admires Paul Glasziou and John Ioannidis (to the extent that he can now spell both of their names without having to look them up.) He’d like to think of them as friends as well but worries he would being to forward as he doesn’t know them so well.

    Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

    You may leave a response but pinging is currently not allowed.

    Posted in Richard Smith.

    1. John Snyder says:

      We who advocate for science based medicine agree that we have much to improve upon with regard to insuring that only the highest quality studies are published. This, however, has little to do with the discussion about the merits of OMM and the odd existence of this vestige of prescientific thinking.

      1. Sorry that “copout” can’t be accepted if you want a site that is of any quality. This site is really on the edge of being of value because of the personal attacks that have no merit on an argument.
        If you are going to debate the merits of studies you have to debate the merits of the circumstances around the study and human nature. If we were studying and debating widgets and all the widgets were the same, made in a widget factor by robots, the human element would be more negligible. Humans are deceitful and deceptive and can alter the conclusions of a study very easily.

  33. Dan says:

    I am a DO, internal medicine, and practicing for 22 years. This article was well written and spot on accurate. I have been embarrassed by so many similar publications over the years, and the continued unscientific teaching and claims of OMM to this day.

    Well done and thanks so much for this article.

    Dan
    Tigard, OR

    1. Madness says:

      Shame you have never learnt anything about osteopathy in those 22 years, I guess you couldn’t get into a regular med school?

      1. John Snyder says:

        @Madness. He likely learned a lot. It sounds as though he simply didn’t allow faith and belief to cloud his ability to rationally appraise the evidence.

        1. Dan says:

          Interesting comments for my support of this article and the false accusation that I must have learned nothing on the subject. I suppose it would not matter if I pointed out that I am on faculty at the local MD school and that I am invited to help at the local DO school on a regular basis and that I have been published on the subject of DO beliefs in the Journal of the American Osteopathic Association. Sigh…no, probably not and probably this will only invite more ad hominem attacks instead. Enough about me and I again offer my full support for this excellent article

          1. Andrey Pavlov says:

            Dan, for what it is worth (I have not been following your conversation and couldn’t find anything more than the one comment on this thread) I don’t know what Madness and John Snyder are on about.

            Unless there is something I am missing, I read you as being embarrassed at the teaching of OMM which is, for the most part, unscientific and not supported by the literature and that you agree with the author here at SBM, not the author of the paper we are critiquing. If that is the case, then I fully agree and appreciate your support.

            Am I missing something? Did I read you wrong?

            1. Dan says:

              Andrey,

              Yes, your initial impression is correct. I am supporting, completely, this article at SBM and not the referenced published article. My second comment was directed at the single post by Madness (which, as a moniker, seems to fit nicely with that post) and it probably did not require my response as John Snyder did offer up some defense to my original post. Articles like this one at SBM (and one by Mark Crislip not long ago on OMM and influenza) need to be written more often. My profession has much to offer and be proud of, but also much that is really quite embarrassing.

              Dan

              1. Andrey Pavlov says:

                Dan,

                Glad to know my reading comprehension is still top notch ;-)

                As for DO’s and what they have to bring – I am totally with you. I think it is very laudable that the field has become almost as science based as any other field. Well, I don’t even know if I can say that because there are things in my own MD curriculum that were not science based as well. After all, nothing is perfect, even though we do (and should) strive for it every day.

                The only reason OMM stands out to me is that it is desperately clung to as a valued vestigial organ of osteopathic practice. In fact, as was pointed out by someone else, the AOA/ACGME merger didn’t go through because the AOA didn’t like that it meant ditching OMM.

                At the end though, it is what you make of your education. Dr. Oz has an MD, after all.

                Personally, I don’t care who you are or what letters are after your name if you bring the goods and can help people alongside me. DO’s have proven that they can do that. DC’s, ND’s, etc have proven that for the most part they cannot. Which really sucks for the very few of them that get stuck into it and I can’t refer or trust them because of their “profession.” But if I were in a position where a DC and I had a good chat and I figured out what his deal was, I wouldn’t dismiss him/her entirely out of hand just because of the letters.

                Anyways, I digress.

                Sorry you ran into some folks with poor manners and even worse poor reading comprehension.

                Best of luck!

                Andrey

  34. LovleAnjel says:

    My DO worked his magic touch on my infant: every time he pressed her abdomen during a well baby check, she passed gass. This was a phenomenon that neither I nor the nurse practitioner could replicate.

  35. dosimetry cobolovsky says:

    With all the socalled ‘primary’ practioners making a case for their need in a PCP void in the US, the story of a zealot DC comes to mind.

    While the oncology team treating this DC for Hogkins lymphoma was making steady progress, this DC decided to treat her condition with ‘lymphatic manipulation’ after the 1st course of traditional therapy. The DC was appauled that she was not invited to the month tumor board meetings and even more indignant when the oncology team did not know of such ‘lymphatic manipulation therapy’. This DC was naturally concerned about the diagnostic tests (MRI, CT and PET) for staging and progessional during Tx. It was very clear during the second meeting that her anatomy and physiology understanding were very limited and this caused even more stress for her during therapy meetings. After mentioning this so called ‘lymphatic manipulation’ and her intentions to use such, the oncologist convinced her to treat scientifically first and then her method second.
    Long story short…traditional therapy reduced the 10 lymphadema structures to 2 and the manipulation used secondly cause the original 10 nodes to increase to 17.

    Tough lesson….not learned because she was convinced that the manipulations were not performed as they were during her training……WEW!

  36. Thomas says:

    OK,

    I’d like to put in my 2 cents on this one.

    I am in my final year in an allopathic residency program as a DO. My undergrad degree is in Molecular Biology – I graduated with a 3.4 and got a 31 on my MCAT. Now while these are not the most stellar scores, I did chose to major in Molecular Biology.
    After undergrad I chose to work in Genetic Research and was second author on two papers on translational gene regulation in the journal Science.

    I chose my DO school because at the time, my in state allopathic program was the only med school shared by 3 states, my 3.4 in mol bio could not compete with the wealth of 3.7s in easier majors and I got lured by my fiancee with family in CA to move to California.

    At the time, I really did not understand how much OMM was still emphasized in DO medical school. It was not huge but it was a good 5-10% of time taken spent learning that crap. As an individual with a strong science background it was like listening to someone drag their nails down a chalk board when I had to listen to all the dribble and droning on and on about shoddy biased Micky Mouse research studies. Believe me, the topic of this article is nothing new to me. In fact, I used to get a fair amount of questions wrong on OMM exams because on T/F questions stating things like ” there is strong research evidence for ….BS manipulation” I refused to answer false as a matter of principle.
    I took and scored well on both the USMLE and COMLEX and am in my 4th year in an academic allopathic Residency.
    OMM needs to be dropped. Ol Andrew Taylor Poot n Toot needs to be laid to rest. Residency programs need to merge. DOs should shed the OMM and at an M for Medicine thus becoming “MDO” if not just merging and becoming all MD.

    I am an excellent Physician. I provide EBM and enjoy what I do. Do the letters DO bother me? Yes… they bother me because I don’t feel they represent me. They represent OMM not practicing medicine.

    1. Thomas says:

      OK,

      I’d like to put in my 2 cents on this one.

      I am in my final year in an allopathic residency program as a DO. My undergrad degree is in Molecular Biology – I graduated with a 3.4 and got a 31 on my MCAT. Now while these are not the most stellar scores, I did choose to major in Molecular Biology.
      After undergrad I chose to work in Genetic Research and was second author on two papers on translational gene regulation in the journal Science.

      I chose my DO school because at the time, my in state allopathic program was the only med school shared by 3 states, my 3.4 in mol bio could not compete with the wealth of 3.7s in easier majors and I got lured by my fiancee with family in CA to move to California.

      At the time, I really did not understand how much OMM was still emphasized in DO medical school. It was not huge but it was a good 5-10% of time taken spent learning that crap. As an individual with a strong science background it was like listening to someone drag their nails down a chalk board when I had to listen to all the dribble and droning on and on about shoddy biased Micky Mouse research studies. Believe me, the topic of this article is nothing new to me. In fact, I used to get a fair amount of questions wrong on OMM exams because on T/F questions stating things like ” there is strong research evidence for ….BS manipulation” I refused to answer true as a matter of principle.
      I took and scored well on both the USMLE and COMLEX and am in my 4th year in an academic allopathic Residency.
      OMM needs to be dropped. Ol Andrew Taylor Poot n Toot needs to be laid to rest. Residency programs need to merge. DOs should shed the OMM and at an M for Medicine thus becoming “MDO” if not just merging and becoming all MD.

      I am an excellent Physician. I provide EBM and enjoy what I do. Do the letters DO bother me? Yes… they bother me because I don’t feel they represent me. They represent OMM not practicing medicine.

    2. WilliamLawrenceUtridge says:

      Hi Thomas,

      D.O. courses will only change when enough people push for change (or when enough people do enough good-quality research to either support, or refute the ideas involved). I hope your passion will push you to try to change, or research the ideas, for the overall good of all humans. There may be some germ of truth to OMM somewhere, and the muscles are an orphan organ that need more research as much of our pain can be located in them.

      Also, I’m really surprised to see the word “allopathic” used in such an otherwise cogent comment. Like, really, really surprised.

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