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RE: What is Osteopathic Medicine? The field I study, and how it is different from the "traditional" MD
@tfeldman I'm sure you have good intentions and have studied your practice intensely. Last thing I wish to do is attack you personally so please don't take this as such. Through your post here you haven't mentioned any of the risks or potential side effects of your practice.
I do not question your training at all. In my estimation DOs go through a rigorous schooling just like MDs. That said I hope people do some research into science based medicine before seeking osteopathic treatment. There are considerable risks associated with the practice worth considering.
Try to add to your research experience of Thai massage. unique ancient technique.
I would be happy to point you to some other sources when I finish my ER shift in about 15 hours. Osteopathic manipulation causes some of the least amount of harm actually! I will be making a complete post on Osteopathic manipulation in a future post. Side effects will be included ;). This post was a very brief overview. Aspirin or ibuprofin, for instance, have a much worse potential for harm than many osteopathic techniques
Firstly, thank you for bringing your thoughts to the table. I have looked at the website above "what's the harm" and actually found no scientific basis in any of the part on osteopathy (if you do find a link for this please send it to me). I would like to point out a few problems I have with what I saw on this site....
One, is that the creator of this site is not a medical professional and is using "stories" from patients who believed they were wronged by osteopaths. This is not science based medicine.
Secondly, I am also not sure if these case reports were from DOs in America. Osteoapath is different in Europe (however, they did adapt many techniques from osteopathic traditions in America, which could still bring validity to your point). From the case reports, these were spanned over several years. In other words, it does not appear that it was happening at high frequency, relatively. For instance if a DO or MDs conduct surgery on someone, will there be complications?....absolutely and at a higher rate (but maybe not a high relative rate). The question at hand is does that procedure/technique pros outweigh the cons? As far as the case reports are concerned, I have trouble finding any proof that osteopathic techniques were the cause of these complications provided on this website.
I also think he makes a completely false statement when he relates chiropractic ( I have no problems with chiropractors by the way either) medicine to osteopathy (unless he did not mean osteopathic physicians in America). We are medical doctors, who in fact, use traditional medical techniques as well as osteopathic manipulative treatment.
*I use the terms osteopath, osteopathic, osteopathic medicine very "loosely" in my article...yet I am only referring to US osteopathic medicine (the place it was founded)...in today's language osteopath and osteopathy is used more around the world where the training is different. In Dr. Still's time, osteopathy was the American term.
I would also like to take a brief moment to discuss my point of view on the overwhelming safety of Osteopathic Medicine (at least in America). Firstly, there are many techniques used, some of which are much more gentle on the body than others. For instance, one technique when someone has a very sore muscle from a new injury, and the doctor actually puts a patient in a position where they feel less pain. This is because you shorten that muscle. The muscle becomes relaxed and the patient has less pain in that area. This is actually objective in itself because if there is less tension in a muscle, that is a physical exam finding. I have never heard of any adverse effects to this technique, one that I use often.
There are techniques that have the potential to causes problems. One is HVLA (high velocity, low amplitude) to the neck. This is essentially "popping the neck." It is a very beneficial technique but has absolute contraindications. For instance, if someone has vertebral artery disease, Down Syndrome, and many others, this technique should NOT be used. As medical doctors, it is our responsibility to ask patients about their medical history. If a physician used this technique in the wrong patient, that is the doctors fault, not the fault of the profession (just like if a DO or MD prescribes a wrong medication). I have practiced this technique but have never actually used it in the hospital setting. Different settings call for less or more aggressive techniques. When someone is hurting in an acute situation, indirect (the direction away from the restriction) should be used more often.
There are many techniques that are supported by medical research, and some that lack enough support. Cranial OMT has less objective research...however there are some studies suggesting its validity. I don't use cranial OMT often, but I do believe in it. However, due to less evidence, I can see how this would lack support for the community at large.
There are so many techniques that I could make 100s of posts on different techniques. I will be providing more data and research in my future OMM (osteopathic manipulative medicine) posts and I invite you to read those in the future.
Because so many techniques we use really have no bad effects (besides maybe temporary muscle pain, dizziness, nausea, and so on), I will give you a source with multiple scientific studies on cervical HVLA, the most dangerous technique of them all (although as the data shows is still relatively very rare...one estimate was 1/5,000,000 suffer a bad consequence. Again, osteopathic physicians don't need to use a technique they or the patient are not comfortable with (patient not feeling comfortable is a contraindication in itself): http://files.academyofosteopathy.org/CME/2012OMEDconvention/King_Presentation.pdf
Thank you for your time. I hope to keep engaging in conversation..and maybe can even turn you into an osteopathic fan!
Thank you for the thorough response. It's true that the link I provided wasn't on the level of a scientific journal. There is a divide between the practice of osteopathy in the United States and elsewhere. You've made a strong case that U.S. osteopathy practices are evidence based.
There are a couple places I get the pseudo-science vibe from you though. One is in your defense of Chiropractic. There is a divide among practitioners. Some offer forms of physical therapy. I have no problem with that. Others are more traditional basing their practice on the findings of D.D. Palmer in the late 1800s. His reasoning was that a subluxated vertebra is the cause of 95 percent of diseases by inhibing the flow if innate. A "life force" traveling the nerves. I'm pretty sure that stands out as an unscientific and quite unreasonable supposition. Again only a subset of Chiropractic practitioners adhere to the origins of the practice. Many have chosen to move forward with science and have thrown out much of Palmer's assertions.
So at the end of the day I wonder why those who have left the origins of Chiropractic behind keep the name. Shouldn't they advertise themselves as P.T. and not feel sullied by the subset dealing with a form of pseudo-science arcana?
If I were to venture a guess you probably find fault with D. D. Palmer's methods and you too would discount traditionalist chiropractors.
Another area I think you stray beyond science is in alluding to the spirit. Spirit as a personal belief is great. No problem. But what does science have to say about the existence of a spirit? If it exists what is it? How do you perform falsifiable tests against the spirit?
There's a reason I'm nitpicking on that word. Because when it's used as a focus of your practice you've stepped into pseudo-science. So many of the pseudo-sciences lean upon words like spirit, power, energy, life-force, chakra that it's a wide open door to introduce feel-good metaphors for spectacularly unfounded claims.
That's not to say you practice in unfounded claims. The mind, body, spirit trifecta of holistic healing approach has the ring of being possibly pseudo-scientific.
As per your response I'm willing to believe that you operate in a professional, scientific and safe manner. I'm wondering why you chose to use unscientific banter when describing major tenets of your practice.
Thanks again. You obviously put great care and time into your well reasoned response. You ooze of passion for your practice. I look forward to hearing from you again.
In my response to you,
I said that I have "no problem" with chiropractors. I was not validating all of their claims. The majority of MDs and DOs I speak with have this to say in general about "alternate medicine".... if it doesn't hurt the patient and makes them feel better then I have no problem with the practice. Lets say for instance that a patient swears taking B-vitamins, although not B-vitamin deficient, makes them feel better. This goes against biochemistry and the amount needed to cause a physiologic effect in the body. The patient may quote the mechanism of action of B-vitamins, but the science of biochemistry/biology would show that if you have a healthy level of B-vitamins, the rest would mostly be sweated out or peed out (B-vitamins are water soluble). On the other side, if they are having a placebo effect this could release hormones in their body that have a true positive physical effect. Furthermore, since B-vitamins can be excreted out in sweat and urine, there is not much harm for the patient to continue using these vitamins.
So you refer to DD Palmer, which I agree does not base those facts off science (maybe pseudo. Either way we can't prove his theories). I would also make the point that the practice of bloodletting to rid of pathogens, which was a widespread practice (as specified in my article) by MDs in the 1800s was not science either! However MDs still go by MDs so I do not understand your point on why chiropractors would need to change their name. Bloodletting has only "scientifically" been proven to be helpful in very rare circumstances such as a disease like hemochromatosis. It was certainly not science based to use this practice in the 1800s and led many to become anemic. It was a "gut feeling" that many with disease could rid themselves of disease by taking out some of their blood. Not science.
Lastly, the topic of the spirit in guiding management to patients. The main point here is the role of the doctor goes further than the role of helping cure the physical disease, it is also to prevent it. There are also psychiatric diseases such as depression that need to be addressed. If you cure someones cancer and they end up killing themselves, then you have not fulfilled your role as a doctor to treat the "whole patient." Not saying that we all can prevent all suicide, but it should be the role of the physician to try and prevent this from happening if we are clinically aware someone is depressed. I think you would agree with the "mind" aspect of holistic medicine (as most MDs would too).
The spirit is a very nonspecific term, but is very connected with the mind. Lets say for instance, that a DO didn't believe in spirit but the patient did. Does the feeling of "it" (since we won't have a philosophical debate on what the pronouns "I, he, she, myself" mean as it pertains to science....we don't need to for this example) still cause the patient to have physical symptoms that are scientifically related....certainly! For example, if a patient was very "spiritual" and committed an act of "bad Karma." Whether Karma exists or not is not the scientific question.... The science is if the patient is stressed, due to feeling that he or she has bad Karma, his or her body will release more cortisol, which will increase his or her blood pressure. Their increase in blood pressure will scientifically lead to physical harm to the body, such as cardiac remodeling. Addressing the patient's "perceived" spirit, could decrease his or her blood pressure and lead to a healthier situation scientifically. The point of mind and spirit is that there is more to the patient than flesh and bone....and science/health would say that these internal thoughts of the patient, reflect on his or her health homeostasis.
I've taken my sweet time getting around to making a response. These writings take time. Again, thank you for the thorough responses. I appreciate you took the time.
I'll tackle your response in a couple of points.
The first is to address the idea of placebo effect. The example you provided was about a patient taking B vitamins because it makes them feel better. If there are no indications of harmful side effects from taking a placebo measure then I'm with you that it's not your job to correct the individual patient's critical thinking. Allowing them to administer their own placebo in the absence of harmful side-effects seems reasonable to me.
Given the above there are still some ethics questions about administering placebo. That's where I draw the line ethically because a medical practitioner must develop trust with the patient. Administering placebo treatments when the practitioner knows the treatment has no proven health benefits is a violation of trust. Patients must trust their doctors to perform in their best interests. I don't believe that administering known placebo and calling it effective treatment to the patient is honest or ethical.
I want to be clear that in your example given you did not advocate for administering placebo, only not interfering with the patient when self-administering placebo methods.
The second point goes back to Chiropractic and MD. You point out that MD has a storied non-scientific past. While that's true there isn't an equivalency in the modern standard of care between Chiropractic and MD.
Before when I pointed out the alleged findings of D.D. Palmer it wasn't to smear Chiropractic because of the past. It was to point out that in some institutions and with some practitioners that is still the standard of care. Many institutions and practitioners have elevated their own standard of care to rise well above the minimum set in each legal jurisdiction. To their credit they practice evidence based medicine fully on the level of other physicians.
The question I was raising is why would these practitioners want to carry a credential with a standard of care that can vary dramatically? If I were to choose two random Chiropractors from my local area I might find one wants to cure an earache by subluxation of my vertebrae and another who will refer me to an ears, nose and throat specialist.
When it comes to MDs the standard of care is at minimum evidence based so I find it no surprise that the certification is well sought after.
On the last point about spirit perhaps I took it in more of a religious/personal belief tone than you intended. Spirit can also refer to demeanor, state of mind and emotional disposition. By what you have stated it looks like you're taking the patient's emotional state into consideration. Spirit is a pithy word to that end.
Thank you for taking the time to write.
After reading the above remarks, I think I agree with most points you make here. I would like to point out that I for sure was not implicating a placebo effect in OMT. If one has a living based off of placebo that is, indeed, an ethical dilemma.
Stay posted for more articles on OMT, and I do plan to provide evidence based sources to the practice of OMT. Some of my writings will be observation/opinion while others will show the theories of why techniques work/ what studies show.
MDs and DOs are both great! The only reason I was discussing the past was that chiropractors also have a very different historical past. However, I do not know a great deal about chiropractic practices. I assume I would have doubts on "some" of these practitioners who hold much weight on non-science related theories. However, if a patient felt benefit from alternate medicine without loss (money or health), then I would not discourage them. I would never personally perform a technique on someone if it did not have some basis (direct evidence or sound scientific theory) of benefit.