MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Lock 10 bright people into a room and tell them they will not be let out until they come up with the silliest idea in healthcare. It is not unlikely, I think, that they might come up with the concept of visceral osteopathy.

In case you wonder what visceral osteopathy (or visceral manipulation) is, one ‘expert’ explains it neatly: Visceral Osteopathy is an expansion of the general principles of osteopathy which includes a special understanding of the organs, blood vessels and nerves of the body (the viscera). Visceral Osteopathy relieves imbalances and restrictions in the interconnections between the motions of all the organs and structures of the body. Jean-Piere Barral RPT, DO built on the principles of Andrew Taylor Still DO and William Garner Sutherland DO, to create this method of detailed assessment and highly specific manipulation. Those who wish to practice Visceral Osteopathy train intensively through a series of post-graduate studies.  The ability to address the specific visceral causes of somatic dysfunction allows the practitioner to address such conditions as gastroesophageal reflux disease (GERD), irritable bowel (IBS), and even infertility caused by mechanical restriction.

But, as I have pointed out many times before, the fact that a treatment is based on erroneous assumptions does not necessarily mean that it does not work. What we need to decide is evidence. And here we are lucky; a recent paper provides just that.

The purpose of this systematic review was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy.

Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis.

Extensive searches located 8 reliability studies and 6 efficacy trials that could be included in this review. The analysis of reliability studies showed that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study showed no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome.

The authors (who by the way declared no conflicts of interest) concluded that the results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent.

It is hard not to appreciate the scientific rigor of this review or to agree with the conclusions drawn by the French authors.

But what consequences should we draw from all this?

The authors of this paper state that more and better research is needed. Somehow, I doubt this. Visceral osteopathy is not plausible and the best evidence available to date does not show it works. In my view, this means that we should declare it an obsolete aberration of medical history.

To this, the proponents of visceral osteopathy will probably say that they have tons of experience and have witnessed wonderful cures etc. This I do not doubt; however, the things they saw were not due to the effects of visceral osteopathy, they were due to chance, placebo, regression towards the mean, the natural history of the diseases treated etc., etc. And sometimes, experience is nothing more that the ability to repeat a mistake over and over again.

  • If it looks like a placebo,
  • if it behaves like a placebo,
  • if it tests like a placebo,

IT MOST LIKELY IS A PLACEBO!!!

And what is wrong with a placebo, if it helps patients?

GIVE ME A BREAK!

WE HAVE ALREADY DISCUSSED THIS AD NAUSEAM. JUST READ SOME OF THE PREVIOUS POSTS ON THIS SUBJECT.

16 Responses to Visceral osteopathy is implausible and does not work … SO, LET’S FORGET ABOUT IT ONCE AND FOR ALL

  • Very well stated, should be the end of the discussion…but im sure it will continue to prosper.
    I might add; after years of taekwondo practice I assume I’ve had my internal organs manipulated plenty. It definitely seemed like more than a placebo.

  • I agree that no more research is needed. It would only be wasting what is often public money and it’s ethically questionable to continue to undertake research on members of the public using something that is implausible. Unfortunately, like other alt med research I suspect they will continue with it anyway. 🙁

  • Please write to the WHO and the GOsC

    The GOsC was mainly responsible for the WHO benchmarks for a global standard in manual osteopathic trainings in which Visceral and Cranial Osteopathy and the knowledge of an esoteric and pseudoscientific ‘involuntary mechanism’ were described as fundamental osteopathic skills

    http://www.osteopathy.org.uk/news-and-resources/news/who-benchmarks-for-training-in-osteopathy-published/

    http://apps.who.int/medicinedocs/documents/s17555en/s17555en.pdf

    http://apps.who.int/iris/handle/10665/44356

  • In 2010 the WHO released benchmarks for training in ‘Osteopathy’ meaning OMM – Osteopathic Manual Medicine in which they considered Visceral and Cranial Osteopathy as important osteopathic skills …

    Here is another research done by the same authors. I posted it in linkedin and reading the respones from a lot of US osteopathic physicians who support Cranial I learned that there is a huge group of US osteopathic physicians who are involved in practising Cranial and Biodynamic Osteopathy.

    They are practising Cranial much more than Visceral Osteopathy which is mainly spread in the Commonwealth and in Europe.

    So such US osteopathic physicians practising Cranial still support the ‘osteopathic principles’ (mainly platitudes) being related to iatromechanism and vitalism with a tendency to the 19th century drugless healing movement.

    It seems to me that US osteopathic physician’s education in all fields of modern medicine has the same problem as it is with the preliminary training and exam in any other medical training in the world. It has no meaning for to stop quackery.
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167823

  • .. and I made the proposal to update the ‘first osteopathic principles’ (I called them platitudes) and to replace them with the principles of evidence based medicine as first osteopathic principle nowadays. The US osteopathic physicians D.O. answering my post about the clinical efficacy of Cranial Osteopathy refused to do so calling evidence based medicine ‘just a movement’ being not relevant to understand Cranial Osteopathy. Saying without Cranial the patients are ‘left with poisons and surgery’ isn’t this the ongoing nonsense of drugless healing? Why are such US- D.O.s accepted as physicians equivalent to M.D.s ??? (May be they are involved in integrative medicine as well and they all like each other to fight against the ‘evidence based medicine MOVEMENT’?

  • Answering to me an US D.O. was arguing that doing research in Cranial in the US is nearly not possible. He was complaining: “about the “system” and how ridiculous Institutional Review Boards are when none of the members are DOs and the research you want to do threatens the status quo. Research also is not free. Who do you think pays for “evidence based medicine here?”

    in another post he wrote:
    “There is nearly no evidence…? Ever try to get an IRB approved for Cranial? They immediately pause at interested reliability and how tonexternalize to data. …. Your comment is exactly why Upledger left and started Cranial Sacral therapy because he couldn’t get the people who should be using Cranial to use Cranial so he went and found people who would and do. …”

  • The enduring capacity of those to rationalise placebo practice with reasoning from perhaps the benign to the exploitative seems extraordinary but is certainly not unknown through history. Phlogiston theory or phrenology spring to mind, but then so to does the prescription of antibiotics for self-limiting minor viral infections in the otherwise healthy, or the routine use of opiates for back pain, or the use of CR XR merely for reassurance with no clinical indication. The list appears as long as it is wide.

    Whether found seriously wanting on the grounds of methodology, (efficacy and reliability) or science (biological plausibility) or ethics (unproved, experimental treatment; best practice v usual practice; EBP) or economics (cost benefit) it appears to elude extinction. Worse, it may become a dominant and defining practice, for example, cranial osteopathy remains the most widely practised form of osteopathy (A global view of osteopathic practice – mirror or echo chamber? McGrath MC, IntJOstMed. 18:2;2015 pp130 – 140).

    Is this reasonable? I think not, because ‘in contrast to late nineteenth century practice, osteopaths today are the beneficiaries of hitherto unimaginable medical and scientific knowledge, and the target of an omnipresent societal demand for evidence-based practice (EBP), that is requiring of professional and institutional support through explicit policy. There is an urgent need to overcome a cultural torpitude within osteopathy to subject any and all aspects of practice to robust scientific scrutiny, and in particular to relinquish those aspects that have assumed the dimensions of a bloated sacred cow, whose chief requirement for sustenance is faith. To manifest both distinctiveness and professional visibility, determined engagement with science (the evidence), and with other communities whether in clinical practice or in the basic sciences is now imperative. Marginalisation through progressive irrelevance is a poor alternative’ (From distinct to indistinct, the life cycle of a medical heresy. Is osteopathic distinctiveness an anachronism? McGrath MC, IntJOstMed. 16:1;2013 pp54 – 61)

    A whole lot needs to be done to educate, explain and inform the general public, because it seems that professional bodies whether educational of legislative appear more than passingly reluctant to jeopardise what might appear to be, and perhaps may be considered by some, to be a leading source of income. Either that or they are simply unwilling. One potentially excellent place to start then: ‘Why do ineffective treatments seem helpful? A brief review. Hartman SE, Chiropractic & Osteopathy. 17:10;2009

    • @Christopher McGrath PhD on Friday 02 March 2018 at 02:08

      Quoting yourself is hardly credible, paticularly as you are a cultist belonging to that other form of witchcraft, osteopathy, from which Palmer stole for his own religion.

      https://www.researchgate.net/profile/Maurice_McGrath

      Experienced clinician and consultant (osteopathic practitioner), with academic credentials in research experience (clinical anatomy) and long involvement in osteopathic education and accreditation. Inspired by: evidence-based best practice; anatomical research, medical history, excellence in education and in-time learning; alarmed by: policy-based evidence.

      Perhaps you would like to provide evidence for osteopathy?

      • Frank Collins where did you get this that Palmer has stolen from osteopathy? The facts are that both DD Palmer and AT Still were educated in magnetic healing. Palmer said it officially and AT Still advertised it in 1974. Both learned it from the same guy nearby who was running an infirmary for magnetic healing already. Both agreed to fight the medical system with drugless healing. Osteopathy therefore was considered as a medical sect together with Homeopathy and Christian Science by the US Government in the beginning of the 20th Century. This was changed as soon as the osteopathic profession changed their trainings and osteopaths became osteopathic physicians in the
        1930ties !!!
        So it is better to rely on facts rather than on osteopathic propaganda. There is nothing better in Osteopathy than in Chiropractic. Both sects still are selling iatromechanism and vitalism as it was the common understatement of the drugless healing movement. Both Palmer and Still were free masons and therefore both were selling the same ideology and religion.
        So what?

        • just to add both systems originate in traditional bone-setting.

          Palmer said that he had learned his techniques from an European immigrant.

          Still advertised as ‘lightning bone-setter’ after the decline of magnetic healing.

          If you look onto the photopgraphs of his paintings and writings on the white board in the first class room in Kircksville you can see that all of this was already published in medical books and journals before in those times.

          So both have stolen their techniques somewhere else. But their religious believes were the same.

  • STOP VISCERAL MANIPULATION !

    The osteopathic profiteers in the UK are gathering in the ODG. They like to sell Visceral Manipulation in the trainings because it is a main part of their income. No evidence ? … doesn’t matter … it’s fixed in the WHO benchmarks …

    It must be prohibited to apply visceral manipulation on babies and children!!!

    As long as the OGD in the UK is not willing to stop visceral manipulation on babies children and adults too they have no competence to create a so called ‘standard’ for babies and children as they are trying to do now.

    The responsible Ethic Review Board must stop this nonsense at once!

    http://osteodevelopment.org.uk/wp-content/uploads/2018/02/Consultation-on-competences-and-accreditation-for-osteopaths-working-with-children.pdf

  • The WHO benchmarks are about traditional complementary medical systems. How did the osteopathic profiteers in the UK manage it to smuggle Visceral Manipulation and Cranial into the benchmarks?
    Osteopathy itself is not traditional. It is a iatromechanistic and vitalistic aberration of traditional bonesetting as Chiropractic is. Both were designed at the end if the 19th Century. Traditional? No way!
    Cranial was tought since the 1950ties with hard pressure the soft touch was new since the ‘invention’ of Craniosacral therapy by Upledger.
    Visceral Manipulation was ‘invented’ in the 1980ties and is a esoteric variation of late 19th Century Thure Brandt Massage which was banned from the medical societies because of having no effects for nothing at all.
    So how did the osteopathic profiteers manage it to sell such 20th Century stuff as traditional?
    The reason is that there was no scientific control neither medical nor historical by the WHO about what the profiteers were writing. They just trusted not being interested.
    Help to tell the truth about such
    ‘benchmarks’.
    http://www.who.int/medicines/areas/traditional/trm_benchmarks/en/

  • Recently the Mayo Clinic published a discovery and asked a speculative question about the function of mechanireceptors (enterochromafin endothelial cells) in the gut similar to cells in the skin expressing serotonin and the authors asked, “what effects a ‘gut touch’ could have?”

    The osteopaths became very excited about this article and were claiming that this article is the proof now for the effectiveness of Visceral Manipulation and that medicine should close up to osteopathic manual treatment OMT now.

    https://advancingthescience.mayo.edu/2018/08/21/gut-touch-mayo-clinic-researchers-discover-important-trigger-for-serotonin-release/?utm_source=facebook&utm_medium=sm&utm_content=post&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&mc_id=us&cauid=100502&linkId=55815186

    I reponded:

    “In talking about an impact of ideas in one field on ideas of another field, one is always apt to make a fool of oneself.”
    Prof. Richard Feynman
    http://people.westminstercollege.edu/faculty/ccline/courses/hon221/feynman.pdf

    The authors of the Mayo Clinic are questioning:
    “This makes us wonder wether there is such a thing as ‘gut touch’, and if so what functions would a ‘gut touch’ have?” This is a question in the quoted article and not a proof to any therapeutic claim.

    Sorry to say but if you would read what is written then you would see that this article is not about osteopathy or visceral osteopathy at all. ‘Gut touch’ is not even about belly fondling. Yes some mechanoreceptors in the skin use serotonin as well as the enterochromafin epithelial cells in the gut do. Yes it is a nice experience to be touched authentically with awareness and it is a nice experience to experience a balanced hold or experiencing awareness during a Feldenkrais FI.

    The article tells something about self-referring mechanisms of the gut. The body has several and different ways to create a picture about its own state and potential. It can be called “Self” or “Oneself”.

    May be an external touch in awareness stimulates the parasympathetic nervous system rises the local temperature and bloodflow and the secretion of serotonin could rise by gentle touch too as the authors were speculating? But that doesn’t proof any therapeutic claims like osteopaths try to do here:
    https://edzardernst.com/2014/01/visceral-manipulation-you-couldnt-make-it-up/

    There is no proof by the authors for their presumption and it is pure speculation.

    Last days the osteopaths were getting very excited too claiming that the following article proofs that “osteopaths had known this already”: https://scopeblog.stanford.edu/2018/07/05/the-beating-brain-a-video-captures-the-organs-rhythmic-pulsations/

    I responded to the profession: “In this movie the brain is pulsating synchronically with the heart beat and the following expansion and retraction of the blood vessels of the brain that means around 60 times per minute and not with an involuntary mechanism of about 12 expansions and retractions per minute like the cranial osteopaths were saying. So therefore what is the right interpretation?”

    So what I wanted to say is: here is the reality about visceral osteopathy. Sorry to mention this but as an osteopath with full training in visceral and cranial osteopathy and being a fellow and achieving the state of a trainer for cranial osteopathy and being and working for 20 years with it in a hospital center by now the following systematic review tells the truth. And telling the truth is never putting down someone or something:
    https://www.ncbi.nlm.nih.gov/m/pubmed/29452579/

    This was my response. So far.

  • You are talking nonsense here, all your scientific medicine is not helping people, you cannot heal one disease, only try to remove symptoms with drugs on one side but to give other problems with contraindications. Osteopathy is actually helping people in miraculous ways, people avoided surgeries and get better from conditions that MD’s will never understand. We don’t need your scientific explanation but visceral osteopathy and craniosacral are having results and helping people in practice.
    Reality is that your medicine is very young discipline, 100 years ago you were letting blood to help people, now you are authorities and scientists. We have more problems, more diseases and people are more sick then ever and you cannot help
    and you will need to change your approach. Don’t attack other people that are honestly doing their job, everybody knows already that we cannot count on you, so proud, full of ego but no results.

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