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

THE CONVERSATION recently carried an article shamelessly promoting osteopathy. It seems to originate from the University of Swansea, UK, and is full of bizarre notions. Here is an excerpt:

To find out more about how osteopathy could potentially affect mental health, at our university health and well-being academy, we have recently conducted one of the first studies on the psychological impact of OMT – with positive results.

For the last five years, therapists at the academy have been using OMT to treat members of the public who suffer from a variety of musculoskeletal disorders which have led to chronic pain. To find out more about the mental health impacts of the treatment, we looked at three points in time – before OMT treatment, after the first week of treatment, and after the second week of treatment – and asked patients how they felt using mental health questionnaires.

This data has shown that OMT is effective for reducing anxiety and psychological distress, as well as improving patient self-care. But it may not be suitable for all mental illnesses associated with chronic pain. For instance, we found that OMT was less effective for depression and fear avoidance.

All is not lost, though. Our results also suggested that the positive psychological effects of OMT could be further optimised by combining it with therapy approaches like acceptance and commitment therapy (ACT). Some research indicates that psychological problems such as anxiety and depression are associated with inflexibility, and lead to experiential avoidance. ACT has a positive effect at reducing experiential avoidance, so may be useful with reducing the fear avoidance and depression (which OMT did not significantly reduce).

Other researchers have also suggested that this combined approach may be useful for some subgroups receiving OMT where they may accept this treatment. And, further backing this idea up, there has already been at least one pilot clinical trial and a feasibility study which have used ACT and OMT with some success.

Looking to build on our positive results, we have now begun to develop our ACT treatment in the academy, to be combined with the osteopathic therapy already on offer. Though there will be a different range of options, one of these ACT therapies is psychoeducational in nature. It does not require an active therapist to work with the patient, and can be delivered through internet instruction videos and homework exercises, for example.

Looking to the future, this kind of low cost, broad healthcare could not only save the health service money if rolled out nationwide but would also mean that patients only have to undergo one treatment.

END OF QUOTE

So, they recruited a few patients who had come to receive osteopathic treatments (a self-selected population full of expectation and in favour of osteopathy), let them fill a few questionnaires and found some positive changes. From that, they conclude that OMT (osteopathic manipulative therapy) is effective. Not only that, they advocate that OMT is rolled out nationwide to save NHS funds.

Vis a vis so much nonsense, I am (almost) speechless!

As this comes not from some commercial enterprise but from a UK university, the nonsense is intolerable, I find.

Do I even need to point out what is wrong with it?

Not really, it’s too obvious.

But, just in case some readers struggle to find the fatal flaws of this ‘study’, let me mention just the most obvious one. There was no control group! That means the observed outcome could be due to many factors that are totally unrelated to OMT – such as placebo-effect, regression towards the mean, natural history of the condition, concomitant treatments, etc. In turn, this also means that the nationwide rolling out of their approach would most likely be a costly mistake.

The general adoption of OMT would of course please osteopaths a lot; it could even reduce anxiety – but only that of the osteopaths and their bank-managers, I am afraid.

10 Responses to Osteopathy is “effective for reducing anxiety” (presumably the anxiety of the osteopaths and their bank-managers)

  • As with most crap studies in placebo based therapy, the goal is not clinical significance. The goal is political significance. A pile of evidence is still a pile even if it steams. As long as people making political decisions cannot or will not understand the evidence, all piles are alike.

  • Well, Swansea teaches Osteopathy to Masters level and claims to be no 1 in the country for this. In its Osteopathy part of the website it makes quite grandiose claims as to what it can do (see list http://www.swansea.ac.uk/hwa/health-and-wellbeing-services/osteopathicclinic/frequently-asked-questions/)

    What has happened to academic rigor in this I wonder….

  • Sorry to be a twit (twat?), but can you give a line for us Yanks who aren’t sure what an osteopath is?

    • From Fads and Fallacies in the Name of Science (2nd ed., 1956, by Martin Cardner — a Yank —
      “Osteopathy, America’s third greatest medical cult, was the brain-child of a medical illiterate named Andrew Taylor Still. … It was Still’s theory that diseases are caused by a malfunctioning of the nerves or blood supply, in turn due to the dislocation of small bones in the spine. These dislocations are called ‘subluxations of the verterbrae’. … The osteopath’s job is to find these subluxations and ‘adjust’ them, though what makes them stay adjusted is an osteopathic mystery. … Since Still’s day there has been considerable evolution of osteopathic doctrines as its doctors try…to enter orthodox medicine by the back door. … all but eight states permit the graduates [of schools of oseteopathy] to give drugs and perform surgery.”

      Your question arises because, in the USA, osteopaths currently undergo pretty much the same training as orthodox MDs with just a touch of osteopathy on the side. In the rest of the world, osteopathy remains closer to its origins. As Gardner points out, chiropractic arose about 20 years after osteopathy, from which it borrowed heavily. In the UK, osteopathy and chiropractic are both pseudo-medical cults.

  • I did a search of this site, but am not sure if this is that equivalent of DO (doctor of osteopathy) in the US?

    Over here they are considered equivalent to MD’s these days, but were formerly more like chiropractors. Their actual practice varies from identical to MD to inclusion and marketing of “osteopathic manipulation” depending on the “woo factor” of the DO. Personally, I avoid them. It seems that either they couldn’t get in to medical school or else they are somewhat susceptible to pseudoscience. I saw one once at my clinic when my doctor was unavailable, and he had lots of pamphlets lying around about “treating the whole patient” and “osteopathic” this and that.

  • In the UK, the basic degrees recognised by the GMC to be registered as a ‘registered medical practitioner’ are Bachelor of Medicine & Bachelor of Surgery. Both degrees are studied for at medical school, both are necessary for registration. Termed as MB,BS; or variants such as MB ChB for schools which use the Greek for ‘surgeon’ (‘chirugeon’ – ‘chiron’, a hand).
    Even MB BCh! All variants are equivalent, BUT:

    MD is a higher degree awarded after a dissertation based on original research and viva voce examination and is equivalent to a PhD. Some surgeons do a MS. Relatively few doctors have MDs or MSs.

    When UK doctors go to conferences in the US, some will style themselves ‘MD’ which is a bit cheeky, but US colleagues don’t understand their status otherwise.

    Osteopaths are health practitioners who follow the teachings initiated by AT Still. They are regarded as ‘alternate’ because they require an alternate mind set to go along with the pseudo-scientific concepts. There is no evidence of any benefit from osteopathic attention (beyond the placebo) – apart from manipulation which has results no better than physiotherapy or chiropractic.

    Quite why any student would want to study osteopathy rather than physiotherapy, chiropractic, nursing or medicine is for them to explain. Some claim they have ‘Diplomas in Osteopathy’ and use the designation ‘DO’ – but unless they intend fraud, that does not mean they are ‘Doctors’ in any academic or medical sense.

    In the UK, anyone can style themselves ‘Dr’ unless they intend fraud , but why would they do that unless fraud is indeed intended?

    Sigh.

    • It’s just tradition…every medical school has its own history, its own emphasis, and its own approaches…the DO schools in the US appeal to different students for all those reasons. They aren’t necessarily easier to get into. I think that the superstar schools are not DO schools, but there are many DO schools that are better than many MD schools.

      https://thedo.osteopathic.org/2017/04/a-closer-look-at-this-years-us-news-ranked-do-schools/

      US News & World Reports gave osteopathic schools high rankings in family practice, rural medicine, geriatrics, and primary care. A number of them seem to be in Appalachia. Not to imply that the rankings are perfect, but it should give you an idea of why someone might choose an osteopathic school.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories