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

There are of course 2 types of osteopaths: the US osteopaths who are very close to real doctors, and the osteopaths from all other countries who are practitioners of so-called alternative medicine. This post, as all my posts on this subject, is about the latter category.

I was alerted to a paper entitled ‘Osteopathy under scrutiny’. It goes without saying that I thought it relevant; after all, scrutinising so-called altermative medicine (SCAM), such as osteopathy is one of the aims of this blog. The article itself is in German, but it has an English abstract:

Osteopathic medicine is a medical specialty that enjoys a high level of recognition and increasing popularity among patients. High-quality education and training are essential to ensure good and safe patient treatment. At a superficial glance, osteopathy could be misunderstood as a myth; accurately considered, osteopathic medicine is grounded in medical and scientific knowledge and solid theoretical and practical training. Scientific advances increasingly confirm the empirical experience of osteopathy. Although more studies on its efficacy could be conducted, there is sufficient evidence for a reasonable application of osteopathy. Current scientific studies show how a manually executed osteopathic intervention can induce tissue and even cellular reactions. Because the body actively responds to environmental stimuli, osteopathic treatment is considered an active therapy. Osteopathic treatment is individually applied and patients are seen as an integrated entity. Because of its typical systemic view and scientific interpretation, osteopathic medicine is excellently suited for interdisciplinary cooperation. Further work on external evidence of osteopathy is being conducted, but there is enough knowledge from the other pillars of evidence-based medicine (EBM) to support the application of osteopathic treatment. Implementing careful, manual osteopathic examination and treatment has the potential to cut healthcare costs. To ensure quality, osteopathic societies should be intimately involved and integrated in the regulation of the education, training, and practice of osteopathic medicine.

This does not sound as though the authors know what scutiny is. In fact, the abstract reads like a white-wash of quackery. Why might this be so? To answer this question, we need to look no further than to the ‘conflicts of interest’ where the authors state (my translation): K. Dräger and R. Heller state that, in addition to their activities as further education officers/lecturers for osteopathy (Deutsche Ärztegesellschaft für Osteopathie e. V. (DÄGO) and the German Society for Osteopathic Medicine e. V. (DGOM)) there are no conflicts of interest.

But, to tell you the truth, the article itself is worse, much worse that the abstract. Allow me to show you a few quotes (all my [sometimes free] translations).

  • Osteopathic medicine is a therapeutic method based on the scientific findings from medical research.
  • [The osteopath makes] diagnostic and therapeutic movements with the hands for evaluating limitations of movement. Thereby, a blocked joint as well as a reduced hydrodynamic or vessel perfusion can be identified.
  • The indications of osteopathy are comparable to those of general medicine. Osteopathy can be employed from the birth of a baby up to the palliative care of a dying patient.
  • Biostatisticians have recognised the weaknesses of RCTs and meta-analyses, as they merely compare mean values of therapeutic effects, and experts advocate a further evidence level in which statictical correlation is abandonnened in favour of individual causality and definition of cause.
  • In ostopathy, the weight of our clinical experience is more important that external evidence.
  • Research of osteopathic medicine … the classic cause/effect evaluation cannot apply (in support of this statement, the authors cite a ‘letter to the editor‘ from 1904; I looked it up and found that it does in no way substantiate this claim)
  • Findings from anatomy, embryology, physiology, biochemistry and biomechanics which, as natural sciences, have an inherent evidence, strengthen in many ways the plausibility of osteopathy.
  • Even if the statistical proof of the effectiveness of neurocranial techniques has so far been delivered only in part, basic research demonstrates that the effects of traction or compression of bogily tissue causes cellular reactions and regulatory processes.

What to make of such statements? And what to think of the fact that nowhere in the entire paper even a hint of ‘scrutiny’ can be detected? I don’t know about you, but for me this paper reflects very badly on both the authors and on osteopathy as a whole. If you ask me, it is an odd mixture of cherry-picking the evidence, misunderstanding science, wishful thinking and pure, unadulterated bullshit.

You urgently need to book into a course of critical thinking, guys!

23 Responses to An impressive demonstration of osteopaths’ inability to think critically

  • Let us not forget that the current president of the USA, Mr Donald Trump has an Osteopath as his personal physician.https://www.nytimes.com/2020/10/03/us/sean-conley-trump-doctor.html?searchResultPosition=1 .

  • Indeed. Quite the TV star.
    Accounts for a lot…

    In the US it is the case that the US medical profession gave up ‘fighting’ and accepted osteopaths as ‘physicians’, albeit without MD qualifications, with lower entry standards for osteopathic medical schools, and inculcation with antiquated concepts of pathophysiology.

    I ask (yet again) – why do folks wishing to be physicians not go to medical school and get MDs (and then specialise in osteopathy, chiropractic, naturopathy)? Or become nurses or physiotherapists.

    I think I know the answer, but I am concerned not all patients do – and failure to explain career choice reflects badly on those ‘professions’ irrespective of what it is they profess.

  • Entrance into med school on the US is very competitive. At least DOs pick the best available alternative. Would you suggest they become chiropractors. My grades did not allow me to get into Med school during Vietnam when the schools could fill their classes with PhD. who were not deferred. I opted to earn a DDS and graduated with honors. If I had gone for a DO I could have had a career as a physician.

  • This paper represents the typical delusional thinking of all SCAM practitioners. They know that they cannot justify their fairy tale nonsensical SCAM by any remotely scientific means but because they just “know” for certain that it just works they allow all the available logical fallacies to come into action.
    They are quite incapable on “critical thinking” and have no interest in learning or in challenging their point of view – cognitive dissonance is uncomfortable.

    Also if your income is dependent upon not recognising something – then it remains profitable never to recognise it.
    It’s called selective blindness.

    Instead what follows is a complicated series of thought processes which they learn from each other:
    – pseudoscientific processes in which things which look as though they might be sciency and which might fool the general public are spouted as proof the SCAM works.
    – Fake science – badly done “scientific” trials which claim to prove the SCAM works but which on inspection fail to pass muster
    – denial of the scientific method – our SCAM is special and it can’t be tested with your “science”
    – popularity – x million people use our SCAM -they can’t all be wrong
    – our SCAM has been around for x hundred years – so it must be good
    – our SCAM was revealed to a special founder who got it from a dead doctor/shaman/God
    – our SCAM uses invisible rays/energy/aliens so your science can’t see it
    – hundreds of people on my website testify that it works – no you can’t talk to them cos confidentiality
    – We’re too busy curing people to do clinical trials
    – Big Pharma is trying to put me out of business………but I have this cure for cancer
    – personal experience is much more important than any amount of trials
    – our SCAM is individually holistic for each patient
    and so on and on.

    The result is a severely critically impaired individual who is stuck in a circular thought process from which they can’t be extricated.
    Except……of course for the ones who KNOW full well that it’s a total SCAM – and like used car salesmen are flogging it for all their worth knowing full well that it’s all flim flam.
    Personally I am never quite sure what the divide is between the two. The true-believers and the snake-oil salesmen.
    Any takers?

    • I was blind but now I see…, ‘the Oracle, the all seeing eye’ of science and logic has spoken! What profound truth. How very stupid all these Osteopaths have been all these years…, amazing really that they have managed to bullshit themselves and their patients for this long!!!
      Wow the power of placebo is really something. I mean what a scam and finally you have managed to shine the spotlight of reason and science to reveal osteopathy for nothing more then a fraud and quackery!!!
      No one could ever accuse you of arrogance , intellectual snobbery or ‘contempt prior to investigation…’ Lol??????

      • @ Miles

        It is none of these things – sneer all you like. Ad hominems are usually all that SCAMmers have left in their arsenals anyway.

        Regardless of how long any of these SCAMs have been in existence, and no matter how many pathetic attempts at “studies” have been attempted, evidence for the efficacy for any SCAM is still sadly lacking.
        The best that has ever been achieved is very weak for the odd very specific condition for the occasional SCAM – and considering the vast number of them a finding hardly greater than chance.
        Hardly earth shattering evidence of efficacy is it?

        Considering the hundreds of thousands of studies of acupuncture, the gross bias in its favour in studies out of China and the appalling standard of these studies it would be amazing if there were not a small number showing mildly positive outcomes at least.

        Apart from other silly beliefs osteopaths believe that they can manipulate the skull bones of adults that have fused SOLID! Also that they can manipulate the CSF flow using the fanciful cranio-sacral therapy – this is pure fantasy. It is hard to know whether these people are delusional or just totally irrational. Have you ever seen the skull of a human adult? Please tell me how the bones can be manipulated…..

        None of which takes away from the fact that nearly all SCAMs are based on magical thinking, “divine inspiration”, simplistic notions, sheer ignorance or pure fakery.
        I am not sure why you say “contempt prior to investigation” when most SCAMs have been investigated at some point. But of course some of us also have logical and reasoning minds and it does not take “investigation” to work out that something like “Reiki” does not require investigation, or that “Tong Ren” is not going to need any practical physical investigation either.

        If you disagree and you feel that these modalities are real or that dismissing them would need a much deeper form of scientific evaluation then I have several large bridges that might interest you as a sound form of investment – going real cheap too!

        You might do well to remember: “Better to remain silent and be thought a fool than to speak and to remove all doubt.”

        • I think you have missed the point (which is surprising…, I thought you were more perceptive)…, surely we are in agreement?
          You have enlightened me: I know see that osteopathy is bullshit. The many thousands of happy patients and practitioners are deluded. Of course, the experiences of all these people stands for nothing, cause at the end of the day your reductionist scientific thinking has to be correct and it is proof that ‘they’ are all wrong! ! Wow !?????

          • Argumentum ad populum. Also pathetically bad attempts at sarcasm. You do neither yourself nor osteopathy any favors.

            “The first principle is that you must not fool yourself—and you are the easiest person to fool.” Richard Feynman

  • The so-called European or Asian osteopathic manipulators (that’s what the osteopathic doctors in the USA call them) and SCAM practizing US D.Os (they exist as well as SCAM in other medical professions, e.g. Drs. med.) even believe that they could permanently feel brain movement from outside. This belief is a relic from the time when the founder of the osteopathic movement A.T. Still making his living from phrenology and mesmerism in the 1870ties. He was a miller’s assistant by profession. After the American Civil War, he falsely boasted about being a surgeon and a doctor. He fought medicine by all means. Even today there are many followers of the basic principles of phrenology in the manual osteopathic movement who believe that one can feel the brain directly through the skull and treat individual areas in the brain, e.g. the pituitary gland directly with your hands from the outside. This is pure phrenology, a relic of romantic medicine from the 18th and 19th centuries.

    • The good thing about osteopathy is that it assigns the functional complaints of the musculoskeletal system a separate subject, in contrast to the traditional division of medical departments. These only recognize medication and surgery. The tragic thing is that this specialty, osteopathic manual treatment, which actually belongs to physical manual therapy, has remained with the techniques and pseudo-scientific explanatory models of the 18th and 19th centuries. In fact, it is increasingly adapting to esotericism.

      The reason for this is unclear. on the other hand, it is clear that as professional degree D.O. of the US American physicians has meanwhile developed into a unique standing position, a formidable marketing, which is about to overtake the professional degree of an M.D. increasingly.

      • I agree with much of what you say but here you say “The good thing about osteopathy is that it assigns the functional complaints of the musculoskeletal system a separate subject, in contrast to the traditional division of medical departments.”

        Conventional medicine has the divisions of Rheumatology and Orthopaedics which seem perfectly acceptable divisions for musculoskeletal complaints and although each of these may have their own preference for drugs or surgery it’s only fair to say that each would also recommend exercise and specific exercises and make use of Physiotherapy for practical therapy – so I really don’t see Osteopathy as adding anything useful in and of itself.
        And of course it comes with all the unnecessary mumbo-jumbo.

        Aside from all the nonsense dreamt up by Osteopathy’s founding father Andrew Taylor Still with the claim that he could “shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck.”
        Osteopathy has suffered the mission creep of all SCAMs and tries to involve itself in all manner of things.

        According to the Advertising Standards Authority in the UK Osteopaths are allowed to advertise that they can treat (beyond as well as a variety of musculoskeletal problems) –

        Circulatory problems
        Digestion problems
        Fibromyalgia
        Migraine prevention
        Neuralgia
        Tension and inability to relax
        Cramp

        Personally I would have grave doubts about the competence of any osteopath to diagnose or treat competently any of the first five conditions on this list.
        It is a little difficult to understand how manipulative therapy might be of benefit especially to someone with circulatory or digestive problems? I presume this comes under the belief that osteopaths’ manipulation of soft tissues can affect overall health and can also affect the improved function of internal organs – a belief that as far as I am aware has yet to be demonstrated in the form of any actual evidence beyond wishful thinking?

        They also claim that research backs up their efforts to treat FM but actually appraising that “research” it appears to range from very weak to non-existent – as usual.
        And of course they aim to treat babies and children just like chiros which is always very concerning.
        All more of the same delusional make-believe from the SCAM world – anything to make a buck.

        • “shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck.”

          Technically not wrong.

    • Osteopath here . I studied under the BSO , now the UCO , university college of osteopathy in London.

      It was a unique and privileged time.

      We don’t follow your systematic rules.

      We are osteopaths . We have our own school of thought . We integrate with patients like human beings.

      You forgot most physios have dog shit people skills. Most universities like Kings and st George’s interview with a mini interview system which is suited to actors and actresses . The tutors are all old bitter hags who need to exercise themselves

      The fact is , Osteopathy is more free and in tune with a patients needs. Osteopaths make patients feel good. And they pay us handsomely.

      Articulation and HVT doesn’t work? Ok then why does my patient feel better.

      There is a reason prostitution is the most lucrative business of all time, always will be and always has been. Nothing can replace feeling good . It’s the ultimate human existence

      The author is just a grump … stick to your lame physio universities run by fat losers who can’t get cash like osteopaths because they lack the ability to get quick results on the day.

      I’ll see you later while I relax in my penthouse with my Russian girlfriend, I’ve gotten respect and money as an osteopath for my contributions to the community . People love osteo and hate physio for a reason.

      • a wonderful example of a person who has fallen victim of the Dunning Kruger effect – big way!

      • “You forgot most physios have dog shit people skills.”

        And osteopaths† have potty mouths.

        (N=2: both physios I’ve used were polite, professional, and friendly, and appeared to know what they were doing at least as far as I could tell. Certainly more than any of Still’s acolytes, given he was just one more quasi-religious grifting goober peddling the usual “One True Cause and Cure” rot that’s endemic to “Alternative Medicine”.)

        † Parent poster may or may not be an actual osteopath, but is an obvious troll either way.

        • Ah the usual physio holier than thou attitude. You see swearing is a normal human thing, when you can relate to patients you understand this . Physios are still using spinal decompression machines and telling patients they have slipped discs .
          Oh you got a 1st in physiotherapy from Brunel but you still can’t relate to your patients because you only see them as medical subjects

          • do you use arrogance as a substitute for brains?

          • “You see swearing is a normal human thing”

            Hilarious. I’m British so love nothing more than turning the air blue with finely crafted invective.

            On the other hand I can also do professionalism, which is where you land on your coccyx.

            “you still can’t relate to your patients because you only see them as medical subjects”

            I don’t have patients. Well, I did, but then I killed a couple through sheer incompetence. (Frankly, many a fluffy puppy dodged a bullet the day I finally flunked out of vet med.)

            And “slipped”, or rather herniated, discs are a thing; though I’m not sure that physios are or should be diagnosing them, nor be first-line prescribing treatment. That’s what orthopedic specialists are for.

            And as the peanut gallery here loves to demonstrate time and again, it’s not conventional medicine which is pathologically incapable of staying in its lane, so on balance I think I’m going to trust actual musculoskeletal experts before I ever trust some anonymous shitposter like you.

  • Possible reasons for the current development of osteopathic manual treatment OMT in the direction of esotericism in US, the Commonwealth and Europe

    1) US osteopathic physicians D.Os have increasingly turned to the methods of modern medicine since the 1st World War. This led to the defeat of A.T. Still’s in its own movement. He wanted to prevent the use of drugs inside the body and was outvoted. 1920 to 1940 is a time with massive advertising for the usage of modern drugs by osteopathic physicians D.O. in the USA. Since World War II at the latest, training for D.O.s in the USA has been equivalent to training for M.D.s.

    2) The professional associations of the M.D.s then made an offer to the D.O.s that they can use the M.D. if they would choose to dispense the D.O. in the future. This was rejected by the professional associations of the US D.O.s.

    3) The training in OMT osteopathic manual treatment was marginalized but retained as a separate specialist area without the possibility of developing into modern physical manual therapy, a defiant fortress mentality arose there. The proportion of osteopathic physicians who love SCAM, is quite similar the case as with Drs. med. too. This SCAM associated D.I.s drove this field of OMT further in the direction of pseudoscience.

    4) In Europe OMT was always known as ‘osteopathy’ through the US-English connection and tradition since the end of the 19th century OMT remained a pseudoscience for the Commonwealth from the start and has been spread with this content in the Francophone countries since the 1980s. From there it was spread to Europe and Asia by Masseurs and physiotherapists in the OMT trainings in Europe.
    6) Due to a change in the law in England (authorization to award university degrees) and the Bologna reform, this need was discovered by universities as a market for training in OMT and this subject OMT training is increasingly being taken away from private schools by universities. It’s a lucrative market.

    7) So it happens that OMT is booming, although there is no evidence whatsoever for the effectiveness of OMT in the area of ​​the ICD-10.

    So it happens that OMT experiences a racing growth both in the US and worldwide.

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