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

Osteopathy is becoming under increasing criticism – not just in the UK but also in other countries. Here are the summary points from a very good overview from Canada:

– Osteopathy is based on the belief that illness comes from the impaired movement of muscles, bones, and their connecting structures, and that an osteopath can restore proper movement using their hands
– Offshoots of osteopathy include visceral osteopathy and craniosacral osteopathy, which make extraordinary claims that are not backed up by good evidence
– There is an absence of good quality evidence to support the use of osteopathy to address musculoskeletal issues
– Osteopathy has been reformed in the United States, with osteopathic physicians receiving training comparable to medical doctors and few of them regularly using osteopathic manual manipulations

An article from Germany is equally skeptical. Here is my translation of an excerpt from a recent article:

When asked which studies prove the effectiveness, the VOD kindly and convincingly handed the author of this article a list of about 20 studies. And emphasized that these were listed in Medline, i.e. a recognized medical database. But a close examination of the studies reveals: Almost without exception, all of them qualify their results and point to uncertainties.
The treatment is “possibly helpful,” for example, they say, the study quality is “very low,” “low” to “moderate,” there are too few studies, they are small, the “evidence is preliminary” and “insufficient to draw definitive conclusions. Again and again it is emphasized that further, methodically better, more sustainable studies are needed, which also record more precisely what happened in osteopathic treatment in the first place.

Another article was published by myself in ‘L’Express’. As it is in French, I translated the conclusion for you:

… would I recommend consulting an osteopath? My answer is a carefully considered NO! For patients with back pain, the evidence is as good (or bad, depending on your point of view) as for many other proposed therapies. So if a patient insists on osteopathy, I might support it, but I would still prefer physical therapy. For all other musculoskeletal conditions, there is not enough evidence to make positive recommendations. For patients with conditions other than musculoskeletal, I would advise against osteopathy.

All this comes after it has been shown that worldwide research into osteopathy is scarce and has hardly any impact at all. The question we should therefore ask is this:

why do we need osteopaths?

PS

Osteopaths in the US have studied medicine, rarely practice manual treatments, and are almost indistinguishable from MDs. Everywhere else, osteopaths are practitioners of so-called alternative medicine.

6 Responses to Osteopathy: an absence of good-quality evidence

  • I recall President Trump’s doctor appeared on TV to discuss Covid in a nice white coat and ‘DO’ after his name.
    And the ‘Dr’ who was involved with the US gym team (and has been jailed) was a ‘DO’.

    The Prof poses a good question, and in particular, why do Americans need DOs?
    If there is no difference between the professional capabilities of a DO and MD, why not style them ‘MD’?
    If there is a difference – what is it?

    Some have suggested that it is easier to gain entry to a school of osteopathy rather than a school of medicine.
    If so, is that generally understood and acknowledged by US patients?
    Why do some US patients go to a DO and not an MD?

    MDs who then wanted to specialise in musculo-skeletal problems should do so as post MD graduates – just as orthopods do. Simple.

  • Thank you DC (whoever you are). An interesting reference.

    In the US (but not UK), “Anyone who dreams of becoming a doctor should understand that there are two types of med schools: allopathic and osteopathic schools.

    While allopathic schools offer a traditional medical curriculum, osteopathic schools supplement lessons in standard medical sciences and practices with instruction on how to provide touch-based diagnosis and treatment of various health problems, such as circulatory issues and musculoskeletal conditions.

    The Distinction Between Allopathic and Osteopathic Medicine: Both allopathic and osteopathic medicine are designed to heal the sick and to ensure that healthy people stay well, so these two branches of medicine share that mission. However, there is an important distinction between osteopathic and allopathic philosophy:

    Dr. Robert A. Cain, president and CEO of the American Association of Colleges of Osteopathic Medicine, says osteopathic medical education is designed to train physicians to treat each patient as a whole person.”

    But so is ‘allopathic’ medicine – there is no distinction there.

    “Cain, a board-certified pulmonologist with a D.O. degree who previously saw patients for 14 years, notes that osteopathic medical principles “emphasize the mind-body-spirit connection and the body’s ability to heal itself.”

    Ah! That’s it! “Osteopathic medical principles emphasize the mind-body-spirit connection and the body’s ability to heal itself.”
    But ‘allopathic’ medical principles also recognise there is (obviously) a connection between mind and body, and we all agree the body does indeed have ability to ‘heal itself’ (to some degree).
    There’s no distinction there.

    What seems to be the only distinctive feature between osteopathic and regular, orthodox medicine (which osteopaths like to style ‘allopathic’ as something of a pejorative term), is ‘spirit’.

    All we need now is for osteopaths to tell us what they mean by ‘spirit’, how they measure it, and how they assess its influence on health/disease.

    And for osteopaths to explain to their patients they are using a ‘spirit’ (or more than one).
    And for students thinking of studying ‘osteopathy’ to have the integrity to explain why they want to study (and practice if they qualify), ‘spirit’ based medicine and not conventional evidence-based medicine.

    The Prof’s question remains unanswered: “Why do we need osteopaths?”

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