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.
29 Responses to Osteopathy: an absence of good-quality evidence
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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.
RR: If there is a difference – what is it?
https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2019-11-07/the-difference-between-do-and-md-degrees
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?”
Need? It appears there is a “need” for something/someone. If there is a desire to close all DO colleges because they aren’t “needed”, OK. But they better be prepared to fill an already present and projected gap in care.
“The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 (PDF), a report released by the Association of American Medical Colleges (AAMC).”
https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act
I call upon all snake oil manufacturers to start pumping more of it to satisfy unmet demand from patients suffering from conditions deemed incurable by conventional medicine.
I think that is an unfair attack on (US) osteopathy. I have worked with many osteopaths over my 40 years in medicine & Medical education and have found them just as competent as my MD colleagues
I am very familiar with osteopathic medicine as it is practiced in the US. As of recently, medical residencies merged so DOs and MDs receive exactly the same post graduate training. Furthermore, most osteopathic medical students consider the osteopathic portion of their training to be little more than a massive joke and an unfortunate drain on their time. Becoming a DO is a way for them to become a doctor only. They are for the most part not true believers in it.
As to why we even have DO’s. If you can’t find a logical answer, follow the money. The AMA (the regulator of allopathic medical schools in the US) offered AAOM (regulates osteopathic schools) to merge since the two are indistinguishable. The AAOM declined. My personal opinion is that the AAOM makes a boat load of money off of poor desperate medical students who are in no position to protest and the current generation of leadership had no desire to lose the gravy train. The future, we’ll see
Whether Osteo, Chiro or Physio, the effectiveness of interventions they offer is similar and unconvincing. Like bickering children, they fight for attention, but each is plagued with poor quality research, unsupported pet-theories for manual therapies and lack of critical thinking. Unnecessary, Self-centred professional monopolie$. Save your money, go for a nice walk, hug a puppy.
EE, I am sure that this article will cause you a few issues. The first thing that you are going to bleat about is the fact that the author is a chiropractor. But look beyond that! Notice that she has a PhD as well as being affiliated with some very prestigious organizations. She is far better qualified to comment on these things than you are. https://www.medpagetoday.com/opinion/second-opinions/104026?xid=nl_mpt_DHE_2023-04-14&eun=g528268d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202023-04-14&utm_term=NL_Daily_DHE_dual-gmail-definition
very good!
I did not know you had humor.
GibleyGibley wrote: “EE, I am sure that this article will cause you a few issues. The first thing that you are going to bleat about is the fact that the author is a chiropractor. But look beyond that! Notice that she has a PhD as well as being affiliated with some very prestigious organizations. She is far better qualified to comment on these things than you are.”
For readers who might be unaware, whilst it is true that Christine Goertz DC has been ‘recognised’ for her perceived academic prowess https://www.pcori.org/people/christine-goertz-dc-phd it is not good news for science. Here’s some valid criticism of her work:
QUOTE
“This trial follows the infamous ‘A+B versus B’ design. It will almost always generate a positive result – so much so that it is a waste of time to run the study because we know its findings before it has started. And if this is so, the trial is arguably even unethical.”
Ref: https://edzardernst.com/2018/05/new-back-pain-study-support-for-the-inclusion-of-chiropractic-care-as-a-component-of-multidisciplinary-health-care-for-low-back-pain/
Well, it can be a little more involved than blindly claiming it’s unethical.
“Most often there is a range of dose combinations that are synergistic and other ranges that are either additive or subadditive.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379564/
I’m not sure how this is relevant. Your comment seems to be discussing the concept of “Integrative Medicine” but Blue Wode is discussing how to research these, or any, techniques…or am I missing something?
It has to do with the A+B versus B’ design.
He used that as a basis to try and discredit Goertz.
Having extensively gone through the literature on spinal manipulation in preparation to writing a textbook chapter on CAM last year, the fact is that while the literature shows a moderate effect from spinal manipulation on low back pain, there are really no high quality studies showing the effects of such manipulation on any other condition. If chiropractors and (non-US) osteopaths would limit themselves to this, or even the treatment of other musculoskeletal problems, they might have an argument for their role in modern healthcare, but their insistence on using manipulation as a hammer to treat every possible nail (health condition) shows the dangers of the care provided by these practitioners.
“..,but their insistence on using manipulation as a hammer to treat every possible nail (health condition)…”
What percentage of current chiropractors hold this view?
far too many!
here is a paper showing Chiros commonly advertise treating patient’s for non-MSK conditions: Chiropractic website claims related to non-musculoskeletal conditions – https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00397-y
and here is an article outlining the ineffectiveness of manipulation for these conditions: The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00362-9
of note is how few high quality studies they could find for use of manipulation in non-MSK.
If your concerned about bias, note that these are both from Chiropractic publications
can you name one chiropractor that states that he or she holds this view and/or practices in this manner?
yes
geesh…let’s see some names.
DD PALMER
BJ PALMER
Dr Hay. Oh, I’m not questioning that some chiros advertise treatment of various health conditions (now if that is via SMT or using other approaches is another discussion).
What I questioned was your use of “every” in this statement
“ using manipulation as a hammer to treat every possible nail (health condition)”
Two dead people? It’s clear he was referring to the now, not the past.
Try to follow along.
Blue Wode. I notice that you had the rudeness not to put Dr. Christine Goetz degree of a PhD after her name in your little tirade as above. It certainly detracts from your comments.
So to quote the esteemed Prof. EE,
“very good! I did not know you had humor.”
@ GibleyGibley
I can only conclude that you are unable to counter the criticism of Christine Goertz’s work above.
Re my alleged rudeness, I usually address Edzard Ernst as EE or Prof. Ernst, rather than Edzard Ernst MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd. It doesn’t seem to bother him (or anybody else for that matter).
BW you either use all of the degrees after the name or just the title. e.g.Prof. or Dr. The fact that you chose to ignore the PhD is just an indication of your rudeness or arrogance. You choose.
Your assumption that I am unable to criticize Dr. Goetz’s work is incorrect.
@ GibleyGibley
https://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/
👆 An update on osteopathy and lobbying for SCAM by Bavarian politicians
https://edzardernst.com/2023/04/so-called-alternative-medicine-scam-in-bavarian-hospitals/
🤣 The Bavarian Economics Minister and self-confessed antivaxxer* Hubert Aiwanger 🤣
⏬
He honors the osteopath Michel Frenzel-Assih as an advertising ambassador.
https://www.therme-bad-steben.de/hohe-auszeichnung-fuer-michel-frenzel-assih
* https://www.spiegel.de/politik/deutschland/hubert-aiwanger-freie-waehler-erneuert-seinen-verzicht-auf-eine-corona-impfung-a-12fac96e-464f-4782-87bb-24ba5abcb055
“You don’t have to make a secret of the fact that you also hear about cases in your personal environment that have massive side effects from vaccination,” said Aiwanger on Deutschlandfunk.
🤔
Petra Gerster / Tourist Director Oberstdorf: “So that we can say at the end of the holiday: “I want to go back there.””
Is that why osteopathy?
https://youtu.be/zex_r08Ehac
👎 👎 👎 👎
And the Bavarian State Spa Bad Steben also advertises:
👉 Schuessler salts
https://www.therme-bad-steben.de/schuessler-salz-sprechstunde
👉 esoteric dowsing places, so-called places of power
“Different feelings, perceptions and impressions can be experienced here. The perception of these natural energy
sources occurs through a sensitivity to radiation that 🙈 not all people possess 🙈.”
https://www.bad-steben.de/erlebnis/natur-erleben/themen-wanderwege/kraft-und-energie-plaetze.html
https://www.bayerische-staatsbaeder.de/de/die-reise-zum-ich/kraftplaetze-bad-steben