Osteopaths on the loose...

[Croydon Bob]

Perhaps they do have an evidence base for understanding that spinal problems can cause disease after all.


And perhaps the tooth fairy is real.

[davidrodway]

http://www.meridianinstitute.com/eamt/files/burns1/bur1ch27.html

I looked up osteopaths treating visceral conditions and came across this interesting site, seems like the early osteopaths tested their ideas using vivesection. Perhaps they do have an evidence base for understanding that spinal problems can cause disease after all.

Are you aware of this kind of work David?

Yes. And for 1907 this work was quite good . and you can see why they wre excited about limks between the spine nd the viscera. i dont know quite how their studies compared to the science of the time, but it sems they were trying to use a fairly scientific approaqch.

we are now 100 years on and i will let others explain why those l;inks, apparent in labs, do not manifest in the human patients we see, or not in a way that can by significantly influenced by osteopathic manipulations.

[Peter]

Yes. And for 1907 this work was quite good . and you can see why they wre excited about limks between the spine nd the viscera. i dont know quite how their studies compared to the science of the time, but it sems they were trying to use a fairly scientific approaqch.

we are now 100 years on and i will let others explain why those l;inks, apparent in labs, do not manifest in the human patients we see, or not in a way that can by significantly influenced by osteopathic manipulations.

David, have you actually read this work by Louisa Burns or have you just glossed over it/dismissed it because it is 'old'.


CHAPTER XXVII.


THE EXPERIMENTAL DEMONSTRATION OF THE OSTEOPATHIC CENTERS:
THE ABDOMINAL VISCERA.


Viscero-Somatic Reflexes.


The first series of experiments upon the abdominal viscera were performed upon animals. The abdominal wall was opened under anesthesia. The viscera were exposed to examination with as little manipulation as possible. The condition of peristalsis and the size of the blood vessels was carefully noted. The fingers of the observers were placed upon different areas of the back and neck in part of the experiments, and in others the muscles also were exposed to view. For the first series, electricity was used except where other forms of stimulation are mentioned.


The stimulation of the peritoneal coat, or the muscles, or the inner wall of the cardiac end of the stomach was followed by the contraction of the muscles near the sixth to the eighth thoracic spines. The inner walls of the stomach were stimulated by pricking and by the use of a hot glass rod. The reflex muscular contractions followed as in the case of the electrical stimulation.


The stimulation of the peritoneum and the gastric muscles by pricking, etc., did not initiate the contractions so constantly. The area of reflex muscular contractions varied somewhat in different animals, but remained constant for each animal, at least during its life under anesthesia. Electrical stimulation of the pyloric end of the stomach gave rise to contraction of the spinal muscles from the seventh to the tenth, but usually near the ninth thoracic spine. This corresponds to the eighth in the human being.


The above description seems to relate to known anatomy and physiology, does the date it was done still really matter? David why do you think that these links existed then and not now? Does the modern osteopathic profession deny that there are viscero-somatic neural pathways?

[Peter]

And perhaps the tooth fairy is real.

Well you obviously haven't read it Bob or perhaps you are just being playful, did you learn physiology at med school?

[Peter]

There is no need to post lots of this, it interests me that there may be a fear of reading this kind of work, both by the medics who may not be aware of it and the musculo-whatever osteopaths of modern times who seem to be denying it exists, which David hasn't really explained why. If I discovered another room that validated a brilliant way of understanding and solving a problem why would I shut the door?

I can see the logic in the idea spinal or any neural irritation may be complicit in pathology when viewed this way, I can also see that the medical solution to suppress or irritate these isolated/perverted reflexes must be based on the same anatomy and physiology.

I can also understand why the pharmas don't want to revalidate any of it. If one can solve for example indigestion by correcting the related pathophysiology there is no need to start the GIT cascade. This usually starts with simple bicarb, goes on to proton pump inhibitors, helicobactor antibiotics, IBS, Chronn's, bowel resection and all the bags that go with it.........

I fully understand the two sides of these scenarios, I have no wish to cause alarm. So the previously quoted text goes on.




In all these experiments, the cervical muscles were somewhat contracted. We did not determine what individual muscles were involved in the reaction.

The stimulation of the duodenum, pancreas and gall-bladder caused the contraction of the muscles near the tenth and eleventh thoracic spines. (It must be noted that cats and dogs rejoice in the possession of one or two extra thoracic vertebrae.)

The stimulation of the rectum was followed by contractions of the muscles near the lumbo-sacral articulation. The stimulation of the portions of the intestine between the duodenum and rectum caused muscular contractions which were fairly equally divided between the tenth thoracic spine and the lumbo-sacral articulation. The stimulation of the caecum and appendix caused the reflex muscular contractions to appear near the fourteenth thoracic and the first lumbar spines. The interior of the appendix was stimulated by pricking, and the reflex contractions appeared as before.

The electrical stimulation of the kidneys and the supra-renals caused the contraction of the muscles near the fourteenth thoracic spine, sometimes the contractions appeared near the twelfth and thirteenth. These correspond to the eleventh and twelfth in man. Louisa Burns DO

[Smith]

CHAPTER XXVII.

THE EXPERIMENTAL DEMONSTRATION OF THE OSTEOPATHIC CENTERS:
THE ABDOMINAL VISCERA.


Viscero-Somatic Reflexes.


The first series of experiments upon the abdominal viscera were performed upon animals. The abdominal wall was opened under anesthesia. The viscera were exposed to examination with as little manipulation as possible. The condition of peristalsis and the size of the blood vessels was carefully noted. The fingers of the observers were placed upon different areas of the back and neck in part of the experiments, and in others the muscles also were exposed to view. For the first series, electricity was used except where other forms of stimulation are mentioned.


The stimulation of the peritoneal coat, or the muscles, or the inner wall of the cardiac end of the stomach was followed by the contraction of the muscles near the sixth to the eighth thoracic spines. The inner walls of the stomach were stimulated by pricking and by the use of a hot glass rod. The reflex muscular contractions followed as in the case of the electrical stimulation.


The stimulation of the peritoneum and the gastric muscles by pricking, etc., did not initiate the contractions so constantly. The area of reflex muscular contractions varied somewhat in different animals, but remained constant for each animal, at least during its life under anesthesia. Electrical stimulation of the pyloric end of the stomach gave rise to contraction of the spinal muscles from the seventh to the tenth, but usually near the ninth thoracic spine. This corresponds to the eighth in the human being.


The above description seems to relate to known anatomy and physiology, does the date it was done still really matter? David why do you think that these links existed then and not now? Does the modern osteopathic profession deny that there are viscero-somatic neural pathways?


I read this work some time ago (I will now, time permitting, reread it). My impression was that there were some fatal flaws in Burns' approach.

With regard to the paragraphs you quote, they concern viscerosomatic reflexes, which are widely accepted. More controversial are somatovisceral reflexes, which might potentially be exploited in physical treatments. Here, Burns' findings have not been widely (or reliably?) repeated.

Sato and his group have done some work in this direction. Note his concluding comments:

http://www.ncbi.nlm.nih.gov/pubmed/8775021

On the whole it seems that there is a reasonable base to believe that somatovisceral effects occur, but that:


they are likely to be mediated by superior centres rather than segmentally.
responses are viscerally generic rather than organ specific.
there is no evidence that responses persist in the medium term.

[Pebble]

I read this work some time ago (I will now, time permitting, reread it). My impression was that there were some fatal flaws in Burns' approach.

With regard to the paragraphs you quote, they concern viscerosomatic reflexes, which are widely accepted. More controversial are somatovisceral reflexes, which might potentially be exploited in physical treatments. Here, Burns' findings have not been widely (or reliably?) repeated.

Sato and his group have done some work in this direction. Note his concluding comments:

http://www.ncbi.nlm.nih.gov/pubmed/8775021

On the whole it seems that there is a reasonable base to believe that somatovisceral effects occur, but that:


they are likely to be mediated by superior centres rather than segmentally.
responses are viscerally generic rather than organ specific.
there is no evidence that responses persist in the medium term.


Well said Mr Smith. I have never explored the older work in this field so looks interesting. But as you point out this is millions of miles away from Peters delusions, in respect on implications. Crohn's disease, ulcerative colitis & Helicobacter, should not be dragged into this - it is offensive to all logic.
However IBD or dyspepsia are fair game. The issues are exactly as you describe - independent reproducibility, targeting of effect, durability of impact and of course demonstrable benefit in clinical trials.
What has been reproduced above does not even get you to step one from a mechanistic perspective - viscero-somatic reflexes are not the issue.

[Peter]

I read this work some time ago (I will now, time permitting, reread it). My impression was that there were some fatal flaws in Burns' approach.

With regard to the paragraphs you quote, they concern viscerosomatic reflexes, which are widely accepted. More controversial are somatovisceral reflexes, which might potentially be exploited in physical treatments. Here, Burns' findings have not been widely (or reliably?) repeated.

Sato and his group have done some work in this direction. Note his concluding comments:

http://www.ncbi.nlm.nih.gov/pubmed/8775021

On the whole it seems that there is a reasonable base to believe that somatovisceral effects occur, but that:


they are likely to be mediated by superior centres rather than segmentally.
responses are viscerally generic rather than organ specific.
there is no evidence that responses persist in the medium term.


The somato-visceral reflex that you dispute, was validated in the BMJ, 1985, in this article below. At the end it even suggest that there was good enough inter-examiner reliabilty for physicians to learn this as a palpatory technique.

The heart is not unique, if these viscero-somatic palpable changes can occur here it is totally logical to assume that it occurs for all viscero-somatic reflexes, isn't it.

There is a lot more much later work than Burns that more than validates what she did so I can post some of that if you like.

What evidence do you have then that these effects are 'likely' to be mediated by superior centres than segmentally. How do you think a paraplegic digests his dinner then, cellnet?



PMCID: PMC1416146

Br Med J (Clin Res Ed). 1985 July 6; 291(6487): 13–17.

A somatic component to myocardial infarction.
A S Nicholas, D A DeBias, W Ehrenfeuchter, K M England, R W England, C H Greene, D Heilig, and M Kirschbaum
http://www.skeptics.org.uk/corehtml/pmc/pmcgifs/rt-arrow.gif This article has been cited by (http://www.skeptics.org.uk/pmc/articles/PMC1416146/citedby/) other articles in PMC.

Abstract
Sixty two patients were randomised to be seen by osteopathic physicians for palpation of the thoracic paravertebral soft tissue, T1-T8. Twenty five patients had clinically confirmed acute myocardial infarction. Of the remainder, 22 without known cardiovascular disease served as controls and 15 were placed in an excluded group because of diagnosed cardiovascular disease other than myocardial infarction. Observations were described in predetermined standard terminology. The control group was found to have a low incidence of palpable changes throughout the thoracic dorsum, and these changes were uniformly distributed from T1 to T8. Examination of the group with myocardial infarction disclosed a significantly higher incidence of soft tissue changes (increased firmness, warmth, ropiness, oedematous changes, heavy musculature), confined almost entirely to the upper four thoracic levels. The 15 patients who were excluded from the experimental group because they had various cardiovascular diseases other than myocardial infarction also showed significantly different changes on palpation compared with the group with myocardial infarction. These findings suggest that myocardial infarction is accompanied by characteristic paravertebral soft tissue changes which are readily detected by palpation.

[Peter]

I read this work some time ago (I will now, time permitting, reread it). My impression was that there were some fatal flaws in Burns' approach.



What are the 'fatal flaws' in this approach by Burn's, doesn't look a lot different to the pharmaceutical industry doing the LD50 test on rabbits to find out, say, if Viagra works.

[Peter]

Well said Mr Smith. I have never explored the older work in this field so looks interesting. But as you point out this is millions of miles away from Peters delusions, in respect on implications. Crohn's disease, ulcerative colitis & Helicobacter, should not be dragged into this - it is offensive to all logic.
However IBD or dyspepsia are fair game. The issues are exactly as you describe - independent reproducibility, targeting of effect, durability of impact and of course demonstrable benefit in clinical trials.
What has been reproduced above does not even get you to step one from a mechanistic perspective - viscero-somatic reflexes are not the issue.

I can post the work specifically on GIT ulceration if you want, goes into great detail about what spinal lesions will produce ulcers in specific parts of the GIT in guinea pigs/rabbits, with post experimental disection to validate the conclusions.

I can appreciate if you haven't read it you don't know?

[Pebble]

The somato-visceral reflex that you dispute, was validated in the BMJ, 1985, in this article below. At the end it even suggest that there was good enough inter-examiner reliabilty for physicians to learn this as a palpatory technique.

The heart is not unique, if these viscero-somatic palpable changes can occur here it is totally logical to assume that it occurs for all viscero-somatic reflexes, isn't it.

.

Is this confusion deliberate or lack of understanding?

Somato-visceral requires that you show that musculaskeletal abnormalities preceeded and indeed caused the visceral consequence - not the reverse. Showing that in a very small group, there was a an association between having had a heart attack and abnormalities on palpation of unknown duration doesn't even get you out of the starting gate.

As for stress ulceration, well known so don't bother - how does that get you as far as helicobacter? As for the stupidity of confusing this with ulcerative colitis and Crohn's it beggars belief.

[Smith]

The somato-visceral reflex that you dispute, was validated in the BMJ, 1985, in this article below. At the end it even suggest that there was good enough inter-examiner reliabilty for physicians to learn this as a palpatory technique.

I don't dispute somatovisceral reflexes. I think they need studying more extensively.

The BMJ article you site seems to be dealing with viscerosomatic reflexes, not somatovisceral reflexes.


The heart is not unique, if these viscero-somatic palpable changes can occur here it is totally logical to assume that it occurs for all viscero-somatic reflexes, isn't it.

It's not "logical" but it is reasonable, and I don't dispute it. I said in my previous post: viscerosomatic reflexes are widely accepted, somatovisceral ones have been less well described.


There is a lot more much later work than Burns that more than validates what she did so I can post some of that if you like.

Yes, please, but on somatovisceral reflexes, not viscerosomatic reflexes, please.


What evidence do you have then that these effects are 'likely' to be mediated by superior centres than segmentally.

I wish to rephrase. Yes, it appears that segmental effects are present, but they are complexly modulated by supraspinal influences.

Research demonstrating reflex modulation of physiological activity has been reviewed by Mein (1) and Richards (10). In anaesthetised animals Sato and co-workers (13, 14, 15, 16) have found that both noxious and innocuous stimulation of somatic afferents evokes changes in function in a variety of tissues and organs and that furthermore, these changes are mediated by reflex changes in sympathetic efferent activity.
Some of these reflexes were segmentally organised, while others were non-segmental and generalised, dependent on the supraspinal centres. In a study of adrenal catecholamine secretion, they found segmental reflexes to be to be excitatory while supraspinal modulation could result either in excitatory or inhibitory effects (16). Sato and his colleagues acknowledge “the complexity and multiplicity of mechanisms involved in the final expression of the reflex response” (15).


Research by Purdy and co-workers (17), and Richards and co-workers (10), focussed on upper limb blood flow response to superior cervical manual treatment. Purdy compared light touch with soft tissue manipulation applied to the suboccipital region, and measured finger blood flow before and after treatment. In both cases, digital blood flow increased, to a greater degree with manipulation, and subjects reporting comfort or neutral response during treatment had larger changes than those experiencing discomfort. Richards et al. measured finger blood flow and heart rate before and after sustained pressure to the upper cervical tissues, or light touch to the shoulders (sham treatment). They report that sustained pressure increased finger blood flow. The effect however, was short lived. The (graphically presented) raw data show that five minutes after treatment ended, finger blood flow was in fact considerably lower than the starting baseline. The authors imply that this was a return to the declining baseline tendency, the effect of a relatively low ambient temperature. Similarly heart rate peaked during treatment when sustained pressure was used, again a temporary effect. Both sustained pressure and sham treatment appeared to cause initial reductions in heart rate. This study had flaws in its methodology: there were no specific selection criteria, the number of subjects and treatments was small, and there was considerable variability in baselines and responses “making statistical analysis difficult”.


Interpretation of this research is difficult, owing to its paucity and, in the latter case, its methodological flaws. It would be interesting to know whether the circulatory effects noted in the latter two studies were generalised, or limited to the upper extremities.
The evidence presented seems to indicate that autonomic reflex effects do result from manual techniques, and that they are complex, involving both segmental and extra-segmental, supraspinal influences, including cognitive ones.


(1) Mein E.A. et al. (2000) Physiologic regulation through manual therapy. In: Physiological Medicine and Rehabilitation: State of the Art Reviews, 14 (1):27-42.
Published on www.meridianinstitute.com 30.11.2006.
...
(10) Richards D.G. et al. (2001) Osteopathic Regulation of Physiology. The AAO Journal, 11 (3): 34-38.
(11) Burns L. (1907) Studies in the Osteopathic Sciences. Volume 1: Basic Principles. Early American Manual Therapy, Version 5.0.
...

(13) Sato A. et al. (2002) Reflex modulation of visceral functions by acupuncture-like stimulation in anesthetized rats. International Congress Series, 1238 (Number unknown): 111-123.
....

(15) Sato A. (1995) Somatovisceral reflexes. J. Manipulative Physiol. Ther. 18 (9): 597-602.
(16) Sato A. et al. (1996) Reflex modulation of catecholamine secretion and adrenal sympathetic nerve activity by acupuncture-like stimulation in anesthetized rat. Japanese Journal of Physiology, 46 (5): 411-21.
(17) Purdy W.R. et al. (1996) Suboccipital dermatomyotonic stimulation and digital blood flow. Journal of the American Osteopathic Association, 96(5): 285.




How do you think a paraplegic digests his dinner then, cellnet?


Uhmm... autonomics ...local plexi ...brain-gut endocrine link.
BTW, why the sarcasm? I have no wish to push an ideological agenda on this, and I do have and personal interest in somatovisceral relations, so if you have any better info than I have, please post it.

[Peter]

Is this confusion deliberate or lack of understanding?

Somato-visceral requires that you show that musculaskeletal abnormalities preceeded and indeed caused the visceral consequence - not the reverse. Showing that in a very small group, there was a an association between having had a heart attack and abnormalities on palpation of unknown duration doesn't even get you out of the starting gate.

As for stress ulceration, well known so don't bother - how does that get you as far as helicobacter? As for the stupidity of confusing this with ulcerative colitis and Crohn's it beggars belief.

Well at least you admit confusion and lack of understanding. So lets get this straight, you can accept a viscero-somatic lesion or effect but not a somato-visceral effect?

Why can an RTA that whiplashes at C345 hard enough to damage the phrenic stop us breathing then? What on earth is in the gap in your knowledge here?

I know it must be distressing that Pubmed of all places dared to go where you are having kittens to explore, but let's do it gently.

Still waiting for an attempt at a reply on what magic higher centres are doing in all this.

[Peter]

I don't dispute somatovisceral reflexes. I think they need studying more extensively.

Uhmm... autonomics ...local plexi ...brain-gut endocrine link.
BTW, why the sarcasm? I have no wish to push an ideological agenda on this, and I do have and personal interest in somatovisceral relations, so if you have any better info than I have, please post it.

Apologies on that, didn't realise you had posted this. Of course I will post the somato-visceral stuff on gut ulceration so you can see it.

[jimwalsh]

Why can an RTA that whiplashes at C345 hard enough to damage the phrenic stop us breathing then? What on earth is in the gap in your knowledge here?


come on now please say that you understand basic human anatomy better than that.

I think you will find that the lungs are still able to work hence mechanical respiration.

you will find that upper csp lesions are somatosomatic....

[Peter]

I don't dispute somatovisceral reflexes. I think they need studying more extensively.

I do have and personal interest in somatovisceral relations, so if you have any better info than I have, please post it.

A T Still Research Institute Bulletin no 7 'Changes in the body fluids due to vertebral lesions' 1931.

If you can post the link, I have the actual document but it is a bit big to copy and paste.

First they saw human subjects who already had symptoms of GIT ulceration, took body fluid samples and then corrected lesions. When symptoms abated they took samples again and found them to be normal.

x-ray plates were made of boney lesions and of the GIT before and after to confrim diagnosis. No single examinations were held to be conclusive all had to be verified by two or more independant examinations. In except few cases, with regard to boney lesioning, all human ones were accidental.

Then experimental lesions copying the findings in the human subjects were inflicted on animals, this process is described in great detail and noted that on release the animals would jump about trying to 'correct' the lesions, in some cases this happened but they had to repeat a lot of the proceedure to get a cohort.

Another group of animals recieved corrective treatment after a period of time and their GIT fluids were compared with the lesioned group.

Various common descriptions of the palpable lesions and effects on local tissue of edema etc. Patholgical changes in these tissues are described in detail as the pattern becomes organised over time.

Some of these changes in tissue were observed for two years, on autopsy the findings were uniform in kind for every lesion.

Lesioning then is listed from atlas and below showing how alkalinity of saliva, GIT mucosa etc. all change when compared with controls. Hyperemia of the liver and moderate cholemia from lesions of the 10th Thoracic and assoc. ribs, this document alone runs to 200 pages.

The part II shows in great detail how the acidity of the stomach juices changed, describes ulcers for example with lesions of the 2nd thoracic in guinea pigs on the anterior surface of the stomach, near to the pylorus.

I can appreciate that pebble hasn't seen this, to get it you have to pay the A T Still library for access, but it clearly makes it obvious to me that the somato-visceral reflex and it's relationship with pathogenisis is far from nonsense.

This was studied extensively for years, there is still a Louisa Burns memorial award but I doubt it has ever been given to anyone with this stature.

[Pebble]

So this is the best you can do! Mechanistic studies showing that there are autonimic consequences of interrupting spinal nerve conduction, which has been shown to reults in stomach ulcers. Is this your breakthrough?

Considering the scientific literature on helicobacter infection, control of acid production, factors affecting mucosal integrity etc. if data drives your approach, this would hardly register on your horizion.

If you are actively researching this area, great - lets see some preliminary findings.

If you are simply a believer in anything that is not endorsed by 'conventional' medicine, then your diatribe fits perfectly.

[Peter]

So this is the best you can do! Mechanistic studies showing that there are autonimic consequences of interrupting spinal nerve conduction, which has been shown to reults in stomach ulcers. Is this your breakthrough?

Considering the scientific literature on helicobacter infection, control of acid production, factors affecting mucosal integrity etc. if data drives your approach, this would hardly register on your horizion.

If you are actively researching this area, great - lets see some preliminary findings.

If you are simply a believer in anything that is not endorsed by 'conventional' medicine, then your diatribe fits perfectly.

I find it hysterical that anything that challenges your perverse idea that 'disease' can only be 'controlled' by doctors beyond comment. Your abject fear of discussion, debate and rational ideas is on a par with some kind of demented religious nutcase.

Just look at that stupid cat thang, says it all really. You can carry on taking Captain Peakard to warp speed for all I care, you are beyond help, you win.

[Pebble]

I find it hysterical that anything that challenges your perverse idea that 'disease' can only be 'controlled' by doctors beyond comment. Your abject fear of discussion, debate and rational ideas is on a par with some kind of demented religious nutcase.

Just look at that stupid cat thang, says it all really. You can carry on taking Captain Peakard to warp speed for all I care, you are beyond help, you win.


What challange? To date you have challanged nothing, all you have done is stated that you believe something different without reasonable evidence.

[jimwalsh]

I find it hysterical that anything that challenges your perverse idea that 'disease' can only be 'controlled' by doctors beyond comment. Your abject fear of discussion, debate and rational ideas is on a par with some kind of demented religious nutcase.

Just look at that stupid cat thang, says it all really. You can carry on taking Captain Peakard to warp speed for all I care, you are beyond help, you win.
[/URL]

Dear Peter

what is good about this site is peoples willingness to listen to reasoned debate providing that the debate is not full of logical fallacies.

Why not try to come up with some rational arguments rather than ad hominem attacks...

[URL="http://en.wikipedia.org/wiki/Ad_hominem"]http://en.wikipedia.org/wiki/Ad_hominem (http://en.wikipedia.org/wiki/Ad_hominem)

[Croydon Bob]

Why not try to come up with some rational arguments rather than ad hominem attacks...

http://en.wikipedia.org/wiki/Ad_hominem (http://en.wikipedia.org/wiki/Ad_hominem)

"an argument which links the validity of a premise to an irrelevant characteristic or belief of the person advocating the premise"

Actually it's not even a proper ad hominem attack, just another meaningless hissy fit from another loony who has lost the argument but isn't smart enought to see it.

I use ad hominem-ish argument sometimes quite consciously, eg: Everything Peter has said previously has been garbage, therefore his latest post is garbage. But as this isn't a logical fallacy it is not really ad hominem. Or, if it is ad hominem, then it is a legitimate use.

[jimwalsh]

"an argument which links the validity of a premise to an irrelevant characteristic or belief of the person advocating the premise"

Actually it's not even a proper ad hominem attack, just another meaningless hissy fit from another loony who has lost the argument but isn't smart enought to see it.

I use ad hominem-ish argument sometimes quite consciously, eg: Everything Peter has said previously has been garbage, therefore his latest post is garbage. But as this isn't a logical fallacy it is not really ad hominem. Or, if it is ad hominem, then it is a legitimate use.

I stand corrected... (note to self get your logical fallacy definitions sorted)

[davidrodway]

[. These findings suggest that myocardial infarction is accompanied by characteristic paravertebral soft tissue changes which are readily detected by palpation.[/QUOTE]

but that just demonstrates a possible viscero-somatic reflex, not somatico-visceral. and it certainly does not imply that the spinal lesions have any role in causing heart problems or that the ttt of the spine benefits the heart.

in practice, osteopaths do not find palpable changes in specific spinal segments to be asociated with specific organs, also, major spinal problems - eg pivd, fracture, hemi vertebra - are not found, either in the short or long term, to incraes the risk of any visceral conditiuons ( except, for example, scolisis in reducing lung capacity, but that is not an autonomic system effect) . there are known automic reflexes connecting the soma and the viscera - pressing the eyeballs, sexual arousal and ejaculation - but these are well charted and not pathophysiological. as anatomist at the new york osteopathic college frank willard says, the sympathetic nervous system is robust, and disrupted only be major physical intervention such as sympathectomy. the british osteopathic profession - the bso at least - abandonded most of its claims to treat most visceral conditions in the 1950s.

[Smith]

in practice, osteopaths do not find palpable changes in specific spinal segments to be asociated with specific organs, also, major spinal problems - eg pivd, fracture, hemi vertebra - are not found, either in the short or long term, to incraes the risk of any visceral conditiuons ( except, for example, scolisis in reducing lung capacity, but that is not an autonomic system effect) . there are known automic reflexes connecting the soma and the viscera - pressing the eyeballs, sexual arousal and ejaculation - but these are well charted and not pathophysiological. as anatomist at the new york osteopathic college frank willard says, the sympathetic nervous system is robust, and disrupted only be major physical intervention such as sympathectomy. the british osteopathic profession - the bso at least - abandonded most of its claims to treat most visceral conditions in the 1950s.

Please do not speak for all osteopaths in your supposed rejection of possible diagnostically/therapeutically significant pathophysiological links between viscera and soma. While I agree that it is wrong to claim to treat visceral conditions, to slam the door on an interesting possibility seems particularly narrow-sighted. And when you say "osteopaths do not find palpable changes in specific spinal segments to be asociated with specific organs", I would say that affirmation approaches being plain wrong, although the somatic manifestations tend to be regional rather than single-segment.

You may presume to speak for osteopaths at large David, but in the event you do not speak accurately for yourself. The following is from the osteopathywales website (the A-Z of which I believe was your brainchild - do correct me if I err):

"Osteopaths treat the whole person, not just the condition. Using the principles of Osteopathy, a wide range of conditions can be treated, including:


Lower & upper back pain
Neck pain
Whiplash
Disc injuries
Joint pain
Arthritis
Sports injuries
Tennis Elbow
Headache and migraine
Digestive disorders
Period pain and irregularity
Recurrent infection
Sinusitis
Asthma and chest complaints
Stress, depression, and fatigue
General ill health
Childhood problems."

http://www.osteopathywales.com/index.php?view=items&cid=1%3Aosteopathy&id=4&option=com_quickfaq&Itemid=26 (http://www.osteopathywales.com/index.php?view=items&cid=1%3Aosteopathy&id=4&option=com_quickfaq&Itemid=26)


And the following is from your own professional website:

"We see patients with:


Headaches, jaw pain, sinusitis, migraines, neck pain
Shoulder problems, tennis elbow, carpal tunnel syndrome
Rib joint strains, pains in the mid back
Low back pain, ‘sciatica’, pelvic pain, sacro-iliac joint strain
Hip disorders, knee trouble, foot problems
M.E. (‘chronic fatigue syndrome’), irritable bowel syndrome
Aches and pains in pregnancy, postural problems, osteoarthritis
Sports injuries, repetitive strain injuries, whiplash injuries
Tendonitis, bursitis, nerve compression, ligament tears
Muscle strain, zygapophyseal joint strain and locking, disc problems"

http://www.osteopathdr.com/treatment.html


Don't you think, in view of your expressed views, they should be purged of visceral/systemic references?

[Pebble]

Don't you think, in view of your expressed views, they should be purged of visceral/systemic references?

The problem I think is what level of knowledge is required for treatment. As an example we know that there is considerable influence of the autonomic system on the heart, and that the only reason people get chest pain fron the heart is through linking of the afferent signals from the heart and chest wall.
The interactions are complex - so we know that stress can cause 'heart attacks' and heart failure, usually reversible:

J Cardiovasc Med (Hagerstown). (javascript:AL_get(this,%20'jour',%20'J%20Cardiova sc%20Med%20(Hagerstown).');) 2008 Sep;9(9):916-21.
Transient left ventricular apical ballooning syndrome: a 4-year experience.

Spedicato L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Spedicato%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Zanuttini D (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zanuttini%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Nucifora G (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nucifora%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Sciacca C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Sciacca%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Badano LP (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Badano%20LP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Minen G (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Minen%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Morocutti G (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Morocutti%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Bernardi G (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bernardi%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Fioretti PM (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Fioretti%20PM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract).
Department of Cardiopulmonary Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy. spedicato.leonardo@aoud.sanita.fvg.it
Comment in:
· J Cardiovasc Med (Hagerstown). 2009 Feb;10(2):204-5. (http://www.ncbi.nlm.nih.gov/pubmed/19377386?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVAbstract)
BACKGROUND: Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. METHODS AND RESULTS: From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64+/-12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein IIb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up. CONCLUSION: Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.



We also know that modulation of spinal feedback attenuates ischaemia:



Anesth Analg. (javascript:AL_get(this,%20'jour',%20'Anesth%20Ana lg.');) 2002 Apr;94(4):948-53, table of contents.
Intrathecal lidocaine prevents cardiovascular collapse and neurogenic pulmonary edema in a rat model of acute intracranial hypertension.

Hall SR (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hall%20SR%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Wang L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Wang%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Milne B (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Milne%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Ford S (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ford%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Hong M (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hong%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract).
Department of Pharmacology & Toxicology, Queen's University, Kingston, Ontario, Canada.
Sympathetic hyperactivity during sudden intracranial hypertension leads to cardiovascular instability, myocardial dysfunction, and neurogenic pulmonary edema. Because spinal anesthesia is associated with sympatholysis, we investigated the protective effects of intrathecal lidocaine in a rodent model. Halothane-anesthetized rats were given a 10-microL intrathecal injection of saline (n = 10) or lidocaine 1% (n = 6). A subdural balloon catheter was inflated for 60 s to produce intracranial hypertension. Hemodynamics were monitored, and hearts and lungs were harvested for histological examination. In Saline versus Lidocaine-Treated rats, peak mean arterial blood pressure during balloon inflation was 115 +/- 4 mm Hg versus 78 +/- 8 mm Hg (P < 0.05), mean arterial blood pressure 30 min after balloon deflation was 47 +/- 2 mm Hg versus 67 +/- 3 mm Hg (P < 0.05), and lung weight was 1.54 +/- 0.03 g versus 1.41 +/- 0.04 g (P < 0.05), respectively. Cardiac dysrhythmias and electrocardiographic changes were more frequent in the Saline-Treated group (P < 0.05). Saline-Treated rats had extensive, hemorrhagic pulmonary edema, whereas the Lidocaine-Treated rats had only patchy areas of lung abnormality. Histological changes in the myocardium were rare, and no difference was found between the two groups. We conclude that intrathecal lidocaine prevents cardiovascular collapse and neurogenic pulmonary edema in a rat model of acute intracranial hypertension. IMPLICATIONS:In a rat model of intracranial balloon inflation, intrathecal lidocaine prevented cardiovascular collapse and neurogenic pulmonary edema. Descending neural pathways are involved in the development of cardiopulmonary complications associated with acute intracranial hypertension.
Anesth Analg. (javascript:AL_get(this,%20'jour',%20'Anesth%20Ana lg.');) 2004 Apr;98(4):903-9, table of contents.
Intrathecal morphine reduces infarct size in a rat model of ischemia-reperfusion injury.

Groban L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Groban%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Vernon JC (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Vernon%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Butterworth J (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Butterworth%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract).
Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1009, USA. lgroban@wfubmc.edu
Systemically-administered morphine reduces infarct size in rat models of myocardial ischemia-reperfusion. We sought to determine whether much smaller doses of spinally-administered morphine offer a similar cardioprotective benefit. Barbiturate-anesthetized, open-chested, Wistar rats with chronic indwelling thoracic intrathecal catheters were instrumented for hemodynamic measurements and subjected to 30 min of coronary occlusion and 90 min of reperfusion. Myocardial infarct size was determined using triphenyl-tetrazolium staining. Rats were randomly assigned to receive intrathecal (IT) 0.9% saline (vehicle), IV morphine (0.3 mg/kg) plus IT saline, small-dose IT morphine (0.3 microg/kg), or large-dose IT morphine (3 microg/kg) 20 min before occlusion. IV and both doses of IT morphine reduced infarct size, defined as area of necrosis expressed as a percentage of area at risk (%AN/AAR), as compared with vehicle. The %AN/AAR group means were as follows: IV (n = 7), 30% +/- 6%; IT(small-dose) (n = 9), 30% +/- 5%; IT(large-dose) (n = 9), 18% +/- 4%; and vehicle (n = 10), 47% +/- 5%. There were no significant differences in infarct size among the morphine-pretreated rats. During ischemia-reperfusion, heart rate was unchanged from baseline in the IT(large-dose) group, whereas in the IT(small-dose), IV and vehicle groups, significant declines in heart rate occurred. Changes in arterial blood pressure were similar among groups. These results indicate that IT morphine reduces infarct size in rats, and this benefit is as great as that provided by IV morphine administration. IMPLICATIONS: Our findings suggest that spinally-administered morphine provides a previously unrecognized cardioprotective benefit. In anesthetized rats subjected to ischemia-reperfusion injury, we show that very small doses of intrathecal morphine reduce infarct size in rats, and this benefit is as great as that provided by much larger doses of IV morphine.


But most of this information cannot lead directly to clinical management, although in one area, the reflex induction of mild ischaemia in the heart is being trialled to protect the heart from more substantial insults:

J Card Surg. (javascript:AL_get(this,%20'jour',%20'J%20Card%20S urg.');) 2009 Jun 22. [Epub ahead of print]
Remote Ischemic Conditioning: Evolution of the Concept, Mechanisms, and Clinical Application.

Saxena P (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Saxena%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Newman MA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Newman%20MA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Shehatha JS (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shehatha%20JS%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Redington AN (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Redington%20AN%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Konstantinov IE (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Konstantinov%20IE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract).
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, University of Western Australia, Perth, Australia.
Abstract Remote ischemic conditioning is a novel concept of protection against ischemia-reperfusion injury. Brief controlled episodes of intermittent ischemia of the arm or leg may confer a powerful systemic protection against prolonged ischemia in a distant organ. This conditioning phenomenon is clinically applicable and can be performed before-preconditioning, during-perconditioning, or after-postconditioning prolonged distant organ ischemia. The remote ischemic conditioning may have an immense impact on clinical practice in the near future. (J Card Surg ****;**:**-**).


So I would argue that when it comes to recurrent infections, asthma etc, given that there are proven therapies, one has to get beyond mechanistic insights to actual clinical trial data to justify offering treatment.
I accept that there are individuals that find benefit (mechanism unknown), would a reasonable compromise be where offereing such services it is explicit that this is unproven, and should only be offered in addition to maximal comventional therapy?

[Smith]

So I would argue that when it comes to recurrent infections, asthma etc, given that there are proven therapies, one has to get beyond mechanistic insights to actual clinical trial data to justify offering treatment.
I accept that there are individuals that find benefit (mechanism unknown), would a reasonable compromise be where offereing such services it is explicit that this is unproven, and should only be offered in addition to maximal comventional therapy?

Yes, I think it would.

[Peter]

come on now please say that you understand basic human anatomy better than that.

I think you will find that the lungs are still able to work hence mechanical respiration.

you will find that upper csp lesions are somatosomatic....

If the phrenic is 'injured and can't function' is the point, of course the lungs can be 'mechanically' ventilated!

Here is something of interest, the point about debate is discussing something, putting in points etc. what do you think. If the only validator is finding an article on Pubmed, it's not a discussion is it. Dismantling threads you don't like or banning people who make you uncomfortable kind of shows up how weak your position really is.

The swine flu scam is a classic example of the paranoid world you live in, hard as you try the 4 or 5 people posting on this site or maybe it is only one, will never make a dent on the real world.



World Health Organisation Manufactured Swine Flu Panic (http://www.theoneclickgroup.co.uk/news.php?start=3080&end=3100&view=yes&id=4089#newspost)

The Swine Flu Pandemic which Novye Izvestija has written about many times, may be the most ambitious scam and corruption of our time. The enormous commercial aspect of the “swine flu scare” is already evident. Many scientists who sit on various committees of WHO, carefully concealed the fact that they receive money from the giant pharmaceutical companies of the world. Some of them WHO 'experts' are literally in the service of the vaccine manufacturers.

“It is disturbing that many of the scientists who sit on various committees of WHO, are presented as ‘independent experts’, but they carefully conceal the fact that they receive money from pharmaceutical companies,” Professor of epidemiology, Tom Jefferson, who works at the Cochrane Center in Rome, told reporters.

Dr Jefferson and several of his colleagues believe that paid advisers of the pharmaceutical companies should be removed from their positions and not allowed to give recommendations to the WHO, but the organization itself is in no hurry to carry out such a reform.

(Professor David Salisbury, UK government Vaccines Director), is Chairman of the WHO's Strategic Advisory Group of Experts (SAGE) on Immunisation and directly responsible for deadly H1N1 vaccine marketing worldwide.
Staff Writer, Infowars Ireland



One day you will have an oppotunity to be forgiven.

[Peter]

Dear Peter

what is good about this site is peoples willingness to listen to reasoned debate providing that the debate is not full of logical fallacies.

Why not try to come up with some rational arguments rather than ad hominem attacks...



That statement isn't based on the facts is it, should read 'providing the 'debate' isn't challenging the status quo'. There is no evidence of 'willingness to listen' either, swine flu health scares is an obvious logical fallacy and I don't see a logical, rational debate on that either.

Dismantling threads that seem to wobble this site is a cowardly, weak way of nose thumbing, hardly scientific.

[DrS]

The swine flu scam is a classic example of the paranoid world you live in
We are paranoid? :confused:

We are not the ones who see a global scam borne out of the corruption of obscure business/political interests which is intending forcibly to vaccinate us all with an untested poison for reasons that only "they" know ...

[jimwalsh]

If the phrenic is 'injured and can't function' is the point, of course the lungs can be 'mechanically' ventilated!

Here is something of interest, the point about debate is discussing something, putting in points etc. what do you think. If the only validator is finding an article on Pubmed, it's not a discussion is it. Dismantling threads you don't like or banning people who make you uncomfortable kind of shows up how weak your position really is.

The swine flu scam is a classic example of the paranoid world you live in, hard as you try the 4 or 5 people posting on this site or maybe it is only one, will never make a dent on the real world.


One day you will have an oppotunity to be forgiven.



Forgiven for what exactly???

[Pebble]

That statement isn't based on the facts is it, should read 'providing the 'debate' isn't challenging the status quo'. There is no evidence of 'willingness to listen' either, swine flu health scares is an obvious logical fallacy and I don't see a logical, rational debate on that either.

Dismantling threads that seem to wobble this site is a cowardly, weak way of nose thumbing, hardly scientific.

Before you can reasonably make a claim like this you must try putting a cogent argument backed by evidence. All you have posted to date is your beliefs, backed by statements that someone else appears to agree with you (appeal to authority) or vaguely related incomplete, usually old, research.
You are not being taken seriously, not because of your position, but because of the weakness of your arguments.

[davidrodway]

Originally Posted by Peter http://www.ukskeptics.com/forum/images/buttons/viewpost.gif (http://www.skeptics.org.uk/forum/showthread.php?p=78367#post78367)
"That statement isn't based on the facts is it, should read 'providing the 'debate' isn't challenging the status quo'. There is no evidence of 'willingness to listen' either, swine flu health scares is an obvious logical fallacy and I don't see a logical, rational debate on that either.

Dismantling threads that seem to wobble this site is a cowardly, weak way of nose thumbing, hardly scientific."


What has swine flu got to do with osteopathy?

What threads have wobbled this site?

[davidrodway]

Please do not speak for all osteopaths in your supposed rejection of possible diagnostically/therapeutically significant pathophysiological links between viscera and soma. While I agree that it is wrong to claim to treat visceral conditions, to slam the door on an interesting possibility seems particularly narrow-sighted. And when you say "osteopaths do not find palpable changes in specific spinal segments to be asociated with specific organs", I would say that affirmation approaches being plain wrong, although the somatic manifestations tend to be regional rather than single-segment.

You may presume to speak for osteopaths at large David, but in the event you do not speak accurately for yourself. The following is from the osteopathywales website (the A-Z of which I believe was your brainchild - do correct me if I err):

"Osteopaths treat the whole person, not just the condition. Using the principles of Osteopathy, a wide range of conditions can be treated, including:


Lower & upper back pain
Neck pain
Whiplash
Disc injuries
Joint pain
Arthritis
Sports injuries
Tennis Elbow
Headache and migraine
Digestive disorders
Period pain and irregularity
Recurrent infection
Sinusitis
Asthma and chest complaints
Stress, depression, and fatigue
General ill health
Childhood problems."
http://www.osteopathywales.com/index.php?view=items&cid=1%3Aosteopathy&id=4&option=com_quickfaq&Itemid=26


And the following is from your own professional website:

"We see patients with:


Headaches, jaw pain, sinusitis, migraines, neck pain
Shoulder problems, tennis elbow, carpal tunnel syndrome
Rib joint strains, pains in the mid back
Low back pain, ‘sciatica’, pelvic pain, sacro-iliac joint strain
Hip disorders, knee trouble, foot problems
M.E. (‘chronic fatigue syndrome’), irritable bowel syndrome
Aches and pains in pregnancy, postural problems, osteoarthritis
Sports injuries, repetitive strain injuries, whiplash injuries
Tendonitis, bursitis, nerve compression, ligament tears
Muscle strain, zygapophyseal joint strain and locking, disc problems"
http://www.osteopathdr.com/treatment.html


Don't you think, in view of your expressed views, they should be purged of visceral/systemic references?

Sorry about the overgeneralisation, written in haste. I should have said that in my experience I have not identified palpable changes at specific spinal segments to be associated wityhh particular organs or conditions. Npor, in conversations with other osteopaths over thirty years, have other osteopaths expressed to me that they have noted any such associations. There may be other osteopaths (perhaps with better palpatory skills) who have found such links. Neither am i aware of any published papers that have shown such a link (maybe they have escaped me)

if there are such papers, or personal experiences, I weould be interested to know.

Websites - SWOS - I instigated it but am not the sole contributor and what you quote i did not write

My website - there are other approaches to IBS, sinusitis etc thast do not involve somatico-visceral reflexes.

I am not saying that somatico-visceral reflexes may not occur. But yopu have probasbly seen those ancient charts that purport to show
links from specific spinal segment to individual viscera via the autonomics - "adjust D3/4 for the gall bladder " or whatever. This is not supportable.

I would be pleased if future research indicated therapeutic opportunities for musculo-skeletal manipulations to influemce visceral health, and such findings may well be made. BUt I do not think they yet exist or that we have a foundation that indicates at present that we can do so or how.

[Smith]

Thanks for your clarifications. I'll come back to you on this when time permits.

[Peter]

What has swine flu got to do with osteopathy?

What threads have wobbled this site?

You should know your history David, osteopathy had phenominal success in the 1918 flu pandemic, mortality rate of 0.25% widely reported in the press of the time with MD's calling for more osteopaths.

Telegram boys at the time said all those who got aspirin died by the afternoon and all those who got homeopathy survived, mortality rate at 'orthodox hospitals' was devistatingly bad.

That is probably why the 'system' is so keen to obliterate the osteopaths, homeopaths and anyone else who put them to shame.

[Croydon Bob]

You should know your history David, osteopathy had phenominal success in the 1918 flu pandemic, mortality rate of 0.25% widely reported in the press of the time with MD's calling for more osteopaths.

Telegram boys at the time said all those who got aspirin died by the afternoon and all those who got homeopathy survived, mortality rate at 'orthodox hospitals' was devistatingly bad.

That is probably why the 'system' is so keen to obliterate the osteopaths, homeopaths and anyone else who put them to shame.

Do you care that is all just a lie? Are you deliberately trolling or so stupid that you think something is only a fact as long as it is not supported by evidence?

Since your hilarious google/pubmed comment I suspect that you are just trolling for a laugh, but as with s_k it is starting to become a bit boring. Why not try to stay vaguely within the real world?

[Pebble]

You should know your history David, osteopathy had phenominal success in the 1918 flu pandemic, mortality rate of 0.25% widely reported in the press of the time with MD's calling for more osteopaths.

Telegram boys at the time said all those who got aspirin died by the afternoon and all those who got homeopathy survived, mortality rate at 'orthodox hospitals' was devistatingly bad.

That is probably why the 'system' is so keen to obliterate the osteopaths, homeopaths and anyone else who put them to shame.

As usual you have not included the original data, supporting my belief that you simply present conclusions lifted from elsewhere without checking the facts.

The mortality during the 1918 flu pandemic was 2.5%. The osteopathic claim is found in two presentations, one of which was published on the orders of the president of the American Osteopathic Association (i.e. without peer review).

The same data was presented twice:

G Ridley Ph B.D.O. to the Chicago Session of the A.O.A in July 1919

and R Smith M.D.D.O. Boston to the Annual Conference of the American Association of Clinical Research in New York 1919.

In essence 2445 osteopaths were surveyed, the each claimed to have treated between 110 and 120 patients with flu. Flu was diagnosed based on certain abnormalities of paraspinal muscle tension. The claimed success rate is based on these reports and attributed to diagnosing the condition before it had become a systemic illness.

Even at the time this can be seen to be nonsense, given what has subsequently been discovered about flu virus behaviour, it is simply a work of fiction.

Certainly up to your usual standard of idiocy.

[ewan_husami]

It could be that instead of osteopaths being brilliant at treating flu that medical treatment was mistaken in its use of megadoses of aspirin for it's antipyretic effect. (see below).

Hence perhaps if Osteopaths really scored it was by avoiding drugs (30 grammes of aspirin is quite a lot). Rubbing backs may not have cured anything, but if it has no effect on physiology it can't have done any harm.


Ref and abstract:

Clin Infect Dis. 2009 Nov 1;49(9):1405-10.
Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence.

Starko KM.
karenstarko@gmail.com
The high case-fatality rate--especially among young adults--during the 1918-1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely "wet," sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0-31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33&#37; and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

PMID: 19788357 [PubMed - in process]

[ewan_husami]

David Rodway, I was visiting a relative in hospital with pneumonia 2 years ago. The nurse and the physiotherapist would pat her ribs several times a day to loosen up the phlegm, and she said it really helped. The doctors were recommending it to help clear the lungs. Is this the kind of technique that an osteopath might be able to use?

[ps73]

David Rodway, I was visiting a relative in hospital with pneumonia 2 years ago. The nurse and the physiotherapist would pat her ribs several times a day to loosen up the phlegm, and she said it really helped. The doctors were recommending it to help clear the lungs. Is this the kind of technique that an osteopath might be able to use?

I'm a physio, and have used this.
Physios can specialise a couple of years after graduating. Some (like me) end up in musculoskeletal, others go into Respiratory (like in your example), Neurology (stroke rehab etc - truly amazing work) and many more specialities.

Even though I;ve been fixing bad backs etc for 13 yrs, I can still help people clear chests to speed recovery from chest infections.

Osteopaths are not trained in this, from my understanding.

[DrS]

The doctors were recommending it to help clear the lungs. Is this the kind of technique that an osteopath might be able to use? But it would be needed alongside the antibiotics that clear the infection that often arises from such congestion.

[Pebble]

It could be that instead of osteopaths being brilliant at treating flu that medical treatment was mistaken in its use of megadoses of aspirin for it's antipyretic effect. (see below).




A valid question indeed, and one that was actually asked in the 1920's. Oddly 80 years later, we are no further forward.

Obvious questions like was there an association between the death rate quoted in the states (2.5%) and some other countries (e.g. China/UK/Spain/France 1%) and aspirin usage?

Why was aspirin used in similar doses (up to 7g/d - standard US advice) for 50 further years, for conditions like rheumatic fever and rheumatoid arthritis?

Why was the observation that high dose aspirin usage was associated with pulmonary oedema made with chronic usage rather than acute overdose?

Why was the dose of aspirin reduced because of its nephrotoxic and gastrointestinal consequences if pulmonary consequences were so obvious?

So many possible questions, so little evidence!

[ewan_husami]

But it would be needed alongside the antibiotics that clear the infection that often arises from such congestion.
Is the congestion caused by infection, or is it the other way around (Virchow's 'stagnant pond'), or is there a bit of reciprocation in this? And do the osteopaths interpret pneumonia in the same way?

[ewan_husami]

A valid question indeed, and one that was actually asked in the 1920's. Oddly 80 years later, we are no further forward.
We may not be further forward, but we're certainly not in the same place. Luckily 1918 hasn't been repeated, so something must be different, every possibility should be considered.

The data quoted earlier could point to the less sick people going to osteopaths, or it could be that the osteopaths obeyed the first rule which is to do no harm, or it could be that they did some good. These should be considered as valid hypotheses, alongside selective reporting and bad data as reasons. DavidRodway, do you have a view on this?

[ewan_husami]

Even though I;ve been fixing bad backs etc for 13 yrs, I can still help people clear chests to speed recovery from chest infections.Are there any trial data supporting an actual accelerated recovery?

[Pebble]

The data quoted earlier could point to the less sick people going to osteopaths, or it could be that the osteopaths obeyed the first rule which is to do no harm, or it could be that they did some good. These should be considered as valid hypotheses, alongside selective reporting and bad data as reasons. DavidRodway, do you have a view on this?


The point is the way of considering the possibilities, it is not sufficient to throw up doubts as insoluble conundrums and foster impotence.

It is clear that aspirin in the doses regularly used is not a cause of widspread hyperventillation or acute pulmonary oedema as I have pointed out.

It should be possibly to look at the relative mortality from 1918 flu by country (accepting the huge inaccuracies in estimates) and see if there was an obviousl correlation with local aspirin usage.

We now know alot more about influenza, no one can offer a reasonable mechanistic basis for manipulation of paraspinal muscles on the timecourse of systemic infection, there is no solid clinical trial data to support such benefit and those who work in the field do not support such a contention.

So unless you have other data to bring to bear, the two most likely explanations must be misdiagnosis and poor follow up (as the papers from the time suggest) or masterly inactivity. The masterly inactivity approach fails, so far, to take account of the high death rate among the poor who had very limited access to aspirin, and doubtless couldn't afford osteopaths or any other medical care.

[ewan_husami]

The point is the way of considering the possibilities, it is not sufficient to throw up doubts as insoluble conundrums and foster impotence.
I'm sorry but I have to disagree, this is the starting point for a rational enquiry, and I didn't say 'insoluble'. I am suggesting that the authorities owe it to us to investigate this possibility. It may turn out that we can foster reassurance instead of panic in this current crisis.

It is clear that aspirin in the doses regularly used is not a cause of widspread hyperventillation or acute pulmonary oedema as I have pointed out.Indeed, but the observation was about aspirin as used then, for febrile and respiratory illness, not for arthritis.

It should be possibly to look at the relative mortality from 1918 flu by country (accepting the huge inaccuracies in estimates) and see if there was an obviousl correlation with local aspirin usage.I agree wholehearteldy, but I don't have the knowledge to do this, which is why the authorities should.

We now know alot more about influenza, no one can offer a reasonable mechanistic basis for manipulation of paraspinal muscles on the timecourse of systemic infection, there is no solid clinical trial data to support such benefit and those who work in the field do not support such a contention.Not my argument, I'm just saying this discussion does throw up many other issues to consider to treat the subject fairly. That said, similar practices are still done in hospitals, I've witnessed them, and we've just had an unsupported claim of benefit from a physio.

The masterly inactivity approach fails, so far, to take account of the high death rate among the poor who had very limited access to aspirin, and doubtless couldn't afford osteopaths or any other medical care.Correct me if I'm wrong but other factors do account for morbidity in the poor, besides access to treatment.

[DrS]

Is the congestion caused by infection, or is it the other way around (Virchow's 'stagnant pond'), or is there a bit of reciprocation in this? And do the osteopaths interpret pneumonia in the same way?
There may well be congestion caused by infection, I don't know as I am not a medical doctor, but I know full well that infection follows congestion very often.

[ewan_husami]

There may well be congestion caused by infection, I don't know as I am not a medical doctor, but I know full well that infection follows congestion very often.
So from a purely practical point of view, on a desert island it would be worth applying the techniques of the physio, even if an actual trial of these methods without antibiotics would be too risky. Could it make it worse?

[ewan_husami]

We now know alot more about influenza, no one can offer a reasonable mechanistic basis for manipulation of paraspinal muscles on the timecourse of systemic infection, there is no solid clinical trial data to support such benefit and those who work in the field do not support such a contention.
Just made me think of something - is the movement of the spine at chest level not involved in breathing efficiency? And if efficiency is impaired, can that make it harder to fight a lung infection?

[DrS]

So from a purely practical point of view, on a desert island it would be worth applying the techniques of the physio, even if an actual trial of these methods without antibiotics would be too risky. Could it make it worse?
No, couldn't make it worse. Neither could eating coconuts. The question is whether it could make it better.

It could help when the patient was having difficulty clearing phlegm him/herself. As you have already said, this is widely recognized and nurses do it routinely. Such patients run a higher risk of infection, however, and at that point, no amount of physical manipulation will do the job of antibiotics. There are of course other extremely effective medicines available to loosen serious congestion as well.

[Smith]

Sorry about the overgeneralisation, written in haste. I should have said that in my experience I have not identified palpable changes at specific spinal segments to be associated wityhh particular organs or conditions. Npor, in conversations with other osteopaths over thirty years, have other osteopaths expressed to me that they have noted any such associations. There may be other osteopaths (perhaps with better palpatory skills) who have found such links. Neither am i aware of any published papers that have shown such a link (maybe they have escaped me)

if there are such papers, or personal experiences, I weould be interested to know.

Websites - SWOS - I instigated it but am not the sole contributor and what you quote i did not write

My website - there are other approaches to IBS, sinusitis etc thast do not involve somatico-visceral reflexes.

I am not saying that somatico-visceral reflexes may not occur. But yopu have probasbly seen those ancient charts that purport to show
links from specific spinal segment to individual viscera via the autonomics - "adjust D3/4 for the gall bladder " or whatever. This is not supportable.

I would be pleased if future research indicated therapeutic opportunities for musculo-skeletal manipulations to influemce visceral health, and such findings may well be made. BUt I do not think they yet exist or that we have a foundation that indicates at present that we can do so or how.



With regard to viscerosomatic effects, it seems that the scientific literature contains quite abundant references to visceral referred pain, and rather fewer concerning reflex changes in skeletal muscle tone or other changes that may be papable. However, here is a useful review of referred muscle symptoms, which indicates that "hyperalgesia most frequently involves the muscle layer, where it is often accompanied by a state of sustained contraction ":

Giamberardino M.A. REFERRED MUSCLE PAIN/HYPERALGESIA AND CENTRAL SENSITISATION J Rehabil Med 2003; Suppl. 41: 85–88

As to other osteopaths, in his various books well-known osteopath Leon Chaitow lists various kinds of viscerally-linked palpable somatic tissue changes that have been described, with references.

Yes, the historic osteopathic charts are highly simplistic, based as they were on a simplistic understanding of functional neurology, and certainly do not justify push-button treatment.

In my own experience, there do seem frequently to be palpable tissue changes in spinal areas with sympathetic relations to diseased organs, but how reliable these impressions are and how real the presumed associations are I have to say I do not know. I have always regarded them as an interesting phenomena that I would like to have the time and resources to investigate properly, but alas, like many a worker at the coal face, I can only speculate. But I do not claim to treat visceral problems. You, on the other hand, do claim to treat visceral and systemic conditions: IBS, sinusitis, ME. When you say "there are other approaches" to these conditions, are you referring strictly to osteopathic approaches? If so, I can only think of three broad categories of osteopathic approach: mechanical, reflex, TLC. Perhaps you could elucidate?


In any case my objection was to your distancing yourself in this forum from the treatment of visceral conditions ("the british osteopathic profession - the bso at least - abandoned most of its claims to treat most visceral conditions in the 1950s") while on your website you imply that you do treat them.

[ewan_husami]

Dr S, what about coconut allergy? Not making matters worse is always the first consideration, that's what they teach at first aid.

I did strain my spine once in a fall, and in A and E they insisted on giving me painkillers as the pain was stopping me breathing deeply. They did say that this would make me vulnerable to infection, and it sounded very reasonable at the time, so I took the painkillers. They didn't mention antibiotics.

It sounds like you don't think that efficient chest movement helps prevent or fight infection. But my wife does buteyko and hasn't had a cold in years. What research is there on this?

[DrS]

Dr S, what about coconut allergy? Not making matters worse is always the first consideration, that's what they teach at first aid. Antibiotics can certainly make things worse, they can cause fatal reactions.

I did strain my spine once in a fall, and in A and E they insisted on giving me painkillers as the pain was stopping me breathing deeply. They did say that this would make me vulnerable to infection, and it sounded very reasonable at the time, so I took the painkillers. They didn't mention antibiotics.

It sounds like you don't think that efficient chest movement helps prevent or fight infection. But my wife does buteyko and hasn't had a cold in years. What research is there on this?The coconuts comment was light-hearted, given that you had set the scene on a desert island.

Efficient chest movement, like general good health, helps prevent chest congestion. It does not stop it happening though, and once it has happened, there is a problem when it becomes infected. At that point, efficient chest movement is not enough (at least not always) to clear the infected phlegm, and cannot actually fight the infection. How could it? With what?

No doctor will prescribe antibiotics without first checking allergies to penicillin or the like.

I don't see the point of your reference to antibiotics in your middle paragraph. If there was no present infection, why would they have needed to mention them.

[ewan_husami]

Yes, I took the coconut thing to be light hearted, my response was similarly meant! The rest was on the wider issue of avoiding harm being always relevant.

Thanks for the replies. If you know of any research on breathing mechanics/efficiency and resistance to infection I'd be very grateful.

[Pebble]

I'm sorry but I have to disagree, this is the starting point for a rational enquiry, and I didn't say 'insoluble'. I am suggesting that the authorities owe it to us to investigate this possibility. It may turn out that we can foster reassurance instead of panic in this current crisis..

A new form of skepticism, I have an idea - the government should investigate. If I disagree with their findings I shall say they didn't look properly! The questions are obvious, the least one must do to differentiate oneself from the morass of trolls asking the 'authorities' to investigate absolute nonsense, is get the available data, and see if the argument still holds water.


Indeed, but the observation was about aspirin as used then, for febrile and respiratory illness, not for arthritis..

Rheumatic fever, is indeed a febrile illness.


I agree wholehearteldy, but I don't have the knowledge to do this, which is why the authorities should..

Then why should they take any notice of you? This question has as I say been around for nearly 90 years. The data does not generally support your position, but investigative methods were not particularly robust before the 1950's. No one uses high dose aspirin anymore, so you need to convince people first that this is a worthwhile question to answer, then that the available data is consistent with the hypothesis. As pointed out, this does not immediately appear to be the case.


Correct me if I'm wrong but other factors do account for morbidity in the poor, besides access to treatment

So, what was the socioeconomic status of the populations being reported on and linked to the aspirin conspiracy? How do we explain the apparently low death rate in China, at a time when poverty was widespread etc?

[Peter]

There may well be congestion caused by infection, I don't know as I am not a medical doctor, but I know full well that infection follows congestion very often.

Have you considered that the 'infection' could be caused by the congestion? Seems more logical really, if we totally cut of the circulation we get gangrene in so many hours and the patient didn't 'catch' that.

Has anyone noticed that Pebble's new makeover looks remarkably like the virgin mary with a sacred pendant round the neck.

Well impressed, so much more personal than that stupid cat thang. Really seasonal, I think you really will be forgiven

[Peter]

A new form of skepticism, I have an idea - the government should investigate. If I disagree with their findings I shall say they didn't look properly! The questions are obvious, the least one must do to differentiate oneself from the morass of trolls asking the 'authorities' to investigate absolute nonsense, is get the available data, and see if the argument still holds water.

The data does not generally support your position, but investigative methods were not particularly robust before the 1950's. No one uses high dose aspirin anymore, so you need to convince people first that this is a worthwhile question to answer, then that the available data is consistent with the hypothesis. As pointed out, this does not immediately appear to be the case.


There is a problem here Pebble, what evidence do you have that the 'authorities' hold the key to the truth? Again the 'data' you always seem to speak so highly of is usually made up by the authorities and usually tends to just validate themselves. They change the goalposts continually, for example in the BNF it makes it clear that 'flu vaccines cannot be used to control pandemics' but now apparently they can?

In addition, it is highly unlikely, to any intellegent thinking person; that anything that is critical of authority is likely to be validated by authority, is it really. So that then begs the question 'what is the point of this forum if no one is allowed to point out that the pants are down on say: swine flu, if there isn't any 'validatible evidence' to support that view'.

Seeing as there isn't any validatible evidence to support the vaccine scam as a success either, surely that is enough evidence to show that any pro comment is just anecdotal nonsense!

200,000 doctors in the USA are saying the swine flu vaccine is nonsense, they have a court order to proove it. Would seem like there are a small morass of trolls still trying to fly the flag on pandemic flu mythology and they are the people we need to distance ourselves from.

As for the 'robustness' of investigative methods before the 1950's being doubtfull, Pasteur predated this era by over 60 years so what on earth makes Pasteur any more rigorous when he was widely known to be a popularist, self promoting idea stealer.

[Pebble]

Peter,

Glad you like my new atvar.

As usual you miss the point by miles, irony is the purpose here, do I need to explain?

As to the pandemic, as I have already pointed out to you, to date it does indeed look like this was overcalled, but as I also pointed out - those who 'call it' in advance only have to be wrong the other direction once to lose all credibility, hence the tendency to err on the side of caution.

What precisely does the BNF say about flu pandemics and vaccination? If one is talking about a general comment on the inability of vaccination to prevent a pandemic, this this is obvious, only after a pandemic has been declared can the vaccine be manufactured and distributed as widely as required.

PS the comment about investigative methods, was specifically targeted at the epidemiological data being quoted, not bench science, so Pasteur is still safe from criticism.

[DrS]

I know full well that infection follows congestion very often.Have you considered that the 'infection' could be caused by the congestion?
Um, yes, thought that was what I was saying!

[Graham Lappin]

Has anyone noticed that Pebble's new makeover looks remarkably like the virgin mary with a sacred pendant round the neck.

Well impressed, so much more personal than that stupid cat thang. Really seasonal, I think you really will be forgiven

Peter - I am voting to have you thrown off this forum. You are an insulting moronic idiot not worth even arguing with. And that's my polite version.


....
Telegram boys at the time said all those who got aspirin died by the afternoon and all those who got homeopathy survived...

And I hope I don't get banned by telling you this is total bollocks.

[davidrodway]

while we are waiting to hear the insights of various osteopaths regarding the autonomic nervous system, could i ask about opinion on the "biopsychsocial" model. With its fine tradition of jumping on bandwagons, the osteopatic profession, or some of it, purports that BPS is what osteopathy has always been about. Maybe. Does the BPS model in general offer therapeutic opportunities that the biomedical model it is supposed to supercede does not? Isnt taking the psychological and social aspects of a patients case into account just old fashioned good health care? Apparently the osteopathic colleges nowadays emphasise the psychological and social aspects of health care more - which i can beleive because it fits with the rather wooly approach some osteopaths have ("talking a good treatment) , but does it make treatment more effective and if so how? Is there really anything of substance in the BPS model or is it just sociological jargon, an attempt to put a sophiticated gloss on the basic rub, push, pull, stretch, crack of osteopathy?

[woofighter]

hi

been reading recent posts re flu pandemic and osteopathic treatment. I think I have some info on the treatments used and why used. If I can find it would anyone want it posted?

It might be interesting to see how it stacks up to a (insert group name)of skeptics.

[woofighter]

while we are waiting to hear the insights of various osteopaths regarding the autonomic nervous system, could i ask about opinion on the "biopsychsocial" model. With its fine tradition of jumping on bandwagons, the osteopatic profession, or some of it, purports that BPS is what osteopathy has always been about. Maybe. Does the BPS model in general offer therapeutic opportunities that the biomedical model it is supposed to supercede does not? Isnt taking the psychological and social aspects of a patients case into account just old fashioned good health care? Apparently the osteopathic colleges nowadays emphasise the psychological and social aspects of health care more - which i can beleive because it fits with the rather wooly approach some osteopaths have ("talking a good treatment) , but does it make treatment more effective and if so how? Is there really anything of substance in the BPS model or is it just sociological jargon, an attempt to put a sophiticated gloss on the basic rub, push, pull, stretch, crack of osteopathy?


in my first year of training 15 years ago we were "taught" to think of patients as a "whole" person. not just their presenting condition. This included their job, accomodation, family life, diet, religous beliefs etc.

we also had lecture/s on holism and multi practitioner treatment plans. all well and good if osteopathy were available as part of the health service, but in practice this "holistic" view is a crock and doesn't work.

so it may be taught but I haven't come accross an osteopath (atleast here in Scotland) that has made it work.

although it is sometimes useful to use patients world view ie religous beliefs to explain osteopathy. afterall placebo or good old bed side manner can and does improve treatment effectiveness.

[davidrodway]

hi

been reading recent posts re flu pandemic and osteopathic treatment. I think I have some info on the treatments used and why used. If I can find it would anyone want it posted?

It might be interesting to see how it stacks up to a (insert group name)of skeptics.

yes, it might be of interest. do not know the gropu name for skeptics. for osteopathsi think it is an argument or a dischord of osteopaths/

[Pebble]

A school of skeptics?

[Blue Wode]

President of Kansas City Osteopathic Medical School fired for suggesting implementing combined DO/MD degree:

Pletz had proposed offering students at the Kansas City University of Medicine and Biosciences the opportunity to become a doctor of osteopathy and a medical doctor at the same time.

The Kansas City Star reported that no other osteopathic school has a similar program.

Critics said the combined degree could raise questions about the whole field of osteopathy, which emphasizes holistic care and employed manipulation techniques somewhat similar to those of chiropractic medicine.

http://www.fox2now.com/news/sns-ap-mo--schoolpresident-fired,0,7363344.story

[JJM]

President of Kansas City Osteopathic Medical School fired for suggesting implementing combined DO/MD degree:
Pletz had proposed offering students at the Kansas City University of Medicine and Biosciences the opportunity to become a doctor of osteopathy and a medical doctor at the same time.

The Kansas City Star reported that no other osteopathic school has a similar program.

Critics said the combined degree could raise questions about the whole field of osteopathy, which emphasizes holistic care and employed manipulation techniques somewhat similar to those of chiropractic medicine.

http://www.fox2now.com/news/sns-ap-m...,7363344.story (http://www.fox2now.com/news/sns-ap-mo--schoolpresident-fired,0,7363344.story)This is utter nonsense, on many levels. First, in the USA MDs and DOs are equivalent (unless they get carried into woo). Thus, an MD/DO is a redundant degree. Imagine "Hello, I'm doctor doctor Smith." It sounds like a Monty Python sketch.

Second, the minor difference between MD and DO is that the latter must take a course in manipulation. When they get into it, many resent it as they discover it is a waste of time and few ever practice it after graduation.

Third, every good doctor practices "holistic" medicine, if you care to make an issue of it. This "holistic" appeal is a marketing gimmick to bring students to DO schools, and patients to their offices; it is meaningless.

Part of the problem may be that the senior faculty and trustees are old-enough to still be bitter that the original field was discredited. Also, schools like to retain traditions in order to keep alumni happy and to sell uniqueness to prospective students. I wonder what Pletz was thinking ...

[fredd]

I did a bit of reading on this, a number of historical myths are wrapped up in it. Within weeks of Still dying the medics moved in and started prescribing drugs, short cutting the osteopathic approach. This carried on, like it is happening today and the mix of palliative suppression from both approaches effectively swamped what osteopathy had to offer.

Osteopathy died in Amercia a long time ago, here it is on it's way out as there are no distinct osteoapthic colleges left now, the slide towards assimilation is well under way so it is no wonder non of the modern lot know what they are doing, why they are doing it or what they hope to achieve in the clincal setting. Adopting the reductionist 'rational' was the biggest mistake osteopathy made and it's game open for asassination really, unless that is they start practicing osteopathy again.

I agree, there is no point having two degrees for a big hybrid with the worst of both. Modern medicine is not 'holistic', it is eclectic, each specialist forms part of a team, if you are a lucky patient, there is no overview, no constitutional diagnosis just symptomatic managment. Hybrids are usually sterile anyway.

[Croydon Bob]

I did a bit of reading on this, a number of historical myths are wrapped up in it. Within weeks of Still dying the medics moved in and started prescribing drugs, short cutting the osteopathic approach. This carried on, like it is happening today and the mix of palliative suppression from both approaches effectively swamped what osteopathy had to offer.

Osteopathy died in Amercia a long time ago, here it is on it's way out as there are no distinct osteoapthic colleges left now, the slide towards assimilation is well under way so it is no wonder non of the modern lot know what they are doing, why they are doing it or what they hope to achieve in the clincal setting. Adopting the reductionist 'rational' was the biggest mistake osteopathy made and it's game open for asassination really, unless that is they start practicing osteopathy again.

I agree, there is no point having two degrees for a big hybrid with the worst of both. Modern medicine is not 'holistic', it is eclectic, each specialist forms part of a team, if you are a lucky patient, there is no overview, no constitutional diagnosis just symptomatic managment. Hybrids are usually sterile anyway.

And "wibble wibble hatstand" to you to.

[polomint38]

I did a bit of reading on this, a number of historical myths are wrapped up in it. Within weeks of Still dying the medics moved in and started prescribing drugs, short cutting the osteopathic approach. This carried on, like it is happening today and the mix of palliative suppression from both approaches effectively swamped what osteopathy had to offer.

Osteopathy died in Amercia a long time ago, here it is on it's way out as there are no distinct osteoapthic colleges left now, the slide towards assimilation is well under way so it is no wonder non of the modern lot know what they are doing, why they are doing it or what they hope to achieve in the clincal setting. Adopting the reductionist 'rational' was the biggest mistake osteopathy made and it's game open for asassination really, unless that is they start practicing osteopathy again.

I agree, there is no point having two degrees for a big hybrid with the worst of both. Modern medicine is not 'holistic', it is eclectic, each specialist forms part of a team, if you are a lucky patient, there is no overview, no constitutional diagnosis just symptomatic managment. Hybrids are usually sterile anyway.


And "wibble wibble hatstand" to you to.

http://www.britishblogs.co.uk/images/606406.jpg.

[Pebble]

http://www.britishblogs.co.uk/images/606406.jpg.

;D;D;D;D;D

[davidrodway]

"Originally Posted by fredd http://www.ukskeptics.com/images/buttons/viewpost-right.png (http://www.ukskeptics.com/showthread.php?p=80732#post80732)
I did a bit of reading on this, a number of historical myths are wrapped up in it. Within weeks of Still dying the medics moved in and started prescribing drugs, short cutting the osteopathic approach. This carried on, like it is happening today and the mix of palliative suppression from both approaches effectively swamped what osteopathy had to offer.

Osteopathy died in Amercia a long time ago, here it is on it's way out as there are no distinct osteoapthic colleges left now, the slide towards assimilation is well under way so it is no wonder non of the modern lot know what they are doing, why they are doing it or what they hope to achieve in the clincal setting. Adopting the reductionist 'rational' was the biggest mistake osteopathy made and it's game open for asassination really, unless that is they start practicing osteopathy again.

I agree, there is no point having two degrees for a big hybrid with the worst of both. Modern medicine is not 'holistic', it is eclectic, each specialist forms part of a team, if you are a lucky patient, there is no overview, no constitutional diagnosis just symptomatic managment. Hybrids are usually sterile anyway."

So are you claiming to be an osteopath then? (I hope not). Or are you perhaps one of those tiresome people who take an unhealthy intersest in other health care professions - not belonging to one themselves - and like to tell osteopaths how they are not really osteopaths because they have deviated from the shining path laid down by A T Still. Do you visit an osteopath and inform them that you have a "second degree lesion" or an " sacro-iliac outflare " or whatever twaddle comes into your mind based on your miscomprehension of out of date texts?

[fredd]

;D;D;D;D;D

Brilliant, just put medical scientist in the text and it's there!

[fredd]

"

So are you claiming to be an osteopath then? (I hope not). Or are you perhaps one of those tiresome people who take an unhealthy intersest in other health care professions - not belonging to one themselves - and like to tell osteopaths how they are not really osteopaths because they have deviated from the shining path laid down by A T Still. Do you visit an osteopath and inform them that you have a "second degree lesion" or an " sacro-iliac outflare " or whatever twaddle comes into your mind based on your miscomprehension of out of date texts?

Uh, I had a look at your site and to be honest I don't think you have a clue what you are doing! Whose path do you follow? Judging by the vitriol in your post I seem to have hit on something here, or not as the case may be.

[Pebble]

The man who knows nothing about the nature of disease and its causes has now become the oracle on alternative medicine as well, fredd is there no beginning to your talents?

[davidrodway]

Uh, I had a look at your site and to be honest I don't think you have a clue what you are doing! Whose path do you follow? Judging by the vitriol in your post I seem to have hit on something here, or not as the case may be.

I note that you do not answer my question.
I dread to think what an osteopath website that gets your approval might be like.
"Whose path do you follow?" - what on earth are you on about

[Croydon Bob]

Brilliant, just put medical scientist in the text and it's there!

WOOOSH!

And, once again, the idiot doesn't understand. ;D

[fredd]

WOOOSH!

And, once again, the idiot doesn't understand. ;D

And woosh the puff on wind belches forth from he/she into the void. Happy new year Bob, better luck next time.

[fredd]

So are you claiming to be an osteopath then? (I hope not). Or are you perhaps one of those tiresome people who take an unhealthy intersest in other health care professions - not belonging to one themselves - and like to tell osteopaths how they are not really osteopaths because they have deviated from the shining path laid down by A T Still. Do you visit an osteopath and inform them that you have a "second degree lesion" or an " sacro-iliac outflare " or whatever twaddle comes into your mind based on your miscomprehension of out of date texts?



I hope you are not claiming to be an osteopath? Happy new year.

[Croydon Bob]

And woosh the puff on wind belches forth from he/she into the void. Happy new year Bob, better luck next time.

;D Wibble wibble hatstand to you too loony boy.

[DrS]

I hope you are not claiming to be an osteopath? Happy new year.
You are now just disrupting and insulting. Not even an attempt to look like you are posting anything that contributes anything. Not even the semblance of a dialogue.

I call you troll, and I call for you to be banned for it.

[davidrodway]

I hope you are not claiming to be an osteopath? Happy new year.

If you had read my website, as you say, then you know that i am an osteopath. Check on the GOsC website if you wish.

Oh, and i thought of an osteopath website i think you might approve of - the BIO website mentioned at the very start of this thread - you sound like the sort of person who thinks that blood cells and bacteria can turn into each other.

[davidrodway]

Osteopath in Forres suspended for a year

Tribunal told woman wrongly diagnosed

Published: 18/12/2009


A MORAY osteopath who left a woman fearing death when he wrongly diagnosed hepatitis C has been suspended for a year.
The General Osteopathic Council made the move after practitioner Goran Stal branded a tribunal into the case as “deeply unfair, unjust and completely unacceptable”.
The organisation’s chairwoman Vicki Harris said the suspension would give him time to demonstrate his willingness to remedy his problems.
Last night Stal, of Beeches Cottage, Iowa Place, Forres, said he was “very sad and extremely disappointed” with the GOC’s decision and vowed to continue working.
At the tribunal, 48-year-old Stal admitted making a definitive diagnosis of hepatitis C which was not supported by valid tests, communicating that diagnosis to the 35-year-old patient without valid tests, and not referring her for further testing.
virus

He denied failing to provide her with accurate information relating to hepatitis C, telling her she would need to take medication for three to four months, failing to explain what the disease was, advising her not to tell her GP and telling her there would not be a blood test to detect it.
All the charges were found proven except that of failing to provide accurate information about the virus.
The council initially found his fitness to practice impaired and imposed a five-week suspension.
It left open the possibility of Stal returning to work subject to conditions of practice, but in a letter dated December 4, he asked to have his name removed from the medical register. He also attacked the tribunal decision, calling it “deeply unfair, unjust and completely unacceptable”.
The council’s Dr Harris said the tone of the letter “indicated a disregard for the regulatory system and the protection of patients” and “a serious and troubling lack of insight into the panel's findings.”
She said that while the council had refused to accept his resignation, a conditions of practice order was no longer appropriate.
Dr Harris said Stal, who did not attend a review hearing this week, needed to demonstrate his willingness to remedy his problems over a year-long period of suspension.
Last night Stal said he felt “very sad and extremely disappointed” with the council.
He said he had decided not to attend the hearing because it was based on “assumptions, conclusions and verdicts” from the first hearing, which he considered flawed.
“I could only see more unfairness coming my way, rather than them admitting to any of their errors and shortcomings. I therefore decided to stay at home,” he said.
“Resigning from the GOC means that I am no longer able to use the title osteopath, or to describe my work as osteopathy.
“However, the practice will be open as usual, and I will continue to contribute to the health and wellbeing of my patients to the best of my ability, using everything I have learned over the past 23 years.”


Read more: http://www.pressandjournal.co.uk/Article.aspx/1530910?UserKey=#ixzz0bB0Z4wL0 (http://www.pressandjournal.co.uk/Article.aspx/1530910?UserKey=#ixzz0bB0Z4wL0)

[Pebble]

Nice to see the GOC has some teeth when it counts.

Why was the initial suspension only for 5 weeks?

What will Stal advertise himself as now?

Is he deluded in thinking that he can carry on as before just without the GOC's stamp of approval?

[davidrodway]

Nice to see the GOC has some teeth when it counts.

Why was the initial suspension only for 5 weeks?

What will Stal advertise himself as now?

Is he deluded in thinking that he can carry on as before just without the GOC's stamp of approval?

dont know why only 5 weeks.

he cant carry on callin himself an osteopath - or will get taken to court and fined thosands - but he can carry on as anything else he likes - osteomyologist, bogglethersapist or whatever. only disadvantage to him really is that he will now have to pay VAT and looses the kudos (?) of calling himself an osteopath.

so - yes, he can more or less carry on as before.

why, you might ask, do the other 3000 or so osteopaths maintain their registration with the gosc - paying 700 pounds a year, keepinhg themselves under the gaze of the gosc - is it just to save paying the VAT, or is it so they can use the magic term Osteopath - I think mostly the latter, although strangely a lot of the "magic " has worn off since the advent of the GOsC.

[Blue Wode]

Word seems to be getting out...


Today’s quackery: osteopathic manipulative medicine (http://www.aarontraffas.com/2009/todays-quackery-osteopathic-manipulative-medicine/)

Unfortunately, osteopathy has a context outside of American osteopathic medicine (http://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_United_States). Osteopathy in the rest of the world has parked itself squarely in the purview of complementary and alternative medicine (http://en.wikipedia.org/wiki/Alternative_medicine) (CAMP). This D in the DO can stand for diploma, not doctor, and the practitioners are more skilled in bamboozling their clients than they are at practicing any kind of real medicine.

Here’s the thing. Real medicine is based on science. If something is “complementary” or “alternative” to science, it’s not medicine – it’s crap (http://crapbasedmedicine.wordpress.com/). If something makes you feel better that shouldn’t, like chiropractic or acupuncture or homeopathy or osteopathic manipulative medicine, it’s called a placebo and it’s unethical to present it as a legitimate treatment for anything.

[davidrodway]

Word seems to be getting out...

Wherews that from may i ask?

Some disinformation - I have a DO, (Dip OSt) but that was from 30 years agop, and nowadys they get BSc OSt or BOSt and MScOst. I still did 4 years full time plus clini tho.

Donr know about osteopathy putting itself in the CAM camp - the mediaid that to us - i think we are no more CAM than dentistry.

"If you feel better its "just" placebo" - well maybe, sometimes. Thats what we are trying to findout.

Of those pateients who recover, its probably true that some would have got better anyway (As quickly?), some get better because of placebo (Are some placebos more effective than others) (not only feel beeter bcause of it but actually get better because of it), some improve becauseof manual ttt, and posibly any reasonablt skilled manual tt would do, and some probably get better because of the specific osteopathic intervention. Thats my peronal view. Of course, we do not know what proportion is in each gropu. We should find out.

As to the "if it works its medicine, if it doesnt its CAM", this is largely a solipsism, but I dont have a problem with it. I would say - if you want to say that if osteopathy works its part of medicine, not CAM, that is more than fine by me - it doesnt mean that medics are osteopaths or vice versa of course.

[grammarking]

(Are some placebos more effective than others?)

Absolutely, there's lots of research on that. Certain coloured pills work better than others, certain shapes work better. There's even placebo surgery which apparently can be combined with placebo pills to enhance the effect. Not to mention, of course, than some people will be affected more by placebo than others.

[JJM]

... Donr know about osteopathy putting itself in the CAM camp - the mediaid that to us - i think we are no more CAM than dentistry. ...Of course; but you also advertise cures for visceral illnesses- so you don't understand. That, plus the fact that the only claim for successful treatment for which there is reliable evidence pertains to low back pain puts you squarely in the CAM industry. Maybe you should post this somewhere so you can memorize it "CAM refers to treatments that are either not known to be safe and effective, or in fact have been shown to be ineffective."

[Pebble]

The question is why there is not more skepticism directed at dentists? Certainly their treatments of gum disease is not evidence based, and does empty alot of pockets. Most of the really fruity stuff they do is cosmetic, so I suppose like car sales and fashion, skeptics simply regard that as not really serious.

However, when it comes to dealing with tooth abscesses, fillings for tooth decay, management of dentures, it would be difficult to argue that they are not on solid ground, even it RCTs are not their forte, given the observational track record that is available to demonstrate the efficacy and relative safety of their chosen treatments for these conditions.

[Smith]

...given the observational track record that is available to demonstrate the efficacy and relative safety of their chosen treatments for these conditions.

Could you clarify - what do you mean by "observational" evidence here?

[Pebble]

Could you clarify - what do you mean by "observational" evidence here?

It would be a challange to go through the old papers to tease out the evidence base for therapies handed down from the 40's and 50's in particular demonstrating that changes in socioeconomic conditions were not responsible for the improvements in dental health. Nevertheless there are some reviews of the data then available added to more recent data from deprived populations - showing at the very least an association between oral care and improved oucome.



J Am Dent Assoc. 1982 Jul;105(1):75-9.
Changes in the prevalence of dental disease. Bureau of Economic and Behavioral Research, Council on Dental Health and Health Planning.
Liss J, Evenson P, Loewy S, Ayer WA.
The literature currently available indicate that there have been substantial improvements in at least four areas of dental diseases: dental caries, root surface caries, edentulousness, and periodontal disease. Oral cancer appears to have remained stable. The literature on craniofacial anomalies, malocclusions, and traumatic injuries is such that similar statements cannot be made. Although decreases have been observed in caries, root surface caries, edentulousness, and periodontal disease, the improvements have occurred largely within the white population. Caries, for example, has been significantly reduced because of water fluoridation, fluoride dentifrices, and perhaps some changes in dietary patterns. Nevertheless, the disease continues to increase with age, although the cumulative effect of fluorides lowers the overall magnitude. The sheer numbers will still be substantial. For a variety of reasons, dental disease still remains substantially high in the nonwhite population, and will require concerted intervention if it is to be reduced.

Aust Dent J. 1992 Apr;37(2):126-32.
Dental treatment and dental health. Part 1. A review of studies in support of a philosophy of Minimum Intervention Dentistry.
Dawson AS, Makinson OF.
Department of Dentistry, University of Adelaide, South Australia.
An international movement emerged in 1986-1987 which heralded a major change in the role of conservative dentistry. This shift was away from the traditional operative dentistry, with its relatively frequent replacement of restorations, to a concept of 'Minimum Intervention Dentistry', which advocates the use of adhesive dental materials, remineralization techniques and monitoring of initial carious lesions. The move away from some of Black's concepts started as investigations examined the dental health of patients in the National Health Service of Great Britain. These investigations, and the report of the Committee of Enquiry into Unnecessary Dental Treatment, have resulted in an extensive re-education programme being initiated by the British Department of Health and Social Security in conjunction with the British Dental Association. This paper, and a subsequent one, were written to enable widespread dissemination of these ideologies to Australian practitioners. While they may appear provocative to some, these papers were merely meant to stimulate discussion on the implications of this research for dentistry in this country. In this paper the results from the British investigations are presented, as is a discussion of some of the outcomes of this and other related research.


Adv Dent Res. 1993 Jul;7(1):19-24.
Changing trends in dental caries experience in Great Britain.
Downer MC.
Department of Dental Health Policy, Institute of Dental Surgery Eastman Dental Hospital London, United Kingdom.
Periodic national surveys of dental health since 1968, and a coordinated program of local surveys of children since 1985, have provided a comprehensive picture of trends in dental caries experience in Great Britain over the course of two decades. This review of some of the findings examines changes in adult caries experience, together with the related phenomenon of total tooth loss; presents evidence of a cohort effect in the decline in caries among children and young adults; and considers likely future trends and their implications for the dental services. Conclusions drawn were: (1) Although the proportion of the population with no natural teeth is declining rapidly among young adults, levels of edentulousness among older age groups will remain high for some time to come; (2) in England and Wales, a modest decline in caries experience of young adults between 1968 and 1978 accelerated between 1978 and 1988 [The greatest change in annual rate of reduction over two decades was in 16-24-year-olds, and in absolute terms, mean DMFT in this age group decreased from 15.7 to 10.4 during the period.]; (3) a cohort effect is discernible in the changing pattern [Thus, caries has apparently stabilized in young children, whereas in adolescents and young adults the rate of decline has increased.]; and (4) smaller improvements in dental health have occurred in Scotland than in England and Wales.


J Clin Pediatr Dent. 2009 Spring;33(3):259-64.
The influence of an oral health education program provided in a community dental clinic on the prevalence of caries among 12-14 year-old children.
Moskovitz M, Abud W, Ram D.
Department of Pediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. motimo@ekmd.huji.ac.il
OBJECTIVES: To evaluate the effectiveness of an oral health education program when given in a public dental clinic, by assessing caries and restorations. METHODS: This was done by assessing changes in caries prevalence in the mouth of children aged 12 to 14 year- old. Data was obtained from files of patients treated in the Dental Volunteers for Israel (DVI) clinic in Jerusalem. Children must prove understanding and also application of what they learned in the educational program in order to receive restorative dental treatment. RESULTS: 280 children were included in the intervention group. The control group constituted 173 children who had never had any restorative treatment in the DVI clinic. The extent of caries surfaces differed greatly between the intervention and the control groups. 35.2% of the control group, and as many as 64% of the intervention group had low caries (DMFS < 3). The situation is reversed when comparing the difference in the restored teeth surfaces between the two groups--56.6% of the control group had no restorations and 66.2% of the children in the intervention group had treated teeth. DMFS scores reveal fewer differences between the two groups. The mean carious surface was 1.8 times greater in the control group, and the restored surfaces were 2.1 times greater for the intervention children. Nevertheless when comparing DMFS means between control and intervention groups t-test result shows no statistical significant difference for the slightly lower DMFS levels in the intervention group. CONCLUSIONS: This study shows that even a comprehensive preventive program given by professional personnel, followed by free dental treatment, is not enough to improve dental health status for children from a lower socioeconomic class. Still, a consideration of the ethical responsibility of the profession to educate children about oral diseases and their prevention should be carried out, irrespective of the implementation of the knowledge.


Caries Res. 2009;43(4):286-93. Epub 2009 May 8.
Prevalence and incidence of caries lesions in relation to placement and replacement of fillings: a longitudinal observational radiographic study of an adult Danish population.
Kirkevang LL, Vaeth M, Wenzel A.
Department of Dental Pathology, Operative Dentistry and Endodontics, Faculty of Health Sciences, Arhus University, Arhus, Denmark. llkirkevang@odont.au.dk
The aim was to describe the prevalence and incidence of caries lesions in relation to the placement and replacement of amalgam and non-metal fillings in a randomly selected adult Danish population. In 1997 and in 2003, 470 individuals underwent a full-mouth radiographic survey. All recordings were based on radiographs. A total of 12,361 teeth were examined. Registrations were performed on surfaces: mesial, distal and occlusal or incisal. In 1997 the total number of teeth and the number of unfilled teeth per individual decreased with the age of the individual, whereas the number of caries lesions per individual did not vary systematically with age. In each age group approximately 50% of the individuals had no caries lesions. In 1997 approximately 70% of the filled surfaces were filled with amalgam and 30% with non-metal filling materials. In 2003 60% of the surfaces were amalgam-filled and 40% were non-metal-filled. Overall non-metal filling material was more frequently used than amalgam in both treatments and re-treatments. During the observation period approximately 20% of both amalgam and non-metal-filled surfaces were re-treated. For amalgam fillings this was constant across the tooth groups, but for non-metal fillings the percentage of re-treated surfaces was larger for molars. The percentage of teeth with caries increased from front teeth to posterior teeth. The lowest percentage of surfaces with caries was detected in unfilled surfaces, and the highest in non-metal-filled surfaces. The results from the present study suggest the need for reflection and diligence when using non-metal materials for dental fillings especially in relation to molars. (c) 2009 S. Karger AG, Basel.

J Public Health Dent. 2009 Spring;69(2):125-34.
Changing inequalities in the distribution of caries associated with improving child oral health in Australia.
Armfield JM, Spencer AJ, Slade GD.
Australian Research Centre for Population Oral Health, Adelaide, South Australia, Australia. jason.armfield@adelaide.edu.au
OBJECTIVES: This study aimed to document the changing distribution of and inequalities in dental caries in Australian children across the 25-year period from 1977 to 2002. METHODS: Oral health data were obtained from Australia's national Child Dental Health Survey Measures of caries distribution included the Significant Caries Index and the proportions of children with high caries experience [decayed, missing and filled teeth (DMFT) > or =4], while inequality was assessed by using Gini coefficients calculated from Lorenz curves. Changes in caries distribution were compared with changes in child dmft/DMFT. RESULTS: While appreciable reductions occurred in child caries experience, in terms of both mean dmft/DMFT and for those children with the poorest oral health, inequalities in the distribution of caries experience increased across the 25-year period. Inequalities in the distribution of decayed and filled teeth differed for the deciduous and permanent dentition and, in the permanent dentition, became increasingly similar in the 1990s. CONCLUSIONS: Increasing inequalities in child dental caries in Australia must be interpreted in the context of declines in both mean caries experience and in the caries experience of those children with the poorest oral health. The Gini coefficient documents that the majority of the caries experience is increasingly being confined to a smaller percentage of the child population; however, this is a consequence of population-wide child oral health improvements.

Nig Q J Hosp Med. 2008 Jul-Sep;18(3):128-32.
Indications for extraction of permanent teeth in a Nigerian teaching hospital: a 16-year follow-up study.
Adeyemo WL, Oderinu HO, Oluseye SB, Taiwo OA, Akinwande JA.
Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Nigeria.
AIM: The aim of the present study was to investigate reasons for permanent tooth extraction at the Lagos University Teaching Hospital, Lagos, and compare this with a study done 16 years previously in the same institution, with a view to evaluating trends in reasons for tooth extractions in the studied environment. METHODS: A retrospective review of patients who had nonsurgical extraction of their teeth at the Lagos University Teaching Hospital, Nigeria between January and December, 2006 was carried out. The following data were retrieved: Age and sex of patients, reason for the extraction and types of tooth removed. The data obtained was compared with similar study done 16 years previously in the same institution. RESULTS: Caries and its sequelae and periodontal diseases were the main reasons for tooth extraction in both study periods. Caries and its sequelae as a reason for dental extraction in the second period increased by a factor of 1.2 in comparison with the first period, whereas periodontal disease as a reason extraction in the second period decreased by a factor of 2.7. In addition, orthodontic reasons and tooth impaction as a reason for dental extraction increased by a factor of 4 and 1.3 in the second period respectively. In both study periods, most extractions were carried out in patients within age group 11-40 years (1990, 77%; 2006, 62.3%). Teeth most frequently extracted were posterior teeth (1990, 89.2%; 2006, 89.4%). CONCLUSIONS: Dental caries and its sequelae, and periodontal disease despite being preventable diseases, still remain the two most common reasons for dental extraction in our environment. Therefore, efforts must be made to improve the dental health awareness and status of Nigerian populace to reduce the morbidity associated with the two preventable causes of tooth loss.

[davidrodway]

It would be a challange to go through the old papers to tease out the evidence base for therapies handed down from the 40's and 50's in particular demonstrating that changes in socioeconomic conditions were not responsible for the improvements in dental health. Nevertheless there are some reviews of the data then available added to more recent data from deprived populations - showing at the very least an association between oral care and improved oucome.
.

Observational data - well this a new aspect, certainly getting away from the sole emphasis on RCT. Unfortunately, the osteopathic profession has never kept this sort of observational data, and, even if it had, given the very small number of trained osteopaths (350 in UK until 1980), would be meaningless. (I stand to be corrected). Dentists have the advantage that only they treat teeth. MInd you - are some aspects of dentistry "WOO" ?- non- mercury fillings, equilibration, cranio-mandibular syndrome? And if some of what a profession does, or what some of its members do, is Woo, is it all Woo?

[choo]

Pebble;81200
J Am Dent Assoc. 1982 Jul;105(1):75-9.
Changes in the prevalence of dental disease. Bureau of Economic and Behavioral Research, Council on Dental Health and Health Planning.
Liss J, Evenson P, Loewy S, Ayer WA.
Caries, for example, has been significantly reduced because of water fluoridation, fluoride dentifrices, and perhaps some changes in dietary patterns. Nevertheless, the disease continues to increase with age, although the cumulative effect of fluorides lowers the overall magnitude. The sheer numbers will still be substantial. For a variety of reasons, dental disease still remains substantially high in the nonwhite population, and will require concerted intervention if it is to be reduced.



There is a piece of mumbo jumbo here, where are the before and after studies that show the link between flouridation of water and reduction in caries? The whole country does not have flouridated water so how does this add up. Also I assume non white people drink the water too, in fact they are more likely to drink tap water instead of some non flouridated bottled designer stuff according to some.

So when is fluouride in tap water supposed to work, or is that another modern myth?

[choo]

Observational data - well this a new aspect, certainly getting away from the sole emphasis on RCT. Unfortunately, the osteopathic profession has never kept this sort of observational data, and, even if it had, given the very small number of trained osteopaths (350 in UK until 1980), would be meaningless. (I stand to be corrected). Dentists have the advantage that only they treat teeth. MInd you - are some aspects of dentistry "WOO" ?- non- mercury fillings, equilibration, cranio-mandibular syndrome? And if some of what a profession does, or what some of its members do, is Woo, is it all Woo?

The osteopathic profession certainly has kept this kind of data it's just that you have never bothered to read it. Austria, Canada, Denmark, Germany, and Sweden have banned mercury fillings so you not informed about that either. Do you just write anything after the pub or is this your usual standard?

[Pebble]

There is a piece of mumbo jumbo here, where are the before and after studies that show the link between flouridation of water and reduction in caries? The whole country does not have flouridated water so how does this add up. Also I assume non white people drink the water too, in fact they are more likely to drink tap water instead of some non flouridated bottled designer stuff according to some.

So when is fluouride in tap water supposed to work, or is that another modern myth?

There have been plenty, but having seen your unnecessary rudeness in the following post, I will simply observe your failure to read the scientific literature before posting nonsense lifted from poor quality internet opinion pieces.

[davidrodway]

The osteopathic profession certainly has kept this kind of data it's just that you have never bothered to read it. Austria, Canada, Denmark, Germany, and Sweden have banned mercury fillings so you not informed about that either. Do you just write anything after the pub or is this your usual standard?

Back from the pub by 9.30 pm ? I dont think so - whatever else people may accuse me of, leaving the pub before stop-tap is not one of them. You, however, seem to have just got bacj from your - unsuccessful l- anger management course.

"The osteopathic profession certainly has kept this kind of data". Dont think so. Im fairly widely read and I would be very surprised if you could point me to anything on the web or in any journals over thge last 50 years. Of course individual osteopaths have kept patient case notes but thats not the same, and there are no studies that show the effect of osteopathic ttt on LBP or anything else in society as a whole over a period of years.

mercury fillings? Personally I have white fillings, my dentist does not use mercury. My point was that some people may consider this Woo (not me, altho I colud be persuaded), but does that mean all of dentistry is woo (i Do not think it does). Some countries have banned mercury. Some havent. Is mercury unsafe in some countries but not others, then? Hardly think so. It means the issue is worth looking at debateing and coming to a sound judgement on (not just a knee jerk reaction).

[davidrodway]

What is/ are the views of well informed skeptiics out there , of whatever background, on pelvic girdle pain and/ or the sacro-iliac joints?

[Blue Wode]

Baroness Thornton in the House of Lords on 7th January 2010:

At present there is no statutory regulatory system in the United Kingdom to govern the practice of complementary and alternative medicine, with the exception of chiropractitioners and osteopaths who are regulated by statute.
http://www.publications.parliament.uk/pa/ld/ldtoday/03.htm


So, at government level, osteopathy appears to be considered a CAM.

This is also interesting:

I took my 5 week old DD [dear daughter] to a cranial osteopath yesterday as she has been suffering from Colic and Reflux and spends much of the day screaming. The thing is that last night and this morning she has been worse, almost completely inconsolable.
http://www.mumsnet.com/Talk/behaviour_development/887896-Visited-a-Cranial-Osteopath-but-is-now-getting-worse

Is there any scientific evidence to support the popular assumption (click on link) that osteopathic treatment causes colic “to get worse before it gets better”?

[Pebble]

What is/ are the views of well informed skeptiics out there , of whatever background, on pelvic girdle pain and/ or the sacro-iliac joints?


Complex subject and beyond my expertise, this seems like a good source of information:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518998/?tool=pubmed

[Blue Wode]

I took my 5 week old DD [dear daughter] to a cranial osteopath yesterday as she has been suffering from Colic and Reflux and spends much of the day screaming. The thing is that last night and this morning she has been worse, almost completely inconsolable.
http://www.mumsnet.com/Talk/behaviour_development/887896-Visited-a-Cranial-Osteopath-but-is-now-getting-worse

Is there any scientific evidence to support the popular assumption (click on link) that osteopathic treatment causes colic “to get worse before it gets better”?
Bump. ::)

[Croydon Bob]

I wouldn't dream of judging all osteopaths because of one bad egg. But I thought that this was interesting: http://news.bbc.co.uk/1/hi/england/merseyside/8453020.stm

[JJM]

I wouldn't dream of judging all osteopaths because of one bad egg. But I thought that this was interesting: http://news.bbc.co.uk/1/hi/england/merseyside/8453020.stmOf course, that person is not the problem with osteopathy. The problem is their belief that they can treat non-musculoskeletal illnesses. More specifically, charging people for bogus treatments.

[davidrodway]

I wouldn't dream of judging all osteopaths because of one bad egg. But I thought that this was interesting: http://news.bbc.co.uk/1/hi/england/merseyside/8453020.stm

im afraid he was a registered osteopath. checked the gosc website and it says -

Mr Russell Oakes (http://www.ukskeptics.com/./Russell_Oakes/2471/369/)
(Suspended)

SUSPENDED
Suspended next to an osteopath’s name indicates that they are currently suspended (http://www.ukskeptics.com/#) and not allowed to practise as an osteopath. Clicking the practitioner’s name will reveal more details

[davidrodway]

Are osteopaths skeptics who practice WOO?

I quote below from 3 osteopaths (none of whom is me)

Stoddard, Manual of Osteopathic Practice 1969;

...'The Osteopathic Blue Book, which was compiled in Britain by the Register of
Osteopaths in 1956, states that 'Osteopathy is a system of Therapeutics which
lays chief emphasis upon the diagnosis and treatment of structural and mechanical
derangements of the body. There is no claim to treat general disorders and
diseases of the body and the scope of osteopathy is vastly reduced'. By limiting
themselves to this sphere of action, osteopaths have become more acceptable to
the medical profession and in this lesser sphere there methods are already
accepted even though much of the theory is still debatable'...


...'Osteopathy is the disputed, indefinable practice by1st rate eccentrics, of primary
care, drugless, medicine, with a conscientious refinement in the empathic and
intelligent use, of hands and voice alone, for love and not much
profit'...( Steeper 2009)



...' Osteopathy is a green, low-tech, cost-effective and environmentally sound
form of 'quackery' for middle-class people, who can afford prolonged
explorations into the causes of their emotional unhappiness, using various
phyiscal techniques whose clinical theory of use, doesn't provide a satisfactory
explanatory model for its apparent success'...

[jimwalsh]

To my suprise and displeasure I saw in this months osteopath magazine (the BOA trade mag) an advert for "ethical" practice building from chiropractors aimed at osteopaths.

Hosted by none other than Carl Irwin...

I wonder if he is going to give tips on how to write advertising copy (http://www.asa.org.uk/Complaints-and-ASA-action/Adjudications/2009/5/Dr-Carl-Irwin-and-Associates/TF_ADJ_46281.aspx)

some of these fellas must be feeling the pinch if they are targeting the osteopaths for work...

http://www.xcelseminars.co.uk/default.html

a 100% satisfaction guarantee never fails to get my skeptical hackles rising...

[Blue Wode]

It appears that osteopaths are having the same trouble as chiropractors when confronted with the ongoing need to define their scope of practice with a constantly weakening evidence base:



Osteopathic Practice Framework consultation findings published
29 January 2010

The consultation on the Osteopathic Practice Framework was held between March and July last year. The consultation comprised:


a consultation pack mailed to all osteopaths, which was also distributed to a wide range of stakeholders including patient groups;
six regional events at which there was an opportunity for osteopaths to discuss the practice framework; and
a questionnaire.
The questionnaires and notes and recordings from the consultation meetings were analysed by an external consultant and a report on the feedback received has now been published.

Key findings

The main findings of the consultation indicated that:

62% of respondents agreed that there is a need to define the scope of practice
65% agreed that the overall approach proposed in setting out a scope of practice seemed to be sensible
48% agreed with the categorisation suggested
49% agreed that the types of practice included in each category accurately reflected current practice.

However, the percentages cited above should be treated with great caution as some respondents indicated a supportive and/or positive response by ticking the "yes‟ box(es) but then gave a very critical or negative response in their free text. Others indicated in their free text response that they had ticked yes or no to the question they thought they should have been asked rather than the one actually asked.

A summary of the further feedback received can be found at the end of this item.

Themes and conclusions

The general consensus is that defining a scope of practice may highlight what is special and unique about osteopathy. It could also have the potential to increase understanding amongst public, patients, and other healthcare professionals of what osteopathy and osteopathic practices have to offer.

However, defining a scope of practice might not be feasible and could have negative consequences. We have also noted the antipathy to the three categories proposed and the request for a further consultation.

Other work on scope of practice

The GOsC is not the only stakeholder with an interest in defining a scope of practice. The British Osteopathic Association (BOA), in conjunction with a range of specialist osteopathic training bodies, is developing an alternative scope of practice.

A working group has been established by the Forum for Osteopathic Regulation in Europe and the European Federation of Osteopaths to develop a European scope of practice.

The World Health Organization (WHO) will also soon be publishing the WHO Guidelines on basic training and safety in osteopathy, which includes descriptions of the different types of osteopathic practice around the world, including definitions of "Osteopathy and osteopathic medicine‟, "Osteopath‟, "Osteopathic physician‟ and "Osteopathic manipulative treatment". The GOsC will continue to monitor this work and participate where necessary.

Next steps include:
 Undertaking research into patterns of osteopathic practice;
 Researching the undergraduate curriculum, with consideration given to whether a core curriculum should be developed. This will feed into work on the scope of practice;
 Monitoring work undertaken by other regulators, UK osteopathic organisations and osteopathic organisations in Europe and the rest of the world. This work may inform and direct the work of the GOsC in this area;
 Engaging with patients and the public to inform work on the scope of practice;
 Agreeing the purpose and effect of any GOsC work on the scope of practice in light of the steps above.

Further feedback

General feedback provided by osteopaths‟ responses highlighted some important issues, which are likely to have an impact on the implementation of revalidation. These included:

Advantages to defining a scope of practice:

"It would bring clarity to patients about how and what conditions we treat and what type of person or condition would respond to our treatment; many people are still confused as to the difference between physiotherapy, osteopathy and chiropractic, and can't decide who treats what better."

"If we are to be seen as professional then we cannot exist without a clear statement of who we are or what we do. Not just for marketing but for public confidence and safety."

Disadvantages to defining a scope of practice:

"A 'scope of practice' limits the possibilities of what osteopathy can offer. This reductionist approach can not represent a holistic medicine. Osteopathy is a philosophy, not a list of techniques."

"Possible pressure on persons who don't meet with the norm - perhaps with legal ramifications which limit the scope of osteopathy."

Approach:

"Not using treatment approaches as a way of defining osteopathy. It is the principles behind the treatment that define osteopathy."

"Remember - osteopathy is a broad church!"

"If you asked 100 representative osteopaths for a narrative version of their view you would get a far better take on the subject."

Categorisation:

"Why is there a need to categorise practice? Is there a typically/less typically/least typically encountered patient? Treatment is patient not practice orientated. I have no idea - what is this based on? What is the rationale for linking the groups in each section? E.g. osteopaths working in a „least typically encountered practice‟ working with babies would use the cranial techniques which are listed under „less typically encountered‟. To me, adjunct treatments are not osteopathic treatments and should not be included as such. And why are elite athletes a separate category from any competitive sportsman or woman?"

"I haven't seen anywhere what osteopathy doesn't include. Is this to keep the scope wide?"

Current practice:

"Cranial osteopathic work is being used by a high proportion of the profession. Post-graduate courses in cranial osteopathy have been the most attended (by days per size, per year) than any other post-graduate course in the profession. They should be in the 'core' group."

"How do you or I know? I am not aware of any survey having been done."

http://www.osteopathy.org.uk/uploads/osteopathic_practice_framework_consultation_findin gs.pdf

[jimwalsh]

It appears that osteopaths are having the same trouble as chiropractors when confronted with the ongoing need to define their scope of practice with a constantly weakening evidence base:
Herding cats is the term that springs to mind there...

It's their own fault though, as they have consistantly ignored the need for defined practice to avoid splintering the profession (thus reducing their income) and swelling the ranks of "osteopractic myologists" or whatever non-registered osteos go on to call themselves.

[Bob Lloyd]

In many ways, the demands that alt-med woo should be regulated by various statutory bodies plays into their hands. The very people whose treatment claims are suspicious become the very people to draw up the criteria for official acceptability. They "regulate" themselves with codes of conduct, and by being administrative in their approach, they discourage any fundamental scrutiny of their claims.

The chiropractors have their own general council which far from investigating the spurious claims made by its members, is there to defend them. The recent libel case against Dr Simon Singh is a case in point. Any genuine regulatory body would have jumped at the chance to expose members of their associations who were making spurious claims, thereby bringing the profession into disrepute. Instead, they throw their legal weight against Simon Singh.

Regulation of these spurious professions is a dodgy path to follow. As soon as they become regulated, it becomes much harder to expose the specious claims they make.

[jimwalsh]

In many ways, the demands that alt-med woo should be regulated by various statutory bodies plays into their hands. The very people whose treatment claims are suspicious become the very people to draw up the criteria for official acceptability. They "regulate" themselves with codes of conduct, and by being administrative in their approach, they discourage any fundamental scrutiny of their claims.

The chiropractors have their own general council which far from investigating the spurious claims made by its members, is there to defend them. The recent libel case against Dr Simon Singh is a case in point. Any genuine regulatory body would have jumped at the chance to expose members of their associations who were making spurious claims, thereby bringing the profession into disrepute. Instead, they throw their legal weight against Simon Singh.

Regulation of these spurious professions is a dodgy path to follow. As soon as they become regulated, it becomes much harder to expose the specious claims they make.

You are not quite correct there Bob.

the BCA (Chiropractic trade organisation) sued simon singh the GCC had nothing to do with it...

The GCC are the statuatory body set up to regulate the profession and protect the public.

It might be argued that they have not fulfilled their obligations by allowing members to pracitice non-evidenced based techniques etc.

but this is not really the place to discuss this as it has nothing to do with Osteopathy.

[JJM]

... but this is not really the place to discuss this as it has nothing to do with Osteopathy.It is relevant in that the osteopathy leadership does not assure that members practice evidence-based treatment, any more than any other quack board. That is the problem with officially licensed quackery, the lunatics are in charge of the madhouse.

[davidrodway]

" It appears that osteopaths are having the same trouble as chiropractors when confronted with the ongoing need to define their scope of practice with a constantly weakening evidence base"

The situation regrding the evidence base is worse or better than that depending on your perspective -admitedly ewither way its not good. The evidence started at zero, we now have a few studies such as BEAM that strengthen it a little. So the evidence base has actually increased (from nothing), but needs to be greater and faster.

As for the GOsC, they are government appointees, half from outside the profession. But they do appear to be administrators and not scientists. the GOscs role - much like to GMC - is to stop osteopaths having affairs with their patients etc., rather than , unfortunately, encouraging research (altho it does fund NCOR) It does, I admit, give an aura of respectability that, from a EBM perspective, it may not warrant. If that concerns you, rest asured that since the GOsC was set up in 1993 the attitude of the "medics" towards osteopaths, with some exceptions, remains as it always hads been - ignorance, misconceptions, or hostility.

This attitude may remain even if, or as I hope when, the profession commits more time and money to research, but nonetheless it behoves us to pursue that course. I doubt that the GOsC will be the vehicle for this.

[JJM]

The situation regrding the evidence base is worse or better than that depending on your perspective -admitedly ewither way its not good. ...

This attitude may remain even if, or as I hope when, the profession commits more time and money to research, but nonetheless it behoves us to pursue that course. I doubt that the GOsC will be the vehicle for this.Remind us, again, why you should be allowed to ply your trade (charging people money) until the evidence exists?

A mark of illegitimate (so-called scientific) research is looking for confirmation of supposed facts.

[davidrodway]

Remind us, again, why you should be allowed to ply your trade (charging people money) until the evidence exists?

A mark of illegitimate (so-called scientific) research is looking for confirmation of supposed facts.

Remind us again why you can't simply revisit the posts that as you clearly know have discussed this issue at length before.

Remind us again why physiotherapists for example now use manipulative techniques more than they ever did and are not included in your woo category. Remind us agian why US osteopaths can come up with a totaly imaginary set of axes of SI movement and yet are exempted in your mind from being woo.

Remind us again that you suggested that osteopaths had caused extreme adverse effects yet when called upon for specifics claimed "poetic license".

[Smith]

Remind us, again, why you should be allowed to ply your trade (charging people money) until the evidence exists?


And remind us why David or anybody else should bother continually justifying their professional practice for the satisfaction of some Internet lobbyist espousing a peculiar, skewed, minority viewpoint?

[JJM]

And remind us why David or anybody else should bother continually justifying their professional practice for the satisfaction of some Internet lobbyist espousing a peculiar, skewed, minority viewpoint?It is known as a rhetorical question. It is meant to make you think about the ethics of selling snake oil based on your unfounded beliefs.

[Smith]

It is known as a rhetorical question. It is meant to make you think about the ethics of selling snake oil based on your unfounded beliefs.

The issue, as you know, has been addressed.
The ethics of osteopathic practice are acceptable, but the rhetoric here is growing stale.

[Blue Wode]

The ethics of osteopathic practice are acceptable
Well, to the legislators anyway, who, not being well versed in matters of science, seem to be very easily led. And let's not forget the apparent pressures they are under from HRH's meddling:
http://www.telegraph.co.uk/health/healthnews/6701717/Prince-Charles-urges-government-to-protect-alternative-medicine.html

Goodness, even the homeopaths, just today, are saying that they need to get more "politically savvy":
http://hpathy.com/homeopathy-papers/first-they-came-for-the-homeopaths%E2%80%A6/

Since voluntary public debates on the various CAM therapies haven't been forthcoming, one can only live in hope that some time in the future there'll be a parliamentary select Science and Technology committee Evidence Check into osteopathy (and chiropractic and acupuncture).

[Smith]

The ethics of osteopathic practice are acceptable


Well, to the legislators anyway, who, not being well versed in matters of science, seem to be very easily led.


Is it correct then to conclude that you assume disagreement with my statement would be the only proper response to it if one were reasonably well versed in matters of science?

[Pebble]

Well, to the legislators anyway, who, not being well versed in matters of science, seem to be very easily led. And let's not forget the apparent pressures they are under from HRH's meddling:
http://www.telegraph.co.uk/health/healthnews/6701717/Prince-Charles-urges-government-to-protect-alternative-medicine.html

Goodness, even the homeopaths, just today, are saying that they need to get more "politically savvy":
http://hpathy.com/homeopathy-papers/first-they-came-for-the-homeopaths%E2%80%A6/

Since voluntary public debates on the various CAM therapies haven't been forthcoming, one can only live in hope that some time in the future there'll be a parliamentary select Science and Technology committee Evidence Check into osteopathy (and chiropractic and acupuncture).







It is easy for scientists and skeptics to carp about legislation and legislators, but it is not entirely fair. Those drawing up legislation, must try to predict how each aspect of it will be interpreted by courts, often there is little information to tell them what the impact of various actions would be, they cannot predict which parts of the law will be adequately enforced. Add to this laws are often passed because of a few very obvious transgressions, the scale of the underlying problems often only emerge after the laws have essentially codified behaviour into acceptable and unacceptable, thus retrospectively providing the evidence base on which the law makers are attacked.

I think the establishment (Royal Colleges) have a hypocritical position here, on the one hand complaining about the quality of ithe evidence base for alternative medicine and on the other hand insisting that it is not given the cloak of respectability that goes with regulation.

Forgetting that regulation of a group of leech mongers, herbalists and blood letters is what created medicine as we know it today. Regulation would gradually bring in standardisation, facilitating proper longterm obseervational studies of outcomes, rather than the current mess. Further it is the nature of legislation to gradually increase restrictions on practice. It is no substitute for good science, but science has lost this argument with the paying public, just as atheism however logical cannot displace the role of religion in society.

So being pragmatic, alternative medicine will not dissappear just because the therapies don't work or because the odd person suffers adverse consequences that can be clearly linked to CAM. Regulation at least provides a mechanism for moving the agenda forward, even if it does not meet the standards demanded by those who object to CAM.

[Blue Wode]

...it is the nature of legislation to gradually increase restrictions on practice.
Indeed, and look at the position the Complementary and Natural Healthcare Council (CNHC) is now finding itself in:




CNHC will tell practitioners to remove claims they cannot justify.
CNHC will conduct a review of evidence base for regulated therapies.
CNHC will contact all registrants to instruct them not to make claims without justification.
CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.
It is my view that adhering to the CNHC’s guidelines will make it impossible to practice complementary medicine.

Could this the end of the CNHC? It would be hugely ironic if forcing its members to act ethically became the cause of its demise.

http://adventuresinnonsense.blogspot.com/2009/11/cnhc-wishes-to-place-on-formal-record_27.html (http://adventuresinnonsense.blogspot.com/2009/11/cnhc-wishes-to-place-on-formal-record_27.html)

[davidrodway]

FRom a current discussion among osteopaths -

Dear Paulopalus...thou meddling maddening mannerless flap-mouthed excuse of an osteopath.

You asked;

//In light of the recommendation that the MHRA should not allow medical claims on labels to be made without evidence of efficacy, what legitimate claims can be made on an Osteopathic or Naturopathic label, when there is no consistent agreement of plausible treatment effects?//

In answer to your own pestiferous babbling milk-livered brain vexing question, thou might find interest in the following.

Review

Effectiveness of manual therapies: the UK evidence report
Gert Bronfort , Mitchell Haas , Roni Evans , Brent Leiniger and John Triano

Chiropractic & Osteopathy 2010, 18:3doi:10.1186/1746-1340-18-3

Published: 25 February 2010

Abstract (provisional)

Background
The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.

Methods
The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.

Results
By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines. Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.

Conclusions
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation. Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile co

[JJM]

... Effectiveness of manual therapies: the UK evidence report
Gert Bronfort , Mitchell Haas , Roni Evans , Brent Leiniger and John Triano Chiropractic & Osteopathy 2010, 18:3doi:10.1186/1746-1340-18-3 ...Yes, chiros and osteos are going to cite this for generations to come. However, it does not point to reliable, high-quality evidence in support of manual therapy for many conditions. More than that, it is (pointedly) about "manual therapy" rather than chiro or osteo. The review covers PTs, doctors, reflexologists, masseurs, etc. So, we have to examine this review to see if it really supports any chiro or osteo claim.

[Pebble]

http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf

An interesting attempt to analyse this area fairly. In essence only RCTs were analysed, the trials were ranked based on quality and risk of bias, then the conclusions of systemactic reviews were added without any real analysis of the quality of those systematic reviews, but generally Cochrane, NICE and SIGN methodology based reviews were treated more seriously.

The use of a bean counting approach after all this work is unhelpful. In essence high quality trials trumped moderate quality trials which in turn trumped poor quality trials (treated as inconclusive).

Thue where a higher quality trial failed to find efficacy then the presence of poor quality trials finding efficacy led to a report of a given treatment not being effective. However, if only poor quality trials were available if one of these (highly biased) trials showed efficacy, one gets a positive statement - inconclusive efidence of efficacy.

There is no attempt to perform a metanalysis of the available high quality trials.

I suspect this will not really advance the argument. Conventional medics, will observe that applying the same rules where there is no logical reason why a therapy should work is not good enough. Chiropractors will argue that one negative trial is not enough to say a treatments does not work, especially where there is an abundance of observational data supporting their belief.

Whether this adds to the 'not a jot' of evidence argument in a timely fashion is another question. The only 'helpful' conclusion is in terms of enuresis (inconclusive), this is based on two systematic reviews of two trials with no new data, and asthma where there is one trial, with three reviews of the data two negative one positive.

[Pebble]

Correction




Whether this adds to the 'not a jot' of evidence argument in a timely fashion is another question. The only 'helpful' conclusion is in terms of enuresis (inconclusive), this is based on two systematic reviews of two trials with no new data, and otitis media where there is one trial, with three reviews of the data two negative one positive.

[davidrodway]

Correction

I feel like starting an Osteopaths for Ernst campaign. His methodology is sound, with some caveats, and if he employs it in determining the value of osteopathy , I think we will come out of it well. Others may welcome switching off the glare of rationality, but I certainly do not. If the dept is short of money, why not some GOsC or BOA funds to keep it going?



Click here to read their views. (http://www.thisisexeter.co.uk/news/Complementary-medicine-research-threatened-finances/article-1885231-detail/#StartComments)</SPAN>

EXETER University's alternative medicine research centre is under threat due to a lack of funds unless a financial backer can be found.

Edzard Ernst, Britain's first Professor of Complementary Medicine, has expressed his disappointment that the centre could close next spring.

Professor Ernst said the university had been given a sum of money towards the centre and he claimed it had committed itself to raising funds in the future. But he said the university had not done that and he now felt betrayed.

He said: "I would feel the closure of the centre would be a great loss because I strongly feel that critical evaluation of this area is what a university should be doing, and it would be a great shame to the nation."

The scientist claimed the potential closure of the centre was due to a lack of support from the university since his public clash with Prince Charles' office in 2005. Professor Ernst had expressed his concerns about a new report into the benefits of complementary medicine commissioned by the Prince of Wales.





He was concerned more people might be tempted to try alternative therapies because Prince Charles was backing them — before many of them had been properly tested.

Sir Michael Peat, the Prince's private secretary, accused Professor Ernst of discussing a document he had been shown in confidence.
A spokesman for the university's Exeter's Peninsula College of Medicine said: "Fundraising in this area of research is recognised as difficult, especially in the current climate. The college is working with Professor Ernst to establish a business plan to make the best use of the remaining funding, and it is likely that the college will be able to support the centre until at least the spring of 2011."

[JJM]

http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf

An interesting attempt to analyse this area fairly. ...

... The only 'helpful' conclusion is in terms of enuresis (inconclusive), this is based on two systematic reviews of two trials with no new data, ...Their evaluations lacked rigor. For example, there are two trials for treatment of enuresis:
Reed WR, Beavers S, Reddy SK, Kern G: Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther 1994, 17: 596-600.


Leboeuf C, Brown P, Herman A, Leembruggen K, Walton D, Crisp TC: Chiropractic care of children with nocturnal enuresis: a prospective outcome study. J Manipulative Physiol Ther 1991, 14: 110-115.


The 1991 study was uncontrolled and unblinded, and did not favor chiropractic. The 1994 study was tiny and found no difference between treatment and sham treatment. Yet the authors of this review find treatment "favorable." Nonsense!

The same holds for their "favorable" rating for carpal tunnel syndrome; which relies on an successful study of chiro and an unsuccessful study of PT.

This is just another attempt to produce a plethora of information that might fool a court.

[davidrodway]

There is, it appears, more to the effectiveness of osteopaths and chiropractors in relieving back pain and similar problems than "mobilising" the joints of the spine. Prof Don Jewett, of the University of California, writing in New Scientist, points out that thecracking sound following their manipulations is caused by a bubble of nitrogen gas formed within the joint as it is forced through the extremes of its range of movement. This causes the joint capsule to swell, inhibiting the pain fibres in proximity and resulting in the relief of symptoms.
James le Fanu, Daily Telegraph

[Pebble]

There is, it appears, more to the effectiveness of osteopaths and chiropractors in relieving back pain and similar problems than "mobilising" the joints of the spine. Prof Don Jewett, of the University of California, writing in New Scientist, points out that thecracking sound following their manipulations is caused by a bubble of nitrogen gas formed within the joint as it is forced through the extremes of its range of movement. This causes the joint capsule to swell, inhibiting the pain fibres in proximity and resulting in the relief of symptoms.
James le Fanu, Daily Telegraph

He may think that - the evidence base from his enitre list of publications, might suggest that he should not be taken too seriously.

What's wrong with single hypotheses?: Why it is time for Strong-Inference-PLUS.
Jewett DL.
Scientist. 2005 Nov 7;19(21):10. No abstract available.
PMID: 17975652 [PubMed]
Related articlesFree article
2.
Human sensory-evoked responses differ coincident with either "fusion-memory" or "flash-memory", as shown by stimulus repetition-rate effects.
Jewett DL, Hart T, Larson-Prior LJ, Baird B, Olson M, Trumpis M, Makayed K, Bavafa P.
BMC Neurosci. 2006 Feb 23;7:18.
PMID: 16504094 [PubMed - indexed for MEDLINE]
Related articlesFree article
3.
The use of QSD (q-sequence deconvolution) to recover superposed, transient evoked-responses.
Jewett DL, Caplovitz G, Baird B, Trumpis M, Olson MP, Larson-Prior LJ.
Clin Neurophysiol. 2004 Dec;115(12):2754-75.
PMID: 15546784 [PubMed - indexed for MEDLINE]
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[jimwalsh]

as a counterpoint to all that stuff about the scope of practice in manual therapy here is an interesting article by an osteopath suggesting that much of the stuff manual therapists do is a load of nonsense and the postural models that osteopaths physios etc use are of no use...

click to download (http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf)

These are interesting times for the manual therapies as there is huge changes occurring in the understanding of pain and neuro-plasticity etc...

As someone once said: "I think you'll find its a little bit more complicated than that..."

[Pebble]

as a counterpoint to all that stuff about the scope of practice in manual therapy here is an interesting article by an osteopath suggesting that much of the stuff manual therapists do is a load of nonsense and the postural models that osteopaths physios etc use are of no use...

click to download (http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf)

These are interesting times for the manual therapies as there is huge changes occurring in the understanding of pain and neuro-plasticity etc...

As someone once said: "I think you'll find its a little bit more complicated than that..."

Interesting review, but does not follow a standardised method of ensuring that all data has been considered. Thus for example ends up concluding that amenorrhoea is a cause of pregnancy related pain when standardised reviews conclude the opposite.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518998/?tool=pubmed

Risk factors for developing PGP during pregnancy are most probably: a history of previous low back pain (OR 1.8–2.2) and previous trauma to the pelvis (OR 2.8). There is slight conflicting evidence (one study) against the following risk factors; pluripara (OR 2.2) and high-work load.
There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking and most probably age (one study reports that young age is a risk factor).


One must also consider crush fractures, ankylosing spondylitis and spinal abscesses - areas where there is a very clear relationship between local pathology and local pain. So while much of what is presented is valid - it is very unclear that any demonstrable abnormality of posture is a reliable predictor of LBP, I think the conclusions are not based on a dispassionate review of all the evidence.

[Blue Wode]

Osteopath, Johathan Hearsey, invites comments on his views on manual therapy for infantile colic:


The topic I wish to discuss has been bothering me for years – certainly for the duration of my practice life but I remember having concerns as an undergraduate too.

I expect some flak – from all sides, actually – but I really feel that this is a discussion that needs to be had. I’d like this to be positive though.

I have toyed with this thread for many months – ever since the BCA vs. Simon Sing case.

Ridiculously, I want to draw your attention to my legal (http://jonathanhearsey.com/?page_id=144) page – never has this page been so relevant. I’m interested in your comments (feel free to add them below) or I invite people to discuss this using the modern-if-yet-untested-by-me-forum-of-twitter (here (http://twitter.com/jonathanhearsey)).

To start this off I’m going to throw a provocative statement out there – ‘fess up’, as my street-wise kids would say! Ready?

‘Colic’ in infants (<6 months old) is simply a collection of symptoms, (such as abdominal discomfort, increased hiccups, difficulty winding, flatulence) caused by hypertonus of the thoracic diaphragm. In the absence of pathology and with a medically qualified clinical lead, simple musculoskeletal, short-term management of the hypertonus using inhibition and a suitable exercise regime resolves the condition. ‘Colic’ is not caused by a disruption of any form of neurovascular tissue, subluxation, lesion or allergy.

More...
http://jonathanhearsey.com/?p=564

It's worth bearing in mind that the recent Brontfort review, 'Effectiveness of manual therapies; the UK evidence report', found no evidence to support the use of spinal manipulation for colic (fig.7)
http://www.chiroandosteo.com/content/18/1/3

[davidrodway]

Osteopath, Johathan Hearsey, invites comments on his views on manual therapy for infantile colic:

It's worth bearing in mind that the recent Brontfort review, 'Effectiveness of manual therapies; the UK evidence report', found no evidence to support the use of spinal manipulation for colic (fig.7)
http://www.chiroandosteo.com/content/18/1/3

Do they give a definition of spinal manipulation? Chiros and physios use it to mean LAHVT - clicking facet joints - but osteopaths pften use it to mean all forms of hands on treatment.

Re Jonathons view - he doesnt say what treatment he uses (and how on earth do you get a baby to do exercises). But maybe he does treat thiese cases - maybe he uses, according to his theory , techniques no one else does. If he does have success with it, this wouldnt then be picked up in research that looks at forms of manual treatment other than his.

[jimwalsh]

http://www.om-pc.com/content/pdf/1750-4732-4-2.pdf


Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial


Abstract

Background

The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.
Methods

406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.
Results

Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.
Conclusions

ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

[Pebble]

[URL]

[FONT=Verdana]Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups.


Interesting, but unfortunately one must highlight the pivotal statement made. An RCT of this size is set up to test a primary endpoint. Only if this is positive can one make deductions in respect of secondary end points. The study remains exploratory, accepting that the failure to recruit the required numbers is not necessarily their fault.

[davidrodway]

Below are some stats from the nerw zealand ACC scheme that pays for treatment after an accident. I wonder how the costs per visit and the number of visitas compares for physios, chiros and osteopaths. Dont think there is any info on outcome unfortunately, altho there may be some on thyeir website



se note you can not add up the number of clients per provider to get the total number of
clients as clients can receive treatment from multiple providersPayments by providersClientsVisitsAmount grossAccident and Medical Clinic Services1998-07/1999-061432$9771999-07/2000-0618,82033,283$1,447,1982000-07/2001-0648,14979,433$3,652,9682001-07/2002-0682,770136,453$6,636,5262002-07/2003-06112,095190,123$9,354,1052003-07/2004-06155,743271,846$14,727,3952004-07/2005-06189,667322,749$20,801,4632005-07/2006-06218,089371,277$25,809,4322006-07/2007-06252,067549,857$34,696,2172007-07/2008-06290,032759,295$42,489,5172008-07/2009-0253,260133,925$7,503,249Acupuncturist1998-07/1999-064,30145,398$1,830,2951999-07/2000-067,57284,574$3,544,4572000-07/2001-068,91792,791$3,906,5752001-07/2002-0611,095110,119$4,648,6172002-07/2003-0615,340124,571$5,089,2152003-07/2004-0617,632136,631$5,556,0712004-07/2005-0619,914153,205$6,369,4282005-07/2006-0622,545168,402$7,195,8012006-07/2007-0627,804218,898$11,283,3402007-07/2008-0634,738285,259$15,973,1482008-07/2009-027,86540,538$2,286,613Chiropractor1998-07/1999-0617,209144,899$2,889,4921999-07/2000-0635,317318,781$6,307,4882000-07/2001-0644,457387,721$7,626,7172001-07/2002-0651,462427,836$8,364,3252002-07/2003-0658,193442,276$8,609,1352003-07/2004-0664,945473,911$9,172,6432004-07/2005-0666,154460,017$8,872,3692005-07/2006-0669,176467,195$9,168,1132006-07/2007-0675,555511,318$11,860,7862007-07/2008-0684,410585,744$14,446,5132008-07/2009-0222,55176,804$1,894,403Counselling - Sexual Abuse1998-07/1999-067,59467,855$3,888,7491999-07/2000-069,818111,511$6,394,9982000-07/2001-06248851$47,5092001-07/2002-069,963109,113$6,316,7442002-07/2003-0611,089139,572$8,229,0482003-07/2004-0611,007149,791$10,550,1552004-07/2005-0610,803151,144$11,979,7772005-07/2006-0612,670159,364$13,398,1752006-07/2007-0613,721172,116$14,322,6512007-07/2008-0613,938162,743$13,938,2622008-07/2009-025,58419,156$1,631,195Dentist2003-07/2004-06162683$42,3712004-07/2005-0640,51792,321$18,870,0512005-07/2006-0657,272195,622$28,234,9272006-07/2007-0654,985188,476$23,167,9722007-07/2008-0658,100199,715$24,834,5052008-07/2009-0210,79930,409$3,546,337Endorsed Physio1998-07/1999-06819$4301999-07/2000-067853,750$120,4812000-07/2001-067,98341,947$1,434,5772001-07/2002-0634,952196,714$6,921,7462002-07/2003-0654,279318,295$11,282,6552003-07/2004-06148,680872,466$33,586,0932004-07/2005-06251,3141,552,390$61,842,3652005-07/2006-06353,3812,183,836$89,803,1692006-07/2007-06427,5282,654,151$113,962,4442007-07/2008-06473,4793,050,055$137,775,3672008-07/2009-02107,126411,696$19,015,054GP Receiving Rural Bonus1998-07/1999-06109,329185,005$5,787,4471999-07/2000-06202,361364,000$11,539,5222000-07/2001-06213,144384,323$12,081,6782001-07/2002-06196,376351,611$11,002,4162002-07/2003-06180,531313,379$9,688,4322003-07/2004-06137,553237,360$10,101,4152004-07/2005-06148,104265,571$14,056,1482005-07/2006-06157,192285,269$15,747,3962006-07/2007-06169,917303,824$17,318,3312007-07/2008-06176,353313,544$18,733,8012008-07/2009-0234,73951,069$3,179,867General Practitioner1998-07/1999-06509,854889,991$26,653,4461999-07/2000-06926,6661,704,934$52,196,4672000-07/2001-06975,5201,788,919$54,630,4252001-07/2002-06956,4161,732,460$52,900,5612002-07/2003-06941,2131,688,752$51,578,0312003-07/2004-06928,9001,665,738$54,324,3542004-07/2005-06887,4391,577,993$61,725,2162005-07/2006-06877,9711,568,361$64,169,4762006-07/2007-06890,9561,568,611$63,911,0412007-07/2008-06875,3211,527,667$62,708,0092008-07/2009-02155,163222,850$9,303,825Osteopaths1998-07/1999-0612,02160,105$1,577,5791999-07/2000-0623,542122,813$3,255,4552000-07/2001-0631,653158,572$4,307,2032001-07/2002-0640,487189,230$5,116,1232002-07/2003-0652,137232,411$6,386,8632003-07/2004-0661,782264,609$7,342,8692004-07/2005-0667,800285,203$7,921,5302005-07/2006-0673,198292,977$8,329,4712006-07/2007-0680,004314,952$10,461,6992007-07/2008-0684,349334,235$11,846,2782008-07/2009-0221,23348,424$1,723,898Physiotherapist1998-07/1999-06179,5811,171,560$24,737,8601999-07/2000-06324,0862,110,085$45,613,3462000-07/2001-06356,4092,254,427$49,408,0172001-07/2002-06351,0992,156,633$48,169,8632002-07/2003-06357,5882,073,298$47,317,1452003-07/2004-06294,0201,630,971$38,120,8692004-07/2005-06214,7401,195,707$28,459,5002005-07/2006-06150,318807,362$19,934,1872006-07/2007-06116,033629,222$18,753,2052007-07/2008-0699,016545,016$17,526,9972008-07/2009-0218,17663,752$2,090,771Radiologist1998-07/1999-06135,518164,990$7,469,5111999-07/2000-06276,332351,233$15,673,3192000-07/2001-06311,890407,879$18,053,0942001-07/2002-06316,679435,956$18,547,4952002-07/2003-06329,663470,356$20,089,7022003-07/2004-06321,785446,703$19,564,4442004-07/2005-06339,728481,561$28,690,9142005-07/2006-06369,569527,712$35,344,4802006-07/2007-06407,237588,635$39,854,3452007-07/2008-06411,502598,991$42,509,1102008-07/2009-0261,35680,409$5,766,875

[chaggle]

It might be just me but I didn't find that to be terribly readable:undecided:

[polomint38]

It might be just me but I didn't find that to be terribly readable:undecided:

It is not just you. O0

[davidrodway]

It might be just me but I didn't find that to be terribly readable:undecided:

Sorry, originally they were in a spreadsheet, but when i pasted them that didnt come out. Anyone know how i can retainthe spreadsheet layout when i post it?

[davidrodway]

Received 3 January 2003; Revised 19 June 2003; Accepted 14 July 2003.
Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P and Muntz R. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Family Practice 2003; 20: 662–669.

http://fampra.oxfordjournals.org/icons/toc/rarrow.gif Abstract http://fampra.oxfordjournals.org/icons/toc/uarrow.gifTop
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#top)http://fampra.oxfordjournals.org/icons/toc/dot.gifAbstract
http://fampra.oxfordjournals.org/icons/toc/darrow.gifIntroduction
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#SEC1)http://fampra.oxfordjournals.org/icons/toc/darrow.gifMethods
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#SEC2)http://fampra.oxfordjournals.org/icons/toc/darrow.gifResults
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#SEC3)http://fampra.oxfordjournals.org/icons/toc/darrow.gifDiscussion
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#SEC4)http://fampra.oxfordjournals.org/icons/toc/darrow.gifReferences
(http://fampra.oxfordjournals.org/cgi/content/full/20/6/662#BIBL)
Background. Spinal pain is common and frequently disabling. Management guidelines have encouraged referral from primary care for spinal manipulation. However, the evidence base for these recommendations is weak. More pragmatic trials and economic evaluations have been recommended.
Objectives. Our aim was to assess the effectiveness and health care costs of a practice-based osteopathy clinic for subacute spinal pain.
Methods. A pragmatic randomized controlled trial was carried out in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. A total of 201 patients with neck or back pain of 2–12 weeks duration were allocated at random between usual GP care and an additional three sessions of osteopathic spinal manipulation. The primary outcome measure was the Extended Aberdeen Spine Pain Scale (EASPS). Secondary measures included SF-12, EuroQol and Short-form McGill Pain Questionnaire. Health care costs were estimated from the records of referring GPs.
Results. Outcomes improved more in the osteopathy group than the usual care group. At 2 months, this improvement was significantly greater in EASPS [95% confidence interval (CI) 0.7–9.8] and SF-12 mental score (95% CI 2.7–10.7). At 6 months, this difference was no longer significant for EASPS (95% CI -1.5 to 10.4), but remained significant for SF-12 mental score (95% CI 1.0–9.9). Mean health care costs attributed to spinal pain were significantly greater by £65 in the osteopathy group (95% CI £32–£155). Though osteopathy also cost £22 more in mean total health care cost, this was not significant (95% CI -£159 to £142).
Conclusion. A primary care osteopathy clinic improved short-term physical and longer term psychological outcomes, at little extra cost. Rigorous multicentre studies are now needed to assess the generalizability of this approach. Keywords. Back pain, economic evaluation, neck pain, randomized controlled trial, spinal manipulation.

[davidrodway]

An article written by an osteopath from fifty years ago has become availalble on the net. I think it shows that even 50 years ago Osteopathy hardly qualifies as woo.
The Journal and Proceedings of the
Osteopathic association of Great Britain

December 1960


The place of Medical Diagnosis in
Clinical Osteopathy

By
Colin I. Dove, D. 0., M. R. O.

There is, I think, very little doubt that the average
osteopathic practitioner in this country today, has rather
different conception of the scope of his work than most
of the earliest members of his profession. The earliest
ideas viewed osteopathy as a revolutionary and
completely independent system of healing which could
with advantage replace existing schools of thought. It is
my belief that anybody who has spent any time at all
studying such basic sciences as anotomy, physiology

.- and pathology must find this view completely untenable.
A careful study of the words of some of the leading
members of the osteopathic profession during the House
of Lords Select Committee Inquiry (only 24 years ago)
reveals however that this view was still largely held.
These worthy gentlemen were however, forced to admit
that surgery and chemotherapy would be needed from
time to time to bolster their so-called independent
system. 1 would be surprised to learn that there are any
adequately trained osteopaths who still beleive or would
insist that osteopathic manipulative treatment is the
treatment of choice in all conditions to which the flesh
will beir. The high proportion of osteopaths using
sclerosing and other injections,
electrical treatment and other adjunctive therapies, lends
colour to this view. There are probably many reasons for
this gradual modificatiom of ideas but I am convinced
the most important single reason in the accumulation of
years of experience which shows beyond all shadow of
doubt that many conditions are not amenable to
osteopathic treatment and further, many that cannot be
prevented by it. I beleive, and I am sure the great majority
of the osteopathic profession will agree with me, that the
reason some patients do not recover, or become ill
whilst undergoing regular treatment, is because there are
other aeitiological factors in disease than the osteopathic
vertebral lesion. This is an extremely important
fundamental beleif and those who accept it can never
hold osteopathy out as a complete system. Now here we
have an interesting anomaly. Whilst a great many
osteopaths support this fundamental belief, some of
them perhaps unwillingly, they yet rarely attempt to track
down, and still more rarely attempt to treat, other
aetiological factors. Almost invariably every patient is
examined and treated osteopathically. One of the
obvious reasons for this is the frequency with which
restricted mobility occurs in spinal joints. Rarely does

one come across a subject who does not present with
restricted mobility of vertebral joints in some area of the
spine. Whether this is necessarily always osteopathic,
and more important still whether at should always be
treated, are fascinating and controversial questions,
discussions of which could easily fill several lectures.
I am told that one of the more senior members of our
profession used to say to students:
"Beware! Osteopathy is too easy! As soon as you lay your
hands on a patient you find something that needs
treatment and forget all about diagnosis."

The role of the lesion

This is extremely sound advice and deserves a wider
audience. There is, I am sure, far too much haphazard
"correction of lesions" without careful consideration of
whether these can conceivably be related to presenting
symptoms. There are many instances where osteopathic
lesions exist but are completely unrelated to the
condition with which the patient is presenting. Often
such cases are subjected to many treatments which
careful diagnosis would have avoided, to the benefit of
the patient's health and pocket, and the osteopath's
reputation. Here I suggest is the place of medical
diagosis in clinical osteopathy, in the early recognition of
conditions not amenable to osteopathic treatment. This
recognition is brought about by supplementing our most
valuable weapon, osteopathic diagnosis, with certain
orthodox clinical diagnostic procedures.
There are of course many factors concerned in the
production of any disease process. Such processes may
be initiated by trauma, infection or dietic, phychological
or developmental factors. If not initiating, any of these
factors may aggrevate or maintaina disease process, and
there are many more beside. Speranskyi seeking a basic
formula for disease processes came to the conclusion
that disease was initiated by some "unphysiological
stimulus" which acting through the nervous system leads
to "circulatory derangements in the terminal circulatory
area." This could lead the way to a breakdown in
function and eventually irreversible pathology via various
routes. Haycock>has made reference to some interesting
comments on the similarity between Speransky's
conclusions and osteopathic thought which are worthy
of study. However it is my purpose here to dwell for a
moment on this idea of an "unphysiological stimulus".
As osteopaths we naturally think that an osteopathic
vetebral lesion is quite capable of acting as such a
stimulus and by such physiological phenomena as
summation, facilities and irradiation may set up a
somatico-visceral reflex which can and does cause
changes in the termianl circulatory area leading to
functional, or hypo- or hyper-physiological, states and
eventually irreversible pathology at a site remote from
the initial lesion. Nevertheless we must accept the fact
that there are other factors capable of initiating these
processes. The osteopathic lesion is causeative,
sometimes it may be secondary and sometimes it is not
present at all.
In any system of healing, the treatment of choice must be


2

the one which seeks to eradicate the most important
aetiological factor, whilst not neglecting such other
factors as may be present. It follows then that
osteopathic spinal treatment is the treatment of choice in
conditions where the osteopathic vertebral lesion is the
most important aetiological factor. It could also of
course be considered as adjunctive therapy in a case
where osteopathic vertebral' lesions were present and
related to the condition yet were not the most important
aetiological factor. In this concept the osteopath
admittedly becomes a specialist in diagosing and
treating one aetiological factor. In fact, as mentioned
previously, many osteopaths employ other modalities in
an attempt to justify the appellation of general
practitioner. This they may even be, but the practice of
these supporting therapies is not osteopathy.
Nevertheless in the present scheme of things patients
frequently consult us in the first instance, and it is
therefore our duty to be proficient in recognising all
these factors and be able to asses their relative
importance one to another. Thus we will be able to

decide which is the treatment of choice for this or that
patient, remembering that this will not always be
osteopathic.
By way of a summary, I would like to quote from

MacDonald and Hargrave-Wilsona:

".. . the osteopathic lesion is a universal aetiological
factor and is capable of playing a part in many cases
admittedly a small one, in practically any breakdown of
normal functioning, This is at once the weakness and the

strength of osteopathy."

When discussing the "weakness" they state:
"... even in me hands of the most sincere exponent, its
universal application may lead to its importance being
easily overstressed to the corresponding neglect of other
factors, by the ostepathic enthusiast."
Having admitted that this principle is true of any
specialist they conclude:
"Obviously then, it is of the utmost importance that a
practitioner specialising upon osteopathic lines must be
fully cognisant of the possibilities of all aetiological
factors."

I think at this juncture it might as well be profiable to
consider the ideal of "regarding the patient as a whole".
This may at first sight appear to be a digression. However,
you will see that such a consideration will lead us into the
main theme of this paper. For some extraordinary reason
the Osteopath proudly boasts that he treats the patient as
a whole whilst other schools of thought arern becoming
more specialist in their approach. I regard this as
extraordinary because on examination the osteopaths'
interpretation of it would appear to be equally
specialised. A typical example is the practitioner who
proudly boasts that all his low back cases receive a
general treatment. In fact "regarding the patient as a
whole" would appear to be exemplified by giving the
patient a thorough general osteopathic treatment from
occiput to hallux leaving to joint untouched. If this is true
we should remember that whole patients possess a
nervous system, a digestive system and a respiratory
system as well as a skeletal system. Whilst the complete
structural examination and treatment may be very good
practice, it does nothing to acquaint us with the state of
the heart and lungs, the conductivity of the nerve

pathways or the condition of the gut. No conception of
wholeness can omit to take into account all the various
tissues, organs and systems which go to make up a
"whole" patient. Viewing, regarding, treating the patient
as a whole then, can only mean that we take all these
things into account when examining a patient and
prescribing treatment.
The word diagnosis has been used in this paper. Perhaps
it would be advisable at this stage to consider exactly
what it means. Black's Medical Dictionary4 defines the
term as follows:
"Diagnosis is the art of distinguishing one disease from
another, and is essential to scientific and successful

treatment. The name is also given to the opinion arrived
at regarding the nature of a disease. It is in diagnosis
more than in treatment that the highest medical skill is
required, an, for a diagnosis, the past and heriditary
history of the case, the symptoms complainedof, and the
signs of disease found upon examination are all
weighed. Many methods of laboratory examination are
used at the present day in aiding diagnosis, such as tests
for various bacilli, agglutination tests, the Wasserman
reaction, etc. Often an absolute diagnosis cannot be
made once, and it becomes necessary to proceed
tentatively with treatment, a careful watch being kept

upon its result."

Diagnosis then is not just a question of putting a name to
a set of symptoms, nor is it, as some people would have
us believe, the first step toward the tabulated process of
giving a set treatment for a given condition. The making
of a diagnosis is indicative of an understanding of the
patient's condition and is essential if the correct
treatment is to be prescribed . It is obvious then that
unless we are prepared to base our work on a
blunderbuss method of "cracking up" every restricted
joint we can find, diagnosis must figure very prominently
in our work; diagnosis both osteopathic and medical,
since the treatment of choice will not always be
ostepathic.
What happens in many consulting rooms when a patient
consults us complaining of say, low back pain? A case
history is taken, and if this appears to be fitting a familiar
picture this may well be scanty. The patient appears to
be fitting a familiar picture and performs a few active
movements. Then he or she is examined in various
positions. Much structural information is obtained
regarding muscle tone and joint mobility or abnormal
positioning. In the absence of any signs of gross organic
disease, the patient's symptoms will almost certainly be
ascribed to the inevitable relative restriction of one or
more vertebral or sacro-iliac joints and treatment will
be commenced. Happily in many cases we are correct,
or in any case the patient recovers. Not all that frequently
however, the patient does not recover. He or she gets
steadily worse. The sequel to this may well be a
reassessment and subsequent relief from altered
treatment. On the other hand the patient may just stop
coming. More careful diagnosis from thorough history
and examination would have eliminated this
unsatisfactory state of affairs.

The Problems of Differential Diagnosis

There are many conditions, which can cause low back of
the type with which we are so familiar, whose treatment


is beyond our scope. Our duty to the public demands
that we be ever vigilant, and diagnose these condition
whenever this is possible, since many of them are not
only outside the scope of osteopathic treatment, but may
well be made worse by manipulation or even more
conservative manual methods. I have listed below a
number of conditions in which low back pain does or
may occur. These are grouped under two skeletal
headings; those in which it is not. It is not suggested that
these lists are in any way complete.
Under the first group we find:

(l)Paget's Disease. (4)Osteomalcia. (9)Proplapsed inter

(2)Turberculosis of ©Osteomyelitis. vetebral disc.
spine or sacroiliac (6)Primary and (lO)Spondylolysis.
joints. secondary bone (1 l)Spondylolisthesis.
(S)Ankylosing tumors. (12)Spondylosis.
spondylitis (7)Myelomatosis. (IS)Spondylarthoris.
(S)Scheuermann's

Disease
Under the second group we find:
(l)Carcinoma (S)Salphingitis. (9)Spinal cord
(uterus, rectum etc.) (6)Prostate tumours.

(2)Dysmenorrhoea. condition. (10)Renal disease.
(3)Ovarian cyst. (7)Constipation. (ll)Cystitis.
(4)Uterine. (8)Pelvic abscess, (12)Threatened
displacements. abortion.
Some of these conditions especially in the first group do
of course respond to osteopathic treatment and the
diagnosis of some of the others is fairly simple. There
remains however a residue of conditions, some very
serious, which may well present with low back pain.
Many of you will say that you will have never seen any of
these more serious conditions. 1 suggest however, that
some of the patients who did respond, or who
discharged themselves from treatment could well have
fallen into this category. My own experience in clinical
osteopathy is of only a very few year's standing, yet
already I have seen a number of condition of this
description, most of which COULD NOT HAVE BEEN
DIAGNOSED FROM A ROUTINE OSTEOPATHIC
STRUCTURAL EXAMINATION.

Case Histories

At this stage I would like to discuss some case histories
which illustrate some of the points I have made.
CASE 1. A woman aged 31, married with one female
child aged 6 years, presented for examination
complaining of low back pain radiating into the right
groin and around the patella. She gave a history of mild
low back pain since the birth of her child. After three
years she had an acute episode which rest on fracture
boards to relieve. A surgical corset was similarly
ineffective. Exercises aggravated the condition, and she
eventually decided to consult and osteopath.
The treatment she appears to have received consisted of
specific adjustments to the lumbar spine. This was given
weekly for three months, monthly for four months and
then at longer intervals until the patient had been under
treatment for some eighteen months. During this time
the more acute symptoms sudsided and the condition
appeared to become chronic.

She next consulted another osteopath who regrettably
made a similar diagnosis of "bones out" and proceeded
to treat the patient with even more strength than his
predecessor despite the pastient's report of considerable
reaction to previous treatment. After five treatments the
patient realised that this was not the solution.
She gave no significant family history and her past
medical history was devoid of any serious illness. She
had undergone a dilatation and curettage operation for
dysmenorhoea shortly before the onset of her acute
symptoms. It had had no effect on her dysmenorhoea.
Her low back pain increased in severity three to four days
prior to menstruation and she had increased low back
pain and abdominal discomfort on the first day of her
period. Her general health she admitted was not good.
She felt run down and became tired easily. She was
attending a herbalist for anaemia. Her appetite was only
fair. Diet was orthodox. She slept for an adequate
number of hours but her sleep was disturbed by
unpleasant dreams.

On examination was found. The tendon reflexes were all
present and normal in response. The plantar reflexes
were flexor and the abdiminal reflexes present in all four
quadrants. There were no sensory changes or muscle
wasting. Muscle power and tone was good. The sciatic
and femoral nerves when stretched did not produce
pain. Cranial nerves showed no evidence of disease. The
blood pressure was 115/60 mms./Hg. The Pulse rate was
regular at 70 beats per minute. Heart sounds were
normal and there were no adventitious sounds heard.
Inspection of finger nails, conjunctivae and general
appearance suggested that a degree of anaemia was
almost cetainly present.

Osteopathically, posture and active movements were
fair. There was restricted mobility between L2 and L3 and
between L3 and L4 with some deep muscle tension
between the transverse processes of the vertabae. The
sacroiliac joints were mobile and positionally
symmetrical. Superficially, it appeared to be like any
other case of lesion in the mid-lumbar spine with pain
referred to the third lumbar dermatome. If it had been
only this, however, the condition should have cleared up
months before with the previous treatment. In addition
there was muscle guarding on springing the lumbar
spine. My conclusion was that the lesion was not
essentially osteopathic and radiographs were obtained.
These showed an alteration in the normal trabecular
pattern of the bodies of the second, and especially the
third, lumbar vertabrae. The picture was suggestive of
osteomalacia and the patient was referred back to the
general practitioner. Unfortunately the local hospital
persisted in regarding the condition as a disc lesion and
it was eventually necessary to obtain a second opinion
privately through a sympathetic consultant. The result of
this was that she was admitted to hospital for
investiagtions to confirm the presence of the deficiency
syndrome. However, this proved not to be the case and
the condition was eventually diagnosed as a
haemangioma of the third lumbar vertabae.
In this particular condition it is accepted and


acknowledged that collapse of the vertebral body does
sometimes occur. When one considers that this
particular spine was repeatedly subjected to
manipulation of a strong variety, it is fortunate, for the
practitioners concerned and the patient, that
pathological fracture did not occur.
I would like to emphasise again that this case presented
with a clinical picture very similar to many another low
back case. The diagnosis rested on a careful case history,
examination and radiographic evidence. The diagnosis
could not have been made on the result of an
osteopathic examination alone.
CASE 2. A male patient aged 64 years presented for
examination complaining of pain affecting both legs
especially the calves. Standing for any length of time
increased the pain as did walking. In fact his limit in
walking was only some 150 yards before pain caused
him to rest. He also complanined of low back pain.
The onset had been slow, one year, previously, with low
back pain. He had spent nine weeks in hospital with
traction applied to his legs. The low back condition
improved but the pain appeared in the lower extremities
and got steadily worse. One year later he was again
admitted to hospital and x-rays were taken. He was
given no treatment. Since that time he had been unable
to return to work.
As a child he had both diptheria and scarlatina and an
appendicectomy had been performed when the patient
was aged 32. His general health he maintained was very
good. There had been no changes in bowel habits and
no digestive disturbances.
On examination the tendon reflex were found to be
normal at the knee but absent at the ankle. The plantar
responses were flexor. There was some impairment of
sensation to light touch over both feet and poor
discrimination between sharp and blunt pin-prick.
There was in addition some loss of vibration sense
bilaterally. There was loss of pain sensation in the tendo
achilles bilaterally. Co-ordination was only fair and
rombergism was present. The gait was inclined to be
ataxic. There was no evidence of disease affecting the
cranial nerves and no Argyll-Robertson pupil.
Osteopathically the posture was poor, the patient having
a degree of kyphosis diagosis and a poor lordosis.
Active movements were poor. Vertebral joint mobility
was poor throughout but L4/5 and L5/S1 were completely
immobile. A provisional of locomotor taxia was made,
but purely skeletal factors, x-rays were taken. These
rather surprisingly showed Paget's disease affecting the
left ilium and sacrum.
The empathasis here of course is on a thorough
neurologocal examination which suggested the
presence once again of a more serious condition.
CASE 3. A single woman aged 49 years presented for
examination at the British School of Osteopathy clinic
complaning of pain in the right buttock radiating into the
right leg. She also complained of numbness in the left
thigh. The symptoms had commenced some eighteen
months previously and the patient had associated these
with a fall the previous year. One month of bed-rest had
releived the symptoms completely. Six months later a
simialr attack occured. The patient was x-rayed at
hospital. A diagnosis of prolapsed intervertebral disc was
made and the patient put into a surgical corset. The
present attack had begun some two months prior to her
presenting for examination. It was definately the most
severe attack that she had experienced.
There was very little in the past medical history except
for an operaton for removal of a so-called fibroid.
Unfortunately the history as recorded is not sufficiently
clear on the nature of the operation and it is not known
whether this was in fact a hysterectomy. The fact that the

menstruation ceased following the operation suggests
that this was done. This is, however as the remainder of
this history will make clear. The general health was
reported to be good.
On examination the tendon reflexes at the knee were
present and normal in response, but the ankle reflexes
were absent. The straight leg raising test proved to be
positive at 60° of elevation on dorsiflexion of the ankle.
Osteopathically the posture was fair with a slight dorsal
kyphosis. Active movements were restricted mobility in
L5/S1 and L4/L5. The sacro-iliac joints were mobile and
there was no pelvic asymmetry. There was marked
localised muscle health tension in the erector spinae
especially on the right side.
A diagnosis was made of lower lumbar prolapsed
intervertebral disc with nerve root invlovement. The
initial treatment increased the amount of sciatic pain.
Following the second treatment the sciatic pain lessened
but there had been a rapid increase in the area of
sensory loss in both limbs and rectal anaesthesia,
noticed during defaecation, had made its appearance.
This picture suggesting compression of the fourth sacral
nerve root can only be accounted for by pressure within
the neural canal. Radiographs were therefore ordered to
try and discover the exact nature of pathology, the
appearance was almost identical to that of secondary
carcinoma. One is led back to the case history and its
regrettable lack of detail.
The patient was referred back to her general practitioner
with a covering letter and from there she was referred to
the National Orthopaedic hospital. We unfortunately
have been unable to get any information regarding the
further history of this patient.
The significant factor in this case is ther evaluation of the
alteration in symptoms. A diagnosis is often a conclusion
drawn from a few facts. As these facts change, or more
facts come to light, we must be prepared to alter our
original conclusions accordingly. It is also worth
remembering the old aphorism that the wise clinician is
one who does not rush into a diagnosis, a valuable
saying which has tended to become lost in these days of
certification and classification.
So far the examples I have dealt with have been cases
where osteopathic treatment was neither indicated or
desirable. It is interesting to note that in one of these
cases an apparant osteopathic lesion was present but
treatment to it had proved ineffective. This was because
there was other pathology in the vicinity and the
restricted mobility and the muscle spasm was related to
this. It is pertinent to quote again from MacDonald or
Hargrave Wilsons:
"The moment definare pathology, other than half of
acute or chronic joint strain, develops, the lesion is no
longer essentially osteopathic."

This I think is a point that we should keep constantly in
mind. Because we diagnose restricted mobility and
altered position of vertebra at rest, it does not follow that

.there is no other pathology present. Only careful history
taking, thorough clinical examination and careful
observation of the patient's response to treatment,
coupled with a willingness to use other methods of
investigation, especially x-rays, will enable us to spot
these cases which need other methods of treatment.
There are many occasions when even although a more

serious condition is present which is not considered
amenable to osteopathic treatment, we may be able to
relieve some of the pain or other symptoms. It is utterly
useless attempting to treat such a case unless one
carefully diagnoses the underlying condition. In fact
diagnosis here is even more important since we must
understand the disease process fully before we can say


what effect treatment may have on it, remembering
always that this may even accelerate the disease process.
In such a case, intituting treatment without attempting to
establish a diagnosis could be held to constitute
negligence.
CASE 4. An example which illustrates these points
concerns a patienty who was under treatment for a time
at the British School of Osteopathy Clinic. This patient
presented with what appeared at first to be normal
brachial syndrome; the symptoms of which were chiefly
pain, loss of power, and sensory changes in the right
arm. Horner's syndrome (a paralysis of the cervical
sympathetics) was also present. There was also a
persistent cough. On inspection the skin over the
anterior and posterior aspects of the chest wall above the
level of the fourth rib exhibited a mottled appearance. As
it happened the patient's wife made a present of the
diagnosis: carcinoma of the right upper lobe. Had we not
had this information and had we failed to make a correct
diagnosis, the result of treatment might well have been
disastrous since the neoplastic tissue was dangerously
close to the spine. With the permission of the patient's
general practitioner we gave a few conservative
treatments in the hope of reducing some of the pain.
These were, however, wholly unsuccessful.
Another type of case we often meet in practice is the one
where an osteopathic condition is combined with, and
often obscured by, a more serious condition. Here again
it is virtually impossible to give a prognosis or prescribe
the correct treatment until a diagnosis is established,
since from confusing mass of symptoms one cannot say
which might be amenable to treatment.
An excellent example of this is furnished by the case
history of a patient who was the subject of a
demonstation by Dr. Pentney and myself at this British
school of Osteopathy post-graduate course in 1975.
CASE 5. This patient complanined of a confusing mass of
symptoms as follows:

(l)Scolisis. ©Facial asymmetry. (9)Loss of power of
(2)Low back ache. (7)Tremor of face right hand.

(3)Headaches. and head. (10)Deviation to the
(4)Stiff neck. (S)Paraesthesia of right when walking.
©Pain in right arm. right hand.
There is probably little to be gained by labourisly going
over a painstaking neurological examination; suffice to
say that eventually, with the help of radiographs, a
diagnosis of cerebellar ataxia and "congenital"
sternomastoid torticollis was made. This diagnosis
enabled enabled enabled us to evaluate the symptoms
and give the patient a prognosis which has proved to be
accurate in practice.
The torticollis being treated for many years, by pulling
the cervical spine strongly to the right, had caused disc
degeneration with simply massive osteophyte formation
giving a buttressing effect on the concave side. It was not
difficult to see that this was responsible for the stiff neck
and the muscle tension and therefore headaches. In
addition the degenerative picture was causing
compression of some components of the brachial plexus
giving the symptoms in the right arm.
Since the head had been pulled to the right for many
years by the shortened sterno-mastoid, facial
asymmetry had occured. In addition, the need to keep
the eyes horizontal when assuming the erect posture had
caused the scoliosis. This scoliosis although very marked
in the erect position showed no sign of being organic
when the patient was lying prone. The low back strain
was thought to be secondary to the scoliosis.
The patient has made the most remarkable progress. Her
right arm is permanently symptom free. Her neck
although still stiff is no longer painful and headaches are
a thing of the past. Since treatment of the torticollis is not
now practical or desirable on account of the
degenerative changes in the cervical spine, the facial
asymmetry remains as does the scoliosis. Not
surprisingly she therefore has occasional low back ache
but this is rare and resonds well to treatment. The
essentially neurological symptoms have showed only a
very little change as was to be expected. There is nothing
more gratifying to the practitioner, or more likely to
inspire confidence in the patient, than to observe a
carefully worked out prognosis, possible only on the
basis of an accurate diagnosis, being borne out in
practice.
There is one last category which I should like to
consider. There are many conditions which display a
symptom picture similar to another totally unrelated
condition, thus a sacro-iliac strain may simulate
appendicitis; intercostal neuitis or a rib lesion may
simulate cholecystitis. An even closer simularity is found
when cervical myelopathy is found to simulate
neurological disease.
Bradshawe has done a statistical analysis of 78 patients
suffering from cervical spondylosis associated with
positive neurological signs. He stressed the importance
of differential diagnosis, particularly since cervical
myelopathy can on occasion sumulate motor neurone
disease, diseminated sclerosis, subacute combined
degeneration of the cord or syringomyelia.
The last case hitory illustrates this point.
CASE 6. A female patient aged 65 years complained of
pain in the right side of her neck, and loss of power in
her right leg, which was cold and cyanosed. In addition
there was loss of power in the right hand and arm. The
patient gave a history of haven fallen down some stairs
and struck her head. The subsequent pain which was
diagnosed a fibrositis was treated ineffectually and one
year later the other symptoms began to make their
appearance, first in the arm and then in the leg. There
was nothing of significance in the remainder of her
history.
On examination the tendon were all present on the left
and the knee and biceps were present on the right, the
other were absent. Plantar responses were flexor. There
was clonus and spasticity. The muscles of both the right
arm and leg showed complete loss of tone. There was
general loss of power in both these limbs but the
hamstrings and wrist flexors showed virtually no power
at all. With regard to sensation there was loss of fine
touch in the right hand. Co-ordination and
proprioception were impaired. Vibration sense was

absent in the right tibia. Rombergism was present.
Osteopathically the posture was poor with a kyphosis
and increased cervico-dorsal angle There are was
restricted mobility in the mid cervical lower lumbar areas
which were both x-rayed. The films of the cervical area
showed extensive degeneration between C5 and Tl with
calcification of annular ligaments anteriorly.
Had this case been one of a neurological disease with
established pathology the prognosis would have been
very poor indeed. As it is this patient is so far improved
that a consultant physician at one of the London
teaching hospitals regards her improvement as
miraculous. The fact that some of the cases will respond
to osteopathic treatment should make us especially
careful to differentiate carefully between them and cases
of true nervous tissue pathology.
In all cases described in this paper there had been no


need for elaborate investigations other than x-rays, to
arrive at the necessary conclusions, although it is
admitted that this would sometimes have been necessary
to establish the exact diagnosis, e.g. Case 1. All the
clinical evidence used apart from the x-rays could have
been obtained in any osteopath's consulting room.
I do not think it is possible to overestimate the value of
x-rays in osteopathic practice. In three of the cases
referred to, diagnosis would have been impossible
without radiographic evidence, however good one's
clinical ability.
I am not a supporter of routine x-ray prior to all
manipulation which I know is an orthodox contention.
This however may be necessary in the case of the
osteopaedic surgeon whose manipulations are stronger
and less specific than the osteopath's and therefore more
dangerous, and whose examination is much more
cursory.

Indications for x-ray investigation

I have drawn up a set of what might be called "golden
rules" governing the use of x-rays in osteopathic
practice:

1. Gentle treatment produces a reaction in the absence
of signs indicating an acute condition. (Often the
case where bony pathology exists, e.g. Case 1).
2. A patient complains of bilateral referred pains in the
extremities. (Often anomalies e.g. spondylolisthesis,
cervical rib, or cauda equina syndrome).
3.
The patient makes on response to treatment
whatsoever. (Occasionally some mild pathology
but x-rays often negative, indicating symptoms
referred skeletally from some remote source, e.g.
visceral pathology).
4.
The patient gets a severe reaction to treatment.
(Often local skeletal or other pathology).
5. If the
patient has had radical operation within the
last ten years e.g. hysterectomy, colostomy or
gastrectomy. (The patient may say that the
operation was for ulcer, fibroid or obstruction.
X-ray may show secondary deposits e.g. Case 3).
Following these simple rules will rarely waste the
patients' time or money. If the films are negative, the
patient often responds dramatically to the words, "there
is nothing seriously wrong."
There are maby other methods of "further investigation"
available to the osteopath. Many osteopath have facilities

within their reach for first class laboratory investigations.
This is certainly true in London. Others within their own
premises carry out urinalysis, erythrocyte sedimentation
rates and haemoglodin investigations.
In the final analysis however however, there is no
substitute for knowledge. In the past the profession has
had little to offer in the way of printed technical matter for
its members. Gradually however this void is being filled
and we now have a quarterly publication devoted to
technical and scientific subjects. By supporting this
publication both by contributing and using it as forum
for discussion, we may help one another to be better
practitioners.

Summary

I do not believe, and I do not think it possible for anyone
else to believe, that the osteopathic lesion, or structural
derangement of the skeletal system, or any combination
of these, is solely responsible for disease and ill health.

There are many other aetiological factors in disease
besides structural ones.
If this is so, it is essential that so long as we are
independant practitioners we must be able to recognise
other aetiological factors and be able to relate these one
to another and to the patient's symptom picture. This
process is dagnosis and is essential to scientific and
successful treatment.
I have discussed treating the patient as a whole, I do not
think that manipulation of every joint of body is treating
the body as a whole. We must, to warrant such a claim,
carefully consider every tissue, organ and system of
which the body is composed. This often means resorting

to measures in examination and treatment which are not

exclusively, and sometimes not even remotely,

osteopathic.

Six case histories have been set out in sufficient detail to

illustrate the place of medical diagnosis in clinical

osteopathy.

Lastly I have suggested some ways in which we might
improve our ability to recognise some of these conditons
which present with similar symptom pictures to many of
our succesful cases, but whose treatment is beyond our
scope as osteopaths. I have also hinted at measures
which may be adopted to assist in diagnosis and given
some detail on the illustration of radiographs.

Conclusion

A practice in which only osteopathic structural diagnosis
is carried out and every restricted joint mobilised, will, by
a hit and miss method, secure a percentage of results
which are favourable. There may well be sufficient to
these to maintain the practice and satisfy the
practitioner. However, in such a practice, cases will be
treated in which osteopathic lesions are present, yet play
little or no part in the causation of the disease process.
Other cases may have centra-indicators to
mainipulation or certain types of manual treatment.
Patients in both of these groups often cease treatment
voluntarily when they fail to respond or get worse. Worst
of all, in such a practice serious errors may occur if
centra-indicators are overlooked or ignored.
By contrast, in a practice where the lesion is being
viewed in its true perspective in relation to other factors,
selection of cases automatically follows, the numbers of
patients not responding to treatment will necessarily be
less and the number of serious errors will be reduced.
Lastly the percentage of successful cases will
correspondingly higher.
Quite apart from the provisional benefit to our patients
and the increase in goodwill toward our profession, our
practices will be more successful, and above all else, our
work will stand an infinitely better chance of finding its
rightful place in the treatment of disease and ill-health.

REFERENCES

(1) Spernasky: A Basis for thew Theory of Medicine. International
Publishers. New York, 1943.
(2) Haycock: The Exapanding concept of Osteopathy. Osteopathic
Publishing Co. London 1955.
(3) MacDonald & Hargrave Wilson: The Osteopathic Lesion.
Heinermann. London 1935.
(4) Black's Medical Dictionary: 20th Edit. A. & C. Black. London
1951.
(5) MacDonald & Hargrave-Wilson: The Osteopathic Lesion.
(6) Bradshaw: Quart. J. Med. 26.

[JJM]

@drodway wrote "An article written by an osteopath from fifty years ago has become availalble on the net. I think it shows that even 50 years ago Osteopathy hardly qualifies as woo."

What the quoted opinion piece shows is that there was a DO who wanted to rein in the most absurd notions of your trade; without totally abandoning the notion of the "osteopathic lesion" as having some (albeit minor) part in every ailment.

Move forward to today, and you still advertise http://www.osteopathdr.com/treatment.html quackery. You say osteopaths treat: "... birth problems, growth disorders, developmental problems ..." You also coyly state that you "see" people with: "M.E. (‘chronic fatigue syndrome’), irritable bowel syndrome"; in which case "see" is apparently not to be equated with "have a beneficial effect."

As long as you make bogus explicit (or implied) claims of therapy, it does not matter what others write today or yesterday.

[Pebble]

@drodway wrote "An article written by an osteopath from fifty years ago has become availalble on the net. I think it shows that even 50 years ago Osteopathy hardly qualifies as woo."

What the quoted opinion piece shows is that there was a DO who wanted to rein in the most absurd notions of your trade; without totally abandoning the notion of the "osteopathic lesion" as having some (albeit minor) part in every ailment.

Move forward to today, and you still advertise http://www.osteopathdr.com/treatment.html quackery. You say osteopaths treat: "... birth problems, growth disorders, developmental problems ..." You also coyly state that you "see" people with: "M.E. (‘chronic fatigue syndrome’), irritable bowel syndrome"; in which case "see" is apparently not to be equated with "have a beneficial effect."

As long as you make bogus explicit (or implied) claims of therapy, it does not matter what others write today or yesterday.



[COLOR=#444444][FONT=Tahoma]The Journal and Proceedings of the
Osteopathic association of Great Britain

December 1960


The place of Medical Diagnosis in
Clinical Osteopathy

By
Colin I. Dove, D. 0., M. R. O.

"but I am convinced
the most important single reason in the accumulation of
years of experience which shows beyond all shadow of
doubt that many conditions are not amenable to
osteopathic treatment and further, many that cannot be
prevented by it."

" Rarely does one come across a subject who does not present with
restricted mobility of vertebral joints in some area of the
spine. Whether this is necessarily always osteopathic,
and more important still whether at should always be
treated, are fascinating and controversial questions,"


" There is, I am sure, far too much haphazard
"correction of lesions" without careful consideration of
whether these can conceivably be related to presenting
symptoms. There are many instances where osteopathic
lesions exist but are completely unrelated to the
condition with which the patient is presenting."

"It follows then that osteopathic spinal treatment is the treatment of choice in
conditions where the osteopathic vertebral lesion is the
most important aetiological factor. It could also of
course be considered as adjunctive therapy in a case
where osteopathic vertebral' lesions were present and
related to the condition yet were not the most important
aetiological factor. In this concept the osteopath
admittedly becomes a specialist in diagosing and
treating one aetiological factor."


"Obviously then, it is of the utmost importance that a
practitioner specialising upon osteopathic lines must be
fully cognisant of the possibilities of all aetiological
factors."


It may be an opinion piece, but there is much to commend in Cove's writings. Recognition of the limitations of one's profession is definitely the starting point, recognition of the role of others in related fields is pivotal. The medical profession doesn't have all the answers either.

[JJM]

It may be an opinion piece, but there is much to commend in Cove's writings. Recognition of the limitations of one's profession is definitely the starting point, recognition of the role of others in related fields is pivotal.Certainly; but, as demonstrated by Mr. Rodway, quackery persists 50 years later. And he believes he is an exemplar of his trade. Furthermore, one of his national organizations sanctions craniosacral quackery. How bad does it have to be for you to acknowledge that prescientific notions still prevail?


The medical profession doesn't have all the answers either.Are you offering this as a straw man? Did anyone make this claim? What does that mean- when medicine has nothing to offer do you consult an astrologer? You might as well do that as consult an osteopath, chiropractor, homeopath or anyone you pass on the street. What do you think quacks offer that medicine does not, except for bogus assurances.

[Pebble]

Are you offering this as a straw man? Did anyone make this claim? What does that mean- when medicine has nothing to offer do you consult an astrologer? You might as well do that as consult an osteopath, chiropractor, homeopath or anyone you pass on the street. What do you think quacks offer that medicine does not, except for bogus assurances.

Why not re read the thread, this is not the first time this issue has come up. I would recommend you search for posts dealing with randomised controlled trials of the management of low back pain.

[JJM]

Originally Posted by JJM http://www.ukskeptics.com/forum/images/buttons/viewpostright.png (http://www.ukskeptics.com/forum/showthread.php?p=90064#post90064)
Are you offering this as a straw man? Did anyone make this claim? What does that mean- when medicine has nothing to offer do you consult an astrologer? You might as well do that as consult an osteopath, chiropractor, homeopath or anyone you pass on the street. What do you think quacks offer that medicine does not, except for bogus assurances.

Why not re read the thread, this is not the first time this issue has come up. I would recommend you search for posts dealing with randomised controlled trials of the management of low back pain.Which issue? I seem to recall you noting there are problems that elude medicine; but not the suggested straw man that 'medicine has all the answers.'

I also seem to recall that you think it is reasonable to turn to quackery when medicine has no answers. From the consumer's standpoint, that is unfortunate because it promotes flummery.

We have a saying that things that are safe and effective are called 'medicine.' What do quacks offer that you (and your colleagues) cannot figure out?

[Pebble]

Which issue? I seem to recall you noting there are problems that elude medicine; but not the suggested straw man that 'medicine has all the answers.'

I also seem to recall that you think it is reasonable to turn to quackery when medicine has no answers. From the consumer's standpoint, that is unfortunate because it promotes flummery.

We have a saying that things that are safe and effective are called 'medicine.' What do quacks offer that you (and your colleagues) cannot figure out?

Most of this is well trammeled, so I shall ignore.

You appear however to be making a fine distinction that eludes me.

There are problems that elude medicine! This does not appear to bother you, and by elude I presume we are agreed that this means people have symptoms or diseases that we neither fully understand nor know how to treat.
To me it follows that there are symptom complexes that we have no evidence base for properly ascribing a pathobiological cause or any rational evidence based therapeutic options.
Yet summarising this as 'medicine does not have all the answers' gets you fired up. Why?

Perhaps you are making the illogical leap to a place where this suggests that others do. Not all questions currently have answers, and probably ever will.

[davidrodway]

I will be interested to see whats in this book (see below)

If it contains good quality RCTs (OK, we can't double blind but we can single blind), then it will be very useful. But if it is just conjecture - ie possible anatomical and physiological pathways that might possibly "explain how osteopathy works", then I'm afraid it gets us nowhere. So I hope it is the former, not the latter.


To: osteopathyforall@yahoogroups.com
From: hhkingdo@hotmail.com
Date: Thu, 2 Sep 2010 12:30:46 -0700
Subject: RE: Osteopathy For All New book on manual treatment of systemic conditions



http://www.elsevierhealth.com/product.jsp?isbn=9780702033872 (http://www.elsevierhealth.com/product.jsp?isbn=9780702033872)

access to this book


The Science and Clinical Application of Manual Therapy

Edited by Hollis H. King, DO PhD, Wilfrid Jänig, MD PhD and Michael M. Patterson, PhD

Approx. 328 pages
Trim Size 189 X 246 mm
Copyright 2011
GBP 45.99, Hardcover, Reference


Expected Release Date: Oct 2010

Description

The Science and Clinical Application of Manual Therapy is a multi-disciplinary, international reference book based on work by the top basic science researchers and clinical researchers in the area of Manual Therapy and Manual Medicine (MT/MM). The first book to bring together research on the benefits of MT/MM beyond the known effects on musculoskeletal disorders, the volume presents evidence of the benefit of MT/MM in treating systemic disorders.

This book makes a powerful case for how MT/MM affects the central nervous system and the autonomic effector systems (the circulatory, respiratory, gastrointestinal systems, and pelvic organs) which impact on a person's health. The volume covers how MT/MM works and details the conditions - such as chronic skeletal and visceral pain diseases, asthma, pneumonia, and cardiovascular deregulation - that can benefit from it. Longstanding theoretical models of MT/MM mechanisms are critically assessed in the light of current understanding of physiological and neurophysiological function, and the influences of psychological and cortical processes on the effects of MT/MM are explored.

The book, which is divided into four main sections, will appeal to osteopathic physicians, osteopaths, chiropractors, physical therapists and massage therapists, as well as all body workers/health practitioners who use their hands in health care. It will be of particular value to all practitioners involved in treatment of chronic pain disorders as well as those involved in basic and clinical research in this field.
Key Features

* Authored by the leading multidisciplinary basic science and clinical researchers from throughout the world

* Describes research confirming benefit of MT for musculoskeletal disorders (which helps provide a rational for greater utilization of manual therapy and reimbursement for this healthcare service)

* Presents the latest findings on the beneficial effect of MT on systemic disorders including asthma, pneumonia, otitis media, heart rate dysfunction and GI disturbance

* Critically assesses longstanding theoretical models of MT/MM mechanisms with respect to the current understanding of physiological and neurophysiological function

* Explores the influences of psychological and cortical processes on the effects of MT/MM, including the effect of placebo

* Uniquely presents research findings from all the manual therapy professions and scientists making the case for the benefits of MT

* The symposium from which the book was derived was supported by the NIH National Center for Complimentary and Alternative Medicine

Contents

Author Information

Edited by Hollis H. King, DO PhD, Professor of Osteopathic Principles and Practice, AT Still University School of Osteopathic Medicine in Arizona, USA; Wilfrid Jänig, MD PhD, Professor of Physiology, Physiologisches Institut, Universität Kiel, Germany and Michael M. Patterson, PhD, Professor of Osteopathic Principles and Practices, College of Osteopathic Medicine, Nova Southeastern University, Florida, USA.

[davidrodway]

See below. If it contains good quality RCTs (OK, we cant double blind but we can single blind), then it will be very useful. But if it is just conjecture - ie possible anatomical and physiological pathways that might possibly "explain how osteopathy works", then I'm afraid it gets us nowhere. So I hope it is the former, not the latter.



http://www.elsevierhealth.com/product.jsp?isbn=9780702033872 (http://www.elsevierhealth.com/product.jsp?isbn=9780702033872)





The Science and Clinical Application of Manual Therapy

Edited by Hollis H. King, DO PhD, Wilfrid Jänig, MD PhD and Michael M. Patterson, PhD

Approx. 328 pages
Trim Size 189 X 246 mm
Copyright 2011
GBP 45.99, Hardcover, Reference


Available: PRE-ORDER NOW
Expected Release Date: Oct 2010

Description

The Science and Clinical Application of Manual Therapy is a multi-disciplinary, international reference book based on work by the top basic science researchers and clinical researchers in the area of Manual Therapy and Manual Medicine (MT/MM). The first book to bring together research on the benefits of MT/MM beyond the known effects on musculoskeletal disorders, the volume presents evidence of the benefit of MT/MM in treating systemic disorders.

This book makes a powerful case for how MT/MM affects the central nervous system and the autonomic effector systems (the circulatory, respiratory, gastrointestinal systems, and pelvic organs) which impact on a person's health. The volume covers how MT/MM works and details the conditions - such as chronic skeletal and visceral pain diseases, asthma, pneumonia, and cardiovascular deregulation - that can benefit from it. Longstanding theoretical models of MT/MM mechanisms are critically assessed in the light of current understanding of physiological and neurophysiological function, and the influences of psychological and cortical processes on the effects of MT/MM are explored.

The book, which is divided into four main sections, will appeal to osteopathic physicians, osteopaths, chiropractors, physical therapists and massage therapists, as well as all body workers/health practitioners who use their hands in health care. It will be of particular value to all practitioners involved in treatment of chronic pain disorders as well as those involved in basic and clinical research in this field.
Key Features

* Authored by the leading multidisciplinary basic science and clinical researchers from throughout the world

* Describes research confirming benefit of MT for musculoskeletal disorders (which helps provide a rational for greater utilization of manual therapy and reimbursement for this healthcare service)

* Presents the latest findings on the beneficial effect of MT on systemic disorders including asthma, pneumonia, otitis media, heart rate dysfunction and GI disturbance

* Critically assesses longstanding theoretical models of MT/MM mechanisms with respect to the current understanding of physiological and neurophysiological function

* Explores the influences of psychological and cortical processes on the effects of MT/MM, including the effect of placebo

* Uniquely presents research findings from all the manual therapy professions and scientists making the case for the benefits of MT

* The symposium from which the book was derived was supported by the NIH National Center for Complimentary and Alternative Medicine

Contents

Author Information

Edited by Hollis H. King, DO PhD, Professor of Osteopathic Principles and Practice, AT Still University School of Osteopathic Medicine in Arizona, USA; Wilfrid Jänig, MD PhD, Professor of Physiology, Physiologisches Institut, Universität Kiel, Germany and Michael M. Patterson, PhD, Professor of Osteopathic Principles and Practices, College of Osteopathic Medicine, Nova Southeastern University, Florida, USA.

[Pebble]

* Describes research confirming benefit of MT for musculoskeletal disorders (which helps provide a rational for greater utilization of manual therapy and reimbursement for this healthcare service)

* Presents the latest findings on the beneficial effect of MT on systemic disorders including asthma, pneumonia, otitis media, heart rate dysfunction and GI disturbance

* Critically assesses longstanding theoretical models of MT/MM mechanisms with respect to the current understanding of physiological and neurophysiological function


* Uniquely presents research findings from all the manual therapy professions and scientists making the case for the benefits of MT


No reviews yet, and not yet available over here. But considering that this is a sales pitch and thus the most exciting things that can be inferred about the book, I wouldn't hold out much hope. The benefits are not critically reviewed only the theoretical models.

[Blue Wode]

Here’s an interesting new figure that’s relevant to this thread: A recent report commissioned by British Osteopathic Association has revealed that just 18% of Primary Care Trusts in England paid for osteopathic treatment for patients during 2009/2010:
http://www.osteopathy.org/OHBQPP53557 (http://www.osteopathy.org/OHBQPP53557)


The call to the public to talk to their GPs or even lobby their MPs about getting osteopathy on the NHS follows the publication of a recently commissioned report by the BOA which showed that just 18% of Primary Care Trusts (PCT) in England paid for patients to have osteopathic treatment in 2009/2010.

The report comes a year on from the issuing of NICE1 (The National Institute for Health and Clinical Excellence) guidance on low back pain which recommends that referral for a course of manual therapy (to include osteopathy) be considered by GPs for patients with low back pain.

It is the association’s second survey into the availability of osteopathy on the NHS and was based on responses received from 126 of the 147 PCTs contacted under the Freedom of information act in England earlier this year.

Analysis of the data showed that approximately 9000 patients received osteopathic treatment on the NHS in the year 2009/10, a small proportion of the estimated 7 million individual osteopathic treatments carried out each year.

The report also indicated huge variations across the country with some PCTs funding over 1000 patients for osteopathy in their area and others none at all.

In its conclusion the report said that the NICE guidelines were not currently being implemented in full by many PCTs and recommended that “PCTs must make more effort to ensure the implementation of NICE guidelines to allow a full range of effective treatments to be available to patients as recommended by NICE”

It also recommended that, in the light of the planned overhaul of the NHS and the shift to GP commissioning “Osteopathy, an evidence based and cost-effective treatment, should be considered as part of any new service developments”

Greater commissioning power for GPs and greater choice for patients is at the heart of the new coalition government’s vision for the health service.

1The National Institute for Health and Clinical Excellence (NICE) is an independent organisation responsible for producing guidance and recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales, based on the best available evidence.
NICE, Guidance for Low Back Pain, May 2009 http://guidance.nice.org.uk/CG88 (http://guidance.nice.org.uk/CG88)


I don’t know how widely applicable the following situation is nationally, but a spokeswoman for NHS Brighton and Hove said it offered patients a variety of treatment that covered all aspects of back pain, so osteopathy was not necessary:

“NHS Brighton and Hove funds the complete range of treatments for lower back pain described in the NICE guidance, including spinal manipulation and acupuncture. Our physiotherapy service employs many staff who are qualified and experienced in the delivery of these treatments and, coupled with short waiting times, provide an exceptional service to all patients irrespective of income.”

http://tinyurl.com/3xy6lrf



It’s also worth remembering that that many GPs have been barred from applying NICE back pain guidance for acupuncture and spinal manipulation, apparently because of the controversy surrounding it:

GPs are being prevented from putting controversial NICE guidance on low back pain into action because primary care organisations are refusing to fund its recommendations of acupuncture and spinal manipulation.

Of 127 PCOs responding to requests under the Freedom of Information Act, half said they were currently providing no funding for spinal manipulation.

-snip-

The institute’s guidance on low back pain advises that patients should be offered exercise, a course of manual therapy or acupuncture as first-line treatments.

The recommendation was fiercely attacked by musculoskeletal specialists, who questioned whether there was evidence the treatments were effective on top of standard care.

Pulse’s investigation suggests PCOs have felt able to ignore NICE’s recommendation because of the controversy surrounding it.

NHS Newham said funding for acupuncture was limited ‘due to the limited evidence of clinical effectiveness’.

NHS Bassetlaw said it would only consider funding ‘as an individual funding request and clinical exceptionality would need to be demonstrated’.

NHS Hastings and Rother and NHS East Sussex Downs and Weald both said: ‘This service constitutes a low priority and is not funded except in exceptional circumstances.’

NHS Salford said it usually limited the number of spinal manipulation sessions patients were allowed to six, despite NICE guidance recommending nine.

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4126959 (http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4126959)




So, fortunately, it would seem that many NHS commissioners are up to speed with the real evidence for low back pain, as well as being aware of the ‘bait and switch’ of unscientific medicine:
http://www.dcscience.net/?p=1516 (http://www.dcscience.net/?p=1516)

:smiley:

[davidrodway]

(http://www.dcscience.net/?p=1516)

Are the PCTs saying "There is no evidence that spinal manipulation helps and anyway our in-house physios provide it already?". Hardly sounds a sensible stance.

[jimwalsh]

sorry for the thread necromancy...

this may be of interest to the Anti osteopathy camp :)

Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials.

Posadzki P (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Posadzki%20P%22%5BAuthor%5D), Ernst E (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ernst%20E%22%5BAuthor%5D).
Complementary Medicine, Peninsula Medical School, 25 Victoria Park Road, Exeter, Devon, EX2 4NT, UK, Paul.Posadzki@pcmd.ac.uk.
Abstract

The objective of this systematic review was to assess the effectiveness of osteopathy as a treatment option for musculoskeletal pain. Six databases
were searched from their inception to August 2010. Only randomized
clinical trials (RCTs) were considered if they tested osteopathic
manipulation/mobilization against any control intervention or no therapy
in human with any musculoskeletal pain in any anatomical location, and
if they assessed pain as an outcome measure. The selection of studies,
data extraction, and validation were performed independently by two
reviewers. Studies of chiropractic manipulations were excluded. Sixteen
RCTs met the inclusion criteria. Their methodological quality ranged
between 1 and 4 on the Jadad scale (max = 5). Five RCTs suggested that
osteopathy compared to various control interventions leads to a
significantly stronger reduction of musculoskeletal pain. Eleven RCTs
indicated that osteopathy compared to controls generates no change in
musculoskeletal pain. Collectively, these data fail to produce
compelling evidence for the effectiveness of osteopathy as a treatment
of musculoskeletal pain.


http://www.springerlink.com/content/h344x346m6u34284/fulltext.pdf


full text here for anyone that really wants to read the full thing.

[Pebble]

Thanks JJM
Useful paper, cannot work out what SC means in the table of interventions - no legend. Authors fail to provide analysis of the 291 who benefited versus the 923 that did not, this could in theory represent a 20% superiority. So although the results are presented as negative, I fail to see a true statistical analysis of the amalgamated cohort. The failure to extract over half of the studies identified as of potential interest is not fully explained (probably unpublished).
So suggests that what is already suspected - no convincing evidence for OMT in musculoskeletal conditions is correct, points out the need to fill this gap - but no statement of inefficacy either.

[jimwalsh]

Thanks JJM

thats the other fellow ;)

It would have nice to have had the search as well

it does come across as something of an academic hatchet job...

as an aside I am part way through my MSc at UCL in sports medicine

and if you think the level of evidence for osteopathy is poor, sports medicine and orthopaedic surgery leaves much to be desired as well. which of course does not excuse the former for its sins of ommission. however I was expecting a much higher standard of evidence for some pretty major interventions. I guess thats what happens when you frequent skeptic sites ;)

[Pebble]

thats the other fellow ;)




Apologies, just shows my bias, I assumed that JJM would have been proposing this as the definitive paper on the subject.