Osteopaths on the loose...

[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
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

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





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

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

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

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

[davidrodway]

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, Ernst E.
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/...4/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.