201 Osteopathy
In the US, Doctors of Osteopathy (DOs) are medical school trained, practicing physicians (equivalent to MD). So what’s the difference?
“Osteopathic physicians bring the additional benefits of osteopathic manipulative techniques to diagnose and treat patients.” Which translates to some additional courses in methods such as Craniosachral Therapy – skull squeezing. Where did they come up with this?
“William Garner Sutherland DO (1873-1954) graduated from the American School of Osteopathy (ASO) in 1900. Dr. Sutherland described different aspects of the PRM, including the motility of the Neural Tube, the mobility of the cranial membranes and bones, and a core link between the cranium and sacrum that coordinated their motion. He identified the fluctuation of the cerebrospinal fluid as the first and most fundamental principle of this mechanism. Within it, he had found a potency, an invisible fluid within the fluid, that had Intelligence. This Tide, containing what Dr. Still called the “highest known element”, was of central importance in the cranial concept. Dr. Sutherland called this invisible element the “Breath of Life”. He observed that when the CSF fluctuation was brought to a short rhythmic period of fluctuation, a stillness was revealed at the center of the Tide, and a transmutative process unfolded in which the Breath of Life nourished every cell in the body.”
Now, I’m not saying that DOs are bad doctors. I’ve tackled this subject once before after a DO almost killed my friend, and subsequently ruined a dinner party when I criticized the practice.
I asked Dr. David Gorski (MD, PhD, surgeon and managing editor of Science-Based Medicine), and he explained:
“In the US, most DOs are not distinguishable from MDs. They still learn woo in school but usually don’t use it in practice. Postgraduate training generally weans DOs from the woo, or they learn it because they have to and then forget.”
How is it that this bit of pseudoscience has attracted so many medical students? Perhaps because it opens up a market of potential patients looking for more “holistic” experience.
For my article, can you explain what you're doing?
DO
Of course! It's a manipulation known as craniosacral therapy.
ROB
How is osteopathy different from alternative medicine?
DO
D.O.'s go through med school. Think of it as an elective.
ROB
So really, you should know better than to perform skull squeezing as a treatment?
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“invisible fluid within the fluid…center of the Tide…Breath of Li-” NOPE NOPE NOPE NOPE NOPE NOPE NOPE
“Not sure what a Doctor of Osteopathy is? D.O.s are M.D.s who complete an additional course in medical school, and less than 10% of physicians elect to claim this title.”
That’s not quite right. It’s not “an additional course in medical school.” There are DO schools and MD schools. Which one you get into, or choose to attend, determines whether you end up an MD or a DO.
Some people want to be DOs, but for others, DO schools are their “safety schools.” DO schools are in general slightly less selective than the average MD school, but more so than, say, a Caribbean MD school.
As previously when you’ve criticized “woo,” I think you underestimate the degree to which allopathic medicine practices and promotes various forms of unscientific or unsupported crap. We’re not all that pure. It’s also important to recognize the social and ceremonial aspects of medical and their importance in healing, such that the dichotomy between EBM and not is not quite as simple or absolute as you seem to think it is.
Robert ***, EMT-P, MD, BCEM (board-certified emergency medicine)
Haha, my sentence on the topic is certainly a simplification, I like your explanation better!
The antibiotics recently prescribed for our infants’ viral ear infection are a good example of “woo” in US medicine – and it was tough as a parent not to give it to our little one EVEN THOUGH I knew it would do nothing.
wait u wot m8 – why would they prescribe antibiotics for a viral infection?
“As previously when you’ve criticized “woo,” I think you underestimate the degree to which allopathic medicine practices and promotes various forms of unscientific or unsupported crap.” This is an irrelevant AdHominem argument which seems to be along the lines of “you can’t criticise woo because mainstream medicine also uses woo”. As presented here, the dichotomy isn’t between EBM (evidence based medicine) and not, but is simpy against woo. There is no dichotomy being presented.
The choice is simple- do you want medicine to be based on sound scientific practices or on woo? That sometimes woo creeps into mainstream medicine isn’t proof of EBM using woo. By definition, if woo is involved then that isn’t EBM. The key words are “evidence based”. I do know if I ever end up in hospital, I’d never choose a room with a woo.
“This is an irrelevant AdHominem argument . . .”
That’s not what an ad hominem argument is, sorry. I think what you mean to say is “I disagree with how you are framing this issue.”
“The choice is simple- do you want medicine to be based on sound scientific practices or on woo?”
That is not the choice, nor is it simple.
Evidence-based medicine is wonderful, but good-quality EBM exists for only a tiny fraction of the decisions we are faced with on a daily basis. Grounding medicine is sound science is an excellent goal, and I think we’ll get a lot closer over the next few centuries.
” I do know if I ever end up in hospital, I’d never choose a room with a woo.”
That would be every room.
” good-quality EBM exists for only a tiny fraction of the decisions we are faced with on a daily basis.” Maybe we have better doctors than you are used to. I certainly don’t find my doctor using woo. Nor would I say I’ve met any doctors in whom “good-quality EBM exists for only a tiny fraction of the decisions”. If I thought doctors were only using EBM for a tiny fraction of their decisions, as you seem to imply you do by using “we” I’d like to see supporting evidence. In fact, I’d expect any doctor not using a significant percentage of EBM methods to be eventually struck off through the inevitable consequences of bad uniformed practice.
If however in your version of “woo” you include the doctor patient relationship and the effect that that can have on a patient, then maybe that is woo. However, I am fairly certain that when “woo” is being talked about here, that isn’t what is being talked about.
And as for “every room using woo” I had many hospital stays and up to now I’ve yet to encounter woo. I’d like to see your evidence as to how my hip operation, my broken leg or my prostatectomy included woo in the way you seem to be alluding to it and in the context of what is being argued about here.
So what we’ve learned from this exchange is that you uncritically accept woo in the context of the allopathic medical system, and don’t recognize it as such.
Unfortunately, as someone who spends every moment of my working life in a hospital, I assure you that your naive faith is, unfortunately, not factually supported.
EBM has it’s problems with folks who abuse “clinical trials” and anything they can get to show a statistical significance (ie NCCAM). This is why many doctors against woo in medicine have pushed for “Science Based Medicine” that not only relies on significant statistics, but also on a proper understanding of the mode of action.
“EBM has it’s problems with folks who abuse “clinical trials” and anything they can get to show a statistical significance (ie NCCAM). This is why many doctors against woo in medicine have pushed for “Science Based Medicine” that not only relies on significant statistics, but also on a proper understanding of the mode of action.”
Well, a better understanding of science is a good idea. When considering the way something works, though, we have to be mindful that sometimes the ideas we have about how things work (even when they do work) aren’t right. Statins, for example, lower cholesterol, AND they decrease your risk of a heart attack, but a lot of smart people doubt the story that statins prevent heart disease BY lowering cholesterol. Ditto with serotonin reuptake inhibitors and depression. We don’t know what causes “round ligament pain” except that it’s probably not the round ligament. And so on.
One of the problems with the literature is trying to generalize from the data we have. THe ABCD2 score for TIAs, for example, has never been validated in emergency patients, but it’s frequently used in the emergency room.
But the biggest problem is stuff that we do because we were taught to do it that way, even though there isn’t any evidence at all. Standard, allopathic medicine has a lot of these “legacy” elements that are maybe not quite as silly as the osteopathic stuff mentioned above, but is equally useless and equally reproduced because it’s the way we’ve always done it.
Examples include bowel sounds (useless), Kernig’s and Brudzinski’s signs (positive in less than 5% of the population), c-collars in trauma (just had a new paper confirming their uselessness) and packing abscesses (supposedly to help them drain; painful and useless.)
An open, skeptical, scientific outlook is really important to gradually improving this stuff. But we in allopathic medicine really shouldn’t get too far up on our high horses about practices not supported by proof. Because we do a lot of that!
I really liked your observation about the antibiotics for the viral ear infection. You know that they aren’t going to help, but there is a strong desire to do SOMETHING. Sometimes that is symptom control. Sometimes perhaps there is a limited role for a harmless (disclosed) placebo, in contrast to the antibiotics, which are a harmful placebo. Because maybe the ritual of treatment has some value in and of itself.
Official medical doctors looking for new angles to squeeze money out of patients? Sorry, not really surprised or tickled by this. : /
Yeah, not all doctors are so callous, but still…
DO? Sounds to me like that voodoo thay they do DO. Actually, Do-DO is very descriptive of this whole topic. (I’m assuming do-do has the same slang meaning in American as in real english! If you’re not sure, it’s the non-liquid part of a babies nappy production line, although knowing babies having owned one myself once, it can also be fairly liquid too.).
There are doctors that practice this in a helpful and safe way for the patient. Those that use osteopathic manipulative techniques as a non-cracking way of getting bones back in place is useful and does have a place. Just because it is abused does not make it crackpot (at least not all of it). All science aside (I can feel you cringe from here), it is popular because it does work for some people. I have had Craniosachral Therapy done when I had a migraine (mind she was so gentle that it did not feel like squeezing) and, at the end of it, the migraine retreated to a nice calm ordinary headache. Perfect? No but it helped.
However, I must admit the person I saw did not spout any of the tide crap. She presented it as a therapy that helps some people and I was willing to try it.
I’m a regular customer for a chiropractor in my area; I’ve consulted with DO’s and chiropractors my whole life. The whole “fluid” business is crap, and the DO’s and better chiropractors I’ve done business with know it. Why do I seek them out? Because, like many people in my family, I’m prone to getting joints out of place. The pain of having a rib out is pretty bad… it’s hard to breathe, and pretty much impossible to concentrate on getting any work done. Having my neck or the lower part of my spine out is pretty bad too. Five minutes with a good chiropractor does wonders; my DO used to charge me more and gave a much rougher treatment, but there were many times it was worth it.
MDs will tell you that your neck or back don’t get out of place; they blame inflammation. I call BS on that, as someone who has received relief many, many times from a proper treatment.
The problem is, chiropractors have a veritable buffet of treatments not approved or accepted by the medical establishment; I know of one that works, and a pile of them that do nothing. So I’m very choosy about chiropractors. I know what the treatment is supposed to feel like, and if it isn’t right, they don’t see me again.
“MDs will tell you that your neck or back don’t get out of place; they blame inflammation. I call BS on that, as someone who has received relief many, many times from a proper treatment.”
It’s nice that it works for you, and in many cases a therapy can work for reasons other than the rationale used to design it. But we can see these structures in really good detail on CTs and MRIs, and they’re not out of alignment.
I worked closely with a DO who ran a pain clinic. He did a wonderful job working with patients who had chronic pain, primarily by adjusting their expectations that the pain would never go away, but could become manageable through stretches, diet improvement (when appropriate) and medication (as needed). I saw him use osteopathic manipulation only three times. Each time he explained to the patient the way in which their musculature was spasming or uneven, made a few brief adjustments providing some instant relief, then prescribed medications and exercises. He is, like many DOs, highly critical of woo and constantly seeks out the latest evidence regarding best practice of pain management.
Do not conflate DOs with woo categorically. Sure, if you read their founding principals, it sounds wonky. Have you ever read the medical treatises published at the same time (circa 1900)? Or the stuff published in the 1950s? Or some of the crap that gets through the peer review cycle even today? For a good look at how the medical profession learned to stop worrying and love the evidence (no matter how big the bombshell), I recommend “The Great Influenza” by John M Barry. Hint* it was not a smooth process.
This always reminds me of retrophrenology (which is, interestingly, in my spellcheck dictionary): http://wiki.lspace.org/mediawiki/Retrophrenology
puedo invitarte a una discusion de patologias estructurales, patologias respiratorias, patologias auditivas, y ver como las evaluas, las abordas y comparamos su evaluacion diagnostico y tratamiento con el Osteopatico?
Can I invite you to a discussion of structural pathologies, respiratory pathologies, auditory pathologies, and see how you evaluate them, and compare how we evaluate and treat with Osteopathy?
im sorry but you need to know Osteopaths from EUROPE and compare!