Topic: Osteopathic Medicine

[sakuma]

I should have known you would be accepting of verbose responses... 

Before I start I would like to mention this Forbes Article that I found that does a nice job evaluating this topic.

Anyway,

A notable attempt at such a merger took place in California in the middle of the last century, and was a spectacular failure that left much distrust on both sides in its wake.

UC Irvine has a great website discussing the history and debate around the merger. The history doesn't really help us determine if we should merge the degrees. If there is no significant difference between DOs and MDs other than OMT is there a reason to maintain the division?

I'm not especially sure that a merger is needed, although I understand the arguments that've been made in this thread.  It's interesting to me to see how MDs and DOs work together more than they used to.

I worry that we run into the problem of subconsciously undermining evidence-based medicine. By maintaining the division between the titles, people see medicine as "allopathic medicine" and "all-the-other-bullshit-that-they-think-works." While hopefully we can all agree that it should just be "the shit that works" versus "the shit that doesn't work." I have seen first-hand how the division of MD and DO can breed magical thinking. My friend knew a DO and she was convinced that the OMT was the heart of the holistic approach and after being introduced to the concepts of "whole person" approach to medicine, she went down the long road of alternative medicine and she is now practicing "applied kinesiology" and she doesn't want her husband to continue his diabetes treatment.


The OMT discussion:

Well, I'm going to be a little intellectually lazy in return and not provide any evidence!

Now I have to get my hands dirty! So I found a meta-analysis that is very positive for OMT in low back pain and another meta-analysis that is very negative about the efficacy. Doing a meta-meta-analysis makes me want to vomit but I will attempt it. The positive analysis examined fewer studies, didn't distinguish different placebo controls, and didn't adjust for publication bias while the negative analysis did.

The fact that there are no highly plausible mechanisms for OMT is a bad sign. There have been suggestions of an anti-inflammatory based mechanism and that would make sense for lower back pain but that hypothesis suggests that you should be able to detect systemic levels of anti-inflammatory proteins to cause amelioration of asthma and other disorders that OMT claims to treat.

[hfleming]

Now I have to get my hands dirty! So I found a meta-analysis that is very positive for OMT in low back pain and another meta-analysis that is very negative about the efficacy. Doing a meta-meta-analysis makes me want to vomit but I will attempt it. The positive analysis examined fewer studies, didn't distinguish different placebo controls, and didn't adjust for publication bias while the negative analysis did.

The second abstract looks much better in its comparison. It's not necessarily meaningful if osteopathic is better than placebo. It's more important to compare it to conventional treatments (like physical therapy) and do a cost-benefit analysis.

For chiropractic this has also been done and the results were slightly different. Assuming you have patients who aren't candidates for invasive therapies, then chiropractic performs about the same for neck and back pain. However, the rapid manipulations of chiropractic are more dangerous than the slower manipulations of physical therapy. Physical therapy is also far more general in scope and can deal with things like referred neck pain.

[rreppy]

I myself am an Osteopathic physician and would like to throw my two cents in here. I feel most of the difference between DO's and MD's is of historical interest only. The two schools had valid distinctions back when they were the only two survivors of the Flexner Report, but one must remember that this was before WWII, so before antiobiotics, anesthesia, modern surgical techniques, transplants, cancer chemotherapy, heart\lung bypass machines, flexible endoscopy, etc., etc. Both disciplines adopted all these modalities as they became available, so the differences between them have become less and less.
    I believe the only barrier between consolidation at this point is political, and that it will eventually happen.
    By the way, when I was going through my ostepathic medical training, we were putting in more hours than my MD school colleagues; I know because my cousin and I compared notes and he was going to an MD school. We were taught the OMT stuff on TOP of the regular medical curriculum, not INSTEAD of.

[hfleming]

We were taught the OMT stuff on TOP of the regular medical curriculum, not INSTEAD of.

That's still a strictly inferior education. It's mixing efficacious therapy with nonsense. Not all of your peers are going to be as smart as you and brush that off.

[sakuma]

I myself am an Osteopathic physician and would like to throw my two cents in here.

Glad to have you in this discussion rreppy.

We were taught the OMT stuff on TOP of the regular medical curriculum, not INSTEAD of.

So I am a little more conservative than hfleming in my criticism of OMT, but I have to agree with his general sentiment here. I never thought that DOs were not receiving quality medical education (the generally positive assessment of their medical skills is echoed by many skeptical physicians), but it seems that their is quackery being taught to them.

Does the research show that OMT works for sure for any ailment? Should it be taught to doctors (DO or MD)? Does it undermine the scientific nature of medicine because of it's unscientific roots?

[kakaydin]

I used to shy away from DO's because of their reputation for woo, but have since discovered that many MD's accept pseudoscience as well.  Perhaps it is not institutionalized in the MD training, but neither is woo particularly discouraged.  A pediatrics MD at the local medical school here practices acupuncture and even gave a lecture on the western "science" behind why it works.

Anybody know of any statistics directly comparing the pseudoscientific beliefs and practices of MD's and DO's?