Edited and updated June 2016.
This has been one of the most popular blogs on osteofm.com. The most significant change is to the paragraph titled “Osteopathy needs different sort of research to standard scientific research”. I have altered this in the light of the work being done by CauseHealth.
It’s been many months since I spoke to Simon Singh on the subject of why there is not more research in osteopathy. He shot down many of my lazily held assumptions like fish in the proverbial barrel. At the time I was as confused and unsure as him about why we don’t have more studies to show to people like him. (Well, to be accurate, he‘s not confused because he’s come to a kind of Occam’s razor answer – there’s no research because it doesn’t work…doh!). I know that osteopaths see incontrovertible first hand results every day as people “get better” with our interventions – too many, and too evidently, to all be people who would have just got better anyway. Yes, amongst ourselves, we have anecdotes up to our eyeballs. Surely we just need to examine them, formally bunch them all together, subject them to analysis, and turn them into statistics. So why isn’t that happening? Or is it? For him it’s a matter of public protection, for me it’s about us getting our act together to prove something that many of us find to be self-evident, and to find ways of directing and targeting our treatments more effectively.
In response to our conversation, I tried to come up with as many reasons as I can think of why there isn’t more evidence, so we can examine them a bit more carefully.
Head in the sand
Yes that’s the first one. Research? That’s the boring bit of the osteopathy degree to many osteopaths. The dissertation in our final year? It was my favourite bit of the whole course; but I was in the minority. So we just don’t do it. Some osteopaths don’t see research as particularly important; lots of them are hands-on people who just want to get on with making people better, and being asked to scientifically justify what they do is a bit of a nuisance they ignore. Hard to understand for people with strong science-based belief systems, but true.
Fearful of a negative result
Well, I think this is what skeptics think. We won’t test our methods because we aren’t confident of a positive result and this will ruin our business. Well, speak for yourself. I believe we do good, but belief in that vague, undefined way isn’t really enough for me. I want something more to guide me. I know that skeptics don’t think indirect techniques in particular have a leg to stand on, and they also dispute that our hallmark technique, high velocity thrust, is what it’s cracked up to be (boom boom!). And they also believe that some of us are cynically marketing techniques we don’t really think work, or don’t want tested in case they don’t, because it would jeopardise our livelihood. (It is true that we do all need to pay our mortgages and feed our children.) The others, they think, are sincerely deluded, mistaking the placebo effect and regression to the mean (i.e. things that would have improved anyway) for efficacy. I obviously believe in what I do and with regard to testing it, all I can say is let’s bring it on so we can find out when and how to use osteopathy for maximum effect.
This is an interesting one, because I have long assumed this is basically the root of the problem. How many times have I explained to patients that because no drugs companies stand to gain, we don’t have millions of pounds to throw at RCTs? Well, he shot this fish straight out of the barrel. Down the phone line I heard him doing mental arithmetic out loud. Only afterwards I realised what a missed opportunity this was. A famous mathmo doing mental arithmetic OUT LOUD for my benefit. He was estimating an average osteopath’s salary as about £20,000, and then multiplying it by the number of osteopaths, ie 5,000, to make £100,000,000. Yes that’s an industry worth £100 million. I have never earnt much doing osteopathy, although I know it’s theoretically possible, but the extra money that I have earnt, I tend to have spent on courses. I love them. They are my ideal mini-break but they cost a lot. I must have spent over £10,000 on courses over my career, and that’s a conservative estimate. Osteopaths mostly don’t look like they have cash to splash, but courses costing from a few hundred pounds for a weekend to over a thousand for 4/5 days are often booked out months in advance. Yes, there is money there, but we don’t choose to spend it on research. NCOR have made over £9,000 from crowdfunding to fund a study exploring the efficacy of manual therapy for children. Most of that money was donated from abroad.
It’s a complex intervention and it’s individualized
Can you measure things easily when they’re a complex intervention? Lots of things go into a good treatment. Yes, many of the things that we find part of what makes osteopathy work (i.e. what you say to the patient, how therapeutic the environment is, how much you believe in what you do), are the very things that cause skeptics to dismiss the treatment as worthless. We both admit those things have a huge effect on the efficacy of the treatment, but that admission causes skeptics to think that there is no potency in specific treatment methods and techniques.
Osteopathy also depends very much on the individual, and what Stuart Korth calls the “alchemy” of the patient-practitioner relationship. Heard the phrase “The Doctor is the Drug”? Well I think there’s a lot in that. You need potency in some aspect of the treatment, but often patients who are extremely impressed with osteopathy have been through a few different practitioners before they find someone they like, or trust, or whose treatment works for them.
We have a guru culture, not a critical thinking culture
Yes we do have a guru culture in some aspects of osteopathy. Yes on courses we are often expected to take things on trust, because someone has been deemed by someone else before him to have attained a certain level of knowledge, in a chain stretching back to Still. And when I look up osteopathy on twitter, I see quite a bit of posting of archives from the early days of osteopathy. I tried to explain that osteopathy is so synonymous with Still, that there is a feeling that we need to preserve the purity of the direct line of transmission, individual to individual, so we don’t lose what he had. This held no water with Simon Singh. There have been great men in science – Louis Pasteur, he mentioned – but it doesn’t mean nobody subjects what he said to the test. Well, the guru culture is not totally endemic to osteopathy, and it has its problems, but I don’t think it is a wholly negative thing either. And Still is not such an authority as much of the literature would suggest. I remember in a first year lecture being clearly told that whereas Still believed that you could cure pathologies such as heart disease or hepatitis by improving function at specific spinal segments, we don’t now believe that. But skeptics still pick on it as if we do.
Many osteopaths also don’t have such a strong belief system in science. I love science, and think it’s an essential tool and it helps us understand and act in the world. And I think osteopathy needs more of it. But the Big Bang is not my creation myth, Darwin is not my prophet, and I don’t think evolution is the purpose of life. Science is not the Truth and the Light. And we find evangelical scientists can be quite difficult to communicate with as they look at the world through a scientific lens and demand that the rest of us do too. (Yes, look at Simon Singh’s profile picture on his website – he is literally looking through a lens. I won’t mention motes and beams as that could be too controversial on many fronts). Fed up with being regarded by this small but vociferous minority as dangerous liars and idiots, we can become disenchanted with the medical and scientific establishment in general. Many of us turned to osteopathy because we had personally experienced harm or lack of efficacy from orthodox medicine based on the scientific method, which made us distrust it. We found help and effective treatment in osteopathy.
Would research actually make any difference? My husband was once an Alexander Technique teacher. One of his cohort was married to a medical professor. This man, so impressed by what he saw, ran a study at Southampton University which ended up in the BMJ. It showed unequivocally that 6 sessions of Alexander Technique were effective for low back pain. Did this lead to a flood of referrals from GPs, and a stampede out of the pain clinics into the rooms of Alexander teachers? No. It didn’t. Do you recommend it to patients? Probably not as much as you recommend Pilates. Fashion has dictated that Pilates is all the rage now, regardless of the fact that recent research has shown it to be no more effective in the treatment of back pain than any other exercise. Alexander Technique trundles on the same as before, although if challenged I suppose at least they have at least a few solid stats to fend off critics.
Read the study for yourself here
Research is weaker than personal bias in decision making
You only have to look at the example of David Nutt, former drugs tsar, who was actually sacked for presenting evidence (which he’d been employed to provide) which conflicted with the government’s drugs policy. In Nutt’s eyes, politicians like to use research to justify decisions already made. “Any evidence that goes against that policy is quietly, or less quietly, ignored.”
I once treated an intimate relative of a minor politician, who at the time appeared only occasionally on Newsnight. Through our conversations I was very aware of the family’s medical and personal history, and their attitude towards various medical issues; everything from diet to alcoholism to vaccination. Over fifteen years I watched this politician’s steady rise to a position of huge political influence. Whenever there is a public debate on alternative medicine, I feel very reassured to know that at least some of his family are favourable towards osteopathy. Sure, scientific evidence might be one factor in decision making, but powerful lobbying from special interest groups, the need to win votes, plus one’s own personal experience and bias, will probably count mightily strongly.
Not true. There’s plenty of brain power in osteopathy.
Osteopathy is too new for research to have happened yet
I was brought down to earth with a bump by Singh’s comment “but modern medicine’s less than a hundred years old”. Ahhh…yes. You have a point. Yes osteopathy might only be recently regulated, giving it fairly new “professional” status, but it’s been around a long time. Let’s face it, it’s Victorian. What feels to us to be new and emerging and cutting edge, particularly with fields like biodynamics and pain science, looks to them like some antiquated charlatanism that is well past its sell-by date and needs chucking in the bin. No, we have had time to do research, we just haven’t had the culture.
Osteopathy needs a different type of research from the standard type of research
This is an argument that I had never truly got my head around. Standard kinds of research don’t work for osteopathy. Don’t they? If not, why not? I posed this question in the blog, not expecting to find an answer so soon. Well, I’m happy to say I have recently come across CauseHealth, who held a conference in Nottingham looking at Causation, Complexity and Evidence in Healthcare. Rani Lili Anjum, who is a philosopher, is leading the way in looking at the way the received notion of causation underpins science, and how that affects scientific research. Perhaps by examining that notion of causation, we can figure out why RCTs don’t seem to work very well for unexplained medical symptoms, including pain, fatigue and depression. Maybe instead of RCTs being at the top of the hierarchy of evidence, these symptoms need a different hierarchy of evidence. If we could put anecdotes at the top of the pyramid, why, you wouldn’t be able to move for the vast amount of evidence supporting osteopathy. If you want to understand this better, look at their website, or read my accounts of their conference here and here, so rich in ideas and information that I had to write it in two parts.
We use research from other disciplines and don’t really need special osteopathic research
Yes the boundaries between the manual therapy professions are becoming blurred, and really, if you have a problem with lots of what osteopaths do, you might as well look at physios as well because they’re doing the same kinds of techniques you don’t like us doing. And physios have faced the same demands and difficulties around EBM as we have, only they maybe got going earlier than us at meeting those challenges, and now are in a position of greater strength. But we are all striving to be more effective and safe, and thanks to Tim Berners-Lee, we are all finding it easier and easier to network and use each others’ research on the same techniques we all use.
We still don’t actually know how manual therapy , including indirect techniques (what we used to call things like cranial and functional), actually work
I tried to say to Simon Singh that we are only at the start of understanding the mechanisms of manual therapy, and that exploration is even branching into things like attention and consciousness which are “hard problems” in neuroscience. So what chance do we have of figuring out the mechanism of action? Well, another fish blown away. You don’t have to understand how it works. Skeptics don’t need to know how it works – just show it works. Look on the bright side; this might be easier to do than explain the mechanism of action.
What are we talking about? There IS evidence, and there IS a research culture developing. We were just late starters
Yes, we have people in reseach posts in educational institutions, we have NCOR, we have ongoing studies, PhDs, research hubs, outcome measuring apps to give patients, anonymous online feedback in the form of PREOS, and anonymous adverse event reporting systems. We are getting our act together, but that’s still fairly new. The infrastructure is still being developed as I write. But we are working on it. And I am amazed at the number of really bright and informed people there are in what is a relatively small profession as ours. And helpfully NCOR, at a WHO conference last year, summed the state of play up by identifying the difficulties of osteopathic research as
- complex interventions
- standardisation vs individualism
- raising research quality
So there we are. We honestly are trying.
26 thoughts on “Why isn’t there more evidence for osteopathy? Latest thoughts following on from my chat with Simon Singh”
Interesting post, though I was very disappointed to read that you still seem to give some credence to “laying on of hands”. That is such obvious nonsense that it does rather belie your professed interest in research. Neither is it a necessary part of osteopathy -one osteopath I know said that those lectures gave them a good chance for a nap, and wouldn’t dream of inflicting it on patients.
The great problem for you is regression to the mean. A nice review by Artus et al showed that low back pain showed a modest improvement after treatment, and it was much the same whatever the treatment, including no treatment at all. All one was seeing was the natural fluctuations in pain level. It shouldn’t be too hard, or expensive, to randomise patients to treatment or no-treatment. Of course the risk is, as you point out, that there might be no difference. But if that were the case, shouldn’t we know?
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Thanks for taking the time to read and comment. Thanks too for the recommendations – I found a few studies by Artus et al on Pubmed which all look interesting and relevant.
With regard to “laying on of hands”, yes I vividly remember the first time I visited an osteopath and found to my astonishment that I was expected to lie still on my back, while he cradled my head, seemingly doing nothing, for a very long time. I had to contain a rising tide of fury and disbelief as I considered that I was actually handing over money for this embarrassing charade. Needless to say my mind changed as I experienced the effects, and twenty years on I see no inconsistency between an interest in research and a high regard for he efficacy of indirect techniques such as those which inspired me to become an osteopath.
And it is true, not all osteopaths are equally at home with both direct and indirect methods of treatment. Much of that comes down to personal preferences and experiences. I’d have happily napped through most of the HVT classes, a technique I use very sparingly in practice.
Thanks for that very civil reply. There’s just one snag with laying on of hands. It’s been shown not to work. Emily Rosa did a good class experiment when she was 9 years old and became the youngest author an a paper in JAMA. You can get a copy at http://www.dcscience.net/2011/05/03/more-dangerous-nonsense-from-the-university-of-westminster-when-will-professor-geoffrey-petts-do-something-about-it/#rosa
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A very enjoyable post, osteofm, thank you. I believe that we share a lot of common perspectives.
Hello David – from reading your description of “The practice of healing” on your blog, it is clear that it refers to a different phenomenon or practice to anything normally practised by osteopaths, or under the name of Osteopathy. With no disrespect, Rosa’s paper – regardless of some obvious ethical and descriptive flaws – cannot and should not be generalised to Osteopathy.
It alarms me that some osteopaths can’t see that, while they sell things like “cranio-sacral” osteopathy, they will continue to be regarded as quacks. Not all osteopaths subscribe to that sort of magical nonsense, but there are enough of them to preclude osteopaths from being recognised as part of serious medicine.
Ah yes! Your comment echoes a sentiment that has been heard in some form or another between osteopaths since the 1940s. The problem is that the issue of cranial or “craniosacral” osteopathy is far more complex than simply being “magical nonsense”, which is why this argument never truly drives a nail into any craniosacral coffin. If it were that simple, we would have all thrown out the baby, the bathwater, and probably the entire bathroom.
Population subgroups crying out for cranial osteopathic research include: people of all ages with head injuries; people of all ages following cranio-facial and maxillo-facial surgery and major dental work; babies following difficult births – and I mean really difficult births – and prolonged difficult in utero lies. One obvious difficulty is setting up appropriate control groups, because cases are so heterogeneous and may not be comparable to the controls. Studies with large enough numbers would help to ease this difficulty, but cost issues have prevailed. This isn’t a maze without an exit however, and as osteofm has said, there IS a growing research culture within the profession so we will find a way through. Fortunately, there are those of us as keen as mustard to keep this ball rolling, becoming more research-savvy as we go.
Can I just clarify something. When you say ‘laying on of hands’ are we specifically talking about those therapies that suggest some sort of energy link or are we talking about touch in general? Isn’t there enough theoretical evidence from studies on disembodiment in chronic pain and the effect of pleasant touch on pain inhibition to suggest a role for ‘therapeutic touch’ in medicine?
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I’m aware only of work that shows that they don’t work. If you have evidence to the contrary, I’d be happy to see it.
What is this magical “energy” that people talk about? I see no reason to think that it’s anything but a figment of the imagination.
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I think my comment may not have come across as I had intended. I don’t believe for a minute that there is a physical dimension undiscovered by physicists yet palpable by complementary therapists. But at the same time I feel the use of simple touch as a therapeutic tool is being lost to the medical world.
Whilst psychological interventions and imagery are essential parts of the modern biopsychosocial approach to treating pain, I see nothing to convince me that human touch should not also play a prominent role in treating persistent pain.
We know that touch has both a discriminative and affective input to the brain, and certain nerve fibres are only activated at the temperature of a tactile caress*. We also know that these tactile afferents code for the rewarding properties of touch** and that the cortical areas such as the insular that these fibres connect to are very much affected in chronic pain conditions***.
So, with chronic pain patients regularly experiencing disembodiment of the painful area and neurological testing showing reduced sensory awareness of these areas, any affective touch that helps reconnect the brain with the body has a strong theoretical rationale.
I agree we need far more research here but to say touch is unlikely to play a therapeutic role is difficult to swallow.
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Thanks very much for your comments. They have directed me towards research I would otherwise have been unaware of.
Regarding the study regarding Therapeutic Touch: like you, I wondered if that was what I was actually doing when I thought I was practising certain osteopathic techniques. I did investigate further, and explored what the “Healing Trust” offered. I think their style of healing is possibly similar to what was described in the paper. Whilst the people in the Healing Trust were indeed very sweet, and I had a great deal of respect for their personal integrity and ethics, I very soon realised that what they do is very different from what I do, and would not have the therapeutic potency or specificity which would be required to help the kind of patient that consults me.
I believe the poor palpation demonstrated in the study is reflected in studies in palpation across the manual therapies, not only when people are trying to palpate something as subtle as the “Human Energy Field”. If it does exist, (and I wouldn’t necessarily regard inability to palpate it as proof of non-existence), I imagine it must be almost impossible to sense accurately, when far more solid structures (for example the carotid pulse, whose existence can be surely verified by the other senses) have been shown to be very difficult to palpate reliably. I am guessing the therapeutic touch subjects were naive and excited and overrated their abilities. (Incidentally, there were also a disproportionately high number of nurses and midwives in the group I visited, not sure what we can infer from that).
I would like to refer you to a very readable and entertaining blog on the very subject of palpatory delusion – https://www.painscience.com/articles/palpatory-pareidolia.php. I came across this phenomenon myself whilst at college when, using a soft toy as a prop to run through my clinical methods before an exam, I realised that I could in fact ‘detect’ a respiratory rate on Snoopy.
I’m still working my way through the references on your post about regression to the mean, I can scarcely believe something so obvious as having a no-intervention arm on every trial, has been missed! It throws the whole very fashionable interest in placebo into sharp relief, but I did notice that it said pain and nausea might be more susceptible to placebo i.e. vindicating the “top-down” approach to treating pain currently advocated in much of the new approach across the different pain management disciplines.
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A good question and a discussion way past due.
“Skeptics don’t need to know how it works – just show it works.” I’m not sure I follow your meaning here. Do you mean scientific skeptic, because we definitely need to know how it works. Perhaps you can clarify that point.
“I suppose you can’t really do an RCT because it’s very difficult to do sham manipulations, for example. Is that what they mean? Is it an insurmountable problem?” I’m going say its almost an insurmountable problem. No manual therapy should be conducting RCT’s at this point without knowing mechanism of effect, and you are correct, we know very little about the mechanism of effect (MOE) for manual therapy in general. With such a complex intervention, there likely isn’t just one. However, RCT’s as gold in standard as they are, are designed to control for, not test confounding variables. They need biological plausibility and without MOE and control of confounds the RCT is not a suitable study for manual therapies and neither money or resources should be wasted on them at this point.
The boundaries between manual therapies are most certainly becoming blurred and perhaps, without exploring all relevant mechanisms (biological, psychological etc) through other means – such as neuroscience, a significant gap in many manual professions, as well as bottom of the pyramid studies – we are missing the point that there is likely an underlying mechanism that connects all manual therapies. One that could transcend the arbitrary boundaries in place now and mean that instead of trying to prove that a particular modality works, we could just look at how touch, movement, and caring intervention works instead and find a better, more clinically rational way to help a patient.
I’m very puzzled by your comment. There is absolutely no need to know the mechanism of action before testing whether ot not a treatment works. For example, local anaesthetics were shown to work long before anything was known about how they worked. And we still don’t know how general anaesthetics work, despite their being a boon to mankind.
And it will be impossible to take the claims of manual therapy seriously until such time as they are tested with proper RCTs. The hazards of regression to the mean are simply too big. For a good account of the evidence that’s needed, and of the hazards in getting it, I recommend http://www.ncbi.nlm.nih.gov/m/pubmed/25929527/
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I understand what you mean about testing and the need for it and the need to show outcome, but manual therapy and chemical therapy are very different beasts with relation to an RCT. Manual therapy hasn’t done enough of the prescience needed to even get to a place where a reasonable theory can be developed let alone tested in such a reductive manner (and I’m not using reductive as a bad word).
An outcome study is not nearly enough, though it might be predictive, but without plausibility it is still a confound. Given the history of manual therapy RCT results, studying a confound like manual therapy with an RCT is not helpful and may even be harmful for manual therapy professions. Even if exact mechanism isn’t known, there still has to be biological plausibility. The problem with osteopathic and other manual therapy studies especially with relation to RCT’s is that the biological plausibility for the mechanistic claims made has yet to be established. The exact mechanism doesn’t need to be known, but what is theorized has to at least fall into known scientific realms.
For example, studying something like cranial osteopathy in an RCT is beyond wasteful. It has not been established that cranial bones move in the way they are described to move and anatomy actually goes against the concept, couple that with a multitude of repeated palpation studies that could collectively be used as evidence to show that manual and osteopathic practitioners have little to no palpation reliability and you begin with no plausibility whatsoever. So what if you show some small outcome in a cranial RCT, it has established nothing except that touching a person’s head may help them feel less pain. Starting with an assumption that cranial treatment has a particular mechanism, without establishing that the mechanism is at least plausible and reverse engineering a study to suit is not what RCT’s were designed to do.
Is it plausible that touching someone’s head in particular ways can help with pain perception? Absolutely. But that plausibility comes from neurophysiological realms related to the cutaneous and somatosensory systems – known science could provide a theory related to function of the cutaneous receptors and nervous system interaction. Yet even with a more plausible explanation there is still a whole lot of prescience needed to develop a scientific theory that could reasonably be tested in an RCT.
I recommend this paper: http://www.ncbi.nlm.nih.gov/pubmed/25150944
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You say “Is it plausible that touching someone’s head in particular ways can help with pain perception? Absolutely.”. I can’t agree. It not only seems very implausible, but it has actually been shown to be untrue. There is nothing to be seen that can’t be explained by regression to the mean. I’m working on a post about that -it’s been known since the 19th century, but it’s still unappreciated how deceptive it can be (and not only in the CAM community).
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Hi David. I guess my next question, with relation to CAM studies, is why would you waste your time trying to show regression to the mean? I understand the concept should be understood for studies where it can reasonably be applied and perhaps your post will illuminate the contexts when applied to CAM, but given that experimental CAM studies are chock full of problems from plausibility to methodology and burdened with Type I and Type II errors and hardly ever repeated, showing RTM would be a bit like shooting fish in a barrel. It would, however, provide one more good reason to support the point I am trying to make – that CAM and manual therapy studies should not be using experimental methods as their testing grounds.
With regard to touching someone’s head, the effect on pain perception has only been shown to be unsupported via the above type of studies and that is not unsurprising, It’s not implausible that touch has a positive effect on pain perception. The science of touch and touch in relation to pain science is actually quite clear in this regard, but context is king. Will the effect ever be significantly shown using an experimental study – very unlikely given that touch doesn’t occur in isolation and isolation of variables is what experimental studies require.
The biggest problem as I see it, and possibly what you are also encountering with CAM studies as well, is that CAM and manual therapies are trying to test unfounded and improbable to impossible claims without regard to current science. As it turns out, biological plausibility is not a requirement to get approval for an experimental study. You can study anything using an RCT, even if it doesn’t make any sense. If biological plausibility was necessary for high level studies this would all be a somewhat moot point because only concepts that fall within known scientific realms would be considered studyable and complex interventions, like touch in relation to pain perception, would be supported or not by ‘evidence’ – science (biology, neurology, psychology, physiology and such), all levels of study from the hierarchy, clinical observation, patient input and patient outcomes.
I look forward to reading your post on RTM.
OK here is why the research methods that you advocate can only mislead.
“Placebo effects are weak: regression to the mean is the main reason ineffective treatments appear to work” http://www.dcscience.net/2015/12/11/placebo-effects-are-weak-regression-to-the-mean-is-the-main-reason-ineffective-treatments-appear-to-work/
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Really interesting post David, thanks. I’ve got to have another more in depth read of course, but placebo has come up again very recently in some manual therapy forums I’m in related to a recent book. I’ve yet to read the book but it seems to accept placebo as given based on (some?) available research. There have been rumblings and debate about placebo effect of and on for a while in these forums and goes directly to questions of ethics as well. This will add nicely to the pot.
A still mind and a compassionate heart is the key to understanding the way a “cranial” approach works. Once one gets the understanding of the Principles controlling life all questions are answered. To the skeptics and their tortuous minds I shrug my shoulder and carry on with the work I love. Osteopathy is appreciated and respected by my patients and It allows me to function fully as a human being.
One day, hopefully soon a new law of physic will be made obvious and many of us will be left with our mouths open. Only then so called scientists and skeptics will condescend to admit the obvious.
A still mind is the key to all the questions we have.
P.S please, I know through experiences where I stand and frankly I couldn’t care less about any comment trying to dispute it. Leave it at that.
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Thanks Yvan, I just love the perfect simplicity, honesty and sense of your comment. Made my day!
I’m not sure why you would bother posting Yvan if you know where you stand and you couldn’t care less about anyone disputing that version. It troubles me you think that a new law of physics would need to be revealed or discovered, or an old one proven incorrect, in order to somehow prove that cranial osteopathy works. That’s a huge and very, very unlikely scenario given that it would probably mean other known laws would be impacted. Clinical anecdote or observation, on larger healthcare scale is not enough to ethically claim something works and then charge money for that claim, especially when “works” is such a nebulous and undefined concept.
Simplistic example ahead, used purely for illustration – If you mean works as in I felt the patient’s temporal bone was rotated and that was causing the symptoms of pain, I de-rotated it using cranial techniques and the symptoms went away, then that’s a hugh problem for burden of proof. If on the other hand you mean works as in I use cranial techniques in these situations and my patients report that their symptoms are less or gone, then you don’t need a new physics law to explain that.
The funny thing is, while you are waiting for new laws to be discovered by scientists who are not even looking from the perspective of trying to prove as verifiable the current proposed cranial treatment mechanism (ie. that cranial bones move and we can feel them and treat them), there is known science – neuroscience – that offers reasonable, neurophysiological, biopsychosocial explanations of why someone might be relieved of their symptoms after a cranial treatment. There is actually no reason to give up touching someone’s head in the course of a treatment, but there is considerable reason to give up the proposed explanation of how it works for one that is actually able to be supported (note, not proven) by science.
I am a medical doctor, and osteopath and I admit I had great difficulties believing in cranial osteopathy in the beginning. Now 13 years later I don’t need to be convinced. I love how Yvan writes: “A still mind and a compassionate heart is the key to understanding the way a “cranial” approach works.”
But I would still like to discuss with colleagues how to do research on this fascinating phenomenon. Or be informed about real convincing research.
I always think that all alternative medicines should have learned from the psychologists. Since the beginning they have done extensive research on all their methods. Universities take care of that and the practitioners/therapists can build on that knowledge and progress of science. Nobody accuses psychologists of being quacks.
Have you heard if there has been any comparitive research with Functional MRI. With different techniques? Different patients? TMJ, tinnitus, headaches?
Standardized questionnairs from patients and professionals?
Yours, Hermelyn Meinardi Italy
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I have just emailed Mr Ernst and asked him to interpret/define: Randomized-Clinical trials, Double-Blind Trials and Evidence-Based medicine. But if anyone already has these definitions to hand, the official definitions( this is critical ) written in standard English, not coded into another form of English like legalese, this would be helpful.
What we do then is take out each word and request the definition/interpretation of each word, in what ever ( coded) language in English has been used.
We then tract these words/terms back to their origin to iron out any contradictions. We must discover who ( not what) invented these terms or else we will continue to go around in circles of presumption.
The most useful response there is to any claim: ‘prove it’.’ A conversation about why it hasn’t been proven may be useful to some, but certainly no substitute. in fact, it’s been disproven, which is often cast as ‘no evidence yet’ or other such weasel words.
Thanks for taking the time to read and comment, much appreciated.
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I actually enjoyed reading it for the rare quality of challenging one’s own beliefs and understanding the scientific method enough to accept it regardless of outcome – good on you, that is not usually found in Osteoland. Look forward to results of any trials.