Osteopathy

{{bronze}}[[File:Osteopathic Manipulation.JPG|thumb|right|165px|Medical Students and physician review an osteopathic technique.]]
{{altmed}}
'''Osteopathy''' is the discipline of (theoretically) treating [[disease]] by stimulating the body to heal itself, with a focus on manipulating muscles and bones. The idea that the body can be cured by manipulation has never been demonstrated in any scientific journal and is essentially [[woo]].<ref name="quackwatchosteopathy"/> 

The nature of osteopathy differs from one country to another. In the [[United States]], the separate but related field '''osteopathic medicine''' is practiced by Doctors of Osteopathic Medicine (DO) (also known as osteopathic physicians) who, for almost all purposes, are indistinguishable from Doctors of Medicine (MD). They have the legal and medical authority to diagnose and prescribe, and U.S.-trained DOs are recognized as medical practitioners in most other countries. Education and training for a DO is the same as for an MD, supplemented with training in "hands-on manual medicine",<ref>[http://www.jaoa.org/cgi/reprint/93/4/473 On the transition from osteopathy to osteopathic medicine]</ref> which is also known as osteopathic manipulative medicine (OMM). In other countries, osteopathy is a form of alternative medicine and its practitioners are not considered physicians in the conventional sense. This article focuses mainly on osteopathy in its [[alternative medicine]] sense.

==History==
[[File:Andrew Taylor Still 1914.jpg|thumb|left|165px|Andrew Taylor Still in 1914]]
Osteopathy was created by Andrew Taylor Still, an American physician, in 1874. He believed that it was possible to treat disease solely by manipulating a patient's bones and muscles. There is no evidence that Still had any medical training, other than some time spent treating [[Native Americans]] with his [[missionary]] father.<ref name=Gardner>Fads and Fallacies in the Name of Science, [[Martin Gardner]], Dover Publications, New York 1957 9780486203942</ref>  

Still believed that subluxations of the vertebrae (i.e. alleged subtle misalignments of the spinal column) had wide-reaching consequences on the rest of the body; in his autobiography, he claimed to have reversed balding via spinal rubbing.<ref name=Gardner/> He believed that each blood cell had an intelligence of its own and that he himself was [[clairvoyant]].<ref name=fishbein>[http://catalog.hathitrust.org/Record/002697794 ''Fads and Quackery in Healing: An Analysis of the Foibles of the Healing Cults, with Essays on Various Other Peculiar Notions in the Health Field''] by Morris Fishbein (1932) Blue Ribbon Books, 382 pp.</ref>

Over time, osteopathy developed to encompass a more complete approach to human health; beginning in 1913, osteopathic schools began including [[User:AceMcWicked|pharmacology]] in their curriculum.<ref name= ostmed>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1521738/pdf/califmed00205-0067.pdf Study of Relations Between Osteopathy and Medicine] June 1953</ref> 

In 1958, Still's name was removed from the "constitution" of the American Osteopathic Association (AOA), following most of his peculiar teachings.<ref>[http://www.chirobase.org/05RB/BCC/08.html Bonesetting, Chiropractic, and Cultism]</ref> In 1960, the AOA officially changed the names of the profession from "osteopathy" to "osteopathic medicine" and of its practicioners from "osteopaths" to "osteopathic physicians and surgeons", the former terms "reserved for historical, sentimental, and informal discussions only".<ref name="Gevitz"/>

The degree of a osteopathy/osteopathic physician had three different names throughout the profession's history, which were always abbreviated "DO": it was at first a "Diplomate in Osteopathy"; in 1900 it changed to "Doctor of Osteopathy" and, in 1993, as osteopaths wanted to show they were in almost all respects equal to MDs, to "Doctor of Osteopathic Medicine" (although there was still some resistance to the latter term as of 2014).<ref name="Gevitz">Norman Gevitz (June 2014), [http://jaoa.org/article.aspx?articleid=2094883 "From 'Doctor of Osteopathy' to 'Doctor of Osteopathic Medicine': A Title Change in the Push for Equality"], ''Journal of the American Osteopathic Association.</ref>

==Actual distinction between DOs and MDs==
The American Osteopathic Association (AOA), the main body regulating and representing DOs in the United States, tends to overstate the minor differences between DOs and MDs, by stating the usual alt med [[talking point]]s: (in common with all branches) that DOs are "more holistic" than MDs, that they focus on the whole person instead of just the disease and that it encourages the body's natural tendency towards good health; (in common with [[chiropractic]]) that musculoskeletal system is central to the patient's well-being and that OMM is indicated as a treatment for many diseases; (in common with "integrative medicine") that combining osteopathic medicine with all other techniques available gives DOs the ability to provide "the most comprehensive treatment available".<ref name="quackwatchosteopathy">[[Quackwatch]]: "[http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html Dubious Aspects of Osteopathy]" by Stephen Barrett.</ref><ref>[[Quackwatch]]: "[http://www.quackwatch.org/12Web/aoa.html Misleading Claims By the American Osteopathic Association]" by Stephen Barrett.</ref>

The reality is that there is so little difference between MDs and DOs that many believe both should merge.<ref name="quackwatchosteopathy"/> However, according to [[Stephen Barrett]], the percentage of DOs who are involved with dubious practices is higher than that of other medical professions.<ref name="quackwatchosteopathy"/> John Rehner estimated in 2000 that 1% of MDs and 10% of DOs were involved in [[quackery]].<ref name="NCAHF">[[NCAHF]]: "[https://www.ncahf.org/articles/o-r/osteo.html Osteopathy's Sectarian Roots], by William T. Jarvis.</ref>

William G. Sutherland, a DO, invented the field of [[craniosacral therapy]].<ref name="quackwatchosteopathy"/> Although not many DOs actually practice the stuff, its ideas are taught in osteopathic schools and the AOA treats it as legitimate, citing Sutherland material as well as writings by other defenders in its "Osteopathic Literature in Print" and co-sponsoring a 40-hour course on craniosacral therapy.<ref name="quackwatchosteopathy"/>

Although the AOA has condemned the practice of [[chelation therapy]], the percentage of DOs promoting it seems to be four to five times bigger than MDs per the calculations of Stephen Barrett.<ref name="quackwatchosteopathy"/> One of those DOs is a former president of the AOA.<ref name="quackwatchosteopathy"/>

Salzberg notes that students enrolling in colleges of osteopathic medicine tend to have lower grades than those in "regular" medicine,<ref name="forbes1"/> although on the other hand, he also notes that this only applies in research rankings, not in primary care, where one osteopathic college is in the top 10, and that at the residency stage, both DOs and MDs both enroll in the same programs.<ref name="forbes2"/>

The osteopathic medicine community uses the term "[[allopathic]]" to refer to medicine practiced by MDs, which Salzberg calls an "element of hostility" towards them. He urges the community to cease using the term, as it "is divisive and misleading".<ref name="forbes2"/>

==What osteopaths actually do==
The concept of osteopathy as an alternative medicine approach is claimed to be based on four primary principles:
#The body is an integrated unit. Any action done to one part of the body will have consequences throughout.
#The body regulates itself, but when ill, those systems can be limited or fail.
#Structure and function are directly related, and are reciprocally interrelated. (That is, if the structure fails, the function must also fail.) This does not mean that a hand is structured like it is because that is the best method for grasping, but that the ability of the hand to function best, is to have the entire body be perfectly in line.
#Active "Relational Therapy" corrects the body in conjunction with the first three principles.

Based on those, the idea of healing the entire body is done by manipulating the structure of the body, which in turn directly affects the function of the body. If the patient is suffering from [[cancer]], it is claimed that it is not enough to provide the patient with pharmaceuticals; one must "help" the body's structure so it can function better, and be ready to heal from the cancer. For example, the movement of lymph through osteopathic techniques such as the lymphatic pump may improve the circulation of anticancer drugs.  

===Types of manipulation and intervention===
* Active Method &mdash; what most people would think of when you hear "musculo-skeletal manipulation". At the doctor's direction, the patient performs a series of movements over a prescribed time frame. Note: this is not like physical therapy, where a muscle or joint is injured and the motion is to help strengthen or stretch the injured area; rather, the exercises are to stimulate the body to heal, and may have no obvious connection, including what part of the body is "manipulated".
* Passive method &mdash; the body is moved by the practitioner. Not unlike a [[massage]], except instead of relaxation or injury treatment and prevention of massage, the intent is again to bring about the body's natural healing.
* Counterstrain &mdash; the illness is attributed to a continual "strain reflex" in a muscle, so that reflex is "trained" out of the system by techniques of counter strain.
* Direct method (D/DIR) &mdash; engagement with a restrictive barrier followed by an "activating force"<ref name=foundations>''Foundations of Osteopathic Medicine'' (2010) 3rd ed. LWW. ISBN 0781766710.</ref>
* Indirect method (ID/DIR) &mdash; disengagement with a restrictive barrier and movement away from the barrier<ref name=foundations/>

==Holism==
{{main|Systems thinking}}
{{cquote|…[[Shaken baby syndrome|shake]] a [[Baby yoga|child]] and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck|||Andrew Taylor Still, founder of osteopathy<ref name="quackwatchosteopathy"/>}}
The principal principle of osteopathy is that most, if not all, disease comes from disorders of the musculo-skeletal system. This is similar to claims made by almost all practitioners of [[alternative medicine|alternative medicines]]: holisticism, or the belief that the entire body is somehow connected. Holistic practitioners argue that conventional medical science [[reductionism|reduces]] patients down to their symptoms and fails to take into account the whole of the person. This is, of course, untrue,{{fact}} but when confronted, a convenient [[escape hatch]] employed by advocates of osteopathy is that the practice includes [[spirituality]] as a factor of the whole patient.

==Actual effectiveness of osteopathic manipulative medicine==
OMM, which as stated early is what distinguishes a DO from a MD, has been called into question. Two studies published by John C. Licciardone, one published in the ''Journal of the American Osteopathic Association'' and another in an "allopathic" journal, showed no added benefit of OMM over the [[placebo effect]] for postoperative knee arthroplasty (where it was actually ''worse'') and chronic low back pain.<ref name="jaoa">''Journal of the American Osteopathic Association'': "[http://jaoa.org/Article.aspx?articleid=2092865 The Elephant in the Room: Does OMT Have Proved Benefit?]" by Bryan E. Bledsoe, DO, FACEP.</ref>

Brian Bledsoe states that osteopathic schools incentivate a [[doublethink]] by teaching the practices of [[evidence-based medicine]] on one hand, then, on the other, telling students to put them aside and believe in OMM.<ref name="jaoa"/> Indeed, OMM is what osteopathic medicine still has most in common with the old practice of osteopathy, i.e., the [[Protoscience|pre-scientific]] ideas of Andrew Taylor Still.<ref name="jaoa"/> Bledsoe also notes that, at the time he wrote the letter, there had been no debate on the "allopathic" study inside osteopathic medicine circles.<ref name="jaoa"/>

Steven Salzberg has called it "'extra' training in [[pseudoscientific]] practices",<ref name="forbes1">''Science Business'': "[https://www.forbes.com/sites/sciencebiz/2010/10/27/osteopaths-versus-doctors Osteopathic Physicians Versus Doctors]", by Steven Salzberg.</ref> noting that the AOA "claims [it] can treat such problems as asthma, sinus problems, and menstrual pain. These claims strain credulity".<ref name="forbes2">''Science Business'': "[https://www.forbes.com/sites/sciencebiz/2010/10/29/second-thoughts-on-osteopathic-medicine Second Thoughts On Osteopathic Medicine]", by Steven Salzberg.</ref>

William T. Jarvis stated that OMM can help muscles to relax, but not "realign muscles and bones", an assertion present in an American Osteopathic Hospital Association pamphlet that Jarvis claims is a relic of osteopathic medicine's past.<ref name="NCAHF"/>

==See also==
*[[Chiropractic]]
*[[Craniosacral therapy]]
*[[Massage]]

==References==
{{reflist|2|90%}}

[[Category:Manipulative therapy]]
[[Category:Medicine]]

Categories: Manipulative therapy, Medicine