Thread by @page88

We need to talk about osteopathy. nytimes.com/2021/07/24/tec…

With the preface that I understand lots of people get help from osteopaths.

And more than that: osteopaths are very VERY insistent that they be taken for MDs.

Larry Nassar is an unlicensed, incarcerated DO. His victims say they were encouraged to see him as The Almighty Doctor. He gave them “intravaginal manipulations” that he told police were a technique of traditional osteopathy.

And they believed him. And he wasn’t totally wrong.

I’m treading lightly because the American Osteopathic Association has threatened me with lawsuits the last time I was critical of Nassar’s practices and the origins of osteopathy in print.

Andrew Taylor Still, the founder of osteopathy, believed that traditional medicine was bullshit.

He had a breakthrough in 1897: “I could twist a man one way and cure flux … shake a child & stop scarlet fever … cure whooping cough in three days by a wring of the child’s neck.”

The specter of violence and child abuse that Still conjured in his early writings continues to haunt osteopathic medicine.

These practices include intravaginal manipulation. Fisting. This was the “medical procedure” Nassar performed on so many young girls.

Osteopathy styles itself as the branch of medicine that rejects medicine.

Famous quote from Still: “I began to see during the Civil War, in that part of the states of Missouri and Kansas where the doctors were shut out, the children did not die.”

Nassar also told patients and their families that he didn’t resort to drugs or surgery or even physical therapy like traditional docs — he used good wholesome massage.

From my research into Nassar’s use of OMT (Osteopathic Manipulative Treatment), the set of practices that set osteopathy apart from traditional medicine.

For a field of such iconoclasts and nonconformists, with such contempt for traditional medicine, osteopathy sure does insist on that word Doctor, though.

There is no podiatrist or PhD or chiropractor or dentist in this world who demands the honorific Dr as passionately as DOs do.

And collectively they get it.

The NYT refers to Mercola as “Dr. Mercola” and Nassar as “Dr. Nassar.”

And all that shoring up of the title means the public and patients rarely understand the difference between DO training & philosophy and MD training & philosophy.

I am bracing to hear as usual from hundreds of patients and DOs defending the field — and as I say it seems that many DOs are excellent healers and many patients are well-served.

But until the DO and MD training are one and the same, or until DOs stop using the Dr. honorific, SOME osteopaths will exploit the confusion.

“Well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent.”

ncbi.nlm.nih.gov/pmc/articles/P…

Mercola and Nassar would not have gotten as far as they did if they had owned the fact that they are alternative healers with disdain for traditional medicine.

Sean Conley—who oversaw Trump’s care when he had Covid—is also a DO.

cnn.com/2020/10/04/pol…

Just for clarity: DOs pass the same licensing tests as MDs do. DOs can prescribe and perform surgery.

Traditional medicine is an ancient field with complex models of the systems of the body and disease.

Osteopathy is abt 120 years old and comes with a focus on bones & massage

DO programs are less selective & elitist, which, in theory, could bring people with a wider range of experiences and backgrounds into medicine.

That’s potentially a good thing.

Programs in osteopathic medicine also teach a range of manipulative techniques that people don’t learn in traditional medical school.

That’s also potentially a good thing, even as the claims osteopathy makes for massage might be overblown.

And, as with Nassar, the techniques could be subject to abuse.

Finally, traditional medical schools are known for much greater intellectual rigor and for exposing students to a much broader range of patients and pathologies than osteopathy schools do.

That’s also potentially a good thing.

Ideologically MDs are going to be more likely to use mainstream, double-blinded, peer-reviewed, time-tested approaches. They might also be blinded by Big Pharma or corrupt in any number of ways.

DOs are likely to be more skeptical of those things and might encourage alternative techniques, notably massage & manipulation. But also diet, positive thinking, etc.

That, of course, can tilt into its own kind of quackery and abuse.

So that’s the difference.

The AOA is very invested in promoting confusion about this.

That group gets many advantages that other groups of healers — acupuncturists, body workers, chiropractors — don’t get. Because they insist on being addressed as “Doctor.”

My rx:

Drop the honorific and call yourself osteopathic healers who are licensed to prescribe medicine and perform surgery.
OR
Keep the honorific and make the training the same as for an MD: just as rigorous and diverse, with no theories from Still, no “manipulative therapy.”

When one of Nassar's victims went to the police, Nassar explained to the cops that she was just anxious about her sexuality; his intra-pelvic massage was legit medicine. And, in osteopathy, it is.

I am not criticizing the whole field of osteopathic medicine and accept that many if not most are excellent physicians. My problem is with the credentialing institutions and the American Osteopathic Association.

For example, Michigan State, known to have the best osteopathy school in the country, did more than just enable Larry Nassar. The school made him a hero, and used his name to raise money, top US News's charts, & promote Nassar's brand of "sports medicine."