Hard News by Russell Brown

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Hard News: Another entry in the Public Address Medical Journal

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  • Russell Brown,

    Bear with me while I satisfy myself I'm not a fool ;-)

    In the United States [Wiki], all the osteopaths are doctors -- about 10% of medical graduates graduate as a Doctor of Osteopathic Medicine, and their practice (almost invariably in primary care) can be hard to distinguish from a conventional one.

    The manipulative therapy is falling out of fashion somewhat, and some practioners prefer to think of osteopathy as a "social movement" in medicine, which is certainly one of its charms.

    We're more like the British model, both in the practice and its regulation. There, osteopathic practice is subject to its own act of Parliament and overseen by a professional governing body. The treatment isn't a general practice but focused on the manipulative therapy.

    In Australia and New Zealand, practitioners must be government-registered. The Australian government mandated formal training in universities in the 1970s, which is why four institutions provide it there.

    Oddly, it seems to me that the tension between conventional medicine and osteopathy is more pronounced in the US, where the governing body still seems to try and crack on that it's a separate branch of medicine -- as opposed to "allopathic" medicine -- rather than just a different approach to patient care or a useful complementary therapy.

    Personally, if I went to an osteopath who started talking about "allopathic medicine" like he had some better mojo, I'd change my osteopath.

    Auckland • Since Nov 2006 • 22834 posts Report Reply

  • giovanni tiso,

    You can't tell from his name, that's fer sure.

    Ah, but there are Maori Italians, and I mean in Italy. Not many, but not none either.

    so what 'sophisticated tools for orientation'
    do you, presumably not a Maori
    draw from any of this now?

    I draw the lesson that astrology was once, in my culture too, woven with astronomy, and myth was an important means of knowledge transmission; which I guess I already knew academically, but experiencing it is a whole nother thing. Also, I have this theory that poetry in the beginning was a tool for remembering essential information, and I find that anthropologically interesting and relevant because scientists and tehcnologists too are storytellers. But mostly, on the non-Maori thing, I never feel left out of Matariki, as if I were on the outside looking into something. It is a truly incluse celebration and it's not as if I can say the same of, for example, Christmas.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Sacha,

    scientists and tehcnologists too are storytellers

    Good ones, yes.

    Ak • Since May 2008 • 19719 posts Report Reply

  • Sofie Bribiesca,

    Personally, if I went to an osteopath who started talking about "allopathic medicine" like he had some better mojo, I'd change my osteopath.

    See, he's no fool.

    here and there. • Since Nov 2007 • 6796 posts Report Reply

  • Sacha,

    Uses words like "mojo" - caint be no fool.

    Ak • Since May 2008 • 19719 posts Report Reply

  • Ian Dalziel,

    Astronomical Legacy...
    I see both the Matariki Festival and Te Papa have "mythed" out on getting any Subaru sponsorship...

    I'd have thought it a given as it is an integral part of the continuum: down from the Greek Pleiades, to that "sophisticated tool for orientation" the Japanese Subaru
    (even if they have lost a daughter somewhere in the logo!) and on to the Maori Matariki...

    Maybe next year...?

    Stars in their Eyes - well tonight Simon I'm going to be...
    Awe Struck!

    yrs
    Drew Id
    & Miss L Toe
    Sickle riding fools

    Christchurch • Since Dec 2006 • 7944 posts Report Reply

  • Islander,

    ID - yessss!

    Big O, Mahitahi, Te Wahi … • Since Feb 2007 • 5643 posts Report Reply

  • Ross Mason,

    Geez, I'm impressed that this has hit such a nerve amongst folk. All I did was ask a couple of questions.....and relativley politely I thought. And why only me? TroyHoward pointed the bone as well you know!

    Sorry Russell, I don't think I ever called anyone, most of all you, a dullard. The comment re "Late News" referred to the latest MOE fight with the school principals on school national standards. I admit it was a dig to suggest instilling some bullshit detecting skills into our children. I think it may prepare our kids for "The Demon Haunted World" we unleash them into.

    Am I correct in assuming you are talking about Michael Schumer? If so then check this out:

    http://www.scientificamerican.com/article.cfm?id=the-flipping-point

    Is your comment out of date?

    Finally,
    Russell: "He also skipped gaily past the part about how ACC and health insurance companies fund it ..."

    The ACC bit may be next on my list. A story for you. A couple of years ago I heard that ACC were actually paying for magnetic underlays for their "clients". I wrote and asked the Minister for ACC (at the time Annette King) if she could confirm that this was in fact the case and could she supply some form of evidence of efficacy. The reply duly arrived and informed me that as of this date, ACC would no longer be paying for the supply of magnetic underlays. Why were they doing this? According to the letter, some "contractors" (unidentified) to ACC had decided that this item could be used in "clients" rehabilitation. They had been told to cease this immediatley. BTW, no evidence of efficacy was included.

    Which reminds me, I have been thinking about asking again to see if the directive was still in place with the new minister.

    Maybe I need to ask a few more questions about other ACC services.

    Now for the grovel. I DO enjoy you columns !!!!!! Keep it up!!!!!!

    I just wish Southerly would write more!!!! :-)

    Upper Hutt • Since Jun 2007 • 1590 posts Report Reply

  • Islander,

    What has become very obvious is - different strokes for different folks-

    please dont get me wrong:science is the best tool we have so far invented (as a species, it's right up there with the word & the worked stone)

    but - placebo effect & all that- or otherwise- some things really *do* work for people. My family is thoroughly irreligious (you want to see see one of our urupa- graves dating from the 1860s and not a christian/religious remark on any of the headstones-)BUT
    -some of us have experienced really good results for physical problems from osteopaths & musculoskeletal practioners & non-religious meditation-

    anyway, whatever: kia ora tatou.

    Big O, Mahitahi, Te Wahi … • Since Feb 2007 • 5643 posts Report Reply

  • stephen walker,

    All I did was ask a couple of questions

    please re-read your previous comments. your memory seems a bit faulty on what you wrote a few hours ago.
    you said:

    the fact that you were seeing a quack

    glad you had established the facts!

    you said:

    I think a good Doc would have found it before the quack realised his "treatment" wasn't working too well.

    your reading comprehension skills seem a little unreliable. the "quack" was treating back pain.

    relativley politely

    so, name calling is "polite"? lovely.
    i'll try to remember that in the future.

    nagano • Since Nov 2006 • 645 posts Report Reply

  • Ross Mason,

    Thanks Stephen, As far as I can see from the original post, Russell had been in pain since "late summer". At some "previous visit" Russell mentioned "urinary frequency, back pain and gouty symptoms" and I read that as Russell telling the Doc this but he/she not picking up on it. It appears that he then visited the osteopath on more than one occasion after the initial Doc visit. (The osteopath telling him that he was treating him too often - which we assume was for the same continuing symptoms??). He then visited the Doc again and we gather that Russell reemphasised the symptoms. Thus bringing on the belated correct diagnosis.

    I may have got some of the timing wrong but I don't think I was far off the track.

    Russell's returning to the osteopath after the first doc visit is the interesting bit.

    Me? I would have gone back to the Doc if it continued and asked a few more questions.

    As far as name calling goes, I am pretty sure I was referring to the other party(s) and not Russell Brown Esq. Obviously, depending on which camp you are in depends whether "quack" or "good Doc" is appropriate nomenclature....or not.

    But what about TroyHoward!!!!!!

    Upper Hutt • Since Jun 2007 • 1590 posts Report Reply

  • Sofie Bribiesca,

    But what about TroyHoward!!!!!!

    Take him! he's all yours, if that's what you're after. Sorted yeah?

    here and there. • Since Nov 2007 • 6796 posts Report Reply

  • giovanni tiso,

    Do it to Julia!

    (What, too much?)

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Russell Brown,

    Geez, I'm impressed that this has hit such a nerve amongst folk. All I did was ask a couple of questions.....and relativley politely I thought.

    No Ross, you were rude and patronising.

    You also seem to ignore anything (including the research I noted) that doesn't suit your beliefs. It's like you're typing with your hands over your ears -- which I'll grant is a good trick.

    Me? I would have gone back to the Doc if it continued and asked a few more questions.

    You're obviously so much cleverer than I am. But I suppose that's easier when you know how the story ends.

    I suppose I could also note that when the GP did diagnose it, he sent me away with some fizzy sachets and told me I'd be fine. But really, it's not a detective story for you to piece together in pursuit of your point.

    Auckland • Since Nov 2006 • 22834 posts Report Reply

  • Raymond A Francis,

    Agree, agree

    But is nice to see you are on the mend RB

    You had us all worried mate,
    Chris K, Jacko & RB
    It was not looking a good week but two out of three is much better

    45' South • Since Nov 2006 • 577 posts Report Reply

  • Kyle Matthews,

    Or perhaps like many others I trust that I'm smart enough to notice the effect over time, notice when it's not there - and ask other intelligent people about their experience to decide whether to go there.

    I'm somewhat amused by the postings by some people on this thread, and contrasting with postings on a religious thread.

    If a person was to pop up and say "we don't know how god helps people, but me and lots of other people have experienced that help" they'd be shot down as religious nutters.

    And yet a similar experience with unexplainable medical treatments seems to get supported.

    Since Nov 2006 • 6243 posts Report Reply

  • giovanni tiso,

    And yet a similar experience with unexplainable medical treatments seems to get supported.

    Oh, come on Kyle! An osteopath manipulates your body, does not pray on your behalf. Besides, there are a lot of drugs that work in mysterious ways, ask any oncologist. It doesn't stop us from taking them.

    Besides, I have ltitle doubt that prayer and meditation can help people, there is nothing inherently irrational in that.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Stephen Judd,

    Kyle, I'm happy to be consisently skeptical on all fronts.

    In the US, where a lot of the more skeptical writing originates, osteopathy has made some whacky claims, particularly in its early days. Like chiropracters, their theory is that spinal misalignment is the cause of all sorts of ailments. So the original founder claimed he could treat whooping cough, for example, through manipulation. I bet even the people who have obtained relief from an osteopath on this thread would hesitate before trying osteopathy for an infectious disease.

    Wikipedia tells me that having embraced evidence-based practice, some branches of osteopathy are nowadays are more or less indistinguishable from conventional medicine, except perhaps in bedside manner. I don't know whether NZ osteopaths are like that though.

    It seems to me quite plausible that a practiced masseur with good anatomical training and a nice manner can get real and repeatable results with back and joint pain no matter what theory is used to explain their techniques.

    Finally, lots of things get better on their own, and the last treatment to be tried gets the credit. This of course applies to conventional medicine as much as it does to woo-woo therapies :D

    Wellington • Since Nov 2006 • 3122 posts Report Reply

  • Russell Brown,

    It seems to me quite plausible that a practiced masseur with good anatomical training and a nice manner can get real and repeatable results with back and joint pain no matter what theory is used to explain their techniques.

    Quite. That's exactly my view of it. What annoys me is the idea that I'm some dupe who hasn't thought about the issue. I have.

    And, as I noted, it's not even as if there isn't medical research that supports the idea that I, Gio's wife and Islander are actually gaining objective relief from symptoms as a result of the treatment (which in my case has largely been skilled soft-tissue massage). Trying to conflate it with faith healing is just building a straw man.

    Auckland • Since Nov 2006 • 22834 posts Report Reply

  • B Jones,

    Finally, lots of things get better on their own, and the last treatment to be tried gets the credit.

    That, absolutely. I've done several rounds with a lumbar disc injury, tried physio, found that the standard treatment either has no effect or makes it worse, and experimented with a few ACC-funded but not-proven things the physio suggested when the first line of treatment sent half my leg numb.

    Acupuncture was a hassle, and perhaps had a temporary effect half the time. Ultrasound was less annoying, but no obvious benefits. But it coincided with getting better.

    So the last two times I've hurt myself I've run a control - gentle exercise, no lifting and no physio. I get better faster and it costs ACC less.

    I had no shortage of people suggesting other random remedies out of general helpfulness, the most extreme of which was breaking a toe, which apparently resolved some guy's chronic unexplainable pain. People record the hits and forget the misses, so stories like that abound. They're a poor indicator of how likely they are to help the next person, though.

    Wellington • Since Nov 2006 • 976 posts Report Reply

  • Kyle Matthews,

    Trying to conflate it with faith healing is just building a straw man.

    Oh I'm not conflating them at all. Just contrasting the reactions to the two, which are completely opposite, when people seem to be indicating that the evidence (or lack of) for both is not poles apart.

    Since Nov 2006 • 6243 posts Report Reply

  • giovanni tiso,

    Oh I'm not conflating them at all. Just contrasting the reactions to the two, which are completely opposite, when people seem to be indicating that the evidence (or lack of) for both is not poles apart.

    Can you give me an analogy that would apply to religion. Somebody being cured or something, or winning at Lotto after praying... what are you looking at exactly? How can religion be said to sometimes "work" in the same way as alternative medicine?

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Russell Brown,

    Oh I'm not conflating them at all. Just contrasting the reactions to the two, which are completely opposite, when people seem to be indicating that the evidence (or lack of) for both is not poles apart.

    Uh, I think you just conflated them ...

    And, yet again, the meta-analysis from PubMedCentral on the NIH website does actually say this:

    Conclusion

    OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

    Perhaps there's something amiss with the study. But it it does seem to match my experience. That's all.

    Auckland • Since Nov 2006 • 22834 posts Report Reply

  • steven crawford,

    I have a friend that is a trained chiropractor. His training was extensive, it even included cadaver inspection. I suppose the reason for all the conventional medical training was to reduce the chances of causing damage. And, having the ability to recommend other specialists, when say kidney problems are suspected.

    My friend Phil, helped me out of neck and back pain from time to time, when I was crew on his shallow draft boat. During that time, I saw people in real pain waddle in mud to get spinal manipulation from the obsessive rune stone reading cosmic hippy doper, medical man. I never saw anybody harmed, except maybe a bit of acid melt, liver inflammation and cannabis inhalation bronchial swelling.

    Atlantis • Since Nov 2006 • 4414 posts Report Reply

  • Stephen Judd,

    steven, here's a quote from an acquaintance in another online forum:

    I'm a grad student in neuroscience at a major hospital. My adviser is a MD PhD neurologist. Every week, there's a morning case conference where all the neurology attendings and residents get together and present all the new cases that have come in in the past week.

    Every single week with little or no exception, one of those cases is someone who died or became a paraplegic due to the actions of a chiropractor.

    Wellington • Since Nov 2006 • 3122 posts Report Reply

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