I didn’t mention this article when it first came out as it is so obviously nonsense. It came back to my attention as there is a really well done deconstruction on the blog ‘Science Based Medicine‘ which I strongly recommend as a regular web destination. I learnt from this new post that the AAP have had the godawful idea to include the publication in their AAP grand rounds!
This is a profoundly flawed RCT of just over a 100 preterm infants (between 28 and 37 weeks gestation) randomized to either usual care or wishful thinking. Many of the flaws are well described on Science Based Medicine. One flaw which is not discussed there is the failure to do an Intention to Treat analysis, in fact there were 8 babies of 55 in the OMT (Osteopathic Manipulative Therapy) group and 1 in the controls that were not analyzed for various reasons. The babies had an average gestational age of 34 weeks, but nevertheless a mean length of stay of 31 days in the controls, which is far longer than 34 week babies stay in my NICU. Supposedly the length of stay was decreased to 26 by messing about with them, but an easier way to reduce length of stay is to just delete the data from some babies who had long stays!
Most importantly Osteopathic Manipulative Therapy is nonsense. It is pseudo-scientific hocus-pocus, and subjecting fragile preterm babies to it is unethical. Why BMC Pediatrics published this and why on earth the AAP have given it a wider readership is completely unclear to me. Next they will be promoting ear candling and homeopathy, or suggesting that immunization causes autism.
Osteopathy is just as hocus pocus as Tylenol-what is the mechanism of Tylenol???? Please tell me.
The active ingredient in Tylenol is acetaminophen, known as paracetamol in Europe. It has several mechanisms of action, it activates descending serotonergic pathways, and interferes with pain perception by 5-HT3 receptors in the spinal cord. It also reduces central prostaglandin production by inhibition of peroxidase activity, and also by effects at a variant cyclo-oxygenase site in the CNS. There are also effects at certain cannabinoid receptors, that account for some of its activity.
In contrast Osteopathy is based on what we in medicine call ‘making stuff up’. Someone in the 19th century (by the name of Still) decided, without any evidence, just because he guessed it would be cute if it was true, that illness is caused by misalignments and obstructions, and that manipulating patients with your hands could cure illnesses by correcting the misalignments and removing the obstructions. There is of course no evidence that any of this is true, and as there is no prior plausibility there is no reason that we should waste research time and money, and expose preterm infant to such nonsense.
Although I’m not using this article to prove that Osteopathy for neonates does work, this new research just published is the first article looking at whether sham treatment meant to be similar to Osteopathy when compared to standard care made no difference: http://www.sciencedirect.com/science/article/pii/S0965229914000120
The preliminary study to the above reviewed study is at:
More research is required to see if similar results to the first article reviewed above can be gained before there would be enough published scientific evidence to prove or disprove whether Osteopathy for neonates does help. This study when completed should help bring some more evidence either way and will include an intention to treat analysis: http://bmjopen.bmj.com/content/3/2/e002187.full