What's the truth about chiropractic for infants?

This post is the first for over a month, during which time I've been on the move in the UK, USA and Canada, teaching, seeing patients, and trying hard to remain focused, as the prospect of 3.5 months in Corfu (which I reached last week) loomed - just ahead - like a mirage of a cool oasis pool, to a thirsty desert traveller.
During this period a drama has been unfolding in the UK, as a major chiropractic organisation sued a journalist for libel. The BCA alleged that Simon Singh (writing in the Guardian newspaper) had alleged that chiropractic claims to successfully treat such conditions as ear infection and infant colic, were 'bogus'.
The original article is no longer available on the Guardian site (doubtless for legal reasons), but numerous pro and con commentaries exist that contain extracts.
An example of an anti-chiropractic view can be found on the Quackometer website.
A more balanced view can be found on The Times Higher Education website.
An initial court ruling found in favour of the BCA, awarding damages, and Singh has now announced that he intends to appeal this judgement.
The whole furore has hinged on the interpretation by the judge of the word 'bogus', rather than on any attempt to analyse whether the claims by chiropractors have any foundation.
Prominent personalities (Stephen Fry, for example) have rallied to Singh's defence, in the name of freedom of speech, while supporters of alternative, complementary and integrated health have been saddened by the failure of the process to allow intelligent analysis of the actual essence of the issue - can chiropractic care help conditions such as ear infection and infantile colic?

Do I have an opinion?
Well it seems to me that health enhancement involves a variety of possible influences - including biomechanical.
A brief search of available, easy to access, data, on research into chiropractic and health enhancement (outside of the obvious biomechanical, musculoskeletal arena) brought me the following articles that might be pertinent, and some of which might well have been part of the BCA defence of their position. Indeed as Singh is appealing the case, there might eventually actually be consideration of the real, underlying, in fact critical, question - can chiropractic enhance general health, and thereby encourage resolution of apparently unrelated health problems?

A brief literature search, limited to the last 3 years, using key words 'chiropractic' and 'colic' and 'ear conditions' yielded a selection of studies and reports, including the following:

• Browning M Miller J 2008 Comparison of the short-term effects of chiropractic spinal manipulation and occipito-sacral decompression in the treatment of infant colic: A single-blinded, randomised, comparison trial Clinical Chiropractic 11(3:122-129.
• Di Duro J 2006 Improvement in hearing after chiropractic care: A case series Chiropractic and Osteopathy 14:2
• Hawk C Khorsan R Lisi A 2007 Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research Journal of Alternative and Complementary Medicine 13(5):491-512
• Hipperson A 2004 Chiropractic management of infantile colic Clinical Chiropractic, 7(4):180-186
• Jamison J Davies N 2006 Chiropractic Management of Cow's Milk Protein Intolerance in Infants With Sleep Dysfunction Syndrome: A Therapeutic Trial Journal of Manipulative and Physiological Therapeutics 29(6):469-474
• Kingston H 2007 Effectiveness of chiropractic treatment for infantile colic. Paediatric nursing 19(8):26

The excellence or otherwise of these is not my focus, only the fact that they exist, which is enough to at least call into question Singh's blanket use of the word 'bogus', with its' connotations of fraud and deception.

The Hawk review paper (2007) contained a number of conclusions, amongst which were:
(1) The few reports of adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.
(2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.

The Jamison and Davies paper (2006) was also insightful, since it makes clear that the 'chiropractic treatment' offered dealt with the issue of cow's milk intolerance, with no mention of manipulation - only of a careful evaluation of possible dietary/invironmental influences that - if modified - might assist in health enhancement.
Singh seems to have failed to recognise that chiropractic is a health care profession, and that seeing a chiropractor does not necessarily mean that the patient will inevitably be manipulated.
This reminded me of a lecture I was asked to give on the subject of amino-acid nutritional supplementation, sometime in the mid-1980s, at Los Angeles College of Chiropractic, where I was a periodic visiting lecturer/tutor on soft tissue manipulation topics. Nutrition, lifestyle and general health maintenance was a major part of chiropractic training back then, and is today.

Since the judgement for the BCA has been appealed, it is to be hoped that at some stage the real issues will be evaluated in court.
Meanwhile the opportunity can be seen to exist for clarity to emerge as to just what chiropractic can offer in health terms, apart from its value in musculoskeletal care.

Conflict of interest note:
I am not a chiropractor, but have taught at some of the best chiropractic training colleges - and am happy to say that some of my best friends are DCs!

I once again apologise to blog readers for the lengthy gap in posts....caused by a tiring trip to the US and UK.
I am now back in blissful Corfu, where I am currently reviving!

Sphere: Related Content

Osteopathic and naturopathic approaches to Influenza: Part 1

NOTE: Part 2 of this posting can be found by going to this link
http://massagemag.com/massage-blog/bodywork-blog/
A reality check this morning (Sunday Times, London) put into perspective the questionable severity of the impending pandemic:

• In the past week around 17 people have died from this strain of flu, allegedly caused by the H1N1 virus (aka Swine flu, or Mexican flu).
• In the same week approximately 5000 people have died from conventional, common-or-garden flu (and a further 35,000+ from AIDS!)

Yes I know, it's early days, and we may indeed see this turn into a devastating world-wide event - although to be sure it's not so long ago since we braced ourselves for the arrival of so-called Avian (aka bird) flu - linked to the H5N1 virus.
Will swine flu go the way of bird flu?

Possibly, but not until a huge amount of economic damage has been done to whole economies (Mexico) and to numerous industries (travel, entertainment, catering, farming etc) with a balancing vast increase in profits for various drug houses (and face-mask manufacturers).
It's just a few days since my last post but I feel somewhat exercised by the whole influenza hysteria that's been bombarding us from all sides for the past 10 days - and am moved to use part of this gloriously sunny Corfu afternoon, to offer a few thoughts and references.
As the title suggests there is a part 2 of this post - because I am using this topic to also involve a second blog, written under the umbrella of Massage Magazine:Chaitow's Bodywork Blog, where I have expanded on the information provided in this post.
Before setting about the highlighting of possibly useful, hopefully interesting, information about osteopathic and naturopathic perspectives on influenza in general, and pandemics in particular, I want to mention a news report that caught my eye today (London, Sunday Times).
This represents a variant on the old idea that a dog biting a man has limited newsworthiness, whereas when a man bites a dog ... that's news!

The headline was:

Man infects pigs with swine flu on farm in Canada

The story informs us that a farm worker in Canada has infected a herd of pigs with swine flu, the first documented case of the virus being passed from humans to animals.
The herd of pigs tested positive for the H1N1 virus after the worker returned from Mexico with the disease.
The herd has been quarantined...... and both the man and the 200 pigs are recovering.

Osteopathy and the great flu pandemic of 1918
As mentioned above...there is more information on this topic in my other blog.
I strongly recommend a diligent read through of an article written in 2007 by two leading American osteopathic physicians (Raymond Hruby and Keasha Hoffman), entitled: "Avian influenza: an osteopathic component to treatment"
This carefully crafted article includes a summary of the data (see below) as well as the methodology employed - various manual modalities that enhance immune function and increase resistance.
They note:
"The known data regarding the success of DOs [Doctors of osteopathy] treating influenza were gathered from the 1918 Spanish influenza pandemic and was first presented by R. Kendric Smith, MD, in a paper in which he described the "osteopathic conquest of disease in which medicine has failed" [Smith 1920]. Doctor Smith reported that the mortality rate for a total of 110,120 patients with influenza treated by 2445 DOs was 0.25%. Mortality due to influenza in patients receiving traditional medical care, however, was estimated to be 5% to 6%. Patients with pneumonia treated with standard medical care had a mortality rate estimated at 33% overall, and as high as between 68% and 78% in some large cities. Of 6258 patients cared for by osteopathic physicians the death rate due to pneumonia was 10%.
In a paper delivered at the American Osteopathic Association meeting in Chicago in 1919, Riley [1920] reported similar low rates of morbidity and mortality from influenza in patients under the care of DOs, in large cities such as New York and Chicago. This information suggests that DOs achieved a high success rate in the treatment of patients during the 1918 Spanish influenza pandemic. This may have been due in part to their use of an additional effective therapeutic method – osteopathic manipulative treatment (OMT)."

Hruby and Hoffman are NOT suggesting that these methods alone should be employed currently - nearly 100 years later - but that they do deserve to be incorporated into management of both influenza and pneumonia.
There is abundent evidence of the usefulness of osteopathic approaches in pneumonia, in where marked reduction in antibiotic use as well as far shorter hospital stays, resulted from introduction of OMT (osteopathic manipulative treatment). [Noll et al 2000]
Hampton et al (2003) - and others - have shown that aspects of immune function are improved, albeit for a short time, after the osteopathic treatment methods are used.
I touched on some of the evidence in my April 9th post, in this blog, which asked whether osteopathy in the UK was 'losing its' soul?

And also....
Other aspects of defence against possible infection - particularly related to viruses - should include consideration (and implementation - if you're convinced) of naturopathic methods, such as :

• Forms of hydrotherapy that have been shown in clinical trials to improve resistance to infection
• Supplementation, with vitamin D in particular

I'll have expanded on these, and other, topics, as well as the idea of osteopathic preventive methods, in my other blog.

Conspiracy?
Without wishing to raise the possibility of a conspiracy theory, linked to the prospects of mammoth profits for pharmaceutical companies associated with anti-flu medication, and ultimately of course mass vaccination products - a question raised by a reader in The Sunday Times (Sven, from Stuttgart), does strike a chord:
"I would really like to know more about ties between WHO officials and certain parts of the pharmacological industry? "

Hmmmm
...and by the way, go to you-tube to see an instructive clip from a US Congressman on the topic of 'the pandemic'

References
Hampton D, Evans R, Banihashem M: Lymphatic pump techniques induce a transient basophilia.J Osteopath Med (Australia) 2003, 6:41
Noll D Shores J Gamber R et al 2000 Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia Jn Am. Ost Assoc. 100(12):776 -782
Riley GW. Osteopathic success in the treatment of influenza and pneumonia. JJn Am. Ost Assoc. 2000;100:315–319. [August 1919. Reprinted in JAOA] Smith RK. One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. JAOA. 1920;20:172–175. [Reprinted in: Jn Am. Ost Assoc, 2000;100:320–323]

Sphere: Related Content

The nonsense of "evidence based medicine": Meet PieMan

Its the 1st of May, and today in Corfu it's been intermittently blustery and baking.
Alkmini busied herself making a traditional wreath, constructed from leaves and flowers, gathered as we wandered through the spring abundence of our garden and orchard.
Then it was back to work to complete a tedious task, trawling through revision of page-proofs for the 3rd edition of Fibromyalgia Syndrome(FMS): A practitioner's Guide to Treatment, due out early next year.
Sasha's back in Athens .... teaching, translating, painting, organising a conference .....so we wont have the joy of her company as we did last Mayday - see her last year's effort above!

The essential procedure of proof-reading involves numerous simultaneous areas of focus - looking for typos; ensuring that captions to illustrations actually match the pictures they describe; being sure not to miss the cryptic "see page 000" messages, that require identifying what page 000 actually is in the manuscript, so that cross referencing takes the reader to the right page; marking carefully in the text where the publishers should place icons to inform the reader that an accompanying video clip is available to demonstrate the particular topic (for example autogenic training relaxation, or breathing rehabilitation, or a specific manual method of treatment)..... and so on and on, through the 400+ pages.
And then it was done....and ready for electronic transmission back to Edinburgh, chapter by chapter, via the wondrous technology, we now work with so casually.
Because of excessive pressure on the local network I avoid using email attachments and simply upload to the excellent "yousendit" website

One of the most important processes in revising a text such as this is to supply validation - as far as it exists - for the numerous therapeutic methods discussed. Of course, individual chapters authored by others (see below) require that this task falls to their attention as they produce their particular focus on this widespread condition.

• What are the possible causes of FMS?
  
• What methods have been shown to be useful in treating FMS?
  
• The link between FMS and CFS; Manual methods of treating FMS
• Differential diagnosis & the use of dry needling for FMS (Jan Dommerholt and Tamer S. Issa)
• Integrated medicine and FMS
  
• Hydrotherapy and FMS (Eric Blake)
• Therapeutic Touch and FMS (Pat Winstead-Fry and Rebecca Good)
• Acupuncture and FMS (Peter Baldry)
• Microcurrent and FMS (Carolyn McMakin)
• Cognitive Behavioural approaches to FMS (Paul Watson)
• Metabolic rehabilitation (i.e. thyroid) and FMS (John C. Lowe)
• Fibromyalgia and the endocannabinoid system (John M. McPartland)
• ....and more

For those chapters that I am responsible for (those above with no author name) this task is fascinating.
Key words inserted into various data bases yield literally thousands of pieces of research, through which it is important to search for up-to-date information that might be useful to the reader of the book.
Meet Brian Kaplan's Pieman
Thinking about this brought my mind to the current efforts of a colleague with whom I work as part of the New Medicine Group, when I am in London - Brian Kaplan MD.
Brian - a fellow ex-South African - is a fascinating practitioner - who employs, among other approaches, homeopathy and Provocative Therapy (a form of psychotherapy).
He's brilliantly outspoken in his antipathy to the demands of mainstream medical science, who - he points out with gusto - have not looked at their own seriously deficient lack of evidence for many of the methods used regularly by GPs and specialists alike.
Look at the pieman chart above - and you'll see that, based on evidence published by the British Medical Journal, current orthodox, mainstream, medicine can claim that there is 'good evidence' that roughly 13% of what it does is useful.
For the rest, the proportions of commonly used medical treatment, that is supported by good evidence, looks like this:

• 23% is likely to be beneficial
• 8% is a trade-off between benefits and harm
• 6% is unlikely to be beneficial
• 4% is likely to be ineffective or harmful
• 46% is of "unknown effectiveness"

So, the next time you hear an 'expert' saying that alternative, complementary or integrated medicine has no foundation, and is based on little or no evidence - think hard about who is saying this, and why?
For my part, having spent many months trawling 'the evidence' in relation to FMS, I know with certainty that much can be done to help sufferers....I've seen, and reported the documentation!

So my Mayday rambling blog post has taken us from the making of wreaths in the garden in Corfu, to my revision blues, and the coming of pieman (via Brian Kaplan's efforts)

I hope it's been amusing, illuminating - and wish someone would comment as to which....

Sphere: Related Content

Introducing a new (to me) Italian approach: Fascial Manipulation ®

One of the more rewarding aspects of editing The Journal of Bodywork & Movement Therapies has been the opportunity it has given to meet new concepts early on.
Back in 1995 Elsevier first agreed to my suggestion to publish this journal - which had (and still has) as its guiding principle, the provision of readable, clinically useful, practical articles.
Now a new journal doesn't have the luxury of an established one (regular submissions for publication) - and so we were obliged to solicit material in order to gather a readership, a reputation.

It was in this way that in the first few years of JBMT's existence we were fortunate enough to receive invited contributed papers from a number of brilliant individuals, some of whom have gone on to become virtual super-stars in the manual therapy, health care, professions.
For example Tom Myers contributed a series of articles in which he laid out his fascial continuity concepts, and these turned into his massively successful 'Anatomy Trains' - a book that has changed thinking on how the body functions.
Another early author was Jim Oschman, who brought to JBMT his collected-research based thoughts, on subtle energy. Jim's subsequent books on energy medicine were based on these journal articles.
And over the years (we're now in volume 13) numerous other innovative ideas and approaches have been exposed via this wonderful peer-reviewed publication - which was accepted for MedLine indexing just 6 months ago.
Last year JBMT/Elsevier co-sponsored the 1st Fascia Research Congress in Boston, and we are doing so again for the upcoming (October 2009) 2nd Congress in Amsterdam.
As a result JBMT was inundated with a wide range of papers on that theme, both pure science studies, as well as clinical applications of a variety of approaches to restoration of fascial/ biomechanical function.

Among these papers were several that described the work of the Stecco group from Italy - whose Fascial Manipulation® approach was new to me, although it has apparently been taught and used around Europe for some years.
At its most basic this fascial manipulation adresses:

• The connections of the fascia with muscles, bones, articulations and nerves (anatomy of the fascia) - based on thousands of dissections, images of which are graphically presented in their writings
  
• Evidence of the coordinating function of the fascia with regards to all components of the locomotor apparatus (i.e the physiology of the fascia),
• Ways to manipulate densified or condensed fascia in order to restore it to its physiological state (treatment of the fascia).

I believe their work is innovative - and very practical, and predict it will become an exciting area of study for those seeking to build on Tom Myers brilliant insights.
Visitors to this blog posting, who are subscribers to JBMT, will have the pleasure of reading a number of the Stecco articles in the current volume - and I promise more in the future, as well as numerous of the most exciting paers and abstracts from the 2nd Congress.

Sphere: Related Content

Is osteopathy (in the UK) losing its' soul?

ABOVE: Two rib raising techniques
LEFT: Thoracic osteopathic lymphatic pump - hand position



When I trained as an osteopath at what is now the British College of Osteopathic Medicine
We were also taught methods and techniques that could be applied in treatment of common biomechanical problems - tennis elbow, stiff necks, back ache etc....however these were seen
to be only of relative importance in the hierarchy of what osteopaths did.
Primarily we were supposed to enhance health - and because BCOM was then named The British College of Naturopathy & Osteopathy (BCNO), we were taught that by focusing on normalising - as best possible - the framework of the body, the musculoskeletal system, we could positively influence the health of the patient.
Of course lifestyle, nutritional, stress management and psychological aspects of health enhancement were also central to the training being offered.
Indeed for many years - starting back then in the late 1950's when I was at BCNO (graduated 1960) - my sense has been that osteopathic methods represented the structural element in total health care (with the biochemical and psychological aspects covered by the naturopathic aspects of my training).
....and so, for the past 48+ years, this is how I have practised, with osteopathy supporting the broader focus that this training gave me.
I have never believed osteopathy to be a form of musculoskeletal medicine, designed to deal with strains, sprains, joint and muscle problems, i.e. another version of physiotherapy.
And yet, that seems to be what has happened to osteopathy - which has become a virtual biomechanical repair profession, where talk of enhancing general health via osteopathy, or of actually treating people with serious health conditions, using osteopathic approaches, is frowned on by both the regulators of the profession, and those who are teaching the next generation of practitioners.

Is there any evidence that osteopathic methods can enhance general health?
You bet!

This was brought home to me when I read a 2008 paper by Hruby and Hoffman - which I heartily recommend that sceptics should read!
I will summarise a few studies that show what's possible - and then you can decide for yourself.

1/ What evidence is there for general health benefits resulting from non-specific osteopathic methods?
Osteopaths Clark & McCombs (2006) observe that the natural post-surgical sequelae of the cumulative insults to physiology:
"are seen daily in every hospital in America: atelectasis, ileus and venous stasis (edema, deep venous thrombosis, skin ulcerations).
Allopathic medicine offers incentive spirometry, early ambulation, continuous passive motion equipment, anticoagulation drugs & skilled nursing to counteract the effects described."They suggest that early intervention with physical (osteopathic) strategies may avert or reduce such adverse outcomes by: 
1) Restoring the cranial rhythmic impulse to its full rate and excursion
2) Restoring ventilation to full capacity
3) Maintaining and/or restore peristalsis
4) Restoring the third space fluid (lymph) to circulation.
They suggest that a various techniques can be used for each of these four goals, and that some of the techniques overlap and meet multiple goals.
They base their opinion, partially on an earlier study by Sleszynski & Kelso (1993)

2/ Post operative atelectasis
A study by Sleszynski & Kelso (1993) compared osteopathic thoracic pump technique to incentive spirometry techniques, in the prevention of post-operative atelectasis. 
Thoracic pump (see photograph above)was used twice daily, while spirometry was used three to four times a day. 
Both treatments were effective in reducing atelectasis from a 50 percent occurrence rate to a 5 percent occurrence rate; however the manual methods achieved the result with half the number of treatments, and patients’ recovery, as measured by pulmonary function tests, occurred more rapidly.

3/ Elderly hospitalized pneumonia patients
Noll et al (1999, 2000) applied osteopathic manual methods to elderly hospitalized patients with pneumonia, with the result that the length of the hospital stay was reduced from a mean of 8.6 days, without osteopathic, to 6.6 day with osteopathic manipulative treatment (OMT). Additional benefits in this study, for those receiving OMT, included reduced length of use of intravenous antibiotics.

4/ Manual methods and pancreatitis
Radjieski et al (1998) conducted a randomized controlled study that demonstrated that in cases of pancreatitis, length of hospital stay was reduced by about one half when OMT, involving 10 to 20 minutes daily of a standardized protocol, using myofascial release, soft tissue, and strain-counterstrain techniques was given, together with standard medical care. Patients who received OMT averaged significantly fewer days in the hospital before discharge (mean reduction, 3.5 days) than control subjects

5/ Post-operative pain
Nicholas & Oleski (2002) utilised a four-step protocol composed of rib raising (see photos above), treatment of the thoracic inlet, respiratory diaphragm and pelvic diaphragm, in treatment of post-operative pain. 
They report that: "Patients who receive morphine preoperatively and OMT postoperatively, tend to have less postoperative pain and require less intravenously administered morphine. In addition, OMT and relief of pain lead to decreased postoperative morbidity and mortality and increased patient satisfaction. Also, soft tissue manipulative techniques and thoracic pump techniques help to promote early ambulation and body movement."

6/ Post-coronary bypass surgery
O-Yurvati et al (2005) documented the physiologic effects of postoperative osteopathic manipulative treatment (OMT) following a coronary artery bypass graft (CABG), to determine the effects on cardiac hemodynamics.
10 subjects undergoing CABG surgery were compared, pre-OMT versus post-OMT, measurements of thoracic impedance, mixed venous oxygen saturation and cardiac index. 
Immediately following CABG surgery OMT was provided to alleviate anatomic dysfunction of the rib cage caused by median sternotomy, and to improve respiratory function. 
This adjunctive treatment occurred while subjects were completely anesthetized.
Results suggested improved peripheral circulation and increased mixed venous oxygen saturation after OMT. These increases were accompanied by an improvement in cardiac index

So the evidence exists - and there is much more of the same available - not only from osteopathy, but also from chiropractic and massage therapy
Osteopaths in the UK are in danger of losing the plot, I fear - it's a different story in the USA (where ALL of the research quoted above took place), as well as in Germany, France, and other European countries where osteopathy is rapidly expanding.
Shame!
(P < or =" .01)." style="font-weight: bold;">

REFERENCES
Clark R McCombs T 2006 Post Operative Osteopathic Manipulative Protocol for Delivery by Students in an Allopathic Environment. American Academy Osteopathy Journal 16(20):19-21
Nicholas A Oleski S 2002 Osteopathic Manipulative Treatment for Postoperative Pain. Journal American Osteopathic Association Supplement.3:102(9):S5-S8
Noll D Shores J Bryman P et al 1999 Adjunctive osteopathic manipulative treatment in the elderly hospitalized with pneumonia: A Pilot Study .Journal American Osteopathic Association 99(3):143-152
Noll D Shores J Gamber R et al. 2000 Benefits of osteopathic manipulative treatments for hospitalized elderly patients with pneumonia. Journal American Osteopathic Association 100(12):776-782
O-Yurvati A et al 2005 Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery. 105(10):475-481
Radjieski J Lumley M Cantieri M 1998 Effect of osteopathic manipulative treatment on length of stay for pancreatitis: a randomized pilot study.Journal American Osteopathic Association 98:(5):264-272
Sleszynski S Kelso A 1993 Comparison of thoracic manipulation with incentive spirometry in preventing postoperative Atelectasis. J. American Osteopathic Association (8):834-838

Sphere: Related Content

Thoughts on the physical aspects of emotion

I have been reflecting on the influences of the physical structures of the body, on emotion - i.e. body-mind or somato-psychic connections.
The on-line dictionary, mondofacto, defines this as follows:"Relating to the body-mind relationship; the study of the effects of the body upon the mind, as opposed to psychosomatic, which is mind on body"
These thoughts emerged after having recently had the clinical experience of - quite dramatically and unexpectedly - seeing a patient's chronic anxiety state moderate, following minimal physical interventions that addressed diaphragmatic and thoracic restrictions.
It's all too easy nowadays to see the mind-body connection as a one way stream of influence. Why indeed should there not be a body-mind flow as well?
And of course there is.
I conducted a brief data search, using Scopus, and the search term "body-mind"
Some fascinating results emerged.

For example there was a paper by Besar (2008) "Oscillations in "brain-body-mind"-A holistic view including the autonomous system" that emphasizes the importance of "developing a common overview, by considering sensory and cognitive inputs".
What we 'feel' is arguably as important as what we 'think'

Shanon (2008), writing in the journal Philosophical Psychology, has clearly been wrestling with this issue - and summarises his thoughts as follows:
"The mind-body problem concerns the relationship between mind and body, or nowadays - between mind or consciousness and the brain. As a relationship, this can be viewed from two perspectives: from body to mind and from mind to body. In this note I point out that the two readings of the problem are not symmetrical and that there are categorical differences between them. In particular, whereas the body to mind problem constitutes a mystery (cf. the contemporary hard problem), the mind to body problem may be approached from a psychological (as contrasted with philosophical) orientation that allows for concrete phenomenological investigation."
It is clearly 'the mystery' that currently interests me.

Loga (2008), writing in a Psychiatria Danubina, seems to have decided - logically - that the body actually matters in treatment of the mind!:
"Psychiatry is a medical discipline addressing the study, diagnosis, treatment and prevention of mental disorders. Psychiatric disorders, which may be seen in people of all ages, involve the emotions, the will, and intellectual processes, verbal and non-verbal behaviour. According to current knowledge we cannot speak about only one cause but of the interaction of several etiological factors, mutually pervading and causing the mental illness. Because of this the treatment of mental disorders involves the complex implementation of biological, psycho-therapeutic, and sociotherapeutic methods of treatment. The contemporary principle of integrative psychiatry immanently requires simultaneous treatment of three human components: body, mind, and spirit. The holistic approach emphasizes the importance of the wholeness of the human person, and the inter-dependence of his components."

As I considered these thoughts, in which those familiar and comfortable with the psychosomatic paradigm, struggle with the somatico-psychic one, I recalled that in a chapter in the book that I coauthored last year Naturopathic Physical Medicine there was evidence for just such (somatico-psychic) effects resulting from various forms of manual therapy.
The problem with these approaches is that they are also usually one sided....they focus on the body, and influence the mind, but in the main the practitioners/therapists involved in delivering manual therapies are ignorant of how to handle mind-issues.
This is true in reverse as well, of course, with very few psychiatrists or psychotherapists familiar with handling the body.
An exception to this resides in the body-centered psychotherapy methods, used by some....and it would make sense for such ideas and methods to be more widely taught/available.

Sagar et al (2007) have evaluated the biomechanical and psychological influences in cancer patients receiving massage.
They write:
"Some cancer patients use therapeutic massage to reduce symptoms, improve coping, and enhance quality of life. Although a meta-analysis concludes that massage can confer short-term benefits in terms of psychological wellbeing and reduction of some symptoms, additional validated randomized controlled studies are necessary to determine specific indications for various types of therapeutic massage. In addition, mechanistic studies need to be conducted to discriminate the relative contributions of the therapist and of the reciprocal relationship between body and mind in the subject. Nuclear magnetic resonance techniques can be used to capture dynamic in vivo responses to biomechanical signals induced by massage of myofascial tissue. The relationship of myofascial communication systems (called "meridians") to activity in the subcortical central nervous system can be evaluated. Understanding this relationship has important implications for symptom control in cancer patients, because it opens up new research avenues that link self-reported pain with the subjective quality of suffering. The reciprocal body-mind relationship is an important target for manipulation therapies that can reduce suffering."

Three examples of research showing benefits in psychological conditions resulting from manual treatment include:

Osteopathic manipulative therapy, depression and panic disorder:
Michaud (2004) tested the proposal that an osteopathic approach could be seen as an alternative treatment to the two types of presently proposed therapies, alone or combined (pharmacological, psychological).
It is observed that panic disorder (PD) is a mental health problem that takes too long to detect, tending to become chronic and lessening the quality of life.
• Step 1: Pretreatment evaluation (1st week): (a) PRIME-MD questionnaire to verify the diagnosis; (b) psychological evaluation with the six questionnaires; (c) osteopathic evaluation.
• Step 2: Osteopathic therapy: four sessions of osteopathic treatment according to protocol (around 1 hour each).
• Step 3: Post-treatment evaluation (13th week): re-evaluating the subjects with the same psychological questionnaires as in step 1.
• Step 4: Follow-up 3 years later: using the same psychological questionnaires in order to verify if the acquired conditions have maintained or disappeared.
Results: First, the results that were obtained show a significant improvement in the quality of life with regard to factors of depression, fear, anxiety, physical sensations and panic attack. Secondly, these acquired conditions were maintained or improved after 3 years.

Slow-stroke massage and depression: A randomized cross-over trial (Müller-Oerlinghausen et al 2004) evaluated the benefi ts of ‘slow-stroke’ massage in treatment of 32 depressed patients (24 women, 8 men; average 48 years).
The trial involved three massage sessions at set times and sessions in two control groups of relaxation and perception, lasting for 60 minutes, 2–3 days apart. Under the control conditions there was no touching. The effects of depression-specific variables were measured by both the patients’ own assessment and that of an independent observer.
Results: Under conditions of both massage and control, comparison of before and after effects, there was not only a moodenhancing
effect, but also some very marked changes in almost all criteria. The benefits of massage compared with control treatment were confirmed by both female and male patients.
Conclusion: Slow-stroke massage is suitable for adjuvant acute treatment of patients with depression, and should be available in both hospital and general practice settings

Massage and biochemical markers affecting both depression and anxiety: Biochemical markers of these conditions have been shown to significantly change following massage.
Field et al (2005) report that in studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases of 31%). In studies in which the activating neurotransmitters
(serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin, and an average increase of 31% was noted for dopamine. These studies combined demonstrate the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.

References

• Başar E. 2008 Oscillations in "brain-body-mind"-A holistic view including the autonomous system Brain Research 1235 (C):2-11
• Field T, Hernandez-Reif M, Diego M et al 2005 Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience 115(10):1397–1413
• Loga, S. 2008 Integrative treatment in psychiatry Psychiatria Danubina 20 (3):349-351
• Michaud C 2004 Osteopathy – a very promising approach to improve the quality of life in persons suffering from panic attacks [Ostheopathie- Ein viel versprechender Ansatz zur Verbesserung der Lebensqualität bei Panikattacken]. Osteopathische Medizin 5(3):9–15
• Müller-Oerlinghausen B, Berg C, Scherer P et al 2004 Effects of slow-stroke massage as complementary treatment of depressed hospitalized patients: result of a controlled study. Deutsche Medizinische Wochenschrift 129(24):1363–1368
• Sagar S et al 2007 Massage therapy for cancer patients: A reciprocal relationship between body and mind Current Oncology 14 (2):45-56
• Shanon, B. 2008 Mind-body, body-mind: Two distinct problems Philosophical Psychology 21 (5):697-701

Sphere: Related Content

Ernst's latest toxic attack

Clockwise:
HVLA manipulation
Prince Charles
Prof. Edzard Ernst
Artichoke
Dandelion






When I saw the BBC headline (see below) I asked myself what the best way would be to denounce an unjust attack on Prince Charles, by Professor Edzard Ernst, of Peninsula Medical School, Exeter University (the UK's first professor of complementary medicine).

Under a headline 'Prince Charles detox 'quackery' the BBC reported Ernst as saying that a detoxification product (dandelion/artichoke extracts), produced by Duchy Originals, the Prince's marketing company "was based on "outright quackery."

Ernst continues: "Where are the studies that demonstrate efficacy? They do not exist, and the reason is simple: these products have no real detoxification effects."

BUT THEY DO! ... please see the end of this blog posting for references

I reflected for a moment on a discussion that took place this last weekend, while I was teaching in Exmouth, just down the road from where Professor Ernst wields his flailing sword of truth and justice.
A number of course participants had discussed their perception of what they judged to be Ernst's inaccurate distortion (writing with his colleague Canter) when reporting on the value of osteopathic and chiropractic treatment.
This reminded me of the editorial I had written following a similar unjustified attack (see below - Chaitow 2006). I am quoting extensively from this to offer a sense of just why Ernst's claim of objectivity is seen to be suspect (to put it mildly!).

"Ernst and Canter (2006) have placed osteopathic and chiropractic manipulation methods under a spotlight, when following a systematic literature review they found them wanting in regard to treatment of neck and back pain.
Writing in the Journal of the Royal Society of Medicine they claim that the data gave ‘‘little evidence’’ of effectiveness despite many individual studies that do show benefit. (Assendelft et al., 2003).
The Ernst and Canter article is very similar to one that appeared in 2005 in the Wiener Klinische Wochenschrift (in this instance, Canter and Ernst, 2005) and to some extent it is also a rehash of information that appeared in a paper by Ernst (2004).

At that time, in a comprehensive review evaluating the evidence base for use of a variety of therapeutic approaches to ‘musculoskeletal conditions’, Ernst highlighted the usefulness of massage (which not many may know he practised as a medical student many years ago), but questioned spinal manipulation’s value in treatment of back pain: ‘‘For acute back pain, spinal manipulation (high velocity low amplitude manipulation—HVLA) was superior to sham therapy and to treatments known to have detrimental effects on back pain. Spinal manipulation generated no advantage over general practitioner care, analgesics, physical therapy, exercise or back school. For chronic back pain, the results proved to be similar.’’

Unpicking this quoted statement brings sharply into focus the danger of relying on such evidence:
‘Acute back pain’ may have a wide variety of causes, ranging from biomechanical to pathological, psychological and functional, possibly involving intervertebral disc problems, facet joint dysfunction, hypermobility, muscular and/or ligamentous imbalances, sacro-iliac restrictions, trigger points and disturbed emotion/ somatisation (among others), making it a virtual certainty that ‘acute back pain’ will not respond to a single intervention, whether HVLA manipulation or anything else.

Professor Ernst and his co-author may or may not be aware that categorisation of problems such as back pain can predict, with some accuracy, which forms of back pain will, and which will not, respond to manipulation (DeLitto et al., 1995; Fritz et al., 2003). There is no indication as to which, if any, of the studies in their systematic review used categorisation in selection of patients to receive manipulation.
The term ‘spinal manipulation’ may mean HVLA, or it might refer to employment of mobilising articulation, or soft tissue methods such as muscle energy technique, or combinations of these, or use of chiropractic ‘activator’ adjustments.
And even where HVLA is the specified intervention, there are a wide range of possibilities as to how, and where this was applied, making evaluation of ‘manipulation’ for ‘acute back pain’ a virtually meaningless exercise, or at best a questionable one—unless each patient (irrespective of etiology) received precisely the same manipulative attention, at precisely the same spinal region.

Similar variables exist in other words/terms used in Ernst’s quoted text. What for example can it be assumed that ‘general practitioner care’, ‘physical therapy’ and ‘exercise’ actually mean, emerging as they do from a systematic review of numerous research papers in which untold variations of each of these areas of care might have been included?

Leaving aside the difficulty of applying systematic review to so many variables it may be useful to reflect on examples of the denseness of the fog surrounding much research. Consider that many research studies emerging from osteopathic medicine describe manual intervention as osteopathic manipulative treatment (OMT).
When the content of ‘OMT’ is broken down, it is sometimes stated to include HVLA, myofascial release, ligamentous balancing, muscle energy and strain-counterstrain techniques (amongst others) (Yates et al., 2002).

To those unfamiliar with these methods it is necessary to say that there can hardly be more diverse methods of
modifying tissue status, or mobilising joints, than those listed. There is frequently therefore no uniformity in application of OMT, apart from the fact that one or other, or a combination of these methods were employed.
This is not a criticism of the use of OMT in this way, since a selection of diverse methods is essential if
patients are to receive individualised attention. However, it is a criticism of reviewers who attempt to homogenise outcomes where actual treatment—uniformly listed as OMT—might have involved all or any of the methods mentioned.

To be sure, in some studies, precise descriptions are offered as to which elements of OMT have been utilised. For example, in a study of the use of OMT in treatment of chronic asthma (Bockenhauer et al., 2002), it is clearly stated that four methods (balancing ligamentous tension in the upper cervical and upper thoracic junctions; normalisation of elevated first rib; mobilisation of lower rib exhalation restrictions; diaphragmatic release) were employed, sequentially, in each patient (by the same practitioner). When the positive outcomes (increased upper thoracic and lower thoracic forced respiratory excursion) that emerged from this OMT intervention are compared with sham treatment, credible, useful and potentially reproducible information is the result.

The generalised content of the term ‘OMT’ is no more confusing than use of terms such as ‘physical therapy’ (a.k.a. physiotherapy).
A recent study (Mehling et al., 2005) compared ‘gold standard physical therapy’ with breathing rehabilitation (also not clearly defined), in treatment of chronic low back pain. Both approaches produced good to excellent results—however, since the reader is left with the mystery as to what ‘gold standard physical therapy’ is, and just how breathing rehabilitation is achieved, the chances of reproducing the results remains questionable.
JBMT’s position is that for these (and other) reasons Ernst and Canter’s controversial finding that osteopathic and chiropractic manipulation have little value in treatment of back and neck pain, is itself of little value, flying as it does in the face of the clinical experience of the chiropractic and osteopathic professions, where manipulation, when appropriately applied, to match the specific needs of the individual, appears to offer clear benefit in a range of back and other problems.
This highlights the need in published studies to carefully describe both generic and specific use of modalities, methods and techniques—not least massage and manipulation (HVLA). And it raises the question as to the credibility of systematic reviews applied in this way.

Other opinions are supportive of JBMT’s stand:
1. The National Council for Osteopathic Research has accused Professor Ernst of working with out-of-date data.
2. The General Osteopathic Council, in a press release in response to the Ernst, Canter paper state:
"[There is] good evidence to support spinal manipulation for low back pain, particularly when combined with exercise guidance—this is typical osteopathic management. This suggests that Professor Ernst is out of date
with this review, a recognised problem when researching secondary data."

In summary, the research design/methodology is not a recognised systematic review, it is limited in
terms of scientific value, and the data presented does not support the conclusions made.
It behoves us all to be as precise as possible in our descriptions of methods, modalities and techniques, as well as in the way we search for evidence of efficacy of the use of these in general, and in specific, settings."

Now lets consider the attack on Prince Charles' health product.
Is there evidence of safe and effective use of the products incorporated into the 'detox' potion?
It took me around 5 minutes to identify the three studies listed below - that vindicate the usefulness of dandelion and artichoke extracts (in animals and humans) .... so I wonder how much time Ernst took to grab his headlines with this unjustified attack?

1. Aktay, G 2000 Hepatoprotective effects of Turkish folk remedies on experimental liver injury. Journal of Ethnopharmacology 73(1-2):121-129
2. Mehmetçik, G. et al 2008 Effect of pretreatment with artichoke extract on carbon tetrachloride-induced liver injury and oxidative stress. Experimental and Toxicologic Pathology 60(6):475-480
   
3. Park, J.-Y. 2008 Hepatoprotective activity of Dandelion (Taraxacum officinale) water extract against D-galactosamine-induced hepatitis in rats Journal of the Korean Society of Food Science and Nutrition 37(2): 177-183

Osteopathic quote References

• Assendelft, W., Morton, S., Yu, E., et al., 2003. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine 138, 871–881.
• Bockenhauer, S., Julliard, K., Sing, K., et al., 2002. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. Journal of the American Osteopathic Association 102 (7), 371–375.
• Canter, P., Ernst, E., 2005. Sources of bias in reviews of spinal manipulation for back pain. Wiener Klinische Wochenschrift117 (9–10), 333–341.
• Chaitow L 2006 Are systematic reviews always accurate?Journal of Bodywork and Movement Therapies 10:163–165
• Ernst, E., 2004. Musculoskeletal conditions and complementary/alternative medicine. Best Practice & Research Clinical Rheumatology 18 (4), 539–556.
• Ernst, E., Canter, P., 2006. A systematic review of systematic reviews of spinal manipulation. Journal of the Royal Society of Medicine 99, 189–193.
• Mehling, W.E., Hamel, K.A., et al., 2005. Randomized, controlled trial of breath therapy for patients with chronic lowback pain altern. Therapeutic Health and Medicine 11 (4), 44–52.
• Yates, H., Vardy, T., Kuchera, M., et al., 2002. Effects of OMT and concentric and eccentric maximal effort exercise on women with MS. Journal of the American Osteopathic Association 102 (5), 267–275.

Sphere: Related Content