Talk:Osteopathic manipulation

Untitled

Merge it.Donaldal 18:20, 19 May 2006 (UTC)

Merge it with what?

OMM its its own treatment modality, like "radiation therapy" or "acupuncture." What would you merge it with? ^Touro OsteopathicFreak ^T 03:50, 26 July 2007 (UTC)

AT STILL DIDN'T HAVE AN MD?

That's not what they teach at Texas College of Osteopathic Medicine... citation? I'm changing to DO, MD without further proof. Reid Sullivan (talk) 23:24, 18 November 2008 (UTC)

I added the reference for this problem and changed the order of degrees to the way it is listed in all other literature. Redrok84 (talk) 19:46, 15 April 2009 (UTC)

AT Still was a physician, but he didn't have an MD. It was uncommon for ANY physician to have one, for that matter, as medicine was more of a trade than a profession - there wasn't much certification and licensure. He also did not have a DO, as he invented the degree. It would be akin to calling Jesus a Christian - he founded the discipline, so who conferred the title on him? At my osteopathic medical school, Des Moines University (the second DO school ever founded, by a relative of AT still no less) teaches explicitly that to call AT Still a MD/DO is doubly incorrect. However, I'm certain that enough institutions would award them posthumously (if given the opportunity) that it hardly matters. —Preceding unsigned comment added by 71.61.204.168 (talk) 05:54, 25 May 2010 (UTC)

Here is a relevant article:

Gevitz, Norman (January 2014). "A Degree of Difference: The Origins of Osteopathy and First Use of the "DO" Designation". The Journal of the American Osteopathic Association. 114 (1): 30–40. doi:10.7556/jaoa.2014.005. Rytyho usa (talk) 20:18, 8 February 2014 (UTC)

The name for OMM

Traditionally, OMM has stood for "osteopathic manipulative medicine." However, it is becoming more fashionable by some institutions (my own, Des Moines University, being one of them) to begin referring to it as "Osteopathic MANUAL medicine," merely to avoid the connotations associated with the word "manipulative." A simple Google search of the term should demonstrate its prevalence. I would like to propose that this term supplant the old term in this article, if anyone else would agree to its usefulness? —Preceding unsigned comment added by 71.61.204.168 (talk) 05:59, 25 May 2010 (UTC)

Is the new term used in reliable sources? Alexbrn ^{talk|contribs|COI} 01:43, 8 February 2014 (UTC)

The terms I see most commonly used in the literature (in no specific order) are osteopathic manipulative treatment (OMT), osteopathic manipulative medicine (OMM), osteopathic manual treatment (OMT again). I haven't really seen osteopathic manual medicine in the literature. If someone can find examples, let me know. TylerDurden8823 (talk) 01:52, 8 February 2014 (UTC)

Scientific evidence for usefulness

As an allopathic medical student who is not well-versed in this discipline, I am curious to see how much of OMM is backed up by randomized clinical trials and other solid evidence. Can anyone provide some content on specifics of therapy and what has been demonstrated to work vs. sham OMM as a control? Bobsagat (talk) 20:07, 30 March 2011 (UTC)

Look into the August 2005 issue of the BMC Musculoskeletal Disorders, which features an article entitled "Osteopathic Manipulative Treatment for Low Back Pain: a Systematic Review and Meta-Analysis of Randomized Controlled Trials," by John C. Licciardone, DO, and colleagues. This article summarizes the results of clinical trials suggesting the potential utility of OMT in both acute and chronic low back pain. Another article of note is "Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline," by Roger Chou, MD, and Laurie Hoyt Huffman, MS. This article from the October 2007 issue of Annals of Internal Medicine cites evidence for efficacy of spinal manipulation in treating low back pain. In addition, a 1999 study in The New England Journal of Medicine shows OMT to be an effective form of medical treatment for low back pain. In this study, participants were divided into 2 groups: 1 treated with standard care for low back pain and the other treated with standard care and OMT. While both groups showed improvement over a 12-week period, the patients who received OMT required significantly less medication and used less therapy. — Preceding unsigned comment added by 65.28.249.2 (talk) 22:26, 25 July 2011 (UTC)

A list of commonly used OMM techniques and accompanying descriptions of each respective technique as well as the body of evidence for each technique, whether absent, limited, or substantial would make this article more complete and would be a great addition. — Preceding unsigned comment added by DoctorK88 (talk • contribs) 17:42, 2 September 2011 (UTC)

myofascial release

Myofascial release isn't limited to D.O. practitioners. Hands-on Physiatrist MDs proably utilize the technique and I know for sure that Physical Therapists do. Since it isn't limited to DOs, why is mentioned here with no reference to other, non-DO practitioners? What techniques ARE limited to DOs? Yours, Wordreader (talk) 21:09, 19 November 2011 (UTC)

Feel free to reference it. It says in the section heading that many of these techniques are used by other disciplines as well. Kerowyn ^{Leave a note} 00:30, 22 November 2011 (UTC)

More OMM Techniques

There are far more OMM techniques than the ones currently explained on this page. More of them should be added with accurate citations to make this article more complete. — Preceding unsigned comment added by DoctorK88 (talk • contribs) 06:39, 9 January 2012 (UTC)

OMM Contraindications

A section that briefly explains when OMM/OMT techniques are not indicated would be a useful addition to this article and would make it more complete. TylerDurden8823 (talk) 06:03, 14 March 2012 (UTC)

Reviewing Introduction

The introduction to this article should probably be re-written. I might do it myself at some point in the future, but at the moment I don't feel well versed enough with OMM to do so.

The introduction is confusing, potentially biased, and contains citations that don't prove the assertions they are cited as evidence for. OMM is classified as a "generally ineffective" therapy, with two citations listed as evidence. However, one of those citations makes no determinations, and rather concludes that the evidence and sample size limits any conclusions about effectiveness (the review contained references to studies that found OMM effective as well as ineffective). The second citation about OMM's ineffectiveness is a single study examining OMM's effect on a single respiratory disorder. Additionally, OMM has been found to be effective for treating back pain, and a citation is listed for that as well. Is OMM a "generally ineffective" therapy if it is found to be effective for one ailment and ineffective for another? I wouldn't suggest antidepressants are a "generally ineffective" therapy because they have limited effectiveness when treating things other than depression. Furthermore, can research ever find anything to be "ineffective?" You can't prove a negative. Researchers have failed to find significant evidence to merit OMM's use as a therapy for certain disorders. This might be splitting hairs, but I feel like this article is ripe of pre-med sniping (med students and docs are probably too busy to make poorly worded passive aggressive edits.

The intro also concludes by saying "some critics call OMM pseudoscience." Well who are these critics? Why do we care? There's a link, but it's to a 15 year old pub-med article that isn't even there. Maybe it's behind a paywall. But again, why do we care what critics have said? Who are these critics? Critics of conventional medicine call MDs corporate tools who exist solely as an arm of the pharmaceutical companies. But those critics are crazy hippies, so we ignore them. You can find critics of anything, and the existence of critics alone proves nothing. It's just a way for a lazy editor to take a swipe at OMM without sifting through scientific literature.

This intro is probably the first thing most internet users will see when researching OMM and deciding whether its right for them. And it should be honest about the pros and cons of the therapy. Readers should understand D.O.s aren't idiots - OMM is definitely effective for some disorders - but at the same time, as with any alternative therapy, practitioners often make ridiculous claims about the extent of OMM's effectiveness.

I made a couple edits that I think makes the intro slightly better, I hope nobody objects. Really, it should probably say something like:

"Although studies have demonstrated OMM's effectiveness for treating back pain, (citation) practitioners often claim OMM can treat a variety of ailments that conventional medicine does not generally associate with manual therapies (citation). Studies into OMM's effect on respiratory disorders, viral infections, and asthma (etc) have failed to find significant evidence that OMM is effective for treating these ailments (Citation). The discrepancies between these studies and the claims made by certain practitioners have led critics to call OMM a pseudoscience" (citation that actually works).

TL;DR: This article sucks. We should fix it in a way devoid of broken links and internet douchebaggery, and just present the facts as currently understood by science. If I've got persistent back pain, OMM might be a good alternative to painkillers. If I have allergies, OMM is probably a stupid idea. This should come across immediately, without any MD/DO politicking or unnecessary swipes. — Preceding unsigned comment added by 67.164.210.210 (talk) 04:03, 5 November 2013 (UTC)

Your rewording tightens things up nicely, thanks. For "pseudoscience", it's mentioned a few times in the article body, so should be summarized in the lede. In general, it should be prominently mentioned because of our policy - and because this aspect is one that mainstream sources cover; and we must follow them. Bear in mind the OMM material is split into many sub-articles on the various techniques, so this article is only Wikipedia's general overview of the topic. One change that might be worthwhile is to merge all of those here, making this a more substantial piece. Alexbrn ^{talk|contribs|COI} 05:22, 5 November 2013 (UTC)

I don't necessarily disagree about mentioning pseudoscience, but I think it could be done more effectively, or at least be better cited. I think that ideally it would be clear that elements of OMM have been demonstrated to be effective. However, practitioners make unreasonable claims about the scope of its effectiveness, and this is why it is considered pseudo-scientific. I tried to convey that with my minor edits, but I didn't add or remove any thoughts, I just reworded the existing view. (I would want to do research before I actually change anything). What I don't know is if there are other conditions that OMM has been found to alleviate. If it's effective for back pain, is it effective for neck pain? Is it effective for shoulder pain? For headaches caused by neck or shoulder pain? The way it's written now (before and after my edit) says it's ineffective for everything other than back pain, but our citations don't really support such a broad condemnation.

Thanks for replying so quickly and constructively. A rarity on the internet, it seems. Especially to non-user editors. I wonder if the "reception" category should be changed to "criticism?" The Chiropractic article has a section entitled "Controversy and Criticism" as the last section on the page. Since everything currently listed in the "reception" section is negative, that might make it more clear. 67.164.210.210 (talk) 10:09, 5 November 2013 (UTC)

A few Wikipedia niceties in play here (lots of links, sorry!) :

• The opening paragraphs (the WP:LEDE) only really summarize the body content, and aren't required to cite sources themselves (though something is often given to prevent the appearance of unsourced content). The meat of the sourcing is in the body itself.
• Because OMM is regarded as pseudoscientific WP:FRINGE guidance applies, meaning the fringe nature of OMM has to be very apparent to readers.
• Relatedly, any claims made for OMM need to be very well sourced. The guidance in WP:MEDRS applies for any claims made about OMM's effectiveness.
• A criticism section is generally seen as a bad idea according WP:CRIT. The chiropractic family of articles represent one of Wikipedia's more dysfunctional areas: we really want to avoid emulating that if we can! :-)

Alexbrn ^{talk|contribs|COI} 10:19, 5 November 2013 (UTC)

Oh, no problem with the links. I need them, thanks, I'm not an experienced wiki editor. And we may not need tons of sources in the intro, but the main citation that states OMM is pseudoscience in the body of the article is the same dead link as the introduction. It's referenced about five times. The page you linked me to regarding fringe theories states "And for writers and editors of Wikipedia articles to write about controversial ideas in a neutral manner, it is of vital importance that they simply restate what is said by independent secondary sources of reasonable reliability and quality." But there's no way to verify the reliability or quality of the source material if we can't check it. I'll defer to your judgement for now. In the future if I do the research, I might suggest some rewrites. I think in a perfect world we'd have a bunch of journal reviews of OMM research to cite. It looks like there are already a couple. I think I would like to see an expanded research section, so that the majority of criticism in the article is directly sourced to research, as opposed to secondary sources complaining.

I'm pretty busy right now though, I'll run any change ideas by the "talk" page, once I have some new sources. Thanks for the links. Why are the chiro articles renown for terribleness? — Preceding unsigned comment added by 67.164.210.210 (talk) 23:44, 5 November 2013 (UTC)

Section titling

I would like to hear from others if they think the section heading currently labeled as effectiveness is better that way or if research was a better section heading. Please weigh in, thanks. Alex, I already know where you stand on this issue obviously since it was your edit. It's definitely okay if you want to add your opinion, but I'm curious to hear from others. TylerDurden8823 (talk) 06:19, 7 February 2014 (UTC)

MOS:MED suggests we use a "Research" heading for research that is being done. Alexbrn ^{talk|contribs|COI} 06:26, 7 February 2014 (UTC)

This is an actively researched topic if that's what you mean. TylerDurden8823 (talk) 06:35, 7 February 2014 (UTC)

If there's "important work going on" we could mention it in a research section. Is there? Alexbrn ^{talk|contribs|COI} 06:36, 7 February 2014 (UTC)

I don't know about every single research project on the topic of OMM. All I know is that it is still being actively researched. We do see new reviews and original research emerging about it all the time. If that's not what you mean, then I am unclear on what you are trying to say. What do you mean exactly when you say "important work"? TylerDurden8823 (talk) 01:31, 8 February 2014 (UTC)

"Is anything important being done?" is some wording from MOS:MED. I guess it would refer to research that is important enough that it gets coverage in secondary RS: if some major trial was underway which the world was waiting on, maybe? Looking at some GAs and FAs it seems this kind of "Research" section is rare. Alexbrn ^{talk|contribs|COI} 01:58, 8 February 2014 (UTC)

Seems ill-defined to me. New reviews for OMM will probably be out soon, but I can't quote you when that will happen. I'd still like to hear what other people have to say (if anything) about the change of the titling from research to effectiveness, but it's not a major point. TylerDurden8823 (talk) 02:01, 8 February 2014 (UTC)

Claimed as treatment for ... ?

PMID 10547412 says

Osteopathic manual therapy is claimed to be useful for treating a wide range of conditions, from pancreatitis to Parkinson's disease, sinusitis, and asthma

What else has OMT been claimed to treat? Alexbrn ^{talk|contribs|COI} 02:05, 8 February 2014 (UTC)

What is the point of this exactly? It's been claimed for many things. Depends who is asked. What it's commonly used to treat...that appears to differ from the range of diseases or conditions it has been claimed for at one time or another. Also, just saying, it's an older source (1999), yes, it's NEJM, but still, I would aim for newer sources. As mentioned earlier, OMT is not one technique, but several, and different techniques have been claimed to treat different things. I'll get back to you regarding sources. TylerDurden8823 (talk) 02:18, 8 February 2014 (UTC)

You mentioned at WT:MED that some diseases were given over-prominence. Andrew Still set out what is meant to happen according to his ideas: it seems he though what could be treated is: everything. Is that right?. I notice PMID 24005090 mentions influenza, and this gets some coverage here. Alexbrn ^{talk|contribs|COI} 02:33, 8 February 2014 (UTC)

Yes, I think using asthma and Parkinson's disease is giving undue weight to those conditions since it is used for many things but from the literature appears to be used more often for musculoskeletal complaints than non-musculoskeletal complaints. Perhaps specify in a different sentence a few examples of non-musculoskeletal diseases for which OMT has been tried in studies/investigated instead. I don't know precisely the entire spectrum of all conditions claimed to be amenable to OMT by those in the osteopathic community, but I can tell you diseases/conditions for which OMT's use has been investigated to varying degrees: Cochrane review (pneumonia) (http://www.ncbi.nlm.nih.gov/pubmed/23450568), this review (http://www.ncbi.nlm.nih.gov/pubmed/23904227) (low back pain in pregnancy), (http://www.ncbi.nlm.nih.gov/pubmed/23776117) (in pediatric community-cerebral palsy, idiopathic scoliosis, bronchiolitis, asthma, otitis media, ADHD, temporomandibular joint disorder, congenital nasolacrimal duct obstruction, infantile colic), low back pain and failed back pain syndrome (http://www.jaoa.org/content/113/3/251.long), gait difficulties associated with Parkinson's disease, chronic vertigo, (http://www.jaoa.org/content/113/1/17.long), lower urinary tract symptoms (e.g., incontinence, nocturia, post-micturition symptoms, urinary retention (http://www.ncbi.nlm.nih.gov/pubmed/23294678), knee osteoarthritis (http://www.ncbi.nlm.nih.gov/pubmed/23139341), COPD (http://www.ncbi.nlm.nih.gov/pubmed/22703901), carpal tunnel syndrome (http://www.ncbi.nlm.nih.gov/pubmed/22411967), headaches (http://www.ncbi.nlm.nih.gov/pubmed/21352222), nipple feeding dysfunction in newborns (http://www.jaoa.org/content/111/1/44.long), torticollis, neck pain, thoracic outlet syndrome, chest wall pain, ankle sprain, cuboid syndrome, (http://www.ncbi.nlm.nih.gov/pubmed/20538156), piriformis syndrome (http://www.ncbi.nlm.nih.gov/pubmed/19011229). I think that's plenty from the last few years. It's a wide spectrum of disorders that fall under the purview of claimed benefit, but in terms of how often OMT is used for each of these, it's probably quite variable. TylerDurden8823 (talk) 02:59, 8 February 2014 (UTC)

I was looking for a secondary source which comments on osteo claims. I notice Ernst covers it here. Some startling stuff. Alexbrn ^{talk|contribs|COI} 11:39, 8 February 2014 (UTC)

OMT is most often used for low back pain. Such use has been supported by the New England Journal of Medicine in a randomized, controlled study. While low-back pain can be a difficult and nebulous condition, it was shown that OMT was as effective as traditional treatment, and required less medication and less physical therapy. There are others that advocate the use of OMM for other purposes, for such uses as asthma. However, the data appears (to me) to be lacking in this regard. In other words, the quality of the data for OMT treating conditions other than low back pain, is insufficient. Rytyho usa (talk) 10:36, 8 February 2014 (UTC)

Yes. It's a startling claim of OMT that it can treat pretty much any condition (based on the belief a tissue layer profoundly affects human health), and this should be clear in our lede, not least because it makes the fringe nature of OMT apparent. Alexbrn ^{talk|contribs|COI} 11:05, 8 February 2014 (UTC)

As I said in my earlier comment, there are many claims, but in terms of how it's actually used in real practice, this appears to be different. I did mention before that OMT's claims for different conditions have varying amounts of evidence/investigation and you should have specified that you wanted a secondary source. I did have some in there such as Ernst's and other review articles. Ernst's review article is more appropriate than his personal comments on his blog IMO. You're again injecting your own bias/interpretation of OMT being "fringe". You're putting that label on it, and yes, Ernst does as well in his blog, but the majority of sources I'm finding are not saying that, especially not review article papers whether they come from the non-osteopathic community or the osteopathic community. Who is it that findings OMT's claims "startling"? TylerDurden8823 (talk) 20:40, 9 February 2014 (UTC)

It's as fringe as it gets, and WP:FRINGE applies (as well as discretionary sanctions since we're editing a pseudoscience topic). We have many sources in agreement on that. It's certainly startling that practitioners claims that prodding the body can treat things like cerebral palsy, isn't it? Ernst seems to think so ...

I think there is a significant difference between fringe and unproven therapies, and I believe OMT falls more into the latter. It's a poorly researched area, and randomized controlled clinical trials are lacking. Unfortunately, much of medicine is based evidence from research other than RCTs. While I do not believe OMT would be effective for non-musculoskeletal conditions, I look forward to having the sort of high quality evidence that could the matter to rest. For example, the meta-analysis on OMT for pediatric conditions concluded that OMT's effectiveness is unproven, not that it is ineffective. It is frustrating when the results of studies are not conclusive, but at the same time, the article should reflect the current state of uncertainty. It is equally important to avoid exaggerating the ineffectiveness of OMT as it is over-stating the evidence supporting the use of OMT.

Also, what issue are we addressing right now? Are we discussing any actual changes in the article? Rytyho usa (talk) 21:08, 9 February 2014 (UTC)

It seems like there's no change to make, unless we find more sources giving us a fuller/different picture of the claims made for OMT. As for whether OMT is unproven, a recent post from Ernst is probably pertinent. All the quack remedies have proponents claiming they are merely "unproven". For fringe categorization we need to rely on sources that specifically consider the question of OMT's fringeiness. Alexbrn ^{talk|contribs|COI} 21:17, 9 February 2014 (UTC)

I have to agree with Rytyho's question. I still say using asthma and Parkinson's disease as though they are the prototypical examples of what OMT is used for is misleading and giving undue weight. They are systemic illnesses that OMT has been proposed for, but how often is OMT really used for those two complaints? I have no idea, do you? If not, why did you select those particular two illnesses as examples? Was there a reason? TylerDurden8823 (talk) 21:24, 9 February 2014 (UTC)

They're mentioned in a source - which is good! Our policy requires us to make plain when fringe is fringe, and this content is in line with that. It's this miraculous cure-all ability of OMT which is at the heart of Still's belief system, isn't it? Alexbrn ^{talk|contribs|COI} 21:29, 9 February 2014 (UTC)

There are plenty of ailments mentioned in reliable sources (e.g., Ernst's review). I'll ask again-why specifically those two? I'm not asking for your interpretation of the sources. Please show me the PubMed review article source that specifically uses the word "fringe". TylerDurden8823 (talk) 21:34, 9 February 2014 (UTC)

I answered already. As to "fringe" other words: nonsense, quackery, pseudoscience, "pseudoscientific dogma" tell us the nature of the topic at hand. If you seriously proposing (surely you're not) that OMT is not a fringe topic, I suggest asking the knowledgeable folk at WP:FT/N. Alexbrn ^{talk|contribs|COI} 21:39, 9 February 2014 (UTC)

You didn't really answer the question. I'm not commenting on whether or not OMT is fringe. What I am saying is that you're using your words, not theirs and generalizing the opinion when your references don't say that instead of specifying who said it. As for Ernst's new blog post about "pseudo-systematic reviews" that you referenced, it discusses chiropractic, not OMT. If you're suggesting that systematic reviews of OMT have done this, you'll need to prove it.TylerDurden8823 (talk) 21:45, 9 February 2014 (UTC)

A lede is meant to summarize the body. That's what we have, without the source misrepresentation your edit introduced (see my response at WT:MED). For the Ernst blog post, I was engaging in the conversation here on Talk - particularly the idea the OMT is merely "unproven". Alexbrn ^{talk|contribs|COI} 21:54, 9 February 2014 (UTC)

Correct, the lead of the article is a summary of the article's body and the body of this article refers to OMT being characterized that way by Stephen Barrett, Bryan Bledsoe, and Stephen Salzberg (I still question the inclusion of the last one of these three in the article). There is no source misrepresentation on my part. I showed on WP Med exactly how faithful to the source I have been. If you're referring to this sentence in the body from the Guglielmo paper: "Initially, D.O.s were regarded by M.D.s as "cultists" whose treatments were rooted in "pseudoscientific dogma", and tensions between the two continued for many years.[5]", then I've already addressed that on WP Med and why that would be problematic justification for your statements. TylerDurden8823 (talk) 22:16, 9 February 2014 (UTC)

So we've got all the MDs for many years and 3 good experts of today. So, saying "critics have characterized" is a fair summary of all that. Alexbrn ^{talk|contribs|COI} 22:21, 9 February 2014 (UTC)

What you omit is that MDs felt that way for many years decades ago. There was essentially zero study at that point and DOs were viewed very differently by the MD community then. Saying that all MDs continue to feel that way, without a reference to directly support that statement, is WP:OR. I'm fine with keeping Barrett and Bledsoe as examples (as I mentioned before-I dispute the validity of using Salzberg's article from Forbes whether he's an expert or not for reasons I've sufficiently explained), but they do not speak for everyone. That's WP:SYNTH. "Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources.". None of these sources explicitly state that the MD community as a whole feels this way today. Stating that because Stephen Barrett, Bryan Bledsoe, and Salzberg share this view, that all MDs share this view, is not acceptable. As currently worded, you are generalizing their view to the entire academic community and assuming that the view of the MD community from 50 years ago is exactly the same today without providing proof that beliefs are unchanged. TylerDurden8823 (talk) 22:30, 9 February 2014 (UTC)

Err, I think your COI must be clouding your eyes. I'm not seeing the text "all MDs continue to feel that way" or "the entire academic community" or "MD community" (I see the word "critics"). It's fine as is. Alexbrn ^{talk|contribs|COI} 22:37, 9 February 2014 (UTC)

No, it's not. The sentence in the article currently reads as "Critics of OMT have characterized it as pseudoscience." It's true you did not explicitly say all MDs continue to feel that way or the entire academic community, but the way it's written is very vague and general in the lead and strongly implies it. Saying "critics of OMT have criticized it as pseudoscience" makes it sound, to the general reader, like it's the mainstream view, even now. If you had a qualifier such as "in the past", that would be acceptable and in a new sentence say current critics of OMT such as Stephen Barrett, Bryan Bledsoe still espouse this view, etc. etc, that's another story. The sentence should have the specific people mentioned from the references used to more accurately reflect the current view. Period. Must I really quote you from just a few moments ago to where you said "So, we've got all the MDs for many years and 3 good experts of today. So, saying "critics have characterized" is a fair summary of all that." to you? Really? You seriously can't see how a reader might read that sentence and think that's still the prevalent view of the mainstream academic community? That's preposterous. Yes, it's not a fair characterization because it strongly implies that it is still the widespread mainstream belief and you have no references explicitly supporting that. I do not appreciate your condescending tone either, what happened to you? When you and I first began debating last year you were quite cordial, but lately, you've been resorting to insulting and inflammatory language. You assumed that I purposely did not inform you of the discussion on WT:MED. Keep in mind that I haven't edit as long as you have, yes, I have edited for a while, but I don't know every single Wikipedia guideline or rule by heart. I have no COI and have never admitted to one though you insist on accusing me of one. I said a potential COI, not the same. In my view, you're coming across as incredibly biased. TylerDurden8823 (talk) 22:50, 9 February 2014 (UTC)

The sentence has a plain meaning, tightly expressed - which you are comprehending in a strange way (and let me gently suggest that might be because of your closeness to the topic?). You are reading all kinds of things into it which are just not mentioned. "Critics" means critics; "have characterized" means have characterized. Alexbrn ^{talk|contribs|COI} 23:02, 9 February 2014 (UTC)

To me, it does look like synthesis in the lead. It doesn't look like the references really support the statement that OMT has been proven "generally ineffective therapy for conditions other than low back pain." The references talk about it being unproven for pediatric conditions, ineffective for pneumonia, but effective for low back pain. Those are different statements. Rytyho usa (talk) 00:33, 10 February 2014 (UTC)

Agreed. Unproven =/= ineffective (not necessarily anyway). I think it should be rephrased basically as suggested above. TylerDurden8823 (talk) 08:19, 10 February 2014 (UTC)

It's not an "odd" interpretation. I'll ask you again to focus on the content WP:FOC and not on me. I would appreciate it if you do not attempt to insult my reading comprehension or intelligence, it's not polite. Please see WP:ETIQUETTE. Stop "gently" suggesting that I have a COI and do not pretend that saying "closeness to the topic" is not a thinly veiled way of saying that. What happened to what you said on Editor assistance page? Last time I'm going to say this: I do not have a COI and you know nothing about me nor I about you. So please, do not pretend like you know me, my life story, who I am, or how I feel about anything.

Now, moving on to the actual topic of importance at hand-saying the sentence has a plain meaning is missing the point. That's your interpretation, not everyone's. It can be interpreted in multiple ways. My point is that it is ambiguous to a general reader and therefore needs to be more specific. Given that you have displayed a staunch anti-OMT bias on numerous occasions (in my opinion your treatment of the subject has not seemed neutral), the way the sentence is currently written sounds like you were attempting to use it to imply what I mentioned earlier-that OMT being characterized as pseudoscience is not just a past view-but the prominent one today. Whether that's true today, I cannot say with absolute certainty. What I can say is that the referenced articles after the sentence do not say that in any way, shape, or form. If my assumptions about what you were trying to imply were unfounded or incorrect and that's not what you're trying to say (or not for that reason), then you should be amenable to rephrasing the sentence so it is clearer for all. If there are any objections to my following proposal, please explain what the precise objection(s) would be to rephrasing the sentence in the following way. Just as a rough example, saying something to the effect of: "Critics of OMT characterized it as pseudoscience for decades after its creation (or OMT was characterized as pseudoscience for many decades after its creation). Today, certain critics such as Stephen Barrett and Bryan Bledsoe have echoed such criticisms. In recent years, skepticism about the use of OMT for non-musculoskeletal conditions has persisted and has often been cited as a major obstacle preventing more widespread acceptance of the techniques. (Referring to Jordan Cohen's statement which is quoted in the body). Etc. etc. You get the idea. It's still a brief summary, faithful to the sources (if not, show me precisely how this deviates from them), and discusses what is in the body of the article. Such a revision, from my perspective, makes the perception of OMT clearer by separately specifying past views and current views. TylerDurden8823 (talk) 08:12, 10 February 2014 (UTC)

What separation? OMT was, and is, seen as pseudoscience. We could add even more sources saying so, but there is no need as the case is clear; the book closed. There is no reliable counter-view, and we musn't imply there is. We are obliged to ensure the fringe nature of OMT is fully apparent in the context of respected expert opinion. Your proposed text "skepticism ... has often been cited as a major obstacle preventing more widespread acceptance of the techniques" is just synthetic POV-pushing (as if there is a force for adoption that exists, impeded by a skepticism "obstacle"). The reason rational people don't use OMT as Still set out is because it is absurd pseudoscience, as is the consensus by everybody who considers the matter, except a dwindling band of "true believer" osteopaths.[1] Alexbrn ^{talk|contribs|COI} 08:36, 10 February 2014 (UTC)

Just poking my head in here for a second (without passing judgment on either side): WP:ARBPS contains some very helpful policy statements on how and when a particular field may be characterized as pseudoscience. See specifically, principles 15-18. —/Mendaliv/^2¢/_Δ's/ 18:53, 12 February 2014 (UTC)

Dubious

Added Template:dubious to sentence in lede "(OMM)...is the core technique of osteopathic medicine." This is certainly not the whole truth, since North American DO's study (in addition to OMM) the exact same things as MD's & have same scope of practice in all 50 states. We can't just rely on the one source given; that's highly misleading and a bit POINT-y. --Middle 8 (leave me alone • talk to me • COI) 23:00, 20 February 2014 (UTC)

I agree that this statement is dubious. "Osteopathic medicine" usually refers specifically to DO physicians who are trained in the USA. While DO physicians certainly all learn OMM, the majority do not use it in practice. OMM is not the core of osteopathic medicine. Rytyho usa (talk) 03:57, 21 February 2014 (UTC)

It does not say it is the core technique used by DOs but that it is the core technique of "osteopathic medicine", and is sourced to an article in NEJM (=topmost journal) which has been praised both by altmed and mainstream commentators. It's true DOs use techniques from mainstream medicine too, but that's beside the point. Alexbrn ^{talk|contribs|COI} 08:03, 21 February 2014 (UTC)

Alex, don't remove [2] the tag while there's discussion going on. Osteopathic medicine in the US = medicine + OMM. --Middle 8 (leave me alone • talk to me • COI) 20:31, 21 February 2014 (UTC)

Unsourced, US-centric assertions from an osteopathic POV, contradicting the strong RS we are using. Drive-by tagging at its worst. And now you're edit-warring to boot. Alexbrn ^{talk|contribs|COI} 20:35, 21 February 2014 (UTC)

No, you were wrong to remove the tag, and what we need to do is keep it and discuss how to proceed. I'm not arguing US-centrically, I'm saying that speaking too globally and ignoring the US is wrong. It's a fact that in the US, DO = MD + OMM. Full stop. Given that, all we have to do is add sources along those lines and modify the wording of the lede to accomodate all the sources. What's the big deal? --Middle 8 (leave me alone • talk to me • COI) 21:41, 21 February 2014 (UTC)

Hmmm, a bit of a problematic behaviour pattern forming: attacking well-sourced content as POV. Similar to the case currently at WP:AN ... Alexbrn ^{talk|contribs|COI} 21:49, 21 February 2014 (UTC)

Who said the source was POV? Per Template:Dubious: "Add {{Dubious}} after a specific statement or alleged fact which is sourced but which nevertheless seems dubious or unlikely. Most commonly, this involves uncertainty regarding the veracity or accuracy of the given source, or of an editor's interpretation of that source." My concern being the latter, and shared by Rytyho usa. Seems like the right template to use under the circumstances. It doesn't improve the encyclopedia to remove it. If you have WP:BOOMERANG issues re the QG RfC/U, don't act them out in article and article talkspace. --Middle 8 (leave me alone • talk to me • COI) 23:33, 21 February 2014 (UTC)

Okay, so if "osteopathic medicine" confuses Americans, let's call it "osteopathy" to be less ambiguous (done). I don't think we should dwell on DOs here, OMT training of DOs is covered in the DO article. Alexbrn ^{talk|contribs|COI} 04:56, 22 February 2014 (UTC)

Certainly an improvement, thanks. --Middle 8 (leave me alone • talk to me • COI) 05:41, 22 February 2014 (UTC)

Fringe sourcing?

I have moved here text that was recently added to the article:

A 2014 systematic review and meta-analysis found low quality evidence to support the use of strain/counterstrain for short-term relief of tender point palpation pain.

sourced to

• Wong CK, Abraham T, Karimi P, Ow-Wing C (April 2014). "Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: A systematic review with meta-analysis". J Bodyw Mov Ther (Systematic review and meta-analysis). 18 (2): 165–73. doi:10.1016/j.jbmt.2013.09.010. PMID 24725782.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Is this a WP:FRIND? I note too the journal doesn't appear to have an impact factor and the article used is not (yet anyway) MEDLINE indexed. Alexbrn ^{talk|contribs|COI} 09:28, 27 April 2014 (UTC)

No, this is well-sourced information and follows WP:MEDRS. It is a PubMed, MEDLINE-indexed journal and a (very recent) secondary source as a systematic review and meta-analysis. I did not take any of the information out of context and followed exactly what the source said. Just because a journal has a low impact factor does not make it fringe. Please provide support for your characterization of this journal. While the article itself (specifically) is not yet MEDLINE indexed, that is because it is new. Please see here to verify that the journal itself is: http://www.ncbi.nlm.nih.gov/nlmcatalog/?term=Journal+of+Bodywork+and+Movement+Therapies . If we have to wait a little while before including the article as MEDLINE index is pending, that's fine, but that doesn't make it fringe or make it fail WP:MEDRS. MEDLINE indexing is only a marker of quality, it is not absolutely required, and it should receive it soon in any case. I cannot verify anything on ResearchGate right now regarding impact factor since I'm getting a notice from them that their website is down for maintenance, but other websites support the notion that this journal has an impact factor (albeit a low one: http://www.scimagojr.com/journalsearch.php?q=16788&tip=sid).

I see nothing on the WP:MEDRS page at all that says a journal must be (or should be) high impact to be considered for inclusion on Wikipedia as a reliable source. Where are you getting this criterion from exactly? The only mention of anything even close to this statement is that ideal sources are from "reputable medical journals" and as far as I can see this journal doesn't have a substantial reputation, but I have not come across any materials referencing this journal as "fringe". As for the WP:FRIND part, this certainly seems like an independent source, not sure where the doubt about that is coming from. The lead author is a PhD, PT, OCS from Columbia University while the other authors are from the physical therapy program also at Columbia University. Study was funded by the NIH and National Center for Advancing Translational Sciences and this information is readily visible in the acknowledgements section of the paper. TylerDurden8823 (talk) 18:12, 27 April 2014 (UTC)

Oh! I see you've stuck your content back in before consensus was reached. Why did you do that? Also you've re-added all the clutter about dates and article types, which is bad writing. Do you think it might be worth asking at WT:MED or WP:FT/N ? Alexbrn ^{talk|contribs|COI} 18:34, 27 April 2014 (UTC)

Actually, I did not put the 2014 systematic review back in, but perhaps you should read the article first before jumping to conclusions. If you're referring to the revert of your completely undiscussed overhaul of the whole effectiveness section (which was stable not to mention that you significantly contributed to this section in the first place), then I don't know what the problem with the current version is. It seems more comprehensive to me and your edit to chop it down all into one sentence seemed oversimplified and didn't seem to do the section justice. So, before you call me a bad writer (may I remind you of WP:CIVIL?-seriously, would it kill you to not be condescending toward another human being?), consider who wrote some of that content in the first place. See here: https://en.wikipedia.org/w/index.php?title=Osteopathic_manipulative_medicine&diff=594848616&oldid=594836984 Clutter? Don't be ridiculous, the entire section is two small paragraphs and a sentence (plus the newer review being discussed which was one sentence).. As for WT:MED, sure, I'm fine with discussing it there, you seem to have some WP:OWN issues going on with this article and over at osteopathy with the IP user as you seem to think each and every edit must have your approval. Notice no one else is discussing these edits on these talk pages except for you. Your opinion does not equal "a consensus". TylerDurden8823 (talk) 18:52, 27 April 2014 (UTC)

Apologies, I got my diffs in a twist; text stricken. I didn't call you a bad writer, I said it was bad writing - and as you point out, it was largely my fault. In general, I can't help it if these articles have few editors and - as fringe topics - they have their fair share of fringe-POV-pushing passing trade, which needs some attention for the the good of the articles. As to WP:OWN, I thought you were the one with the osteopathy connections here... WP:KETTLE maybe? Alexbrn ^{talk|contribs|COI} 19:00, 27 April 2014 (UTC)

There isn't a big difference between calling someone a bad writer and saying someone's writing is bad. I'm not saying that you can help it is some of these articles have few editors, but just because there are fewer editors working on this page does not mean your opinion counts more than usual. We still must strive to build consensus and lately your attitude has been very hostile and your approach to editing has been stifling and reminiscent of WP:OWN. I never said I have "osteopathy connections". You asked me once if I have a "potential POV" and I said maybe potentially, but I never admitted to any COI despite the fact that you tagged me on this article as having such. I have long considered removing that unreasonable tag, but I knew it would be swiftly reverted by you, that is the only reason I haven't removed it since it is untrue that I have a COI/POV problem. I don't, though you tirelessly accuse me of COI/POV (accusations aren't exactly civil) and I do not automatically revert all of your edits.

I attempted to add reasonable information (one sentence) from a 2014 secondary source (systematic review and meta-analysis) from a PubMed source, from a journal that is MEDLINE indexed (if we must wait for the article itself to be MEDLINE indexed, as I said earlier, there is no objection to that), and reasonably restated their findings in the evidence section. You seem determined to prove that OMT does not work, but I have added information that shows positive, neutral, and negative results showing that I have approached this in a balanced/neutral way. I have often said (when there was disagreement) that we should directly quote the article in question to sidestep the issue of disagreements in interpretation, but you have rebuffed such offers in favor of your own view. Much of the content that you have added that I do not agree with remains, but it is unreasonable that each and every single edit that I put on here must be discussed on the talk page first. Even minor edits that I do seem to be reflexively objected to or reverted. I do not have any WP:OWN issues, I do not prevent other editors from writing on this page nor have I claimed anyone is "ruining my work" or anything to that effect. So, I will have to say no to WP:KETTLE. You're comparing apples to oranges. I think what you are correct about is that we need more eyes on this article. TylerDurden8823 (talk) 19:13, 27 April 2014 (UTC)

More eyes are always good, so returning to the content, my initial question doesn't seem to have been answered. Is this source RS? For a fringe topic like this we need to be careful to avoid fringey sourcing. Alexbrn ^{talk|contribs|COI} 19:19, 27 April 2014 (UTC)

I think I answered it pretty well above. This is not "fringy sourcing". Since you are the one raising the question of whether this source is "fringy" or not, it appears to me that the onus is now on you to prove that it is since I have already provided substantial evidence that it is not. Evidence summation is as follows: recent (2014) secondary review article source, PubMed indexed, MEDLINE indexed journal (already discussed the issue of this particular paper being MEDLINE indexed and holding off if needed), has a low impact factor (but not a criterion on WP:MEDRS to be a reliable source of medical information), paper is not pharma-funded (funded by NIH and National Center for Advancing Translational Sciences), authors are independent from Columbia University and are not osteopathic physicians or European osteopaths, and this is a systematic review and meta-analysis. I google searched the journal and found no references to it from any reliable source that this journal is regarded by the academic community as a "fringe journal". Please provide evidence that this is the prevalent view of this journal by the academic community if you're going to raise this objection. TylerDurden8823 (talk) 19:24, 27 April 2014 (UTC)

Its age does not affect whether it's fringe or not, neither does the type of article. A journal of "bodywork" is in the altmed space so automatically fringe - and likely to contain fringe content. And sure enough this one seems to have published articles on chiropractic, homeopathy, naturopathy and "vibrational medicine" as well as OMT. Some red flags, surely? Alexbrn ^{talk|contribs|COI} 19:55, 27 April 2014 (UTC)

I'm not saying the age or the fact that it's a review article affects whether it's fringe or not. My point is that these are significant aspects of this source that are consistent with WP:MEDRS (i.e., listing strengths of the article that should be considered aside from the fact that it comes from a low impact journal), which states sources from within the last five years are preferred. With respect to your other point, no, a journal of "bodywork" is not automatically fringe by definition. What are you basing this assessment on? Where is your evidence for this statement that bodywork is synonymous with fringe and that this invalidates the use of this academic peer-reviewed PubMed and MEDLINE-indexed journal? Is it your opinion or someone else's? Is it the consensus of the academic community that this is a fringe journal? If so, please provide evidence of this. Plenty of journals have published articles on the topics you mentioned and are not fringe journals. Are you suggesting any journal that even publishes a review of these topics (as the journal article in question did) is a fringe journal? Or is it only journals that publish original research on these topics?

So, by your logic, the following MEDLINE indexed journals would be considered fringe journals because they have published original research and/or review articles covering these alternative medicine topics? Keep in mind, there is no shortage of examples, these are just a few I dug up with ease. If I have your point pegged incorrectly, let me know and I'll rephrase. Current Rheumatology Reports (http://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Curr+Rheumatol+Rep%22[Title+Abbreviation]), the International Journal of Pediatric Otorhinolaryngology (http://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Int+J+Pediatr+Otorhinolaryngol%22[Title+Abbreviation]), Cochrane Database of Systematic Reviews (http://www.ncbi.nlm.nih.gov/pubmed/23904227), and the Annals of Family Medicine (http://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Fam+Med%22[Title+Abbreviation]) to name a few that have published original research or review articles on these topics. These links are mostly proving that these are MEDLINE-indexed journals though I think I linked to the actual article in question in one or two cases. However, my point is that just because a journal publishes original research articles and/or review articles covering these alternative medicine topics, it does not mean the journal itself becomes a "fringe journal". TylerDurden8823 (talk) 20:24, 27 April 2014 (UTC)

(edit conflict) A journal about alternative medicine is not "automatically fringe". A journal about _____ field of medicine (or anything else) is not automatically non-independent.

In the end, Wikipedia evaluates sources according to the basic standard of Hoyle's Law: Whatever the game, whatever the rules, the rules are the same for both sides. Unless and until you are prepared to declare all surgery (or oncology, or physics, or whatever else) journals to be non-independent with respect to their specialization, then you cannot declare that all altmed journals are non-independent with respect to their specialization.

I don't understand why this keeps coming up. At its core, WP:INDY is about making money (or gaining power or personal fame) for the authors themselves. The herb-o-the-week manufacturer is not independent. The big pharma company is not independent. The guy who's promoting his new book is not independent. Academics—regardless of their academic field—are (usually) independent, because their paychecks don't (usually) change when they say something better or worse about a "product". Making the woo-of-the-month more (or less) popular has no personal effect on these authors. A bunch of specialists talking to themselves about their own field are not automatically non-independent. They're doing what specialists ought to do.

Your real complaint appears to be that you assume that the journal is WP:BIASED in favor of a subject that you happen to be biased against. (You are also assuming, again without evidence, that the specific paper is only published in a "biased" journal because it would be impossible to publish it in a "neutral" or "mainstream" journal.) For better or worse, WP:BIASED sources are permitted. WhatamIdoing (talk) 20:36, 27 April 2014 (UTC)

@TylerDurden8823 - It is not as simple, surely, as applying a series of yes/no questions (otherwise source evaluation would be much easier); good journals publish ropey papers all the time and lesser journals excellent ones. However a fringe journal publishing on a fringe topic should surely be in question. The Homeopathy journal publishing a systematic review of homeopathic treatment would be an obvious case, no? Alexbrn ^{talk|contribs|COI} 04:30, 28 April 2014 (UTC)

I'm still waiting for you to provide actual evidence that it is the consensus opinion of the academic community (and not your own opinion) that this is a "fringy" journal. Do you have any such evidence? Your assertion earlier was that The Journal of Bodywork and Movement Therapies is a fringe journal because it publishes articles (original or review) on alternative medicine topics. I respectfully disagree. As for your example of the Homeopathy journal publishing a systematic review of homeopathic treatment, that's a hyperbolic example and beside the point. The merit of each paper should be considered individually even if the journal in which it was published is taken into consideration. That aside, I have already shown (with numerous criteria) that the paper in question is a strong one regardless of journal (which as I mentioned earlier is PubMed and MEDLINE indexed). Must we really go around in circles deciding how good of a journal it is? Face it, this paper meets WP:MEDRS guidelines. Since you were the one to raise the objection and remove this material from the article in order to first discuss it on the talk page, the burden is on you to provide proof that this is a "fringe" journal as you claim and that this characterization is not your own, but that of meaningful academic authorities. If you cannot provide such evidence (and in a timely manner), the sentence from this review should be included in the article. End of discussion. TylerDurden8823 (talk) 04:39, 28 April 2014 (UTC)

In point of fact, the WP:BURDEN is on the editor who "adds or restores" material; however that is not the real issue here. Alexbrn ^{talk|contribs|COI} 05:34, 28 April 2014 (UTC)

Actually, as I said before, I already provided strong evidence that this article follows WP:MEDRS guidelines (I'll say it again-it does) and therefore satisfied WP:BURDEN (but we both know WP:BURDEN is not what I was referring to in the first place) and was nothing more than a derailing sidetrack. I provided a clear inline citation (which you included above in this very talk page section) The burden of proof is now on you to prove your claim that this is regarded as a fringy journal unless that is only your assessment (which is not sufficient cause to keep it out of the article). Normally, yes, the burden of proof is on the one who decides to add/restore the material, but since I already did that more than once (originally added the material once but did not restore it, I hope you weren't falsely accusing me of that again...), the burden has shifted on to you since I clearly did my part. As I said earlier, if you cannot put up stronger evidence that trumps that which I have put forward, then your claim should be withdrawn and the sentence should go in. If you refuse to (or cannot) provide this evidence and continue to object, then you run the risk of tendentious editing per WP:DISRUPTSIGNS and such behavior should be regarded as obstructionism since you seem to be disregarding provided evidence about the paper (more importantly) and journal in question. I will ask you once more-where is your evidence to support your claim to counter the strong evidence I have presented? Your opinion alone is insufficient and does not outweigh the opinions of other Wikipedia community members or that of the academic community. I am not saying that you claim your opinion is higher than others in the community (Wikipedia or the academic community), but your actions seem to indicate otherwise. TylerDurden8823 (talk) 05:52, 28 April 2014 (UTC)

You need to calm down and WP:FOC rather than setting WP:DEADLINEs and inventing new conventions: you're the one seeking to add this new material to the article, so yes the WP:BURDEN is yours. My worry is that this is a non-MEDLINE indexed article in a low impact fringe journal. Your response has been to say the impact factor and MEDLINE indexing don't matter and that it would require evidence of the "consensus opinion of the academic community" before a source could be questioned for its fringe nature. I'm inclined to agree the MEDLINE indexing is moot. The other factors in combination still worry me. I'm also wondering if the Counterstrain article would be a better candidate for this type of content too. Alexbrn ^{talk|contribs|COI} 06:10, 28 April 2014 (UTC)

So, have any evidence yet from a source other than yourself (an academic one perhaps)? Still waiting... A few more markers that this is a reliable source include that the journal is part of a citation index and has an editorial board based in a respected accredited university. The journal is also not a "questionable source" or "self-published source" per Wikipedia definitions. The discussion on https://en.wikipedia.org/wiki/Talk:Vitamin_D begs to differ that MEDLINE-indexing is not important as does your own use of this earlier today as an important reason not to use it in the following quote: " Is this a WP:FRIND? I note too the journal doesn't appear to have an impact factor and the article used is not (yet anyway) MEDLINE indexed. Alexbrn ^{talk|contribs|COI} 09:28, 27 April 2014 (UTC)". I never said MEDLINE-indexing isn't important, I said it is a marker of quality, but is not a strict requirement of WP:MEDRS. That does not mean it doesn't matter, it means non-WP:MEDLINE indexed journal articles are permissible (if shown to be a strong article or journal in its own right-but back to the topic at hand). I did not invent any new conventions or set a specific time deadline at all. If I set a deadline time, please show me where and I'll revise. I believe I did ask you to provide evidence that this article does not meet WP:MEDRS since I have provided strong evidence that it does and that the burden has shifted on to you since I more than did my part. You continue to insist about your worry despite the evidence I have provided and other editors (e.g., WAID) disagreeing with you. You are now running the risk of WP:IDHT behavior. Your claim that this is a fringe journal remains unproven, it is only your characterization of the journal so far (vicious cycle about your worrying there) and the fact that the article itself is not yet MEDLINE-indexed was properly addressed earlier. I'll refer you to my earlier comments (I said it more than once-please read it, I tire of repeating myself). I have no objection to adding this information into the counterstrain article as well, but counterstrain is an OMM modality and therefore the information also belongs on this page. Counterstrain is firmly established as an OMM technique and there are proper inline references supporting this notion. Adding this information to the counterstrain article is not the issue here. Let me know when you have some actual evidence to support the claims you have made. I've done my part. If you continue to keep the information out after the information is proven to come from a reliable source that meets WP:MEDRS, you run the risk of WP:DISRUPTSIGNS behavior as well. So far, I would say #1, #4, and #5 are present and I have satisfied WP:Verifiability. I think this is also pertinent https://en.wikipedia.org/wiki/Wikipedia:Tendentious_editing#One_who_disputes_the_reliability_of_apparently_good_sources TylerDurden8823 (talk) 07:21, 28 April 2014 (UTC)

I didn't say MEDLINE indexing was "unimportant", but in this case "moot" (because: in time this article will likely be indexed, it's just system latency why it's not now). WAID is a mighty editor indeed but not plural ("editors"), I think! WP:BURDEN is quite explicit: you're restoring content so the onus is on you. (Are you really wanting to rely on burden as an argument tactic; can't we please stop discussing it as it's not to the point -- as indeed are any of your procedural quibbles). The fringe nature of the content is inherent: OMT is fringe (as is well set out in our article). Does this journal penetrate beyond an insular altmed world? what kind of take up does it have from other sources? (impact factor suggests, not a lot; a datum, BTW, that is not my "opinion"). Is it mainly altmed people talking to themselves or is there good independent review? These are the pertinent questions. Alexbrn ^{talk|contribs|COI} 07:44, 28 April 2014 (UTC)

Okay, small correction. I agree that WAID is one editor. Satisfied with your pointless semantic argument that only points out a typographical error? Good. Note, however, that you appear to be disregarding the opinions of two editors including myself. Do you have a threshold for how many editors must oppose your view? Also, I really would prefer (I know you don't care about my preferences) that you stop insisting that I am "restoring content" (if we're going to play semantic games) since I only added the information once and never restored it. I am stating that the information should go back into the article but have not put it back in since I am engaging in proper discussion on the talk page first. I appreciate the clarification that you are not saying MEDLINE-indexing is unimportant or irrelevant, but is moot since in time the article will be MEDLINE-indexed and just hasn't been yet. Glad to see we are in agreement on that part. Again, I did my part and supplied more than adequate evidence to show that the source meets WP:MEDRS and is a reliable source. Your turn to prove it does not or withdraw your objections. My procedural quibbles, as you say, are often important to you and are important to the encyclopedia in general. Your disregard for them is a bit alarming. Anyway, a reliable source is not required to "penetrate beyond an insular altmed world". That's not anywhere in WP:MEDRS. Now you're just making stuff up. It's a brand new paper, so clearly we cannot yet assess uptake from other journal articles or other sources (which you obviously know). So far, it is your opinion that this is a fringe journal, I have yet to see you provide any evidence of academic consensus or even several experts characterizing the journal in this manner. This is nothing but your characterization pure and simple. Time will tell if the paper is cited by other papers, but this alone is insufficient to invalidate this paper as a reliable source. You don't get to just keep the paper out of the article for weeks or months or years while we wait to see if the article is cited by other papers in other journals. Stick to the question of whether it's a reliable source or not. And you say I'm the one who needs to WP:FOC. Sheesh TylerDurden8823 (talk) 08:03, 28 April 2014 (UTC)

A low (or zero) impact factor is an indication the publication has no impact in the mainstream, which is prima facie evidence of its fringeiness. You haven't addressed this. Or are you contending that WP:FRIND does not apply here? As to independent review, what evidence is there of that? The funding too looks more than a bit suspicious, with support coming from such bodies as The International College of Applied Kinesiology The Rolf Institute and The Upledger Institute. And the journal admits it features cranial therapy. Plenty there for the WP:Lunatic charlatans. My objection continues to rest on this being a fringe journal lacking mainstream respectability and evidence of independence (in fact there is circumstantial evidence to the contrary). The content you wish to restore, and the health claim implied would be undue & unreliable respectively. Show me good corroborating sources or some evidence of the journal's impact or independence and I can re-think. (BTW, this is not a vote.) Alexbrn ^{talk|contribs|COI} 09:28, 28 April 2014 (UTC)

The BURDEN has been met. See the footnote in that policy: Once an editor has provided any source that he or she believes, in good faith, to be sufficient, then any editor who later removes the material has an obligation to articulate specific problems that would justify its exclusion from Wikipedia (e.g., undue emphasis on a minor point, unencyclopedic content, etc.). All editors are then expected to help achieve consensus, and any potential problems with the text or sourcing should be fixed before the material is added back.

Tyler has added "any source that he or she believes, in good faith, to be sufficient". It is now your job to "articulate specific problems that would justify its exclusion from Wikipedia (e.g., undue emphasis on a minor point, unencyclopedic content, etc.)". WhatamIdoing (talk) 15:08, 28 April 2014 (UTC)

Break

@WAID - You say Unless and until you are prepared to declare all surgery (or oncology, or physics, or whatever else) journals to be non-independent with respect to their specialization, then you cannot declare that all altmed journals are non-independent with respect to their specialization but is that not the very embodiment of the WP:GEVAL fallacy? There is an essential difference between the top physics journal and the top homeopathy journal, precisely because of the field in which they publish: one is not mainstream, and so is where WP:FRINGE guidance applies. So far as I can see, the field of Bodywork (alternative medicine) is a umbrella term for a area which contains a number of nonsensical things (e.g. Bates method and reflexology). Any claimed health benefits deriving from these things is extraordinary and needs strong sourcing. Sure we can use potentially biased sources, but we would make that potential bias clear and take weight into account. Alexbrn ^{talk|contribs|COI} 05:16, 28 April 2014 (UTC)

Perhaps this should be true, but there are no policies that say you get to exclude sources based on their subject matter. You don't get to say that all altmed (or animal rights, or pro-gold standard, or any other minority viewpoint) journals are unreliable because they're interested in minority viewpoints. Not even FRINGE says this. Here's the summary of what constitutes a reliable source:

According to our content guideline on identifying reliable sources, a reliable source has the following characteristics:

• It has a reputation for fact-checking and accuracy.
• It is published by a reputable publishing house, rather than by the author(s).
• It is "appropriate for the material in question", i.e., the source is directly about the subject, rather than mentioning something unrelated in passing.
• It is a third-party or independent source, with no significant financial or other conflict of interest.
• It has a professional structure in place for deciding whether to publish something, such as editorial oversight or peer review processes.

There's not a single word in there about whether the source appears to hold a mainstream or minority viewpoint.

Furthermore, have you thought about what you're achieving here? You have a good type of source saying that the evidence in favor of bodywork is pathetic. And if someone comes along and says, "Oh, that's just some biased mainstream thing, then they're going to be surprised: even what you've assumed is a "pro-bodywork" journal says that there's no good evidence for what bodywork. WhatamIdoing (talk) 15:08, 28 April 2014 (UTC)

Thinking some more, I don't see the issue here as exclusively one of reliability in the WP:RS sense, since even the ropiest source can (in that sense) reliably be cited for reporting what it states ("According to [ropey source] ..."). The problem is more to do with the neutrality of including the (possibly unreliable) information that the source carries, and here we do have policy: "Conspiracy theories, pseudoscience, speculative history, or even plausible but currently unaccepted theories should not be legitimized through comparison to accepted academic scholarship. We do not take a stand on these issues as encyclopedia writers, for or against; we merely omit them where including them would unduly legitimize them, and otherwise describe them in their proper context with respect to established scholarship and the beliefs of the greater world". (My bold). As the article currently stands we list a series of "systematic reviews" and the proposal is to include alongside the ones from respected journals, this one of more questionable origin, without any hint of difference. In the past when I have cited such journals (for example when there is absolutely nothing else), I've done it with heavy attribution, for example in the last paragraph of Bowen Technique. Perhaps here for OMT too, in the context of the weightier reviews (whose findings should be simply asserted), this approach may be enough to establish the required "proper context", and could be a way forward? But I would be interested to here from the folks at WP:FT/N about this ... Alexbrn ^{talk|contribs|COI} 16:18, 28 April 2014 (UTC)

Does it "unduly legitimize" bodywork to say that even their (assumed) proponents think there's no evidence for it working? I don't think so. In fact, it is a fairly disparaging statement.

That section in NPOV is about supporting garbage by comparing it to mainstream views. It's the conspiracy theories and other garbage that we don't want to legitimize. This section says nothing about trying to "legitimize" the sources—and especially not academic sources (which, for better or worse, this actually is)—by citing them. For example, we don't want to legitimize philosophical criticism of Einstein's theory of relativity by comparing philosophical realism and anti-realism to the theory of relativity. The problem is not citing a basically reliable source from the "wrong POV holders" that says that their "wrong POV" is probably wrong. WhatamIdoing (talk) 17:04, 28 April 2014 (UTC)

The proposed edit is not to say "(assumed) proponents think there's no evidence for it working" - it's not been rendered for lay consumption in that way. Sorry, I don't understand your last sentence. Alexbrn ^{talk|contribs|COI} 17:25, 28 April 2014 (UTC)

The text you removed says that: "A 2014 systematic review and meta-analysis found low quality evidence to support the use of strain/counterstrain for short-term relief of tender point palpation pain". In blunt language, "There is no evidence that this stuff works".

The last sentence is about the goal of NPOV's text, which means something like, "Don't spam around nonsense about trivial garbage like Timecube, because that might make people think that Timecube was important enough to be seriously considered by academic and other experts, or that it's a major point of comparison". NPOV's text does not mean anything like, "Don't use apparently reliable academic journals if the journal has, in your opinion, 'the wrong POV', because citing anything from people who disagree with you is only going to legitimize their existence". WhatamIdoing (talk) 20:43, 28 April 2014 (UTC)

I have to say, I think "no evidence this stuff works" is a peculiar reading. I take the proposed edit to mean "there is low quality evidence, but - heh! - in altmed that's good enough". That's what the article authors seemed to believe anyway, as they say "This systematic review and meta-analysis supports SCS as a clinical option available to the practitioner working with patients with TP tenderness." If we can agree the source is accurately summarized by saying it found SCS did not work then I have no objection to including that, as an unexceptional claim alongside the other unexceptional claim this source is being used for already. Alexbrn ^{talk|contribs|COI} 21:20, 28 April 2014 (UTC)

Do you think that the cited source supports the statement that you removed? WhatamIdoing (talk) 03:52, 29 April 2014 (UTC)

Technically, yes. Do you think the statement accurately digests the the findings of the source and conveys that meaning clearly in a way the lay reader will understand? Alexbrn ^{talk|contribs|COI} 04:56, 29 April 2014 (UTC)

I haven't read the whole source, so I don't know. (We aren't really required to summarize entire sources anyway.) But if it's a plausibly accurate statement, then I think you should restore it. I really doubt that anyone, lay or professional, is going to see "low quality" and think that it's a good thing. WhatamIdoing (talk) 15:31, 29 April 2014 (UTC)

!!! An iffy journal, an iffy article and (it now seems) an iffy representation of its iffy content. Think I'll pass on reinstating rubbish like that. But if some other editor thinks it's swell I'll not revert them - in the grand scheme of things it's pretty minor I suppose. I'll step back and raise this at WP:FT/N as I think the policy & guidance interpretations here raise questions that could benefit from a widened consensus. Alexbrn ^{talk|contribs|COI} 18:33, 29 April 2014 (UTC)

Well, then let me suggest that you read and think about Wikipedia:Neutral point of view#Bias in sources before you bother posting a claim that articles in scholarly journals about altmed should be tossed out because they're biased in favor of altmed. And if you want to change that policy, then I'd suggest starting the discussion at WT:NPOV instead of at FT/N. WhatamIdoing (talk) 19:06, 29 April 2014 (UTC)

I think the policy is fine: "Biased sources are not inherently disallowed based on bias alone, although other aspects of the source may make it invalid". If this same source had appeared in a different host publication (The Lancet?) there could be no objection. Alexbrn ^{talk|contribs|COI} 19:20, 29 April 2014 (UTC)

If the same article would be fine if only it had appeared with a different publisher, then the article is fine now. WP:SOURCES gives the relevant definition. If any one of the criteria is acceptable, then the source is reliable (at least to a first approximation).

The "other aspects" clause in NPOV does not include "I think the publisher has the wrong POV". It is meant to cover things that make the source unreliable, such as being self-published by a non-expert. You can't disallow FOX News because the publisher has the wrong POV; you can't disallow NPR because the publisher has the wrong POV; you can't disallow academic journals about surgery because the publisher has the wrong POV (real example, if I haven't mentioned that); and you can't disallow academic journals about altmed because the publisher has the wrong POV. As I've said before, whatever the rules, the rules are the same for both sides. NPOV's section about bias does not allow you to select only those academic journals that happen to agree with your POV (no matter how right your POV is). WhatamIdoing (talk) 21:02, 29 April 2014 (UTC)

What is this "wrong POV" you keep invoking? Fringe and mainstream and not just two "sides" with the same rules: Wikipedia is heavily biased in favour of the mainstream. We minimize, contextualize and/or omit fringe notions (not always "disallow", N.B.), and we can determine what those fringe notions are without recourse to thinking about POV, but by assessing the degree of mainstream scholarly acceptance (e.g. by looking at the impact factor of the journal, the uptake of the article, or many other pieces of evidence). By your reasoning we'd be "allowing" the journal Homeopathy, would we not? Yet this is named in WP:FRINGE as an unreliable journal. Alexbrn ^{talk|contribs|COI} 21:21, 29 April 2014 (UTC)

Your position that "not mainstream" and "fringe" are synonyms is untenable. Determining "the degree of mainstream scholarly acceptance" is biasing your choice based on POV: your test is "let's evaluate the worthiness of this minority POV according to how well the POV is accepted by the majority POV".

We can disallow publications like Homeopathy for reasons that have nothing to do with its POV (e.g., a reputation for being lax about fact-checking). WhatamIdoing (talk) 05:09, 6 May 2014 (UTC)

Doesn't seem like a conclusion was reached here one way or the other from what I see. However, I've decided to not include the article (at least right now) for reasons other than the ones discussed here. For future reference, with respect to a journal's impact factor, where exactly are we setting the bar in terms of what is deemed a journal with adequate impact? 2? 5? 10? Higher? Is there a guideline I am unaware of somewhere on Wikipedia that guides us on this particular question? I am curious to know what Wikipedia users consider to be a threshold (if there is one) for this. TylerDurden8823 (talk) 03:56, 5 May 2014 (UTC)

Don't think there's a hard and fast rule - it's a factor (hah!) to be taken into account, depending on the claim being supported. So, the Wong source is okay for the other uses in the article here, I think. Alexbrn ^{talk|contribs|COI} 06:15, 5 May 2014 (UTC)

I would settle for an estimate or even a range for what's generally deemed a noteworthy impact factor per Wikipedia if there is no hard and fast rule about the topic. I fully understand that the impact factor is only one of many factors taken into consideration. With respect to the claim, let's break it down by three situations. Situation #1-statement is not controversial at all, situation #2-situation is perhaps somewhat controversial in the literature, situation #3-highly controversial claims. Obviously these are qualitative delineations and deciding what qualifies as "highly controversial" vs. "somewhat controversial" vs. well-accepted could potentially require discussion amongst Wikipedians since there can be gray zones, but humor me with these categories. TylerDurden8823 (talk) 06:52, 5 May 2014 (UTC)

Not sure it's so much "controversial" as (slightly more broadly) "exceptional" claims which need the stronger sources. This list gives some numbers which might be of interest for general medicine journals. But some specialist fields will necessary have, on average, lower numbers. Alexbrn ^{talk|contribs|COI} 09:53, 5 May 2014 (UTC)

Well, from the provided source I saw a range of about 2-50ish with the 50s being gold standard journals like NEJM. Is it fair to assume (for statements that are not "exceptional" that a journal impact factor of 2+ would be deemed acceptable/a notable enough journal? Is there a bit of leeway for a journal with a little bit less than that (e.g., 1.5)? I understand for exceptional claims that a stronger source would be needed, that part is clear. TylerDurden8823 (talk) 20:46, 5 May 2014 (UTC)

In my view (as I say) it's only one factor so doesn't lead to a journal being "deemed" acceptable or not. I think of the number is above 2, one generally wouldn't include it in the mix of things being considered. — Preceding unsigned comment added by Alexbrn (talk • contribs)

There simply is no "good" or "bad" impact factor. From what I've heard, the impact factor depends significantly on the field (a "bad" IF for physics is a "good" IF for arts) and the focus of the journal (smaller, specialist journals get "bad" IFs). There are also problems with it giving higher scores to journals that publish famously bad work, because that bad work gets cited as bad examples. It's regularly described as the worst possible metric for determining whether a journal is any good, except for all the others that have been proposed. WhatamIdoing (talk) 05:09, 6 May 2014 (UTC)

Pseudoscience

The sources used in the lede are of poor quality and seem to characterizing the entirety of OMT/CMT as pseudoscience. Are these really the type of sources that we use to label a whole therapeutic intervention? That seems like a sweeping generalization to me, and it seems like there's a better categorization out there. DVMt (talk) 21:22, 16 May 2014 (UTC)

The lead is just a summary of the body of the article, main points, and the sources appear reasonable. What specific objections do you have to them, bearing in mind that a great deal of work went in to the solution we have at the moment.? Vague hand waving will not do. -Roxy the dog (resonate) 22:51, 16 May 2014 (UTC)

Well, let's look at them:

• The first is a story written by the editor, 16 years ago, and says that some MDs used to hold this opinion: "For many years, M.D.s looked upon D.O.s as cultists, determined to practice according to the osteopathic principles laid out in 1874 by founder Andrew Taylor Still. An allopathic physician himself, Still rejected the prevailing medicine of his day, in particular its reliance on drugs and surgery.... To many in the allopathic community, the principles articulated by Still and embraced by his followers seemed like so much pseudoscientific dogma. That suspicion continued for many decades." It says nothing about the modern state and does not subscribe to that opinion itself.
• The second is just a letter to the editor, which are normally considered WP:SPS. If you wouldn't take the same opinion ("I cannot continue to support an antiquated system of healthcare that is based on anecdote or, in some cases, pseudoscience") off that writer's blog, then you can't take it out of a letter to the editor.
• The third is an op-ed in a business magazine (i.e., the very thing that WP:RS warns against using as a source of facts, rather than opinions, "opinion pieces, whether written by the editors of the publication (editorials) or outside authors (op-eds) are reliable primary sources for statements attributed to that editor or author, but are rarely reliable for statements of fact").

I don't really think that the sources appear reasonable. (I assume that there are better ones out there, but these aren't very good.) WhatamIdoing (talk) 00:50, 17 May 2014 (UTC)

Err guys, this is not being asserted as a "statement of fact", but relayed as opinion: "Some critics have characterized it as pseudoscience". Alexbrn ^{talk|contribs|COI} 03:05, 17 May 2014 (UTC)

If you can't find better sources that promoting these opinions, then it's not DUE.

Think of it this way: if I came to you with the same sources on another subject, would you accept it? Imagine that I want to say that "some critics have characterized vaccination as pseudoscience" in the lead of Vaccine. Would you take a story written by the publication's editor, saying that some MDs (years ago) thought that vaccination was pseudoscience, a letter to the editor from one physician, and an op-ed from a business magazine for that?

If you won't accept that (and I'd lead the pitchfork brigade against it), then you can't accept it here. It doesn't matter if some Wikipedians agree with this characterization. If this characterization is DUE, you will be able to provide good, independent, secondary sources to back it up, not just letters to the editor. If you really can't find better sources, then it's not DUE.

There's also a problem with WP:REDFLAG, which is opposed to "challenged claims that are supported purely by primary or self-published sources or those with an apparent conflict of interest". You really do need to find a decent secondary source for this. WhatamIdoing (talk) 14:55, 17 May 2014 (UTC)

Vaccination is not a fringe topic, so WP:PARITY is not in-force guidance. It's your false equivalence argument again, which fails to acknowledge that some things are fringe and so different rules apply. As the guidance says: "Parity of sources may mean that certain fringe theories are only reliably and verifiably reported on, or criticized, in alternative venues from those that are typically considered reliable sources for scientific topics on Wikipedia". If there were counter-sources opining that OMT was fully grounded in science, or that OMT had changed over the last few years (and the trouble with dogma-based belief systems is that they are largely change-proof) that would be a different matter. Since these are not primary sources (for their use), and there is no COI, WP:REDFLAG does not apply here. Alexbrn ^{talk|contribs|COI} 15:03, 17 May 2014 (UTC)

Changes to OMM

INTRO _________

"Research into OMM has generally not found it to be an effective therapy.[3][4][5] Some critics have characterized it as pseudoscience.[6][7][8]"

?Research into OMM has generally not been able to prove with certainty whether or not it is an effective therapy since it is very difficult to study manual therapies. Some research studies have found OMM to be effective while others have not. Some critics have characterized it as pseudoscience but OMM has many advocates in the medical community"

The old text is very misleading. Research hasn't generally found it to be an effective therapy but it also has not proved it to be an ineffective therapy. This is a technicality in the way scientific reviews are written and the wording of the original text will lead visitors to believe that OMM is ineffective. The new text is a much more accurate way of descriving the current state of the research. This can be verified at http://www.med.nyu.edu/content?ChunkIID=37409#evidence.

EFFECTIVENESS ____________ Added this additional research information on OMM. The original text includes only studies that are outdated and only one view of a topic with two sides.

"In a study of 183 people with neck pain, use of osteopathic methods provided greater benefits than standard physical therapy or general medical care. Participants receiving OMT showed faster recovery and experienced fewer days off work. OMT appeared to be less expensive overall than the other two approaches; however, researchers strictly limited the allowed OMT sessions, making direct cost comparisons questionable. Another study evaluated a rather ambitious combined therapy for the treatment of chronic pain resulting from whiplash injury (craniosacral therapy along with Rosen Bodywork and Gestalt psychotherapy). The results failed to find this assembly of treatments more effective than no treatment.

In a 14-week, single-blind study of 29 elderly people with shoulder pain, real OMT proved more effective than placebo OMT. Although participants in both groups improved, those in the treated group showed relatively greater increase in range of motion in the shoulder. And, in a larger study of 150 adults with shoulder complaints, researchers found that adding manipulative therapy to usual care improved shoulder and neck pain at 12 weeks.

In a small randomized, placebo-controlled trial researchers used oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, to treat 23 subjects with chronic tendonitis of the elbow (tennis elbow or lateral epicondylitis). Subjects in the treatment group showed significant improvement in grip strength, pain intensity, function, and activity limitation due to pain. These results however, are limited by the small size of the study and the fact that the therapist delivering the treatment could not be blinded.

Twenty-four women with fibromyalgia were divided into five groups: standard care, standard care plus OMT, standard care plus an educational approach, standard care plus moist heat, and standard care plus moist heat and OMT. The results indicate that OMT plus standard care is better than standard care alone, and that OMT is more effective than less specific treatments, such as moist heat or general education. However, because this was not a blinded study (participants knew which group they were in), the results can’t be taken as reliable. In another study, 93 women (average age 53) with fibromyalgia were randomized to receive sham treatment or craniosacral therapy (one-hour sessions twice a week for 20 weeks). The women in the craniosacral therapy group experienced a decrease in pain at 20 weeks, which persisted for at least one year. In another randomized trial, 94 people with fibromyalgia received either myofascial release or sham therapy for 40 sessions (20 weeks). 21 At the 6-month follow-up, the people in the treatment group reported less pain and more physical ability. But, only some of these results lasted until the 1-year follow-up.

A study of 28 people with tension headaches compared one session of OMT against two forms of sham treatment and found evidence that real treatment provided a greater improvement in headache pain. A small randomized controlled trial with 63 patients compared two myofascial release techniques to a control group. Myofascial release treatments resulted in fewer headaches for the 4-week trial period compared to the control group.

OMT has shown some promise for the treatment of back pain, including a randomized trial of 455 patients. The trial assessed the effects of 6 OMT sessions over 8 weeks compared to sham treatments. At 12 weeks, OMT was associated with moderate or substantial pain reduction compared to sham OMT. OMT also reduced the use of prescription pain medications. However, one of the best-designed trials failed to find it a superior alternative to conventional medical care. In this 12-week study of 178 people, OMT proved no more effective than standard treatment for back pain.6 Another study, this one enrolling 199 people and following them for 6 months, failed to find OMT more effective than fake OMT. This study also included a no-treatment group; both real and fake OMT were more effective than no treatment. A much smaller study reportedly found that muscle energy technique enhances recovery from back pain, but this study does not appear to have used a meaningful placebo treatment.

Researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and manipulation) for osteoarthritis of the hip or knee. The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo.

Some studies have evaluated the potential benefits of OMT for speeding healing in people recovering from surgery or serious illness. The best of these studies compared OMT against light touch in 58 elderly people hospitalized for pneumonia. The results indicate that use of osteopathy aided recovery.

OMT showed improvement in 6-minute walk test distance in a small randomized trial of 20 patients with stable chronic obstructive pulmonary disease. Distance in patients in the OMT group improved on average by 72.5 meters compared to 23.7 meters for patients in the sham OMT group.

In 2013, a Cochrane Review reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults." A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.

A small study found some evidence that OMT might be helpful for childhood asthma.?

201.229.95.34 (talk) 03:00, 22 June 2014 (UTC) 6/21 - Stephen F., D.O.

While some of your additions were definitely acceptable, other such as the last mention of a small study are primary sources, and do not abide by the policy on medical sourcing WP:MEDRS. Please look at that before you try to add new content again. -- CFCF (talk · contribs · email) 11:11, 22 June 2014 (UTC)

References

Recent revert

Alexbrn, please explain the grounds for your revert. Your objection to the rewrite seems to be nothing more than stylistic and I don't think that's adequate cause for the revert (especially without a constructive counterproposal and just a simple revert). I left a very clear edit summary explaining the reason for the change: "More accurate-should not generalize and instead specifically state that some/certain practitioners use it for conditions such as asthma or PD." The point of this edit was to clarify that not all practitioners of OMT use it in this manner and that the application of OMT in this manner is likely done by a small minority.

Your objection to this initial edit per your edit summary (here [3]) was about tense. I responded by correcting the tense in my original edit while maintaining the wording correction. Therefore, I see no grounds for your reversion unless you're changing your tune about why you objected. This feels extremely nitpicky and like you are unable to collaborate with me on the simplest/most minor of changes and that's rather disheartening. The meaning has not been changed at all except to be more specific in saying that only certain practitioners apply OMT in this way. Can you seriously say that's not a fair statement? If so, please explain how so with specific quantitative evidence to support your position. Additionally, the claim of "clunky" seems rather absurd since it's only a few words. It's really more helpful to suggest alternate wording instead of what's already there (I think it can be improved upon though perhaps you don't think so). As written, this sentence can be interpreted to mean that all OMT practitioners "sometimes" use these techniques in this way and that is an inaccurate statement. Only certain practitioners use it in this way (in reality this is likely a rather small minority). Do you have suggestions for alternate wording to avoid this issue? If so, I am open to a dialogue and I hope you are open to a collaborative dialogue as well. TylerDurden8823 (talk) 06:26, 18 December 2014 (UTC)

The sentence can be interpreted that way, or maybe not; it's fine. As you say, it's nitpicky but I'd prefer changes at least to be reasonable English. You now changed it again which is okay except we're now refering to "a minority of OMT practitioners". What's your source for "minority"? Do I recall you have a COI for this topic? Alexbrn ^{talk|contribs|COI} 06:34, 18 December 2014 (UTC)

I have no qualms with reasonable English, but wholesale reverts are unnecessary to accomplish this feat. As for the issue of COI, your recollection is incorrect. In the past you have asserted that I have such a COI, but I have never assented. Therefore, it is merely speculation on your part. You are certainly welcome to your opinion of course, but I think my editing history on this page speaks for itself as I have strived to achieve a neutral page (e.g., see my edits from earlier today prior to this word choice disagreement). As for minority, I don't think there is any specific source that comments quantitatively as to the exact number of practitioners that use it in any specific way. However, we clearly state in this article that back pain is the most common use for it, so it seems like a logical inference. I will look around for specific quantitative data to see if there are any such reports. If you do not agree with the phrase "minority of practitioners" (though there is absolutely nothing to suggest otherwise), what would you propose (since this is pretty clearly the reality)? Do you have any evidence to the contrary suggesting more than a minority (and what would be our cutoff for minority?) utilize OMT in this way? TylerDurden8823 (talk) 06:43, 18 December 2014 (UTC)

Though this paper does not specifically address the use of OMT for the exact examples mentioned in this article (asthma & PD as examples of systemic conditions), the 1998 Guglielmo paper indicates rather strongly that only a minority of DOs persist in using treatments for more "dubious" indications (per Stephen Barrett's quote in that article). Do you require another example? TylerDurden8823 (talk) 06:50, 18 December 2014 (UTC)

Apologies about my false COI memory: I must have mis-remembered. As you know it's considered especially important for medical topics that editors are squeaky clean so I'm happy to accept that you have no connnection to the world of osteo* (if that's what you mean). You "minority" claim is unfortunate however as it goes against the source we use which states "many" osteopaths will treat chronic conditions. Would be grateful if you would correct this WP:V error. Alexbrn ^{talk|contribs|COI} 06:52, 18 December 2014 (UTC)

Your apology is accepted. As for your mention of a source stating many osteopaths will treat chronic conditions, which source are you referring to exactly? As I stated earlier, I will look around and see if I find additional evidence supporting the "minority" claim. Perhaps the numbers are different for non-physician osteopaths and osteopathic physicians and perhaps this is mentioned in a qualitative or quantitative way somewhere. I'm looking... TylerDurden8823 (talk) 06:55, 18 December 2014 (UTC)

The Wiley book we cite right there (also used for the claim back pain is most commonly treated). Alexbrn ^{talk|contribs|COI} 06:58, 18 December 2014 (UTC)

Yes, the 1997 source, I see it now. I will see if newer sources can offer any clarification since this source simply says "many osteopaths" without quantifying (and as mentioned earlier this may be a point of difference between non-physician osteopaths and osteopathic physicians which would be worth mentioning). TylerDurden8823 (talk) 07:01, 18 December 2014 (UTC)

This 1999 paper from BMJ does not offer specific quantitative data, but also seems to clearly indicate that OMT is mainly used for musculoskeletal issues and less so for systemic problems though the precise wording of "a minority of practitioners" is not found (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116959/). In the meanwhile, I'm still searching to see if there are any papers discussing this specific issue. This link from NYU Langone supports the idea that the majority of OMT practitioners are not using it for systemic conditions (but this idea is not presented quantitatively): http://www.med.nyu.edu/content?ChunkIID=37409 TylerDurden8823 (talk) 07:54, 18 December 2014 (UTC)

It's not normal editorial practice to put content in the lede (which runs against the source cited), and then hunt for other sources in support. Are you aware this article is subject to discretionary sanctions? Alexbrn ^{talk|contribs|COI} 08:11, 18 December 2014 (UTC)

Overall, I cannot find specific quantitative data to support or refute the minority of practitioners claim. I wouldn't be surprised if the data is out there, but if it is, it seems fairly well hidden. How do you wish to proceed? Do you have a proposal for alternate wording? Perhaps emphasis should be placed more on the fact that the most commonly treated issues are MSK in nature and the issue of the number of practitioners using these techniques for a given issue (MSK vs. systemic) should be deemphasized since we do not have specific supportive data discussing how many OMT practitioners regularly use these techniques for systemic conditions and how many do not. TylerDurden8823 (talk) 08:23, 18 December 2014 (UTC)

WP:STICKTOSOURCE and just say "many" practitioners use it for chronic conditions? Alexbrn ^{talk|contribs|COI} 08:33, 18 December 2014 (UTC)

Your memory isn't false Alexbrn, TD is just in denial. -Roxy the dog™ (resonate) 08:38, 18 December 2014 (UTC)

Chronic conditions are not necessarily the same as "systemic conditions" as stated verbatim in the source if you're going to tell me to stick to the source. Certainly, asthma and PD are both chronic and systemic conditions, but chronic nonspecific low back pain is also a chronic condition but I doubt most would argue it's a systemic condition. If you want to change the phrasing to say chronic conditions and cite the 1997 source for support and explicitly state that osteopaths (referring to non-physician osteopaths do this), then I have no objection and we would be sticking to the source as you suggest, Alex. Roxy, this is inappropriate behavior on your part implying a COI for which you have zero evidence. Very disappointing behavior from a veteran Wikipedia editor. Maybe it would be more productive to focus on content instead, hmm? TylerDurden8823 (talk) 15:12, 18 December 2014 (UTC)