Chronic fatigue syndrome— known to many of its sufferers as myalgic encephalomyelitis (ME), a term I’ll use from now on — is a problematic disease. Even after decades of research, what we know about the causes of ME symptoms comes down to a wide spread of speculation and guesswork. It might be gut microflora, there might be some kind of virally-activated exhaustion, it’s possible — although controversial — that there is a psychological component as well*.
Basically, we’ve got no idea what’s causing ME.
For sufferers, this means a lifetime of pain. With so few conventional medical treatments available — and one of the principle proposed methods used by many medical professionals now largely discredited — many sufferers turn to alternative therapies to try and manage their symptoms.
Sadly, these therapies are often little more than poorly-evidenced nonsense peddled to the desperate after everything else has failed.
So why are headlines around the world proclaiming that osteopathy— a well-known ‘alternative’ therapy — can diagnose and even treat ME?
Enter Dr. Ray Perrin.
Perrin is an osteopath** who gained a PhD from the University of Salford for his research into — shockingly — osteopathic manipulation for the diagnosis and treatment of ME. In other words, a doctor but not that kind of doctor.
The study that all of the news articles have been quoting is a piece of research recently published in the BMJ Open. It’s a fairly simple diagnostic accuracy study — comparing a new test called the Perrin method (no points for guessing where the name comes from) with a clinical exam by a doctor to see which works better at diagnosing ME. They took a bunch of patients who they knew had ME, another group who didn’t, and looked to see whether the clinicians could correctly identify them as either having ME or not.
There’s a lot in there about epidemiologic terms like specificity and sensitivity, but the bottom line is that the two osteopaths using Perrin’s method of diagnosis had a better ‘hit rate’ than the doctor using a clinical exam. Basically, the osteopaths were better at identifying which patients had ME (for the science buffs, fewer false negatives), although they were worse at identifying who didn’t have the disease (more false positives).
Overall, the osteopaths were correct about 80% of the time, and the doctor about 70%. The difference was statistically significant, meaning that osteopaths were statistically better at identifying when someone truly had ME.
Sounds rosy, right?
There’s just a few small problems.
Leading The Blind
There are a few big issues with this piece of research, but there’s one thing that stands out:
This has nothing whatsoever to do with treatment of ME.
So anyone claiming from this research that osteopathy can treat ME is just wrong. You could try and quote Perrin’s other work, but to paraphrase a JAMA review of ME treatments, they weren’t done very well so you can’t really use them as evidence for anything at all.
But the osteopaths did identify ME better than the clinician, right?
Usually, in a study like this, you compare the new diagnostic test with the ‘gold standard’ of testing. So, for example, if you developed a new test for a broken leg, you’d have to compare it to, say, physical exam and x-ray.
But this study didn’t use the ‘gold standard’ diagnosis for ME. Among other things, ME diagnosis requires a long and detailed clinical history, but none of the clinicians were allowed to talk to the patients whilst performing their exams.
It’s a bit like comparing your used 30-year-old Hyundai to someone walking on the side of the road — it might be crap, but compared to a slow trudge it looks fantastic.
There are other issues with the study. It’s hard to tell how blinding was maintained — there’s a decent possibility that the osteopaths could’ve actually known who the ME patients were before the tests were done. The sample size was too small to make any definitive conclusions. It’s hard to tell whether the doctor performing clinical exams was actually experienced in ME diagnosis — there’s little reference to their training except that they had “experience working in ME clinics”, and if you look at their professional profile it makes no mention of ME anywhere.
And, of course, the diagnostic test is based on osteopathy. Or, to use another term, pseudoscience.
Here we come nicely back around to the Perrin technique. You see, there are a lot of nice physiological terms in there, but when you dig a little deeper it appears to be based on what can only be termed pseudoscientific nonsense.
Here’s the Perrin technique, as written in the study:
At first glance everything looks ok, but on close inspection you’ll notice that point D references the “cranial rhythmic impulse”.
What is this impulse, you ask?
Well, it is described by the website craniosacral biodynamics using such wonderful flowery terms as “not a tide” and “an expression of the conditions of our lives”.
If this sounds like nonsense to you, that’s because it is. The cranial rhythmic impulse is a vital part of craniosacral therapy, otherwise known as useless charlatanism, and has been discredited as an objective phenomenon in controlled studies for quite some time.
It’s also a central part of the Perrin technique.
The other elements of the Perrin technique appear to be similarly poorly-evidence, although a bit less pseudoscientific. They are mostly based on small pilot studies of less than 20 people, as well as anecdotes from Dr. Perrin himself.
Not exactly the best foundation for a diagnostic method.
This study isn’t useless. It’s very interesting that, simply by poking and prodding a few ME sufferers, an osteopath was able to correctly diagnose quite a lot of them. Given the current extreme difficulty of diagnosing ME — for many sufferers, it can take years — it’s well worth doing a larger, better controlled study to see how this technique fares.
It’s certainly possible that there’s something there, despite the dubious basis of the test.
However, I’m very cautious. Osteopathy is, at best, tenuously related to science, with many practitioners making claims that are completely unsupported by evidence. The field of ME is also filled with pseudoscience parading as medicine, with largely-discredited ideas such as vaccine denial often used by alternative practitioners to peddle ineffective treatments to the desperate.
Add to this the fact that the evidence suggests that osteopathic treatment is useless for ME, and you’ve got a biologically dubious diagnostic test that is based on a technique that probably doesn’t work. Not great.
Bottom line? The headlines were wrong.
This isn’t a breakthrough for Myalgic Encephalitis sufferers.
At best, it’s an interesting first step.
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*Note: I am well aware of the controversy regarding the proposed psychological component to ME. I’m not going to go into the arguments except to note that it’s pretty damn controversial and if you want to yell at someone about ME there are plenty of people on Twitter who will gladly have a shouting match with you.
**Osteopathy can be basically summed up as chiropractic except with a bit less crazy and a bit more massage. The similarities between the two treatment methodologies are largely because the founder of chiropractic, D. D. Palmer, nicked pretty much all of his ideas from osteopathic tradition.