Posadzki P, Lee MS, Ernst E. Osteopathic manipulative treatment for pediatric conditions: a systematic review [published online June 17, 2013]. Pediatrics. 2013;132(1):140-152. doi:10.1542/peds.2012-3959  

The recently published systematic review by Posadzki et al gives a sobering but flawed view of the application of osteopathic manipulative treatment (OMT) in pediatric health care. It is sobering because there are so few studies on this topic, and those that have been published are really only pilot or preliminary studies. It is flawed because these studies, when looked at as a whole, give a mixed picture of the benefit of OMT in pediatric care. 

The article by Posadzki et al was published by a major pediatric journal and, along with the accompanying publicity, painted an inordinately negative picture of OMT use in pediatrics. The authors concluded, “OMT cannot be regarded as an effective therapy for pediatric conditions, and osteopaths should not claim otherwise.” In addition, 1 of the authors was quoted by Reuters Health news service as saying, “I think the onus is on osteopaths to show that their claims are not bogus.”¹ To me, this language—from supposedly objective researchers—is hostile and inflammatory and represents a certain attitude that osteopathic researchers seem to be facing in the medical scientific community at large. 

The authors searched the literature up to November 2012. Only randomized controlled trials were included. They identified 17 trials originating from Belgium, Germany, Italy, Spain, Switzerland, the United Kingdom, and the United States that included terms such as OMT, osteopathic treatment, osteopathy, osteopathic technique, and even osteopathic-based manual physical therapy in the titles. 

The authors cited “low methodological quality and paucity of the primary studies” as a factor in reaching their conclusions. I do not disagree with this general conclusion. However, this systematic review is misleading to the medical scientific community and—more importantly—to the general public on several grounds. 

First, there seemed to be a mixture of apples and oranges. Although the authors described the differences between US-trained osteopathic physicians and nonphysician foreign-trained osteopaths, they grouped research from both traditions of health care without distinction. The use of osteopathic manual therapy may not be standardized in each country and could therefore lead to inaccurate comparisons, a consideration that the authors did not address. In addition, 4 of the randomized controlled trials reviewed had nonosteopaths as the lead authors, and 2 trials were published only as abstracts, further raising questions about the authors' conclusions. 

Second, as I point out in my letter to the editor² in response to the article, the benefit of OMT in pediatric care has been demonstrated in numerous case control and cohort studies,^3-5 as well as in everyday clinical practice. Furthermore, the standard of practice of osteopathic medicine in the United States is of the highest quality, ensuring public safety in the use of OMT for all patients, including children.