If you want to become a physician in the United States, you have two educational routes available to you: osteopathic and vanilla medical schools. Osteopathic medical school graduates earn a Doctor of Osteopathic Medicine (D.O) degree, and vanilla medical school graduates earn a Doctor of Medicine (M.D) degree. If you’re wondering what the difference is between the two, the answer is basically nothing. Students at osteopathic medical schools must take the COMLEX series of board exams, and can optionally take the USMLE series of board exams which are important for the residency matching process. Students at DO schools also receive 200 hours or more of training in osteopathic manipulative medicine (OMM). Outside of those things, there’s no difference between MD and DO schools. The research has shown that there is no difference between physicians with an MD or DO degree in the quality of care provided, approach to patient encounters, or clinical decision-making despite what the American Osteopathic Association’s marketing would have you believe. In short:
Osteopathy rarely gets talked about because very few physicians who graduate from osteopathic medical schools utilize OMM in their practice (as Mark Crislip put it, OMM “is the price they pay to obtain an otherwise standard medical education“). Also, physicians with a DO aren’t running around saying OMM can treat stuff like ADHD. In other countries, osteopaths are not physicians and are basically the same as chiropractors. While there are some OMM techniques that have at least some evidence they work, the same could also be said about chiropractic techniques. Many aspects of osteopathy are abject quackery not unlike chiropractic. But the American Association of Colleges of Osteopathic Medicine make it very clear in their Brief Guide to Osteopathic Medicine that they don’t want osteopathy to be mixed up with chiropractic:
Chiropractic was first enunciated in 1895 by Daniel David Palmer, who observed that displacement of vertebrae could affect neurotransmission, thus manifesting as disease. Palmer was a magnetic healer, but unlike A.T. Still, he did not have a medical background.
Now that is really odd statement to make if you want to deny the similarity between the two because A.T Still was also pretty into hydropathy, diet, bonesetting, and magnetic healing. They go on to say that chiropractic is focused on the nervous system while osteopathic medicine is focused on the need to restore blood flow via manipulation of the neuromusculoskeletal system. I’m still struggling to see how they’re dissimilar, but okay. I imagine one difference you could point to is chiropractic subluxations. Many chiropractors claim that there are invisible misalignments in the spine, subluxations, that can cause organic disease and can be cured through chiropractic manipulations. A major topic in OMM education is Chapman’s points or Chapman reflexes, which aren’t any different from meridians, or chiropractic subluxations. They’re total nonsense, let’s look at why.
The foundations of Chapman’s reflexes
Before we get started, I want to make it clear that I’m not just digging up the craziest stuff I can find. Chapman’s points are a key topic in OMM and are explicitly mentioned in the AACOM’s brief guide to osteopathic medicine. Throughout this piece I will be referencing the 3rd edition of the Atlas of Osteopathic Techniques (Atlas) and the 3rd edition of Foundations of Osteopathic Medicine (Foundations). The Foundations textbook was written and published in partnership with the American Osteopathic Association. With that out of the way, let’s do this.
What are Chapman’s reflexes and what do they do? According to the Atlas:
The current definition used by the osteopathic profession defines CRs as “a system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of the involved tissues) assumed to be reflections of visceral dysfunction or pathology” (ECOP, 2006). This definition encompasses the lymphatic, neuroendocrine, and autonomic response to injury, illness, and disease as palpable and predictable viscerosomatic tissue reflexes found on the anterior and posterior body surface.
I have a question for people that write like this in medical journals and medical textbooks. Do you kiss your mother with that mouth? Nobody understands what you’re saying. What they’re proposing is that when you get sick, bumps called Chapman’s points or Chapman’s reflexes will appear on your body in specific locations based on what’s wrong with you. The most recent version of the Atlas describes these bumps as being rice, BB-shot, or pea shaped. They may be severely or slightly painful when pressed, or completely painless. The osteopathic societies have created charts illustrating where these points will show up and the illnesses or organ systems they correspond to:
Posterior Chapman points:
Anterior Chapman points
Now if you’re an SBM regular you might be feeling like you’ve seen these charts before. You’re probably mistaken, but it’s easy to see why you might get it mixed up with another alternative medicine chart. Perhaps you were thinking of a chart like this?
This is a chart of reflex points I pulled from a random reflexology website. Maybe you’re thinking this one?
This is a chart of meridians used in acupuncture. What do all of these charts have in common? They’re all utter nonsense. The Foundations textbook doesn’t really cite any credible evidence showing that they actually exist and that the presence of these points correspond to a dysfunction in the part of the body. The book spends a quarter of a page explaining the proposed scientific basis of these points and two more talking about the history of Chapman points and the heroes of osteopathy. The book describes several proposed mechanisms for why these Chapman points might appear by “those who value their use empirically”, whatever they mean by that. These theories include: lymphatic abnormalities, fibrositis deposits, inflamed lymph vessels passing over ribs and bones, inflamed nerve endings, and inflamed sympathetic nerve filaments around terminal arterioles. This is the equivalent of me saying the web page is broken because of something wrong with the network connection, the database connection, or the code on the web page. That isn’t a mechanism, it’s listing possible thing under the sun that could possibly explain almost any given phenomenon in the body.
Obviously it’s hard to show that they don’t actually exist because the only evidence the authors provide is either from papers written in the 1940s that I don’t have access to, or single case studies. In the they reference Case Studies Presented at Chapman’s Think Tank Retreat. In what universe does this count as good evidence or a valid source in an academic setting? There isn’t any good research validating the existence of “Chapman points” or that they correspond with some type of dysfunction in a specific part of the body. In Foundations the authors state that palpable tissue texture changes corresponding to dysfunctions of the body have been mapped for thousands of years in the case of acupuncture. They reference a study that found there was 44.2% topographical congruence between posterior Chapman points and acupuncture points. Acupuncture points have no scientific validity, so showing that the two are similar doesn’t make either of them more scientifically valid. They begin their conclusion of the section:
A given point in a given system does not need to “read a book” to know where it should or could be; it simply exists.
If don’t want me to argue that a given magical point system doesn’t exist, you’re going to have to meet me halfway and present credible evidence they do exist. Despite lacking any credible scientific evidence that Chapman points exist, they tell readers that “Chapman points” can be used as a diagnostic aid.
Chapman’s points as a diagnostic tool? Nope.
In Foundations the authors claim that many physicians utilize Chapman points as a diagnostic tool or to show that there is organ dysfunction. But they make it clear from the start that nobody should make a diagnosis based on the presence or absence of a tender Chapman point alone. However they are ultimately claiming that the presence of these points has diagnostic value, backing their claim with only individual case studies. Let’s look at one of them:
A 13-year-old female is admitted to the pediatric floor of an osteopathic teaching hospital for complaints of severe lower abdominal pelvic pain. She is examined and is found to be tender in the RLQ and midline pelvis. Urinalysis is normal. In this age group, the three most likely diagnoses to consider (in no particular order) are as follows: (1) Appendicitis, (2) Cystitis, and (3) Ovarian cysts. CRs showed bilateral tender reflexes on the anterior/medial pubic bones near the pubic symphysis and unilateral posterior CRs at T9-10 on the right side only.
Let’s look at the charts to diagnose what is wrong with her. According to the book we need to start with the anterior points first.
We’ve already run into problems. In the Atlas there are ten Chapman points on the chart in the pelvis/groin area. The chart in Principles of Osteopathic Medicine only shows four anterior points in the pelvic area. They also don’t line up at all. The Foundations chart says that the ovaries and urethra share the same Chapman point, but the Atlas chart shows that the ovaries and the urethra have their own Chapman points in very different positions in addition to another Chapman point for the urinary bladder. I guess we can rule out appendicitis? On the board we still have bladder inflammation and ovarian cysts. Now we should be able to get to the bottom of this by looking at the posterior Chapman points:
We’ve hit the same problem, the charts don’t match up. Who am I to believe? It’s not like there’s any evidence there’s a correlation with whatever condition she may have and the presence of anterior and posterior Chapman points. There isn’t even a correlation between where Chapman points appear on the body and what organ dysfunction they correspond to between textbooks. In Foundations, T9-10 are clearly labeled and correspond to the ovaries and the pylorus of the stomach. The chart in the Atlas is a bit harder to read so you have to use your imagination to approximate where T9-T10 are, but it looks like they correspond to the two Chapman points that the appendix, ovaries, adrenal glands and ileum all share. Based on these findings we can conclude it’s an right ovarian cyst. It’s the only part of the body corresponding to both the anterior and posterior Chapman points that were felt on physical examination. So how’d I’d do?
- Preoperative diagnosis (without the use of CRs): Appendicitis versus right ovarian cyst (50/50 probability)
- Preoperative diagnosis (with the use of CRs): Problem with right ovary involving the entire ovary—both the medial and the lateral halves
- Postoperative diagnosis: Massive right ovarian cyst obliterating the entire right ovary
With diagnostic prowess like this, the medical schools should be sending applications to me. There are a lot of problems with this this, chiefly there’s no evidence that this diagnostic technique works and there’s no good reason to believe that it does. How often do the presence of these Chapman points in these specific locations predict that the patient will have a specific problem? We don’t know because after looking, it seems like there’s no published evidence. So from a diagnostic standpoint they should be given as much credence as a horoscope, but that’s also how much weight the doctors in this case gave them. If you’ll notice, cystitis wasn’t even considered in the pre-operative diagnosis because the urinalysis came back negative. They didn’t know the diagnosis going into surgery, so using Chapman points had no impact on diagnosis or treatment. It was basically a lucky guess, so what was the point? No doctor is using these as a diagnostic tool. In the absence of any good scientific evidence, the only thing palpitating these imaginary points will do is induce salivation in medical malpractice attorneys because you’re using pseudoscientific relic from pre-internet era to diagnose potentially serious medical conditions instead of doing literally anything else.
Chapman reflexes for treatment?
While the authors of Foundations admit there is very limited evidence proving the effectiveness of using Chapman points to treat medical conditions, they still present the some studies that suggest that they could. The study they reference was published in 1978 titled “The application of neurological reflexes to the treatment of hypertension” in none other than The Journal of the American Osteopathic Association. I was unable to find the full-text of this study. The JAOA website has it listed as a free article but there’s no text. So it’s impossible to know the sample size of the study, the exact outcomes, or what osteopathic technique they used to treat patients using “Chapman points”. According to the authors, it was shown that patients had reduced serum aldosterone levels lasting 36 hours after treatment. First, if you want to claim that a therapy treats hypertension, you have to actually measure the patient’s blood pressure.
You’re probably wondering what osteopathic technique they used involving Chapman points. Neither Atlas nor Foundations tell which osteopathic specific treatment is supposed to be used but Atlas does give a hint. The word hypertension is used exactly once in the entire book, and it appears in the Chapman points chapter of the book as an indication for vibratory or stimulatory treatment. While there are many treatments listed in the chapter, only two seem like they might possibly have anything to do with blood pressure. The first is the Occipitomastoid Suture Pressure which is referred to in the literature as the V-Spread technique. It involves applying light pressure to certain points on the back of the patient’s head to supposedly treat cranial somatic dysfunction.
The second is Alternating Pressure Left Second Rib, which involves the physician implying pressure at specific points on the patient’s chest and back. It is supposed to “treat thoracocostal somatic dysfunction at this area, which may influence cardiac rate”.
Now I would assume since these techniques fall under the “Reflex Oriented Treatment” category, the treatment would involve stimulating the appropriate Chapman points, but that’s not what we see. If you’ll direct your attention to the anterior Chapman point charts above, you’ll see that the physician is pressing on the part of the chest where the anterior and posterior heart Chapman points should be (theoretically, if they exist). If this therapy were based on stimulating the Chapman points corresponding the dysfunctional organ, they should be stimulating the adrenal chapman points located much, much lower on the torso. Aldosterone is released by the adrenal glands. The V-Spread technique is pressing on the points corresponding to the tonsils, eyes, sinuses, pharynx, and larynx, so it’s way off. These therapies don’t make sense considering the Chapman reflex point theory, let alone the established laws of the universe or common sense. There’s no evidence showing that these imaginary Chapman reflex points can be used to treat any medical condition.
You don’t need to have any medical education to see that Chapman points or Chapman reflexes are bogus. You won’t be able to find an article in JAMA or Nature looking at Chapman points as a diagnostic tool, a treatment, or even a thing that exists. The entire theory is so convoluted; the presence of Chapman points supposed to be used as a diagnostic tool, but later in chapter there’s a guide to treat them as if they’re a medical problem in and of themselves. On top of all of that, the book suggests that stimulating these Chapman points can somehow treat serious medical conditions. The only research I’ve found on Chapman points are case studies published in The Journal of the American Osteopathic Association with no more than 50 cases in them. Chapman points are only taught in American osteopathic medical schools, and I really, really doubt any doctor uses them.
I’m not bashing medical schools that award a DO degree or physicians with a DO degree. To reiterate there is no difference in the care provided by physicians with either degree. There are MD schools that require students take courses in alternative medicine. They have been and should be criticized for it. But you won’t see something like homeopathy or acupuncture appear on the USMLE. The theory of Chapman reflex points is ridiculous and it’s obvious Chapman points don’t exist, but every year medical students at DO schools are required to memorize the locations of these magical points and regurgitate them on their school and board exams. No doctor is using Chapman points to diagnose appendicitis, we have labs and scans for that. Someone could fail out of medical school or fail boards because they couldn’t remember that the Chapman point for the kidneys is located on the left side of L1 vertebrae. Students have to pretend every year that they can feel Chapman points in their OMM lab. This is madness.
The American Osteopathic Association tries really hard to make itself seem like it’s not a budget-AMA. They claim that their goal is to “advance the distinctive philosophy and practice of osteopathic medicine”. No offense AOA, but I don’t think a distinctive philosophy of teaching medical students to rub a patient’s head to treat hypertension with no evidence it will work is a philosophy you want to be promoting. I could rip on the techniques in these books for as long as I want, and believe me I want, but Chapman’s points are a perfect place to start. I downloaded the most popular OMM Anki deck posted on /r/MedicalSchool, AnkiStill, and there is a 200 card subdeck on Chapman’s points, it’s one of the biggest ones.
The AOA and DO schools aren’t going anywhere, and removing Chapman points from the curriculum doesn’t mean that the AOA is legally obligated to merge with the American Medical Association or whatever. It just means they’ll be saving hundreds of thousands of future physicians from hours of trying to master mystical arts that they will hopefully never use when they graduate. The American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine are growing fast, 6 new DO schools will open next year. Twenty five percent of physicians will graduate with a degree from a DO school. Listen AOA, you’re a grown-up medical organization. Part of growing up means ditching the dark eye-liner, lip rings, and My Chemical Romance.