Veterinary Orthopedic Manipulation (VOM)-A Familiar Tale of Quackery

The hallmark of classic medical quackery is the lone genius proclaiming the discovery of a radical new approach to healing that is simple, perfectly effective, and perfectly safe. This magical new therapy, described in impressive scientific terminology invented from scratch for the purpose, would revolutionize medicine if not for the sinister individuals and institutions of conventional medicine suppressing the good news about it. Fortunately, published research demonstrating the safety and efficacy of such innovations isn’t necessary anyway, because the proof is in all the happy stories the inventor can tell about his own successes.

While I’ve posted several lists of warning signs of quackery (1, 2, 3), and discussed a number of individuals and companies whose marketing activities exemplify some of the specific signs on these lists (such as Eric Weisman, Gloria Dodd, Nzymes.com, and others), seldom have I seen such a paragon of quack medical self-promotion as Dr. William Inman’s Veterinary Orthopedic Manipulation and Laser Therapy Roadshow.

I became aware of this operation through a direct mail solicitation to attend a training workshop in Dr. Inman’s special style of cold laser therapy. I’ve written about cold laser before, and the bottom line is that while there is some plausibility to the idea that low-frequency lasers might have beneficial effects, based in preclinical research, the clinical trial evidence is mixed and inconclusive in humans and non-existent in veterinary medicine. So no firm conclusion about the efficacy of this treatment is justified by anything more than speculation and anecdote. Despite Dr. Inman’s revolutionary new “Chaos Conversion Therapy” (a term he apparently invented, since I can find no other use of it) that has apparently made lasers even more effective for allergies, endocrine disease, and cancer, I was not tempted to attend. I was also not tempted to write a post about it, until I checked out his website.

Apart from having apparently devised a whole new theory to dramatically improve the effectiveness of the questionable practice of cold laser therapy, Dr. Inman has made great strides (and a good deal of money) reinventing the even more questionable chiropractic theory of subluxations and devising an entirely way to waste your time and money banging on your pet to cure every imaginable ill caused by this imaginary abnormality.

According to his web site:

Veterinary Orthopedic Manipulation (VOM) is a healing technology that locates areas of the animal’s nervous system that has fallen out of communication, and re-establishes neuronal communication and thus induces healing. VOM is singularly the most simple, effective and safe healing modality in veterinary care to date.

Wow, sounds cool! So what can it fix? Well, apparently almost any musculoskeletal, gastrointestinal, glandular, or behavioral problems, ear infections, allergies, and just about anything else.

And how does it work? This is the fun part. Some proponents describe it as simply a variation of veterinary chiropractic, in which the imaginary vertebral subluxation complex interferes with either nerve conduction or the mysterious spiritual force known as innate intelligence, thus causing disease in almost any body system. This disease is supposedly treated by “adjusting” the spine to fix the undetectable subluxation and restore the body’s natural state of health. Apart from some evidence that chiropractic is about as useful for back pain as other kinds of physical therapy, over a century of research has failed to document the subluxation or any other benefits to this therapy.

This lack of evidence hasn’t much hampered the work of chiropractors in human or veterinary medicine. However, selling just another variant of chiropractic apparently isn’t good enough for Dr. Inman. He even went so far as to found his own organization, the International Association of Veterinary Chiropractitioners, and  according to his web site:

Is Veterinary Orthopedic Manipulation (VOM) chiropractic care?

No! VOM exists in between veterinary medicine and chiropractic care. It has similarities to some of the chiropractic modalities and functions by restoring function by reducing “subluxations” as is done in chiropractic care. It uses a hand-held device that is used in a popular human chiropractic technique called “Activator Methods” but it is not to be confused with that technique. The differences between VOM and Chiropractic care are significant and distinct.

VOM exists in a gray area between both professions (Veterinary and Chiropractic) and benefits from the positive aspects of both, a hybrid, and thus more effective than either by themselves.

Ah, so it is neither chiropractic nor veterinary medicine, and naturally this means it’s better than either one. (?!) In an article on the subject Dr. Inman published in the Journal of the American Holistic Veterinary Medical Association, he expands on his notion of the subluxation.

The location of the subluxation phenomenon is not the nerve or the bone, but it is the neuronal interference that exists at the interneuron of the dorsal horn of the facilitated spinal segment. 

It cannot be seen on x-ray, cannot be imaged by ultrasound or MRI, but can be readily demonstrated with the application of a simple diagnostic protocol using a hand-held device….

Subluxation is only a switch that can potentially be turned back on. This is simply done by providing adequate force to the interneuron through the mechano-receptor inputs into the dorsal horn. (Please see diagram). Note: this is mechano-receptor force, not motion, thus the process is inherently safe and amazingly effective.

…Thus 100% of all subluxations can easily and objectively be located and evaluated using the VOM Diagnostic Technology and neurological subluxation signs.

…The VOM Diagnostic Technology is amazingly accurate. Diagnostic reading patterns are demonstrable weeks to years before radiographic and other diagnostic technique will verify.

Now any medical approach which fixes a problem that cannot be detected except by the special methods of that approach and that does so with perfect accuracy, absolute safety, and “amazing” effectiveness is by definition either a miracle or bullshit. It would seem likely that if this one was in the miracle category, it would have succeeded in replacing the rest of veterinary medicine in the 30-odd years since Dr. Inman claims to have begun developing the technique in 1982. Certainly, many revolutionary new medical practices have gone from ridicule to dominance in that amount of time. But Dr. Inman has some thoughts on both the fact that VOM sounds too good to be true and why it hasn’t achieved the recognition it deserves.

How can VOM be that easy?

Why not? Who says that a healing modality has to be complicated, difficult and expensive? Who says it should take hundreds of hours to learn and perfect? A technology that goes to the root of the problem, a simple technology that relies on the animal’s innate ability to heal itself, one that re-establishes communication with the pet’s ability to heal itself, will be easy, powerful and effective. 

Why haven’t I heard of the VOM Technology before?

Because it works! That may not make sense at first, but consider this: if the VOM Technology does what it appears to do, it makes a lot of techniques, surgeries and medications obsolete. The professionals that provide those techniques, surgeries and medications will be placed in academic and financial jeopardy. These are the people that control publications in the field and control licensure and applications. AKA politics.

Ah, of course, the Dan Brown Gambit, in which a vast conspiracy suppresses the miraculous truth out of fear and greed. Sure.

So what sort of evidence is offered for the quite grandiose claims made for VOM? As usual, pseudoscientific ramblings based on bogus theories and piles of anecdotes, which (as Dr. Mark Crislip has pointed out in a different context) don’t become evidence by force of numbers any more than piles of cow dung become gold when enough is collected. VOM is apparently a one-man vision with no need for input from science or any formal clinical research.

VOM was developed in a vacuum, meaning it was developed with a trial and error approach in a clinical setting without input from other sources. Dr. William Inman has been the sole source of the VOM Technology.

Over the past 18 years and represented by over 45,000 clinical cases (on file and available on computer) the patterns for over 250 disease conditions have been recognized and tested for reliability.

Wow! One doctor, 45,000 clinical cases, and not a single published clinical trial. Why is that again? Oh yeah, the obstinate oppression of the medical establishment. Uh huh.

Well, at least VOM is an efficient form of quackery and easy to learn. As Dr. Inman points out,

Unlike AVCA certification and instruction that takes 150 hours and five modules to complete, a veterinary Chiropractitioner (VCP) can adequately apply VOM after a “VOM Small Animal Module One” seminar attended in their home town in a weekend.

Apparently, Dr. Inman no longer practices so he can devote himself to teaching:

In 1996 he began teaching the VOM, VMR, Somato-Visceral, and Myofascial Release fulltime in lieu of clinical practice. Currently he is not licensed in any jurisdiction and limits his efforts to teaching only. He does not consult on specific cases as that infers clinical practice.

Of course, this might have something to do with his history of legal troubles:

The license of Dr. William Inman, Seattle veterinarian, has been suspended for a minimum of five years and he has been fined $10,000 by the state Department of Health’s Veterinary Board of Governors…The board found Inman displayed “incompetence, negligence or malpractice”….The action is believed by longtime veterinarians to be the harshest ever taken in this state.

Dr. Inman has maintained that the Board identified his technique as safe and effective even while disciplining him for other reasons. However, news reports claim, “The board in its report, however, made “no conclusion” whether the technique was improper conduct.”

And the record of his appeal of the veterinary medical board case indicates:

The Board found twelve violations, four of which are not at issue on appeal: the failure to keep adequate records; unprofessional conduct in failing to perform a proper work-up on a cat named Mickey; surgery that did not conform to the appropriate standard of care; and misrepresentation to Mickey’s owners that veterinary orthopedic manipulations were effective when Dr. Inman should have known they were not.

The appeals court affirmed the veterinary medical board’s findings and after a review of the procedures found the judgment and punishment appropriate. These findings include gross misconduct including deliberately encouraging staff to falsely identify parasites patients did not actually have and giving medications and vaccinations in clearly inappropriate circumstances. Apparently, unable to practice conventional medicine appropriately, Dr. Inman chose to invent his own alternative approach to healthcare and sell that instead.

Of course, Dr. Inman and his supporters will undoubtedly dismiss my criticism and his legal troubles as mere vindictive attacks by those threated personally and financially by his revolutionary invention. And undoubtedly many anecdotes will be presented from satisfied pet owners and veterinarians convinced that VOM works wonders and that Dr. Inman is unjustly accused.

But the pattern seen in this case is strikingly similar to that seen in the other examples of snake oil salespeople I have discussed here. Lone misunderstood genius offers revolutionary therapy supported by theories inconsistent with established science and anecdotes. This therapy makes money and converts but is either not tested in any formal scientific way or fails such testing. Lone genius is undeterred and continues practicing. Said genius then persecuted by the establishment and accused of gross misconduct or incompetence unrelated to revolutionary invention and switches from clinical practice to full-time promoter of said revolutionary practice. Supporters claim genius is misunderstood martyr and critic are frightened, greedy, or just plain mean.

One has to wonder whether this pattern can be said to indicate the seemingly obvious: Each of these people is either deluded or deliberately deceiving the public, and the reason their therapies are not accepted with adulation by the mainstream is because there is not good reason to think they work. Isn’t this more likely than the alternative the each and every one of them has discovered something original and miraculous that should be accepted widely without any proof beyond their say so and the testimonials of their clients?

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