Critical Analysis of "A Global Osteopathic Approach to Persistent Pain and Chronic Functional Disorders" by Jean-Pierre Marguaritte, Founder of Osteopathic Vascular Treatment (OVT)

Introduction

The article "A Global Osteopathic Approach to Persistent Pain and Chronic Functional Disorders" proposes Osteopathic Vascular Treatment (OVT) as a revolutionary framework for managing chronic conditions by prioritizing vascular mechanics. While the author, Jean-Pierre Marguaritte, ambitiously attempts to revive the historical osteopathic principle that "rule of the artery is supreme," the article suffers from significant scientific, conceptual, and methodological weaknesses. This critique will deconstruct its flawed premises, overreliance on outdated dogma, and lack of empirical rigor, which undermine its credibility and clinical relevance.

1. Erroneous Representation of Vascular Physiology

The central pillar of the article – the "Rôle Clé des Capillaires" (Key Role of Capillaries) – is built on factual inaccuracies. The claim that "les capillaires contiennent 80% du volume sanguin" (capillaries hold 80% of the blood volume) is demonstrably false: capillaries contain approximately 5% of total blood volume, while systemic veins hold ~65%. This error reflects a superficial understanding of hemodynamics and calls into question the author’s grasp of basic physiology.

Similarly, the assertion that "l'acidose hépatique ou le stress oxydatif" (hepatic acidosis or oxidative stress) directly damages capillary walls is presented without supporting evidence. While oxidative stress contributes to endothelial dysfunction, the liver’s role in regulating acidosis (via bicarbonate and urea cycles) is oversimplified. The liver does not eliminate "acides fixes via les reins" (fixed acids via the kidneys) – that is the kidneys’ primary function. Such inaccuracies erode the article’s scientific foundation.

2. Mechanical Reductionism and Exaggerated Causality

The premise of OVT rests on a deterministic view of vascular compression as the root cause of chronic dysfunctions. For example:

• The claim that "les tensions viscérales compriment l'aorte abdominale, réduisant l'apport sanguin aux organes" (visceral tensions compress the abdominal aorta, reducing blood supply to organs) ignores the rarity of such compression syndromes outside specific pathologies (e.g., median arcuate ligament syndrome). Chronic functional disorders are multifactorial, involving "neuro-immune," metabolic, and psychosocial components, yet the article reduces them to a hydraulic model of "tuyaux d'arrosage déformés" (deformed garden hoses).
  
  

• The idea that "la tension diaphragmatique altère la position du cœur via son ligament suspenseur, induisant une torsion de l'artère coronaire" (diaphragmatic tension alters the heart's position via its suspensory ligament, inducing coronary artery torsion) is speculative and unsupported by anatomical or clinical studies. Coronary artery disease results from atherosclerosis, inflammation, and thrombosis – not mechanical torsion due to diaphragmatic tension.
  
  

This mechanical worldview neglects modern insights into pain science, such as central sensitization or bio-psychosocial models, which dominate the contemporary understanding of chronic pain.

3. Lack of Empirical Evidence

The article relies heavily on anecdotal reasoning and metaphors ("un véritable GPS palpatoire" - a true palpatory GPS) rather than empirical data. Key claims – such as OVT’s ability to "restaurer la fluidité tissulaire" (restore tissue fluidity) or to "briser les cycles vicieux mécano-vasculaires" (break mechanovascular vicious cycles) – are presented as axiomatic, without any reference to randomized trials, biomechanical studies, or imaging validation. For example:

• There is no evidence that "la palpation ciblée" (targeted palpation) can reliably assess liver perfusion or "la tension mésentérique" (mesenteric tension) causing aortic compression.
  
  

• The assertion that "l'hypertonie musculaire ischémique" (ischemic muscle hypertonia) causes vertebral fixations contradicts research showing that muscle tone is regulated by neural, not purely vascular, mechanisms.
  
  

Without solid evidence, OVT risks being classified as pseudo-scientific dogma rather than a credible therapeutic approach.

4. Rejection of Structural Osteopathy and Contradictory Logic

The article paradoxically criticizes structural osteopathy while promoting its own unproven methods. For example:

• The claim that "les manipulations articulaires sont souvent inefficaces dans les troubles fonctionnels chroniques" (articular manipulations are often ineffective in chronic functional disorders) ignores studies demonstrating the efficacy of spinal manipulation for conditions such as certain low back pain.
  
  

• The recommendation to prioritize "le traitement vasculaire avant l'intervention neurologique" (vascular treatment before neurological intervention) lacks justification, as the vascular and nervous systems are interdependent. Ischemic neuropathy, for example, requires treating both microvascular and neural pathologies.
  
  

This selective skepticism reveals a bias aimed at validating OVT rather than engaging with evidence-based practice.

5. Revival of the "Law of the Artery" Dogma

The article’s conclusion glorifies the "Loi de l'Artère" (Law of the Artery) as a "fondement historique" (historical foundation) of osteopathy, presenting OVT as its modern incarnation. However, this principle – a relic of 19th-century vitalism – has been refuted by contemporary physiology. Blood flow is regulated dynamically by autonomic, metabolic, and hormonal factors, and not simply by mechanical "décompression" (decompression). By idealizing Still’s dogma, the author perpetuates a regressive view of osteopathy that hinders its integration into modern medicine.

6. Clinical Overreach and Unfounded Claims

The article’s systemic vision borders on clinical hubris. For example:

• Linking "la congestion des vaisseaux chylifères digestifs" (congestion of digestive chyle vessels) to elevated triglycerides and cholesterol oversimplifies lipid metabolism, which involves genetic, dietary, and enzymatic factors far beyond mechanical "compression" (compression).
  
  

• Asserting that OVT can "compléter le travail des cardiologues" (complement the work of cardiologists) in managing atherosclerosis is dangerously misleading, as no osteopathic technique can reverse plaque formation or coronary artery disease.
  
  

Such claims risk misleading patients and practitioners into prioritizing unproven therapies over established medical interventions.

Conclusion: A Wonky Concept in Search of Legitimacy

Jean-Pierre Marguaritte’s article illustrates the pitfalls of osteopathy’s struggle to reconcile tradition with scientific progress. By anchoring OVT in obsolete concepts, mechanistic reductionism, and anecdotal reasoning, the author fails to propose a credible model for the management of chronic pain. Rather than reviving the "Law of the Artery," this approach entrenches osteopathy in a pre-scientific era, distancing it from the evidence-based, interdisciplinary care that modern patients deserve.

For osteopathy to gain legitimacy, it must abandon such dogmatic frameworks and adopt rigorous research, transparency, and collaboration with broader medical science. Until then, articles like this one serve as cautionary tales – reminders of the dangers of prioritizing ideology over evidence.