The GCC’s study entitled “Effectiveness of manual therapies: the UK evidence report” http://www.chiroandosteo.com/content/18/1/3 was released on 25 Feb 2010. The study reported on the evidence (or lack of) to support a number of claims made by chiropractors. However the report covered not only spinal manipulation as used by chiropractors but also Osteopathic manipulation (OMT) and came to the same conclusions regarding childhood conditions such as colic and asthma.
A quick google search would seem to indicate that there are now more Osteopaths making treatment claims for non-musculoskeletal conditions (colic & asthma ect) than Chiropractors. So I wondered how the General Osteopathic Council (GOsC) felt about the evidence for colic & asthma ….. and worse!
Earlier this week (12 April) I sent a quick email to the General Osteopathic Council to find out their views:
As I’m sure you are aware a recent study entitled “Effectiveness of manual therapies: the UK evidence report” ( http://www.chiroandosteo.com/content/18/1/3 ) was published on 25 Feb 2010.
The report focused on the effectiveness of a range of manual therapies (chiropractic, OMT, massage) as treatment for a range of conditions.
There would appear to be a number of osteopathic clinics in the UK making public statements on the efficacy of osteopathy for the treatment of a range of childhood non-musculoskeletal conditions. Many of these conditions have been reported in this latest review as having either inconclusive or negative evidence to support those claims. The report goes on to say that even ‘inconclusive – favourable’ should not be used to make public claims.
Can you tell me if the General Osteopathic Council has considered the results of this review and what is view its of the current level of evidence to support OMT as a treatment option for colic, asthma, feeding & sleeping difficulties.
If the General Osteopathic Council supports the findings of this study, what actions/advice it has offered to its members.
I have checked your website News & Press release pages, but can find no mention of this report of the GOsC’s views on its findings .
On 15 April, I got a reply. On the surface the GOsC seem to be making all the right noises, they talk about evidence, CAP, ASA ect, but are things as good as they seem?
Osteopathic Research – NCOR:
The first thing the GOsC made clear was that it’s not their job to evaluate evidence relevant to osteopathy. That task falls to the National Council for Osteopathic Research (NCOR), who would seem to be connected with Brighton University. The NCOR website contains a selection of PDF files under the title of Evidence-Based Practice Tutorials which may be worth a read (I have only quickly scanned a couple). The NCOR website may be worth keeping an eye on in the future, especially once their searchable database comes on line.
Thank you for bringing these points to our attention. The study to which you refer has been recently brought to our attention by the National Council for Osteopathic Research (NCOR – www.ncor.org.uk), whose role it is monitor the publication of evidence relevant to osteopathic practice and to offer information and guidance to the profession and its patients with regard to study findings and their application in practice. (The NCOR website will soon offer a searchable database of all relevant published research, including this review, which will be accessible to the public and practitioners alike. Attached is a statement we have received from NCOR regarding this review.)
With the exception of research the General Osteopathic Council has itself commissioned, it is not our normal practice to publish comment on clinical studies, it being outside the scope of our expertise. However, we have a practice of encouraging registrants to stay abreast of current research findings and we support the NCOR by facilitating the dissemination to registrants of relevant evidential information (the publication of this review, for example) through the medium of our print and web-based communications to osteopaths (our bi-monthly The Osteopath magazine), our dedicated registrants website, and e-bulletins.
As far as the Bronfort report goes, the NCOR_statement (PDF ) comments on the scope and limitation of the review, but makes no comment or judgement on any of the areas where the report is critical of OMT (osteopathic manipulative treatment) in the treatment of conditions like colic or asthma. The final paragraph of the NCOR statement simply says:
As a scoping exercise, this work provides healthcare professionals with an indication as to areas where research is currently lacking and where, possibly, to prioritise funding for future scientific investigation.
Whilst it is true that the Bronfort report has its limitations, (covered very well on Zeno’s Blog) it does provide an assessment on the quality of evidence (both chiropractic & osteopathic) used to support these claims, the report also excludes any studies or trials that contained serious flaws in their methodology. Importantly, Bronfort clearly lists treatments for which the evidence for OMT is at best inconclusive, yet the NCOR statement does not address this criticism. Something I find a little strange for an organisation tasked with monitoring evidence relevant to osteopathy, particularly as it is reasonable to assume they would have access to any evidence to support the claims !
The General Osteopathic Council:
So as a regulatory body responsible for overseeing the Osteopathic profession within the UK, what is their role
As a statutory regulator, the GOsC’s primary purpose is to protect the public by maintaining and developing standards of osteopathic education, training and practice. It is our view that also promoting a culture of evidence-based training & practice is integral to raising the standards of care provided to patients by osteopaths.
We routinely and repeatedly remind registrants that all public and patient information must be legal, decent, honest and truthful and must conform to current guidance, such as the British Code of Advertising, Sales Promotion and Direct Marketing (CAP Code). It may be helpful to know that a recent meeting between the NCOR and the Advertising Standards Authority agreed the need to ensure that communication between the two organisations facilitates the exchange of current information, thereby increasing the prospects that the public is well advised and able to make informed decisions regarding their choice of healthcare.
The GOsC also sent me a copy of the advice recently sent out to registrants Does your advertising conform to the rules ? . I was told that this was published in the Dec 09 – Jan 10 edition of The Osteopath, the official journal of the GOsC …. however it was actually published in the Oct 2009 edition – a small error, but you would assume they would know what they told their members and when.
Copies of The Osteopath can be found here: The Osteopath
The advice given to osteopaths is quite clear in pointing out that any publicity material should conform to the guidance issued by the GOsC and the ASA (CAP codes), the final paragraph of the article is also quite clear:
Although the CAP Code does not cover the content of websites – concerns about website content are dealt with by your local Trading Standards offices – it is likely that complaints from the public regarding your website will be brought to the attention of the GOsC
Talking a good game:
So on paper things look quite good (compared to most CAM professions) they have a separate body (independent ?) who look into the research (NCOR) and that body does have discussion with the ASA and the GOsC advise all their members that their advertising must be legal, honest and truthful and must conform to the standards expected by the CAP and warn that public concerns over website content could attract the attentions of Trading Standards.
However, whilst the GOsC may be talking a good game, neither they nor their members are actually playing one! Not much good if the ref and players all know the rules of the game, but decide to ignore them and simply do their own thing!
The GOsC must be well aware of the claims being made by its members, yet these claims go unchecked and appear on many osteopathy websites and no doubt in their advertising literature, particularly those osteopaths who have moved on to specialise in ‘cranial osteopathy’. The claims are at least as wide spread as they once were amongst the chiropractic profession.
Some typical quotes from UK osteopathy websites:
“Birth can compromise your baby’s musculoskeletal system. Gentle cranial and structural osteopathy can alleviate some of the symptoms that lead to excessive crying, colic, feeding or movement problems”
“Osteopathic treatment can help with all of these potential causes of colic, and in general does have good results.”
“If the problem (colic) persists after the fourth months, you are recommended to visit an osteopathic clinic, where medical professionals will conduct a thorough examination and look for tensions within your child’s the body.”
And some go much further than just colic !
“For the Treatment of: Crying babies, Colic, sickness, and wind Feeding difficulties, Sleep disturbances, Recurrent infections, Ear infections, Asthma, Sinus and adenoidal problems,Behaviour problems, Learning difficulties, Cerebral palsy and other types of brain damage and more”
“disturbed nights, sleeplessness, poor suckling, colic, “won’t settle”, continuous distress and crying, glue ear, otitis media, painful ears, catarrh, blocked nose, sinus trouble, adenoid problems, recurrent infections, poor co-ordination, poor concentration, learning difficulties, slow development, aggression, hyperactivity, facial pain, toothache, uneven or misshapen teeth, cerebral palsy, Down’s syndrome“
……. I do hope they have the evidence to support those statements !
The GOsC did reply to my email and they did say to what extent they have considered the findings of the Bronfort report. However, just putting the words down on paper is hardly enough. The profession that they are tasked to regulate are making claims that would appear to be lacking any reliable evidence, if they want to know where that can lead they should give the GCC a call!
I will be replying to the GOsC asking if they or the NCOR are aware of any reliable, good quality evidence that can be used to substantiate these claims.
Oh and if I my memory serves me correctly …. I pass an osteopathic clinic on my way into town! 
Zeno
April 18, 2010
Excellent work!
skepticbarista
April 18, 2010
Cheers. I started looking at the colic & asthma claims, but the Cerebral palsy & Down’s syndrome go way beyond minor complaints! Now going to look a little deeper.
One osteopath publishes a link to a ‘research’ paper on ‘The Osteopathic Management of Children with Down’s Syndrome’.
The summary says “This paper raises the hypothesis that postnatal hypoxia causes much of the handicap of Down’s syndrome and that osteopathic treatment may be used effectively to reduce it. Evidence is presented to support the proposal that much of the handicap of Down’s syndrome is not due directly to the chromosomal defect, but to impaired postnatal development as a result of hypoxaemia from upper airway obstruction”
skepticbarista
April 18, 2010
Whilst searching for some osteopath/colic quotes, I found this blog.
http://scepticalletterwriter.blogspot.com/2010/02/sylvie-hamilton-2-can-she-reduce-colic.html
Will be interesting to see how the ASA respond to his complaints.
Sceptical Letter Writer
April 25, 2010
That complaint was passed to the ASA’s compliance team, who don’t send further details of their action to the complainant.
Sylvi Hamilton’s clinic still advertises weekly in the local papers, but all the non-substantiated claims about colic and the like have been removed.
James Jones
April 22, 2010
Oh dear. I hadn’t yet got round to looking at osteopaths and had somehow got the idea that they were possibly more respectable than the now discredited chiros and the never credited homeopaths. Sadly they seem from the reports here to be just as dismissive of their regulatory system and its requirements as the chiros and from that evidence are possibly just as bogus in other areas too. I wonder if the are as prone to misleadingly call themselves “Doctor” when they are not in fact registered medical practitioners.
skepticbarista
April 25, 2010
Letter gone off today to GOsC asking about evidence to support some of the quite widespread claims made by osteopaths for the treatment of Autism, Cerebral Palsy, Allergies, Colic & others.
One site claiming benefits for Down’s syndrome links to a report that simply raises a hypothesis:
(The Osteopathic Management of Children with Down’s Syndrome)
“This paper raises the hypothesis that postnatal hypoxia causes much of the handicap of Down’s syndrome and that osteopathic treatment may be used effectively to reduce it”.
Clearly a hypothesis may be the basis on which to conduct further research, but is not sufficient evidence on which to base a treatment!
If the NCOR or GOsC don’t have any evidence, then the individual clinics won’t have any ….tut tut tut…. and that’s not allowed!
skepticbarista
May 7, 2010
This post is getting repeated, daily hits from Sacralmusings.com ‘Quackery – it’s your turn next’ threat and also some from the British School of Osteopathy intranet.
None seem keen to leave a comment – pity really as your views would be very interesting.
Alice Bardough
May 7, 2010
As a current Osteopathic student. I feel that Osteopathy is overall a very honest profession. With ethics and law being at the forefront of conversation in the teaching clinic and classroom alike.
These claims of treatment for the above stated conditions are unsubstantiated. I feel perhaps the terms would be better written as: for treatment of those suffereing from…….(colic, etc). The focus of these treatments being to respond to the musculo-skeletal symptoms that these conditions can cause – i.e hypercontractive musculature in the thorax and abdomen due to the reflux in colic and not for treatment of the colic itself as this will eventually resolve on it’s own accord. The “treatment” supplied could just ease the aches and pains being suffered due to the condition and could be considered palliative but can not be considered to treat the condition itself.
Osteopaths are trained to treat, and have a built a good reputation by doing this well, and rehabilitate musculo-skeletal pain.
This reputation is unfortunately at risk because of a small minority of practitioners and wording in advertising which is not accurate.
As a student, I am yet to be in practice life and I cannot speak for previous years of graduates gone by but in my experience all lecturers speak about trying to get the best result for the patient at the fewest sessions possible and are concious of evidence based treatment which is required to be sure of safety and success.
skepticbarista
May 9, 2010
Hi,
Thanks for your comment, interesting to get a view from somebody involved in osteopathy.
I fully accept that not all osteopaths claim to be able to treat these non-musculoskeletal conditions and am happy to see that as a student you share the view that they are unsubstantiated.
If this is not being taught at grass roots level, then it does make me wonder at what point in an osteopaths initial training, clinical practice or CPD this belief takes hold and becomes an accepted treatment option (perhaps ££££ is the driving factor).
Claims for these conditions do seem more prevalent amongst those who offer ‘cranial osteopathy’, although it is by no means confined to that area of practice and even cranial osteopaths are qualified and regulated.
I don’t fully agree with the view that osteopathy can be used to treat musculoskeletal symptoms caused by these conditions. I’m sure that there are some conditions where palliative care could apply, but it’s hard to see what musculoskeletal symptoms osteopathy could ease from somebody suffering from ‘ear ache’ a ‘blocked nose’ or ‘learning difficulties’.
I can accept that it may be a minority of osteopaths who hold these beliefs, but it seems that it is not an insignificant minority, a simple google search turns up many such claims.
It should be clear from my post that it is only this minority area of osteopathy that I am questioning and I have simply asked to see some evidence to support these specific claims, not actually submitted any complaints. Although that would have been a simple process and would be interesting to see how the GOsC, ASA and Trading Standards each viewed the evidence / claims.
As a skeptic I am willing to be convinced by (good quality) evidence …. not just anecdotes!
So far the NCOR or GOsC have not supplied any evidence, despite issuing advice to its members that all claims should be supported by such evidence. The NCOR did offer some comment on the findings of the Bronfort report, but only on the scope of the study. It stayed well clear of making any statement of the effectiveness of osteopathy for the conditions listed in the study where OMT was shown to be inconclusive – If anybody has access to the evidence then I assume it would be the NCOR!
You say that the osteopathic profession has built a good reputation, but that could be seen as a part of the problem!
If we accept that there is a good public perception of the profession and the profession is divided between on the validity of treating musculo and non-musculo skeletal conditions, how are the public expected to make an informed choice when an osteopath offers to treat lower back pain and also ‘glue ear’?
If, as you say, it is a minority who’s views damage osteopathys reputation, then surely the best course of action should come from within the profession itself.
The GOsC would seem to be perfectly aware of these claims, yet seem content just to offer advice rather than openly state to its members that there is or isn’t reliable evidence to substantiate these claims. However I am still waiting to hear back from them on my second letter(they have said they will reply).
It would be good to hear the views of other osteopaths on this subject. Judging by the number of blog hits from osteopathy websites (especially Sacralmusings) there has been some interest, yet no other comments – or at least no ‘public’ comments
Sceptic Osteopath
May 9, 2010
Dear Sceptic Barista,
Your thread is getting hits from osteopaths because it has been widely circulated and is receiving a lot of attention. I hope you think this is a good thing. I read your call for osteopaths to respond so I am willing to try. It’s a bit of a shame if we have to rely on one of our students to represent the views of a whole group. I can sense the excitement in your audience. “Here we go, one of the loonies is going to have a rant”. Sorry but no.
20 years ago, with diploma courses, and no state register, patients who chose osteopaths had low expectations, were often at the end of a long line of failed interventions and were very happy with any improvement we could offer. Now we have chosen to play in the first division. I fully accept the reasonable criticism that we should be judged by the same standards as other professions.
Using the Title Doctor.
Osteopaths never use the title Doctor as this would be deliberately confusing for patients; it is proscribed by the Osteopaths Act, the G.Os.C., and even before then our old voluntary register also proscribed this misleading practice. My colleagues who have proper research PhD’s still do not use the title.
Osteopathic Practice Framework
The G.Os.C. is mid way through a painful scope of practice exercise that is shaking our profession up, down and sideways. The consultation documents are available on line. The base question is what interventions and behaviour should be “Branded” osteopathy and what is something else. Things that are in will have a stronger research base and will need less justification to patients, things that are out will need individual explanation of the risks and benefits (including the evidence) to each patient. I think that this goes to the heart of the sceptic’s issues.
The profession is dividing down a line of thinking folk who try to offer a good service for a limited range of conditions with a proven benefit and the rest who are the ones who so irritate your readers who believe they can help anyone with anything. Your intervention at this time will add momentum to a process that began 2 years ago. My fear is only that in pushing too hard now you may break the very process you wish to see deliver change. The G.Os.C. is currently about to begin consulting on Compulsory Revalidation of Osteopaths. I believe the process is open for public participation so there is an opportunity to shape policy if that is where your energy lies.
I don’t think the “treat anything” osteopaths are motivated by money, more a naive wish to help everyone and reluctance to realise that improvements seen in a raft of patients conditions may have little to do with the actual intervention and more to do with reversion to the mean, the natural recovery of benign conditions or what are called contextual effects. When you talk to them they all have stories of great improvement in patients who have no business improving with manual treatment. This is what fuels their desire to spread the word. I am no apologist for the behaviour but I know that there has been historically the belief that the phrase “treatment for colic” is an offer of a service not a claim of effect. You may well ask how the public can tell the difference and I agree. So does the regulator and the ASA so it’s time to shape up.
You ask:
“If we accept that there is a good public perception of the profession and the profession is divided between on the validity of treating musculo and non-musculo skeletal conditions, how are the public expected to make an informed choice when an osteopath offers to treat lower back pain and also ‘glue ear’?”
The aim of the Osteopathic Practice Framework is to address this issue by placing the commonly treated conditions and commonly accepted methods in a separate category to the rest.
Osteopaths are up to their necks (good pun) with regulation. The G.Os.C. are far from the benign organization that you hint they may be. The directions they have given us on advertising are not advisory or optional they have the force of statute behind them. As you have found, osteopaths are under direction to “clean up” their claims. As to why the G.Os.C. have not yet acted to enforce this, I cannot answer. I suspect that they have to be proactive with their regulations and reactive with their enforcement. Also if the aim is to change behavior, a professional disciplinary process is a slow and costly vehicle. I am not an official spokes person for the G.Os.C. but I would suspect if you were to offer them a list of web sites whose owners could benefit from a stern letter from their regulator, you may find you quickly achieve the ends you desire.
So is it all Quackery?
The core of the majority of UK osteopaths work is musculoskeletal pain. Our own practice breaks down as 50% low back pain, 25% neck pain and 24% other joint pains. The research base for back pain is proven for the sorts of lifestyle advice, exercises, massage and manipulations we offer. There is another discussion about the risks of cervical manipulation but that’s not what patients get as a first line treatment. We see people about 4 times at a cost of about £150 for the episode. At the end they have a full understanding of what they did to get the problem, how to avoid it and exercises to do, to keep well.
Patients are generally seen within 24h of referral and are better in a month. Anecdotal – I hear the cry. Well we had a 98% satisfaction rate and “would recommend rate” and a 30% response rate to our in-practice questionnaires. Small sample – no control – the rest hated you I hear you say. Well maybe but I think we stand up well to other musculoskeletal therapies.
If you read the Clinical Standards Advisory Group report on Low back pain you can calculate that osteopaths see more back pain than physiotherapists. These are old figures but it gives you an idea that we are not some small fringe player. Back pain is the second largest cause of time off work. And Osteopaths are in amongst it, keeping people at work and at no cost to the NHS.
The interventions we use for neck pain are also supported by evidence and the riskiest manipulations are avoided except where nothing else has worked, the patients are fully screened and fully advised to the common and rare but serious risks. This is again a statutory responsibility delivered to us by clause 20 of our code of conduct.
Other joint treatments are largely repackaged from orthopaedics and combined to a more integrated and coherent approach (e.g. combining say knee and hip treatments rather than saying these are separate conditions) but do not offer much controversy.
I like being an osteopath. A lot of the people I see have been recommended by a friend or family member or even the local NHS. Often we have the only intervention that is going to help. How do I know, because they may well have tried the GP and the physiotherapist and still got the problem.
Here’s an anecdote I use in lecturing to GP’s from the past President of the Royal College of General Practitioners, Professor David Haslem.
GP’s views on osteopathy
Two days before this year’s [examiners] workshop, I developed sudden and very severe low back pain getting out of my car.
This resulted in my… [missing] …the examiners conference, but [I] spent much of the time negotiating over the telephone on the subject of summative assessment with many very senior general practitioners, including four regional advisors, senior RCGP officers, a couple of professors, and leaders of our profession.
Of the 12 doctors that I spoke to, 10 advised me to see an osteopath.
When you think how doctors have thought about and talked about complementary therapists in only the relatively recent past, this advice is quite astonishing and shows a dramatic change in mainstream medical thinking.
If senior members of our profession now feel this way, surely it is time for such important therapies to be available to our patients
as part of the National Health Service.
Is it ethically acceptable to deny effective treatments to our patients simply because they can not afford to pay?
Incidentally, I did see an osteopath and he worked wonders.
Professor David Haslem PRCGP
President of the Royal College of General Practitioners.
BJGP Sept 1995
I hope this gives some food for thought.
Sceptic Osteopath
Zeno
May 10, 2010
Sceptic Osteopath
There are a few things I’d like to discuss, but it’s late. However, you said:
I’ve searched through the Osteopaths Act 1993, but I can find no mention of this proscription. Can you highlight the clause?
The osteopaths Code of Practice says:
which, I suppose sort of implies they can’t use the title Dr.
You say osteopaths never use the title Dr – I assume you mean unless they are registered as a proper doctor with the GMC?
However, it looks like non-GMC registered osteopaths calling themselves Dr are not that hard to find. This one came up on a quick search: Dr David W. Evans. There is no mention of any medical qualification, although there are several David W Evans on the GMC’s LRMP.
Then there’s this one: Dr Michael Burt ND:
My emphasis, but it requires no further comment.
Sceptic Osteopath
May 10, 2010
Zeno
I have looked at this again and technically the Osteopaths Act requires a Code of Conduct and the Code section 126 as you have found is the relevant rule.
I have looked at the links you gave for both the Osteopaths you have found in your search. I am not in any way an authority fit to make a judgment but my personal opinion is:-
Evans has a PhD from a UK university and is an active researcher and proponent of evidence based research. His use of the title is not in breach of the Code, he does make it very clear that his qualification is a research PhD. He has done the work and perhaps deserves the right to set himself apart from the remaining plebs. I think personally I would chose Mr Evans PhD rather than Dr Evans.
Burt makes no representation as to why he feels able to describe himself as Doctor, his rather long and varied qualifications ( one wonders where he gets the time) seem to include no medical degree or research PhD. and in view of the requirements of the Code section 126 I dont want to make any more comment on him.
Sceptic Osteopath
skepticbarista
May 10, 2010
Hi Sceptic Osteopath,
Thanks for the comment, good to get the views of an osteopath.
Clearly osteopaths are divided on the subject of treatments and the requirment / reliability of evidence needed to support those treatments.
From my perspective (one you may disagree with) it is not simply a case of those who seek to run an evidence based practice Vs those who don’t. Even the ‘treat anything’ osteopaths talk of evidence and often supply what they consider to be justification for their claims.
This usually amounts to little more than anecodtes, unverified customer surveys or abstracts from poorly conducted or discredited studies.
What seems to be lacking from the ‘treat anything’ camp is either a lack of understanding of what constitutes ‘good quality’ evidence, or a lack of commitment to adhere to the principles of an evidence based practice, which requires them to practice using the best quality of evidence currently available.
It is good to hear that the GOsC are currently involved in the process of examining which treatments fall under osteopathy and which ones don’t. What action the GOsC take do once they have their results will show if they are benign or not.
On paper the advice from the GOsC regarding ASA/CAP compliance is goood and very clear. You say it is “not advisory or optional they have the force of statute behind them” yet in practice there are osteopaths openly breaching these regulations with little or no action taken to prevent it.
For me, I can only judge the effectiveness of the GOsC as a regulatory body on the actions they take, not on the quantity of paperwork they produce! … “actions speak louder than words”!
Let me assure you, the GOsC and any other osteopaths reading it, this blogpost was never intended as some campaign against the GOsC or osteopaths in general.
It came about as an objection to those osteopaths (albeit a minority) who are promoting treatments that are unsubstantiated by evidence – The ones I might call the ‘quack element’ of osteopathy (my first use of the term in this discussion).
If that ‘quack element’ goes unchallenged, then there is little difference between them an other forms of quackery, such as homeopathy, reiki, craniosacral therapy, TCM. I can’t imagine any serious osteopath wanting to be judged along those lines!
In challenging these claims all I have done is ask for evidence, no complaints have been submitted against any osteopath (so far). If there is no evidence, then the GOsC are the ones who should take action to properly regulate the profession (and maintain its reputation) and therfore avoid any complaints.
If there is good quality evidence to support the claims then that’s great for osteopaths and patients alike, but that evidence needs to be made publicly available and stand up to scrutiny.
Another Osteopathy Student
May 10, 2010
Hi all.
Another osteopathy student here, with my personal take on the situation.
I would stress this is *personal* and does not reflect the opinions of my college, the faculty, qualified osteopaths, other students, the profession… etc etc etc.
I agree with Alice and “Sceptic Osteopath” above. Many disorders that are not musculoskeletal can present with musculoskeletal manifestations, as I understand things, and it is these manifestations that I would address. It is fervently discussed among students in my college whether our interventions reduce symptoms, improve comfort, or even have a direct or indirect influence on underlying disease processes — without conclusion, and with much poring over textbooks, research papers, and articles. Further high quality research is most definitely warranted.
Some osteopaths will no doubt believe firmly that their work directly influences specific conditions. I personally suspect that anyone advertising “treatment” of certain specific conditions is doing so simply out of a lack of awareness of current thinking on making such claims, and based on their interpretation of feedback they get from patients in their clinic. I do not think anyone is doing it to deliberately fleece members of the public. I appreciate that naivety is no excuse; placebo effects; regression to the mean; etc etc etc. There are thousands of blogs devoted to this discussion. I’m not praising or criticising, and I can’t profess for one second to know the thoughts of osteopaths making unsubstantiated claims; I’m simply commenting on the background to the current situation.
I suspect that the GOsC does not know what every one of its members advertise. I also suspect that not all members read all the literature that they are sent. I’d warrant that this is the same for any given profession. It *does* warrant investigation, and I’m sure that the GOsC and NCOR would be more than happy to oblige. After all, they exist to protect the patients, and to further the knowledge-base.
I feel that the simple fact the NCOR exists is a huge step in the right direction. However, I suspect that NCOR, the GOsC, and the profession as a whole are likely to take small and faltering steps for a while. This may be due to frictions within the osteopathic community, professional relationships with other CAM bodies, the spotlight of sceptical enquiry, and simple naivety as the profession learns how to operate alongside and within an EBM approach. Again — this is based on nothing more than my subjective feel for things.
Finally, I’d like to re-iterate that this is all personal opinion. I may have got it all wildly wrong. Please do not assume that I speak for anyone other than myself. However, I thought the readers of this blog may like to see that some osteopathy students are actively interested in research, and fully willing to investigate the claims of our own profession and history. I would ask that the EBM advocates and assorted sceptics out there — is there a collective term?
— encourage this process by supporting those of us who are keenly pursuing this course of action.
Another Osteopathy Student
May 10, 2010
Glad to hear it
I think a lot of people are a little “twitchy” at the moment, for obvious reasons. I’ve no doubt that includes practitioners and sceptical analysts alike.
I’d like to think that everyone involved is capable of working constructively towards best-practices in osteopathy, including advertising.
skepticbarista
May 10, 2010
Sceptic Osteopath:
Could you expand on what you mean by:
“historically the belief that the phrase “treatment for colic” is an offer of a service not a claim of effect.”
I understand that this may not be representative of your views and it may now be now a mainly historic viewpoint, but if we are talking about curing the ‘symptoms’ of a condition rather than the condition itself, this has not stood up well to scrutiny during complaint investigations for other CAM therapies.
Another osteopathy Student:
“Many disorders that are not musculoskeletal can present with musculoskeletal manifestations”
As mentioned in an earlier reply, this can only be used with a limited number of non-musculoskeletal conditions. For example there are instances where those suffering from Cerebral Palsy can suffer from (often quite severe) spinal and limb pains due to the effects of the condition, this is totally different from treating the condition itself. In that case the therapist is treating limb or spinal pain … NOT cerebral palsy.
The majority of the conditions that I’m concerned with would present no musculoskeletal effects what-so-ever, certainly none worth seeking a manipulative treatment for. A child with catarrh or a baby with feeding difficulties is hardly likely to need, or benefit from OMT. Providing ANY treatment to ANY patient when it is not actually necessary is not in the patients best interest and could be seen as misleading.
Also, whilst I still say that this blog was not intended as a witch hunt against anybody (other than perhaps the quack element), I do find myself feeling critical of the GOsC for not being as proactive as it could be. It is in a position to openly say to UK osteopaths that these conditons are, or are not supported.
Sitting on the fence may be the easy option, but being an industry regulator is not always about taking the easy option!
NOTE: I realise that neither of you claim to support treatment of these conditions, so am simply seeking your views, NOT asking you to explain WHY you would do it!
Sceptic Osteopath
May 10, 2010
Sceptic Barista
Thanks for your acknowledgment of my position on this stuff I will try to clarify.
Could you expand on what you mean by:
“historically the belief that the phrase “treatment for colic” is an offer of a service not a claim of effect.”
Way back in the dawn of time when I graduated . . . . . . . .
The old voluntary register the General Council and Register of Osteopaths had a blanket ban on ALL advertising. Yes, no advertising at all except a small brass plaque on your door and six weeks of local paper advertising saying “Mr Sceptic has begun practice at 21 the High Street”. Then Mrs Thatcher got on a trip about anticompetitive practice in the professions and put a stop to the rule.
So osteopaths started putting ads in the yellow pages, which as a responsible publisher, knocked back ads that were not “legal” and gave some guidance to our floundering marketing efforts. As I recall the general line was, no talk of Cancer (Cancer Act?), no talk of Arthritis, and no claims to cure. My line about an offer of service goes back to these good old days. My YP ad might have said.
Mr Sceptic – Osteopath 25 High Street,
Treatment for back pain, Neck Pain. Etc
01234 456789 for appointments.
Put simply, people come with back pain, I treat them, I therefore put in my advert “Treatment for Back Pain”. In this context my advert makes no claim for effect.
Roll forward 20 years and we are in a different climate where advertising regulators insert a silent “effective” in front of the word treatment, which makes the ad read very differently.
Mr Sceptic – Osteopath 25 High Street,
[Effective] Treatment for back pain, Neck Pain. Etc
01234 456789 for appointments.
I believe that many osteopaths are stuck in a time warp and believe that the old ways still persist. When people come with a condition and the osteopath offers a treatment, they think they can reasonably say “treatment for x y z” without any implied claim to cure or even improvement. I don’t think they do this to be deliberately dishonest. In general when thinking about Osteopaths, if there is a choice between conspiracy theory or cock up I would guess on the second choice. Our regulator has been ramming the new message down our throats but some are only just getting the point.
Does that help?
I will try to say something about your other points in another post.
Sceptic Osteopath
pailiTapwek
May 15, 2010
Just want to say what a great blog you got here!
I’ve been around for quite a lot of time, but finally decided to show my appreciation of your work!
Thumbs up, and keep it going!
Cheers
Christian,
arthur
June 6, 2010
When I trained as an osteopath, we were very specifically taught that we treated individuals not conditions. I think that this is where the problem of this particular thread/blog lies.
One of the basic principles of Osteopathy is that there is a correlation between structure and function.
If biomechanical motion is compromised, then an area of dysfunction ensues.
Our role might therefore be seen as to allow the body to realign so as to restore or optimise tissue motion encouraging a better dynamic state of balance. Homeostasis is restored, the body can repair damage and “normality” returns. Very simplistic, but that is generally the crux of it. It does not matter how you do it: you may claim to be “classical”, “cranial”, “biomechanic”, “structural”…. so long as you adhere to your osteopathic principles – create change, allow motion. It matters not whether it is musculo-skeletal or visceral – the body does not make those distinctions (that is a manifestation of a reductionist paradigm).
So, this brings us to the aforementioned charges of treating conditions such as colic, asthma, Downs syndrome, cerebral palsy… it would be quite wrong to imply that we were to cure these with osteopathic treatment and so should refrain from advertising such feats. However, as was alluded to earlier by skeptic osteopath, “treat” has become, quite wrongly, synonymous with “cure”. When the term “treat” is used, it is in fact referring to the act of applying osteopathic techniques during a consultation, not necessarily “curing”.
When a parent of a child suffering with asthma is brought to me for a consultation, the first thing I would like to establish is what are their expectations? Perhaps by improving rib mechanics, diaphragmatic motion, I can influence their symptom picture. Perhaps, they will experience less acute episodes, respond more readily to their medication? Perhaps they will never have another attack.
Downs syndrome – osteopaths are not going to cure Downs, that would be absurd. Maybe the aim of the treatment would be to help drain their dribble more effectively, or help their hypermobile joints deal with the increased mechanical stresses.
I could go on.
Most pathophysiological processes will have a mechanical component to them – that is why we study them in such detail. An osteopath should be able to, with refined palpation and technical skills, influence the course of that disease. Not necessarily cure, but influence.
Another problem: Evidence.
Osteopathy does not fit the evidence based medicine model.
There are osteopaths working in Neonatal Intensive Care Units in North London. This has been occurring since 1993. As you can imagine, these are very fragile and sensitive environments and quite simply would not be tolerated if in any way whatsoever were to pose a threat to these babies. In addition to that, these osteopaths provide care in acute paediatric wards and have been asked by the paediatric consultants, to “troubleshoot” some of their patients in paediatric outpatients when they are unresponsive to allopathic approaches. There are no efficacy studies, but their presence alone is evidence.
You may be pleased to know that GOsC is about to embark on a consultation process with the profession regarding “Scope of Practice”.