Please see Part 1 of this series to get a view on what Cranial Osteopathy is and the reliability of the available evidence.
This post will cover:
* How common is Cranial Osteopathy
* Advertising advice & guidance!
* What answers has the GOsC given?
* And finally!
How common is Cranial Osteopathy?
It is worth looking to see how often Cranial Osteopathy it is used and who is most likely to be offered the treatment. For this I will turn to information in the GOsC’s Standardised Data Collection (SDC) report released in June 2010. Available here in pdf format. This covers the whole of the UK Osteopathic profession, Cranial Osteopathy is mentioned regularly throughout the document but for now I am only interested in the figures that show how common this treatment is.
Page 157 covers the ‘Profile of Osteopathic Care’. This show that osteopaths predominantly treat musculoskeletal conditions, typically over 40% of patients will have symptoms relating to lower back problems. Conditions where Cranial Osteopathy is more likely (but not exclusively) to be recommended are headaches (7%), conditions suffered by infants & children (8.5%) and ‘clinically diagnosed co-morbidity’ where more than one condition is present (13%).
Figure 2 on page 158 shows that regardless of symptoms or conditions presented, Cranial techniques are used as a treatment given during the first appointment in 25.8% of all cases and the sub-note to this figure states that:
‘The type of treatment given at second and subsequent appointments showed a similar distribution’
Page 175 of the report mentions a proposal that a version of the SDC tool, specifically for capturing data related to the treatment of children, is being considered :
“The development of a version of the SDC tool for infants and children is proposed, in collaboration with the osteopathic organisations specialising in this area of practice e.g. the Foundation for Paediatric Osteopathy, the Sutherland Cranial College, and representatives from the children’s clinics within Osteopathic Educational Institutions.”
This was also confirmed in a GOsC email from Dec 2010. So it is clear to see that although Cranial Osteopathy is some way from being the most popular treatment offered by Osteopaths and although not all osteopaths use cranial techniques, is certainly not uncommon – particularly for children and the elderly. I do wonder if the reason it is so popular for infants and babies is that regular osteopathy may be unsuitable – so providing a ‘gentle’ treatment option adds another revenue stream!
Advertising advice & guidance!
The statutory regulator for Osteopathy within the UK is the General Osteopathic Council (GOsC). The GOsC are talking to me via email (at least for the moment – but they’ve yet to read this!), so they are most certainly aware that there are questions surrounding the evidence for Cranial Osteopathy, but they were certainly aware of the issue well before I asked any questions. The minutes of their committee meeting in July 2010 contains the following statement:
“9. Osteopaths’ advertising. The GOsC was actively monitoring discussion of osteopaths’ advertising by members of the public in the blogosphere. There were claims by bloggers that osteopaths were making unverifiable claims for the treatments they offered and it appeared that cranial osteopaths’ websites were particularly under scrutiny.”
I should point out that it is ONLY Cranial Osteopaths that I have looked at!
“In addition to this monitoring, the GOsC continued to advise the provision in editions of the Osteopath and in the newly launched Fitness to Practise e-bulletin, that they should check their publicity for compliance with the Code of Practice and the Advertising Standards Authority Code. Osteopaths’ attention had also been drawn to up to date research published by the General Chiropractic Council – The Effectiveness of Manual Therapies – the UK evidence report , which could be used to check any claims being made in publicity. The help of the BOA in re-enforcing the advice to osteopaths on this issue was acknowledged.”
Rather than releasing evidence or a clear statement to counter the view that these claims are unverifiable, they choose to draw Osteopaths attention to their own Code of Practice, the ASA/CAP codes and the information in the UK Evidence Report. Is it not perfectly reasonable to assume that if they held reliable evidence, they would release it when asked and in doing so counter any claims being made in the ‘blogosphere‘! The UK Evidence Report was coverd in Part 1 of this topic.
The GOsC have certainly issued clear, unambiguous advice to their members and as the following examples show, they have been issuing this advice for well over a year.
The Osteopath Oct / Nov 09 edition (Page 9)
<-- Read this text then look at the image!
This is just the opening statement of a full page article called ‘Does Your Advertising Comply With The Rules‘. The article links advertising claims to their Code of Practice Clause 92, 122 and 123 and it goes a step further and asks their members to consider the following question:
“can you provide evidence that osteopathy in general,and the treatment you are offering in particular, is effective for the conditions you are claiming to treat?”
EVIDENCE that a treatment is EFFECTIVE – Is this not the same thing I’ve been asking the GOsC & NCOR!
The Osteopath Oct / Nov 10 edition (Page 16)
A year later another full page article called ‘Advertising Regulator To Look At Website Copy‘ said:
“All osteopaths must comply with the ASA’s requirements on healthcare advertising, as set out in the CAP Code, and you should therefore ensure that the claims made in your publicity material – both in print and online – can be verified by robust clinical evidence.”
And also …
“The change means that complaints regarding website content will now be considered by the ASA rather than trading standards officers, as is currently the case. Any complaints against an osteopath’s website could also be made directly to the GOsC, which we will be required to investigate.”
And more recently ….. The Osteopath Dec 09 / Jan 11 edition (page 22)
This is another full page article called ‘Advertising Guidelines Changed To Reflect Osteopathic Practice‘. This is an interesting one, not only does it tell osteopaths that they need to conform to the ASA/CAP guidelines and where to obtain advice. It shows that the British Osteopathic Association have been talking to the ASA on this matter, also it actually tells osteopaths where to find a list of conditions that will require evidence to support them.
“The full list of conditions that osteopaths can refer to in their publicity material is contained in the Help Note on Health, Beauty and Slimming Marketing Communications that Refer to Medical Conditions.”
This list applies to more than just Osteopaths. Anybody making (or challenging) health, beauty or slimming claims should read it. You need to register (free) to gain access to this list, but states that evidence may be required to support claims for colic, bed wetting and many, many more. It also states that suitably qualified medical advice should be sought for conditions such as Asthma, Ear Disorders and Learning Difficulties …. ALL conditions that Cranial Osteopaths offer to treat!
The Osteopath also provides a good deal of coverage on The Effectiveness of Manual Therapies – the UK evidence report and have devoted a number of full page articles to the findings of this report. These articles also contain references to ASA/CAP guidelines and advice on implementing the findings of the report. As this report has been covered elsewhere I will simply provide links.
The Osteopath Jun / Jul 10 edition (page 14) This gives an initial evaluation of the report by NCOR.
The Osteopath Aug / Sep 10 edition (pages 14-16) This provides a more detailed breakdown of the conditions covered and the quality of the evidence reported. Colic, Asthma and Ear Infections are all reported as Inconclusive.
What answers has the GOsC given?
Whilst it is true to say that the GOsC have not provided any research evidence to answer my questions and the only real action they have taken is to issue advertising guidance, they have made a number of statements on the subject and some of these are worth commenting on. Back in May 2010 I asked the GOsC if they could point me in the direction of suitable evidence to support the use of Osteopathy as a treatment for a range of non-musculoskeletal conditions.
I have covered the majority of these comments in earlier posts:
18 Apr 2010: Osteopaths: Talking a good game..
23 May 2010: Osteopathy: More words, Some actions, No evidence!
However since then I have had further contact with the GOsC and they have made a few interesting comments.
Dated 21/12/2010:
“You have asked us to provide details of current clinical evidence supporting osteopathic practice. The role of the GOsC – and indeed any healthcare profession regulator – is to regulate the professional conduct of individuals who are on its register; it is outside the scope of our role to collect evidence of the efficacy of particular treatments.”
They claim that collecting evidence is not a part of their role as a regulators, but they do have the services of NCOR to perform that task and that task has been done.
The GOsC are very aware of the claims being made and also of the poor quality of research evidence there is to support those claims. They undoubtedly recognise that this could constitute a breach of their Code of Practice (item 122) otherwise there would be no reason to issue all the advertising guidance. What they have said is:
“As you are probably aware, research development within UK Osteopathy is in its formative stages”
This may be a fact, but it is certainly not an excuse that would allow claims to be made without reliable evidence. The British School of Osteopathy was founded in 1917, the GOsC was established under the Osteopaths Act 1993. Osteopathic research should be well beyond its ‘formative stages’.
“Currently, as part of our work on improving the quality of information provided by registrants, we are focusing on the content of practice websites because of the growing public reliance on web-based information. Along with actively advising osteopaths to assess the accuracy of the information they provide in this way, we are also in the process of reviewing registrants’ practice websites, in order that we can advise them individually and more specifically on good advertising practice.”
Here is an acknowledgement that the content of a website is increasingly important to the public when seeking healthcare advice, therefore it is increasingly important that those claims are based on reliable evidence.
The GOsC are focusing on the content of their members websites and actively advising osteopaths to check their accuracy … The GOsC have a statutory duty to protect the public, yet these websites and claims are still common place – Why!
And if the GOsC are looking at their members websites, shouldn’t they at least have a view on the evidence ….. something they claim is outside of their remit!
To summarise what I’ve been told when asking for evidence – these comments are taken from a series of emails – sadly none contained any evidence!
“Anecdotal evidence in any healthcare field is not to be dismissed out of hand as it is often the precursor of controlled trials. In addition, lack of evidence is not in itself evidence of lack of efficacy.“
Anecdotes do not count as evidence!
“That said, the paucity of quality data relating to osteopathic practice is a deficit that must be addressed”.
I appreciate the acknowledgement that the is a lack of quality evidence – but this has so far not been addressed
“the treatment of non-musculoskeletal conditions has yet to be properly explored in terms of efficacy and safety, and in terms of what both the patient and the clinician believe to be the purpose of the osteopathic intervention.”
If the efficacy and safety have not been explored – Osteopaths should not be treating anybody ….. let alone babies! Why is this even remotely acceptable. Websites regularly say how safe and gentle the treatment is.
“To take the examples of colic and asthma – it is likely that neither expects a cure from the osteopath, but both parties are hoping to enhance the management (rather than the treatment) of the condition”
I totally disagree – When Osteopaths advertise a treatment for colic, I would believe paying customers are expecting something more positive. I think ‘it is unlikely‘ this is based on actually asking patients or parents, just personal opinion.
“In addition to the right to be informed where there is no evidence of positive effect the GOsC considers it essential that patients are also alerted to any identified risks associated with osteopathic care”
Patients have a right to be informed …….. I agree, but nobody is doing it!
“Notwithstanding the points above, your observations regarding osteopathic websites indicate that the GOsC must be more targeted in our guidance to practitioners.”
I will accept that a reasonable amount of clear guidance has been issued ……. but it is being ignored. So GOsC need to take further action.
“Your additional queries relating to “cranial osteopathy” highlight another area where information could be fuller in the public interest.”
What information has been made public. There certainly doesn’t seem to be anything on the GOsC website to inform the public.
It is difficult to avoid the similarities between this and the General Chiropractic Councils regulation of chiropractic!
And finally!
I firmly believe that there is insufficient evidence to support the claims being publicly made by Cranial Osteopaths. I believe that making these claims constitutes a breach of the Osteopaths Code of Practice and also of the ASA/CAP advertising guidelines. What is more the Osteopaths regulator within the UK is aware of this and seems content to simply issue advertising guidance – something that is clearly being ignored!
I am absolutely certain that there are people out there who will strongly disagree with what I have said. The majority of the comments on the quality of the evidence have been drawn from sources within the Osteopathic profession. If they disagree with that assessment, then they need to be able to provide robust evidence to show otherwise.
My own views on Cranial Osteopathy have been formed by looking at the information that is available and given what I have found, I believe I can justify those views.
What is more, I am not alone in thinking this and the criticisms come not just from Skeptics but from UK Osteopaths.
This division is recognised by the GOsC and the NCOR evidence summary contains the following message:
“Dissenting voices
Cranial osteopathy is not without its critics who question its scientific plausibility, its place within osteopathic medicine, and its lack of evidence of effectiveness. The growth of good quality clinic trials and scientific investigation will attempt to act as a rebuttal to such critics.”
I would point out here that it is equally valid (and more likely) that good quality evidence will support the views of critics!
Since my last post on the subject, I have had comments from UK Osteopaths some wishing me ‘good luck’ and others going somewhat further:
“Unfortunately cranial osteopathy is becoming increasingly popular, I think the celebrity woo endorsement has a lot to answer for… Believe it or not your campaign will have tacit support amongst many osteopaths.”
If true then that would be good. And also …
“I would say from personal experience that while the “philosophy” underpinning cranial practice is wrong and much of belief systems that have grown up around it are flawed, there is much to be said for simple touch and a friendly face. I have had cranial treatment done on me by colleagues And I felt it to be a pleasant and relaxing experience. This however does not justify the grand claims being made by some practitioners.”
I have no problem with the notion that a friendly face and time spent with a patient is of benefit and agree that this can be lacking in many doctors surgeries, although doctors may spend more time with you if you pay them £30-£40 per session (typically 30 mins & 1 hour). I can also understand how it may be pleasant and relaxing (even if only temporarily) and I agree with the comment that this is not a license to practice nonsense!
“However there is a large epistemological variance between what I claim to be able to do and some of my colleagues are claiming. I find this extremely worrying and to be honest feel that this needs to be addressed..”
I can understand many Osteopaths being reluctant to be openly critical of their peers, but they need to recognise that to the public ……… you are all Osteopaths!
Criticism of Cranial Osteopathy is nothing new, as this (2004) article from Ben Goldacre shows. Bad Science – Cranial Osteopathy
I will do an update once the results of the NCOR literature review have been published and am interested in seeing if it comes to a difference conclusion and on what research it is based upon. (I’ll try to make it shorter!)
Until then, it is very clear that the evidence for Cranial Osteopathy is extremely weak and has been openly criticised by many with the Osteopathic profession.
Andrew Gilbey
March 6, 2011
For the really desperate, the Bach flower remedy for ‘desperation’ is, apparently, cherry plum.
A N Other
March 6, 2011
@ Andrew Gilbey
I enjoy the debate too. However, by not answering question(s) that develop over the course of a debate and then saying that i sound desperate when i clarify points seems to me a bit unfair.
Andrew Gilbey
March 7, 2011
@A n other
Fair point. I’m afraid a lot of my debating skills were acquired in the School of Hard Knocks! It wasn’t meant to be specific to you, just a general observation.
Bruce
March 7, 2011
@ Andrew Gilbey
I am not sure there is any evidence to support either ANOther or myself are desperate in our approach or even questioning.
Desperation surely reflects; not to answering questions, banning people from sites and censorship.
Bruce
March 7, 2011
@ Andrew Gilbey
As Maria (Skepticat) has refused or is unable to answer this question, would you be happy to;
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base?
Or what about this, how much of the ASA list of treatable conditions for osteopathy are covered by robust evidence?
Come on Andrew, I know you find this fun:-)
Bruce
March 7, 2011
@ Andrew Gilbey
But maybe you would be happy to answer the question the Maria (skepticat) has refused or simply can’t answer?
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy
and it’s evidence base? Appreciating the same critiquing mechanisms should be used for all three
Blue Wode
March 7, 2011
Although it wasn’t my intention to post here again, in an effort to put an end to all the squabbling I have put together the following:
A N Other wrote on 24th Feb: “He does state [Gordon Waddell] “What matters is the balance of effectiveness versus risk, and that is strongly in favour of manipulation”.”
I wrote on 24th Feb: “Can you confirm that Gordon Waddell factored in the RAND (Research and Development) organisation’s published review of the literature on cervical spine manipulation and mobilization in 1996 in which it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate?”
I wrote to Bruce on 25th Feb: “Obviously neither you, A N Other, or I am able to prove that he [Waddell] did. However, I am not aware of any proof identifying conditions for which neck manipulation is absolutely essential. Indeed, chiropractic’s own reviews of the literature fail to show neck manipulation to be superior to physical modalities having little or no risk of adverse effects. Therefore the trick is using manipulation appropriately in carefully selected cases, with informed consent after weighing benefit against risk. IMO, it is unconscionable for chiropractors to use neck manipulation as routinely as they appear to, even if they consider the risk small or hypothetical.”
I wrote on 25th Feb: “A N Other wrote: “Who is impartial between Ernst and Waddell in their views on spinal manipulation?” [ME] Ernst. *IMO he understands the downside of chiropractic more fully than Waddell*.”
A N Other on wrote 25th Feb: “I will repeat the question – Who is impartial between Ernst and Waddell in their views on spinal manipulation? This is not about chiropractic it is about spinal manipulation.”
[ME TODAY] As spinal manipulation (adjustment) is the hallmark intervention of chiropractors, this is very much about chiropractic.
I wrote on 25th Feb: “A N Other wrote: “I will repeat the question – Who is impartial between Ernst and Waddell in their views on spinal manipulation?” [ME] Ernst.”
Bruce wrote on 25th Feb: “Come on Blue Wode, do you listen to yourself. How can you honestly expect people to take anything you say seriously. The answer is, they don’t. But you knew that. You honestly think Edzard Ernst is impartial and Gordon Waddell is not. The latter individual really is an eminent scientist and is recognised internationally as such, while the former is loosing credibility as a serious researcher on a daily basis.”
A N Other wrote on 25th Feb: “Explain how Ernst is impartial compared to Waddell?”
[ME TODAY] I thought I had already made that clear on 25th February when I stated that I thought that Ernst understood the downside of chiropractic more fully than Waddell.
I replied to Bruce and A N Other on 25th Feb: “Your lightweight ad homs and nit-picking smack of desperation.”
A N Other wrote on 25th Feb: “You still have not answered the questions I have put! Also where is the ad hominem?”
[ME TODAY] It is my view that I did answer your questions. Regarding the ad homs, I was referring Bruce, but pointing at you re the nit-picking.
I wrote on 25th Feb: “Do you think that Bruce is being polite, objective, and professional? I don’t.”
[ME TODAY] As SkeptiCat has kindly taken the trouble to illustrate [new readers should click on 'older comments' on the bottom left of this page], it is clear that Bruce’s behavior has, at various points, been immature and ill-tempered.
I wrote on 25th Feb in response to A N Other saying: “You still have not answered the questions I have put!” [ME] “In view of what I wrote in my previous comment above [summarising the lack of scientific evidence for chiropractic and osteopathy], I think that’s now irrelevant.”
A N Other wrote on 25th Feb: “So I didn’t write an ad hominem. Then why say that I did? I think it is still a relevant question considering you are questioning the impartiality of respected orthopaedic surgeon, who has been involved in research regarding back pain for 20+years. So please explain why you feel Ernst is more impartial than Gordon Waddell regarding spinal manipulation?”
[ME TODAY] As already stated above, it is my view that I did answer your question about Ernst and Gordon Waddell.
A N Other wrote on 27th Feb: “Please point out the “overt conflict of interests” that relates to Gordon Waddell. Also, please explain why you feel Ernst is impartial and Gordon Waddell is not in your opinion, regarding spinal manipulation?”
[ME TODAY] Ernst was referring to his detractors in general, not Gordon Waddell. Re your Ernst/Waddell question, I repeat, I have already answered it.
SkeptiCat wrote on 5th March: “it’s obvious to the casual reader that Blue Wode was only accusing you [A N Other] of nitpicking, probably inspired by the last paragraph you addressed to him, which does sound a bit desperate.”
[ME TODAY] I’m glad SkeptiCat understood that. It’s what I hoped that I had conveyed.
Bruce wrote on 7th March: “I am not sure there is any evidence to support either A N Other or myself are desperate in our approach or even questioning. Desperation surely reflects; not to answering questions, banning people from sites and censorship.”
[ME TODAY] Resorting to adhoms and nit-picking are well known tactics of alt-med proponents when they are desperately attempting to belittle skeptics. It invariably shows that they are struggling to defend their views, so they resort to the fallacy of: don’t like the message? Then shoot the messenger.
Bruce
March 7, 2011
Well that got you out the bath lol
Will review when time allows
Bruce
March 8, 2011
@ blue woad
Bit by bit as work allows:
Blue Wode says:
March 7, 2011 at 12:16 pm
Although it wasn’t my intention to post here again, in an effort to put an end to all the squabbling I have put together the following: @ Blue woad: no squabbling here
I wrote to Bruce on 25th Feb: “Obviously neither you, A N Other, or I am able to prove that he [Waddell] did. However, I am not aware of any proof identifying conditions for which neck manipulation is absolutely essential. Indeed, chiropractic’s own reviews of the literature fail to show neck manipulation to be superior to physical modalities having little or no risk of adverse effects. Therefore the trick is using manipulation appropriately in carefully selected cases, with informed consent after weighing benefit against risk. IMO, it is unconscionable for chiropractors to use neck manipulation as routinely as they appear to, even if they consider the risk small or hypothetical.”
@Blue Woad
This is a ridiculous statement: my understanding is the treatment meets the needs of the patient and the symptoms/ diagnosis that is presented. So once again risk over benefit. I would presume this to be the same if osteopaths or physios utilised manipulation? What you are saying above is like blaming phlebotomists for taking blood, or a surgeon for using a scalpel both have potentially grave outcomes. In all things there are risk, but the risk factor relating to chiropractic excluding Ernsts ‘particularly biased’ synopsis is very small. However, even then and with an attempt to massage the figures with non chiropractic cases, very small indeed.
In fact considering the ‘serious risk’ of some common medical procedures such as angioplasty 1:100 and colonoscopy 1:300, the risk of chiropractic is not even on the chart. These figures are not based on desperation they are based as a realistic comparison and fact
Bruce
March 8, 2011
@ Blue woad who wrote
‘I wrote on 25th Feb: “A N Other wrote: “Who is impartial between Ernst and Waddell in their views on spinal manipulation?” [ME] Ernst. *IMO he understands the downside of chiropractic more fully than Waddell*.”
@ Blue Wode
However, in the podcast at http://ontheotherhand.podbean.com/2011/01/19/ep-16-edzard-ernst-cam-critic-on-chiropractic-and-bias/. Ernst openly admits to knowing nothing about the profession itself and his knowledge is only based on ‘his’ perception of the current research. This is no different to Waddell. However Waddell still took time in his paper to describe Ernst’s research as ‘particularly biased’. Once again, not desperation, facts.
Blue woad wrote;
‘Bruce wrote on 25th Feb: “Come on Blue Wode, do you listen to yourself. How can you honestly expect people to take anything you say seriously. The answer is, they don’t. But you knew that. You honestly think Edzard Ernst is impartial and Gordon Waddell is not. The latter individual really is an eminent scientist and is recognised internationally as such, while the former is loosing credibility as a serious researcher on a daily basis.”’
A N Other wrote on 25th Feb: “Explain how Ernst is impartial compared to Waddell?”
[ME(Blue woad) TODAY] I thought I had already made that clear on 25th February when I stated that I thought that Ernst understood the downside of chiropractic more fully than Waddell.
@ blue woad
Again see above. I get the impression that your opinion of Ernst is not mirrored by the wider scientific community either within Exeter and Pen Med School or external to it. But once again Ernst’s statement says it all :
‘From Ernst to Kerberosk ‘it’s nice that someone likes what i do.most who comment on my work are not complimentary because of overt conflicts of interests’.
Wow, maybe it’s simply because they see the research he does as being biased and weak. Once again if people don’t agree with me they are wrong? Shock, horror lol
Bruce
March 8, 2011
Blue Wode wrote;
I replied to Bruce and A N Other on 25th Feb: “Your lightweight ad homs and nit-picking smack of desperation.”
@ blue woad
One actually could respond with the same banal rhetoric but I won’t. Read above.
Blue Wode wrote;
‘A N Other wrote on 25th Feb: “You still have not answered the questions I have put! Also where is the ad hominem?”
[ME TODAY] It is my view that I did answer your questions. Regarding the ad homs, I was referring Bruce, but pointing at you re the nit-picking.
@ blue woad
How can a request for you to answer the question be nit picking? It is simple just answer the question if you can?
Blue Wode wrote:
I wrote on 25th Feb: “Do you think that Bruce is being polite, objective, and professional? I don’t.”
[ME (blue wode) TODAY] As SkeptiCat has kindly taken the trouble to illustrate [new readers should click on 'older comments' on the bottom left of this page], it is clear that Bruce’s behavior has, at various points, been immature and ill-tempered.
@ blue woad
Well!
Immature, and ill-tempered, only the readers can decide lol.
I sincerely hope they do check out these sites and view some of the comments from the ‘swarm’ or zenophobes as they are becoming known. Skepticat’s and her classic rants and in fact check out quackometer’s ‘the world has become less quacky’ thread where they even attack, with some serious venom, one who looks to be their own and a newbie at that:-) Andy had to apologise lol
Bruce
March 8, 2011
Blue wide wrote:
‘I wrote on 25th Feb in response to A N Other saying: “You still have not answered the questions I have put!” [ME] “In view of what I wrote in my previous comment above [summarising the lack of scientific evidence for chiropractic and osteopathy], I think that’s now irrelevant.”’
@ blue woad
Sadly others dont think you answered the question, simples. So please answer the question as requested?
Blue Wode wrote
‘A N Other wrote on 27th Feb: “Please point out the “overt conflict of interests” that relates to Gordon Waddell. Also, please explain why you feel Ernst is impartial and Gordon Waddell is not in your opinion, regarding spinal manipulation?”’
‘[ME (blue wode) TODAY] Ernst was referring to his detractors in general, not Gordon Waddell. Re your Ernst/Waddell question, I repeat, I have already answered it.’
@ blue woad
For Ernst to make that statement ( see above) , my goidness one should simply allow the readers to decide just how stable in his views he really is.
Blue Wode wrote
‘Skepticat wrote on 5th March: “it’s obvious to the casual reader that Blue Wode was only accusing you [A N Other] of nitpicking, probably inspired by the last paragraph you addressed to him, which does sound a bit desperate.”’
‘[ME ( blue woad) TODAY] I’m glad SkeptiCat understood that. It’s what I hoped that I had conveyed.’
@ blue woad
Skepticat defending and agreeing with you, what a surprise. What a comedy double act you guys are lol. Sadly again no evidence of any post being desperate
Blue woad wrote
‘Bruce wrote on 7th March: “I am not sure there is any evidence to support either A N Other or myself are desperate in our approach or even questioning. Desperation surely reflects; not to answering questions, banning people from sites and censorship.”’
‘[ME ( blue wode) TODAY] Resorting to adhoms and nit-picking are well known tactics of alt-med proponents when they are desperately attempting to belittle skeptics. It invariably shows that they are struggling to defend their views, so they resort to the fallacy of: don’t like the message? Then shoot the messenger.’
@ blue woad
Intolerance, bigotry and closed mindedness are well known tactics of the ‘sKeptics/zenophobes’ which leads to the feeling and belief that debate is not on the agenda but censorship is. One only struggles with putting across alternative views when they are stonewalled and attacked by the swarm. See my response to skepticat on this thread. Debate never flourishes, nor are answers reached in an autocratic dictatorship, irrelevant of the strength of the opposing views.
Once again see above re quackometer, who also bans and censors as a tactic to improve ratings and perceived consensus it would seem?
But let’s get back to osteopathy:
Are you happy to answer the question I posed Andy and Skepticat or is that a no no as well?
Blue Wode
March 8, 2011
Bruce wrote. “This is a ridiculous statement”
It is not a ridiculous statement at all, and I suspect you know it. It is a responsible and rational account of the problem which demonstrates the importance of applying the precautionary principle in the interests of patient safety. For the benefit of drive-by readers, here it is again:
Quote
“However, I am not aware of any proof identifying conditions for which neck manipulation is absolutely essential. Indeed, chiropractic’s own reviews of the literature fail to show neck manipulation to be superior to physical modalities having little or no risk of adverse effects. Therefore the trick is using manipulation appropriately in carefully selected cases, with informed consent after weighing benefit against risk. IMO, it is unconscionable for chiropractors to use neck manipulation as routinely as they appear to, even if they consider the risk small or hypothetical.”
Bruce wrote: “However, in the podcast at http://ontheotherhand.podbean.com/2011/01/19/ep-16-edzard-ernst-cam-critic-on-chiropractic-and-bias/. Ernst openly admits to knowing nothing about the profession itself and his knowledge is only based on ‘his’ perception of the current research.”
There is a difference between research and behaviour-influencing beliefs. It is more than evident that Ernst understands the (unacceptable) deluded belief system that forms the basis of the vast majority of chiropractic practices (e.g. 90% in the US, and 60-70% in the UK).
Bruce wrote: “How can a request for you to answer the question be nit picking? It is simple just answer the question if you can?”
As with your own unsavoury contributions to the comment sections on various blogs (as highlighted by Skepticat), I was referring to A N Other’s overall blog comments, not just the ones here.
Bruce wrote: “I sincerely hope they do check out these sites and view some of the comments from the ‘swarm’ or zenophobes as they are becoming known. Skepticat’s and her classic rants…”
So you can dish it out, but can’t take it? As far as I can see, most skeptics are polite and patient whereas most alternative medicine proponents appear to have a short fuse when their cherished beliefs are seriously challenged. It’s not hard to see why.
Blue Wode
March 8, 2011
Bruce wrote: “But let’s get back to osteopathy”
My views remain unchanged from the comments I wrote here:
http://skepticbarista.wordpress.com/2011/02/03/osteopathya-question-of-evidence-part-2/comment-page-2/#comment-1243
Bruce
March 8, 2011
@ Blue woad
Neither intolerant nor a short fuse at this end and happy to both give and take on many levels lol but on Ernst we must agree to disagree. There are skeptics and skeptical scientists who impress me on occasions and Dawkins springs to mind but Ernst, well the guy seems way out his league and doesn’t have the capacity to recognise it. His blatant bias precludes many people in anything he says seriously. Therefore fly with crows etc.
With regards manipulation, once again I think my comment was reasonable, you may disagree, you may not even like it but it is a reasonable comment. But surely that’s what debate is yes/no or maybe we just play by your rules lol. You are right and I am wrong, sorry don’t respect you enough for that, by a long shot. But hey who knows lol
But in an attempt to get back on track, are you happy to answer my question/s or not? Here they are:
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base? Appreciating one would expect the same critiquing rules to apply for all three professions?
Or what about this, how much of the ASA list of treatable conditions for osteopathy areHow does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base?
Or what about this, how much of the ASA list of treatable conditions for osteopathy are based on robust evidence?
My position is relatively easy what is good for the goose, in this instance and based on our conversation: chiropractic, should be good for the gander to include allopathic medicine, physiotherapy and based on this thread: osteopathy etc.
I genuinely have to problem with either criticism or critique as long as it is fair and evenly spread.
Simples
Blue Wode
March 8, 2011
@ Bruce
*Before* comparing the evidence for physiotherapy with the evidence for osteopathy and chiropractic it is crucial to remember that in the UK most physiotherapists work in salaried positions within the NHS and are therefore:
1. Not likely to advertise (and therefore make false claims that would interest the ASA).
2. Expected to treat patients in the minimum number of visits so as to be as cost-effective to the NHS, and to discourage patient dependency.
Can the same be said for most osteopaths and chiropractors? For example, an investigation into UK chiropractors’ attitudes towards the NHS revealed that the vast majority of them were interested in providing their services through the NHS, but only on a part-time basis and in a way that most closely resembled private practice:
http://www.ncbi.nlm.nih.gov/pubmed/11898015?dopt=Abstract
Could it be that chiropractors and osteopaths, most of who work in private practice, would find that working within the restrictions of the NHS (practicing in a similar manner to physiotherapists) would work against their financial interests?
In other words, physiotherapists may possess the same level of evidence as osteopaths and chiropractors, but most are not financially exploiting their patients, nor are they exposing them to potentially dangerous quackery.
IMO, physiotherapy is a vocation, whereas chiropractic and osteopathy are more about profit.
Bruce
March 8, 2011
@ blue woad
That is a huge assumption: chiropractors and osteopaths are less ethical/ patient centred than physiotherapists, good grief, listen to yourself. I believe that there are as many, if not more private physios in the UK than both osteopathy and chiropractic combined. Based on your reasoning, does that mean that those physios automatically become unethical and driven by finances?
Does that also mean that private practice in itself leads to finances over ethics? If so how would dentistry and medicine fare in your assumption.
Your leaps of faith/accusations always amaze me. They are based simply on a biased viewpoint rather than any evidence out there.
As for physiotherapy being a vocation while chiropractic and osteopathy is not, this is surely another ridiculous statement with no evidence other than opinion to back it up.
Yet still you failed to answer my question re evidence and the three professions. But hey I wasn’t holding my breath
Blue Wode
March 8, 2011
Bruce wrote: “I believe that there are as many, if not more private physios in the UK than both osteopathy and chiropractic combined.”
Could you provide a link to the latest figures on that please.
Bruce wrote: “Based on your reasoning, does that mean that those physios automatically become unethical and driven by finances?”
It wouldn’t surprise me if quite a few did.
Bruce wrote: “Does that also mean that private practice in itself leads to finances over ethics? If so how would dentistry and medicine fare in your assumption.”
Aren’t there some very rich MDs in the States – the land of hugely expensive private healthcare – as well as a good number of very rich chiropractors from the “Mercedes 80s” onwards? As for dentists, aren’t most in the UK going private for financial reasons? It’s a topic that appears in the press with great regularity.
Bruce wrote: “… still you failed to answer my question re evidence and the three professions.”
I’ve already commented on the evidence for chiropractic and osteopathy. Even if there was a little less evidence for physiotherapy, IMO it would be the wiser option due to its more judicious use of spinal manipulation and the fact that it is not nearly so mired in quackery.
Bruce
March 8, 2011
@ blue woad
Clarification of numbers of private physios can be attained from these two organisations:
The Organisation of Chartered Physiotherapists in private practice:www.physiofirst.org.uk
and The Chartered Society of Physiotherapists: www.csp.org.
Blue Wode wrote;
‘Bruce wrote: “Based on your reasoning, does that mean that those physios automatically become unethical and driven by finances?”’
‘It wouldn’t surprise me if quite a few did.’
@ Blue Woad
So only quite a few physios but ALL chiropractors and Osteopaths. Don’t be silly.
‘Bruce wrote: “Does that also mean that private practice in itself leads to finances over ethics? If so how would dentistry and medicine fare in your assumption.”’
‘Aren’t there some very rich MDs in the States – the land of hugely expensive private healthcare – as well as a good number of very rich chiropractors from the “Mercedes 80s” onwards? As for dentists, aren’t most in the UK going private for financial reasons? It’s a topic that appears in the press with great regularity.’
@ blue woad
Not sure I accept your blanket statement but at least you are being inclusive for all forms healthcare this time, which is a start
‘Bruce wrote: “… still you failed to answer my question re evidence and the three professions.”’
‘I’ve already commented on the evidence for chiropractic and osteopathy. Even if there was a little less evidence for physiotherapy, IMO it would be the wiser option due to its more judicious use of spinal manipulation and the fact that it is not nearly so mired in quackery.’
@ Blue woad
So you exclude the tens of thousands of chiropractors who are solid, ethical musculoskeletal practitioners at the sweep of your pen. Sorry, can’t allow you to do that. It really is nonsense and if you don’t see it, others thankfully, most certainly will.
Blue Wode
March 8, 2011
Bruce wrote: “So only quite a few physios but ALL chiropractors and Osteopaths. Don’t be silly.”
I now have the figures and apparently there are 47,000 physiotherapists in the UK, of which “as many as” 5,000 treat “some” patients privately:
http://www.csp.org.uk/uploads/documents/csp_pa7.pdf
So, I estimate that roughly 10% of the physiotherapy profession works in private practice, whereas nearly all chiropractors and osteopaths do.
Bruce wrote: “So you exclude the tens of thousands of chiropractors who are solid, ethical musculoskeletal practitioners at the sweep of your pen. Sorry, can’t allow you to do that. It really is nonsense and if you don’t see it, others thankfully, most certainly will.”
You know as well as I do that what you’re saying is an outrageous exaggeration. In the US, only around 10% of chiropractors are *ethical* musculoskeletal practitioners and in the UK it looks like it’s less than 30%. Given that the US has the highest population of chiropractors at around 70,000 and the UK has around 3,000, the figure I arrive at for *ethical* chiropractors is in the hundreds – and that’s probably on a global scale.
BTW, in another comment you wrote: “However, in the podcast at http://ontheotherhand.podbean.com/2011/01/19/ep-16-edzard-ernst-cam-critic-on-chiropractic-and-bias/ Ernst openly admits to knowing nothing about the profession itself and his knowledge is only based on ‘his’ perception of the current research.”
I have carefully listened to that podcast and what was asked of Ernst (at 28.30 mins) was that in view of recent developments in CPD, did he think there had been more of a shift in evidence based v. vitalistic chiropractors? He replied that he “hadn’t got a clue”, particularly in relation to the US, and that it was no in his remit to address it. He reminded Brett Kinsler, the interviewer, that he was a researcher who questioned mainly if a treatment worked, for what conditions, and what side effects there might be. Further on in the interview when asked if he thought that there was an increase in chiropractors getting involved in producing higher quality research, he said that his team had looked at the output of published research after chiropractors had become regulated by statute in the UK and it showed that regulation in the UK had led to a decrease in it. He then said that he had to admit he hadn’t got a clue about the related situation in the US and elsewhere, although he thought it would be nice for it to be documented in view of his impression that it wasn’t booming in terms of numbers and quality.
As for the rest of the interview, I also can’t see where there was any evidence of bias on Ernst’s part. Indeed, I’m tempted to transcribe the whole 45 minutes and put it online for any chiropractors who can’t be bothered to listen to it and just go along with the negative comments of those chiropractors who have.
Blue Wode
March 8, 2011
Erratum: My comment should read that the figure I arrived at was in the TENS of hundreds (as opposed to Bruce’s tens of thousands).
Blue Wode
March 8, 2011
@ Bruce
BTW, re Ernst’s impression that chiropractic research isn’t booming in numbers, a search for ‘chiropractic’ on clinicaltrials.gov shows only 41 chiro studies recruiting, yet it’s a multibillion dollar industry:
http://clinicaltrials.gov/ct2/results?term=chiropractic
Not very impressive.
Andrew Gilbey
March 8, 2011
Well chiropractic does seem to turn out quite a lot of case studies. Having read quite a few, I can assure readers that’s not necessarily a good thing! Not least because they only seem to turn out the ones which show postivie findings. So no risk of publication bias there, then!
Andrew Gilbey
March 8, 2011
In that post just above, ‘show’ should have obviously have been in inverted commas.
Bruce
March 9, 2011
@ blue woad
With regards the physios on private practice, the information you have in nearly 4 years out of date (April 2007) and was actually collated in 2005/2006 before the cut backs in physio posts in the NHS. I therefore stand by my statement as my understanding is it is nearly double the figure now compared to 2007.
Accepting my comment was covering both osteopathy and chiropractic: my understanding, and I think you can get this from http://www.wfc.org is that chiropractors covering the musculoskeletal model is in the majority in the US, around 70%. However I accept they all use the term subluxation which is cultural and seems to mean one thing to the traditionalists and another to the MSK guys. I also understand you are aware of that through ongoing debates.
As around 80% of osteopaths in the states are musculoskeletal based we are already into ‘tens of thousands’ . The information given to me suggests that within the UK chiro scene, there are 4 associations and 3 colleges.
According to their websites in the past, the United and McTimoney associations are traditionalists. The British and Scottish groups are split. The former is around 85% MSK, and the latter around 50% MSK. That would suggest half the UK chiros are MSK. Of the 3 schools 2: AECC and WIOC are MSK and the MCC is traditional. At least that’s how I understand it. For osteopathy there are 10 schools in the UK with 1 major association, the BOA but with subgroups/associations/foundations, covering sports, cranial, animals and children.
My understanding is around 60% of osteopaths are pure MSK and the rest either mixing traditional and MSK or are traditional.
I am sure a chiropractor or osteopathy would adjust the figures if wrong, but this us my understanding.
That doesn’t cover the rest of the world although I believe chiropractic education follows a set of international standards whereby osteopathy currently doesn’t.
I will address the rest later
Bruce
March 9, 2011
@ blue woad
With regards the podcast I now get the impression, based on your comments, the message gleaned varies according to side of argument
However as usual you have tried to skip off onto something else, without answering my questions.
@Andrew Gilbey
Can you answer my questions please rather than jumping on the band wagon and going off at a tangent:-)
A N Other
March 9, 2011
@ Blue Wode
Personally, I don’t think I am being desperate or nit picking. I am just clarifying statements, questions and accusations that have been put to me. I don’t think it is polite to be called desperate or nit picking (“As far as I can see, most skeptics are polite and patient…” – Blue Wode). I don’t think I have made any accusations over the course of our debate.
Thank you for clarifying your position with the questions I have asked. I still find it difficult to understand your opinion that Ernst is more aware of the downsides of spinal manipulation compared to Waddell, especially when in the comment I quoted he states “Although the subject of this editorial is low back pain, they concentrate on the admittedly higher risks of cervical manipulation. Even then, orthodox medicine has a long way to go to reduce the rate of serious complications of most of our investigations and treatments to the order of 1:0.2-1 million. The adverse reactions to which the authors refer are temporary aggravations of symptoms or minor subjective reactions; in a personal series, that rate is comparable to figures for every other orthodox treatment for back pain. What matters is the balance of effectiveness versus risk, and that is strongly in favour of manipulation”.
From this quote he seems to be aware of the risks with spinal manipulation but still happy for it to be used.
Here is another interesting quote from a leading physiotherapist researcher:
“In the idealistic scenario of evidence based practices, there is no unequivocal evidence for any treatment for musculoskeletal or indeed many other disorders at this time.”
I think this highlights the issue of when you look at the evidence for manual therapies only and do not include clinical experience. So as i have shown before evidence is continually being added and these should change how therapists practice, but as with many things this will take time. Therefore, there is no certainty within manual therapy but i am certain there is a place for it.
p.s. Have you read the article by Karel Lewit yet? It will help you understand the complexity that is musculoskeletal medicine!
Blue Wode
March 9, 2011
Bruce wrote: “With regards the physios in private practice…my understanding is it is nearly double the figure now compared to 2007.”
We’ll call it 10,000 then (out of 47,000), which is less than 25% of all UK physiotherapists compared to around 98% of UK chiropractors who work in private practice.
Bruce wrote: “…my understanding…is that chiropractors covering the musculoskeletal model is in the majority in the US, around 70%.”
The problem with that figure is that it’s unlikely to represent those chiropractors who *exclusively* cover the musculoskeletal model. Indeed, your World Federation of Chiropractic (WFC) link is very revealing. Page 30 of one of the WFC’s ‘Consultation Identity’ documents illustrates that at least 65% of chiropractors do not adhere to the musculoskeletal model *only*. Perhaps even more revealing (and worrying) is that the right hand side of the chart displayed on that page shows how erroneous the general public’s perceptions of chiropractic are:
http://www.wfc.org/website/images/wfc/docs/wfc_report_january2005_05.ppt
Bruce
March 9, 2011
@ blue woad
My understanding is my numbers are accurate. But even if your last post is correct ‘ tens of thousands’ is still am accurate statement.
Not sure I see anything ‘worrying’ but hey it’s a debate.
Bruce
March 10, 2011
@ blue woad
It stil goes into the tens of thousands and surveys are only as good as the respondents yes/no
I stick by my comments
Blue Wode
March 9, 2011
@ Bruce
In another WFC document regarding its ‘Consultation Identity’ (‘Abstracts of the most relevant research’ – see p.15 of the link below), I came across an interesting survey of 1,418 active and semi-active UK chiropractors [Wilson FJH, A survey of chiropractors in the United Kingdom, European Journal of Chiropractic, 2003:50:185-198]. It had a response rate of 58% (816), and its participants included members of the British Chiropractic Association (BCA) and Scottish Chiropractic Association (SCA), educated at accredited colleges, and members of the (former) British Association for Applied Chiropractic (BAAC) and McTimoney Chiropractic Association (MCA), educated at unaccredited colleges but grandparented to practise in the UK. A strong majority (69%) considered organic or visceral conditions to be within the scope of chiropractic practice:
http://www.wfc.org/website/images/wfc/docs/abstracts_of_the_most_relevant_research.pdf
By the way, it’s interesting to note what veteran, evidence-based chiropractor, Samuel Homola, had to say about the outcome of WFC’s Identity Consultation in one of his papers [Can Chiropractors and Evidence-Based Manual Therapists Work Together? The Journal of Manual & Manipulative Therapy; Vol.14 No.2 (2006), E14-E18]:
Quote
“On June 15, 2005, the World Federation of Chiropractic, at its 8th Biennial Congress, unanimously agreed that chiropractors should be identified as “…spinal health care experts in the health care system…with emphasis on the relationship between the spine and the nervous system…” This definition fails to place proper limitations on chiropractors who use spinal adjustments to treat general health problems, plunging the profession deeper into pseudo-science and away from establishing an identity for chiropractors as back-pain specialists.”
Blue Wode
March 9, 2011
Bruce wrote: “As around 80% of osteopaths in the states are musculoskeletal based we are already into ‘tens of thousands’.”
No, we’re not. Osteopaths in the US are MDs first and foremost, and therefore not comparable with osteopaths in the UK:
Quote
“In America today there are more than 49,000 Doctors of Osteopathy (known as DOs) who are trained in orthodox scientific medicine with additional training in manipulative therapies. They have the same entitlements to prescribe and perform surgery as mainstream medical practitioners and make up 20% of all general practitioners is the US.
The UK’s 5,000 or so osteopaths, require no scientific medical training and so are more firmly established in the ‘alternative’ camp. Very few are MDs and many combine osteopathy with dubious practices such as naturopathy and cranial osteopathy.”
More…
http://forums.randi.org/showpost.php?p=3871518&postcount=15
Bruce
March 10, 2011
It depend what you class as medical training. Chiropractic undergrad education has been covered in the past…. and ignored. It includes all the health sciences, neurology, paediatrics, orthopaedics etc. Education is a gift and not the property of one school of thought. Once again a rather silly statement.
Further, it is my understanding that hour for hour the education and a large percentage of the content at AECC and WIOC is the ‘same’ as med school with a focus on function rather than prescription or surgery.
Blue Wode
March 9, 2011
Bruce wrote: “The information given to me suggests that within the UK chiro scene, there are 4 associations and 3 colleges. According to their websites in the past, the United and McTimoney associations are traditionalists. The British and Scottish groups are split. The former is around 85% MSK, and the latter around 50% MSK. That would suggest half the UK chiros are MSK.”
That’s not the impression I get:
http://tinyurl.com/6afaj7h
Bruce
March 10, 2011
@ blue woad
This survey was carried out by something called the AUKC which, as I understand it, is made up of the Scottish, United and Mctimoney associations.
I stand by my previous figures
Blue Wode
March 9, 2011
Bruce wrote: “Of the 3 schools 2: AECC and WIOC are MSK and the MCC is traditional. At least that’s how I understand it.”
That might be so about the first two, but what, precisely, are they teaching that’s uniquely chiropractic? It’s an important question that’s been raised before:
http://sciencedigestive.blogspot.com/2010/06/email-to-university-of-glamorgan.html
Bruce wrote: “For osteopathy there are 10 schools in the UK with 1 major association, the BOA but with subgroups/associations/foundations, covering sports, cranial, animals and children. My understanding is around 60% of osteopaths are pure MSK and the rest either mixing traditional and MSK or are traditional.”
So, similar to chiropractic schools in many ways.
Blue Wode
March 9, 2011
Bruce wrote: “That doesn’t cover the rest of the world although I believe chiropractic education follows a set of international standards.”
Do you know if the New Zealand College of Chiropractic follows those standards?
See…
http://tinyurl.com/653uhnw
Blue Wode
March 9, 2011
…and the Barcelona College of Chiropractic, too, about which there is currently some controversy regarding its educational standards:
http://tinyurl.com/33svz2u
Bruce wrote: “With regards the podcast I now get the impression, based on your comments, the message gleaned varies according to side of argument.”
I suspect that part of the problem is that English isn’t Edzard Ernst’s first language. Although he took British nationality around 18 years ago, he is from Germany and his staccato style of pronunciation can sound hesitating and unsure to those who are not familiar with the way he speaks. It wouldn’t surprise me if most chiropractors think he sounds under pressure and is trying to bluff his way through the interview, whereas it’s simply his normal voice.
Bruce wrote: “However as usual you have tried to skip off onto something else, without answering my questions.”
I’m not aware of that. Please list the questions that you feel I haven’t answered.
Bruce
March 10, 2011
@ blue woad
As usual you have skirted around the questions but never really answer them:
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base?
Or what about this, how much of the ASA list of treatable conditions for osteopathy are covered by robust evidence?
Blue Wode
March 9, 2011
A N Other wrote: “What matters is the balance of effectiveness versus risk, and that is strongly in favour of manipulation”.
That is not what the science tells us.
Physio researcher quote: “In the idealistic scenario of evidence based practices, there is no unequivocal evidence for any treatment for musculoskeletal or indeed many other disorders at this time.”
Doesn’t that mean, then, that those who work in private practice can use their ‘clinical experience’ to exploit patients financially? That’s in addition to exposing them to unacceptable risks, and essentially rendering them little more than guinea pigs as they experiment with different styles of quackery. BTW, regulation, it would appear, is pretty much useless when it comes to combating such behaviour.
A N Other
March 9, 2011
@ Blue Wode
Blue Wode wrote “That is not what the science tells us.”
Spine J. 2010 Oct;10(10):918-40. This study seems to show that there is effectiveness and as far as I understand the risks are low for spinal manipulation.
Regarding your other statement, you have no evidence to explain why you think private practice causes financial exploitation.
So have you read the Karel Lewit article yet?
Blue Wode
March 9, 2011
A N Other wrote: “Spine J. 2010 Oct;10(10):918-40. This study seems to show that there is effectiveness and as far as I understand the risks are low for spinal manipulation”.
Yes, the risks are apparently low, but a responsible risk/benefit assessment cannot favour spinal manipulation while other safer, cheaper and more convenient options are available.
Even patients in discomfort who have exhausted all other options, and agree to undergo manipulation after giving their fully informed consent, would not be likely to have any impact on the following major problem:
Quote
“Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain.”
[Ref: Ernst, E. Spinal manipulation for the early management of persistent non-specific low back pain? a critique of the recent NICE guidelines. Int J Clin Prac, Vol 63, No10, Oct 2009, pp.1419-1420 ]
A N Other wrote: Regarding your other statement, you have no evidence to explain why you think private practice causes financial exploitation.
One only has to look at this web page listing a range of chiropractic ‘practice building’ outfits to see that unethical chiropractic practices are rife:
http://www.chirobase.org/09Links/pb.html
Indeed, the ‘Spine Salesmen’ chapter of the book, ‘The Health Robbers: A Close Look At Quackery In America’, explained very succinctly why economic predation has to lie at the heart of chiropractic practices:
Quote
“If a chiropractor limited his practice to muscular conditions such as simple backaches, if he saw patients only on referral from medical doctors after medical diagnosis has been made, if he were not overly vigorous in his manipulations, if he consulted and referred to medical doctors when he couldn’t handle a problem, and if he avoided the use of x-rays, his patients might be relatively safe. But he might not be able to earn a living.”
Andrew Gilbey
March 9, 2011
@Blue Wode
Interesting qoute you provide “If a chiropractor limited his practice to muscular conditions such as simple backaches, if he saw patients only on referral from medical doctors after medical diagnosis has been made, if he were not overly vigorous in his manipulations, if he consulted and referred to medical doctors when he couldn’t handle a problem, and if he avoided the use of x-rays, his patients might be relatively safe. But he might not be able to earn a living.”
Maybe I shall send that to the local chiropractors who set up their stalls in the malls over here. On that topic, a pal of mine suggested we should hang around one of these stalls and try to interview all the people who grab a ‘free’ consultation to see how many have ‘subluxations’ requiring urgent treatment and on-going consultations. Interestingly, the subluxations will probably be diagnosed without an x-ray.
A N Other
March 10, 2011
@ Blue Wode
The quote you have used from Ernst, in my view, is out of date in context with current rehabilitation views. As i have stated before in some cases of low back pain it is appropriate to treat other areas i.e. neck, foot, hip etc, because the musculoskeletal system is interconnected. This idea comes from Karel Lewit, a world renowned rehabilitation expert. This idea has been adopted by a wide section of the rehabilitation community including physiotherapists, chiropractors osteopaths etc. You should really read that article by Karel Lewit, it may change your mind on a few things.
With your last quote from the health robbers book, i think it is a bit of an exaggeration. If any manual therapsit followed those guidelines, all of them would make a living just by the very fact that musculoskeletal complaints are very common.
Also can i point out that in the vast majority of low back complaints there is no medical diagnosis other than non specific low back pain!
Bruce
March 10, 2011
@ Andrew Gilbey
Answer the questions;
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base?
Or what about this, how much of the ASA list of treatable conditions for osteopathy are covered by robust evidence?
Also I get the impression from your previous statement is that your problem would go away if chiropractors ceased being chiropractors, is this the same for primary contact/ private physios and osteopaths. Thanks for the smile.
@ blue woad.
I have posted the questions above it you can use Andrews. All you have to do is answer the questions rather than skirt around it.
Andrew Gilbey
March 10, 2011
@Bruce,
I’m not well up on on the evidence base of either osteopathy or physiotherapy. I suspect osteopathy will be roughly the same as chiropractic. The only difference being that osteopaths don’t publish loads of rubbish trying to kid themselves and others that their discipline is evidence-based. It seems to me that there are loads of chiropractors who get stuff (crap case studies and crap attempts at RCTs)published and think it’s research. I have very little concern about physiotherapists as they are part of mainstream health care. When did you last see a physiotherapist touting their trade in a mall or offering 55% off vouchers online!
As I have said before, I personally do not see the point of chiropractors. It’s my opinion that they have managed to muscle their way into the healthcare system, but they should not be there. That they are there is testimony to a few clever lawyers and a few easily duped politicians and/or panels of enquiry. The very way in which chiropractic evolved and has matured, I personally find risible. Quite simply, when the fundamentals and the underpinning of a system are so badly flawed, it is time to give up. The theory should not be tinkered with – it should be thrown out. Start again – go to med school. My old alma mater, Warwick University, has a med school and they take mature students. Possibly they would consider training in chiropractic and evidence of a solid first degree as sufficent to enter med school as a mature student.
Blue Wode
March 10, 2011
If readers care to look back over the comments section here they will see that we are now going round in circles with Bruce and A N Other with their constant re-hashing of questions that have already been answered. It seems to me that they are attempting to postpone losing face for as long as possible by trying to tire out the opposition.
Despite their twisting and spinning, readers should be aware by now that there is still no escaping the following with regard to chiropractic:
Quote
“WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”
[Ref. ‘Trick or Treatment? Alternative Medicine on Trial’, p.285]
As I have said previously, the above strongly suggests not risking one’s time, money, or life with either chiropractic or osteopathy.
@ Andrew Gilbey
Yes, apparently stalls in malls can be a conman’s dream, and potentially quite lucrative…
(Penn & Teller – chiropractic segment at 2:44 in)
A N Other
March 10, 2011
@ Blue Wode,
Please point out the twisting and spinning i have done. Also it is not polite to accuse people of twisiting and spinning. All i am doing is showing you evidence which you should add to your point of view regarding manual therapy.
Bruce
March 10, 2011
@ blue Wode
What a cop out. You fail to answer questions in depth and when in doubt bring our Ernst’s book trick or treat like some form of religious book, but as has been pointed out Ernst is recognised as being ‘ particularly biased’ in his writings.
Sorry mate, sane old bolt hole doesn’t work
@ Andy Gilbey
No one is saying CAM practitioners don’t have bad apples but neither does allopathy. So what’s new. However you still refuse to answer the questions by asking people to ‘ look at this’ rather ‘ I haven’t a clue’
Sad really
Bruce
March 10, 2011
@ blue woad
You’re reputation of playing by one set of rules for yourself while setting another for others is well known. What we see here is also a weak attempt to fit nonsense into the debate in an attempt to enhance your own weak position.
You and Andrew have failed to answer the questions posed albeit continuously repeated, so one must assume that you either wont or can’t and I am certain to any fair minded reader this is plainly obvious. Regarding the accusation of going around in circles, I totally agree, but not because of nit picking nor desperation but because of your procrastination. Once again, the readers can decide.
What a shame, close mindedness seems to supersede abilty to debate in a rationale manner.
Once again Andrew and Blue woad, answer the questions please?
Andrew Gilbey
March 10, 2011
I have attempted to answer the question a few posts above. Let me know if doesn’t answer your question.
Bruce
March 11, 2011
@ Andrew Gilbey
No you haven’t answered either of the questions:
How does the evidence for osteopathy compare with chiropractic evidence (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base?
Or what about this, how much of the ASA list of treatable conditions for osteopathy are covered by robust evidence?
Happy for you to have another shot at it?
I will add this down the page as well.
Happy
Blue Wode
March 10, 2011
@ A N Other
You have just demonstrated my point re going round in circles, twisting and spinning.
I have already considered the evidence you have presented and my view regarding manual therapy remains unchanged.
A N Other
March 10, 2011
@ Blue wode,
So evidence, which is accepted by the wider rehabilitation amd manual therapy community (including world renowned experts such as Karel Lewit, Gwendolyn Jull, Paul Hodges etc.), seems to have no effect on your view on manual therapy!
Also by asking how have I twisting spinning doesn’t demonstrate i have been twisitng and spinning. If you are going to accuse me of something back it up with some clear evidence. For example you (Blue Wode) stated that “As far as I can see, most skeptics are polite and patient…”. Do you think you are being polite and patient by saying that i nit pick, i am desperate and i twist and spin things?
Blue Wode
March 10, 2011
A N Other wrote: “Do you think you are being polite and patient by saying that i nit pick, i am desperate and i twist and spin things?”
Yes.
A N Other
March 10, 2011
@ Blue Wode,
Let me re-phrase the question to be absolute certain. Do you think it is polite to say that i nit pick, i am desperate and i twist and spin things?
Bruce
March 11, 2011
Sorry Andrew you did respond, albeit in your usual way lol
@ Andrew Gilbey
AG said:
‘I’m not well up on on the evidence base of either osteopathy or physiotherapy. I suspect osteopathy will be roughly the same as chiropractic…….. I have very little concern about physiotherapists as they are part of mainstream health care. When did you last see a physiotherapist touting their trade in a mall or offering 55% off vouchers online!’
@Andrew Gilbey
This is still not answering the questions. However I am happy for you to say you haven’t a clue and can’t be bothered to investigate it because it doesn’t quite fit the bigoted agenda on chiropractic. No problems with that, but be honest at least.
Re physiotherapy: the arguments over these many months that this is all about evidence, value for money and public safety is nonsense. The fact that physios are ‘ within’ mainstream doesn’t preclude them from needing robust evidence to practice. What about the guys in private practice and their claims. What about the people who attend physiotherapy every day, yet are never advised that in actual fact there is no robust evidence to support what us going on. They still pay for that service. Is that ethical. You have just proved my point. All the mall stuff, I agree every profession has bad apples even IT, research, journalism, ‘mainstream’ healthcare’. Get over yourself
With regards Osteopathy, let me help you out, this is my understanding : The ASA listing does not cover treatments based on robust evidence. The difference between the evidence for Chiropractic and osteopathy is minimal at best but it is still far greater than physiotherapy.
Bruce
March 11, 2011
Part 2 lol
Andrew Gilbey said
……’It’s my opinion that they have managed to muscle their way into the health care system My old alma mater, Warwick University, has a med school and they take mature students ‘with chiropractic degrees’ (ed)
@ Andrew Gilbey
You say some really silly things but here goes; Wow, opinions rather than evidence? Re getting into healthcare, both osteopathy and chiropractic are professions IN healthcare because the treat, and have always treated the health of the public. Simples.
Warwick Uni. Good place to study, good reputation. But isn’t this the Uni that wrote a damning paper on physiotherapy actually stating it was a lot of nonsense. I’ll let you find that one yourself lol. Re degrees, of course they would accept them.:-)
Sadly opinion based on intolerance is what will let you guys down. I accept that there is not a lot if evidence, in a similar vein to medicine etc, but both osteopathy and chiropractic are trying and it will improve. Not because if people like you but in spite of you.
You denounced case studies showing ‘ positive’ results well duh! I understand that case studies are accepted in ‘mainstream’ journals as well.
Sadly you presume a title eg chiropractic or osteopathy makes every individual simple or unethical where ALL the research is weak and all the opinions are wrong. While on the other hand the actions of ‘mainstream’ medicine are due to very bright and astute people who are always ethical and always right, where everything they do has no risk and covered by robust evidence. Sorry mate now that really wouldn’t hold up in a court of law. Really, stop making a fool of yourself. No really lol