Osteopathy: Dealing with change …

Posted on March 14, 2011

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My last 2 posts on Cranial Osteopathy looked at what (Part 1) cranial osteopathy is, what was being claimed and the available evidence to support those claims. I also looked at (Part 2)  what advertising advice had been provided. This all seemed quite appropriate as the ASA’s remit was about to change and these website claims would then come under their remit ……

….. Well the rules changed on 1 March, so it is worth a quick a look and see if anything has actually changed on the websites.

First though it is worth just clarifying something about the ASA remit and the CAP codes. The advertising regulations themselves have not really seen any dramatic changes, the only real difference is the fact that advertisers website content now comes under the remit of the ASA. If you can’t say it on your website now …… You shouldn’t have been saying it in your adversing before!

So back to Osteopathy….

In the past the GOsC had been issuing clear advertising guidance to its members, guidance that had largely been ignored by Cranial Osteopaths. The GOsC had also stated that it was their intention to start actively looking at the website content of its members and, where appropriate, advise the website owner on any potential breach of the ASA code and therefore the GOsC Code of Practice on advertising.

In Feb 2011 I was talking to the GOsC about a leaflet that was being supplied (via the internet) on one of its members websites. The leaflet carried the GOsC logo and made claims about the effectiveness of Osteopathic treatment for babies and children and includes a list of conditions ranging from colic to Cerebral Palsy and Downs syndrome.

I asked if this leaflet was ‘current‘ and if it was based on any robust evidence. The GOsC told me that this leaflet had in fact been withdrawn a number of years ago and that they had now contacted the clinic concerned to have the information removed and I can confirm that this has happened.

This was the osteopathic statutory regulator actually getting misleading information taken out of the public domain.

The GOsC email contained some interesting and very encouraging information.

They stated that they sought and achieved (in 2008) an amendment to the Osteopaths Act that removed their ‘promotional remit‘. This has to be a good thing as it removes any conflict of interest from an organisation that is tasked to both regulate and promote a profession. You only have to look at the GCC’s past Patient Information Leaflet to see what problems that can cause!

The GOsC also made an important statement regarding evidence.

As osteopathy matures into a mainstream regulated practice, the importance of empirical rather than anecdotal evidence is rapidly changing the culture of practice and steadily improving the quality of public information, including our own.

How the GOsC define ‘empirical‘ remains to be seen, but it acknowledges the limitations of anecdotal evidence if osteopathy is to be taken seriously ….. the ‘it worked for me‘ kind of testimonial just isn’t good enough … it never was!

They also confirmed something that they had alluded to in earlier emails. The fact that they are now looking at osteopaths website content and where appropriate, offering advice on how that content relates to current ASA guidelines …… and therefore the GOsC Code of Practice.

As you will already know, we are in the process of systematically reviewing all our registrants’ practice websites, so that we can advise osteopaths individually and more specifically on current good advertising practice. We hope the benefit of this action will be evident very soon.

This has to be seen as a very positive move from the GOsC. The osteopaths regulator actively regulating what their members say. It could be argued that this should have been done earlier, it could be argued that it shouldn’t NEED to be done at all (osteopaths are aware of the rules), but it is being done and it is to be hoped that the osteopaths take notice and make changes where needed.

On 1 March (the day the rules changed) the GOsC said:

Our review of registrants’ practice websites started late last year and we have used a variety of search terms and approaches. There are at this time 2,342 practice websites listed on the GOsC’s online Statutory Register of Osteopaths and, we estimate, a further several hundred osteopathy websites that are not linked to the Register.
Reviewing all of these has not been a simple exercise as website content tends to change fairly frequently and we know that many osteopaths have heeded the general advice that we and others have been giving to ensure their sites are compliant. We hope that we have identified the majority of those with content that might be confusing or misleading for patients, but we have not set ourselves a completion date for this process as we may well decide to undertake further similar exercises in future.
Notwithstanding that, we are encouraged that the focus on practice advertising is stimulating increased research awareness and interest amongst practitioners that can only be to the benefit of patients and the quality of osteopathic practice.

This has also been announced in the Feb/Mar 2011 edition of The Osteopath.

It would seem to be a clear statement that the GOsC are taking this seriously and that it remains an ongoing process. Importantly it acknowledges that this information may be confusing or misleading. If the GOsC believe that to be the case, then there is good reason to get these claims removed before they become the subject of complaints.

There are still quite a few websites making these claims, so I’m not sure if I agree with the statement that ‘many osteopaths‘ have heeded the advice, nor that they have ‘identified the majority‘ of those with misleading content.

Whilst there are osteopaths who have chosen to ignore the advice so far, there are certainly those who have acted upon it.

(Thanks to Zeno for sending me this info)

I am not clear if this is as a result of the GOsC’s actions or if the clinic acted independently. Either way, given the ASA’s new remit it is a sensible move.

This informal list shows just a few sites that continue to make these claims and may help to highlight the level of claims still being made. Even this small list shows the range of conditions being claimed. Colic, Asthma, Allergies, Learning Difficulties, Autism, Infections (ear & recurrent), Cerebral Palsy & Brain damage (or symptoms associated with) and even ‘Threatened Miscarriage’. Not a single one of these sites provide any robust evidence to support these claims!

http://www.cambridgeosteopaths.com/osteopathy.php

http://www.coachhouseclinic.com/motherandbabyclinic.htm

http://www.osteopath-bristol.co.uk/baby-childhood-ailments.asp

http://www.bridgendosteopath.co.uk/paediatric_cranial_osteopathy.html

http://www.ealingosteopathyforchildren.co.uk/

http://www.busheyosteopathy.co.uk/cranial-osteopathy.html

http://www.leomeyerosteopath.co.uk/whatosteocanhelp.htm

There are lots more sites just like this ……

Note: Simply saying ‘may benefit‘ rather than ‘cure‘ doesn’t matter. Anything that implies a particular condition can be treated would require evidence. The ASA/CAP website provides some clear guidance and there is Osteopathy specific advice available if needed (requires login – free)

(At present) I am not aware of any complaints having actually been sent to either the ASA or GOsC on this matter yet, however those making claims for Cranial Osteopathy would do well to heed the GOsC advice and also to familiarise themselves with how the ASA viewed similar claims for Craniosacral Therapy. http://www.asa.org.uk/Asa-Action/Adjudications/2010/9/Craniosacral-Therapy-Association/TF_ADJ_49005.aspx

We have already seen how research ‘evidence’ for the two therapies is virtually interchangeable and the claims being made are almost identical.

On the subject of evidence. NCOR are still conducting their literature/evidence review and have said they hope to release the results sometime around the end of March.

The results of an RCT into Cranial Osteopathy for Cerebral Palsy has recently been published and an abstract can be found here: http://adc.bmj.com/content/early/2011/02/23/adc.2010.199877.abstract

The conclusions of the trial say:

Conclusions: This trial found no statistically significant evidence that cranial osteopathy leads to sustained improvement in motor function, pain, sleep or quality of life in children aged 5–12 years with cerebral palsy nor in quality of life of their carers.

There is an interesting comment in the results that says carers of those in the intervention group were almost twice as likely to report that ‘global health’ had improved, rather than decreased.

I have contacted one of the researchers on this, although I suspect that any perceived improvement could be down to the fact that they were actually getting some form of treatment, compared to the control group that were simply on a waiting list. It remains to be seen if this comment will be ‘cherry picked’ as evidence, the overall conclusions however show no benefits for carer or patient.

I’m sure this will be included in NCOR’s review.

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Posted in: ASA, Osteopathy