Be careful what you wish for ...... That is something that BOA member, Mary Monro should keep in mind when writing articles for Osteopathy Today, the British Osteopathic Association (BOA) journal.
The article called ‘If the CAP fits” was published in the April 2011 edition of Osteopathy Today. It covers the Advertising Standards Authority (ASA) guidance on advertising, the quality of evidence required to substantiate claims being made and the list of conditions currently permitted by the ASA/CAP for osteopaths.
Osteopathy Today can be found here: Osteopathy Today (login seems to accept any email address)
First I should cover a couple of the inaccuracies in the section called ‘Keeping advertising in perspective’.
In the article the author, Mary Monro, wrongly associates this blog with the Nightingale Collaboration. In the article, she mentions the Nightingale Collaboration and their Focus of the Month. She then goes on to say that ”They do identify some websites that they disapprove of – to see if one of them is yours, follow the link to the Skeptic Barista article on ‘Osteopathy – dealing with change’“
I am going to take this opportunity to make it absolutely clear that this blog and any comments posted on it DO NOT in any way represent the views of the Nightingale Collaboration. Whilst I may agree with the Nightingale Collaboration’s aims and where appropriate I may support their objectives, I have been looking at (cranial) osteopathy and asking questions about evidence for well over a year …. before the Nightingale Collaboration was formed.
As far as I am aware the Nightingale Collaboration has not made any public comment regarding osteopathy, nor have they listed any osteopaths websites. If Mary Monro, the BOA or anybody else wants the Nightingale Collaboration’s views on osteopathy, they should contact the Nightingale Collaboration direct and not make assumptions based on comments on this blog.
I have contacted both the Nightingale Collaboration and the editor of Osteopathy Today to point out these inaccuracies, as yet there has been no answer from the BOA.
Something else that she seem to have misunderstood. In the article she says: ”the ASA can only ask you to withdraw your advertisement if it fails to comply. They have no other sanctions – no fines, no jail, no threat to your business“. I have seen this sort of argument repeated on a number of CAM/Quack discussion threads. Whilst this may be technically true that there is a limit to the ASA’s powers to prosecute, it would be foolish to believe that the ASA don’t have teeth (should they wish or need to use them), however it should rarely, if ever come to that.
Usually any breaches of the advertising regulations are dealt with, without referring the matter to the courts, but if needs be the ASA can refer those who refuse to work with them to the Office of Fair Trading (OFT) for legal action.
ASA: Self Regulation of Non-Broadcast Advertising Any advertiser who deliberately chooses that route deserves what they get!
Now I’ll move on to the main points I wanted to cover in this post.
Be careful what you wish for …..
Most people reading this will be aware that claims made by complementary (or alternative) therapists have been under some scrutiny over the past year and with the ASA’s new remit these are likely to continue. So it could be seen as a rather foolish move to openly state that your particular therapy is lacking in evidence to support your claims.
Well that’s the admission made by Mary Monro, who says:
“currently CAP only really accepts randomised controlled trials (RCT’s) as adequate evidence. This is not the place to debate the relevance of RCT’s to the study of osteopathy. Suffice to say that we are unlikely to come up with much research acceptable to CAP within the next decade“
This statement seems even more foolish if you then wish to make any sort of challenge to the ASA/CAP’s views of your particular profession or wish to successfully defend any complaint. However she then goes on to comment on the list of conditions the ASA/CAP currently allow osteopaths to advertise and blames this limited list on two things.
Firstly a lack of evidence and then quite bizarrely a lack of complaints!
“We are told that the CAP code only allows us to mention a short list of possible conditions that we can claim to treat. This is partly down to lack of evidence and partly down to a lack of complaints. CAP almost never receive complaints about osteopaths’ advertising so (until very recently) they have no idea what we do.”
Be careful what you wish for …..
She also seems to encourage osteopaths NOT to stick to the CAP code list .. ”If we restrict ourselves now to the CAP code list, the list will never get any longer and osteopathy will retreat into ‘very minor orthopaedics‘”
So what we have is an admission that there is a lack of acceptable evidence, a limited list of permitted conditions that she does not feel osteopaths should restrict themselves to and belief that this limited list is in part due to a lack of complaints!
Mary Monro may genuinely believe that osteopathy could benefit from more complaints, but that has not stopped her contacting the CAP to seek compliance advice for her own website. And I am not sure that to many other osteopaths would welcome a string of ASA complaints against their website claims.
There is also something important that she has missed from the article, or perhaps just doesn’t realise. It is NOT the number of complaints that will influence the list of conditions that osteopaths are permitted to claim …. it is the quality of the evidence available to support those claims! And as Mary tells us, there isn’t likely to be much of that for at least a decade.
Well the answer to Mary’s woe’s may well have arrived in the form of Fishbarrel.
Fishbarrel is a clever little plugin for the Google Chrome browser created by Simon Perry. It dramatically simplifies the process of submitting both ASA and Consumer Direct complaints. Once installed the misleading claims can be highlighted, then with a few mouse clicks the ASA online complaint form is automatically filled in …. then simply click submit!
Simon Perry has made this as easy as shooting fish in a barrel!
As I understand it versions suitable for Australia, the US and New Zealand may well be in the pipeline: Fishbarrel Australia
You can find out more about fishbarrel here: Martin Robbins – The Lay Scientist (The Guardian)
You can try fishbarrel yourself by visiting Simon Perry’s website – Adventures in Nonsense Use if with care, it’s a powerful tool!
A simple Google search shows that there are still many UK osteopathy websites that claim to be able to treat conditions such as autism, gastric reflux, hyperactivity, behavioural difficulties, dyslexia, eczema, colic, glue ear, Cerebral palsy and other types of brain damage, epilepsy, insomnia, asthma, hypersensitivity, headaches, back pain, diabetes, Feeding difficulties, Learning difficulties. All of these require evidence.
I know there has been a good level of interest in fishbarrel in the few days since it was released and it can only be a matter of time before those using it find the osteopaths website claims and the ASA start getting complaints.
I should mention that the GOsC have been reviewing claims being made by their members, but this is a long process. The GOsC may well gain some small comfort from the thought that any complaints will be heading towards the ASA or Trading Standards, rather than to them. I know they are very aware of the problems the GCC had (and are still dealing with) over website complaints. However I do wonder what the GOsC will do when the ASA eventually issue adjudications against these osteopaths claims. Any breach of the CAP codes is, by default, a breach of clause 122 of the Osteopaths own code of practice!
I wonder how many osteopaths will share Mary Monro’s view that there is a need for more complaints when those ASA letters and emails start arriving!
If you get one of these, you should simply look upon it as being given the opportunity to extend that list of CAP conditions ….. you just need to find the evidence!
Be careful what you wish for ..
Alan
April 24, 2011
Thanks for clearing up Monro’s confusion.
skepticbarista
April 24, 2011
Oh those happy people over at Sacral Musings have already spotted this post !
http://www.sacralmusings.com/forum/topics/921165:Topic:25592?page=51&commentId=921165%3AComment%3A85968&x=1
Wonder if they agree with Mary?
I did ask Sacral Musings if I could join their forum (they regularly mention & link to my blog), I was genuinely looking to address the issues they raise.
But they don’t seem to want me ….. which hurts!
Bruce
April 25, 2011
After what the chiropractors have been through, albeit to their benefit I believe, I honestly would have thought the osteopaths would have reacted in a far more sensible manner.
I think the problem many have with the sKeptic point of view is the standard of evidence required. Once again, trumpet time: level playing field with allopathy and allied professions would be good.But I do believe that will happen, not because of sKeptics but in spite of them.
staingtheobvious
April 29, 2011
Who gives a toss what you think? You are like a Mormon, nothing to say and you actually believe that anyone is interested. What the hell do you contribute, are you one of those proper doctor who is licensed to kill?
I bet you believe in swine flu and the Ernster.
staingtheobvious
April 29, 2011
Considering it’s ok to give immune suppressants to arthritics without any evidence that it cures anything nor any idea of any diagnosis of cause whatsoever, one wonders what on earth you are talking about.
Are you paid to write this crap or do you just hallucinate for a hobby!
skepticbarista
April 25, 2011
Response to Sacral Musings comment:
“They are wrong about osteopathy and back pain, by the way, (and all the other things they dispute in this blog).”
Donald: Can you show me where I have posted on ‘back pain’, as for ‘all the other things’, the vast majority of articles I have commented on come direct from within the UK osteopathy profession (GOsC & NCOR) and where possible I have concentrated on the evidence they provide.
This latest post is simply in response to an osteopathy, who for some bizarre reason, feel more complaints would benefit osteopathy.
I suppose it is easier to question my arguments/motives rather than question your own profession, the evidence it relies on or the comments made by others. However if you look back through some of the comments on Sacral Musings, you’ll find there are those who understand why these claims get questioned.
I assume you’ve worked out how I get to know what’s going being said on your forum. It could be my undercover spies who report your every word! “Someone is letting the members of this forum down and needs to desist now, please”
Or maybe the ‘OPENFORUM’ header at the top of the page should give you a clue !
Edit: It would appear that the ‘open forum’ of Sacral Musings have decided to remove the ‘Quackery Whose turn is it next’ thread!
skepticbarista
April 27, 2011
It would seem that ‘The Village Osteopathic Clinic’ had an ASA complaint sent in about their advertising (not by me).
This was ‘informally resolved’ which means the advertiser chose just to remove the claims, rather than defend them ……. so unlikely that it will help advance the list of conditions permitted under the CAP Codes!
http://asa.org.uk/ASA-action/Adjudications.aspx?date=27/04/2011
Sceptic Osteopath
April 27, 2011
What do Osteopaths wish for?
I haven’t read your blog lately but I am pleased to see your still on the case. From my side of the Osteopathic fence I can say that the Sceptical Pressure on our profession is a positive force for change. Advertising is getting cleaned up, attitudes are changing and the Sceptic Osteopaths are finding their voice.
Wish One : Money for research.
The much quoted General Osteopathic Council costs each osteopath £750 a year.
The less quoted and largely ineffective British Osteopath Association cost £230 a year.
By comparison the Health Professions Council which regulates Physiotherapists, Podiatrists etc do the same work as the GOSC for about £80 a year.
What do I get for my £1000 and what do 4.5 k osteopaths get for £4,500,000.
Nice posh offices in London. About 10 disciplinary cases a year. (Mostly about inadequate note keeping) 6 magazines from the GOsC saying what a good job they do. About 6 magazines from the BOA saying what a bad job the GOsC do. And a bit of funding for NCOR.
Now if we had a good value regulator we could channel the £920 each, a year into research. That would be cool. £4.1M research budget. What could we do with that.
Next time you write to the G.Os.C. ask them how many staff they have and how many are Osteopaths. Why they cost 10x the HPC and how much money they give to research.
Wish Two : A learned society.
A precursor to a Chartered Society or Royal College. We are a long way off of that. The GOsC is a retrospective regulator. It enforces rules based on established practice. No innovation here. The BOA is a pressure group (largely ineffective) that is supposed to represent the interests of members. What we need is a third group. Run by academics and rational, critically thinking clinicians who
1. develop clinical guidelines for best practice in the management of specific conditions and presentations.
2. Plan and fund research
3. Reward researchers with status E.G. fellowships, big offices, Labs named after them etc (currently our best researchers are probable the poorest and lowest status members of the profession).
4. Extend the role of the profession in appropriate directions using proper clinical trials.
There it is. Get our money back from the GOsC and give it to a new Learned Society to spend on research.
Sceptic Osteopath
skepticbarista
April 27, 2011
Thanks for the comment. Nice to get a response from an osteopath, even better that it is a positive comment.
It would be good if more osteopaths posted comments, positive or not, as long as they can provide a good, well argued response.
The arguments by some that we have the ‘wrong type of evidence’ isn’t really going to change anything. If there is genuine evidence that shows promising results …… Refine the test methodologies and do more research into that area.
Interesting comments about the GOsC funding. I can’t comment as I don’t know what benefits you do or don’t actually get, but I certainly can’t argue with your desire to see a group who focus on good quality research .
Thanks again
staingtheobvious
April 29, 2011
So are you planning to leave the GOSC and go it alone, how many do you think are interested in doing this?
Simone
May 3, 2011
What about the psychological findings about relationship between therapist and client, disguised in some form of therapy, which adds hope and removes despair. How come this level of their work is almost a ‘dirty secret’ ?
skepticbarista
May 3, 2011
Simone,
I don’t think any skeptics I know class patient-practitioner interaction as a ‘dirty secret‘, actually most recognise it as a genuine benefit. Calling it a dirty secret may make it seem like there is some conspiracy to hide something and this may well suit the CAM argument!
It is perhaps the only point where CAM has any benefit over conventional medicine. But lets not forget, this is simply down to the amount of one-on-one time patient (or CAM customer) gets with the therapist or GP and the placebo effect gained from the extra attention.
CAM supporters often cite this as a failing of modern medicine, but they forget that when spending an hour with a CAM practitioner ….. they are paying for that time. I wonder how many would be happy paying (for example) £50 and hour for a GP appointment!
The problem with using this argument is that it often ignores the fact that people do not visit a CAM therapist just to have a somebody give them a bit of sympathy. And importantly, practitioners don’t advertise their services as offering a sympathetic ear ….. they offer to treat specific conditions. I’ve never seen a CAM website advertising tea & sympathy, but I have seen them offer to treat cancer, Parkinson’s disease, thyroid problems etc.
Simply focusing on this patient-practitioner relationship detracts from the fact that the therapy itself has little or no evidence to show it works. In fact it could be argued that when CAM retreats to the position of focusing on the benefits of interaction, the details of the mechanism by which the treatment is supposed to work has already failed.
Sort of a “lets not talk about if my therapy works ….. lets talk about how nice I make people feel” – that’s over simplifying it a little, but it makes the point.
So, whilst I agree with your point that there may be some psychological benefits or placebo effect from this interaction …. the treatments being offered and the conditions/problems the patients have, are (for the most part) NOT psychological problems.
SB
Bruce
April 28, 2011
@ Skeptic osteopath
I think you should be commended for your post.
staingtheobvious
April 29, 2011
Congratulating somone on the size of their knob/post seems about right, most people who put ‘septic’ in front of their profession should remember to clean deep and long!
skepticbarista
April 29, 2011
I always find it amusing that those who support ‘holistic’ caring therapies are so quick to throw out the abusive comments.
Especially like the references to ‘Mormon’, when it is you who relies on pure faith to keep your particular beliefs intact.
By all means contribute, but as I’ve said before “If you do feel that your argument can only be supported by derogatory or abusive comments, then don’t complain if your comment is edited or deleted.”
staingtheobvious
April 30, 2011
It is amazing how the septic fraternity is so quick to ‘cut and paste’ the threads of criticism but I suppose the art of cherry picking is your game. There is plenty of unwarranted abuse in your actions, perhaps you should start by cleaning up your act to set an example.
So on the subject of ‘belief’ do you believe there was a swine flu pandemic last year?
staingtheobvious
May 1, 2011
It is getting a bit tiring coffee boy to see that again and again you ‘tidy up your blog’, removing any post that points out how banal your religious blithering is. The Nightyflower coloration is again another group of self publicists, hell bent on creating false realities. You should apply for a job as an MEP, at least you could legitimately claim fees for spouting.
How can you quote Ernst and his silly Trick book when it only references himself as any kind of real evidence of anything real?
Bruce
April 30, 2011
@ Staingtheobvious
Do you not agree with more research for osteopathy.
As I have said before the level of evidence should be the same for all healthcare and at present the sKeptic approach precludes this. But evidence must benefit both your profession and the public at large?
It will be interesting to see if the Nightingale Collaboration starts looking at dentists, physios etc as well as CAM which is what skepticat has suggested it would? But words are a lot easier than actions and I don’t hold my breath.
skepticbarista
April 30, 2011
Bruce,
None of the following comments should be taken as having anything to do with the Nightingale Collaboration (Some people need that spelling out to them).
The cry of ‘why don’t skeptics look at dentist, GP’s etc’ is a common one but misses an important point. Tackling these professions in the same way as CAM therapists requires them to be making misleading claims on their websites.
I have yet to see a GP with a website that makes these sort of claims …… if I found one then I would treat it the same as the CAM-quacks. Have you actually taken the time to look at a dentist or GP’s website and compared the claims they make (if any) to the claims the average homeopath makes …… or an osteopath claiming to cure cerebral palsy, or maybe a chiropractor claiming that correcting a subluxation can help cure deafness!
If you find any …. please post a link.
As for physio’s …… if they make outlandish, potentially misleading claims, then there is no reason why they shouldn’t be treated the same as any others.
Another common call is to take on the claims of the large pharma companies. I fully agree that if their claims are wrong, or their trial results have been ‘tweaked’ for financial gain, then they need to be challenged. However, these companies don’t tend to make the same claims as the quacks (and for good reason), so tackling them would need a much different approach.
And of course from a personal point of view I’d miss the huge monthly pay cheques they all send me! (for the benefit of the CAM brigade – that’s a joke: For the benefit of Big Pharma – £££££ rates negotiable!)
What is often neglected is that these claims DO get challenged!
Andrew Wakefield’s (I refuse to call him doctor) disgusting MMR scare was challenged and exposed. As I understand it, Doctor (a man who deserves the title) Ben Goldacre’s next book will take on the practices of the pharmaceutical industry. http://www.medcommsnetworking.co.uk/
I wonder how many CAM supporters will quote from that book ……. yet refused to accept Dr Goldacre’s views on homeopathy and other forms of quackery!
SB
Bruce
April 30, 2011
I actually agree with a lot of what you say but as the listings for physios for instance by the ASA is not that much different from the osteos or chiros. I do appreciate the latter has been tightened, but the ‘evidence’ for all three is not dissimilar and in fact may be less for physio for even MSK.
Is it only non-MSK stuff you guys ( I include the NC in this) or all evidence. If it is the latter, and you are pushing for robust evidence bases practice then it should be across the board? This would include prescription orthotics by podiatrists, lumbar surgery by neuro/ortho surgeons for routine disc problems, psychotherapy, physiotherapy, orthodontics…… The list is endless?
Or is it simply as you imply, unless i have read it wrong, CAM is an easier and cheaper option than say allopathy or big pharma?
T
skepticbarista
April 30, 2011
Bruce,
As I’ve said …… I’d judge physio claims in the same manner as chiropractor and osteopath claims. If you look at my posts on osteopathy (and chiro) I have actually concentrated on the far more ‘fringe‘ claims being made. I have not really challenged the stiff backs & aching shoulders …… but those like cerebral palsy, threatened miscarriage, asthma etc have been challenged (
and not successfully defended
) -if you can find a physio making similar claims – put an ASA complaint in …. or post a link and I’m sure somebody will take care of it!
You say is it just that CAM is and easier and cheaper option.
Cheaper ? – no not really, it doesn’t cost me anything to read a website claim and challenge it!
Easier ? – Well you can answer that for yourself. Take fairly common conditions such as allergies, colic or asthma, see how easy it is to find 10 CAM sites (any therapy) that offer to treat any of these conditions. Now try find a single GP website doing the same.
Speaking purely for myself, there is one point people need to keep in mind. It is the ‘misleading claims‘ that get challenged. If CAM is the ‘easy option’ it’s because they make themselves an easy target.
Bruce
April 30, 2011
I decided to google and within a few minutes this is what i found.
Here are just a few physio clinics and what they claim to treat. How are these different from osteos or chiros? Is there robust evidence to support all the disorders they say they treat?
If the evidence is not there does that mean they are not helping these patients? Surely this is the same for chiros and osteos?
http://www.physiozilla.com/category/wrist-physiotherapy-exercises/like-physiotherapy.html
http://www.beechgroveclinic.co.uk/
http://www.symingtonphysiotherapy.co.uk/craniosacral-babies-children.html
http://www.londonphysiocentre.co.uk/conditn.htm
http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/surrey/croydon/croydon-physiotherapy-osteopathy-and-sports-injury-clinic-addiscombe-rd
http://www.childrenfirstphysio.co.uk/practiceCondition.shtml
http://www.whitehouse-clinic.co.uk/neurophysiotherapy.htm
I am not suggesting complaints should be made, as these are only examples after a few minutes on google. What I am suggesting based on your previous statements, we must all be careful what is wish for? If the level of evidence you have set for chiros is the bench mark how do these clinics claims hold up?
Bruce
May 1, 2011
@ SB
Based on your posting, I decided to google and within a few minutes this is what i found.
Here are just a few physio clinics and what they claim to treat. How are these different from osteos or chiros? Is there robust evidence to support all the disorders they say they treat?
If the evidence is not there does that mean they are not helping these patients? Surely this is the same for chiros and osteos?
http://www.physiozilla.com/category/wrist-physiotherapy-exercises/like-physiotherapy.html
http://www.beechgroveclinic.co.uk/
http://www.symingtonphysiotherapy.co.uk/craniosacral-babies-children.html
http://www.londonphysiocentre.co.uk/conditn.htm
http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/surrey/croydon/croydon-physiotherapy-osteopathy-and-sports-injury-clinic-addiscombe-rd
http://www.childrenfirstphysio.co.uk/practiceCondition.shtml
http://www.whitehouse-clinic.co.uk/neurophysiotherapy.htm
This exercise was carried out, not to simulate complaints against these individuals but to give an example of what is out there in some physio advertising. Brings a little perspective to the CAM argument I think?
skepticbarista
May 1, 2011
Thanks Bruce,
I’m actually working at the moment, so won’t get a chance to look at the claims until later ……however if they are making the same sort of claims as osteos and chiros then there is no reason why these shouldn’t find their way to the ASA!
SB
staingtheobvious
May 1, 2011
Research is a great idea, problem is who does it. There are no current medical peer review publications that are not in disrepute for funding issues with regard to research honesty, so who do you think should be doing it? Seems weird that the lowly ASA and CAP boys are using an out of date standard already and a judicial review on the efficacy of their decisions would be a good way to proceed.
Perhaps we should all be funding this instead of taking sides?
staingtheobvious
April 30, 2011
‘Research’ is an interesting word, it depends who does it and how it is done. Most of the current medical peer review mags are in disrepute for funding issues with regard to what they publish, who do you think should do research on osteopathy and other alternatives.
skepticbarista
April 30, 2011
It looks like the link to Osteopathy Today no longer works.
Not a problem ….. I will update the post with a pdf copy of the article later.
skepticat
April 30, 2011
Just popping in to correct yet another of Bruce’s fabrications:
Bruce wrote, “It will be interesting to see if the Nightingale Collaboration starts looking at dentists, physios etc as well as CAM which is what skepticat has suggested it would? But words are a lot easier than actions and I don’t hold my breath.”
What skepticat actually wrote was:
“It doesn’t matter whether the person who makes a misleading claim is a doctor, a dentist, a chiro, a homeopath or anything else. What matters is that information in healthcare advertising should be accurate so that people can make informed choices on what to spend their money on and any healthcare service or product provider who makes misleading claims is fair game.”*
Poor Bruce, foiled again.
*Source: http://www.chiropracticlive.com/its-getting-harder-and-harder-for-coats-and-dixon-to-mislead-the-profession-there-is-a-paper-trail-you-just-need-to-know-where-to-look-in-gcc-minutes/#comments
Bruce
April 30, 2011
@ skepticat
Never foiled, and most certainly not by your good self lol. However if inaccurate, happy to be put right.
But your comment re what you actually wrote does imply that the NC will take a broader look at advertising irrelevant of where that appears in healthcare or not. Is that correct? That is basically all I said and is backed up by your comments?
Sometimes you can trip yourself up moving that little bit to soon bases on an expectation that people will fall. However, thanks for being there to catch me, you’re a gem lol
Hope you enjoyed the Royal Wedding lol
skepticat
April 30, 2011
@Bruce
No, it isn’t correct. I’ve no idea how you manage to interpret this
“information in healthcare advertising should be accurate…and any healthcare service or product provider who makes misleading claims is fair game.”
as implying this:
“the NC will take a broader look at advertising irrelevant of where (sic) that appears in healthcare or not”
But I imagine most readers of this blog will have at least average comprehension skills, so they are unlikely to make the same mistake you have.
Enjoyed the wedding very much, thanks.
Bruce
April 30, 2011
@ skepticat
As always we must agree to disagree, but isn’t that always the way lol
Glad you enjoyed the wedding, it definately was a wonderful turnout for them and not an anarchist to be seen
Bruce
April 30, 2011
@ skepticat
My comment above was:
It will be interesting to see if the Nightingale ‘Collaboration starts looking at dentists, physios etc as well as CAM which is what skepticat has suggested it would? But words are a lot easier than actions and I don’t hold my breath.
How does the implication of that statement greatly differ from yours:
“information in healthcare advertising should be accurate…and any healthcare service or product provider who makes misleading claims is fair game.”
Sorry, can’t see it?
skepticat
May 1, 2011
@Bruce
As I’ve said before, I don’t think I can dumb down enough to make it as simple as you apparently need it to be but I’ll give it another go:
I did not say anything like, “The NC will start looking at physios, dentists, etc.” which is what you claimed that I said.
What I said was that anyone who makes a misleading claim in their advertising – regardless of what particular healthcare therapy they are promoting – is fair game.
This was in response to the accusation that we are “just anti-CAM”. What we are – what we have always been and always will be – is against is false claims in healthcare advertising. That large swathes of CAM practitioners make blatantly false claims in their advertising is undeniable. It’s not so easy to find physios and dentists websites carrying long lists of conditions that they claim they can treat, nor have I ever had any member of either of these professions accost me in shopping malls and lie to my face about what they can do for me. As SB said in his last but one comment:
“Tackling these professions in the same way as CAM therapists requires them to be making misleading claims on their websites.”
If you can find a website of any mainstream therapist that you think is in breach of the ASA CAPs or any other regulations, send it to the NC or, better still, use the information helpfully provided on the NC website to complain about it yourself.
I suspect your comprehension difficulties stem from the fact that you are labouring under the misapprehension that there is some kind of sinister “political agenda” behind the attack on chiropractic. You have made this charge repeatedly but you’ve never explained or substantiated it, so I don’t really know you mean by it. But I do know that sometimes individuals become so convinced of the truth of a false idea that they are permanently blinded to the possibility that they can be wrong. This seems to be what’s happened with you. As a result you brush aside – don’t even read – argument or evidence that contradicts your belief.
Hope that helps.
Bruce
May 1, 2011
@skepticat
I will try and make it easy for you: with regards the NC and all the usual hype you throw out there it really is very simple: actions speak louder than words !!!!!
I await your attack on non CAM related adverts with bated breath.
Skeptic Barista
May 1, 2011
@Bruce
“actions speak louder than words !!!!! ”
I agree that actions speak louder than words. I’m sure there are quite a few CAM-Quacks who wish NC were less active!
“I await your attack on non CAM related adverts with bated breath.”
Patience Bruce, you need to remember that NC started in March, so have only been active for 2 months. As I think we all agree …. It’s CAM that makes the vast majority of claims, so I fully understand why NC have gone there first.
Bruce
May 1, 2011
Hi SB
I posted some website addresses for discussion with skepticat. Were they excluded because they were off thread or is there a spam filter that they went in.
I am happy to await the NC reaching a level of sensible proven maturity and , as stated before, believe that it could be a positive entity.
However, irrelevant of what skepticat says, as it was built out of a political agenda in support of Simon Singh, I await to see if they can look at things in a fair and balanced manner and across the board of healthcare rather than soft targets?
Let’s wait and see
skepticbarista
May 1, 2011
Bruce:
Your comments ended up in the spam bin due to the number of links …… now recovered and approved.
Bruce
May 1, 2011
@ skepticat
A simple google of a few seconds brings this up:
http://www.physiozilla.com/category/wrist-physiotherapy-exercises/like-physiotherapy.html
And this:
http://www.beechgroveclinic.co.uk/
And this:
http://www.symingtonphysiotherapy.co.uk/craniosacral-babies-children.html
And this:
http://www.londonphysiocentre.co.uk/conditn.htm
And this:
http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/surrey/croydon/croydon-physiotherapy-osteopathy-and-sports-injury-clinic-addiscombe-rd
And this:
http://www.childrenfirstphysio.co.uk/practiceCondition.shtml
And even this:
http://www.whitehouse-clinic.co.uk/neurophysiotherapy.htm
One must presume there is robust evidence to support all these claims and if not why not?
My argument is that all healthcare professions struggle with the level of evidence you require fir CAM. Dies that mean that these physios don’t do good work, or that patients don’t benefit of course not it just means the evidence isn’t there. So how does that differ from Chiro or Osteoporosis?
Bruce
May 1, 2011
@ skepticat
I have tried posting some web addreses of physio websites as an example if what’s out there but for some reason the don’t post. I presume links will have to go through a filter process?
These links discuss the treatment of childhood conditions, neurological conditions and digestive problems and asthma. Took a few minutes on google?
Does that mean that the treatments offered by the physios don’t work or it it simply that there is no robust evidence that it works. Both are totally different concepts however, the difficulty with setting standards is that ALL must comply not simply the NC target of the day which to date has all been CAM ( I include the skeptic attacks on chiropractic and homeopathy in this as well as Cranial osteopathy)?
Of course you could use the argument that many physios dont make unjust claims. But even if its only one, or if there is no evidence to support a treatment claimed, it is all the same where protecting the public is concerned? But as I said the NC’s actions speak louder than words.
I think to be honest, if your comments above are accurate you may just have opened a hornets nest that will have serious repercussions for the whole of healthcare. Is that a bad thing, only time will tell?
skepticbarista
May 1, 2011
Bruce,
Only had time for a very quick look at those sites as I’m still working.
There are some that should/will get reported, one where I’m not sure if one is a UK site or not (physiozilla) and at least 2 or 3 of the others who, although they are physios, the treatment they are offering is craniosacral therapy.
skepticat
May 1, 2011
@Bruce
“One must presume there is robust evidence to support all these claims and if not why not?”
I don’t know what evidence there is for any of those claims but, if there isn’t any, they shouldn’t be making them and will, in the fullness of time, have to remove them or face the consequences, as will the thousands of other healthcare practitioners who breach the CAPs.
I’ll take this opportunity to remind you that the NC website provides very comprehensive information on how to complain, the purpose of which is to encourage and empower any member of the public to challenge false or questionable claims about healthcare treatments, regardless of who makes them. Nobody has to wait until the NC decide to focus on a specific therapy. If they waited for that to happen, it could take years to get all the bad websites cleaned up.
“My argument is that all healthcare professions struggle with the level of evidence you require fir CAM.”
You mean ‘the level of evidence the ASA and other regulatory bodies require for CAM’, not that it matters. It’s just that we don’t make the rules you seem to be angry about.
You are conflating “healthcare professions” with “healthcare treatments”. Granted, there are some cases where the two are interchangeable: homeopaths, for example, treat everything they claim to be able to treat – which seems to be everything under the sun – with homeopathic “remedies” that are ingested by the customer. But most healthcare professionals have a range of therapies at their disposal. There are treatments for which there is robust evidence and treatments for which there isn’t. Ethically, and out of respect for the paying customer, those treatments for which there isn’t good evidence shouldn’t be promoted by practitioners as if there is.
“Dies that mean that these physios don’t do good work, or that patients don’t benefit of course not it just means the evidence isn’t there.”
That may well be true but it doesn’t alter the fact that they should not claim to paying customers that they can treat specific conditions unless there is good evidence that they can do so. I’m sure the reasons don’t need spelling out yet again.
“So how does that differ from Chiro…”
It doesn’t.
..”or Osteoporosis?”
LOL!
Bruce
May 1, 2011
@ skepticat
Yes osteoporosis should have been osteo but this prescriptive text lol
And genuinely not angry
skepticbarista
May 2, 2011
It would seem that some osteopaths are getting the message.
I am not aware that this osteopath has had any complaints submitted, so this may be that they just got the message, or the GOsC have been in touch:
Bridgend Ostopathy http://www.freezepage.com/1300102038LMOHZCRDKS (Captured 14 March).
At present the whole site seems to be down.
Bruce
May 2, 2011
@all
The samples from the physiotherapy websites were broad based in the conditions they claim to treat and took literally minutes to find, yet posters on other sites have claimed that they don’t exist? Finding occurs, only when one looks I think?
My argument is that this goes on in a regular basis in ALL healthcare advertising, without any robust evidence to support it. If you guys eg NC set standards for complaints based on the CAP and ASA guidelines then it should cover ALL healthcare and if that is the case, I have no problem with that in part?
The physio sites were not posted to stimulate complaints but to show you that in order for the NC to do its job correctly, others who you really don’t want to target may have to be targeted in order to be seen to be fair and unbiased. Maybe a rethink of strategy by NC is called for?
The problem I do have ( the ‘in part’ statement above) is the level of evidence being set for ALL healthcare as I am sure, in a similar vein to osteos and chiros, physios believe that what they are advertising falls within their treatment remit and may have had training for the same? It also may suggest that patients are gaining benefit from those treatments. That is why the College of Medicine’s awaited guidelines may in fact put a far more sensible approach on the evidence required by the ASA and CAP and reduce the propensity for such attacks?
As it stands, does that mean the neurophysio treating cerebral palsy etc in the same vein that chiros and osteos talked of treating asthma, is wrong to advertise this treatment when they have obviously been trained in the same?. Not treating the pathology of course but simply treating the function surroundIng it. However there will probably be ‘ not a jot of evidence’ to support the treatment of any neurological disorders by any physiotherapists out there? Where does that leave that branch of the profession, or paediatric or geriatric physios or in fact any physio based on the current level of evidence required? Does that remove the value of the treatment they offer? Yet not to attack these ads would be morally wrong and fall well short of the standards you have set yourselves? Difficult one eh ?
Of course what about the patient that is helped by these treatments surely with or without robust evidence they must come into the equation.
Bruce
May 2, 2011
@ Skepticat
as I said before, words are easy and I await your publicised monthly targets to see which group is next, or should I make it easy and say CAM is next ?
To set yourselves up as a gatekeeper with a set of transparent principles which are set on self imposed ‘high standards’ albeit hiding behind the ASA and CAP, is a difficult thing. Based on that I believe, irrelevant of the rhetoric from you that CAM will not always be the target for the NC, I believe it will be the mainstay. Not because they ALL have a propensity to non- evidence based claims over other healthcare groups to include PAM’s (professions allied to medicine) or medicine itself, a sample being these websites, but based simply on the rhetoric of past postings on Alan’s site. I therefore believe that it is yours and Alans raison d’être and thus that of NC to attack CAM. However as SB has asked and he has been very fair in letting me voice my opinions here rather than banning me for them, I must give you guys time to prove otherwise.
I would only ask that one thing must be remembered above all else: the patient who gets benefit from these treatments. To quote SB ‘be careful for what you wish for’.
I watch and wait
skepticat
May 3, 2011
The samples from the physiotherapy websites were broad based in the conditions they claim to treat and took literally minutes to find, yet posters on other sites have claimed that they don’t exist?
Posters on other sites have claimed that there are no sites on which private physios are offering quack treatments? I don’t believe that for a second and I note that you provide no link to these alleged claims. It comes as no surprise to anyone to see private physios offering quack therapies and making false claims. Private doctors do it too and they make me angrier than anyone else. They seem to be a bit cleverer in their advertising than those physios, though.
Finding occurs, only when one looks I think?
Not at all. Some quacks harangue hapless shoppers and make false claims to their faces. On the other hand, I’ve spent a while looking at dentists websites – since you mentioned them – and I’ve seen nothing that breaks any rules. If you can supply a bunch of links for them as well, I’d appreciate it.
My argument is that this goes on in a regular basis in ALL healthcare advertising, without any robust evidence to support it.
It doesn’t, actually. There is plenty of healthcare advertising that doesn’t involve unsupported claims to treat specific conditions. I’ve even seen CAM websites that don’t contain any lies, which just goes to show it’s possible to promote CAMs without lying. You just have to be economical with the truth but isn’t that what advertising is all about? The fact remains that the vast majority of false claims in healthcare advertising are made about CAM treatments and not about conventional treatments.
If you guys eg NC set standards for complaints based on the CAP and ASA guidelines then it should cover ALL healthcare and if that is the case, I have no problem with that in part?
As has been repeatedly pointed out, it does. That’s why we have a website that shows people how to complain about ANY false claims about healthcare. You evidently do have a problem though and that, as you have shown us time and time again, is with your comprehension.
The physio sites were not posted to stimulate complaints but to show you that in order for the NC to do its job correctly, others who you really don’t want to target may have to be targeted…
Well that backfired spectacularly! Your idea that there others we “don’t really want to target” is something you have conjured out of your own fevered imagination. As I said before, you are conflating healthcare professions with healthcare treatments and you seem to have the notion that we want to protect physios and attack chiros. I’ve no idea why you would think this and it doesn’t make any sense from any perspective (unless you think we’re getting backhanders from physios organisations?) I would be happy to encourage people to focus on physios if they are a big problem. Why exactly do you think I wouldn’t be?
…in order to be seen to be fair and unbiased. Maybe a rethink of strategy by NC is called for?
Your appalling punctuation is beginning to irritate me. Putting a question mark after a statement, doesn’t make it sound any more tentative or any less arrogant and your arrogance never ceases to astound me. We don’t give a crap about how a bunch of lying quacks/rip-off merchants sees the NC – the people we care about are your victims. Personally, I wouldn’t mind broadening the strategy to include establishments that offer courses in quackery since the lies told on these are the source of the problem but most of them seem to be closing down due to lack of interest anyway.
Of course what about the patient that is helped by these treatments surely with or without robust evidence they must come into the equation.
Indeed they do. As do the patients who have not been helped by the treatments and have been ripped off by the practitioners. And the patients who’ve been physically harmed. These people are the reason the NC exists. If all these treatments were, in fact, beneficial and if there weren’t any casualties, then nobody would give a stuff. In fact, we’d all be delighted. Why wouldn’t we be? But as long as there are people unhappy about being lied to, then complaints will be made about the liars. Get over it.
as I said before, words are easy and I await your publicised monthly targets to see which group is next, or should I make it easy and say CAM is next ?
Here’s a question for you: If you set yourself the mission of trying to ensure that healthcare promotion is truthful, which group or therapy would you target next? Bear in mind that it is not we, but the regulatory bodies, who decide what can or can’t be said. Which group do you think makes the most false claims in their promotional material to the public? Or had you already asked yourself that question and narrowed it down to CAM?
Based on that I believe, irrelevant of the rhetoric from you that CAM will not always be the target for the NC, I believe it will be the mainstay.
Stop putting words in my mouth – it’s getting wearisome having to correct your lies. NOWHERE have I said or implied that CAM will not always be the target for the NC. What I have said is that the target for NC is misleading claims made in the promotion of healthcare. Of course CAM will be the mainstay because – to put it simply – it is in the promotion of CAM that most lies are being told. You can’t, in all seriousness, deny this or deny that the consequences of those lies have sometimes been tragic. Only someone with a vested interest in being able to continue to tell lies to people could get this as arse-backward as you’re getting it. And you can’t even make a proper argument out of it. Let’s do a comparison:
US:
P1. We believe we should be able to make an informed choice about healthcare treatments as we do about anything else
P2. Making misleading claims about healthcare therapies in order to encourage patients to try them is unethical and potentially dangerous
P3: The vast majority of misleading claims are made about CAM treatments
P4. There are regulations in place intended to prevent false claims being made in the promotion of healthcare therapies
C1: Therefore healthcare practitioners shouldn’t make misleading claims in their advertising
C2: Therefore we should challenge those claims and try to get them withdrawn.
YOU:
“The NC only attacks CAM because it’s agenda is to attack CAM because….well, they’ve got an anti-CAM agenda and they were set up to attack CAM because….”
I know which argument the quacks prefer but which do you suspect the objective reader will find more convincing?
he has been very fair in letting me voice my opinions here rather than banning me for them
Just to remind you that you haven’t been banned from anywhere for your opinions, only for being repeatedly and gratuitously abusive. As SB has made it clear he doesn’t tolerate the same level of abuse that I don’t, I’m glad you’ve managed to control yourself on this blog at least.
skepticat
May 3, 2011
Dammit!
This bit should have been italicized because I was quoting Bruce:
If you guys eg NC set standards for complaints based on the CAP and ASA guidelines then it should cover ALL healthcare and if that is the case, I have no problem with that in part?
Bruce
May 3, 2011
@ skepticat
Actually please don’t get irritated or angry, but I am starting to agree with some of what you are saying. All i have ever asked for is a level pmaying field and at least you sound like you are trying to achieve this and for that you must be commended.
Or maybe it’s all that ginkgo biloba that I am taking for my concentration lol
Aging is a wonderful concept.
I will give the NC a chance. Notice you haven’t put up a new target for this month, but it was a good wedding lol
As for my grammar, I note and accept your point, I really must be getting old lol
Bruce
May 3, 2011
@ skepticat
A few minutes on google?
So there is strong evidence for these ?
Dr title. Are you saying this isn’t ok for dentists, even though the GDC accepts it?
http://www.portmoredental.co.uk/treatments/treatment-for-headaches
http://www.bellevuedentalpractice.co.uk/tmj.html
http://www.poplardental.co.uk/Headache,_Jaw_ache_and_TMJ_treatment_in_Merton_at_Morden_and_Wimbledon.html
http://www.gentledentistry.co.uk/TMJ-syndrome-treatments-bournemouth.html
http://www.vivadental.co.uk/?gclid=CNizuuTiy6gCFQRqfAodJGdzrA
http://www.pinnerdentist.co.uk/general.html
Appreciating I don’t have Alan, your partners skills to write programs. As always, interesting stuff.
Surely you aren’t going to tale on the world?
Once again although probably not a lot of hard evidence, still helps people?
skepticat
May 3, 2011
@Bruce
Thanks for those links! Very interesting. Clearly you need to know what search terms to use to uncover a lot of these questionable claims. It would never have occurred to me to search for dentists and shoulder pain or lower back pain or hip pain or ankle pain – jesus! On the other hand, I doubt whether many people would seriously consider visiting a dentist to ask for help with their hip or ankle pain.
I’ve no idea whether whatever treatment they are offering helps people or not.
skepticat
May 3, 2011
@sameoldsameold
The site you link to isn’t “offering” antivirals for treatment of swine flu. If you actually read it, you will see that all it does is provide information about swine flu and how it is treated. The only advice it gives to people who think they may have it is to stay at home and contact their GP and not to try buying antivirals online.
So, no, I don’t think it’s in breach of any CAP but contact the ASA directly if you need any help understanding why.
skepticbarista
May 4, 2011
Your anti-vax message is nothing short of dangerous and encourages the spread of vaccine preventable disease. Your message is NOT going to be spread via the comments on this blog.
For the benefit of anybody who thinks that pro-vaccination is somehow anti-CAM, or that it is some sort of conspiracy.
The National Centre for Complementary and Alternative Medicine (NCCAM) believe that the message put out by the anti-vax brigade puts children at risk.
Childhood Vaccinations—Vital to Our Children’s Health
This is the message that ‘sameoldsameold’ would have you ignore and in doing so put your children at risk!
Director of NCCAM:
“The benefits of vaccination in preventing illness and death have been repeatedly proven and greatly outweigh the risks. I fully support the CDC’s current evidence-based recommendations for pediatric vaccinations, and I urge parents to safeguard their children by following these recommendations. I also urge all health care provider organizations—including CAM organizations—to raise vaccine awareness among their members, and enlist them in efforts to help increase adherence to childhood vaccinations.”
Plain, simple and from a CAM source. Your message is increasingly seen as dangerous rants from a paranoid minority!
PubMed:
Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers.
Bruce
May 5, 2011
@SB
Yip that’s the evidence. I can’t believe this is still being argued about.
However when parents have children who fall into the ADHD spectrum it is easy to look for a scapegoat.
My only concern and there is no evidence to support that concern, is the potential of overloading a child’s immune system. My understanding is the amount of vaccinations given in a short space of time, is worse in the US than here.
Interestingly, all my children were vaccinated but one does fall into the ADHD spectrum. Is it the fault of vaccinations, probably not but like the patents who are also in this position, there is always a small doubt in the back of my mind.
Surely this is way off thread though?
Bruce
May 4, 2011
@ skeptic barista
Great advertising banner you have going on at the start if your page. Took me to this osteopathic clinic site:
http://www.bodybalance.co.uk/index.php
Sciatica, whiplash etc ?
I just love your sense of humour lol
Skeptic Barista
May 4, 2011
LoL
I have no control over ad links on a free wordpress account, nor do I have any control over the list of conditions osteopaths advertise ….
…… But I know a man who does!
Bruce
May 5, 2011
@SB
I’m sure you do lol
skepticbarista
May 4, 2011
sameoldsameold:
There are lots of places on the web where the anti-vax brigade can try push their dangerous message ……. this is not one of them.
Sceptic Osteopath
May 5, 2011
Regarding
http://www.bodybalance.co.uk/whiplash.php
Did you read any of the site. It seems pretty well balanced and objective to me. For example
• Physiotherapy / Manual Therapy / Osteopathy. It is not clear whether these treatments makes much difference to the outcome. What may be helpful is the advice a therapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises. If symptoms do not begin to settle over a week or so, you may then be referred to therapist to help with pain relief and for advice on specific neck exercises.
There is no reason why this clinic can’t give information about Whiplash injury. Surely what is of concern is unreasonable claims to cure / treat.
I get a steady flow of referrals from Doctors for WAD management pretty much as described above.
Sciatica is on the CAP list as given by the esteemed GOsC
http://www.osteopathy.org.uk/uploads/osteopathyaolnh.pdf
and is supported by some evidence.
http://cks.nhs.uk/sciatica_lumbar_radiculopathy/evidence/supporting_evidence/non_drug_treatments/spinal_manipulation#-401003
This is for proper nerve root compression sciatica. I’ll accept the quality could be better. If you consider that most “sciatic” pain is not nerve root we move into the mechanical back pain category where evidence is stronger.
Sceptic Osteopath
skepticbarista
May 5, 2011
Sceptic Osteopath,
Thanks for your comment. My remark about “But I know a man who does!” was directed at targeted advertising in general rather than that one specific site. I get some interesting CST ads!
I agree that sciatica is listed by the CAP as permissiable for osteopaths to advertise, however the issue of whiplash is less clear cut. The CAP include whiplash as one of the “conditons for which suitably qualified medical advice should be sought”.
The sticking point here is medically qualified. I’m sure that a GP referral would be seen as an acceptable reason to offer treatment, however advertising whiplash in general would present more of a problem. The ASA have already upheld whiplash complaints against chiropractors, so that may give an indication how they would approach osteopathy.
http://www.asa.org.uk/ASA-action/Adjudications/2008/9/BritChiro-Clinics-Ltd/TF_ADJ_44999.aspx
Whiplash complaint upheld:
The next one is particularly interesting, due to the inclusion of ‘osteomyologists’ and the ASA/CAP comments may present problems for osteopaths offering to treat whiplash.
The ASA say:
“We understood that osteomyologists were therapists who had trained in osteopathy or chiropractic but were not regulated by the General Osteopathic Council or the General Chiropractic Council. ”
http://www.asa.org.uk/ASA-action/Adjudications/2008/9/Optimum-Health-Centres/TF_ADJ_45005.aspx
Whiplash complaint upheld:
That could be quite a significant comment and is where the GP referral comes in.
Here they mention regulation. Clearly osteopathy is a regulated profession, however so is chiropractic so just being a regulated profession is not the answer!
The ASA are looking at a few ostopaths sites for conditions such as cerebral palsy etc and these sites also advertise whiplash, so we may see how the ASA view osteopathy & whiplash sometime in the near future.
The whole subject of ‘osteomyologists‘ and what they claim to treat is something I’ve not looked at and may be worth a bit of investigation!
SB
skepticbarista
May 7, 2011
Silly little Anti-Vax trolls …. they never learn!
No matter how much time or effort they put into their posts …… it take seconds to hit the ‘Spam’ button!
Oh how amusing, my Anti-Vax troll thinks that a change of username or email address is all it takes!
Awww … My little troll is trying really hard to get his rants published. Putting far more effort into posting his rants than I am into spamming them ;-D
Sceptic Osteopath
May 8, 2011
Whiplash
Thanks for those links. Interesting. Broadly I find I agree with what’s being said.
Osteomyologists choose to operate outside regulation. The only obvious reasons are they can’t get registered; they don’t like or can’t stick to the rules.
I think there a two issue here.
One is a safely concern on the management, in a primary care setting, of undiagnosed trauma (including whiplash). This I would expect to be handled appropriately by “Suitably Qualified Practitioners.” Patients with undiagnosed whiplash or other trauma presenting to Osteopaths should be denied treatment and referred for imaging or to A&E. I once had a Guy book in after falling 24 feet. Ouch!
The other is the efficacy of treatment of in this case whiplash.
My care pathway for Whiplash would look a bit like this.
Presentation
1. Not been imaged / seen by GP or A&E -> Refer
2. Getting worse -> Refer
3. Progressive Neurological Problems ->Refer
4. Night pain – Pain at rest ->Refer
5. Examine Patient
6. Nerve root compression ->Refer
7. Can reproduce local mechanical symptoms ->treat
That’s enough of that. It’s not supposed to be an exhaustive list but serves to illustrate the point that by the time I have reached the decision to treat the person they don’t have a “Serious Medical Condition”. They are back to having simple mechanical neck pain as a consequence of the whiplash injury. This would be on the CAP list and is supported by some evidence.
Referred patients locally are sent to the Musculoskeletal referral service – currently a 13 week wait. This is the gateway to MRI imaging and physiotherapy (a further 13 week wait and with no better evidence for whiplash treatment). Often they get fed up waiting and represent, still undiagnosed, 6 weeks more chronic, off work etc. This is “Best Care” to which we are so often compared. Ho Hum.
So the challenge is to encapsulate this into an offer of service inviting people with the right sort of post whiplash mechanical neck pain to come for treatment whilst discouraging the rest.
Perhaps I will make my own call to the copy advice team.
Bruce
May 18, 2011
@skeptic osteopath
What is the evidence for osteopaths treating whiplash, whether as secondary practitioners eg GP referral or primary contact eg patient straight off the street?
Are your opinions shared by the majority of UK osteopaths as I get the impression you may be in the minority?
Scepticosteopath
May 18, 2011
Evidence for the best practice management of wad is thin but there’s some out there supporting early mobilisation over collars and pain killers. I don’t think research belongs to any particular profession. So if physio’s or others have done the work so what.
I wouldn’t dare speak for the rest of the profession. But they don’t seem to speak for them selves.
I am confident that 99.9 % of Osteopaths would know when to referr a red flag neck injury. It’s in the competences and we were all examined on it once. Whiplash is a big subject. The Quebec task force categorised WAD. Grade 4 and 5 need referral the rest is mechanical neck pain.
Evidence for manual therapy for this is on nhsevidence. See my earlier post.
Sorry about the typing but I’m doing this on the train on a phone.
Bruce
May 19, 2011
@skeptic osteopaths
Thank you for your response. I agree with you relating to the sparse evidence relating to the treatment of osteopathy by those practicing manual medicine to include osteopathy, chiropractic and physiotherapy yet for some reason you choose to ignore chiropractic in your listing which seems a bit strange especially as you quote the Quebec Task Force?
@skeptic barista
With this in mind, based on current argument protocols by you and other skeptics re robust evidence, how can you support the treatment of a patient irrelevant of whether they walk through the door or are referred by a GP. Although I agree with you in part, the evidence or lack of it is, as I understood the argument, the crux of the matter or isn’t that right?
@skeptic osteopath
My understanding is that Dr David Cassidy, a prominent chiropractic researcher was hand picked to play an integral role in the Quebec task-force, which I alluded to before. As this resulted in a rather robust paper on the subject I have been made aware of it’s existence. My question was what evidence is there for osteopaths to treat whiplash?
Your answer was to paraphrase, good evidence is good irrelevant of where it comes from, is that right?
If so, do you think it’s fair osteopaths retain their right to treat whiplash by the ASA and chiropractors do not? That’s up to the ASA would not be a good answer.
With regards your information regarding how many osteopaths share your stance, I agree totally with your statement but would disagree with your percentage and suggest, if educated in the UK, 100% of osteopaths would know when to refer. The simple question is would they? This of course leads me on to this:
Could you answer my initial question: Are your opinions shared by the majority of UK osteopaths as I get the impression you may be in the minority?
This is not an attack, just clarification of the information being published here which the readers deserve.
Bruce
May 19, 2011
@SB
Just to clarify, I appreciate your comment re GP referral being acceptable was with regards sciatica, however in the same vein as whiplash the evidence, based on Bronfort, is not accepted by the ASA as being robust for chiros, Osteopaths to date have never been tested but I’m guessing they all row the same boat.
Bottom line, irrelevant of who refers for what, the argument of no robust evidence = no advertising or treatment, surely still stands. It is the evidence you guys base your argument on not the referral procedures or is there a change in direction?
skepticbarista
May 19, 2011
Hi Bruce:
To be honest with you I have rarely ever looked at musculoskeletal conditions for any manipulative therapy (including chiro & osteo). I tend to stick to the non-musculoskeletal conditions and have only mentioned sciatica and whiplash here because they came up in the comments (thanks to that targeted advertising).
The reference to GP referal was not about sciatica but about whiplash and was not intended as a comment on the level of evidence to support claims for either condition. It was concerned with the list of conditions that the CAP currently allow osteopaths to advertise. Currently sciatica is on the list of conditions that osteopaths can advertise, whereas whiplash is on a list of conditions where the CAP say “suitably qualified medical advice should be sought” and as I mentioned earlier, I think this makes the situation for whiplash less clearly defined.
I agree with you that it is about more than a referal, but in mentioning GP referals I was suggesting that the ASA may view this as coming from somebody suitably medically qualified. Although that remains to be seen and does not address the issue of evidence.
The ASA/CAP have previously ruled on other therapists (inc chiropractors) advertising the treatment of whiplash and I strongly suspect the situation with osteopaths will become clearer in the near future!
That’s what targeted advertising does for you!
Of course challenging claims for whiplash may not bring about any changes to the list of conditions permitted for osteopaths, that Mary Monro is so keen to see happen, this will only come if complaints are successfully defended and once again that requires evidence!
Which brings us back to the thrust of this post and the article in Osteopathy Today:
Quote: “We are told that the CAP code only allows us to mention a short list of possible conditions that we can claim to treat. This is partly down to lack of evidence and partly down to a lack of complaints. CAP almost never receive complaints about osteopaths’ advertising so (until very recently) they have no idea what we do.”
Given the current focus on CAM advertising claims, I still think it was a stunningly stupid (or at best ill advised) view to express publicly. And I find it a little ironic that the osteo making these statements, has already contacted the CAP to ensure her website complies with the codes.
If Mary Monro is reading this and wants to put a list of claims & conditions on her website, I will gladly give her the opportunity to defend them and attempt to expand the list of conditions the CAP permit.
But perhaps she is happier for others to do the fighting for her!
SB
Bruce
May 19, 2011
@SB
I actually agree with you on many counts and think that your approach to all this seems very fair.
I am however, intrigued at how skeptic osteopath perceives his professions stance in all of this and whether or not his views are shared by the majority of osteopaths. I get the impression they do not and your piece regarding osteopathy today may support my assumptions. It will be interesting to read his response.
skepticbarista
May 19, 2011
@Bruce:
When it comes to the views expressed in Osteopathy Today, I’d be very interested in comments from any osteopaths.
One of the views expressed in that article is one that seems to be quite widely held throughout the CAM community.
”the ASA can only ask you to withdraw your advertisement if it fails to comply. They have no other sanctions – no fines, no jail, no threat to your business“
This shows a total lack of understanding on how the ASA work. It is very true that there is a limit to the level the ASA itself can force advertisers to comply ……… but those who refuse to work with the ASA, could soon find that other organisations knocking on their door.
http://www.asa.org.uk/ASA-action/Sanctions.aspx
Indeed, I have heard today that the ASA has referred at least one alt-med advertiser to the Office of Fair Trading for continual non-compliance. It was not one of my complaints and I have no further details about the trader – the process is ongoing.
But that kind of blows away the ‘no fines, no threat to your business’ argument – So some people may be in for a shock!
SB
WOsteopath
May 20, 2011
the latest copy of OT actually has a statement from the editor saying that they do not advice anyone to follow that advice and that the ASA can refer to the OFT and you could face potential charges…
why the editor didn’t put it in the last issue is anyones guess
Bruce
May 21, 2011
@WOsteopath
Maybe you would like to help us out by clarifying how many osteopaths would be of skeptic osteopaths ilk and share his opinions?
Also I would like to pose a question to you: accepting the content of the Bronfort report, how much evidence exists to support the current ASA listing of treatable conditions for osteopathy?
Sceptic Osteopath
May 21, 2011
@ Bruce
Which opinion do you mean?
If you mean a rational, science based approach. I would say 66%. I tested this figure on a few colleagues and they came up with a similar number. At the far end of the curve there are probably 25% with an irrational approach.
Some work was done on this by the GOsC for the scope of practice document “Osteopathic Framework” (OF) which is clear that the core work of osteopathy is musculoskeletal conditions and methods. The other stuff sits on the periphery. However the minority view is very vocal and evangelical.
On evidence. Evidence is evidence. Its not Osteopathic Medical or Chiropractic or whoever. Patients have little interest in the philosophy of one or another profession. They are interested in a solution to their current issue as quickly and cheaply as possible.
Furthermore. Osteopathy is a job, at most a philosophy or an attitude to problem solving. The problems found and methods used are not unique to osteopaths. You can get you back treated all over town. The question that should exercise us is where is the best value and how can we demonstrate that?
@Skeptic Barista.
Since my comment about cost of regulation the GOsC have announced their intention to reduce their costs by collaboration and resource sharing with other regulators. Perhaps they do read your blog!
Sceptic osteopath
Sceptic Osteopath
May 21, 2011
@Bruce
>>>If so, do you think it’s fair osteopaths retain their right to treat
>>>whiplash by the ASA and chiropractors do not? That’s up to the
>>>ASA would not be a good answer.
Sorry – forgot to comment on this.
I think technically it’s the right to advertise the treatment of whiplash that’s the issue here. There’s nothing wrong with delivering treatment for WAD if the patients come requesting it or your get the patient referred to you.
Whiplash is a type of injury, an aetiology, like sports injury or overuse injury. It tells us nothing about the actual diagnosis of injury. Some people with WAD have simple mechanical neck pain which I am confident can be helped by an osteopath using manual therapy (careful choice of words). Its worth saying that some will just get better on their own. Others have a range of more serious conditions E.G. fracture, ligamentous instability. Some are contraindicated.
I don’t want to advertise for fresh, undiagnosed trauma cases. Its higher risk and whist I may have the expertise to screen out the red flags, request the necessary imaging etc, these people are best served by acute medical service. 90% will probably get better with no treatment, 9 % with simple advice and my share of the 1% will find me anyway based on professional or personal recommendation. (Figures stolen from CSAG report and really relate to back pain).
I wonder if the real issue is one of humility and scope of practice. If I lost the right to mention whiplash I don’t think it would make any difference at all to my practice. I don’t for a moment think people search in google for “Whiplash” and pick the first web site that comes up. The demographics of our patients is ABC1 with a high level of education. They are bright and discriminating. BY the time they have found our website they have already decided they want to come in, they just need the phone number. Mostly our web pages are to deliver pre-treatment information so people get what they are expecting.
I am thinking you are a chiropractor – is that correct?
Do you think it would be right to advertise, “Been in a car accident – go straight to your chiropractor”?
Bruce
May 21, 2011
@ skeptic osteopath
As for who or what I am, I am simply a troll, if some if the others posters are correct, albeit a rather good looking troll if I say so myself lol
With regards your responses, I think they are in the main, fair and measured and if the percentage you suggest is accurate where just under 70% of osteopaths share your views, I applaud your profession. However, I have spoken to osteopaths who would disagree with you and would suggest that you guys may actually be in the minority. It all depends on the opinions of those around you I guess. Most, but definitely not all of my friends share my opinions. Its a pretty normal situation.
My belief is that there is a reasonably large section of chiropractors, osteopaths and physiotherapists who are likeminded in their approach and treatment principles and there are others who are definitely not. So where manual medicine will end up, I really don’t know but I think the skeptic backlash has done a lot of good and if used sensibly, will continue to do so. Only time will tell where that will go and my comments regarding the NC mirror my concerns.
With regards whiplash, I totally agree. Whiplash seems to me to be a bucket syndrome covering a host of biomechanical, sociological as well as psychological factors that may or may not be helped by those in manual medicine who treat it. Of course the outcomes and thus the success will be dependent on many factors but that works the same for medicine. Sadly I don’t agree with a statement made in the past by Blue Wode I think who suggested that if medicine cannot cure it, rather than trying anything else, coping mechanisms should be used. I’m certain that a great many patients, albeit not all, who attend osteopaths or chiropractors will get far more benefit that any coping mechanism would offer. Aren’t you ?
My understanding regarding what and what isn’t advertised, is also in agreement with what you say. A word of mouth referral rather than an advert is a far more powerful tool and that is true in all walks if life. I remembers seeing a chiropractor, who was very very busy, long before they were allowed to advertise. The results, I presume spoke for themselves.
My questions are based on the fact that based on current evidence regarding both osteopathy and chiropractic in the areas of MSK, why the ASA listing for the two professions, and of course physiotherapy are not very similar. But that may resolve itself over time, as SB has alluded to, if the complaints continue to flow.
I was also very intrigued to get the opinions of osteopaths who are willing to debate and offer opinions on the subject. I thank you for your responses.
Pointitout
May 22, 2011
To be honest I think the only people taking any notice of these IMO comments is yourselves, most people have no idea that you even exist and the quality of posting sort of makes up the decision for most. What complaints are continuing to flow Bruce?
Most osteopaths are not members of the BOA so they don’t even represent the whole of the profession, in some senses it is totally worthless either consulting them for opinion or regarding any opinion they have on anything.
The board isn’t even properly elected.
Bruce
May 22, 2011
@ pointitout
The Nightingale Collaboration and the anti CAM sKeptics are still laying complaints to the ASA based on website advertising.
I think you have put over a valid point, I got the impression that the BOA represent only part of the osteopathic profession a bit like the BCA for chiropractors. But that the vast majority of members in these two bodies are MSK guys while the majority of traditionalists are external to them. Is that right?
Can you answer what percentage of the UK osteopathic profession would hold the same views as skeptic osteopath. My understanding is it is less than 50% ?
pinpoint
May 24, 2011
I think it is all a puff in the wind. Most people with a reputation don’t even advertise so anyone stupid enough to think they can build a business on a website probably hasn’t got one.
In a sense the whole process will not affect the alternative movement because most people who are totally pissed with what regulation has done for choice wouldn’t take a medical experts view over anything more than acute trauma which of course they have value for and it is important to have people able to do this work.
Most surgeons would admit there is no EBM for their work, what they do is based on what they see works in the large part. The public are demanding and alternative to chronic and degenerative disease processes, if they weren’t the work would not be there. Considering most peer review is population bias anyway the chances of a rational attempt at EBM for anything outside mainstream is non existent. Asking the ASA to demand evidence is beyond stupid.
We are in a no different situation to anyone who challenges the myths of orthodoxy and that will never change, there is no debate either. The BOA basically represent themselves, it is in their interest to never reach a plateau of satisfaction, same with the regulator. If we do they are all redundant and we can’t have that, can we.
Any battle that may be going on is irrelevant to what matters, it’s a political BS soup. The vast majority of the public who choose an alternative ask their friends, not the web and that will always continue irrespective of dodgy politics. Ask yourself this question: if you wanted someone to fix your car would you look at lists of ‘reputable registered mechanics’ or ask someone you trust to recommend someone?
Registers of people are usually politically motivated, in this country we have common law which is more than enought to highlight the dodgy dealer.
skepticbarista
May 24, 2011
If as you say this is “all puff in the wind“, that raises the question of why are there so many websites making these sort of claims (not just osteopathy) and why are they so reluctant to remove the claims.
Various regulators and trade organisations have issued quite specific advertising advice to their members.
Some have acted on this advice, but many have deliberately chosen to ignore it, hoping it will all go away. Some obviously do not understand the advice or advertising regulations (although they are quite clear).
Those that do take their claims down, tend to complain bitterly that their profession is under attack. It can actually be quite amusing to see how quickly these ‘healing, holistic, caring‘ therapists become offensive and insulting when their right to advertise nonsense is questioned.
buckthetrend
May 29, 2011
We are in a time where people just don’t trust ‘centralised direction’ SB. There is no evidence that regulators and trade organisations are independant and for the real benefit of the public.
Currently the osteopathic regulator is trying to force through a totally inept re validation scheme for which there is no baseline evidence for need. There is no support whatsover for this job creation scheme and many expect mass resignations from the register, the recent sweetner from the new boy at osteopathy house of reducing fees by 25% won’t have much impact either.
They are no different to banking regulators, medical peer review, ASA, TS whilst there must be some people working there who are honerable their impact is lost in the tide of sewage called pragmatism. This obstensibly is only interested in protecting corporations who certainly are not lead by morally organised beings.
Would you trust your best friend or a policeman these days?
yamuncher
May 25, 2011
As has been mentioned the osteopathic trade org doesn’t represent anywhere near the profession so any advice is obviously ignored by most people except you. The BOA did in its rag mention useful tactics – like not using the cranial word in insurance claims, which is actually fraudulent, so perhaps you could ask them about that?
skepticbarista
May 26, 2011
Had a letter from the ASA today.
One (cranial) osteopath now has the opportunity to defend claims, or to accept that there is no evidence and simply remove them.
I have removed the name of the clinic, as the case is still ongoing and they may choose to defend the claims. But at least this should give others an indication of how the ASA view these sort of claims.
goingforit
May 27, 2011
This will only affect new practitioner with no reputation ahead of them. Those who have years of experience, sorting this kind of day to day work, won’t even notice this because they don’t need to advertise.
Recommendation from a friend has far more value than a population biased peer reviewed study in a corrupt medical magazine, especially if the Ernster edits it!
goingforit
May 27, 2011
I am in the process of referring a complaint to the MHRA about the no EBM basis for flu jab. The absence of any efficacy data whatsoever should make this an interesting story. The ASA advised this route as funnily enough they don’t handle medical complaints of false claims!
Thanks for your help.
Andrew Gilbey
May 29, 2011
@Goingforit
Brilliant – I’m sure it’ll give them a good laugh!