Osteopaths: Talking a good game ..

Posted on April 18, 2010


The GCC’s study entitled “Effectiveness of manual therapies: the UK evidence report”  http://www.chiroandosteo.com/content/18/1/3 was released on 25 Feb 2010.   The study reported on the evidence (or lack of) to support a number of claims made by chiropractors.  However the report covered not only spinal manipulation as used by chiropractors but also Osteopathic manipulation (OMT) and came to the same conclusions regarding childhood conditions such as colic and asthma.

A quick google search would seem to indicate that there are now more Osteopaths making  treatment claims for non-musculoskeletal conditions (colic & asthma ect) than Chiropractors.  So I wondered how the General Osteopathic Council (GOsC) felt about the evidence for colic & asthma ….. and worse!

Earlier this week (12 April) I sent a quick email to the General Osteopathic Council to find out their views:

As I’m sure you are aware a recent study entitled “Effectiveness of manual therapies: the UK evidence report” ( http://www.chiroandosteo.com/content/18/1/3 ) was published on 25 Feb 2010.

The report focused on the effectiveness of a range of manual therapies (chiropractic, OMT, massage) as treatment for a range of conditions.

There would appear to be a number of osteopathic clinics in the UK making public statements on the efficacy of osteopathy for the treatment of a range of childhood non-musculoskeletal conditions. Many of these conditions have been reported in this latest review as having either inconclusive or negative evidence to support those claims.  The report goes on to say that even ‘inconclusive – favourable’ should not be used to make public claims.

Can you tell me if the General Osteopathic Council has considered the results of this review and what is view its of the current level of evidence to support OMT as a treatment option for colic, asthma, feeding & sleeping difficulties.

If the General Osteopathic Council supports the findings of this study, what actions/advice it has offered to its members.

I have checked your website News & Press release pages, but can find no mention of this report of the GOsC’s views on its findings .

On 15 April, I got a reply.  On the surface the GOsC seem to be making all the right noises, they talk about evidence, CAP, ASA ect, but are things as good as they seem?

Osteopathic Research – NCOR:

The first thing the GOsC made clear was that it’s not their job to evaluate evidence relevant to osteopathy.  That task falls to the National Council for Osteopathic Research (NCOR), who would seem to be connected with Brighton University.   The NCOR website contains a selection of PDF files under the title of  Evidence-Based Practice Tutorials which may be worth a read (I have only quickly scanned a couple).  The NCOR website may be worth keeping an eye on in the future, especially once their searchable database comes on line.

Thank you for bringing these points to our attention.   The study to which you refer has been recently brought to our attention by the National Council for Osteopathic Research (NCOR – www.ncor.org.uk), whose role it is monitor the publication of evidence relevant to osteopathic practice and to offer information and guidance to the profession and its patients with regard to study findings and their application in practice.  (The NCOR website will soon offer a searchable database of all relevant published research, including this review, which will be accessible to the public and practitioners alike.  Attached is a statement we have received from NCOR regarding this review.)

With the exception of research the General Osteopathic Council has itself commissioned, it is not our normal practice to publish comment on clinical studies, it being outside the scope of our expertise. However, we have a practice of  encouraging  registrants to stay abreast of current research findings and we support the NCOR by facilitating the dissemination to registrants of relevant evidential information (the publication of this review, for example) through the medium of our print and web-based communications to osteopaths (our bi-monthly The Osteopath magazine), our dedicated registrants website, and e-bulletins.

As far as the Bronfort report goes, the  NCOR_statement (PDF ) comments on the scope and limitation of the review, but makes no comment or judgement on any of the areas where the report is critical of OMT (osteopathic manipulative treatment) in the treatment of conditions like colic or asthma.  The final paragraph of the NCOR statement simply says:

As a scoping exercise, this work provides healthcare professionals with an indication as to areas where research is currently lacking and where,  possibly, to prioritise funding for future scientific investigation.

Whilst it is true that the Bronfort report has its limitations, (covered very well on Zeno’s Blog) it does provide an assessment on the quality of evidence (both chiropractic & osteopathic) used to support these claims, the report also excludes any studies or trials that contained serious flaws in their methodology.   Importantly,  Bronfort clearly lists treatments for which the evidence for OMT is at best inconclusive, yet the NCOR statement does not address this criticism.  Something I find a little strange for an organisation tasked with monitoring evidence relevant to osteopathy, particularly as it is reasonable to assume they would have access to any evidence to support the claims !

The General Osteopathic Council:

So as a regulatory body responsible for overseeing the Osteopathic profession within the UK, what is their role

As a statutory regulator, the GOsC’s primary purpose is to protect the public by maintaining and developing standards of osteopathic education, training and practice.  It is our view that also promoting a culture of evidence-based training & practice is integral to raising the standards of care provided to patients by osteopaths.

We routinely and repeatedly remind registrants that all public and patient information must be legal, decent, honest and truthful and must conform to current guidance, such as the British Code of Advertising, Sales Promotion and Direct Marketing (CAP Code). It may be helpful to know that a recent meeting between the NCOR and the Advertising Standards Authority agreed the need to ensure that communication between the two organisations facilitates the exchange of current information, thereby increasing the prospects that the public is well advised and able to make informed decisions regarding their choice of healthcare.

The GOsC also sent me a copy of the advice recently sent out to registrants Does your advertising conform to the rules ? .  I was told that this was published in the Dec 09 – Jan 10 edition of The Osteopath, the official journal of the GOsC …. however it was actually published in the Oct 2009 edition – a small error, but you would assume they would know what they told their members and when.

Copies of  The Osteopath can be found here:   The Osteopath

The advice given to osteopaths is quite clear in pointing out that any publicity material should conform to the guidance issued by the GOsC and the ASA (CAP codes), the final paragraph of the article is also quite clear:

Although the CAP Code does not cover the content of websites – concerns about website content are dealt with by your local Trading Standards offices – it is likely that complaints from the public regarding your website will be brought to the attention of the GOsC

Talking a good game:

So on paper things look quite good (compared to most CAM professions) they have a separate body (independent ?) who look into the research (NCOR) and that body does have discussion with the ASA and the GOsC advise all their members that their advertising must be legal, honest and truthful and must conform to the standards expected by the CAP and warn that public concerns over website content could attract the attentions of Trading Standards.

However, whilst the GOsC may be talking a good game,  neither they nor their members are actually playing one!   Not much good if the ref and players all know the rules of the game, but decide to ignore them and simply do their own thing!

The GOsC  must be well aware of the claims being made by its members, yet these claims go unchecked and appear on many osteopathy websites and no doubt in their advertising literature, particularly those osteopaths who have moved on to specialise in ‘cranial osteopathy’.   The claims are at least as wide spread as they once were amongst the chiropractic profession.

Some typical quotes from UK osteopathy websites:

“Birth can compromise your baby’s musculoskeletal system. Gentle cranial and structural osteopathy can alleviate some of the symptoms that lead to excessive crying, colic, feeding or movement problems”

“Osteopathic treatment can help with all of these potential causes of colic, and in general does have good results.”

“If the problem (colic) persists after the fourth months, you are recommended to visit an osteopathic clinic, where medical professionals will conduct a thorough examination and look for tensions within your child’s the body.”

And some go much further than just colic  !

For the Treatment of: Crying babies, Colic, sickness, and wind Feeding difficulties, Sleep disturbances, Recurrent infections, Ear infections, Asthma, Sinus and adenoidal problems,Behaviour problems, Learning difficulties, Cerebral palsy and other types of brain damage and more”

disturbed nights, sleeplessness, poor suckling, colic, “won’t settle”, continuous distress and crying, glue ear, otitis media, painful ears, catarrh, blocked nose, sinus trouble, adenoid problems, recurrent infections, poor co-ordination, poor concentration, learning difficulties, slow development, aggression, hyperactivity, facial pain, toothache, uneven or misshapen teeth, cerebral palsy, Down’s syndrome

…….  I do hope they have the evidence to support those statements !

The GOsC did reply to my email and they did say to what extent they have considered the findings of the Bronfort report.   However, just putting the words down on paper is hardly enough.  The profession that they are tasked to regulate are making claims that would appear to be lacking any reliable evidence, if they want to know where that can lead they should give the GCC a call!

I will be replying to the GOsC asking if they or the NCOR are aware of any reliable, good quality evidence that can be used to substantiate these claims.

Oh and if I my memory serves me correctly …. I pass an osteopathic clinic on my way into town!