Osteopathy:Campaigning! Get some evidence..

Posted on January 25, 2011

15


Some months ago I got in contact with the General Osteopathic Council (GOsC) to see if they could provide some evidence to support the wide range of claims relating to Cranial Osteopathy.

My earlier blogs on the subject can be found here:

Osteopathy: talking a good game

Osteopathy: More words

Osteopathy: Look out that evidence

Recently Cranial Osteopathy came to my attention again. On October 22 2010 my local paper the Loughborough Echo reported on a charity set up by a local woman to promote Cranial Osteopathy for the treatment of childhood colic. This campaign has also been reported in the Leicester Mercury:

Not content with simply trying to raise awareness of this therapy they are actively campaigning to get NHS funding for this unproven treatment. As a part of that campaigning they have enlisted the support of Loughborough MP Nicky Morgan (Con).

Indeed Nicky Morgan asked a question in the House of Commons on this very subject, thankfully the response from Anne Milton follows the view of the current evidence: They Work For You

Nicky Morgan is quoted in the papers as saying:

As a mum whose child has benefited from osteopathy, I am keen to see whether the NHS, and especially midwives and health visitors, could be telling parents more about how treatment might help them

“In these economic times, there isn’t a lot of money to go round but there is no harm in allowing parents to explore this treatment.”

“It is going to be a while before it is available on the NHS but if there is more awareness it will also help with research.”

What concerns me about this campaign isn’t that a mum paid for cranial osteopathy and now thinks it is a cure for colic, although in this case I would have expected the mother concerned to have a greater appreciation of the requirement for evidence than most.  She is after all a lecturer in criminology at De Montfort University in Leicester. One would hope that evidence features quite highly in the study of criminology and it is a pity it doesn’t seem to have been considered in this campaign!

More worrying than this is the fact that a politician who regularly takes an interest in the NHS and who usually seems to take a sensible approach to healthcare issues can support a campaign calling for NHS funding for a treatment, without ever looking for evidence …….. proper evidence, not anecdotes!

The NHS is pitifully short on funding, so anything looking to take more from the pot should be based on reliable evidence.

I will say at this point that I understand, from first hand experience, how distressing colic can be, not just for the child, but arguably more so for the parent. Colic in general is poorly understood and treatment is by no means certain. But the fact that something causes some distress, doesn’t mean we should instantly turn to unproven treatments that have no plausible mechanism by which they might work. Furthermore we need to remember that colic is a self limiting condition, even if left untreated it will resolve itself in a few weeks and ultimately will cause no harm.

Of course osteopaths, mums with anecdotal evidence, politicians looking for a vote winner are free to claim that the evidence does exist … but we need to see it and I wouldn’t simply expect people to take my word for it.

With this in mind I looked again at the General Osteopathic Council (GOsC) and the National Council for Osteopathic Research (NCOR) to see what evidence actually existed for Cranial Osteoapthy in general and specifically in the treatment of childhood colic:

GOsC NCOR

I asked the GOsC if they could provide details of the latest/best quality evidence to support Cranial Osteopathy treatments for four common conditions advertised on many osteopathy websites: Colic, Asthma, Ear Infections (Glue Ear) & Learning difficulties.

Their response was a long email, that said very little about evidence, other than it was outside the scope of our role to collect evidence of the efficacy of particular treatmentsWHAT!

How can they seriously claim to regulate a profession if you can’t even judge if the treatments being offered have any value!

They then directed me to NCOR for an answer. So I asked the same question to NCOR, actually feeling quite confident that they must have some evidence, they are afterall based at Brighton University. What I got back was a very polite, but unhelpful answer of  we are proceeding with the literature and will get Back to you probably in 6-8 weeks .we obviously want to carry out a thorough search.

Well that’s fine, but I did ask about ‘current‘ evidence and was given none.  This doesn’t go very far to supporting cranial osteopathy for colic, but until the results of the literature review are published I’ll need to look elsewhere.

It didn’t take long to find that NCOR had previously done a literature review on this same subject and the results were reported by NCOR in The Osteopath Dec 09. (pdf)

A total of 506 relevant papers were examined. The literature looking at OCF covers a wide range of methodological approaches. The largest number of studies can be classified as opinion pieces, largely unreferenced and not published in peer-reviewed journals. A small number of case studies exist, as do editorials and hypotheses. A small number of clinical trials have been published, including a small number of literature reviews and one systematic review.

The literature available in this area is predominantly viewed as lower grade evidence in terms of the hierarchy of research. The case study, however, should not be undervalued; it is frequently the most interesting type of study to many clinicians.

Note: OCF = Osteopathy in the Cranial Field

If this is as good as it gets, then I am not surprised that neither NCOR or the GOsC were keen to give a straight answer on the question of evidence!

As long as colic has been correctly diagnosed, by a Doctor, the use of Cranial Osteopathy in an attempt to treat infant colic doesn’t represent any great danger to the child (in other conditions it may!), but neither will it actually cure the colic. And if parents want to pay a therapist to perform unproven treatments on their children then fine, but it is clear that there isn’t anywhere near enough evidence to support NHS funding for this treatment.

There is far more to come on Cranial Osteopathy and the evidence, or lack of it and this will be covered in further posts. The results of the NCOR literature review should be published around the end of Feb or early March and will be very interesting to see if their findings have changed dramatically from those published a year ago.

But for now I would strongly suggest parents to look here, it’s a far better use of NHS funding:

http://www.cks.nhs.uk/patient_information_leaflet/colic

Alternative and traditional therapies.

There are many alternative and traditional therapies for colic, but there is little evidence to suggest that they are effective, and some may harm your baby.

And MP’s should at least make an effort to review the evidence before throwing their support into a campaign that want to waste NHS funding while achieving nothing of value!

Nicky Morgan MP is on Twitter and I did send ask her about her support for this campaign and the evidence, but got no reply which is a pity – I’d actually welcome the opportunity to meet and discuss the evidence!


Advertisements
Posted in: Osteopathy