Osteopathy: Be careful what you wish for …

Posted on April 24, 2011


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 ..