During the weekend of 30th June / 1st July the Sutherland Cranial College of Osteopathy (SCCO) held its 2018 Conference. The SCCO focuses on providing training in cranial osteopathy. If you aren’t familiar with cranial osteopathy, I’ve written about it here. The information being shared during the conference gives an insight into some of the rather strange thinking and approaches within the osteopathy profession. Some of that information is also, quite simply, wrong.
The Evidence Base for Osteopathy
Ben Katz, President of the Institute of Osteopathy, stated in his talk that there is a “strong evidence base for some conditions (LBP, neck pain, etc)” (LBP = Low back pain). This is, quite simply, WRONG. There is no condition for which there is a strong evidence base for osteopathic treatment. In the case of low back pain the NICE guidelines suggest it as a second-line treatment but only in conjunction with the first-line treatment (exercise). It is not recommended as a first-line treatment as there is a lack of evidence that it is effective when used alone. If you look more closely at the NICE guidelines it becomes apparent that the evidence for it to be used even as a second-line treatment is actually pretty thin. As I’ve said previously, NICE clearly agonised over whether to recommend it at all. Suggesting that there is a “strong evidence base” for osteopathy for low back pain or any other condition is factually incorrect and highly misleading.
At this point I think it’s worth reflecting on Evidence Based Medicine (EBM) and the approach taken by sceptics. EBM should ideally be a combination of the best available research and clinical evidence, the expertise and experiences of the clinician and values of the patient. I’ve seen comments from some osteopaths and other CAM providers that sceptics aren’t applying the guidance of EBM correctly because we focus exclusively on the best available clinical evidence. I can’t comment on the views of other sceptics but in my case this simply isn’t true. I do recognise the need to take into account the views of patients and the expertise of the practitioner when reaching a decision about the best treatment. However, what you cannot do is use the experiences of the practitioner as a SUBSTITUTE for solid research and clinical evidence. In the case of osteopathy, the evidence indicates that it provides limited or no benefit for any health condition. It is therefore quite correct that sceptics challenge osteopaths who are treating patients when there is so little evidence of treatment effectiveness. This isn’t going against EBM, it’s recognising that in the absence of clinical evidence of effectiveness osteopaths shouldn’t be continuing to treat patients regardless of their own experiences as a practitioner.
In the absence of clinical evidence, decision making is taking place at the junction of the red and green circles in the diagram, which isn’t EBM. In reality it is very difficult for osteopaths and CAM practitioners to provide fully informed consent as highlighted by Edzard Ernst. In this case decision making is taking place purely on the basis of the clinical expertise of the individual clinician (red circle). This is definitely not EBM and not in the best interest of patients.
I also think it’s important to apply the principles of Science Based Medicine when considering the suitability of treatments. Treatments offered should have some scientific plausibility and certainly shouldn’t conflict directly with a current understanding of science. Cranial osteopathy fails on this. As I highlighted in an earlier post, cranial osteopathy is a fanciful concept based on something that doesn’t exist. It therefore should not be offered as a treatment to patients at all. There should also not be any further research carried out on it as it is unethical to provide research participants with a treatment that lacks any plausible scientific basis.
In this context the study into colic and crying babies by SCCO is unethical. There is no plausible basis for cranial osteopathy or any reason to suggest that it could be helpful for colic or crying babies. It is therefore unethical to recruit participants into this study and doing so requires deception of those research participants.
Treatment of babies and children
One of the presenters at the conference, Peter Cockhill, is an osteopath who is “particularly interested in the treatment of children”. Oh dear. “His long term aim is to provide a free service for all new-born babies to be checked and treated osteopathically”. If this ever happened it would put babies at significant risk because osteopaths are simply not qualified to carry out “checks” on new-born babies. Babies are not small adults and assessment and treatment of babies requires specialist knowledge and expertise that osteopaths don’t have. There is more information on the treatments offered on the Baby Check Bath website. Apparently, medical professionals are referring babies for osteopathic treatment for things like feeding difficulties, prolonged periods of distress (i.e. colic), plagiocephaly, “sticky eyes”. There is no evidence that osteopathy is beneficial for any of these problems and it’s appalling that medical professionals are referring patients to this clinic. They should be offered evidenced based treatments instead.
Division in the osteopathic profession
There continues to be division within the osteopathic profession, which was discussed at the conference. This was presented as:
- Cranial vs structural
- MSK vs broad scope (MSK = musculoskeletal)
- Evidence vs principles
This helps to highlight that the principles of osteopathy are not evidence based, which is correct. AT Still, the founder of osteopathy, described osteopathy as “a total healthcare system, diametrically opposed to the orthodox medical system, which relies totally on understanding and trusting in the laws of nature as a means of establishing the best possible health of a patient. Therefore, to practice osteopathy in its intended format requires an appreciation of the laws of nature.” Anyone with a basic level of training in science or medicine will realise that this is nonsense. The “orthodox medical system” (i.e. mainstream medicine) has been developed over many years to become an effective healthcare system. It has done this by rejecting those treatments that have been shown not to work and continuing to use and develop those that do. Having a healthcare system that is “diametrically opposed” to this makes no sense at all as it involves rejecting a vast number of treatments that have been shown to be effective. This is clearly not in the best interest of patients. Osteopaths who follow these principles also have to believe that they can successfully treat ANY condition because osteopathy is “diametrically opposed” to conventional medicine. It is quite absurd to suggest that a manual therapy like osteopathy could be used to treat things like asthma, cancer or diabetes.
Osteopathy on the NHS
On the positive side, one of the talks in the conference did highlight that many NHS Clinical Commissioning Groups (CCGs) have osteopathy listed under the section “Procedures of Limited Clinical Value (PLCV)”. That’s a good thing because osteopathy does have limited clinical value and therefore taxpayers money shouldn’t be wasted on it. Homeopathy is no longer routinely available on the NHS anywhere in England and the same approach should now be applied to osteopathy. Precious NHS funds should instead be given to treatments that have a scientific basis and have been shown to be effective.
It’s easy to see how incorrect beliefs continue to be maintained throughout the osteopathic profession when there are conferences like this one. When the President of the Institute of Osteopathy says that there is a “strong evidence base” for some conditions, osteopaths are likely to believe him. It’s also clear that there are some osteopaths who continue to believe in cranial osteopathy even though it conflicts with a modern understanding of the way the human body works. Who loses out due to the perpetuation of these incorrect beliefs? It’s not the osteopaths because they think they are providing treatments with a “strong evidence base”. It’s actually the patients who lose out. Members of the public who waste their money going for treatments that they have been led to believe will benefit their health when actually they won’t.