Misleading the public into fundraising for evidence free osteopathic treatments

fundraisingMany members of the public give up their time to undertake fundraising activities for the benefit of others. Indeed many charities are heavily reliant on the generous work of their fundraisers in order to carry out their charitable activities. Sometimes individuals or organisations ask people to carry out fundraising in order that they can provide healthcare. For instance, the Alder Hey Children’s Charity raises funds to carry out research, innovation and education in medical care for children. A very worthwhile cause. What about when an individual or organisation raises funds for treatments that have not been shown to be effective? That seems rather less worthwhile and potentially involves misleading the fundraisers in order to persuade them to help the cause. That seems to be the case with CORE of Clapton and their osteopathic treatments.

On the face of it, the CORE of Clapton website gives the impression of trying to benefit the community. They state “We believe everybody has the right to a pain-free life and our aim is to make osteopathy accessible to all.” Wanting to make people more pain-free can only be a good thing. However, suggesting osteopathy as the solution seems to be misguided. Osteopathy is a treatment for which there is very little evidence of effectiveness. In the case of low back pain, the “home ground” of most osteopaths, osteopathy is no longer recommended as a first-line treatment. When it comes to treatment of other conditions, the evidence for osteopathy is even weaker or in many cases non-existent. Unfortunately, the treatments being offered at CORE of Clapton don’t even align with this weak evidence base but instead use approaches that are outdated and have been shown to be ineffective.

Treatments at CORE of Clapton

There has been coverage of the types of treatments being offered at CORE of Clapton in the news recently. The treatments described in that article are far from evidence based. For instance, the NICE guidelines for low back pain and sciatica make it clear that exercise is the first line treatment and that things like osteopathy should only be offered in addition to exercise. Is there any mention of exercise in this treatment program? No. It therefore doesn’t comply with the guidelines and is not evidence based. Things get far worse than this, however. In the sixth and final session, acupuncture is used as a treatment. Now, acupuncture has been removed entirely from the latest NICE guidelines due to lack of evidence of effectiveness. The treatment being offered by CORE of Clapton clearly does not follow relevant guidelines or recent research and this can’t be in the best interest of patients.

At this point you may be wondering whether fundraising for CORE of Clapton is such a good idea after all, but there is more. The treatment approach being used came in for stiff criticism from within the osteopathic profession on twitter. There were a large number of comments including “Focusing on fixing posture and mechanical dysfunction reinforces negative beliefs and from a pain science perspective clinically ineffective” and “In some case more than clinically ineffective, but potentially harmful”. So, here is an organisation that’s asking members of the public to donate or fundraise and yet the treatments they’re offering are “clinically ineffective” or even “potentially harmful”.

As an aside, it’s good to see that some osteopaths are trying to bring about change in a profession that is closely associated with quackery. They are few in number but it’s good that they are willing to challenge the many osteopaths who are using outdated, non-evidence based treatments and frequently misleading the public into taking these inappropriate treatments.

Research at CORE of Clapton

CORE of Clapton are keen to carry out research in osteopathy. When planning to carry out research it’s important to have a good understanding of all relevant existing research so that the new research is relevant and appropriate. Unfortunately, that doesn’t seem to be the case at CORE of Clapton. First of all, the treatments described above are clearly not based on a good understanding of the latest research. The “Research” section of the website makes this lack of understanding even more obvious. For instance, it says that “NICE recommends osteopathy for sub-acute and chronic low back pain” and provides a reference to the NICE guidelines from 2009. Now, these guidelines were superseded by the version published in November 2016 which downgraded the role of osteopathy in the treatment of low back pain. So, here is an organisation that is keen to carry out “research” yet still refers to NICE guidelines that were superseded nearly 6 months ago.

Another thing that’s absolutely key when carrying out research is to minimise the risk of bias. When research is carried out it should be to test IF something works rather than to deliberately try and search for evidence that it does. The latter would be a clear case of bias and is unfortunately what happens far too frequently in most research in complementary and alternative medicine, such as osteopathy. The Research page on their website lists a number of “further positive trials”. Unfortunately, this appears to be a cherry-picked list of studies that apparently show the benefits of osteopathy. There are no trials listed that showed a negative outcome for osteopathy and the list of trials presented are far from a complete list of all research in any of the areas mentioned. There is clearly a very strong bias here towards trying to show that osteopathy works rather than genuinely researching to see IF it works.

What’s worse is that the interpretation of the trials themselves is actually incorrect and clearly suffers from further bias. For instance, CORE of Clapton say that “In elderly patients hospitalised with pneumonia, treatment significantly reduced the duration of intravenous antibiotic use and length of hospital stay compared to a sham treatment.” The trial they reference doesn’t say that at all! It’s actually a negative trial and shows that osteopathy was NOT beneficial for this patient group. In the results section it clearly states “Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups”. In other words osteopathy was NOT effective. On the basis of this study, further research in this area is not warranted.

What is the chance of the “research” that’s going to be carried out at CORE of Clapton resulting in an accurate unbiased assessment of the effectiveness of osteopathy? Based on the extremely biased view presented on their website I would say “zero”. Whatever “research” does get carried out is therefore unlikely to add anything at all to our understanding of what osteopathy can and cannot treat. Any public money spent on such “research” is being wasted and could be spent better elsewhere.

Conclusions

A Community Interest Company (CIC) like CORE is supposed to be of benefit to the community. CORE are asking the general public to donate to them or fundraise for them because they want to improve access to osteopathy for the public and to carry out research into osteopathy. These are goals that, on the face of it, appear to be in the public interest. However, once you look more closely it’s very clear that this is not the case. The treatments offered are not evidence based and in some cases potentially harmful. The “research” that they plan to carry out is likely to be so biased as to provide no useful information on the effectiveness of osteopathy. It’s hard to imagine how this venture can benefit the community at all given the types of treatments and research being offered. Misleading the public to fundraise for something that isn’t actually going to benefit the community is unethical. Public time and money should instead be given to other organisations that provide a genuine benefit.

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UK Health Centre: Misleading information about osteopathy, chiropractic, homeopathy and acupuncture all on one site

The UK Health Centre website says that it provides “Access to Health and Medical Information on the Internet”. However, this is not a site that just provides information. It has an appointment booking service and the focus seems to be primarily on providing information that encourages people to make bookings for private treatment. Unfortunately, the information is therefore somewhat biased and in some cases very misleading. Some of the information on the site is actually of a good quality and provides evidence based advice. One example of this would be the information on vaccines. The area where the advice is much more misleading is alternative medicine. This includes osteopathy, chiropractic, acupuncture, homeopathy and herbal remedies. Mixing this misleading information about alternative treatments with more accurate information about conventional medical treatments is likely to cause confusion for the general public and could result in them opting to take treatments that are completely unsuitable.

Osteopathy

The UK Health Centre website promotes osteopathy as a treatment for a wide range of medical conditions including:

  • Whiplash
  • Asthma and chest problems
  • Diabetes
  • Long term illness
  • Stress
  • Depression
  • Tiredness
  • Osteoporosis
  • IBS
  • Glue ear
  • Infections
  • Insomnia
  • Growing pains
  • Dysmenorrhoea (period pains)
  • Issues specifically related to pregnancy (such as morning sickness, wounds from childbirth)
  • Common infant problems (including colic, colds and teething pain)
  • Conditions arising from oxygen deprivation during birth
  • Monitoring baby’s growth and development
  • General poor health

Osteopathy has not been shown to be effective for any of these conditions and therefore advertising such treatments breaches advertising regulations. It is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice (http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ and https://www.asa.org.uk/asset/44783612-C34B-4084-9B8A7036F01C43D7/ ). This misleading information could result in someone booking an appointment with an osteopath when their treatments are completely unsuitable. Some of the conditions on the list, such as asthma, are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not an osteopath.

Chiropractic

Although less outrageous than the treatment claims made for osteopathy, the information provided about chiropractic is also misleading. The site suggests that chiropractic treatment can improve the immune system, provide a solution to fertility problems and also to treat asthma. None of these claims can be substantiated and this information is therefore misleading. Elsewhere it says “The National Institute for Health and Clinical Excellence (NICE) support the use of chiropractic for treatment of acute lower back pain as they have analysed the results of studies that prove its effectiveness in this area.” Actually, the recent NICE guidelines have downgraded the role of chiropractic in treatment of low back pain due to a lack of evidence for its effectiveness.

Besides treatment for specific medical conditions, the site has other misleading information about chiropractic such as “It is considered most beneficial to undergo chiropractic treatments on a regular basis in order to prevent future damage to the skeleton.” Wow! There is no evidence to suggest that chiropractic is suitable as a preventative treatment. Furthermore, suggesting that not having such treatment might result in “future damage to the skeleton” is blatant and unsubstantiated scaremongering to try and get people to take treatments.

Interestingly, they do highlight risks of chiropractic: http://www.healthcentre.org.uk/chiropractors/chiropractors-safety.html . What’s rather puzzling is that the site doesn’t consider similar risks of osteopathy even though many of the same risks apply to both.

Acupuncture

The UK Health Centre website recommends acupuncture or acupressure for a range of different conditions including:

  • Tooth pain
  • Other pain
  • Muscle tightness
  • Nausea
  • Erectile dysfunction
  • Bronchitis
  • Anxiety
  • Stress
  • Drug use / alcoholism
  • Overeating
  • Fertility
  • Conditions during pregnancy including tiredness, anxiety, tenderness in the breasts, varicose veins, induction of labour, to correct foetal position

Acupuncture hasn’t been shown to be effective for any of these conditions and claiming otherwise is misleading. This also conflicts with the Advertising Standards Authority guidelines for acupuncture.

It then goes on to say that effectiveness of acupuncture for some conditions is in a “grey area”. Conditions that it puts into this category include depression, neck pain, stroke, sciatica, tinnitus, asthma, addictions (substance abuse). However, there is no such thing as a “grey area” in treatment effectiveness. Either a treatment has been proven to work or it hasn’t – in this case it hasn’t and suggesting otherwise is misleading.

Like osteopathy, some of the items on the list are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not treated with acupuncture.

Homeopathy

The site suggests that homeopathy is an effective treatment for hay fever (http://www.healthcentre.org.uk/allergies/hay-fever-homeopathy.html ) and snoring (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). It then goes on to say that homeopathy is the most suitable treatment during pregnancy (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). None of these claims are backed by any sort of evidence and are misleading the general public into potentially taking a treatment that is completely ineffective.

Herbal Remedies

The UK Health Centre website suggests that herbal remedies are effective for allergies, menopause, erectile dysfunction, skin tags and sleep problems. There is no evidence to back up these claims and they are therefore misleading the general public.

Actions Taken and Next Steps

I contacted UK Health Centre in November 2016 to ask them to amend the misleading content on their site. In the first instance I opted to focus on the content about osteopathy to see if they would be willing to correct their site. If they responded positively I then planned to tackle the other issues. Here is the e-mail I sent:

“I’m following up on the information provided about osteopathy on your website. A number of the claims made about osteopathy on your site do not have evidence to support them and are therefore misleading prospective patients and the general public. Furthermore, making these kinds of claims breaches advertising regulations and is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice. See this link for the guidance they provided to osteopaths: http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ Many of the pages on your site breach these guidelines and provide misleading advice. This includes references to treatment for whiplash, asthma and chest problems, stress, depression, tiredness, osteoporosis, IBS, glue ear, infections, growing pains, common infant problems and “general poor health”. Furthermore, your site suggests that preventative osteopathic treatment is appropriate and that “osteopathy can provide health benefits to most people”. However, there is no evidence to support either of these claims and therefore your site is misleading prospective patients and the general public.

Could you please remove all of your misleading articles about osteopathy from your website or amend them to make it clear what osteopathy can / cannot actually treat? I look forward to hearing from you.”

I received no response so sent a follow up in December 2016. Again there was no response. The information they provide is misleading the general public and has the potential to cause people to take unsuitable treatments. As such, the information on this site represents a risk to the public. I have therefore reported UK Health Centre to the Advertising Standards Authority (ASA). It will be interesting to see the outcome of this.