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.

Osteopathy and Chiropractic: Are they as safe as we’re led to believe?

risksUK osteopaths and chiropractors often claim that their treatments are “very safe”. However, there is a paucity of evidence to back up these claims and any practitioner who claims this is therefore misleading patients and the general public. A recent study suggests that the potential for long-term harm from the types of treatments provided by osteopaths and chiropractors may be significantly higher than previously thought.

This study looked at the adverse effects experienced by students after having manual techniques performed on them as part of their orthopaedic manual physical therapy training. The questionnaire was completed by 1640 respondents spread over 22 countries. This survey highlighted more people suffering longer-term adverse effects from treatments than have previously been reported. The treatments that caused most of the adverse effects were manipulation and mobilisation, treatments that are used frequently by osteopaths and chiropractors. The two key areas highlighted were major adverse effects and moderate adverse effects.

With regards to major adverse effects, participants in the survey were asked To your knowledge, have any of your fellow students experienced a major adverse effect (e.g. stroke, death or permanent neurological damage) directly resulting from a technique performed on them during their manual therapy training?” If these types of therapies are really “very safe” then you would expect nothing other than ZERO positive responses to this question. In actual fact 3.3% of respondents reported knowing of a fellow student experiencing a major adverse event (stroke, death or permanent neurological damage). Let’s just reflect on this for a moment. 3.3% on the face of it seems like a pretty small number. However, when you consider the severity of the effect: stroke, death or permanent neurological damage, anything other than 0% is a cause for concern. This certainly isn’t what you would expect from a treatment that is described as “very safe”. As the paper states, it’s not possible to quantify the absolute number of major adverse events from this data as we don’t know if some of the respondents are referring to the same cases. However, what this study does tell us is that some people do suffer very serious harm from the types of treatments provided by osteopaths and chiropractors. It is therefore unreasonable for any osteopath or chiropractor to claim that their treatments are “very safe” unless they can provide evidence to back up this claim. (I’m not aware of any such evidence.)

Looking at moderate adverse effects, 6.7% of respondents reported still experiencing adverse effects from the treatment they had during their training. The most common effects were chronic or recurrent neck pain, headache and low back pain. In the vast majority of cases these adverse effects were reported after manipulation or mobilisation, exactly the treatments that are used frequently by osteopaths and chiropractors. Most osteopaths and chiropractors don’t even highlight these risks to patients and instead (if they even talk about risks at all) only mention the mild transient risks of tiredness, temporary increase in pain or stiffness that typically last less than 48 hours. The frequency with which the participants in this study reported long-term effects highlights the potential for much greater harm from chiropractic or osteopathic treatment. In this study, 1 in 15 people treated suffered long-term problems due to the treatment.

Osteopaths and chiropractors will undoubtedly argue that this study was based on treatments carried out by students during their training and does not reflect the risks to patients being treated by someone with many years’ experience. That may be true, although these were postgraduate students developing their skills to an advanced level not undergraduates just starting out. In any case, what this study does do is make it clear that these treatments are NOT inherently safe. It’s possible that the risks from being treated by an experienced practitioner will be lower than in this study but the fact that these serious risks do exist cannot be ignored. Furthermore, how does an osteopath or chiropractor gain their many years of experience? By treating patients, of course. Therefore, some patients are going to be treated by someone who has just graduated or is only very early in their career. In this situation it seems likely that the risks of treatments will be closer to the figures quoted here which are far higher than most osteopaths or chiropractors are willing to admit.

This is an important study that highlights the potential for the types of treatments used by osteopaths and chiropractors to cause long-term damage to patients, in some cases including stroke, death or permanent neurological damage. Given the lack of effectiveness of these treatments for the most often treated patient group (low back pain) it’s important to consider whether the risks involved actually justify the use of the treatment at all. If a drug was developed that provided no or small benefits to patients and carried risks of long-term harm including the possibility of stroke, death or permanent neurological damage it would not get licensed. It’s therefore puzzling why these types of treatments are allowed to be offered at all.

Osteopathy and chiropractic are holistic … or are they?

Many osteopaths and chiropractors claim that their treatment approach is more holistic than conventional medical treatment and that this therefore makes it “better”. Firstly, this makes the assumption that conventional medicine is not holistic. That’s actually an invalid assumption and more on that later. But are osteopathy and chiropractic really holistic? Holistic is defined as “dealing with or treating the whole of something or someone and not just a part” (source: Cambridge English Dictionary). Osteopaths and chiropractors treat the musculoskeletal system and only the musculoskeletal system. They cannot do anything about the other systems in the human body, such as the respiratory system, lymphatic system and cardiovascular system. How can a treatment that focuses on only one of the body’s systems ever be considered “holistic”? The short answer is that it can’t. Whilst osteopaths and chiropractors may look at different parts of the musculoskeletal system, it is impossible for an osteopath or chiropractor to treat holistically as there is so much of the body that they cannot treat.

Now let’s return to the question of whether conventional medicine is holistic. The NHS has some doctors who are “generalists” and some who are “specialists”. The generalists have a reasonable knowledge of a wide range of health conditions but don’t have deep expertise in any particular area. They then refer on to an appropriate specialist when more detailed knowledge of a particular condition is needed. This is an entirely natural and sensible way of setting up a healthcare system. After all, would you want your GP to treat you if you have cancer or someone with more specialist knowledge like an oncologist? In this case the GP might carry out initial investigations and tests but would always refer on to the right specialist. The “generalists” in the NHS are GPs (General Practitioners), paediatricians and geriatricians. They look after a patient’s holistic care, leaving the specialists (of which there are many different types) to focus on the areas where they have particular expertise. These generalists can, unlike osteopaths and chiropractors, be truly holistic as they are able to assess and treat all systems in the human body.

Now we are in a good position to answer the question “Is osteopathy or chiropractic holistic?” The answer is clearly “no” and it’s actually impossible for an osteopath or chiropractor to treat holistically. Any osteopath or chiropractor who claims that they treat holistically is misleading their patients and the general public. Conventional medicine on the other hand is very much holistic. If you want to be treated holistically, stay away from osteopathy and chiropractic and stick with the NHS instead.

NICE guidelines for low back pain and sciatica: a clarification

The recently published NICE guidelines for low back pain and sciatica are clear and unambiguous. However, they seem to have been misinterpreted by some people. One area where this has happened is the part about manual therapy. Here is what the guideline says:

“Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.”

I have seen this misinterpreted as:

  • “Select just the bits you like”
  • “Manual therapy with exercise or psychological therapy”
  • “Exercise and manual therapy is the choice for low back pain”
  • “Osteopathy or manual therapy continues to be the treatment of choice for low back pain with the proviso that it is provided with exercise”

It’s important to understand that the wording from the guideline above makes it clear that exercise is a mandatory part of a treatment package. Manual therapy and psychological therapy are optional add-ons but exercise is compulsory. That means that the treatment options are: exercise alone, exercise plus manual therapy, exercise plus psychological therapy, exercise plus manual therapy and psychological therapy. Using a treatment package that consists of manual therapy alone, psychological therapy alone or manual therapy plus psychological therapy does not comply with the guidance. It’s also important to understand that there is no requirement to provide a multimodal treatment package and in some cases exercise alone will be the most appropriate treatment. You certainly can’t “select just the bits you like” as exercise is not an optional component.

Now let’s look at what the NICE guidelines say about exercise:

“Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.”

One important point from this guidance is that NICE recommends a “group exercise programme”. This presents something of a problem for pure manual therapists such as osteopaths and chiropractors as they don’t normally have access to a group exercise programme for their patients. I have already highlighted the fact that osteopathy and chiropractic are no longer first line treatment choices for low back pain and sciatica. NICE have made it clear in their own press release that exercise is the “first step in managing the condition”. The right person to deliver an exercise programme is of course a physiotherapist.

Ultimately, the purpose behind these guidelines is to bring about improvement in care for patients. Views such as “Osteopathy or manual therapy continues to be the treatment of choice for low back pain with the proviso that it is provided with exercise” give an interesting insight into the goals of the osteopathic profession. This statement is far too obviously in conflict with the guidelines to be a mere “misunderstanding”. These kinds of statements appear to be more focused on promoting the businesses of the osteopaths. In so doing, osteopaths seem to have forgotten the most important thing of all: looking after the best interest of their patients.

The new NICE guidelines are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons:

  1. It doesn’t seem to be in the best interest of their patients
  2. They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC.

Osteopathy and Chiropractic no longer recommended as a first line treatment for low back pain or sciatica

If you ask a member of the public what osteopaths and chiropractors treat you will probably get the answer “bad backs”. It is true that most people who go to an osteopath or a chiropractor do so because of back pain. However, the treatments offered by osteopaths and chiropractors are no longer considered to be first-line treatments for low back pain or sciatica. The recently published NICE guidelines for low back pain and sciatica emphasize exercise as being central to the treatment approach.

Manual therapy, such as that provided by osteopaths and chiropractors, can only be considered in addition to an exercise programme. Manual therapy should not be offered in isolation. This is a “downgrading” of the role of osteopathy and chiropractic in the treatment of low back pain as those treatments were previously considered as a valid alternative to exercise. What has brought about this change? Quite simply, evidence. Recent research has shown that osteopathy and chiropractic (manual therapy) are not an effective treatment in isolation for low back pain and sciatica. Any osteopath or chiropractor who recommends their treatments to a patient who is not already following an exercise programme is not following the NICE guidelines. This brings into question whether they are acting in the best interest of the patient.

The right person to deliver an exercise programme is of course a physiotherapist. Physiotherapy is available on the NHS via a referral from a GP. Alternatively, private physiotherapy is available and it’s easy to search for a suitable physio on the Chartered Society of Physiotherapy website.