The Charity Commission consultation on complementary and alternative medicines reveals some “interesting” responses

charitycommissionBetween 13th March and 19th May 2017 The Charity Commission held a consultation about whether an organisation which uses or promotes CAM (Complementary and Alternative Medicine) therapies should be allowed to be a charity. This was prompted by the work of the Good Thinking Society. Although the consultation closed over 12 months ago, The Charity Commission have yet to publish the outcome and have stated that they will do so “in the first half of 2018”. A summary of the feedback received is available on this page and makes for “interesting” reading.

The first thing that’s apparent is that The Charity Commission is surprised by the number and type of responses they received. They say We received over 670 written responses, far in excess of the number usually received for a Commission consultation.” I’m struggling to understand why this was such a surprise. CAM covers a whole range of therapies such as homeopathy, chiropractic, osteopathy, acupuncture, reiki, reflexology, naturopathy and many others. There are a large number of organisations and individuals who have an interest in this area for a variety of reasons. Therefore it’s to be expected that there would be a large response. The Charity Commission also seem surprised by the number of individuals who responded. They say “The majority of responses received were from individuals apparently writing in a personal capacity”. Many individuals have relevant expertise in this area that enables them to usefully contribute to this sort of consultation even if they don’t work for an organisation that itself has an interest. Again, I’m not sure why The Charity Commission finds this surprising.

The Responses

The Charity Commission say “A broad range of opinions were expressed in response to the consultation, some of which clearly are strongly held.” Indeed they are. Some of those responses are reasonable and make logical sense and some, quite simply, don’t.  Reading through the responses gives an interesting insight to some of the highly illogical thinking of CAM providers.

Responses to the first question “Question 1: What level and nature of evidence should the Commission require to establish the beneficial impact of CAM therapies?” include those that think patient testimony is more valuable than scientific evidence. This is, of course, nonsense. It is well known that most CAM practitioners promote their services largely or exclusively based on testimonials. The trouble is that testimonials actually tell you very little about the effectiveness of a treatment and they should therefore not be used as a basis for making treatment decisions. It’s clear that CAM practitioners either lack an understanding of the science behind measuring treatment effectiveness or conveniently choose to ignore it because it conflicts with the weird and wonderful therapy that they happen to provide. The most sensible responses to this question are the ones that align with this “Some responders expressed the view that the evidence to be considered in respect of CAM therapies should be the same in nature as that to be considered in respect of any other therapies. When assessing effectiveness of a therapy this should be done without bias. Therefore the level of evidence required should be the same regardless of the type of therapy. The suggestion by some respondents that “the breadth and/or history of use of a therapy should be used as a measure of evidence is laughable. Should we go back to using leeches as a treatment because it has a long history? Of course not. Science and medicine gradually improves by accepting new treatments that are shown to be effective and dropping those that are shown to be ineffective or where the risk / benefit ratio is not acceptable. Unfortunately, what we are seeing here is the opinion of CAM practitioners and organisations who have failed to reject the things that don’t work and keep misleading people into taking them as “treatments” for a whole range of conditions.

The second question in the consultation was “Question 2: Can the benefit of the use or promotion of CAM therapies be established by general acceptance or recognition, without the need for further evidence of beneficial impact? If so, what level of recognition, and by whom, should the Commission consider as evidence?” This is a really strange question to ask because the only rational answer is clearly “no”. The suggestion that a benefit of any therapy can be established merely because it is accepted or recognised is nonsense. It requires only a basic understanding of science to realise that this is not how treatment effectiveness should be assessed.

The responses to “Question 3: How should the Commission consider conflicting or inconsistent evidence of beneficial impact regarding CAM therapies?” show an astounding lack of science comprehension from some respondents. For instance, some responders urged the Commission to give applicants “the benefit of the doubt”, or to register CAM organisations unless and until their contentions are disproven.” Again, this is simply not how science works. The person or organisation making the claims needs to provide the evidence that they are valid rather than expecting that there should be proof that they are invalid first. This is really the only way that science can sensibly work and an example will help to make this completely clear. I could choose to make the claim that somebody on the planet is able to fly to the moon by flapping their arms. If we have to disprove my claim before it is seen as invalid then we would have to get every single person on the planet to try before we could do so. This is something that is clearly both impractical and very silly. Instead, we should assume that it’s not possible until someone proves otherwise. We can also use science to calculate the amount of force required to leave the earth’s atmosphere and conclude that even to try going to the moon by flapping your arms is an entirely pointless activity. No further research required. If only the same approach was used with CAM therapies, a lot of public money would be saved that is currently squandered on research into things that are completely implausible.

The next question was “Question 4: How, if at all, should the Commission’s approach be different in respect of CAM organisations which only use or promote therapies which are complementary, rather than alternative, to conventional treatments?” Some respondents “questioned whether there is a real distinction between the two categories referred to in this question, or whether it is possible to draw the distinction clearly.” If you study the way that CAM practitioners use their treatments it does indeed become difficult to separate these two things. Regardless of whether the particular type of CAM that a practitioner happens to use is homeopathy, acupuncture, chiropractic, osteopathy or anything else there is a need to believe in the treatment approach. In most cases this is in direct conflict with mainstream medical treatment and science. For instance, homeopaths believe that “like cures like” and that diluting a substance makes it stronger. Osteopaths and chiropractors believe that structure dictates function. Belief in any of these treatment approaches requires the practitioner to reject conventional approaches because it’s simply not possible to fully understand and accept science and medicine and to hold these beliefs. It’s therefore almost impossible for a CAM practitioner to apply their treatments in a complementary manner to conventional treatments. They will inevitably want to steer their patients away from conventional treatments that do not align with their belief system.

For “Question 5: Is it appropriate to require a lesser degree of evidence of beneficial impact for CAM therapies which are claimed to relieve symptoms rather than to cure or diagnose conditions” we have some further nonsense responses such as “Some responders thought that the Commission should assume that a benefit is provided by a particular therapy, unless it can be shown that it is harmful.” This is pretty ridiculous and again is clearly not how science and evidence actually works. Is it really okay to just use dubious unproven treatments on unsuspecting members of the public and continue to do so until harm is shown? Are we supposed to wait until people die or are suffer serious health consequences before putting a stop to a particular therapy? If conventional treatments were developed in the same way then lots of people would die. There is a reason why treatments are carefully developed and researched over a number of years before they start being used in routine care. Many initially promising treatments either turn out not to work that well or have harmful side effects. The same approach should be applied to CAM therapies. Why do CAM providers not want this? It’s very simple, most or all of them would not show sufficient benefit and have too many risks to recommend using them. CAM providers don’t want this research to be done because it would probably signal the end of their business.

Question 6 was “Do you have any other comments about the Commission’s approach to registering CAM organisations as charities?” Like the earlier questions, there are some responses that really make no logical sense. For instance, “CAM therapies are not susceptible to assessment in the same way as conventional treatments.” This is something that a large number of CAM providers claim. They say they don’t have evidence for their treatments because they can’t be assessed in the normal way or because they treat the individual not the condition. This is a complete cop out. With some thought it should be possible to test pretty much any treatment in a scientific and objective manner to see if it is effective. Again, CAM providers are making excuses because they know that when their treatments have actually been assessed they have been shown to be ineffective. This is the case with many CAM approaches that have been around for a long time such as homeopathy, acupuncture, osteopathy and chiropractic. They have actually had significant research carried out on them and the results are spectacularly uninspiring as they show that they have little or no benefit.

One of the answers to this question raises a classic argument from many CAM providers: “A decision which might result in the removal of CAM organisations from the charity register would compromise patient choice.” There are two key points here. Firstly, this consultation is about whether CAM organisations can be eligible as charities. Even if the decision is that they can’t that doesn’t stop CAM providers from existing, just that they can’t be registered as a charity and receive the associated benefits. Secondly, and more importantly, providing patients with a “choice” that includes treatments that don’t work is misleading and unethical. Imagine if you went to a doctor and they said “Would you like to try treatment A that has been shown to be effective or treatment B that hasn’t?” This kind of “choice” is a false balance argument that is absolutely not in the interest of patients.

At the end of the document is a list of organisations that responded to the consultation.  It’s quite the collection of CAM organisations promoting a whole range of weird, wonderful and unproven therapies from homeopathy to reiki to osteopathy to meridian energy to acupuncture. There are also a small number of organisations that provide a more rational view such as the Good Thinking Society and The Nightingale Collaboration.

Conclusion

Charities are required to provide a “public benefit”. The benefit part states “a purpose must be beneficial – this must be in a way that is identifiable and capable of being proved by evidence where necessary and which is not based on personal views” (https://www.gov.uk/guidance/public-benefit-rules-for-charities). Many CAM charities fail this test as they actually promote treatments that have either been shown not to work or that have not been shown to work. I have written about a couple of examples previously: The Sunflower Trust and CORE of Clapton. An excellent article from Michael Marshall of the Good Thinking Society highlights several others. However, this really only scratches the surface and there are a whole range of charities offering unproven “treatments” from the whole spectrum of CAM. When The Charity Commission finally get around to reaching a conclusion from this consultation it is hoped that they will act in the interest of the health and safety of the general public and remove all CAM charities from the charity register.

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Statutory regulation of osteopathy and chiropractic: Protecting the public or legitimising quackery?

In the UK, osteopaths and chiropractors are statutory regulated by the General Osteopathic Council (GOsC) and General Chiropractic Council (GCC). The primary aim of the GOsC and GCC is supposed to be protection of the public. The question is, are they fulfilling this duty or not? Some osteopaths and chiropractors see statutory regulation as a “badge of honour” and use it in the promotion of their businesses. However, this is not the purpose of statutory regulation. It’s supposed to be about patient safety, not marketing.

Misleading Advertising

There are a number of examples of situations where the GOsC and GCC have failed to adequately protect the public. One example is the issue of misleading advertising. Neither the GOsC or GCC have adequately addressed the issue of misleading advertising by their registrants, with many osteopaths and chiropractors continuing to mislead the public. This includes advertisements for potentially serious health problems such as asthma or infections. Members of the public could be seriously harmed by seeing an osteopath or chiropractor for these conditions instead of a medically qualified doctor.

Although the GOsC have issued guidelines to their osteopaths, they have sent a very mixed message to them about the need to comply. For instance, they have failed to take action against osteopaths for misleading advertising instead leaving this to the Advertising Standards Authority (ASA). They have also allowed adverts in their own “The Osteopath” magazine that offer training to osteopaths in the very things the guidelines say they shouldn’t be treating. It’s reasonable to expect that “protection of the public” should include stopping osteopaths from making bogus treatment claims. Unfortunately, the GOsC has completely failed in its duty here. Although HUNDREDS of complaints have been submitted against osteopaths for misleading advertising claims the GOsC has not (as far as I’m aware) taken action against ANY registrant for misleading claims.

In the case of the GCC, they have taken action against a registrant for misleading advertising: http://www.gcc-uk.org/chiropractor-result/?id=33&postcode=&surname=ambrose&pagenum=1 . The GCC gave an admonishment to the chiropractor in question. However, they decided not to provide any higher sanctions as they concluded that the chiropractor “no longer poses a risk to the public”. This sanction seems to be insufficient as the chiropractor continues to use misleading advertising. A single page on her website includes claims about childbirth being harmful to babies, C-sections creating problems in babies, spinal / cranial dysfunction in children and the influence of misaligned vertebrae on hormones: https://www.familychiropractic.uk.com/pregnancy-babies-and-kids/ All of this is complete nonsense. It’s hard to imagine how someone who has these beliefs and is treating patients does not represent a risk to the public.

Handling of Complaints

There is another issue with the way that complaints and fitness to practice cases are handled by the GOsC and GCC. Many cases require one or more experts to provide advice on the suitability of the treatment that has been provided. However, the GOsC often uses an osteopath as an “expert” and the GCC often uses a chiropractor. This is a significant problem because osteopaths and chiropractors are NOT medically trained. If a member of the public complains that the treatment they have received was unsuitable, or even harmful, a chiropractor or osteopath is not well placed to assess whether a patient has actually suffered harm. There are also pseudoscientific beliefs that exist in both osteopathy and chiropractic. For instance, some osteopaths use cranial osteopathy and some chiropractors use craniosacral therapy. However, both of these treatments are based on a concept that doesn’t actually exist  and they have never shown evidence of effectiveness for any condition. When using an osteopath or chiropractor as an “expert” there is the potential for them to hold similar pseudoscientific beliefs. They may therefore conclude that the treatments being used are acceptable when a medically qualified professional would realise that they are complete nonsense.

It’s quite clear that the GOsC and GCC are not adequately protecting the public from the potential for harm by treatment from an osteopath or chiropractor. Instead, statutory regulation has become a marketing tool that is used to mislead the public about the suitability of the treatments offered.

An opportunity for change

The Department of Health are currently consulting on changes to the regulation of healthcare professionals, including osteopaths and chiropractors. Statutory regulation of osteopathy and chiropractic currently lends legitimacy to professions that have pseudoscientific beliefs at their core, without adequately protecting the public. This consultation is an opportunity to address this issue, to remove statutory regulation of osteopathy and chiropractic and to reserve it for those professions that are based on science. Please take the opportunity to have your say.

 

iO Convention 2017: Continuing to train osteopaths in conditions they are not allowed to advertise to treat (as well as other quackery)

I previously highlighted the issues with The Institute of Osteopathy’s Convention 2016 and training being provided to osteopaths in conditions they are not allowed to advertise to treat. Unbelievably, the same thing has happened a year on at the iO Convention 2017. Take for instance the session “Lymphatic treatment during pregnancy”. This workshop focuses on the “physiological changes of the liver functions” and goes on to suggest a link between “impaired lymphatic circulation” and “low back pain, headaches, nausea and constipation”. Now, nausea and constipation are conditions that osteopaths are not allowed to advertise to treat. In the case of headaches, the claims they are allowed to make are very restricted and focused only one specific type of headache: cervicogenic. Why is that? Simply because there is no evidence that the treatments provided by osteopaths are helpful for these conditions.  The training that’s being provided here is clearly in breach of the guidelines issued by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice. What’s really puzzling is why any osteopath would think that they could help these conditions in the first place. It only takes a very basic understanding of the way the human body works to realise there is no way the treatments an osteopath can provide (manual therapy) can possibly have any effect on nausea or constipation. Maybe it’s because osteopaths aren’t actually medically trained at all and they therefore lack sufficient understanding of the way the human body works?

The next workshop at the conference was called “The portal system & natural therapeutics”. It is also focused on the liver and says “Its role in detoxification will be illustrated and how us, as osteopaths may provide suitable adjustments”. Is this actually for real? In the 21st century are osteopaths really suggesting that they can provide manual “adjustments” to affect the function of the liver? This is pure quackery. It’s quite incredible that The Institute of Osteopathy who brand themselves as “the UK’s leading professional membership organisation for registered Osteopaths” can allow this to take place. Far from providing relevant training to osteopaths, this is actually teaching them complete nonsense.

Underlying Osteopathic Principles

The convention also provides training on some of the underlying principles of osteopathy. The session “Applying the Wisdom of A.T. Still” gives some insight into how much of the early development of osteopathy and underlying osteopathic principles conflict with the way the human body actually works. The abstract for that session includes the following (emphasis mine):

Osteopathy was established upon a law of nature unexplained by science – nature’s innate tendency to express health – and therefore he argued that we need a different philosophical framework than scientific materialism for understanding the living being. A philosophy that includes science, but also acknowledges that every living cell possesses an intelligence far greater than our own reasoning faculties.”

So there you have the basis of osteopathy. It was created by someone who thought that “every living cell possesses an intelligence far greater than our own reasoning faculties”. Oh dear. How about the fact that our “reasoning faculties” are made up of these cells? It’s now easier to explain why there are so many problems with osteopathic treatment – it was invented without any understanding of science or how the human body actually works. That’s probably why osteopathy treatment is so ineffective. Even for low back pain, the “home ground” of osteopaths, it’s no longer a first-line treatment.

Awards  

The Institute of Osteopathy gave out several awards during the convention. Unfortunately, they didn’t take much care over the people chosen to receive an award. For instance, the “Principal of the Year Award” was given to James Ruddick of Summertown Clinic. The Summertown Clinic provides a whole host of unproven “treatments” including cranial osteopathy, acupuncture, reflexology and homeopathy. None of these have any basis in science or evidence of effectiveness for any condition. If you dig a bit further into their website you can find a range of gems such as “Babies often greatly benefit from cranial osteopathy as it helps resolve strains from the birth process.” This is very misleading because the birth process does not result in “strains” that need to be resolved via cranial osteopathy or otherwise. The Advertising Standards Authority has already made it very clear to osteopaths that this is a misleading and unproven claim. Choosing one of the main osteopaths from this clinic for the “Principal of the Year Award” shows how deeply entrenched unproven treatments and misleading claims are in the osteopathic profession.

Yet again the iO Convention serves to highlight all that is wrong with osteopathy. If you want to be treated by someone who believes in “treatments” that have no connection with reality then go to see an osteopath. Otherwise, you’d be well advised to look elsewhere.

The Perrymount Clinic in breach of advertising guidelines for osteopathy for babies and children

Rulings - ASA I CAP_ Perrymount Clinic - https___www.asa.org.uk_codes-and-rThe Perrymount Clinic offers a range of different therapies including osteopathy, homeopathy, acupuncture, naturopathy and many others. The “treatments” they offer are mostly pseudoscientific nonsense but that hasn’t stopped them building a business on the back of them. Their website is chock-a-block full of misleading claims in an attempt to lure members of the public into taking the “treatments” they provide. Worryingly, they have a big focus on babies and children.

I complained about the clinic to the Advertising Standards Authority (ASA) which has resulted in an “Informally resolved” complaint. There are plenty of misleading claims on their website that could be raised with the ASA. In this initial complaint, I opted to focus primarily on their claims relating to osteopathy for babies and children as this seems to be the “treatment” that they promote the most. The Perrymount Clinic promotes osteopathy as a treatment for a whole range of conditions in babies and children including:

  • Colic
  • Sleep problems in babies and toddlers
  • Breast feeding / feeding problems
  • Learning difficulties
  • Ear infections
  • Behaviour problems
  • Constipation
  • Other common baby problems

There is no evidence that osteopathy can help with any of these conditions and such claims are misleading and in breach of advertising regulations. The main “treatment” that they use is cranial osteopathy, which as I’ve said previously is pure quackery.

The Perrymount Clinic also suggests that birth is traumatic for babies and that the clinic can provide baby “checkups”. Although this is not an uncommon claim from osteopaths and chiropractors, the reality is that childbirth is not inherently traumatic for babies and does not require “treatment” to “correct” the problems it “causes”. As osteopaths are NOT medically qualified it is completely inappropriate for them to carry out “checkups” on babies. That should instead be left to someone who is medically qualified, such as a paediatrician.

Complaint Outcome

Although my complaint to the ASA has been informally resolved, it’s quite clear that the Perrymount Clinic have not addressed the issues and are continuing to make misleading claims. They seem to have made minimal changes in response to the complaint and have try to excuse their misleading advertising with a disclaimer:

Disclaimer - http___www.theperrymount.com_toddlerhelp.html

This is simply not acceptable and is not a way to get around the advertising regulations.

I can understand why this business are unwilling to modify their advertising as the way that they make money is by misleading the public. If their misleading advertising was removed they wouldn’t have much of a business left at all.

Social Media

Within my complaint I also highlighted the fact that The Perrymount Clinic make misleading claims via social media, as this also falls under ASA’s remit. This includes two Twitter accounts (@theperrymount and @calmingcolic) and on Facebook. See below for an example:

Christian Bates (@calmingcolic) Twitter 11 reasons cranial osteopathy - https___twitter.com_calmingcolic

The misleading claims on social media have also continued in spite of my complaint to the ASA.

Other Issues

Besides their claims relating to osteopathy, The Perrymount Clinic makes numerous other misleading claims. For instance, they say this:

“C-Section and antibiotic use are two of the main causes of an upset, colicky, crying baby. But perhaps more importantly they can both detrimentally affect the FUTURE health of your baby, being a trigger for eczema, asthma, food allergies and even obesity.”

What parent reading this wouldn’t feel scared about the future of their child and contact the clinic for an appointment? The reality is that these claims are pure fantasy. There is simply no evidence that C-Section or antibiotics cause any of these conditions.

Next Steps

Misleading claims in osteopathy are a widespread problem with even the professional body, The Institute of Osteopathy being found in breach of advertising guidelines. The Perrymount Clinic is one of the worst examples I’ve seen of misleading information combined with pseudoscience. It’s quite clear that they do not intend to bring their advertising in line with the guidelines so further action will be required. Watch this space!

Institute of Osteopathy in breach of advertising guidelines

Rulings - ASA I CAP_ - Institute of Osteopathy https___www.asa.org.uk_codes-and-rThe Institute of Osteopathy promotes itself as “the UK’s leading professional membership organisation for registered Osteopaths.” As a professional membership organisation you would expect the Institute of Osteopathy to set an example to their member osteopaths. Unfortunately, they don’t. The Good Thinking Society has conducted a long campaign to try to tackle the many misleading claims in osteopathy. Rather than setting a good example about the promotion of osteopathy, the Institute of Osteopathy’s website was clearly in breach of the Advertising Standards Authority (ASA) guidelines. This has resulted in a recent “Informally resolved” complaint to the ASA. Specific issues raised in the complaint include claims about treating “unsettled children” and the use of osteopathy to improve immune function and for sleep problems. Osteopathy is not effective for any of these things and the Institute of Osteopathy should have known better than to make such misleading claims. Things get worse for the Institute of Osteopathy, however. Rather than undertaking a review of their entire site and ensuring that it complies with the guidelines, they instead just corrected the specific items raised in the complaint. There are other areas of their site that don’t comply with the guidelines and they also make unsubstantiated claims on social media. They are therefore at risk of further complaints. Like much of the osteopathic profession they represent, they clearly think it’s perfectly okay to mislead patients into undertaking unsuitable treatments. It isn’t.

It’s also interesting that the Institute of Osteopathy provides guidance on their website that conflicts with that provided by the regulator (the General Osteopathic Council (GOsC)). The GOsC have made it clear to osteopaths that they need to be able to substantiate any claims they make both in their advertising and when discussing treatment options with patients. The Institute of Osteopathy have taken a different approach and state on their website that the guidance “does not restrict your clinical practice or verbal communication with your patients.” They seem to be suggesting that osteopaths can continue to mislead patients when they speak to them outside of advertising. This is clearly unacceptable and it’s not smart of the iO to provide advice that conflicts with guidance from the GOsC. The Institute of Osteopathy goes on to say “It is only by collating the experiences of osteopaths’ targeted that we are able to determine how best to defend the profession from this campaign.” It should be noted that the iO are very clearly focused on the benefit of osteopaths here. They haven’t given any consideration to patients at all, which is what this “campaign” is really all about: protecting patients from misleading treatment claims by osteopaths.

 

Making a complaint to the ASA

It is relatively straightforward to make a complaint to the Advertising Standards Authority (ASA). Just fill out the form on their website: https://www.asa.org.uk/make-a-complaint.html. The Nightingale Collaboration also have an excellent guide on how to find and challenge misleading claims: http://www.nightingale-collaboration.org/making-a-complaint.html. They also have specific guidance on making a complaint to the ASA: http://www.nightingale-collaboration.org/making-a-complaint/who-to-complain-to/advertising-standards-authority/how-to-submit-a-complaint.html

UK Health Centre: Misleading information about osteopathy – an Advertising Standards Authority (ASA) complaint

Core Health Rulings - ASA I CAP_ - https___www.asa.org.uk_codes-and-rulings_rulings.htmlI have previously highlighted the many misleading claims about complementary and alternative medicine on the UK Health Centre website. The website is owned by Core Health Ltd and they provide misleading information about osteopathy, chiropractic, acupuncture, homeopathy and herbal remedies. The information they provide is misleading the general public and has the potential to cause people to take unsuitable treatments. In the interest of public safety I therefore reported UK Health Centre to the Advertising Standards Authority (ASA). In this initial complaint I focused on their claims relating to osteopathy. The complaint was “informally resolved” because Core Health Ltd provided the ASA with assurance that they would “remove claims that osteopathy can treat conditions outside of those the ASA has seen evidence it can assist with”. Regardless of the assurances they may have given the ASA, Core Health Ltd have definitely NOT brought their site in line with the guidelines. The UK Health Centre website continues to promote 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 and illness
  • Improving the immune system
  • Increasing the efficiency of nerve supply
  • Insomnia
  • Low energy
  • Growing pains
  • Dysmenorrhoea (period pains)
  • Recovery from childbirth
  • Common infant problems (including colic, sleep problems)
  • Monitoring baby’s growth and development
  • Improving cognitive function
  • Visual and hearing impairment

If you compare this list with the one from my previous article you can see that rather than removing the conditions that osteopaths may not advertise to treat they have actually added more!

Osteopathy as a “Preventative Treatment”

They also continue to recommend osteopathy as a “preventative treatment”. Preventative treatment is very attractive to osteopaths because it provides a way to keep patients coming back over a long period of time even if they have no current medical problems. This issue is highlighted by other authors such as Edzard Ernst . From a patient perspective, there is no reason why they should attend for preventative treatments and osteopaths are misleading them by suggesting otherwise. Let’s be really clear about this: there is ZERO evidence that osteopathy prevents anything and the only person who benefits from preventative treatments is the osteopath (and their bank balance).

Systemic Problems in UK Osteopathy

Core Health Ltd are clearly reluctant to remove their misleading advertising claims. This actually gives us an insight into the behaviour of UK osteopaths. Osteopaths should not be treating any of the conditions highlighted above because osteopathy has not been shown to be effective. If all osteopaths were complying with the regulations then there would be no incentive for Core Health Ltd to keep advertising these treatments. The fact that they are so keen to keep this misleading information on their site indicates that there must be osteopaths who are willing to carry out these treatments. Yet again this highlights the serious problems with the UK osteopathic profession. They are continuing to “treat” patients when it is entirely inappropriate for them to do so.

There is clearly a lot more for Core Health Ltd to do to bring their site in line with advertising standards for osteopathy. As I highlighted in my previous article osteopathy is only one of several areas of complementary and alternative medicine where their site makes misleading claims. Watch this space for more updates over the coming months!

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.