Foundation for Paediatric Osteopathy Conference 2017: Osteopaths embracing quackery

quackeryThis weekend (8th and 9th April 2017) it’s the Foundation for Paediatric Osteopathy Conference. The osteopathy profession in the UK currently has major issues with many osteopaths making misleading claims about what they can treat in order to lure patients into their practices. I have previously highlighted that this problem also exists with some of the training being offered to osteopaths. The Foundation for Paediatric Osteopathy Conference seems to be taking this misleading training information to a whole new level. Talks at the conference include:

  • “Osteopathic Support of the Immune System in Infancy and Childhood”
  • “Special Aspects of Treating Unborn Babies”
  • “Vaccination – the Science”
  • “The Immunity Spiral – How being ill can make kids better”

You will notice that there is a focus in the above talks on medical care and treatments. In the UK, osteopaths are not licensed to practice medicine so they have no business doing anything to do with the immune system, vaccination decisions or, heaven forbid, treating unborn babies! All of these are things that should be handled by medical professionals and osteopaths shouldn’t be learning about them. With regards to the immune system, there is no evidence that any osteopathic treatment can help the immune system. “Osteopathic Support of the Immune System” is therefore a fallacy.

The talk about “Vaccination – the Science” is particularly interesting. It’s being given by Dr Jayne Donegan who, from her website, appears to be anti-vaccination. She is also a homeopath and recommends it for a range of different conditions including bruising and shock, burns and scalds and fever management. Homeopathy isn’t effective for any of these conditions, or anything else for that matter. She supports disgraced doctor Andrew Wakefield who wrongly claimed that the MMR vaccine can cause autism. Oh dear. It is well known that some alternative medicine practitioners recommend against vaccination. Might this talk result in more osteopaths becoming anti-vaccination? That can’t be a good thing for the health of their patients or the public as a whole. After the talk, the Foundation for Paediatric Osteopathy posted this on twitter “Dr Jayne Donegan inspired us about how to treat acutely ill children, and boost immunity naturally”. It’s quite incredible that osteopaths are being offered training in treating acutely ill children. Acutely ill children need proper MEDICAL help from a DOCTOR not quackery from an osteopath. They certainly don’t need their immune system “boosting naturally”.

The Foundation for Paediatric Osteopathy has recently been the subject of a complaint to the Advertising Standards Authority due to making unsubstantiated claims about the effectiveness of osteopathic treatment for babies, children and pregnant mothers. This complaint was informally resolved after they updated their website. However, they still do not comply with the guidance and continue to make misleading claims. This includes suggesting that osteopathy can help babies “recover from delivery” and treat indigestion and heart-burn in pregnant mothers. There is simply no evidence to support osteopathic treatment in these situations. They also suggest that babies would benefit from an “osteopathic check-up”. Babies receive perfectly adequate checks in the hospital after they are born and are subsequently monitored by health visitors. Osteopathy has no place in this and osteopaths are not the right people to be carrying out checks on newborn babies. By suggesting otherwise, osteopaths are blatantly misleading parents. Through their conference, the Foundation for Paediatric Osteopathy are now providing training to other osteopaths in the very things that they shouldn’t be treating and therefore spreading this misleading information more widely. Other authors have written about how osteopathy is closely linked with pseudoscience. Conferences like this suggest that osteopathy is fully embracing quackery.

Osteopaths seem to be continuously trying to widen their scope of practice, presumably to increase their income. However, by trying to move into areas that they have no skills and for which their treatments are not effective they are putting their own income ahead of the needs of patients. This is a dangerous game and in the long-term can only be harmful to the reputation of the profession.

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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.

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.

UK Osteopaths advising on choice of medication: A potential risk to patients

medicationUK osteopaths are not medically trained and are not licensed to prescribe medication. You wouldn’t therefore expect an osteopath to advise patients on choice of medication. However, that’s exactly what they are being trained to do. On 17th March, the British School of Osteopathy are running a training course “Pain and Pharmacology”. Within the description of this course it states “This course will give delegates the opportunity to increase their knowledge and confidence of pharmacology and pain control medication. The course will discuss assessing and treating patients with poorly controlled pain, with advice and education on safe and effective pain control medication selection.”

It seems quite ridiculous (and potentially dangerous) for an osteopath to provide advice to patients on choosing medication as they are not qualified to do so. If an osteopath is asked about medication by one of their patients they should refer them to a suitably qualified MEDICAL professional – usually their GP.

Much like their recent interest in exercise, osteopaths yet again seem to be trying to offer services that are outside of their expertise. The core treatments provided by osteopaths are no longer considered to be first-line treatments for many of their patients. This recent move to try to widen their services appears to be a desperate attempt by a profession to justify its existence. Osteopaths should be sticking to their core treatments in which they have expertise. After all, what really matters is improving care for patients. An osteopath advising on choice of medication is completely inappropriate and can’t be in the patient’s best interest. If you need advice on choice of medication, are concerned about side effects or need other medical advice please see your GP. Do not place your health at risk by taking advice from an osteopath.

 

Should osteopaths provide an exercise program? (Part 2)

weight-trainingThis is a follow up to one of my previous posts: Should osteopaths provide an exercise program? This generated some interesting discussions on twitter with some osteopaths accepting that exercise programming isn’t something they are routinely taught and others claiming that osteopaths are well placed to offer an exercise program. One of the points made is that it’s the skill and experience of the individual therapist that really matters. That’s a valid point as, within any profession, some people are more skilled and experienced in a particular area than others. However, this presents something of a practical problem. It is difficult for many members of the general public to assess the training and qualifications of a professional offering an exercise program. It’s therefore important to have some guidance available so that members of the public are not misled into being given an exercise program by someone who lacks the qualifications and expertise to provide it. This post provides some clarification on whether osteopaths are well placed to provide an exercise program or not.

The National Council for Osteopathic Research (NCOR) produced a report that profiles day-to-day osteopathic practice. This report identifies the different types of treatments used by osteopaths in their first and subsequent appointments with patients. Less than 1 in 4 appointments involved exercise. In contrast, nearly 3 in 4 appointments involved articulation and a similar number involved soft tissue treatment. Approximately 1 in 3 appointments involved HVLA thrust. Osteopaths therefore used manual therapy (hands on) techniques much more than they used exercise. When someone practices a particular skill or technique frequently they usually become better at it. As most osteopaths use manual therapy more than exercise it is therefore very likely that they are also more skilled in manual therapy than exercise. It is also not clear what proportion of those appointments that did include exercise actually resulted in a suitable personalised exercise program.

Elsewhere in the report it is stated that “A high proportion of osteopaths have documented that they are recommending exercise to patients. Little work has been undertaken in this area which is not formally taught in all osteopathic educational institutions.” and “Investigation of the exercise regimes/advice being offered by osteopaths would be a helpful area of investigation. The inclusion of exercise in the management of patients is notably present in many clinical guidelines. It is important that the advice and recommendations by osteopaths are not only evidence based but appropriate and effective for patients.” The National Council for Osteopathic Research (NCOR) therefore recognises that there is a lack of evidence of the suitability and effectiveness of exercise advice provided by osteopaths.

You may be wondering why osteopaths are suddenly taking such an interest in exercise. That’s because osteopathy is no longer considered to be a first-line treatment for low back pain or sciatica. Treating “bad backs” is what osteopaths are known for and makes up a significant proportion of the patients seen by most osteopaths. The new NICE guidelines therefore put the businesses of many osteopaths, and potentially the profession as a whole, under threat. Osteopaths are therefore trying to tackle this issue by adding exercise programming to the services they offer. Most osteopaths don’t receive training in exercise nor do they use it routinely as part of their current practice. It therefore seems unrealistic to expect that they can suddenly become skilled in providing an exercise program to their patients. In the February / March edition of The Osteopath, the NCOR suggest that osteopaths could form a working relationship with a local exercise or movement specialist as a means of providing an exercise program to their patients. In that situation, wouldn’t the patient be better off just seeing the exercise specialist and not bothering with the osteopath at all?

Whilst it may be possible to find an individual osteopath who has taken specialist training in exercise programming and uses it regularly as part of their practice it is quite clear that these individuals are not commonly found within osteopathy. Osteopaths are primarily manual therapists and use mostly manual therapy techniques. The suggestion that osteopaths are well suited to help someone get started with an exercise program, teach the exercises correctly and progress the exercise program is therefore misleading. Most osteopaths lack the skills or experience to do this. If you need help with an exercise program please make sure you see someone who is suitably qualified in this field. As I made clear in my previous post on this subject it is physiotherapists who are more routinely trained in exercise programming rather than osteopaths.

30,000 People Visit an Osteopath Every Day, But Should They?

One figure that’s often quoted by osteopaths when promoting their services is that 30,000 people visit an osteopath in the UK every day. However, we know that misleading patients and the general public is widespread within the profession. This means that some of those 30,000 people will have been misled into having a treatment that was unsuitable for them.

The people who are misled into having an unsuitable osteopathic treatment include:

  1. Anyone with a condition that is not on the “allowed” list.
  2. Any pregnant woman, baby or child who is misled into taking treatment by information in conflict with the ASA guidelines
  3. A significant number of people with low back pain or sciatica as osteopathy is no longer a first-line treatment.
  4. Anyone who has a “preventative” or “maintenance” osteopathic treatment. There is no evidence that either of these is effective.

It’s impossible to quantify how many of the 30,000 people who visit an osteopath every day are misled into doing so. However, there are a large number of conditions that osteopaths CANNOT treat. Osteopaths also treat more people with back problems than any other condition and their treatments are no longer a first-line option for these people. It therefore seems likely that a significant proportion of the people who visit an osteopath every day have been misled into doing so.

The next time you are told that 30,000 people visit an osteopath every day, just remember that a significant number of them should not have done so.

Should osteopaths provide an exercise program?

weight-trainingSome osteopaths include exercises as part of their treatment approach. The Institute of Osteopathy has recently taken this up a notch suggesting that osteopaths are well suited to help someone get started with an exercise program, teach the exercises correctly and progress the exercise program. We know that misleading claims in osteopathy are widespread. Is this yet another attempt by the osteopathic profession to get people to pay for their treatments without considering what’s actually best for the patient? Or do osteopaths really have the expertise to provide an exercise program?

Osteopaths are primarily manual therapists and it’s actually physiotherapists who are the professionals most associated with using exercises as part of their treatment approach. We therefore compared the undergraduate training for osteopaths and physiotherapists to better understand which profession is best placed to provide an exercise program.

Osteopathy and Exercise

There are relatively few institutions that provide undergraduate programmes for osteopaths. A complete list is available here. We reviewed the syllabus for three of the organisations on the list:

None of the undergraduate programmes above provide any training on exercise. This immediately brings into question whether an osteopath should provide an exercise program. They haven’t been trained in exercise or exercise programming so it doesn’t seem like they are well placed to do this.

Physiotherapy and Exercise

There are a large number of Universities that provide undergraduate programmes for physiotherapists. As a comparison to the three organisations providing osteopathy training above, we reviewed the syllabus for three programmes for physiotherapists:

The Right Professional to Provide an Exercise Program

Of the undergraduate training programmes reviewed, none of those for osteopathy provide any specific training on exercise. This isn’t actually surprising as osteopaths are primarily manual therapists not exercise specialists. They therefore receive most of their training in manual therapy rather than exercise. In contrast to osteopathy, all of the undergraduate training programmes for physiotherapy reviewed above included specific modules on exercise. This suggests that physiotherapists receive more direct training in exercise programming and are therefore better placed than osteopaths to provide an exercise program for their patients.

It’s actually quite concerning that the Institute of Osteopathy have suggested that its members can provide exercise programming and technique advice when osteopaths do not receive training in this area. An osteopath providing an exercise program is rather like an electrical engineer designing a bridge. They might have more idea of the general engineering principles involved than a member of the public but there’s a very real risk that the bridge might fall down! In the same way that bridge building should be left to civil engineers, exercise programming and technique should be left to professionals who specialise in this area and that is physiotherapists. 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.

Regular exercise is, in general, a very good idea. If you need help with an exercise program please make sure you see someone who is suitably qualified in this field. That would be a physiotherapist and NOT an osteopath!