Last weekend I wrote a skeptical overview of osteopathy, how it was generally seen as a mainstream healthcare option but was actually born of pseudoscience, and how, even though modern evidence has pushed back many of its original wild claims, it is still rooted there and has at least one foot fully planted in the world of complimentary and alternative medicine (CAM). You can read part 1 here.
As part of my research I had started to survey a number of osteopaths’ websites within my own home county, and used that data to show the field’s continued connection to unevidenced CAM. As a result I received more than one criticism that I had cherry-picked osteopaths who were on the fringes of the field, and that mainstream osteopathy was scientific and well-researched medicine.
With that in mind I decided to continue my review and spend the rest of (coincidentally) International Osteopathic Healthcare Week (17-23 April 2016) surveying the websites of 100 randomly chosen osteopaths in the UK and Ireland, to see just how much pseudoscience remained within the profession. Is it fringe?
Obviously, this is not a scientific study, I can only claim it is a careful review. I used only declarations published on the websites (as they appeared in April 2016) and took them at face value. The websites were selected using a random number generator and the General Osteopathic Council’s own online register of members.
The majority of osteopaths practice in the south, so the randomly selected websites come from four southern counties (ten each from West Sussex, Dorset, Surrey and Devon), two midland (not Midlands) counties (ten each from Staffordshire and Suffolk), two northern counties (ten each from Yorkshire and Lancashire), and then ten from Scotland, six from Wales, and four from Ireland. If a random number selected a GOC register entry with no website (or a dead link), I continued down the register until I hit the next entry with a working website.
To check for pseudoscientific claims I picked four criteria:
i. the claim that osteopathy allows the body to ‘heal itself’;
ii. the practice of cranial osteopathy;
iii. the claim that osteopathy can treat specific conditions not related to the musculoskeletal system;
iv. whether an osteopath also personally uses another CAM therapy as part of his or her treatment system.
Let’s look at these in more detail …
The claim that a therapy aids the ‘self-healing’ process is a recognised red flag of pseudoscience and one that osteopathy shares with other CAM treatments such as chiropractic, naturopathy, homeopathy, reiki, therapeutic touch, energy healing, reflexology, acupuncture … and I could go on and on. It’s pretty much the central refrain of most quackery, and is perfectly placed to take credit for conditions that are temporary, that regress to the mean, or that appear to react to various placebo factors. The best evidence for this kind of self-healing is the least reliable: post-treatment anecdote.
The philosophy of Andrew T. Still, the founder of osteopathy, stated that the human body is perfect and contains within it everything needed to self-heal, and that the only impediment to this is if bones or nerves cause an obstruction to the free-flow of the body’s “fluids of life”. Osteopathic manipulation, he asserted, can be used to clear the obstruction and allow the body to return to its natural state of self-healing.
While it has been tempered slightly, this philosophy remains at the core of osteopathic medicine, often accompanied by a statement saying that no drugs or surgery are needed – it’s ‘natural healing’. Here’s how the World Health Organisation defines osteopathy:
“Osteopathy is grounded in the following principles for treatment and patient management:
i. the human being is a dynamic functional unit, whose state of health is influenced by the body, mind and spirit;
ii. the body possesses self-regulatory mechanisms and is naturally self-healing;
iii. structure and function are interrelated at all levels of the human body“
In my survey of 100 randomly selected osteopath websites, 57%, just over half, explicitly stated that osteopathic treatment aids the body’s own innate self-healing mechanism.
I did not count those that alluded to the idea but weren’t explicit, eg. “osteopathy is based on the principle that the body has the ability to heal”. No one can deny that, but the question is whether money is paid for a treatment that actually aids that process, whether it would have happened anyway, or even if it would have happened more quickly without treatment.
The greatest danger with the CAM definition of ‘self-healing’ comes when it is applied to the many serious and semi-serious afflictions that do not normally obey this supposed universal rule of ‘natural healing’.
ii. Cranial osteopathy
I discussed cranial osteopathy (also known as craniosacral therapy) in part 1, but, briefly, it’s based on the belief that tiny pulsations can be felt with the fingertips and can be gently manipulated to ‘release restrictions’ and promote health.
In my survey of 100 randomly selected osteopath websites, 70% said they offered cranial osteopathy as part of their treatment services.
It was especially pushed as being beneficial for babies and children, with many setting no lower limit on age – often explicitly stating “from birth” or “from a few days old”. One website said “osteopaths believe all babies should be routinely checked after birth”. (Out of interest, only 2% of osteopathic practitioners reviewed stated they would not see babies).
And whereas general structural osteopathic manipulation focussed predominantly on conditions related to the musculoskeletal system, cranial therapy had much fuzzier claims made for it, often relating to general health and unsettled babies (eg. 19% said it could help with colic).
iii. Treatment of conditions unrelated to the musculoskeletal system
The NHS website proclaims that there’s …
“good evidence that osteopathy is effective in treating persistent lower back pain* … there’s currently no good evidence that osteopathy is effective as a treatment for health conditions unrelated to the musculoskeletal system (bones and muscle).”
(*Many osteopathy websites cite NICE’s 2009 guidance that suggested this positive outcome for early lower back pain, but in March 2016 this advice was updated to say that manual therapy should not be used on its own due to a lack of evidence.)
About this time last year, the Good Thinking Society investigated a number of websites that claimed osteopathy could treat a variety of non-musculoskeletal conditions, including colic, asthma, dyslexia, and many more. After a number of complaints made to the Advertising Standards Authority (ASA) this eventually resulted in a directive from the General Osteopathic Council suggesting that their members check their claims were in line with those advised by the Committee of Advertising Practice (CAP).
While the profession has reigned in many of the wilder claims on their marketing, osteopathy still sees itself as a ‘holistic’ treatment that can tackle a plethora of human disabilities and illnesses.
In my survey of 100 randomly selected osteopath websites, 61% claimed to be able to help with specific conditions that were unrelated to the musculoskeletal system. These included various digestive problems, asthma, colic, ME and Chronic Fatigue Syndrome, eye and ear infections, haemorrhoids, post-natal depression, boosting the immune system, menstrual problems, insomnia and more.
In the light of the CAP guidelines, there were some interesting statements. The majority of websites included a list of CAP-approved conditions, rounded off with “plus many more” (such generalisations were not counted in my survey). Some were more brazen …
“Osteopathy can help with many other conditions. If your symptoms are not listed, please telephone to enquire whether osteopathy might be effective for you.”
Another alluded to the ASA directly …
“The Advertising Standards Agency will only allow osteopaths to mention conditions where the efficacy has been proven by large-scale clinical trials. This data is not available for many conditions that patients report improvement in, so they may not be mentioned here.”
While another said …
“There is no statistical evidence it [osteopathy] can treat conditions such as asthma, colic, IBS, painful periods. However, there is plenty of clinical and anecdotal evidence suggesting it can.”
One even stretched his hand into the world of conspiracy theories …
“Most clinical trials are funded by drug & pharmaceutical companies, and osteopaths do not have prescribing rights for drugs. As a result data is not currently available for a lot of the conditions that our patients report to have improved, and so we cannot mention them here.”
Although I only looked at four osteopathic clinics in Ireland, these made some of the most far-fetched claims and were out of the jurisdiction of the ASA, including some bold statements about the treatment of autism, cerebral palsy, dyslexia, Down’s Syndrome, fertility and immune difficulties due to ‘post vaccination’, to name a few.
Concerning vaccines (excuse this short detour into another personal interest), while it is by no means a mainstream osteopathic view, the founding philosophy of osteopathy was anti-vaccine. On his website, one UK osteopath states …
“not only does immunisation directly oppose our [osteopaths] principles, it is a key point on how our principles supersede others. Immunisation is a slow poison.”
Another UK osteopath uses the shield of ‘I’m not anti-vaccine, I’m pro-choice’, before stating “often, it is the family that has vaccinated and has lived through the horror of vaccine damage unfolding within their family, that precipitates a change in their choices”.
The British Institute of Osteopathy also has an ‘interesting’ view on vaccines, strongly suggesting you have a choice whether to vaccinate or not and then spending some time adding weight to the ‘not’, in particular by linking to the website of ‘vaccine-concerned’ homeopath, Jayne Donegan, not the only osteopath I found to do so.
Thankfully, these are outliers, and the vast majority of UK osteopaths accept the science, the safety, and the benefit of vaccination.
iv. Osteopaths who use other CAM therapies
While this category does not address the field of osteopathy directly, it does, I believe, say something quite strongly about the mindset and philosophy of the practitioner in question. It is an interesting marker of how much store they set in science-based medicine, and perhaps how much they are happy to wallow in pseudoscience.
In my survey of 100 randomly selected osteopath websites, 48%, almost half, had practitioners who personally practiced and offered another CAM therapy. The majority of these were acupuncture, but they also included naturopathy, homeopathy, reiki, ear candling and even magnified healing and Bach flower remedies.
While just 29% of websites surveyed seemed to show they practiced osteopathy alone with no other CAM available in their clinic, 71% practiced in clinics where other CAM was available, either from themselves or from fellow clinic tenants. Many presented this as having the advantage of quick referral to one of the other CAM therapies as part of an ‘holistic treatment’.
In relation to children, one osteopath said “I may suggest using homeopathic remedies. These are harmless, have no side effects and can be extremely helpful.”
Another had a different source of healing power … “God’s values and principles will underpin your treatment session”.
To sum up
• 57% of websites in the survey published the ‘self-healing’ claim;
• 70% publicised the fact they offered cranial therapy;
• 61% made a claim to treat one or more specific ailments not related to the musculoskeletal system;
• 48% of practitioners also personally offered another CAM therapy – with 71% of all sites surveyed located in a setting where other CAM was immediately available.
All in all, 93% of the randomly selected websites in my survey checked at least one, often more, of these criteria for pseudoscientific claims, concluding that they are far from existing only on the fringe of osteopathic practice.
The average price for treatments seemed to be around the £40 mark, with hour-long initial consultations being more expensive than the subsequent half-hour regular treatments.
And while the FAQs often indicated a finite number of sessions were required to bring the patient back to a ‘state of balance’, there was also a strong suggestion that clients should continue with regular treatments, or ‘MOTs’, to prevent old conditions from resurfacing, and to forestall new ones from emerging. As one website put it …
“Who needs an Osteopath? Potentially everybody, of any age!”
See part 1 here.
Notes: A good follow-up by Professor Edzard Ernst can be read here.