Calling all osteopaths – Ignore research at your peril

I received in my inbox today a message from the lovely Georgina Leelodharry.  She was reminding members of iO to make no unfounded claims for our treatments.  It appears that the Good Thinking Society is checking up on the accuracy of osteopaths’ claims about treating children.  This is not a bad thing and shouldn’t concern us if we explain clearly and carefully to prospective patients what we do.

I always explain that we cannot guarantee results, and whatever the symptoms or conditions, what we are really doing is improving the function of the physical body.  We do this by resolving physical strains, releasing tight areas, encouraging movement where there is stiffness, reducing torsion in twisted tissues.  We hope that this improved physical state will have an effect on symptoms.  Obviously some conditions are more likely to respond to that type of treatment than others.  I would have a higher expectation that tension headaches or asthma or whiplash would respond to osteopathy, than measles or meningitis where I would not expect to alter the course of the disease.  However for doctors and patients who are used to having a targeted treatment for a targeted condition, (i.e. this drug works for asthma, that one for TB), the notion of a therapy just making your body feel better regardless of the condition sounds hopelessly vague and woolly.

The Good Thinking Society was set up by Simon Singh to “encourage curious minds and promote rational enquiry”.  I suppose it harks back to the days of the Enlightenment, when the Royal Society was in full flower, and Robert Hooke and Christopher Wren earnestly discussed their latest experiments in bustling coffeehouses in the heart of London. However the emphasis in the Good Thinking Society seems to be to stop the practice of alternative medical therapies with no solid scientific basis.  While I don’t particularly empathise with the tone of their investigations, I do sympathize with some of their objectives.  They share my frustration with the lack of scientific thinking in alternative medicine.  At a conference recently I attended a lecture by a lady from Germany, who seemed utterly charming and sincere.  She presented a machine which she said scanned and treated the body’s electromagnetic field (or something like that.)  She told us some miraculous stories, firstly of how it helped her son recover from a serious illness.  She then showed us images of incredibly speedy recoveries of burns victims. The pictures were impressive but seemed to lack any context.   I couldn’t fault her enthusiasm or passion, but where were the numbers?     I just couldn’t trust her, nor her machine, based on anecdote and sentiment alone, however powerful.

I am a fan of scientific enquiry.  In my kitchen we have a chart on the fridge with four columns:  time of leaving for school, route to school (via Olive or Sackville Rd), weather conditions, and time of arrival at school.  As  a result of this I now know it takes an average of 23.45 minutes to get to school.  It doesn’t matter which route I take.  It is unaffected by the weather or the time we leave.  The shortest journey time is 18 minutes; the longest 28.  I prefer to know this, rather than to guess.  I  previously thought it was a 20 minute journey, and was quicker if I left early (it was not), if it was dry (it was not), and if I drove via Olive Rd (wrong again).  Our intuition is fallible, and even assumptions based on common sense cannot be relied upon.

I became an osteopath because of the incredible benefit I received as a patient, when doctors had totally failed to diagnose or treat my low back pain.  I need no convincing that osteopathy “works”, because I know it beyond any doubt through my personal experience.  However I expected the training to teach me how to do it with a bit more certainty than it did.  I still remember the confusion of the class when halfway through year 1 we were told that nobody knew for sure whether manipulation made disc prolapses better or worse.  What?  Why don’t they know?  Not enough research. But how will I know whether to do it if someone comes in with a disc prolapse?  Quite.  You won’t.  And then let’s get onto cranial.  Talk about the elephant in the room.  I think cranial is the true target of the skeptics, and who can blame them?

Cranial osteopathy was the real reason I got into osteopathy.  Yes the massage and manipulation did help my back I’m sure, but I could tell that the cranial side of treatment was the truly life-changing stuff.  I couldn’t wait to learn to do it myself.  Something that is so gentle you can’t feel the practitioner doing anything, but so powerful it could lift headaches untouched by solpadeine.  I could sometimes feel my body adjusting itself for a day after treatment, and with it my mind and my feelings.  We didn’t get to cranial until our final year, when it was regarded even by the osteopathic college as a slightly weird, optional add-on.  We didn’t even have to pass an assessment in it.  I couldn’t really understand the theory behind it.  I can put my hand on a sacrum and drive cerebrospinal fluid up to the skull?  Really?  I could compress the fourth ventricle?  Through the occiput?  How?  I was certain that someone out there knew what they were doing and one day would be able to explain it to me.  I went into practice and got pretty good results using this cranial approach, alongside the more physical techniques.  I volunteered one day a week at the OCC, where most of the osteopaths worked for nothing but the learning was worth its weight in gold.  There was an infectious passion and a dedication in the air, and my palpatory skills and confidence grew.  I would get a startling, vivid sensory impression of a twisted falx, or an electrical impulse in the ventricular system, or the dura releasing around the spinal cord.  But still I struggled to find a consensus on how this whole thing worked. And where were the stats?  We treated huge numbers of children for all sorts of things.  Couldn’t we write down our results?  How did we know what we were most effective for?  How could we be sure that the changes we felt under our hands were translating into improvements for the children?

Research is essential now, I think.  There are some promising new shoots.  But I still don’t understand the reluctance of osteopaths, particularly in the cranial field, to fully engage with this issue.  Skeptics would say that they are trying to make sure that we are not ripping off unsuspecting members of the public, and that is not an unworthy aim in itself.  But they don’t understand what we do and how we benefit so many people.  Has anyone looked at the kind of things you read if you look up cranial osteopathy on the web?  It sounds like baloney.  It’s hard enough to assure some patients and their parents that you are actually doing something, while you are staring into space with hands totally static, without having to contend with an almost total lack of evidence and a small but vocal group of scientists doing their best to demonize you as deluded at best and a charlatan at worst.

What is one thing that osteopaths need?  Confidence.  Not the misplaced confidence that comes from blind faith, but the confidence that comes from being able to point to a study that says, look, of 100 children we treated who have asthma, this number had this measurable outcome.  I know this is not universally popular, but as an osteopath of nearly 20 years in practice I am still not sure why.    I do think there are reasons why cranial osteopathy faces difficulties in its research, but let’s be open and transparent about those.  Keeping our heads under the radar isn’t working.  We’re on the radar and we need to speak up for ourselves. The skeptical community contains some incredibly sharp, bright and agile minds.  In my optimistic view, it could be a great ally.  We are making tentative moves into somehow integrating this 19th century alternative model of healthcare into this evidence-based, science-dominated 21st century medical system.  It’s not easy for those two vectors to converge.  Maybe if we are less defensive to those critics,  they will see not only that our motives are pure and our minds are clear, but that this is an exciting and groundbreaking field.  They will join forces, or at least give us some valuable help and guidance.  What’s wrong with a dialogue? The way I see it, we are the Isaac Newtons and Galileos of our age, not the flat earthers nor the snake-oil salesmen.  We have curiosity, we have commitment and we have inspiration.  We just need a bit more of the rational enquiry.

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6 thoughts on “Calling all osteopaths – Ignore research at your peril

  1. Pingback: What exactly happens at a meeting of the General Osteopathic Council? – I went along to see | osteofm

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