and on the hottest weekend of the year, delegates arrive for a weekend of Enquiry, Research and Evidence in the air-conditioned splendour of Wokefield Park, Reading
Some years ago I attended the Hidden Treasures Conference held by the Sutherland Cranial College of Osteopathy – a conference promising to showcase the state of play of research in the cranial field. At last! I so looked forward to being able to return to my practice with that added confidence that some robust data would give me. Well, the event was phenomenally well attended, and felt like the herald of a new dawn. Which, indeed, it was. It felt like the start of the recognition that a research culture would be good, if not essential, for this most subtle end of osteopathic practice. I was impressed by the intelligence in the room, and the dedication and practical skills of the osteopaths present, however a bit underwhelmed at the actual amount of published research. I had previously assumed it was there, somewhere, hiding in the corners of publications. I presumed someone was doing it. Well, a few people were, and what they had produced was very decently executed; but the “hidden treasures” tended to be small studies. In terms of what we had to show to critics, (and those of us who like a bit of hard, objective data to back up what we do), well, we needed a bit more.
At this most recent conference, the rush of positive energy seemed to have developed into a more mature, and focused feel. There were fewer people here this time, maybe because the emphasis was on research and getting to grips with the new CPD scheme, whereas we know that most osteopaths really just want to get their hands on people and practise techniques. The growing integration of our profession was also in evidence, as there were speakers this time from the GOsC, iO and UCO. But without further ado, for those of you who’d like to know what happened, here’s my precis.
Ben Katz, Pres of iO, SCCO Faculty member
Ben is an old and esteemed colleague from my OCC days, and I’m pleased to see him at the iO, where he’s admirably survived a baptism of fire with a very active first year. Ben pointed out that only 10% of the public have ever seen an osteopath, and most of those rate us highly, but to the other 90%, we are a bit of a mystery. He pointed out that we have “pockets” of hard data, showing what we do, but we need very much more. There are very interesting small studies – for example, this one in Italy which showed that osteopathic treatment for premature babies reduced the hospital stay by 2 days, and a had a significant cost benefit. I think there were similar “hospital stay” studies on pneumonia patients and cardiac patients.
But however exciting these studies are, they need to be repeated if we want to convince people of the value of our work. While we all realize that evidence-based, or evidence-informed medicine, is not merely about RCTs, having some statistics will really help us to stop being designated a “protocol of limited clinical value”, as we currently are, by several CCGs – the people who decide where to spend the money.
Jo Wildy – how osteopathy can explain itself without losing its identity
Jo Wildy then amazed and inspired us with the depth of her understanding and love for osteopathy. She did a degree in genetics, but abandoned a PhD to become an osteopath when she realised that though she loved genetics, she didn’t love doing research. Jo claims that her interest is in language and communication, but to be honest, her interests seem far wider than that. She’s never been in an osteopathic “ghetto” and has lectured and examined extensively. She acted as an External Examiner at the LSO whilst under Robin Kirk and was an FCC examiner. She taught osteopathy in Vienna to physios and doctors on a six year masters programme which gave cranial, visceral and structural techniques equal credence. Despite encountering some instances of hostility towards what she was teaching – the chalk was once wrested from her hand! – she said that in the end, they “got it”.
Jo made the point that history is great for context, but we must make osteopathy relevant to the modern day. She thinks we need a change in the language which describes what we do, as she says she sometimes didn’t believe the things she was teaching in terms of language and explanation, despite, presumably, believing the things she was doing.
Divided and evolving
She spoke of her influences. She made some reference to the work of Iain McGilchrist, who wrote a book about the divided brain, which informed one of her 3 very interesting essays. She also told us about an incredible-sounding 5 year course in Belgium that she has taken, called EvOst. You do 2 modules a year (at 550 euros apiece). The curriculum looks very biological. The people who run it want to ‘study natural laws, and bring them into a modern context with a modern language’. They look at how living systems develop and maintain themselves. (EvOst is short for Evolutionary Medicine in the Osteopathic Field). Amongst other things, they also look at how the laws of nature are expressed in the development of the embryo, and include Blechschmidt’s work. Jo described how at each level of complexity through the advent of life, there is emergent behaviour.
Form and behaviour, not structure and function
Jo talked in a freewheeling manner of memetic evolution, morphology, systems theory (each stage transcends but includes the previous stage), tides, anticipatory framing and processing, and the three metabolic fields. I loved it, but was out of my depth. She pointed out that while orthodox medicine looks at the molecular/biomolecular level, and at the whole body level (home, job, lifestyle), it is missing the middle dimension. This I could relate to. She used as an example the depression that can come from unresolved somatic traumas – psychological states related to childhood injuries, for example. She does think soma is different from psyche, in that they are different dimensions. She talked about how tissue that is a stimulus also becomes a restraint of growth, how form has history, present, and future, and thinks that “structure governs function” is a misconception. She prefers the word “form” to structure, and so, she says, did Still. I stopped even trying to understand every bit of what she said and simply noted “EvOst” down on my “things to do when the kids have left home” list.
Jo thinks our particular skill is understanding at what level the system is struggling to maintain itself, and then shifting to the level above that – its environment – for treatment. It is the environment that will be the stressor on the system. “Simple is not easy” she said. She’d change undergraduate education by teaching more extensive anatomy and indirect techniques. Refreshingly, she believes in describing what we as practitioners do as “an osteopathic intervention”. Full stop.
Mary Monro’s take home message: think form and behaviour, rather than structure and function.
Steven Bettles, Policy manager, GOsC
Here followed a very useful talk by GOsC’s Steven Bettles on the new CPD scheme. With apologies and respect to Steven, pressures of space and the wish not to repeat myself have inclined me to refer readers to three, yes three, previous blogs I have written on the new CPD scheme) plus there’s a bit on the peer discussion review below
Peter Cockhill and Rosalind Ward – Baby Check Bath
Now this was very interesting and a really substantial research effort that I’ve been hearing noises about for the past year. Pete and Rosalind have a proper big project going on – part clinic, part research – known as Baby Check Bath. This sounds like something that was fated to happen. In his introduction Peter said that on this particular research journey the “path was made clear” and “doors were opened”, but that’s not to say they haven’t had to work incredibly hard. Back in 1997, due to some spare cash and a request from a health visitor, a GP funded their treatment of babies for 18 months. With the encouragement of the research-minded health visitor, and assistance from the very capable Carol Fawkes from NCOR, they used a questionnaire to gather data. From that auspicious beginning two decades ago they now run a clinic to treat babies, signposted by health visitors, midwives and lactation consultants free of charge.
The clinic has become focussed on early distress and feeding difficulties. Something I hadn’t grasped was how prevalent frenulotomies have become. Tongue tie is frequently diagnosed these days, and the rate of babies having the cutting procedure was at one point recently running at 20%, according to the head of infant feeding at Bath. (NB the actual incidence of tongue tie is estimated at 5%). The rate dropped significantly at the same time that more babies were having osteopathic treatment. Surely this warrants some serious research? Well, yes it does. Somehow, Rosalind and Peter have arrived at the present position that they are doing a feasibility study in partnership with their local NHS hospital trust, for a larger study on osteopathic treatment and feeding difficulties:
“Does the addition of osteopathic treatment to specialist breastfeeding support improve breastfeeding outcomes for infants with biomechanical sucking difficulties? A feasibility study”
The study is funded by the General Nursing Research Council Trust and is a single blinded randomised controlled trial using “sham” osteopathic treatment as the control, alongside specialist NHS breastfeeding advice.
Peter and Rosalind (the Baby Check team, along with Helen and Violette) are evidently deep into a very fulfilling research journey. It has definitely been a huge learning curve, but they have found goodwill and support in all sorts of places: the local hospital management have been “amazing” and the research has enabled them to meet and communicate with other health professionals. Everyone involved is apparently very open to how they treat; in paediatrics people are used to working in “greyness”, as they put it, and just willing to try anything that seems to help. They have also found authors of a similar study in Canada in 2016 very helpful.
One of their chief tasks has been to discover how to perform “sham” osteopathic treatment – it’s all about the intention apparently – which sounds like it’s been a fascinating research project in itself. Where have they found the time? They just don’t know. Clearly, where there’s a will there’s a way. You can check out their excellent website here. And it doesn’t sound like they will stop here; they’re on a roll. Not only do they think data collection might be able to spread nationwide, they are also keen to widen their focus to look at the mothers of these distressed babies, who can have up to twice the usual rate of mental health issues.
Take home message, courtesy again of Mary Monro: this is a service to the entire profession, too daunting for many to attempt, but we will all benefit from their work.
Peer Discussion Review
I chose as my workshop the peer discussion review; essential and intriguing component of the new CPD scheme. I have chosen my own future peer reviewer – she doesn’t know it yet – but I had a dry run with the lovely Helena. We followed the question and answer template helpfully provided by Steven (with-a-V) Bettles. I’m pleased to say it was all quite straightforward; it will just require a bit of thought and preparation, which is, after all, the point. I think it’s just their way of making you be a bit self-aware, think things through, plan your CPD accordingly and hold yourself to account – with a witness. In the past, when “planning” my CPD, I have generally been aware that my weaknesses are clinical methods and differential diagnosis while my strengths are palpation and efficacy of treatment. This astute insight is then followed by me signing up for yet another biodynamics course which focuses on, yes, palpation and treatment, because I just love those courses so much. Well, we can’t take the line of least resistance any longer. Honest self-reflection and addressing our shortcomings is the name of the game.
Well, that was the end of day one, and a very full and interesting day it was too.
Day Two coming soon…………….