osteopathy

August 6 2021August 6 2021

New Levels Of Crazy But I Shouldn’t Be Surprised

Last night I was waiting for the cricket highlights on BBC2 and I got the stream going a little bit before 19:00. This meant that I saw the last five minutes or so of some nature programme [Animal Park] covering koala bears at some sanctuary. I didn’t pay enough attention to know where it was set. The gist of this bit of the programme seemed to be wondering whether any of the female koalas were pregnant or at least feeding a joey in the pouch, let’s go with “with child”. To help figure this out and rather than manhandling the koalas they got someone in who had an infrared camera to remotely measure the body temperature of the bears [not bears]. This person was introduced as an “animal osteopath” and I was suckered in to everything that person said.

I’m going to write this communication “live” in the sense that it will be a diary of the next hour as I have a look at whatever the fuck an animal osteopath is. Firstly, let me tell you that human osteopathy is mostly bollocks and doesn’t do anything. I have looked into this along with reading many books concerning osteopathy. I wrote a communication about it in 2014 where I explained what osteopathy does and does not do. TLDR – it does very little except remove money from people. Now I’m really curious about animal osteopathy and what that might be so it’s time to get googling and see what stuff comes up. My initial heuristic is that it’s bollocks, but if I am wrong I will say so later on.

Let’s look at what the “animal osteopath” brought to the television programme. They had a IR camera and could measure temperature of the koalas remotely. The first temperature reading was taken from a male [who couldn’t possibly be “with child”] and the temperature was noted. As far as I can tell this has little to do with female koala temperatures and while it seems quite reasonable it really isn’t. Who is to say that male and female koalas have the same body temperatures over the surface of their bodies? Who is to say what the normal range of temperatures of koalas is? Why was this introduced as though it was scientific when it absolutely was not? Oh, it makes good television I suppose but it was not good method.

Next a couple of the female koalas were temperature measured remotely and the “theory” was that if they had a joey in the pouch then maybe the temperature would be higher in that area of the body. This was not even backed in science. They didn’t announce that we “know” that temperatures are higher where joeys are feeding. This was a first and therefore any differences they find might be down to koala physiology rather than anything else. What sort of temperature difference would be enough to convince the show that a koala was pregnant? All of this reeked of “made for TV” rather than any groundings in science. I’ve just looked up how big joeys are and they are initially the size of a jelly bean and therefore any temperature difference wouldn’t be measurable through the skin and fur of the pouch.

So, the entire process covered on television to decide whether the koalas are pregnant was utter theatre. I doubt very much that this is a valid method and it quite clearly wasn’t standard as the presenters were very much explaining this was a new thing. This brings me to the “animal osteopath”. You don’t need to be an osteopath to operate a IR camera. You don’t need to be anyone specially training. You point the thing and take spot measurements. Why an animal osteopath was introduced I don’t know. They could have had Geoff who lives next door and uses his IR camera to spot couples in flagrante in the bushes near his house. This did not require an animal osteopath.

Human osteopathy is bollocks and so let’s see what animal osteopathy is like. I honestly can’t imagine it’s going to be more evidence based. I somewhere suspect that they make shit up like other osteopaths, but let’s see. A quick google search brings me results for general osteopathy but I’m going to see what courses there are to learn animal osteopathy first and then look over the website of a practitioner.

The first animal based advert within Google was for the above people who train osteopaths and are actually linked to the European School Of Osteopathy which is down the road from me. The website seems to offer courses in horse and dog osteopathy and not much else. It’s a well designed website and offers many courses for people who are interested in animal osteopathy. Their courses are accredited by the ESO so I think I’ll have a look at what they say about animals and shit.

The ESO website is mostly about human osteopathy but they mention a little about animal osteopathy and link to the Association Of Animal Osteopaths. This website design looks very much like AOI and so it’s time to investigate who governs who and whether they are independent and also, it’s time to remember that just because there’s a national association it doesn’t mean that it’s regulated or even science. There’s an international association of osteopaths and that’s bollocks for humans. The top two names in the AAO are also the top two names in AOI and so there’s an overlap there of who checks the work for who. One organisation looks as though it checks the work of the other but they are the same people.

I doubt very much that animal osteopathy has any real effect on animals. Wikipeida doesn’t even link to anything about animal osteopathy, you just get linked to the page for normal osteopathy and so the conclusion is that it does very little. We know that the “placebo” effect operates on those humans who have animals treated with alternative medicine [ie not medicine] and I don’t think there’s any real documented scientific evidence to claim that animal osteopathy is a real thing. I suspect that with people appearing on television and being given credence by that appearance this thing will continue and people will pay money to experience a thing that is not real. Oh well.

This is communication 1912 and so here are some things that happened in that year:

First presentation of continental drift theory.
Airships used in war for the first time, by Italy.
Lawrence Oates says “I am just going outside and may be some time”.
Vitamins are identified.

July 16 2018

Probably Not

I went for a swim after work today, it was nice to get out of the heat for a while and get my arms moving. However, I was a little perturbed by one of the posters in the cafe area of the gym. To be honest there are many gym-type posters that are disturbing showing body shapes and types that are not achievable by most. This does seem to be changing over time as the advertising world recognises that people are who they are and don’t really buy into the perfect body. Unless you watch Love Island.

So, on first inspection this poster seems pretty good. It’s for a sports injury clinic and that should be a good thing. A special place for all to go to ensure that those niggles get sorted out. But, let’s look a little closer at some of the treatments offered:

Osteopathy – not a fucking thing and doesn’t do anything. Read my previous, controversial, communication.
Sports Massage – could be OK, I don’t really know what it entails.
Therapeutic Massage – again, I’m not sure what this is and I should probably discuss this in a future communication. I’ll look into it. I doubt it’s anything good.
Aromatherapy – massage with nice smells. Doesn’t do anything.
Physiotherapy – probably the only legitimate treatment on this advert. Go see a physiotherapist for those sorts of things. Don’t see woo.
Nutritional Therapy – most likely bollocks. If you want diet advice see a DIETICIAN, they are a proper profession. Anyone can call themselves a nutritionist.
Acupuncture – bollocks squared.

Look, the issue with this clinic is not that they offer some legitimate therapies the problem is that they also offer a load of bollocks and so you can’t assume they will be good at any part of their job. It’s the company you keep that defines who you are.

Don’t go here.

I’ve just had a look at the website for this clinic and it is a beauty. I will add it to my communication drafts with the hope that I one day complete writing about it.

January 15 2014February 18 2019

Introduction

Osteopathy is a treatment that is prevalent in the area I live. There are 60 results of osteopaths within 10 miles of Maidstone for comparison there are 46 osteopaths (from Yell.com) within 10 miles of Bristol. Close to Maidstone is the European School of Osteopathy. There are many osteopaths working in Kent and many people I know see osteopaths and probably pay reasonable sums of money for the sessions.

What I aim to do here is look into the history of osteopathy, what osteopathy is and the medical efficacy of osteopathy to treat various conditions. Although I will admit up front to being very sceptical of osteopathy as a treatment and I would describe myself as a free thinking, religious free, sceptic however, I will try to give a balanced view. If you think I have made errors of fact then please let me know. If I have written opinions with which you disagree then keep it to yourself.

The History

Osteopathy started in 1874 in the USA. A school was started in 1892 and the term osteopathy was coined. Andrew Still, the founder, was dissatisfied with the limitations of conventional medicine and chose to award DO or Doctor of Osteopathy degrees. Osteopathy as a practice spread and is commonly practised around the world. [1]

What Is Osteopathy?

Osteopathy is a form of healthcare that emphasises the interrelationship between structure and function of the body. Osteopaths claim to facilitate the healing process by the practice of manual and manipulative therapy. [2]

Classical Osteopathy

This is a traditional form of osteopathy where practitioners claim to be able to heal infections and diseases with manipulations which unblock the body’s mechanisms for transferring fluids. [3]
The John Wernham College of Classical Osteopathy is an example of classical osteopathy practised in Maidstone. They have made claims in the past of being able to treat diseases with osteopathy. They were told to change their claims by the ASA who found there was no good evidence to support their claims. I know about this because I challenged their claims through the ASA. [4]

Modern Osteopathy

Is a mixture of treatments applied by people trained in the physiology of humans. This is what the European School of Osteopathy says:

The ESO has always had a broad approach to osteopathic education, covering a wide range of osteopathic modalities and concepts at undergraduate level. This includes a full range of structural osteopathic techniques, General Osteopathic Treatment (GOT), studies in the cranial field (Involuntary Mechanism studies), Balanced Ligamentous Tension techniques, Muscle Energy Technique (MET) and Visceral osteopathy. Students receive a good grounding in obstetric and paediatric osteopathic care and are able to see a wide range of patients within the teaching clinic, including some time spent in the specialist Maternity and Children’s clinics. [5]

Efficacy

It is vitally important to know whether a treatment works or not before it is endorsed. I will briefly cover medical trials and how we know what works and what doesn’t.

The best form of medical evidence is a double-blind randomised controlled study. The worst form of medical evidence is a collection of anecdotes. Reading and interpreting medical trials is pretty much an academic discipline in itself. I shall do my best here to explain. [6]

Medical trials need to be randomised and controlled. There should be a control group that receives either no treatment, the next best treatment or sham treatment. The participants should be divided between groups randomly. The participants should not know which group they are in. The people administering the treatment should not know which group they are in. All scientific evidence shows that knowledge of what you receive increases your chance of it “working”.

The placebo effect is mentioned a lot in medical trials. The placebo effect is a misnomer. The placebo is no effect at all. In trials where subjective reporting is used people will report feeling better even if they have had no effective treatment. In trails where objective outcomes are measured there is no effect when there is no effective treatment. For example, in an asthma trial, people who were in the placebo wing reported that they felt more able to breathe but when this ability was measured it was no different. The placebo is just the fact that humans will feel better but that they are not actually any better. This is why anecdote is useless. [7]

Acupuncture often shows to be as effective as sham acupuncture in studies. In essence “real” acupuncture is as effective as “sham” acupuncture. This is the placebo effect. Objective measurements show no difference between the two groups.

For evidence of efficacy each condition being treated must have its own trial. It is not acceptable for a therapy to claim that just because it works for lower back pain it is also effective at treating upper back pain. We would not accept a drug that is good for healing tonsillitis to also be able to heal athletes’ foot. It would need to be tested in both circumstances.

Good scientific evidence for a medical treatment can be considered to be double-blind placebo controlled randomised trials with a good structure and well defined aims. From this “gold standard” the quality of the evidence deteriorates as more freedom is introduced into the trial. Scientists always qualify what they say with the terms good/excellent/limited/variable evidence for something. That is because scientists do not work in absolutes. Even with something as obvious as evolution or gravity scientists will talk about the overwhelming evidence and not that it “is”.

So I shall look for good scientific evidence that osteopathy works in a variety of medical problems. My sources for this will be The Cochrane Collaboration, the NHS and NICE (The National Institute for Health and Clinical Excellence). PubMed has a wealth of papers published about osteopathy but there is too much for me to read through, especially when looking at each initial problem that is being treated. If you look through these yourself please make sure that you understand statistics, causation and the flaws in designing medical trials.

The National Health Service and NICE

The NHS Choices website explains that there is good evidence that osteopathy is an effective treatment for lower back pain and there is limited evidence that it may be effective for other neck, shoulder or lower limb pain [my emphasis]. There is no good evidence that it is effective for any other form of condition. [8]

The NHS Choices website then explains that osteopathy is considered an “alternative” or “complimentary” therapy, i.e. not medicine and therefore doesn’t work.

Osteopaths may use some conventional medical techniques, but the use of osteopathy is not always based on science.

This means that the good bits are what we would call medicine and the rest is not.

Cochrane Collaboration

This is an organisation that reviews all the medical trials available to come to valid conclusions for the treatments being suggested.

Osteopathy and pain control during childbirth:

We found six studies, with data available from five trials on 326 women, looking at the use of massage in labour for managing pain. There were no studies on any of the other manual healing methods. The six studies were of reasonable quality but more participants are needed to provide robust information. We found that women who used massage felt less pain during labour when compared with women given usual care during first stage. However, more research is needed. [9]

Let me interpret this for you. Women who had massage and other nice things done to them during childbirth “felt” less pain. This is a subjective measurement and means nothing in terms of actual reductions. The last sentence asking for more research essentially says that although this is interesting there aren’t enough data for the results to be conclusive.

Osteopathy, manipulations and period pains:

The review of trials found no evidence that spinal manipulation relieves dysmenorrhoea. [10]

‘nuff said.

Osteopathy and infant colic:

Although five of the six trials suggested crying is reduced by treatment with manipulative therapies, there was no evidence of manipulative therapies improving infant colic when we only included studies where the parents did not know if their child had received the treatment or not. [11]

So, when the patients were blinded there was no improvement. Often with “alternative” therapies the better designed the trial the effectiveness disappears.

These trials were looking at things that are more likely to be practised by a traditional osteopath. Curing infant problems and pain not related to the back. In essence, from the information so far osteopathy is only effective for lower back pain and that may be because they use more medical techniques than osteopathic treatments.

In America

In the USA Doctors of Osteopathy are recognised. But as explained by Marc Crislip most leave behind their osteopathic training when they graduate, turning into proper doctors. [12]

It Costs Money

In the UK people generally have to pay to visit an osteopath. It is well understood that paying more for a product invests that person into believing it works. Just look at audio cables. You can pay a fortune for audio cables and when blinded random trials are conducted people are unable to tell the difference between expensive cables and cheap cables. If osteopathy costs a lot of money then you are invested to believe it works and so will feel better. This does not mean that you are any better.

My Conclusion

Osteopathy can be effective for lower back pain.

However, osteopathy cannot be taken seriously. There is scant evidence that it can treat or is effective at treating many of the conditions that it claims. It started as quackery in a time when our medical knowledge was poor. As our medical knowledge has increased it has tried to change to meet new standards and treatments. However, it fails to provide GOOD SCIENTIFIC evidence that it works. Practitioners of osteopathy are mostly either doing regular physiotherapy and modern medicine and so shouldn’t be called osteopaths or they are practitioners of something that just plain doesn’t work.

You can tell it doesn’t work by the company it keeps in shops and practices. As explained in this communication if somewhere offers homoeopathy and something else consider it a red flag to be wary of what they do.

As Tim Minchin says:

“By definition”, I begin “Alternative Medicine”, I continue “Has either not been proved to work, Or been proved not to work. Do you know what they call “alternative medicine” That’s been proved to work?

Medicine.”

As an aside I personally find it appalling that you can gain a SCIENCE degree from studying this stuff at the European School of Osteopathy. There isn’t really any science content in the “science” course. It’s a shame that the University of Greenwich validates this. [13]

References

1. Wikipedia page on osteopathy. Link
2. Glossary of Osteopathic Terms. Link
3. Wikipedia page, section “Scope of manual therapies”. Link
4. Advertising Standards Authority ruling on Wernham clinic. Link
5. European School of Osteopathy pages. Link
6. Wikipedia page on clinical trials. Link
7. A description of the placebo effect. Link
8. NHS Choices. Link
9. Cochrane Collaboration. Pain control in childbirth. Link
10. Cochrane Collaboration. Controlling painful periods. Link
11. Cochrane Collaboration. Manipulative therapies for infantile colic. Link
12. Science Based Medicine – Marc Crislip. Link
13. ESO Courses validated by the University of Greenwich. Link

This is my first proper article on this website and it’s taken six hundred communications before I got there. I’ve tried to include some links to specific claims and I will add some when I find the sources. Most of my knowledge on this matter comes from years of reading Scientific American and listening to some excellent podcasts on the matter “Skeptics’ Guide To The Universe” and “Skeptics With A K”. I do not claim to be an expert. I do not claim to understand everything but my understanding is that most of what an osteopath practises is not science and has little evidence to support it. I have written this in good faith.

If you have something factual you would like to correct then email me (ianparish@gmail.com) and I will do my best to correct what is factually incorrect. If you really want to impress me then send me the links or papers of good medical trials for osteopathy and other conditions to show it is effective. I will gladly change my mind if the evidence shows I am wrong. That’s what being a rational thinker is about. Accepting good evidence and changing my views if needed.

January 13 2014January 13 2014

How You Know

The picture shows the window from a local “osteopathy” practice. One day I will go into the shop to ask them about their various practices. However, for now, I shall rely upon the scientific evidence for the following treatments.

This shop purveys:

Osteopathy
Homoeopathy
Allergy Testing
Chiropody
Beauty Therapy
Massage
Sports Injury
Ultra Sound Therapy

So, beauty therapy is fine. I don’t care what you slap on your face I’m pretty sure that, as long as they make no health claims, I couldn’t care what they do. Beauty advertising is beset with rubbish [the “n” signs of aging etc where “n” is a value between 3 and 11 and preferably an odd number] so any claims should be substantiated but these are unlikely to be detrimental to the health of anyone, just their wallets.

Chiropody is a proper thing and I will not take issue with this.

Massage is ok as long as they make no claims to any health effects of massage apart from it making you feel nice. The potential benefits arise from being relaxed and calm, not from any particular aspect of the massage itself.

And now we head into more dangerous territory.

From looking around the web and critically assessing the evidence for therapeutic ultra sound I have to say I am extremely sceptical that it does anything. It is widely accepted as a form of therapy but there is remarkably little evidence that it works or does anything good. I think this is the first form of “woo” from this little shop. I doubt there are any good, documented benefits from this therapy.

Homoeopathy is rubbish. There is no good scientific evidence that it does anything or even contains anything. It is essentially water. I can’t reinforce just how much this stuff doesn’t work. If you have an establishment that is happy to dose people up with homoeopathy then you should be very wary of everything else that they do. It is utter and complete rubbish.

Finally, osteopathy. This mode of dealing with health problems is the most contentious here. The area I live in is blighted by the existence of the European School of Osteopathy nearby. My local doctors surgery even allows osteopathy to take place in its confines. I find this distressing. Osteopathy is an “alternative” medical treatment. This means it is not a treatment nor is it medical. It is based on a completely wrong understanding of how our bodies work. Scientifically osteopathy has been shown to be good for lower back pain and NOTHING else. The very best osteopaths practise what is more commonly known as physio-therapy. Much like chiropractic osteopathy has its roots in bullshit and has tried to change with a greater scientific understanding of medicine but can’t shoe horn itself in to the establishment. If you are suffering then you are best advised to see a physio-therapist, they at least have been taught the proper causes and effects of their work.

The problem with this shop frontage is that it has some [almost] legitimate services to offer and then it also offers utter bullshit.

You can tell osteopathy is rubbish by the company it keeps in these premises.