Ben Goldacre
Thursday September 23, 2004
The Guardian
· “Cranial osteopathy – aligning the plates of the skull.” Sounds great. Maybe I can use it to treat my hangovers. The Times certainly likes it, and it even got Dr Toby Murcott to tell us how it works in a box, alongside a case study, called “What’s the evidence?” Toby says: “Can cranial osteopathy treat the brain? Cranial osteopathy is a gentle technique – practitioners claim to feel a subtle pulse in the fluid surrounding the brain. There is some research to suggest that these pulses are related to slow, regular changes in blood pressure in the brain. This has yet to gain wide acceptance and it’s not clear how working with these might lead to health improvements.” Here’s what you need to know.
· First, cranial osteopaths don’t even think the pulses are blood pressure; their theories revolve around the “inherent rhythmic motility” of the brain and spinal cord, mixed with breath and cardiac cycles, causing rhythmic fluctuation of the brain and surrounding fluid, which they think they can feel through the bones of your skull, and fix up with a bit of wiggling. They write long articles about actin and myosin (the things in muscle cells that make them move) being present in brain cells; unfortunately, they always forget to mention that brain cells lack the dense arrays of those filaments which are necessary to generate any significant movement.
· But are there real “cranial pulses” to be felt, however they may be generated? It’s easy to find out: ask a couple of cranial osteopaths to write down the frequency of the pulses on the same person’s skull, and then see if they give the same answer. There have been five papers published doing just this, and in none of them did the osteopaths give similar answers. Which suggests to me that (a) this is not a reliable biological phenomenon, and (b) perhaps these cranial osteopaths are, er, imagining it. So: the discipline is based on a misunderstanding, they can’t measure what they claim to measure and work with, and there’s no evidence to say it works.
· When I see a box labelled “What’s the evidence?” next to a health article by a Dr Toby Murcott, call me naive, but I assume he’s a medical doctor, rather than a science journalist with a PhD. And by now, regular readers must be wondering how I’m going to crowbar Gillian McKeith into this column. Well, what do you know, Dr Toby Murcott was the “science adviser” on You Are What You Eat, the TV show that told us we should eat more dark leaves, because the chlorophyll would oxygenate our blood. Bravo.
The following appeared two weeks later:
Don’t knock it
Thursday October 7, 2004
The Guardian
I don’t care what Ben Goldacre says (Bad science, September 23), after having severe sleeping problems for almost two years due to stress I was referred to an osteopath by my GP. I haven’t needed sleeping pills since (three months now). Bad science? Perhaps, but it worked for me.
E McDonald
Antwerp, Belgium
cath having fun said,
September 9, 2006 at 1:07 am
re above comment
I’m always reminded of a college lecturer, who constantly reminded us that
‘the plural of anecdote is anecdotes, not data’. I predict I may be using this comment again sometime later this month…
Gunga Din said,
September 19, 2006 at 5:24 pm
Anecdote vs. data.
Too true, but without the recorded anecdote to pique interest, no scientist would ever spend any time on collecting data to prove the validity of anecdotal claims.
It is hardly the anecdote’s fault that there are some who jump at the chance to believe everything they hear/read. Some anecdotal evidence has, after many years of exploration, turned out to be truly astounding science.
Some has also turned out to be twaddle.
Dr. Garner said,
December 23, 2006 at 9:49 pm
I would succes that you take a new look at the research done on Cranial rythmic impuls. It has been measured. It is true that we don´t know what it mean and where does it come from. Inter-examiner reliability is not good for palpating this, but it´s not good in many other things either. (check out the knee surgery techniques for example). The main thing with this is that it´s safe and effective when ablied with the right medical knowledge.
I´d just like to quote Carl Sagan and say “The absence of evidence is not evidence of absence”.
Dr. Garner
jonathanhearsey said,
July 6, 2008 at 9:07 pm
Dr. Goldacre, it gets worse…..
http://jonathanhearsey.com/?p=24
…..and, as you know, I am an osteopath!
JH
Osteopathy « The Crystal Conundrum said,
December 28, 2008 at 12:16 am
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Cranial Osteopathy please help!!!! - Netmums Coffeehouse said,
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benrubi said,
June 25, 2009 at 8:45 am
How long did you study it?
How long did you practice it?
In Rome there is some one who received the Holly Spirit.
For all others, they are not request to speake about what they beleive in. They have to prove, overall when having a public talk.
tom said,
September 30, 2009 at 3:16 pm
My friend and his partner have been taking their infant son to see an oesteopath for cranial massage because the child does not sleep as much as they would like at the times that suit them. This concerns me for two reasons: the first being that that it seems to me that the manipulation of the soft skull of a baby might actually be dangerous; and the second reason being that they have been paying £21.50 per session which they can ill afford.
I would be grateful if anyone could point me to some objective and accessible literature which discusses objectively the lack of evidence supporting cranial osteopathy as a treatment for babies. My argument to my friend that my four children all cried at night and the solution was either to feed, burp or cuddle them does not seem to “cut any ice”!
I checked the NHS website, and found that it mentions cranial osteopathy in a list of “specific therapies [that] have been suggested and might be considered, although no reliable evidence was found to support these management approaches”.
http://healthguides.mapofmedicine.com/choices/map/infantile_colic1.html
The text containing mention of cranial osteopathy is reached by clicking on the box marked “General Advice”, about six boxes from the top.
In the words of the NHS web site:
“The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.
The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated.”
Whilst this Map of Medicine does point out that there is no reliable evidence in support of cranial osteopathy, it is still saying that it “might be considered”.
This too concerns me, because it could be interpreted that the NHS is condoning such unproven treatments.
Please note that my friend was not referred to the osteopath by an NHS doctor, but by another acquaintance.
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rachel108 said,
November 29, 2009 at 9:40 pm
Hey pinhead. How are you are so ignorant as to even have time to knock somthing so blatently effective? Have you even had one treatment ? Have you even spoken to one osteopath? Have you even spoken to one patient?
No. I guess not. You just get your kicks out of criticising what you know NOTHING about.
Well all I can say is this: if you ever get a whiplash, migraines, ongoing headaches, head pain after dental work, if you ever have a baby that won’t sleep, or won’t stop screaming with colic – don’t come knocking on my door. And I would thank you not to tell other people to stay away when their quality of life could be greatly improved by this most extraordinarily effective and SAFE treatment.
You just keep prescribing people pain killers that cover up their pain, damage their livers and offer them no hope of long term recovery.
Because you of course are the intelligent one aren’t you. And the rest of us who spent 5 years at university studying the cranial system are idiots. Obviously.
UK Cranial Osteopath. And very, very proud of it.
Ben Goldacre said,
November 29, 2009 at 9:46 pm
if you’re proud, can you give your name please?
rachel108 said,
November 29, 2009 at 10:15 pm
Sorry for being a bit strong, it is just so irritating to have somthing you see effectively resolving so many probelms everyday beung critisised so harshly and unfairly by such a high profle journalist. Perhaps you could do another review since it is 5 years since your article. I think the public need balanced literature. There are studies that have proven the movement of the cranial bones but you don’t quote them.
In America, the fact that the cranial bones move was proven in xray studies and accepted 10 years ago. They are now 10 years into their research. Only MD’s practice cranial osteopathy in America and it is a highly accepted treatment form.
Why is the UK so insistent on criticising it and waiting for it to be proved a farce?
At the end of the day the public vote with their feet.
Ben Goldacre said,
November 29, 2009 at 10:19 pm
nothing has changed so there wld be no benefit in updating, except to make the same points again.
lots of people fall for scams, look at the popularity of pyramid schemes. just because people buy into them, does that they work?
i note you are proud of what you do and say but wish to remain anonymous. people will read what they wish into it, i always find it a bit surprising.
rachel108 said,
November 29, 2009 at 10:35 pm
So you are not prepared to re-assess the research then. Even though I am telling you there are research papers available that you have not reviewed which paints a very different picture?
Even though hundreds of GP’s, consultants, midwives and dentists now refer patients to us every week.
You just want to know who I am.
Hmmmm
Yes you are right. The public will read into it what they wish.
Ben Goldacre said,
November 29, 2009 at 10:51 pm
please do post the latest trial data on cranial osteopathy.
i dont mind if you want to hide your identity, rachel108, i just think it’s pretty funny (in passing) that you talk about how proud you are of what you do but don’t want to give your name. i know that’s common. i just think it’s funny.
rachel108 said,
November 29, 2009 at 10:53 pm
Righto. Well that’s a start.
Ben Goldacre said,
November 29, 2009 at 10:56 pm
so post the data/
rachel108 said,
November 29, 2009 at 11:30 pm
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11831342&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
rachel108 said,
November 29, 2009 at 11:34 pm
Review the evidence. the public deserve it.
rachel108 said,
November 29, 2009 at 11:53 pm
http://www.freepatentsonline.com/5630422.html
http://www.cranialacademy.com/pdf/PRMresearch.pdf
http://www.jaoa.org/cgi/content/full/106/6/337
Bones said,
December 21, 2009 at 6:18 pm
Perhaps readers might be interested in the following review of cranial osteopathy:
Green C, Martin CW, Bassett K, Kazanjian A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med.1999; 7:201–207
To quote its results and conclusions:
“RESULTS: The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found. CONCLUSIONS: This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.”
Bones said,
December 21, 2009 at 6:29 pm
You might also be interested in this v interesting article, tracing the origin of Sutherland’s model, the founder of cranial osteopathy:
“Swedenborg’s influence on Sutherland’s ‘Primary Respiratory Mechanism’ model in cranial osteopathy”. T. Jordan. International Journal of Osteopathic Medicine. Volume 12(3), September 2009, pgs 100-105
Sutherland borrowed heavily from Swedenborg’s long-abandoned 18th century physiological hypotheses.
gary said,
December 25, 2009 at 10:36 am
Interested to know your response to the two studies measuring cranial bone movement posted above?
Trish_M said,
January 23, 2010 at 11:06 am
When my mother gave birth to my brother, this resulted in a twisted pelvis. She was in agony for years. The doctors / hospital put her into plaster of paris, and then surgical corsets, before discharging her ‘a cripple’ for whom they could do nothing more.
Thank goodness she found an osteopath to put her right. At 80, she is still dancing ~ but still having regular treatment.
All of my children have benefitted enormously from cranial osteopathy. The one suffered during a difficult birth and would later collapse regularly. The other had problems, following, a road accident, where his skull was hit by a car, like a table-tennis bat hitting a ping pong ball. The third could not swim, except in circles, because she had hurt her leg and one was shorter than the other.
When my friend’s son kept collapsing, after a road accident, it was my son who recommended the cranial therapist / osteopath ~ and he put the boy right. As his mother said, why could he do this, while the hospital left him in a state of contant collapse?
Anecdotal, of course.
Similarly anecdotal is the fact that, though my son visited doctors and hospitals, following his road accident, none diagnosed his broken leg, until I insisted on an x-ray. Two weeks after the accident he was put in plaster!
I could give other stories indicating cases where the doctors got it wrong ~ but they would be anecdotal, too.
Osteopathy works. Cranial osteopathy works. Of course there may be disreputable practitioners, but there are disreputable dictors, too.
I don’t expect anyone to believe me, just because I say something is so ~ especially of they don’t know me. I will just say this, if ever you or your loved ones are injured, or if you know of a baby who has been negatively affected by a traumatic birth, just give it a try and see for yourself.
sarah100 said,
March 11, 2010 at 9:22 am
Of course there is not absolute evidence for everything that may work. As a HV I went to watch cranial osteopathy as many of my mum’s were spending quite a lot of money on trying to help their babies settle in the first 6 – 8 weeks, and go back for 3 or 3 or more appointments in that time. I went in ‘believing it’ and came out more than doubtful. The cranial osteopath I spent time with said that it does not involve manipulating the plates of the skull, which surprised me, but was about the flow of fluid. I would say don’t waste your money. The majority of babies settle on their own in the first 6 weeks when parent and baby have managed to work it all out and increasingly parents have high and unrealistic expectations of when, if ever, a baby should cry. I have only read the abstract of the article that Rachel mentions, and the first thing I notice is it is talking about adults and not babies. I cannot find any good evidence. I don’t suggest it to mum’s now, but if they ask I tell them that other parents have found it helpful, and equally some don’t, it doesn’t seem to do harm.
Dresden said,
April 7, 2010 at 9:38 am
Trish
I don’t agree that any story you related about a doctor getting it wrong would be ‘anecdotal’, as much as a claim about any variety of osteopathy: if true, it would be evidence for incompetence or malpractice and couldn’t be used to generalise about the general conduct of doctors.
A personal experience used to support a generalisation about a therapy is indeed anecdotal, by the same token.
If you and your children have personally gained from therapy offered by osteopathy, then fine; what you’re not entitled to do is to make claims for its wider application. As someone said (above, I think): “The plural of anecdote is anecdotes, not data”.
Graeme said,
April 15, 2010 at 8:14 pm
Ashamed to admit this, but when our daughter was 18months and driving us insane with her poor sleeping – we took her to a CO in Leamington Spa.
He was clearly bonkers, although jolly nice. Claimed he could cure our daughter through my wife’s back!
One thing though – he dangled our baby by her head and waggled her body around supported only by her neck. I know. We were nuts – why did we allow this!? He went on to encourage me to do this technique – and I did a couple of times. He charged good money for this.
I’m sure if we hadn’t been so desparate – and if there had been enough info around back then (there wasn’t anything helpful on the internet) – we would never have allowed this quack loose on our precious baby.
I just wanted to ask: how dangerous does this neck dangling sound, and do COs still routinely do this?
Graeme
fiolondon said,
April 25, 2010 at 1:47 pm
Hi
I have been revisiting this post since November waiting for Ben to update his article or comment on the research posted by Rachel108 in November.
While I was here I thought that there were a couple of recent posts worth commenting on.
To state my bias, my husband is an osteopath and his treatment on me worked when ‘conventional/allopathic’ medicine was not able to offer any solutions. I have also seen treatment work for many more people (although not all) so I think it is a matter of getting the evidence together to support the anecdotes rather than sying there is ‘nothing to it’.
It is fair to say that the osteopathic community (who are a regulated profession) feel as though they have been caught ‘flat footed’ in the area of research and evidence supporting their profession.
In part this is because most osteopaths are sole practitioners working in isolation and running one’s own business does not leave a lot of time for running research trials, not the opportunity to compare the efficacy of different osteopaths and treatment approaches. However there are now national bodies who are encouraging and supporting osteopaths to produce good quality research. Much of the evidence produced so far has not been terribly well organised, so hopefully this ne initiative will be productive shortly.
Another problem is that the seminal 1996 paper by Sackett et al (http://www.bmj.com/cgi/content/extract/312/7023/71)
describes evidence based medicine as a triad with research, clinicial expertise and patient preference at each of the three points.
However, osteopaths with years of experience are unable to draw data from past patient records as participation in clinical studies need the explicit consent of patients. Retrospective permission is fraught with difficulty – not least the time involved. So many practicioners find that their cumulative expertise counts for very little in the search for ‘evidence based medicine’ despite Sackett’s definition.
I think that Ben’s comments about lack of evidence are fair, but it should not be long before that is addressed.
fiolondon said,
April 25, 2010 at 2:03 pm
In reply to Graeme, the ‘neck dangling’ is (according to my husband) not a standard cranial osteopathic technique which is normally gentle to the point you might think nothing is actually happening! However it is a known manual therapy technique so you would need to speak to the osteopath that treated your baby to see why it was indicated.
That practicioner should also have explained the risks to you in order to obtain your informed consent so you are completely entitled to go back for answers to all your questions. It would probably be more informative than posting your questions to strangers on the web!
But in my completely unmedical opinion, I would assess the risk of dangling under self weight, with the much higher forces applied to babies’ necks when delivered by forceps or ventouse (where the obstetrician has to put his/her foot on the bed to generate enough force to pull the baby out of the mother by its neck).
As obstetricians assure us that assisted delivery is perfectly safe, and as the forces involved in this would far exceed the ones applied to your baby, I think an obstetrician would have to say that there was minimal risk from the ‘dangling’ you describe.
However given that obstetrics was awarded the ‘wooden spoon’ in 1979 by Archie Cochrane for its unscientific methods you might be best to come to your own conclusions…..