Osteopathy for asthma? The results may take your breath away
Can osteopaths really cure asthma, and should newspapers be running uncritical promotional pieces for products claiming to treat serious conditions?
In the wake of Simon Singh’s battle with the British Chiropractic Association, chiropractors have been the subject of the sort of intense scrutiny and discussion you would not normally get without a super injunction.
Much less attention has been paid to osteopaths, close cousins who occupy very similar territory in alternative medicine; treating similar conditions with similar manual therapy techniques.
Like chiropractic, osteopathy has a reasonable body of evidence backing its effectiveness in the short term relief of back and joint pain, but little to support its use for much else. In spite of this osteopaths in Britain have a history of making the sort of extravagant claims an Iraqi Information Minister would be proud of. Which advertising regulators and the General Osteopathic Council (GOsC) – the profession’s pretty decent statutory regulator – have now begun to crack down on.
In particular, the GOsC’s review of the evidence for osteopathy and chiropractic unearthed no good evidence for the use of either in asthma, a position shared by the British Thoracic Society (BTS), the US National Heart Lung and Blood Institute’s Asthma Education and Prevention Program (NHLBI), and many other respectable combinations of letters.
So it was a little bit surprising to see the Guardian’s Lifestyle section running an uncritical plug for a London osteopath who claims to treat osteopathy for asthma.
Osteopathy for Asthma is medications mostly work by relaxing the airways or inhibiting the inflammation, but osteopathy has another approach. The expansion and contraction of the chest with breathing is like a pump which draws air into the lungs. It also helps in stimulating the drainage that clears the lungs of mucus, inflammation and irritants like dust particles and viruses. When this pumping mechanism isn’t working, these substances accumulate, exacerbating the condition.
In Osteopathy for asthma we should do like this, Use your hands to try to find and work on any tensions or misalignments that might be compromising normal motion. In asthma we use to do gentle stretches to release the ribs and the soft tissues that are restricting them, or use gentle oscillatory movements, using the patient’s arm as a lever to promote drainage.
A major British charity funding research into treatments for the condition, who kindly put us in touch with senior research fellow, GP and asthma specialist, Dr Mike Thomas. Unsurprisingly he told me that the claims like these were “not backed by any evidence that osteopathy for asthma,” noting that “there hasn’t been adequate research to say either way.”
His comments are backed up by a comprehensive meta-study conducted by the Cochrane collaboration, which noted that the few adequate trials to have taken place were poorly reported or too small to draw conclusions from, and concluded that “there is insufficient evidence to support or refute the use of manual therapy for patients with asthma.”
Osteopathy for Asthma is the treatment which using in any case, using someone’s arm as a lever to pump irritants out of their chest isn’t the most plausible treatment ever devised. “It’s hard for me to envisage a method by which it would work,” Thomas told me. An asthma sufferer put it more colourfully on Twitter: “is having asthma enough expertise to know that pumping mucus out of my lungs in a Looney Tunes style fashion will not work?”
The Advertising Standards Authority’s code also has something to say about claims like these. The ASA sensibly lists asthma among conditions for which “suitably qualified medical advice should be sought”, and told me:
“If an osteopath was making a definitive claim about treating asthma we would need to see the evidence to back that up. To date we have not seen that evidence.”
The same goes for pneumonia, which is also mentioned in the piece with a reference to ‘one study’:
In the development of pneumonia, where the lungs end up secreting more fluid than they can clear, we use a similar approach. One study showed that elderly patients who received osteopathic treatment after being admitted to hospital with pneumonia needed less antibiotics and recovered more quickly compared with those who didn’t receive this extra treatment. These kinds of results could save the health service a great deal of money.
We contacted the osteopath, who kindly supplied me with a couple of supporting papers by a Noll et al which you can see here and here.We do not have time to go through them in depth , but their methodologies read at times like a bit of a farce.
Osteopathy for asthma , Both papers attempt to compare osteopathy with a ‘sham treatment’ control group, but in the first paper they admit they have no idea how often the practitioner visited patients in each group (“however, the specialist attempted to see both groups for the same amount of time and frequency”), while in the second study the blinding was so successful that around half the patients figured out whether they were receiving the real treatment or the sham.
At one point they suggest that a change in body temperature was significant on the 2nd and 5th days after treatment, but not on the 3rd, 4th, or 6th days. In the second, more rigorous paper (‘more rigorous’ in the sense that my right buttock is ‘more slim’ than my left buttock, but both are still basically fat), no significant change can be found unless you ignore all the people who failed to complete treatment, and then only in some specific measures.
In short, if you analyse enough variables in enough different ways you can usually find something vaguely promising, but between the mediocre results and what the authors admit is a flawed design, this is not the evidence you need to transform the NHS budget.
Regardless of the opinions you or we might have on the possible efficacy of osteopathy (Osteopathy for asthma), when it comes to conditions as serious as asthma journalists have a responsibility to at least try to get it right. That means making absolutely sure that medical claims made by their sources are checked against the medical profession, professional regulators, advertising standards and, ultimately, the evidence. The Guardian’s promotion piece is not even remotely acceptable to us, andwe hope the readers’ complaints coming in are taken seriously.
For more details on Asthma, please keep visiting the Good Healthy World’s Asthma section.