Jonathan Hearsey

Chiropractors in the UK and New Zealand have loaded a legal gun. The BCA and NZCA have their sights set firmly in the direction of two eminent commentators, but I wonder if it is the chiropractor’s very own feet that are in their crosshairs? The internet is awash with discussion about chiropractor’s actions and in the heat of all this it has been suggested that I comment on the plausibility of Complimentary and Alternative Medicine in the NHS.

It appears that someone in the chiropractic profession might be helping the National Institute of Clinical Excellence in their attempt to develop a new set of clinical guidelines for the treatment of non-specific lower back pain. Whether or not this is a conflict of interests remains to be seen but, due to the fact that non-specific lower back pain is such a problem in the UK at the moment, any review, in my mind, is a good thing.

Complimentary and Alternative Medicine as a NHS treatment protocol raises a great deal of debate. For the last 12 years I have worked for the NHS as an osteopath. Contractually, I have worn different hats but, however and whomever funds my work, the rules remain the same – no ‘funny’ business.

Generally, there is precious little science out there that supports what I do. The most positive information available, whilst wearing my heavily rose-tinted spectacles, suggests that spinal manipulation, when used in a safe, medic lead environment, as part of a multidisciplinary approach might be as good as existing approaches.

So, why employ me? Am I an alternative to physio? Am I a ‘nod’ towards ‘modern’ (a la, en vogue) therapies? Am I just better at spinal manipulation than physios?

To be honest, I’d say that I’m all of these.

So – the big question is should public money be used to pay my salary?

Provided I stick to what I’ve been told then I can see no reason why not.
I ‘audit’ our patients, I stick to the waiting list/times criteria set by the PCT and, above all, I know my place. That place, is firmly within a multidisciplinary team offering a service that has not been offered with any proficiency before. I am the manipulator – over the years, the referring clinicians have come to value that fact and they refer me the patients that, generally, would benefit from manipulation.
Sure, I’d love to tell you how I’m changing the world and curing all MSK conditions. I’d love to print the testimonials of A-list celebrities that can’t live without me but they simply don’t exist. If you want the truth – I’m probably getting the same positive results as the previous set up but, with me involved, patients get a choice of whom they see and seem to value my input.

The problem I foresee is what if pragmatic manipulators like me stop keeping to the rules? Whilst my contract states what type of osteopathy I must use and on what type of patients, other contracts might not. Osteopaths might try using other forms of osteopathy – cranial, visceral, functional, fascial. All have their roots firmly in the profession but are all totally unproven and should not have a place in the NHS.

Some bloggers have made the assumption that osteopathy has already stated its case to the NHS and that the NHS have agreed ‘terms’. I am pretty sure that this has not happened. There are a few osteopaths in the UK that have NHS contracts of varying sizes but I am not aware that the profession has made a move in conjunction with the NHS. Incidentally, I have offered my services to the osteopathic profession but, as yet, I have not been called upon.

With regards to the chiropractic profession gaining NHS funding I would offer the same words of caution. As manipulators in a multidisciplinary team (MDT) or as part of an integrated clinical assessment and treatment service (ICATS) then I can see no problem but if chiropractors want autonomy and they are not willing to prove their 200 year-old claims then we (the NHS) are going to have a problem.

The problem that manipulative physiotherapy, chiropractic and osteopathy have is how we gain evidence. (Remember that I’m only talking about the pragmatic manipulators not the ‘disease all stems from the nerves/rule of artery is supreme/cyriax’ disciples).
All manipulation is slightly different – you can’t manipulate the facets of L5/S1 in exactly the same way on different patients due to the way those facets are formed. Patients are also influenced by other factors and the primary care centre where I practise is a good example of an environmental placebo effect (big consulting room in a brand new primary care centre with plasma screens. Apple computer on the desk – really comfy – ubercool, almost).

Homoeopathy is easy the easiest CAM to test and prove though, isn’t it?

Patient is consulted, patient lists symptoms, diagnosis is made, and patient gets pills – job done. Forgetting the physics for a second, and the geriatric history, a double-blind study could easily be done here. I am appalled that no one has taken up the challenge laid down at Quackometer either. So, homoeopathy/herbalism on the NHS? Not on your nellie – if patients can’t have their beloved Cox-IIs then they certainly can’t have arnica!

As for other CAMs – well, there are too many to list. Acupuncture is the obvious final protagonist but I’m not even sure that the Chinese understand meridians so how can we publicly fund it?

There are a great deal of CAMs out there making a decent living but to them I’d like to say the following…

Proof of financial success using a therapy does not prove that a therapy is successful as a treatment modality.

My ‘osteopathy’ is in basic form. I provide a small amount of physical therapy as part of a MDT, which gets patients on the road to recovery. If the patients do their exercises, improve their fitness and make a few postural changes then they have a better chance of getting a resolution to their symptoms. I’m not really a CAM at all so, perhaps, I shouldn’t really try and speak for CAMs. I’m not a medic either and I’m certainly not a scientist (annoyingly, due to the age of my qualification, a Diploma in Osteopathy, I’m not even an ideal candidate for a research post either – CAM universities can be quite fascist sometimes, you know).

I do, however, work for the NHS and it’s a position that I value and I do feel valued in that position.

My peers have always belittled me for my pragmatic views about osteopathy. I don’t pretend to believe or even understand the ‘philosophy of osteopathy’ either.

With the entire hubbub surrounding the chiropractic profession at the moment, the original philosophies of Palmer are often quoted. The ‘father’ of osteopathy also spouted some right-royal BS too. It’s CAM religion after all – I have learnt to leave them to it.
I would love to believe that the vast majority of CAMs no longer believe in what their discipline’s philosophy dictates but, the more I witness and the more I research, the less I like and it is for this reason that I can’t see anyone other than pragmatic spinal manipulators working for the NHS. If the NHS is to offer ‘new’ treatments in the future then they should be closely monitored and legislated for.

If I had a seat on the NICE table I’d be saying just that.

JH