The Other Medicine: Programme Five

ACTUALITY - OSTEOPATHY STUDENTS

FORD
At the British School of Osteopathy, second year students practise handling patients in a clinical setting.

ACTUALITY - OSTEOPATHY STUDENTS
Okay what I think we’ll do is if we just have another for 10 minutes or so, 10 or 15 minutes of doing this …

FORD
Osteopathy is a manual therapy that detects and treats damaged parts of the body such as muscles, ligaments, nerves and joints. The emphasis is on aiding the body’s health by correcting the alignment of the skeleton and restoring balance.

It was given statutory status in 1993 after a battle with orthodox medicine which lasted the best part of a century. Like other regulated healthcare professions, the General Osteopathic Council is headed by a lay chairperson, Nigel Clarke. I asked him what the main benefits of regulation have been.

CLARKE
The single most important thing it’s done is that when a patient goes to see an osteopath they know that that person has been - has demonstrated themselves to be safe and competent to a set of agreed standards. They also know that that practitioner is insured because all osteopaths registered with us must have professional indemnity insurance and they also know that if - were anything to go wrong - God forbid - there is a complaints mechanism and a proper way of bringing that osteopath to book if they have either demonstrated professional incompetence or unacceptable professional conduct.

FORD
Do osteopaths now feel that they are a profession - they’re properly regarded as a profession?

CLARKE
Yes they do.

FORD
And what is their relationship now with GPs would you say?

CLARKE
I think it’s variable, if one’s to be fair. Quite a number of osteopaths work closely with local GPs, others don’t have a particularly close relationship with them and in some areas GPs don’t have any contact at all with osteopaths. But compared with say 10 or 15 years ago even that is quite a big change.

FORD
And what would you do if there were a registered osteopath who was guilty of unprofessional conduct in some way?

CLARKE
Well we have a number of options available to us. First of all, having made a complaint it’s investigated by our investigating committee who determine whether there is a case to answer. If they so determine it’s referred to the professional conduct committee and if they find that that person is guilty of unacceptable professional conduct or professional incompetence they can either be struck off the register - erased from the register - which means they can’t practise as osteopaths, they can be suspended for up to a year, we can impose conditions of practice to ensure that they become safe and competent, they can be admonished which is effectively a slap on the wrist but in a small profession is a significant gesture or there can be interim suspensions if more needs to be determined before a decision can be made.

FORD
Chiropractic, not dissimilar to osteopathy, came in from the cold in 1994. Twenty-five years ago it was a disciplinary offence for a GP to refer patients to a chiropractor, such was the hostility towards them. So how has regulation changed that experience? Scott Middleton practises in Manchester and is a spokesperson for the British Chiropractic Association.

MIDDLETON
I think it’s opened the doors, the modern GP or consultant who is au fait with modern medical research wouldn’t hesitate but to refer a patient to a chiropractor and be very happy with it. Because I’ve lectured so extensively in my area and to GPs and consultants over the years they roughly knew what we did anyway and I’m part of the post-graduate medical circuit for GPs and in the last three weeks I’ve had six medical doctors watching me work. That opens up the doors, once they realise our limitations, they realise that we’re very honest and we tell people what we can’t do they’re more than happy to refer patients to us.

FORD
By establishing these codes of conduct covering ethics and professional standards, organisations like the British Chiropractic Association try to ensure that their members don’t overstep the mark and make exaggerated claims about the therapeutic benefits of chiropractic, giving the public the wrong impression about what conditions can be treated and what can’t.

MIDDLETON
We don’t deal with immunisations or diseases in any way shape or form. There’s nothing chiropractic can do for a disease. We’re mechanical, we treat mechanical problems - we treat pain, pins and needles, numbness and weakness of mechanical origin, so we treat bad backs, sciatica and things - we don’t treat tumours, we don’t treat diseases, we don’t treat all the arthrotides or forms of arthritis. Individual chiropractors like individual doctors of medicine might give varying opinions but we shouldn’t move out of our field, we don’t need to.

ACTUALITY - SHIATSU CLASS

FORD
A key component of the drive towards greater regulation in CAM is higher educational standards. Over the last decade, two and three year courses have been developed in a variety of disciplines which ground students not only in the traditions of their chosen therapy, in this case shiatsu, but also in anatomy, biomedicine and practitioner development skills.

SHIATSU TEACHER
Having an interest in working directly with the body was something that attracted me to shiatsu. Also it being founded in Chinese medicine, which has got thousands of years of pedigree to it. And that’s been helpful for me to place that Western - the Western models in a broader context. So we do talk about physiology and anatomy and next year we’ll talk about pathology. My eyes have been opened actually to the value of Western models and Western approaches, having them placed within a much broader more holistic context.

STONE
Part of the trend towards professionalisation has seen a shift in the training and the education required to become a complementary or alternative practitioner towards more academic, more professionalised training and the key to that is that this is externally accredited training, in other words you can’t run your own training school and then set up a register for the graduates of your own training school.

FORD
Julie Stone.

More than 40 higher educational institutions now offer studies in one or more forms of complementary medicine, often at degree level. The pioneer, was the University of Westminster’s Department of Complementary Studies, whose chair is Brian Isbell. He explained that it’s a challenge to integrate traditional therapies into modern academia.

ISBELL
It’s been a very delicate balance because obviously making academic programmes out of therapies has been a challenge. But provided it’s a partnership between the practitioner resource that we’re using, the academics that we have, the professional bodies we can get the balance right. And the balance needs to be right because obviously we need skilled practitioners, ones that not only can talk about what they do but obviously practise effectively. In fact the themes of health sciences, practitioner development and research go throughout the courses. So it’s not as if there’s sort of a division or polarisation because obviously if we organise the course like that the students may see it in that way. So in fact their therapy plus the other themes are taught all the way through the course, so that they see it as integrated package. And the other thing which we feel is vital is that not only do they have the opportunity to of course learn in mixed groups - that is with those studying other therapies - but we do our utmost to make sure they get experience of working in the NHS as well.

FORD
Education, ethical guidelines and practitioner development - all positive moves towards best practice in the CAM world.

But as far as regulation goes, don’t expect a general council of aromatherapy or crystal healing in the near future, if ever.

When the House of Lords published its landmark report on complementary medicine in 2000, they recommended that only certain therapies would need to be regulated. They were those which "pose a direct risk to public health", which could demonstrate a significant body of research, and whose practitioners shared a common ideology. Two professions which have met most of those criteria are acupuncture and herbal medicine.

But the process has not been easy because of the political in-fighting between the different tribes within these professions. There are 7,000 registered acupuncturists in this country, spread over several organisations. The herbalists, both Chinese and Western, account for at least six different bodies.

A further recommendation by the Lords was, unlike the osteopaths and chiropractors, the creation of a single CAM council for all the other professions, which has proved to be an unpopular option. Mike O’Farrell is chief executive of the British Acupuncture Council.

O’FARRELL
It’s in our interests that we work together. I don’t think it’s in our interests or the public’s interests that we should combine acupuncture and herbal medicine in one generic body unless we’re able to clearly specify within that body the responsibilities of each. For me it’s very, very important that the public is able to look at a list or a register and say x is an acupuncturist, y is a herbal medical practitioner. Now they’re on that list, what exactly do they do?

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