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Last year the Royal London Homeopathic Hospital was rebranded as the Royal London Hospital for Integrated Medicine (RLHIM). The exercise seems to have been entirely cosmetic. Sadly, they still practise the same nonsense, as described in Royal London Homeopathic Hospital rebranded. But how different will things be at the Royal London Hospital for Integrated Medicine?.

Recently I came across a totally disgraceful pamphlet issued by the RLHIM [download pamphlet].

If you haven’t come across craniosacral therapy (and who could blame you, a new form of nonsense is invented daily), try these sources.

uclh-cranio-vs

In short, it is yet another weird invention of an eccentric American osteopath, dating from the 1930s. Like Osteopathy and Chiropractic, there is no ancient wisdom involved, just an individual with an eye for what makes money.

What the UCLH pamphlet claims

UCLH-cs2

The claims made in this pamphlet are utterly baseless. In fact there isn’t the slightest evidence that craniosacral therapy is good for anything. And its ‘principles’ are pure nonsense.

No doubt that is why the Advertising Standards Authority has already delivered a damning indictment of rather similar claims made in a leaflet issued by the Craniosacral Therapy Association (CSTA)

The Advertising Standards judgement concluded

" . . the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and beauty products and therapies)."

"We noted that the CSTA believed that the leaflet was merely inviting readers to try CST to see if it could alleviate some of their symptoms and did not discourage them from seeing a doctor. However, we considered that the list of serious medical conditions in the ad, and the references to the benefit and help provided by CST, could encourage readers to use CST to relieve their symptoms rather than seek advice from a medical professional. We therefore concluded that the ad could discourage readers from seeking essential treatment for serious medical conditions from a qualified medical practitioner.

Complaint through the official channels. It took 3 months to extract “No comment” from Dr Gill Gaskin

Given that I have every reason to be grateful to UCL Hospitals for superb care, i was hesitant to leap into print to condemn the irresponsible pamphlet issued by one of their hospitals. It seemed better to go through the proper channels and make a complaint in private to the UCL Hospitals Trust.

On 21st December 2010 I wrote to the directors of UCLH Trust

I have just come across the attached pamphlet.

“Craniosacral” therapy is a preposterous made-up invention.

More to the point, there is no worthwhile evidence for the claims made in the pamphlet.

The leaflet is, I contend, illegal under the Consumer protection regulations 2008. It is also deeply embarrassing that UCLH should be lending its name to this sort of thing.

If you can think of any reason why I should not refer the pamphlet to the Advertising Standards Association, and to the office of Trading Standards, please let me know quickly.

Best regards

David Colquhoun

On 7th January 2011 I got an acknowledgment, which told me that my letter had been forwarded to the Medical Director for Specialist Hospitals for a response.

The Specialist Hospitals of the Trust include the Eastman Dental Hospital, The Heart Hospital, The National Hospital for Neurology & Neurosurgery (the famous Queen’s Square hospital) and, yes, The Royal London Hospital for Integrated Medicine. I’ve been a patient at three of them and have nothing but praise, Queen’s Square and the UCLH baby unit saved the life of my wife and my son in 1984 (see Why I love the National Health Service).

The Medical Director for Specialist Hospitals is Dr Gill Gaskin, and it is to her that my letter was forwarded. Of course it is not her fault that, in 2002, the Royal London Homeopathic Hospital (as it then was) was acquired by the UCLH Trust in 2002, The excuse given at the time was that the space was needed and the nonsense espoused by the RLHH would be squeezed out. That hasn’t yet happened.

After that nothing happened so I wrote directly to Dr Gaskin on 14th February 2011

Dear Dr Gaskin
The letter below was sent to the Trust on 20 December last year. I am told it was forwarded to you. I’m disappointed that I have still had no reply, after almost two months.  It was a serious enquiry and it has legal implications for the Trust. Would it help to talk about it in person?
David Colquhoun

I got a quick reply, but sadly, as so often, the complaint had simply been forwarded to the object of the complaint. This sort of buck-passing is standard procedure for heading off complaints in any big organisation, in my experience.

From: <Gill.Gaskin@uclh.nhs.uk>

To: <d.colquhoun@ucl.ac.uk>

Cc: <jocelyn.laws@uclh.nhs.uk>, <Rachel.Maybank@uclh.nhs.uk>

Dear Professor Colquhoun
 
I received your email in January.
I have now received the response from the Associate Clinical Director of the Royal London Hospital for Integrated Medicine, which is as set out below.
 

The brochure makes no claims of efficacy for Craniosacral Therapy (CST).  In terms of safety, only two randomised trials have reported adverse effects, neither found an excess of adverse effects of CST over control interventions (disconnected magnetotherapy equipment and static magnets respectively):
 
(Castro-Sanchez A et al.  A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil 2011 25: 25–35.  published online 11 August 2010 DOI: 10.1177/0269215510375909
Mann JD et al. Craniosacral therapy for migraine: Protocol development for an exploratory controlled clinical trial.   BMC Complementary and Alternative Medicine 2008, 8:28 published 9 June 2008 doi:10.1186/1472-6882-8-28)

The only reports of adverse effects of CST relate to its use in traumatic brain injury.  (Greenman PE, McPartland JM. Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopath Assoc 1995;95:182-88).

The RLHIM does not treat this condition and it is not mentioned in the brochure. 

The Craniosacral Therapy Association is planning a safety audit, to be launched later this year.  The RLHIM intends to participate in this.

With best wishes
 
Gill Gaskin



Dr Gill Gaskin

Medical Director

Specialist Hospitals Board

UCLH NHS Foundation Trust



I don’t know who wrote this self-serving nonsense because there is no sign on the web of a job called "Associate Clinical Director of the Royal London Hospital for Integrated Medicine".

It is absurd to say that the leaflet makes “makes no claims of efficacy”. It says "Craniosacral therapy can be offered to children and adults for a variety of conditions:" and then goes on to list a whole lot of conditions, some of which are potentially serious, like "Recurrent ear infections and sinus infections, glue ear " and "Asthma". Surely anyone would suppose that if a UCLH Hopsital were offering a treatment for conditions like these, there would be at least some evidence that they worked. And there is no such evidence. This reply seemed to me to verge on the dishonest.

Remember too that this response was written on 16th February 2011, long after the Advertising Standards Association had said that there is no worthwhile evidence for claims of this sort, on 8th September 2010.

I replied at once

Thanks for the reply, but I thought that this was your responsibility. Naturally the RLHIM will stick up for itself, so asking them gets us nowhere at all.  The buck stops with the Trust (in particular with you, I understand) and it is for you to judge whether pamphlets such as that I sent bring the Trust into disrepute

. . ..

I’d be very pleased to hear your reaction (rather than that of the RLHIM) to these comments.  It seems a reasonable thing to ask for, since responsibility for the RLHIM rests with you

David Colquhoun

On the 13th March, after a couple of reminders, Dr Gaskin said "I will respond to you tomorrow or Tuesday,". No such luck though. On 25th March, more than three months after I first wrote, I eventually got a reply (my emphasis).

I do not wish to comment further on the matter of the leaflets as a complaint to the advertising standards authority would be dealt with formally.

I am aware of your views on complementary medicine, and of course am entirely open to you pointing out areas where you believe there is misleading information, and I ask colleagues to review such areas when highlighted.

I would make several additional comments:

– patients are referred into NHS services by their GPs (or occasionally by consultants in other services) and cannot self-refer

– patients attending the Royal London Hospital for Integrated Medicine report positively on NHS Choices

– GPs continue to make referrals to the Royal London Hospital for Integrated Medicine and many request that patients stay under follow-up, when UCLH seeks to reconfirm this

– UCLH is engaging with North Central London NHS commissioners on work on their priorities, and that includes work on complementary medicine (and combinations of conventional and complementary approaches)

I think you will understand that I will not wish to engage in lengthy correspondence, and have many other competing priorities at present.

With best wishes

Gill Gaskin

So, after three months’ effort, all I could get was ‘no comment‘, plus some anecdotes about satisfied customers -the stock in trade of all quacks.

I guess it is well known that complaints against any NHS organisation normally meet with a stonewall. That happens with any big organisation (universities too). Nevertheless it strikes me as dereliction of duty to respond so slowly, and in the end to say nothing anyway.

The Advertising Standards Authority have already given their judgement, and it appears to be based on sounder medicine than Dr Gaskin’s ‘reply’..

There are plans afoot to refer the UCLH pamphlet to the the Office of Trading Standards.IIt is for them to decide whether to prosecute the UCLH Trust for making false health claims. It is sad to have to say that they deserve to be prosecuted.

Follow-up

28 March 2011. Two days after this post went up, a Google search for “Dr Gill Gaskin” brought up this post as #5 on the first page. Amazing.

On 25 May, the same search alluded to this post in positions 2, 3, 4 and 5 on the first page of Google.

29 June 2013

Despite several judgements by the Advertising Standards Authority (ASA) against claims made for craniosacral therapy, nothing was done.
But after UCLH Trust was comprehensively condemned by the ASA for the claims made for acupuncture by the RLHIM, at last we got action. All patient pamphlets have been withdrawn, and patient information is being revised.

. It isn’t obvious why this has taken more that two years (and one can only hope that the revised information will be more accurate)

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17 Responses to Cranial Osteopathy at the Royal London Hospital for Integrated Medicine, and inaction by Dr Gill Gaskin

  • David,

    Hard to believe that the UCLH allow this nonsense to go on ‘under their roof’. I thought is was a little more fringe than that.

    As you point out the ASA have already looked at CranioSacral Therapy (CST) and many of the conditions that are on the RLHIM leaflet were covered in the CranioSacral Therapy Assoc leaflet I looked at last year and the ASA adjudicated on.

    I actually had an email from the ASA (dated 25 Mar) on a CranioSacral, in it they say:

    “We have previously investigated similar claims about craniosacral therapy and found them in breach of the Code, so it is a more clear-cut matter”

    This leaflet obviously breaches the CAP codes, as the ASA say it is a ‘clear-cut matter’.

  • I complained to the ASA (but not to Trading Standards) about a bunch of RHIM leaflets, including the Cranial Sacral Therapy one, some months ago. I’ve been told they will be the subject of a formal adjudication.

  • One of the High Representatives of the Lanoitar people, Nuohuqloc, also known as Forp, accumulated many documents to show that the many tribes of Obmuj-obmum had based their belief system on stupid ideas that were without foundation. Year after year the Lanoitar people exploited the knowledge that science gave them to extend their territory and the followers of the Obmuj-obmum belief systems were always retreating.
    However, the people said to Nuohuqloc you are a great Forp and we like to live in the land of the Lanoitar and enjoy its benefits but we do not want the Obmuj-obmum to be banished and sent into exile because we have heard many tales of the good they can do in the temple at MIHLR. Furthermore, many of the Lanoitar medicine men (Scidem) used the ‘skills’ of the Obmuj-obmum when Lanoitar medicine didn’t work.
    And so it came to pass that Nuohuqloc Forp realised that this was a fight that would never end until the Scidem could be persuaded to be truly Lanoitar.

  • @CrewsControl
    You’re missing the point, love. Nobody would deny that the RLHIM serves a useful purpose as a dumping ground for untreatable patients who, after a lengthy consultation in a relaxed environment with someone who can listen sympathetically, are likely to feel somewhat better. But any such benefit must be considered alongside other issues. One of these is the ethics of presenting unproven and implausible therapies as if they can, in fact, treat real disorders. To put it another way, do we think it’s OK for our doctors to lie to us? Another issue is that NHS resources are finite. Should we be publicly funding quack therapies when there isn’t enough for proper, life-saving treatments? I must say I’m surprised that you would answer ‘yes’ to either of these.

    You might want to reconsider your last sentence and replace the word ‘Scidem’ with ‘skcauQ’, though I should point out that writing words backwards doesn’t make a bad argument any better.

  • @Skepticat.
    ‘…presenting unproven and implausible therapies as if they can, in fact, treat real disorders..’.
    ‘ ….it’s OK for our doctors to lie to us.
    ‘….publicly funding quack therapies when there isn’t enough for proper, life-saving treatments..’

    I wasn’t arguing for any of these approaches.
    The status enjoyed by GPs means that if they make use of the RLHIM ‘dumping ground’, and the bizarre untested treatments on offer there, then this is likely to be perceived by the general public as an imprimatur that the treatments on offer there are real medicine interventions. I would be interested to know whether the GPs involved are economical with the truth about placebo treatment when they dump the untreatable at the RLHIM.
    Now there are some people, Professor Colquhoun is one of them, who “have no objection to the NHS funding placebos as long as they are honest about what they are doing.” Professor Edzard Ernst is of the contrary view he states “I would argue it is unnecessary, unreliable and unethical to prescribe placebos through the NHS; …”
    I believe the Ernst position is correct precisely because there is the danger that the theatre of nonsense surrounding placebo treatment will be perceived by the layman as legitimate medicine, no matter what provisos are in place. And, more significantly, there will never be an end to the demand from patients for these mumbo jumbo interventions that draw scarce funds away from ‘proper, life-saving treatments’. I believe that the Cranial Therapy Clinic pamphlet is an indication that placebo treatment requires the invention of ever more bizarre medical theatricals.
    Furthermore if GPs (not quacks) send their patients to the RLHIM then it will quite legitimate for the likes of Dr Gaskin to, effortlessly, field letters from Professor Colquhoun by pointing this out; thus blurring lines of responsibility. As Dr Gaskin says
    ‘- GPs continue to make referrals to the Royal London Hospital for Integrated Medicine and many request that patients stay under follow-up, when UCLH seeks to reconfirm this’
    I’m sorry if my original stick was so badly designed that you got hold of the wrong end, hopefully this one has a more clearly delineated handle.
    Love.
    CrewsControl

  • Thanks for the clarification. I agree with most of your last post. Sorry for the misunderstanding.

  • You are right David, this is dereliction of duty and Gaskin should be disciplined by the trust board. But they won’t of course.

  • I am sure I am in agreement with others here who find Gaskin’s attitude to be even more scary than that of the people who published the original pamphlet.

    Would CranioSacral Therapy enable Gaskin to locate her backbone? Or possibly to distinguish her arse from her elbow?

  • p.s. I wonder whether Gaskin actually knows what CST is: a light massage of your scalp treats glue ear!

    CST is at the deeply laughable end of the alt.med spectrum. Is it really feasible that she could know about it and still support it?

  • Further to my point about the desirability of a demarcation between medicine and complementary medicine a recent article in the ‘Herald ‘(Life and Style section, 21 March 2011) will surely have the Alt Med crowd jumping for joy.
    http://www.heraldscotland.com/life-style/fashion-beauty-wellbeing/pregnant-with-possibilities-1.1091477
    It reports a collaboration between the private Natural Fertility Clinic (you get Chinese herbal medicine and acupuncture at the NFC) and the private Glasgow Centre of Reproductive Medicine (where you get conventional IVF medical treatment). “There are other parts of Europe where the two are working hand in glove,” says the scientific director of the GCRM.
    The lack of a clear demarcation between medicine and complementary medicine, made particularly hazy by the collaboration of conventional medics (in this case Prof Scott M. Nelson Professor of Obs/Gyn at Glasgow University) and the holistic folk at Napiers of Edinburgh (who not surprisingly link to the article), is I humbly suggest why blogs such as this will always be in business. Unless Medics can be persuaded to stop dabbling in evidence-free nonsense the patina of respectability will always attach to JuJu and you’ll find, like the Hydra of mythology, that no sooner has one head been cleaved than two others will spring up in its place.

  • Given students pay circa £5000 for a Diploma of Cranio-Sacral Therapy (CST), and that the 5 major schools produce in the order of 200 – 400 graduates per year, most of which believe CST is a genuine form of secondary health care as taught by the colleges, what is being done to call these the teaching staff and principals of the colleges to account?

    It seems to me poor practice to target individual therapists who have (in good faith) spent a lot of time and money on their training, when in fact the colleges continue with their own unregulated, scientifically doubtful curriculum which presents the therapy in a medical context, profiting financially from students who are largely unaware of advertising standards until after graduation.

    Take Doug Hutchings for example, who is a tutor at the College of Cranio-Sacral Therapy (CCST) run by Thomas Attlee.

    He says:
    “Conditions that Respond Successfully Include… Autism, Bronchitis, Dyslexia, Multiple Sclerosis (MS), Visual disturbances” (amongst other things).

    http://www.freezepage.com/1330097000SQMMMWEBDX

    How is this not a test case for the Trading Standards? (and is this not ethically illegal?)

  • @Bobbi
    I agree entirely. That’s why, in this post, I don’t try to name and shame individual people who practise CST. They may be ill-informed and not very bright, but I expect most of them actually believe their nonsense.

    That’s why I didn’t approach them, but rather Dr Gill Gaskin, the senior person at the UCLH Trust who has responsibility for the hospital from which this advertisement emanated.

    You can see how far it got me.

    Only the ASA has done much, and we are still waiting for them to judge this particular leaflet.

    Have you submitted the CCST thing to Trading Standards? Please let me know by email. In general Trading Standards require several complaints, and once they have several complaints, they decline to apply the relevant law. They are, I fear, a shambles.

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