CAMLAW: Complementary and Alternative Medicine Law Blog

Response to spinal manipulation questioning

The UK's General Osteopathic Council responds to questions regarding the safety of spinal manipulation. The General Osteopathic Council's answer is thus:
The General Osteopathic Council (GOsC) is committed to patient safety and supports any research that works towards minimising the risk of harm to patients. It is essential that incidents of adverse reaction to spinal manipulation are monitored and investigated and this latest systematic review contributes to that body of knowledge.

However, it is important that the conclusions drawn from the report are presented in context.

All therapeutic interventions carry risks as well as providing benefits. Serious adverse events associated with spinal manipulation have historically been related to the upper cervical spine.

No clear figures currently exist for such events associated with osteopathy, which has historically been regarded as a safe form of treatment for a variety of conditions. In the interest of patients, the General Osteopathic Council, which regulates the practice of osteopathy in the United Kingdom, is currently funding a series of research projects to investigate the level and nature of risk that might be associated with osteopathic treatment. It is a provision of the Osteopathic Code of Practice that any relevant information about risks associated with an intervention is provided to the patients to enable them to make informed decisions about their care.

Patients should note that spinal manipulation is but one of a range of techniques used by osteopaths. Therapeutic techniques are applied selectively by osteopaths to suit the needs of the individual, ensuring patients are treated as effectively as possible, but - above all - safely.
I have seen similar responses from chiropractors and chiropractic organizations in the U.S.

And who can ever forget Wilk v. American Medical Association?

The General Osteopathic Council (GOsC) exists to protect patients by promoting excellence in osteopathic care. The GOsC regulates, develops and promotes the profession of osteopathy by: 1. Maintaining the definitive Register of those who have satisfied the GOsC that they can practise osteopathy safely and competently. 2. Defining and maintaining high standards of education, training and clinical practice. 3. Guiding osteopaths in standards of professional practice. 4. Dealing promptly and effectively with osteopaths whose competence or fitness to practise is called into question. 5. Developing the profession and practice of osteopathy. 6. Promoting osteopathic standards and the role of the regulator. The Statutory Register of Osteopaths 1. Osteopaths are statutorily regulated health professionals and form an integral part of primary care teams. 2. The General Osteopathic Council (GOsC) regulates, promotes and develops the osteopathic profession, maintaining a Statutory Register of those entitled to practise osteopathy in the United Kingdom. 3. Only practitioners meeting the highest standards of safety and competency are eligible for registration. Proof of good health, good character and professional indemnity insurance cover is also a requirement. 4. It is an offence for anyone to describe themselves as an osteopath and practise as such, unless registered with the GOsC. The public can, therefore, be confident in visiting a registered osteopath that they will experience safe and competent treatment from a practitioner who adheres to a strict Code of practice: 5. "13. (1) The General Osteopathic Council shall from time to time determine the standard of proficiency which, in its opinion, is required for the competent and safe practice of osteopath" (Osteopaths Act 1993) 6. "Any patient consulting an osteopath is entitled to a high standard of care. The register of osteopaths exists so that members of the public can identify those who have demonstrated their ability to practise to the required standards" (extract from the GOsC 'Code of Practice', GOsC, 2005). 7. The 2007 Statutory Register of Osteopaths provides a geographical index of all practising osteopaths, and is available to healthcare providers and the general public. Printed copies are available from the GOsC. A current and searchable listing of osteopaths is available on the GOsC website:
In general the UK has a system of voluntary professional self-regulation, though the osteopathic profession is one of those whose self-regulation is supplemented by a scheme of statutory regulation. The usual malpractice and standard of care issues familiar to U.S. chiropractors as well as medical doctors also face U.K. osteopaths, albeit with slightly different case law.
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