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The persistence of implausible ideas

Edzard Ernst looks at the evidence for cranosacral therapy

Craniosacral therapy (CST) is based on utterly implausible ideas: tiny rhythmic motions of the cranial and other bones are supposed to adversely influence our health. But fortunately, the hands of an osteopath can right all wrongs by gently mobilizing these bones.

We could easily push all of this aside to the lunatic fringe, but lots of people swear by CST, in particular as a treatment for cerebral palsy (CP).

It was therefore courageous of colleagues at my medical school to test CST in a rigorous, pragmatic RCT (I or my team were in no way involved in this study). They recruited 142 children with cerebral palsy and treated them either with CST for six months or, in an attempt to allow for non-specific effects, gave them some attention control. At the end of the treatment period, none of the outcome measures (e.g. motor function, quality of life, sleep, pain) was significantly affected. In other words, CST does not work – at least not for cerebral palsy.

So will CST now become less popular? Will parents spend their money on therapies that might actually help? I somehow doubt it – for far too many of them, such implausible rituals have become a belief system; and no evidence in the world will alter evangelic belief.

If that is so, why do the research in the first place, one might ask. The intervention is too implausible to have a realistic change of generating a positive result – unless, of course, the study is dripping with bias. This means that there is no real likelihood that an unbiased, negative result will change anything. So, is the scientific investigation of popular yet implausible CAMs a waste of time, patient co-operation, money, talent, etc? What do you think?

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter

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