Trick or Treatment: Alternative medicine

[Guest guest]

Trick or Treatment': Alternative therapy study

Holly Tucker, Sunday, August 24, 2008

Trick or Treatment: The Undeniable Facts About Alternative Medicine

By Simon Singh and Edzard Ernst. Norton; 342 pages; $25.95

When it comes to alternative medicine, what you don't know can be bad

for your health.

Who hasn't sprinted to the vitamin aisle or the herbal supplement

store at the first sign of flu, fatigue or sleeplessness? Alternative

medicine may not be what the doctor ordered, but Americans are

increasingly staking their health on therapies for which the

distinction between credibility and quackery is far from clear.

Simon Singh and Edzard Ernst sort fact from hype in " Trick or

Treatment, " their detailed analysis of alternative medicine, past and

present. Singh is a journalist with several science books to his name;

Ernst is a medical doctor with decades of research on complementary

medicine under his belt. In short, a perfect team.

" Trick or Treatment " broadly defines alternative therapies to include

any health intervention that is outside of mainstream medical

practice. However, its goal is much more specific. Unflinching in its

commitment to evidence-based science, the book aims to offer the last

word on the effectiveness of more than 30 common therapies - from ear

candling to colonic irrigation.

Singh and Ernst's swift and summative appendix, " Rapid Guide to

Alternative Therapies, " will appeal to readers who are looking for an

authoritative quick fix to confusion. The authors review the origins

of a multitude of therapies, how they are practiced, what research has

been conducted, and which ones they recommend, dedicating one page to

each therapy. For as much as we are assaulted by claims of fast cures

and easy answers, it would be tempting to flip furtively through the

appendix at the local bookstore. But this would be to miss the point

of the book entirely.

" Trick or Treatment " is as much a primer for critical thinking about

health decisions as it is anything else. To this effect, the authors

plead with readers to take the time to explore the book's first

chapter, for good reason: Framed around the fascinating dual histories

of bloodletting and the race to cure scurvy, Chapter 1 introduces the

book's quintessential question: " How Do You Determine What Is Truth? "

For Singh and Ernst, the answer is simple: scientific method. Good

science - and, by extension, good health decisions - are those made

after careful review of studies that are randomized and double-blind,

that employ identical conditions for both control and treatment

groups, and that take into account what we know about the placebo

effect. Through compelling case studies, the authors demonstrate why -

despite its long history and devoted followers - alternative healing

must be held to the same, strict research practices that are dominant

in conventional medicine.

" Trick or Treatment " walks readers through existing studies on four

well-known but nonetheless disputed practices: acupuncture,

homeopathy, chiropractic therapy and herbal medicine. The authors

offer examples of why research on alternative medicine has been so

elusive and so difficult to test. How do you create needles and

needling techniques that mimic acupuncture in control groups? And how

does that help to explain the wildly differing conclusions regarding

acupuncture's effectiveness across studies?

Each chapter also reminds us that past and present are inseparable.

Singh and Ernst use page-turning stories from the history of medicine

to frame their presentation of when and why each treatment came into

being and how it is believed to work. This historical lens provides

new ways of looking at the strengths - but more often, the limitations

- of the way we understand, use and abuse complementary medicine in

our own era.

While Singh and Ernst clearly lean toward the side of skeptics when it

comes to many alternative treatments, their respect for proponents of

alternative medicine - and their readers more generally - is evident

throughout. Why is it, the authors ask, that smart people believe the

oddest things? In this question lies a welcome assumption: Readers are

smart. And this diagnosis sets " Trick or Treatment " apart from the

multitude of books about alternative medicine on the market today. {sbox}

Holly Tucker is associate professor of Medicine, Health & Society and

French Studies at Vanderbilt University.

This article appeared on page M - 3 of the San Francisco Chronicle

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/08/22/RVRO1234SA.DTL & type=\

books

[Guest guest]

Trick or Treatment

Published by Harriet Hall under Book Review

I've just finished reading Trick or Treatment: The Undeniable Facts

about Alternative Medicine by Simon Singh and Edzard Ernst. I'd been

looking forward to the publication of this book, and it exceeded my

expectations.

Edzard Ernst, based at the University of Exeter in England, is the

world's first professor of complementary medicine, a post he has held

for 15 years. An MD and a PhD, he also embraced alternative medicine

and used to practice homeopathy. He has done extensive research and

published widely. His stated objective is " to apply the principles of

evidence-based medicine to the field of complementary medicine such

that those treatments which demonstrably do generate more good than

harm become part of conventional medicine and those which fail to meet

this criterion become obsolete. " His most important accomplishment has

been to " demonstrate that complementary medicine can be scientifically

investigated which, in turn, brought about a change in attitude both

in the way the medical establishment looks upon complementary medicine

and in the way complementary medicine looks upon scientific

investigation. "

Simon Singh is a science writer with a PhD in particle physics. As a

team, he and Ernst are uniquely qualified to ferret out the truth

about alternative medicine and explain it to the public.

The book is ironically dedicated to HRH The Prince of Wales, who is

infamous for encouraging unproven treatments. Prince has

called for scientific studies of alternative medicine but has

consistently disregarded the results of such studies.

The first chapter asks " how do you determine the truth? " and explains

the scientific method. Four chapters address the scientific evidence

for the 4 major alternative therapies: acupuncture, homeopathy,

chiropractic, and herbal medicine (36 lesser therapies are covered in

an appendix). The final chapter asks " does the truth matter? "

They give an example that beautifully illustrates the value of

rigorous science. Dr. Bill Silverman was frustrated by seeing

premature babies go blind with retinopathy of prematurity (ROP). He

tried treating them with ACTH and had astounding success: only 2 out

of 31 infants lost their sight. In another hospital where ACTH was not

used, 6 out of 7 babies lost their sight. Most doctors would have

simply continued using ACTH treatments and would have recommended them

to everyone, but Silverman was a true scientist. He recognized that it

might not be fair to compare babies in two different hospitals and

that a proper randomized controlled trial was needed. When he did such

a trial, 70% of the babies on ACTH recovered, but 80% of the untreated

babies recovered, and more babies in the ACTH group died. A followup

study confirmed these results. If Silverman had not had the integrity

to question his own hypothesis, a useless and possibly harmful

treatment might have become standard, and more babies might have ended

up blind or dead.

Singh and Ernst provide many other memorable examples of good and

not-so-good science, from Lind's experiments on British sailors with

scurvy to Benveniste's discredited homeopathy study in Nature. They

debunk many of the fallacies of alternative medicine: the " natural "

fallacy, the " traditional " fallacy, the " holistic " fallacy, the

" science can't test alternative medicine " fallacy, the " science

doesn't understand alternative medicine " fallacy, and the " science is

biased against alternative ideas " fallacy. They discuss placebos and

explain why they don't condone using them. They name ten classes of

culprit in the promotion of unproven and disproven medicine, from the

media to alternative gurus to the World Health Organization.

They discuss the role of prior plausibility in deciding directions for

future research. They quote Carl Sagan:

It seems to me what is called for is an exquisite balance between

two conflicting needs: the most skeptical scrutiny of all hypotheses

that are served up to us and at the same time a great openness to new

ideas… f you are open to the point of gullibility… then you cannot

distinguish useful ideas from worthless ones. If all ideas have equal

validity then you are lost, because then it seems to me, no ideas have

any validity at all.

They review all the published evidence for alternative medicine, and

their conclusions are not very favorable:

While there is tentative evidence that acupuncture might be

effective for some forms of pain relief and nausea, it fails to

deliver any medical benefit in any other situations and its underlying

concepts are meaningless. With respect to homeopathy, the evidence

points towards a bogus industry that offers patients nothing more than

a fantasy. Chiropractors, on the other hand, might compete with

physiotherapists in terms of treating some back problems, but all

their other claims are beyond belief and can carry a range of

significant risks. Herbal medicine undoubtedly offers some interesting

remedies, but they are significantly outnumbered by the unproven,

disproven and downright dangerous herbal medicines on the market.

These are strong words, and they have met with understandable

hostility from the alternative community. Simon Singh has already been

sued by the British Chiropractic Association for libel because of an

article saying that chiropractors knowingly promoted bogus treatments

for illnesses including asthma and ear infections.

Criticisms of Trick or Treatment reveal an appalling poverty of

thought. No one can seriously question the facts and the reasoning in

the book, so opponents resort to other tactics. A homeopathy website

resorts to denying that science is a useful tool. It essentially calls

evidence-based medicine quackery! Other critics simply criticize every

defect of conventional science-based medicine, as if imperfections in

applied science somehow proved that a nonscientific approach was

better! They misrepresent what the book says and use ad hominem

insults, ridiculously attacking Ernst as " desperate to find ANYTHING

to discredit CAM. " I haven't found any critics who have even tried to

cogently address the points the book makes.

It's easy to criticize with generalizations. 's therapeutic

touch study was accused of " poor design and methodology, " but as Singh

and Ernst point out, " [her] protocol was simple and clear and her

conclusion was hard to fault. Moreover, nobody has ever come up with

an experiment that has overturned her findings. " If proponents of

alternative medicine come up with good experiments that overturn the

present findings, Singh and Ernst have made it clear that they will

gladly accept them. In fact, Ernst has offered a prize of £10,000 to

be given to the first person who can show homeopathy is better than a

placebo in a scientifically controlled trial. No one has applied to

take his money.

Trick or Treatment is well worth reading. I highly recommend it. It

ought to have more credibility than other books critiquing alternative

medicine, simply because it is harder to accuse Dr. Ernst of bias. He

is an avowed supporter of everything in alternative medicine that can

be shown to work. He has used homeopathic remedies himself. He accepts

herbal medicine claims that many of us reject (for instance, Echinacea

to prevent and treat the common cold). He has demonstrated his ability

to change his mind and follow the evidence. He has no ax to grind; his

only agenda is to find the truth.

I wonder if the tide is starting to turn. We've recently seen a number

of books critiquing complementary and alternative medicine. Natural

Causes, Snake Oil Science, Suckers, and now this. People are no longer

trying to be " politically correct " but are freely calling most of CAM

a scam and a sign of the " Endarkenment. " They are calling for a return

to scientific medicine and to one standard for judging all treatments.

Just as we are doing on this blog.

Singh and Ernst are not attacking alternative medicine; they are

attacking overblown claims for unproven treatments. As Ernst says,

" People must not confuse the perceived benefits of so-called

alternative medicine with the medical facts. " Or as

Moynihan put it, " Everyone is entitled to his own opinion, but not his

own facts. "

http://www.sciencebasedmedicine.org/?p=195

[Guest guest]

Holistic Hooey

Two authors set out to expose the quackery of nonconventional

therapies by t Lapidos | August 28, 2008

Trick or Treatment: The Undeniable Facts About Alternative Medicine

By Simon Singh and Edzard Ernst

W.W. Norton, 352 pages, $25.95

The yearly global expenditure on alternative medicine is $77 billion.

To put that number in perspective, consider that the National

Institutes of Health 2009 budget for H.I.V./AIDS research is not quite

$3 billion, and that Croatia's gross domestic product is about $51

billion. Granted, if you believe that back-cracking and pin-pricking,

energizing lotions and herbal potions actually work, then it's not

unreasonable for the spending on such remedies to exceed a European

country's G.D.P. But in that case—at least according to Simon Singh

and Edzard Ernst, authors of Trick or Treatment—you're a sucker.

Dedicated to the Prince of Wales, an enthusiastic advocate of

homeopathy, Trick or Treatment sets out to give a definitive verdict

on the efficacy of nonconventional therapies. Messrs. Singh and Ernst

warn in their introduction that if you're an adamant believer in

alternative medicine, you might as well save your $25.95, because you

won't like their findings. And sure enough, in lengthy chapters

devoted to acupuncture, homeopathy, chiropractic and herbal medicine

(plus an appendix covering 36 treatments, including feng shui and

reiki), the authors deploy evidence from numerous clinical trials to

demonstrate that the overwhelming majority of alternative " cures " are

just placebos. In other words, bunk.

Getting duped into spending hundreds or even thousands of dollars on

what is, essentially, a sugar pill with a Chinese character on it is

arguably the best possible outcome for those who wander into the

holistic realm. Alternative remedies, Messrs. Singh and Ernst argue,

are often hazardous: Upper spine manipulation, a common chiropractic

technique, can cause strokes; needling at the base of the skull during

acupuncture can lead to brain damage; and herbal medicines may be

laced with pharmaceuticals.

Aware that nanny finger-wagging and prose like a warning label listing

side effects isn't everyone's cup of ginseng, Messrs. Singh and Ernst

frequently drop in anecdotal accounts of history's worst sham

remedies. Also, careful not to fall into a " trust insiders, mistrust

outsiders " dichotomy, they point out that many bad ideas have been

endorsed by the medical establishment. Just one example: Bloodletting,

though it had been a mainstream procedure for centuries, was arguably

to blame for the death of Washington, whose doctors drained

half his blood in less than a day because he was having difficulty

breathing.

What's missing from Trick or Treatment is a satisfactory explanation

for why so many people spend so much money on such transparent

quackery. In their last chapter, Messrs. Singh and Ernst include a

" top ten culprits " list; they scold the usual suspects, such as

celebrities and the media, but also health care staff who have " too

little time, sympathy and empathy " for their patients. This brief

aside on the brisk or even cold bedside manner of doctors hints at a

crucial factor in the motivation of otherwise rational people who shun

the lab-coated class and embrace alternative practitioners: They're

looking for a better therapeutic relationship. This is a matter worthy

of a whole chapter, if not a whole book. Suckers aren't born; they're

made in anonymous hospital waiting rooms.

t Lapidos is an assistant editor at Slate.

http://www.observer.com/2008/arts-culture/holistic-hooey