Trick or Treatment?

Written by a respected science journalist Simon Singh, and Britain's first professor of complementary medicine, Edzard Ernst, Trick or Treatment: Alternative Medicine on Trial claims to be "the definitive book on alternative medicine... honest, hard-hitting and impartial." I had high hopes.

The book has six chapters, the first of which has a discussion of the scientific method, clinical trials, and evidence-based medicine. This is important to set up the arguments of the next four chapters, each of which looks at the evidence for the efficacy of four branches of alternative medicine: acupuncture, homeopathy, chiropratice, and herbal medicine. Each of these chapters discusses the history of each therapy, how it is administered, and any clinical studies or other evidence of its effectiveness in treating certain conditions. Acupuncture and homeopathy get scathing reviews as being little more than placebos. Chiropractice scores on a few illnesses/conditions, and herbal medicine gets a conditional pass.

The final chapter tries to answer the question does it matter if alternative medicine is effective or ineffective, and then lists the "top ten culprits in the promotion of unproven and disproven medicine": celebrities, medical researchers, universities, alternative gurus, the media (twice), doctors, alternative medicine societies, government and regulators, and the World Health Organisation. There is also a substantial appendix with a short evaluation for each of a long list of alternative therapies (some of which I'd never heard of, which is quite an achievement for someone who lived in Glebe for seven years).

Three of the four therapies chosen for in-depth analysis, according to the authors, have little evidence to show that they are effective (compared to some for which there is more substantial evidence and are only given a short analysis in the appendix). The authors claim they have chosen the four therapies listed above because these are the most widespread - this is probably true in Britain, where homeopathy has been part of the establishment for hundreds of years and is available on the NHS, but probably not true in other countries where the book has been published.

The authors make some good points in the book about the lack of evidence for some alternative medical practice, beyond the placebo; and they also expose how many practitioners have been shown to be unethical in not operating on principles of informed consent, and in failing to keep records of how their patients have been treated, why, and any subsequent ill-effects. Another point they make very strongly is that alternative medicine is a financial rip-off. Again, this is probably more true in the UK, where conventional medicine is free, perhaps not so much in Australia or the US where alternative medicine can be a comparable price or covered by insurance.

I was a bit disappointed by this book. I found the language somewhat sensationalist and biased (in contradiction of its claim to being impartial and honest). The book is preaching to the choir to some extent, and is unlikely to win across any alternative medicine 'believers' to the authors' side. If they want to do that, they need to tone down the rhetoric.

To me, the more interesting question which the book scarcely touched, is not "what" alternative medicine is, but "why". We've never been healthier or lived longer, we've never had a more educated population, yet we are still yearning, it seems, for miracle cures and magic. Maybe that's a question for another book, best answered by a different set of authors.

Trick or Treatment: Alternative Medicine on Trial
Simon Singh and Edzard Ernst
Bantam Press

Cross posted at reading|reading|reading