The Sunday Times review by Bee Wilson
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“For 2,400 years,” wrote the historian of medicine David Wootton, “patients believed doctors were doing them good; for 2,300 years they were wrong.” Only in the past 100 years have treatments in the mainstream of medicine been consistently subject to clinical trial, to discover what works and what doesn't. Much medicine, though, still stands defiantly outside this mainstream. Can these alternative therapies really claim to be medically effective judged by today's standards, or are they no better than the blood-letting and snake oil of darker centuries?
Simon Singh, a science writer, and Edzard Ernst, a doctor, have set out to reveal the truth about “the potions, lotions, pills, needles, pummelling and energising that lie beyond the realms of conventional medicine”. Their conclusions are damning. “Most forms of alternative medicine,” say the authors, “for most conditions remain either unproven or are demonstrably ineffective, and several alternative therapies put patients at risk of harm.” The book is dedicated, in ironic homage, to HRH the Prince of Wales, that famous champion of complementary medicine, especially homeopathy (said to be used both for the prince's own body politic and for the cows at Highgrove).
Fearless, intelligent and remorselessly rational, the authors exemplify the same Enlightenment spirit of criticism that animated The Lancet in its early days. One by one, they go through the most influential alternative therapies (acupuncture, homeopathy, chiropractic and herbal medicines) and subject them to scientific scrutiny. In each case, they ask what is the evidence base for saying that a given therapy “works”? Acupuncture, homeopathy and chiropractic all come out badly. Singh and Ernst build a compelling case that these therapies are at worst positively dangerous - chiropractic neck manipulation can result in injury or death - and at best, are more or less useless. For example, tests done in Germany have shown that “real” acupuncture works no better in easing migraines than sham acupuncture, a random application of wrongly positioned needles, working as a placebo.
Singh and Ernst do not deny that placebos are powerful things. This being so, does it matter if homeopathy really “works” in scientific terms? If it makes me feel better to rub arnica cream into a bruise (notwithstanding the fact that the active ingredient in the cream is so dilute as to be nonexistent), what harm is done? The authors argue that it does matter, for three reasons. First, if, as the evidence base indicates, homeopathy is merely a placebo, then the price tag is a rip-off. They give the example of a single French duck, whose endlessly diluted heart and liver were used to generate $20m worth of homeopathic flu remedies. A second problem lies in the ethics of the doctor-patient relationship. In order to make the placebo effect work, doctors would have to suppress their knowledge that homeopathy was bogus. “In fact, the best way to exploit the placebo effect is to lie excessively to make the pill seem extra-special, by using statements such as ‘this remedy has been imported from Timbuktu' etc.” Third, and most worrying, by putting his or her faith in homeopathy, a patient may fail to seek out more effective conventional treatment. In the case of a minor bruise, this doesn't matter. It's altogether more serious when it comes to asthma, say, or cancer. The authors mention a Devon-based homeopath who used her own medicines to treat a malignant melanoma on her arm and, as they bluntly put it, “condemned herself to an inevitably early death”.
Does this mean that all alternative therapies are to be dismissed? In the case of herbal medicines, Singh and Ernst admit that some are effective, such as devil's claw for musculoskeletal pain, or hawthorn for congestive heart failure, but even here they argue that that, once an alternative treatment passes proper tests, it will be accepted into the mainstream and cease to be alternative. The examples they give are St John's Wort for the treatment of mild depression as well as osteopathy (a gentler alternative to chiropractic) and fish oils for preventing heart disease. They would like to see all alternative medicines jump through the same expensive hoops as mainstream drugs. Until they have passed such tests, they should come with cautions (“Warning: this product is a placebo”), though of course any such warning would work against the placebo effect.
Their case against the folly, vanity and damage of HRH et al is hard to argue with. But it would have been even stronger had they been more honest about the reasons people run so eagerly into the arms of quacks. They admit that, in the 19th century, patients were sometimes better off with homeopathy (ie no treatment at all) than with the mainstream practices of “bloodletting, intestinal purging, vomiting, sweating and blistering, which generally stressed an already weakened body”.
Today's medicine is, of course, infinitely more effective in the treatment of disease. But it is hopelessly primitive when it comes to preventing it. The past 100 years have not been an unmixed triumph for benevolent science. The “evidence-based” medicine that Singh and Ernst are so fond of does not look so great when we consider the profiteering of big pharmaceuticals, who would rather sell us drugs to manage our illnesses than to help us stay well. Alternative medicine flourishes in the space that conventional medicine neglects by focusing so relentlessly on cure rather than prevention. Is it any wonder that some people - against all the evidence - prefer the warm lies of the crystal merchants to the cold drugs of the men in white coats?
Trick or Treatment? Alternative Medicine on Trial by Simon Singh and Edzard
Ernst
Bantam Press £16.99 pp352

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Ernst and Singh can only see and measure things within the well defined box that they liv in. Life is so much more that we don't yet understand. Their attempt to contain human thought and evolution is ridiculous.
Stavros Mihaletos, Cardiff, Wales
If acupuncture is placebo, how come it works on animals?
Acupuncture has in fact been the object of more clinical trials than any other CAM therapy, and has frequently shown equal or better results than "conventional therapy" with no negative side effects.
Laura Bradburn, Auckland, New Zealand
The gullibility of supposedly intelligent people who can rationalize their irrational beliefs in quack mumbo jumbo is astounding. Very few alternative treatments are any better than placebos, while some are positively dangerous, and only a few have been shown to give temporary relief
Pat, London, country
I would like Harry Kauntze to name a single CAM therapy that is strongly supported by research. Certainly, chiropractic, acupuncture, and homeopathy are not.
Steve Hilliard, Avon Lake, OH,
Thanks for releasing this book. Most people dont know that they themselves have the power within them to promote healing and that antibiotics and other medications accelerate the healing effect. Most alternative therapists work on people's gullibility and their vulnerability when they are sick.
Gnani, Sydney, Australia
Scientific research is all about the cold hard repeatable facts and I think this is the point that Prof. Ernst et al continually try to sledge hammer us with. The point that he consistently dismisses is that we deal with whole people, not just afflicted bits and you can't measure that.
Poppy Burgess, Moretonhampstead, UK
P Race clearly doesn't understand the 'quantum entaglement' of which s/he speaks. Andrea Hochgatterer may not have heard of Occam's razor. Brenda Hawkes doesn't seem to know the difference between angular momentum and energy. Is this typical of the scientific ignorance of CAM apologists?
Daniel Rendall, Leamington Spa,
what about quantum entaglement whereby if substance A touches Substance B and are then seperated both are subtley changed - overcomes over dilution issue
p race, pulborough, west sussex
Another case of biased or ill informed reporting. The Acupuncture trial mentioned did indeed demonstrate that genuine & sham acupuncture were equally good at treating migraines. It also showed that they were twice as effective as conventional treatment! Why is this proven fact so little mentioned?
Andy Green, Penzance, UK
It is my honest view that if todays science cannot find any proof for why alternative methods work its because the instruments and methods of trial are just not advanced enough.
Best regrds
andrea hochgatterer, bristol, uk
I am amazed this discussion still goes on!
As far as nutrition is concerned, have a look at http://lpi.oregonstate.edu/infocenter/
Look at the pages and pages of refrences with "proper" research done.
Do journalists ever feel responsible for the information they select? Why not select some research from this website. sorry it is so positive. Might not sell very well.....
Bodil Mjoelkalid, Charmouth, UK
If Professor Ernst had any genuine concern for the health of the public he would be better directing his efforts towards the soft drinks and junk foods industries whose products are scientifically proven to be harmful.
The recent hysteria against alternative medicine is a strong indication that powerful vested interests know it is effective and safe, and see it as a threat to their financial and political status
Mike Rawlinson, Taunton, Somerset
The distinction between allopathic medicine and 'alternative health' is artificial. It is supposedly drawn up along the lines of evidence based vs unproven therapies but this is overly simplistic. In reality the divide is grey and porous: allopathic medicine has varying levels of evidence basis and some CAM therapies are strongly supported by research. All therapies must be subject to scientific scrutiny to justify their claims, but the only conclusion that can be drawn from the thriving alternative health industry is that allopathic medicine does not have all the answers to a patient's needs and until they do, an open mind would be a good thing. Viewing health through the lens of randomised controlled trials provides a limited and mechanistic view of health which is left wanting.
Ernst and Singh are trying to sell their book using a critical eye on CAM that should also be cast at the limitations of medical alternatives inorder to deliver a balenced approach.
Harry Kauntze, Chiropractor, Bristol, UK
The distinction between allopathic medicine and 'alternative health' is artificial. It is supposedly drawn up along the lines of evidence based vs unproven therapies but this is overly simplistic. In reality the divide is grey and porous: allopathic medicine has varying levels of evidence basis and some CAM therapies are strongly supported by research. All therapies must be subject to scientific scrutiny to justify their claims, but the only conclusion that can be drawn from the thriving alternative health industry is that allopathic medicine does not have all the answers to a patient's needs and until they do, an open mind would be a good thing. Viewing health through the lens of randomised controlled trials provides a limited and mechanistic view of health which is left wanting.
Ernst and Singh are trying to sell their book using a critical eye on CAM that should also be cast at the limitations of medical alternatives inorder to deliver a balenced approach.
Harry Kauntze Chiropractor, Bristol, UK
Scientists can't yet prove what lays beyound space but we know its there, most scientists are none beleivers in any faith but for most people their faith gives them hope, most scientists cannot explain the energy that keeps the world turning , we know why it is but we do not know why it ever was. Not all drugs work without causing other problems and sometimes those that have been trialed and tested in laboratories years down the line are found to be dangerous if not fatal. Why is it then that scientists always feel the need to put themselves above others and assume that every thing has to be a proven science. Chemical reactions within our bodies to emotions are a powerful source not to be overlooked and if holistic therapies trigger a response in helping to keep the body healthy then surely they are worthy of celebration as much as a successeful heart transplant or a drug that fights disease. Maybe as with all things we should try to work together! And yes it can cure some Asthma's.
Brenda Hawkes, Bournemouth, England
For a start, why does the placebo effect only seem to be relevant to alternative treatments? Surely it will play a similar role in conventional medicine but doesn't.
Also, why do many people become CHRONICALLY ill over their lives, needing more and more conventional drugs to 'keep them alive'? It is because conventional treatment, more often than not, is suppressive, i.e., people do not get better, their symptoms are just changed, with the body getting progressively worse as its forms of healing (expressed through the production of symptoms) are sabotaged by drugs.
Doctors should learn the Law of Cure (Hering - check it out).
People who scoff at the dilution of homoeopathic remedies miss the point of potentisation - a process which makes the remedy more powerful the more it is diluted. If there is enough power in an atom to destroy a city, then maybe there is enough power in a diluted remedy to enable a person's body to complete the process of healing it is going through.
Clare Chapman, Bruton, Somerset, UK
Isn't the placebo affect what it's all about, complemantary therapy is all about relaxing the mind and body and starting the natural healing process. I believe that all physical illness comes about due to negative emotions. The best example of this is cancer. It is a known fact that a fighting spirit and positive outlook is the best cure. If you give up your body will give up to. What patients need is support and the knowledge that their life is in their own hands and complementary therapists especially energy therapist can help with this simple process. I know that alternative medicine is more popular than ever. People are tired and fed up with being subscribed more and more pills and don't get me started on the drug companies. It's a sorry state of affairs.
Sharon Beer, Weston-super-mare,
If we are coming at this from a scientific basis why not read Energy Medicine, James L. Oschman for the other side of the scientific debate. We can all write books that denigrate and find the 'evedence' to back it up. I am a Bowen therapist and remember treating someone with frozen shoulder, when I finished treatment her range of movement wasn't much greater than before, so it must be an 'evedence based' failure! But wait, she now slept well, had more than halved her pain killers and felt much brighter and happier. In her words 'You've completely changed my life, I was in constant pain and life wasn't worth living'. Science wouldn't have measured that, just the range of movement!
Keith Cherrington, Bristol, England