Book Review

Trick or Treatment:
The Undeniable Facts about Alternative Medicine

Authors: Simon Singh, PhD and Edzard Ernst, MD, PhD
Publisher: W.W. Norton Co., New York, London
ISBN: 978-0-393-06661-6
Publication date: 2008
Reviewed by: Harriet Hall, MD

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 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.

Ironically, the book is dedicated to HRH The Prince of Wales, who is infamous for encouraging unproven treatments. Prince Charles 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 four major alternative approaches: acupuncture, homeopathy, chiropractic, and herbal medicine. Thirty-six lesser modalities are covered in an appendix. The final chapter asks “does the truth matter?”

Chapter 4 provides a beautiful example of 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 follow-up 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 noteworthy examples of good and not-so-good science, from James Lind’s life-saving 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… [I]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.

Their conclusions about the four major approaches are quite unfavorable:

These strong words have met with understandable hostility from the alternative community. Simon Singh has already been sued by the British Chiropractic Association for libel in response to 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 authors' reasoning, so opponents resort to other tactics. A homeopathy Web site 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 prove that a nonscientific approach is 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. Emily Rosa’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 the first person who can show homeopathy is better than a placebo in a scientifically controlled trial. No one has applied for his money.

Ernst's criticisms deserve special credibility because he is an avowed supporter of everything "alternative" that can be shown to work. At one time, he even prescribed homeopathic remedies. He accepts claims about herbs 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. He warns that, “People must not confuse the perceived benefits of so-called alternative medicine with the medical facts.” Years ago, Daniel Patrick Moynihan put it similarly when he said that “Everyone is entitled to his own opinion, but not his own facts.”

Trick or Treatment can be ordered from Amazon Books by clicking this link.

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Dr. Hall is a retired family practitioner and Air Force colonel who resides in Puyallup, Washington. She contributes frequently to Skeptic, Skeptical Inquirer, and the Science-Based Medicine Blog.

This report was posted on August 27, 2008