Trick or Treatment: The Undeniable Facts About Alternative Medicine is one of the best-written and most accessible books on the topic available. It is written by Edzard Ernst and Simon Singh.
Ernst is a medical doctor and homeopath with extensive experience practicing and studying complementary and alternative medicine (CAM). He is an ideal author for this book because he combines a true open-mindedness and personal experience with alternative therapies in practice with a rigorous adherence to the principles of evidence-based, scientific medicine. He cannot be tarnished with the nonsense so often leveled at critics of CAM that he is motivated only to maintain the supremacy of some corporate medical establishment, that he is intellectually closed-minded and blind to the potential of therapies not arising from the establishment, and so on. He clearly cares about the wel-being of his patients and believes deeply that he can best help them only by knowing the truth about the therapies available.
Simon Singh is a journalist and science writer with a gift for language and an admirable commitment to truth, even when it is unpopular or dangerous. Right now he is being persecuted by the British Chiropractic Association, with the help of Britain’s bizarre libel laws, for statements The Guardian newspaper. While it is difficult to imagine for those of us accustomed to U.S. libel law, in Britain it is possible to be successfully sued for making truthful statements, backed by evidence, about scientific controversies. He has courageously stood alone, at great personal and economic cost, to support the right to speak the truth about scientific questions.
Trick or Treatment begins with an introduction to the history and basic principles of the scientific method and evidence-based medicine. But rather than a dry, technical account, the authors make use of a technique all too common among CAM proponents and all too often shunned by science writers. They illustrate the principles with vivid personal narratives. The history of bloodletting as a medical therapy is rightly used as a prime example of why science is superior to experience, authority, and anecdote as a way of judging the truth about medical practices. And the story of George Washington, slowly bled to death by his doctors, is a powerful example of how tragically misguided the faith-based approach to medicine is.
There are then a series of chapters examining in detail Acupuncture, Homeopathy, Chiropractic, and Herbal Medicine. These offer some brief historical perspectives and a review of the evidence that is clear and comprehensive but not overly technical and quite accessible to the general reader. While I could certainly find fault here or there with specific points, the overall assessment is clear, cogent, and well-supported.
Ernst is a dedicated proponent of evidence-based medicine. I would argue that this approach is far better than the faith-based medicine most CAM proponents practice, but it does have some flaws. For one, it tends to view all ideas, no matter how wacky, as equally deserving of extensive clinical research to determine if they are safe or effective therapies. I agree with the arguments of science-based medicine that given the limitations of resources and the practical realities of research, selecting which approaches to investigate rigorously should be a careful and deliberate process that takes into account the scientific plausibility of the idea. Faith healing and non-steroidal anti-inflammatory drugs do not have an equal probability of being useful treatments based on the context of well-established scientific knowledge, and spending talent and money on both equally is ludicrous.
Nevertheless, I cannot fault the intellectual or scientific rigor of Ernst and Singh’s summaries, and I cannot laud highly enough the quality and accessibility of the writing. While I am even more impressed by the thoroughness and rigor of a similar recent book (Snake Oil Science: The Truth About Complementary and Alternative Medicine by R. Barker Bausell) I would be far more likely to recommend Ernst and Singh’s book to a lay reader. They make their case eloquently and in such a way that the sense of what they are saying is evident even to those skeptical of the general superiority of science as a way of knowing the truth.
A number of other CAM approaches are covered in brief, 1-page summaries, which are useful quick references but not sufficiently thorough to be used as definitive assessments of these approaches.
The final chapter, Does the Truth Matter, is one of the best. It makes very clear the economic cost associated with CAM. Billions of dollars are spent worldwide on therapies that at most have marginal, non-specific or placebo affects on patients’ perception of their disease and at worst maim and kill patients and prevent them from taking advantage of truly effective medicine. And as Ernst and Singh carefully discuss, taking advantage of these placebo affects by lying to patients is a slippery slope that scientific medicine cannot afford to start down if we don’t want to end up where medicine was when Washington was killed by his doctors.
They also summarize nicely many of the reasons CAM is so popular despite the evidence against many of its practices. Both the active promotion by commercial interests and charismatic true believers, and the reticence of mainstream scientists to engage in controversy or to make effective use of the media are touched upon, as well as many other factors.
Overall, I cannot recommend this book highly enough. Certainly, anyone skeptical of CAM or honestly open-minded and curious will find much useful information as though-provoking discussion. Even proponents of CAM, other than those farthest out on the ideological fringe, will be impressed by the genuine interest of the authors in looking fairly and honestly at CAM therapies, even if they do not accept the book’s conclusions. Thoughtful, informative, cogent, and well-written, this one belongs on the shelf on anyone with an interest in CAM.
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I love this blog already!!
Thank you, SkeptVet, for providing this valuable blog, eagerly awaiting the next article!
Welcome, and thanks for the encouragement!
I think this book and “The Demon Haunted World” should be required reading for all medical professionals of any type, and throw in Ramey and Rollin for veterinary professionals. There might be less woo in use by DVM’s if they had to read these at some point during their education.
I have a pretty long reading listI’d require of all DVM students if I were king! 😉 The books you mention are certainly on it. Science-Based Medicine had a good post recently on the differences between a medical and a scientific (read research) education. I think this is a key part of understanding why vets and MDs are more susceptible to woo than we might expect.
Yes, that is an interesting topic, and I posted a comment there under my real name. I was fortunate to have two scientists for parents and the opportunity to work in several different labs (biology, paleontology, industry and theriogenology) during undergrad and vet school. I am not a basic scientist, but at least I have a good understanding of how it works.
I was surprised during vet school that a lot of my classmates were great at taking exams and memorizing reams of information (and usually got better grades than I did!) but did not really understand how that information was gained. I had an interesting discussion with a couple of them about acupuncture at the AAHA meeting this spring. They really think there is something to it, more than just a potent placebo effect.
I’ll be at TAM and the Science-Based Medicine conference this weekend-should be a great experience.
Enjoy the meeting! I’m off to the AVMA myself this week, and I expect I’ll see plenty of woo to comment on.
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