Dr. Fred Bortzbooks

Review of Trick or Treatment: The Undeniable Facts About Alternative Medicine

by Simon Singh and Edzard Ernst, M.D.

(Norton, 352 pages, $25.95, August, 2008)





Reviewed by Dr. Fred Bortz

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To learn more about complementary medicine and its value when combined with traditional treatments, see the Science Shelf review of Anticancer: A New Way of Life by David Servan-Schreiber, M.D., Ph.D..

The title of the book pulls no punches. Trick or Treatment: The Undeniable Facts About Alternative Medicine by noted British science journalist Simon Singh and Edzard Ernst, M.D., the U.K.'s first professor of complementary medicine, is a powerful indictment of medical treatments based on anecdotes and conjectures rather than on established science.

The book describes scientific evaluation of all forms of conventional and alternative medical treatments, with fully developed chapters about acupuncture, homeopathy, chiropractic therapy, and herbal medicine. Its message is vital: These therapies are rarely beneficial and often dangerous.

The authors discuss a few cases where alternative medications or procedures seem to have slight but unproven benefits that conventional medicine does not. But the risks always outweigh the benefits, especially considering that conventional medicine is tightly regulated and alternative medicine is not.

The importance of their message is sometimes overshadowed by their strident tone. In the introduction, as if anticipating push-back from practitioners of alternative medicine and their true-believer patients, they flaunt their credentials and objectivity:

"Although there are already plenty of books that claim to tell you the truth about alternative medicine, we are confident that ours offers an unparalleled level of rigour, authority and independence. We are both trained scientists, so we will examine the various alternative therapies in a scrupulous manner. Moreover, neither of us has ever been employed by a pharmaceutical company, nor have we ever personally profited from the 'natural health' sector--we can honestly say that our only motive is to get to the truth."



Every chapter hammers away at the message. Evidence-based medicine demonstrates that alternative treatments are no better than placebos. Sham acupuncture produces the same effect as actual acupuncture. Only for certain types of pain or nausea is there "borderline" evidence favoring the treatment, and that evidence is becoming less convincing as the number of reputable studies grows.

Homeopathy claims to produce its best effects with products that are the most diluted. That dilution leaves not a single molecule of the active agent to be found. Scientific testing reveals no evidence of the claimed "memory" of the presence of the agent in the water. Injection of pure water as a control has demonstrated that the very expensive homeopathic product (the labor cost of numerous dilutions raises the price) is nothing more than a placebo.

Chiropractic manipulation has limited benefit for back pain and is not demonstrably better than standard physical therapy. Vigorous spinal manipulations may even be harmful, especially in the neck area, where they may produce hidden damage that leads to a stroke a few days later.

Herbal medicines may be effective. But those that are most beneficial, such as St. John's Wort for mild or moderate depression, are moving into standard medicine. There, stronger quality control offers greater protection against contamination or improper dosage.

Practitioners of alternative regimes often claim benefits for a wide range of conditions, contrary to the science, and disparage the benefits of conventional treatment. Patients who follow such advice have allowed life-threatening conditions to progress beyond the point of no return. This fact alone justifies the authors' shrill warnings.

The book's most important message may be for the physicians who are in the best position to counter the appeal of dangerous alternatives. It may be difficult to persuade a patient whose close personal interactions with alternative practitioners enhance the placebo effect. "The message for mainstream medicine is clear: doctors need to spend more time with their patients in order to develop better doctor-patient relationships."

That's the simple trick that can lead to more effective treatment.

Physicist and author Fred Bortz explores the science behind space aliens and other alternative life forms in Astrobiology, his latest book for middle-grade readers.