This is a brief review of the book Trick or Treatment by Simon Singh and Edzard Ernst, MD. This book covers the importance of clinical trials and regulation in the field of medicine and highlights the lack of scientific scrutiny involved in much of the alternative field of medical therapy. This book is not light on alternative medicine, so if you are a believer in various alternative therapies, then you may not like what this book has to say. Regardless, I think it is an excellent read for anyone who is interested in learning about which alternative approaches are useful and which are not, once put to the test by the scientific method.
In the first section of this book the authors breakdown the importance of the scientific method using historic examples. Opening up with a history on the use of bloodletting and how medicine worked before the advent of the scientific method, the authors describe the discovery of the cure for scurvy through controlled trials on British sailors. After discussing Dr. Lind’s (the man who ran one of the first documented controlled trials) achievement the authors went on to discuss Florence Nightingale’s championing of greater hygiene in hospitals. They wrap up the introduction with a breakdown of the first prospective cohort study on smoking. All four topics brought to light the idea behind this book, that testing findings through the scientific method is the only way to truly understand if a treatment works. The authors mention in the closing statements that alternative medicine shouldn’t be ignored but also shouldn’t be trusted until it has been tested and retested rigorously.
The first treatment covered in this book is acupuncture. Just so you don’t have to read this whole paragraph if you don’t want to, the answer as to whether or not acupuncture works is pretty much no. The World Health Organization published a large meta-analysis stating some positive benefits to things like pain, nausea and a whole host of other illnesses. This meta-analysis is largely viewed as flawed for including many poorly conducted trials and biased publications from the source of acupuncture, China. The reason the authors bring up that these Chinese studies might be biased is based on the culture surrounding acupuncture and social environment where the researchers published (or didn’t publish). The meta-analyses that followed were much more critical of the poorly conducted studies which led to a much more negative report on the efficacy of acupuncture. Once better sham therapies (misplaced needles, shallow needles and eventually needles that looked and felt like they had penetrated the skin but never actually did) were incorporated into the studies, the validity of the research convinced most researchers that acupuncture was mainly a placebo based therapy. Advanced needling techniques like moxibustion or vibration have not been as thoroughly studied but research will continue to come out on these specific therapies and acupuncture as a whole will be revisited again.
The next treatment to be covered in this book is homeopathy. I must admit that I knew very little about homeopathy before reading this section and I was quite surprised as to the details of this practice. Apparently, the main concept of homeopathy is summed up in the phrase “like cures like”, which means that a substance that causes the symptoms of a particular disease can cure that disease. Another aspect of the treatment is that the more diluted the substance in the solution, the more powerful the treatment is. Homeopathic medicines are often diluted so much that there is no trace of the original substance in the medicine. Even though it already seems like this is a sham of a practice, the authors still went into depth on the various meta-analyses involving homeopathy and the results are not at all in its favor. Since homeopathy’s invention in 1790, there have been many meta-analyses on its effectiveness. Recently only one of these meta-analyses were in support of homeopathy in 1997 but it was revisited in 1999 by the same researcher who stated that his previous findings were faulty. There have never been any convincing clinical trials claiming that homeopathy works and it is most likely a scam. At the end of the chapter the authors point out that homeopathy is also a very expensive scam, especially considering that they are charging for literal sugar pills without even a trace amount of a healing substance. Better to avoid homeopathy in the future and seek out legitimate medicine for legitimate illness.
The next subject covered in this review was chiropractic, another therapy that I knew little about. Previously, I had assumed that most chiropractors were just fancy back crackers but apparently the whole system of chiropractic treatment was intended to be a panacea for all ailments. According to this review, it is definitely not that. Chiropractic care was invented by a man named Daniel David Palmer. The treatment takes its roots from bone-setting which had been practiced as early as 400 BC during the time of Hippocrates. Chiropractors who believe that chiropractic care is a panacea are known as straight chiropractors, and according to this review they are to be avoided at all costs due to widely unsubstantiated claims about the efficacy of chiropractic therapy to treat a multitude of ailments. Straight chiropractors believe that the spine has an “innate intelligence” which functions to heal the body once the vertebrae allow for proper flow (similar to the concept of chi). No scientific literature supports the idea of “innate intelligence” so again, these straight practitioners should be avoided. There is, however, another branch of chiropractic care that uses the title of a “mixer”. Mixers are more likely to use conventional medicine and complementary treatments with their adjustment training, and they also believe chiropractic care to be limited in its ability to heal. According to this review chiropractic treatment has been shown to alleviate (temporarily) some musculoskeletal issues such as low back pain. However, chiropractors should under almost no circumstance manipulate babies or children, or manipulate any patient’s neck. The reason for this is that the adjustments that chiropractic practitioners utilize require a quick forceful motion near the end range of a joint which can be disastrous to a patient’s neck since vital blood vessels are vulnerable to damage from this action. There have been multiple cases of death from this exact treatment, so if you consult a chiropractor it is best to understand what their individual approach to the therapy is before they touch you. Another issue the authors bring up about this therapy is that they use X-rays rather excessively, which exposes patients to unnecessary radiation. For your own research I recommend you look into the history of chiropractic care so that you can understand its shady beginnings and proliferation. Let’s just put it this way, Daniel David Palmer was supposedly run over by his own son who had taken over a majority of the chiropractic business ventures that Palmer started. There are many other details beyond that which make me rethink the validity of chiropractic treatment as a valid therapy.
The section that followed discussed herbal medicine and this section was much more nuanced than the previous ones. In earlier chapters the authors disparaged the treatments rather scathingly (for good reason if you consider the literature they reviewed) but the herbal medicine section opened on a more positive note. They highlighted the use of many plants that have been analyzed for the extraction of active ingredients such as Advil (or acetylsalicylic acid), a molecule that is related to salicin (an extract from willow tree bark). They even discuss the usefulness of the herb Saint John’s Wort for relieving mild and moderate symptoms of depression. However, they argue that many plants are not useful in any way for healing and some may even be harmful by interacting with conventional drugs that a patient could be taking. They provide a long table of plants and herbs that have been studied and rank them by effectiveness and lack of harm. According to the authors, there are few herbal remedies that are more effective than conventional treatments and they dispute a main claim from herbal practitioners who believe that herbal medicine is superior because of the “naturalness” and lack of side-effects. In all likelihood most herbal treatments are less potent or completely useless in comparison to conventional medicine but there are a few exceptions. If you are interested in taking herbal medicines make sure to discuss it with your general practitioner and do your best to review the available literature on the particular substance you want to use. Reading this book might not be a bad start.
The rest of this book is spent discussing the nuances of the placebo effect and the ethics involved in using alternative treatments that (as this book discusses in detail) are largely effective by the placebo effect alone. The authors highlight the people and organizations that are involved in misleading the public about the effectiveness of alternative treatments and stress the importance of integrating the scientific method into the alternative medical field. A great point made in this book is about the process of a therapy becoming conventional. In essence, any therapy that hasn’t been proven by clinical research is alternative, so using the term alternative should probably carry a more negative tone than it does in many circles. That is not to say that every alternative therapy is ineffective and will never be effective, it just gives a potential patient a framework for finding an effective treatment with the current information available. All conventional forms of medicine were once alternative and misunderstood. The authors just want to make sure that alternative therapies undergo the same amount of scrutiny and regulation that conventional therapies navigate to becoming mainstream. I firmly stand behind their conclusion and I hope that you found this summary of their review useful. Before signing off, I want to leave you with a quote that I found in the book from renowned physicist Carl Sagan in which he discusses his approach to science: “the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas.”