Trick or Treatment

Trick or Treatment: Alternative Medicine on Trial
By Simon Singh and Edzard Ernst

Cheekily dedicated to HRH The Prince of Wales, Trick or Treatment is an investigation of alternative therapies, using scientific methods to determine whether any of them work.

Between them the authors have medical and scientific backgrounds, and Prof. Ernst has also practised homeopathy and other alternative treatments. They argue that this places them in a strong, objective position from which to investigate these therapies.

The book specifically examines over 40 complementary therapies, from aromatherapy to yoga. The authors have critically reviewed the available research, and drawn conclusions about whether the therapies are effective, and for what sort of conditions they might be beneficial.

Whole chapters are devoted to four of the therapies: acupuncture, homeopathy, chiropractic and herbal medicine. Within these chapters, the authors give detailed descriptions of the history and development of the therapies, and discuss the theories behind them. In valuable addition to the discussion of the therapies themselves, these chapters include colourful explanations of research methodology, and concepts such as bias. For this reason I strongly recommend the book to anyone who wishes to understand how clinical trials are conducted, and what factors can affect the results.

The chapter devoted to the placebo effect considers the ethics of promoting ineffective treatments for conditions that might respond to conventional medicine.

Singh and Ernst conclude that homeopathy and acupuncture are at best benign placebos, but can in fact be dangerous quackery. Chiropractic treatment is shown to work for a limited number of conditions, but the financial and physical risks to patients are high, and it is no more effective than conventional treatment. Some herbal medicine is shown to be effective, but the paucity of the research leaves a muddied picture.

The conclusions reached about most of the other therapies are that they are largely ineffective, although some, such as yoga, may have a short-term calming or de-stressing effect. Most are shown to be expensive, not founded in actual scientific knowledge, and may be dangerous, particularly when used instead of an effective conventional treatment.

The book is extremely readable, with hundreds of memorable examples, such as the death of George Washington being caused by his doctors’ practice of bloodletting. The tone is amusingly scathing, occasionally strident, and the authors pull no punches. The book would not be enjoyed by believers in or practitioners of alternative medicine but ought to be required reading for anyone considering using it, for their own good.