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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.

Where’s the evidence?

Louise Timlin is a Health Economist and mother of two.

When I was pregnant with my first child I was often asked about baby-brain. A colleague or friend would smile indulgently and share a story about how they left their laptop on the train, or their wife put their socks in the fridge while pregnant. I smiled politely whilst I thought to myself, of course no non-pregnant person has ever made such a mistake. One day at work, when I was about 6 months pregnant I inadvertently sent out two invites for the same meeting to the same colleagues but for different days. Oops, I thought and shared my error with my boss who was one of the invitees. He laughed heartily and jokingly referred to my “baby-brain”. On my return to my desk I noticed that everyone invited had accepted both meetings without question, yet none of them were pregnant.

I am sure that baby-brain is simply another example of finding evidence for something if you look hard enough. For example I believe that some people are labelled “forgetful” who are probably no more forgetful than anyone else but every time they make a small mistake it is pounced on as evidence of their intractable forgetfulness.

And apparently I am right, according to a study conducted by Dr Helena Christensen from the Centre for Mental Health Research at the Australian National University. The study, published in the British Journal of Psychiatry, followed a representative cohort of women and measured cognition before, during and after pregnancy. No significant differences in cognition were found, leading to the conclusion that previous studies were flawed or biased.

Dr Helena Christensen said, “Part of the problem is that pregnancy manuals tell women they are likely to experience memory and concentration problems, so women and their partners are primed to attribute any memory lapse to the ‘hard to miss’ physical sign of pregnancy. Not so long ago, pregnancy was ‘confinement’ and motherhood meant the end of career aspirations.”

It may be that pregnancy shifts a woman’s focus away from work, and who wouldn’t forget where they’d left the remote control whilst chronically sleep deprived from looking after a new-born baby. But come on girls, give yourselves a break, you are not cognitively deficient and don’t let anyone tell you otherwise.

Having spent 12 years working in the highly regulated field of clinical research I am not a big fan of “alternative therapies”. Don’t get me wrong, I am a big fan of the placebo effect, just don’t kid yourself it is anything else. If it’s not backed up by evidence from a series of well designed, placebo controlled, regulatory and ethically approved clinical trials then you would do well to be sceptical.

The 1023 group concur. They staged a demonstration at 10.23am on 30^th January in which more than 400 homeopathy sceptics took a “homeopathic overdose” in protest at Boots continued endorsement and sale of homeopathic remedies. Homeopathic remedies are hugely diluted substances. They are commonly sold at strengths labelled 6C. This means there is 0.0000000001% of the active substance in them.

There are people who are certain that homeopathy works for them. This is why the most rigorous clinical trials are placebo controlled. In clinical trials for antidepressants, up to 40% of patients taking placebo report a beneficial effect. A paper published in the Lancet in 2005 and the Cochrane Collaboration concluded that homeopathy is nothing more than a placebo effect. Proponents will claim that at worst it does no harm. However even this claim should be treated with scepticism. If patients delay seeking proper expert medical advice whilst using homeopathy to treat their condition, they could risk their condition degenerating. By all means go ahead and try it, but don’t forget, we have medicines that have actually been proven to work; why not give them a go at the same time?

Originally written for the Wokingham NCT Newsletter
Views expressed here are my own, and do not represent the views of NCT.