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Trick or treatment? Alternative medicine on trial
  1. Colin Lewis
  1. aim.bmj.com

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Simon Singh, Edzard Ernst. Published by London, Bantam Press 2008 £16.99 978-0-59306-129-9

Guess what? There is very little scientific evidence to support complementary and alternative medicine (CAM). It is potentially dangerous but booming and the public is being misled by expensive techniques that probably work by placebo mechanisms anyway! This is the tone of this book. If there is no controlled trial or evidence to support the complementary therapy then beware, dear patient!

To a certain extent the authors are right. Culling the evidence is the ultimate goal — if only it were that easy. The book jumps on the need for evidence before accepting any treatment, going back to the days of scurvy, and the death of George Washington to prove the point. The authors delight in tearing homeopathy apart, finding no scientific evidence to support the effect of a remedy that is devoid of any active ingredient. Ernst having practised and received homeopathy now takes the view that this therapy is nothing more than an elaborate placebo.

The big four — Acupuncture, Homeopathy, Chiropractic and Herbal Medicine — make up the bulk of the book, with single page résumés of 36 further therapies. Acupuncture leads with 49 pages starting with reference to Ötzi the iceman, China, gate theory, and the power of placebo. It is conceded that acupuncture works for pain and nausea but the World Health Organization is attacked for the large number of conditions “recommended” for acupuncture. Cue for the Cochrane Collaboration and a long list of conditions where there is no evidence to support acupuncture, and a tiny list where there may be some benefit. Bring on the decent trials but be wary of the Germans as their trials show that sham acupuncture is almost as good as the real stuff!

“Acupuncture works only because the patients have faith in the treatment… If the patients paid attention to the latest research then they would lose confidence in acupuncture and the placebo effects would largely melt away.” More advice is forthcoming in recommending a chiropractor only if there is a problem with your back but to watch out for the dangers and remember that conventional treatments should be tried before chiropractice and are likely to be cheaper.

The book is wonderfully critical and depressingly negative about most aspects of CAM. I rather enjoyed it. There were lots of stories and explanations of medical history, the evolution of medical research and the devotion to evidence-based medicine which, despite repetition, progressed in a logical and informative manner. The writing was easy to absorb and pitched at the right level for a curious patient. Now you know what is in the book, can you risk recommending it to your patients?

It’s time to hang up my hat as a medical acupuncturist and reinvent myself as a bespoke “placebopractor”. The book suggests that I could do rather well.

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