Posts Tagged ‘quackery’

REVUE: “TRICK OR TREATMENT: The Undeniable Facts About Alternative Medicine” by Simon Singh and Edzard Ernst, MD.

Sunday, February 28th, 2010

TRICKcoverDid you know that George Washington came down with a bad cold, and that his doctors treated him with four sessions of bloodletting (still held to be a tried and proven treatment), ushering him toward his death?  I didn’t.  Turns out, there was a lot I didn’t know about the history of modern, evidence-based medicine.

2,000 years ago, Hippocrates of Cos, recognized as the father of medicine said: “There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.”

This is a book that rather straightforwardly lives up to its title.  The introductory chapter is a lesson in the value of evidence-based medicine, with a concise history and explanation of the modern double-blind placebo clinical trial that gives us the most reliable evidence for the effectiveness of any medical treatment.  For it turns out that one of the wonders of us humans (which is also one of the main hindrances to properly evaluating the effectiveness of any treatment) is our susceptibility to the “placebo” effect.  So strong is this perceptive power that it alone can be responsible for a large part of any actual improvement in symptoms when we believe in the treatment (or prayer) we are receiving.  This phenomenon, combined with the fact that most illnesses have a life-cycle that means we will eventually get “better” with or without medical intervention, underlies most of the anecdotal evidence that has supported pretty much all of the quackery we humans have believed in throughout our “medical” history.  It has only been the arrival of the scientific method as applied to medicine that has allowed researchers to out-wit both the placebo effect and the normal healing process to actually establish the true effectiveness of various medical interventions.  Though these initial sections of the book feel as if written for a High School reader, they are nonetheless worth reading as they do give a solid basis for understanding the treatment by treatment critiques that will follow.

The book then tackles the major “alternative” treatments, each with their own chapter (and if your ‘favorite’ treatment is not covered here, there is a lengthy index in the back of the book that offers summaries of a surprisingly wide range range of additional treatments).  I have to tell you that the news is not good for believers in “alternative” medicine.  It turns out (and how have I not known this?) that there is no reliable evidence to support (almost all) “alternative” medicine.  There are exceptions noted, but they are narrow ones limited to specific applications of certain treatments.  In short it seems that we humans believe a whole lot of things despite actual evidence, relying instead on belief and the testimony of individuals, the danger of which is pointed out in this quote from the book:

“In short, the medical establishment will not accept anecdotal evidence — based on either human or animal patients — as reliable enough to support homeopathy or any other treatment.  No amount of anecdote can stand in place of firm evidence, or, as scientists like to say, ‘The plural of anecdote is not data.'”

Of course “modern” medicine evolved from all sorts of quackery (with the occasional tested cure).  A wry perspective on this is given by this quote:

“In his book Bad Medicine, the historian David Wootton writes, ‘For 2,400 years patients believed that doctors were doing them good; for 2,300 years they were wrong.'”

But the book makes the simple point that modern medicine (or “evidence based medicine”) is essentially “alternative” medicine that has been proven to actually do something for the patient (Herbal medicine is really the only “alternative” that fares moderately well in this book, though its popular claims also often overreach the actual evidence).  The problem lies in the sheer hucksterism that continues to promote “alternative” healing as being superior to evidence-based medicine.  We spend billions a year on treatments that do nothing for us (beside trigger our placebo effect — an ethical question that is also dealt with in the book).  This issue is touched upon in this quote:  “Yet, alternative therapists continue to wear the name ‘alternative’ as a badge of honor, using it to give their substandard treatments an undeserved level of dignity.  They use the term ‘alternative’ to promote the notion that they somehow exploit alternative aspects of science.  The truth, however, is that there is no such thing as alternative science, just as there is no alternative biology, alternative anatomy, alternative testing, or alternative evidence.”

The authors make the rather clever suggestion of a “warning” that should be attached to some of the alternative treatments (here the one for Homeopathy): “Homeopathy.  Warning: this product is a placebo.  It will work only if you believe in homeopathy, and only for certain conditions such as pain and depression.  Even then, it is not likely to be as powerful as orthodox drugs.  You may get fewer side-effects from this treatment than from a drug, but you will probably also get less benefit.”

“Trick or Treatment” derives its authority from the fairly recent meta-analysis of years of clinical research that allow a solid basis for scientific conclusions about alternative medicine. (this is a very recent book), and though it delivers yet another blow to our very human reliance on “belief in belief”, it is a book that deserves to be read for the simple clarity of the facts it gives us.  There is no good reason that those of us living today should not take advantage of the reliable evidence that science has brought us to live better, more informed lives.

The authors close with a quote from a lecture in Pasadena in 1987 by the American physicist Carl Sagan, where he explained how science should treat new ideas:

“I seems to me that what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time great openness to new ideas.  If you are only skeptical, then no ideas make it through to you.  You never learn anything new.  You become a crotchety old person convinced that nonsense is ruling the world.  (There is, of course, much data to support you.)  On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish useful ideas from worthless ones.  If all ideas have equal validity then you are lost, because then it seems to me, no ideas have any validity at all.”

Though it reads a bit like a High School textbook, “Trick or Treatment” is timely and, I think, essential for those of us who have “believed” and tried alternative medicine (and who have had our doubts about mainstream medicine as well).  Although most healing treatments through history have been devised by people with only the best of intentions, in the end we must rely on the evidence.  Otherwise, we are walking blind into the hands of the charlatans who will gladly make a buck from our suffering and credulity.

Reviewed by t.n.s.r. bob