An avid reader calls it as she sees it on books, publishing and the written word in general.

Saturday, August 20, 2011

BOOK REVIEW: Trick or Treatment by Simon Singh and Professor Edzard Ernst

I added this book to my “to-read” list upon hearing that as a result of its publication, the authors had been sued by the British Chiropractic Association.* My reasoning went something like: defamation case = scandal = juicy secrets. As it turned out, while the book is not at all dry, “juicy” is probably a description that the authors would scorn. In fact they clearly pride themselves on the meticulous research that went into their examination of alternative medicines.
Trick or Treatment looks at the evidence for or against five of the main streams of alternative medicine, being homeopathy, chiropractic therapy, herbal medicine and acupuncture. It also examines the history of evidence-based medical treatment and its applicability to “alternative” forms of medical treatment.
Simon Singh, one of the authors, works as a science journalist, and I expect the books readability is largely his work. In contrast, Ernst is a doctor with a great deal of experience in natural therapies, and I suspect the level of scientific rigour brought to bear is a testament to his influence. You can’t help but feel that the authors also brought a pre-existing level of scepticism to the project, but perhaps this is necessary for a scientific and objective enquiry.
The general thesis of the book is that if alternative medicines were proven to work, they would have been adopted by the medical establishment and ceased to be “alternative.” While this could be debated, it is difficult to refute the number of studies cited by the authors, almost all of which show no or dubious benefit to the patient by alternative therapies. The book also provides an interesting window into the field of medical ethics, particularly in its examination of the ethics of exploiting the placebo effect (if a placebo makes people feel better without side effects, should doctors prescribe placebos?) The authors’ reasoning is too detailed to go into here but also makes sense to a layman, as is characteristic of the rest of the book.
So his is clearly an interesting and informative book – but is it useful? I think so, with some caveats. It is unlikely to change the mind of those who are already convinced of the benefits of alternative therapies. They are unlikely to accept the contention that the results of these therapies can be “measured” and compared with any other treatment. However, for those who are unconvinced one way or another, the book does provide a clear summary of the current state of medical knowledge. It even has an exceedingly useful index listing the therapies they were unable to cover in detail and outlining the main points of any research done in relation to them. Where the evidence is insufficient to conclude either that a therapy is effective or ineffective, the authors say this clearly.
Trick or Treatment is certainly a very blunt book and pulls no punches where a therapy is not supported by evidence or could potentially harm a patient. They are particularly critical of chiropractors as an organisation, hence no doubt the court case. The book concludes by suggesting that if alternative medicines carry some of the risks of conventional treatment, they should be regulated to the same standard and the same warning labels should apply. It’s difficult to see this happening if alternative treatments remain on the fringe, but if they do move into the mainstream (for example by obtaining government funding) it may yet come to pass. In that case it would remain to be seen whether a warning label stating “this product has been shown to have little or no effect” would be detrimental to the alternative medicine industry, or whether its follows continue to believe in its intangible, immeasurable and probably illusionary benefits.
* Wikipedia tells me that Singh was actually sued over a column, not over this book. I expect the content was similar though.

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