Trick or Treatment (48 page)

Authors: Simon Singh,Edzard Ernst M.D.

BOOK: Trick or Treatment

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What is the evidence?

The concept of healing ‘energy’ is utterly implausible. Many clinical trials of various healing techniques are available. Some initially generated encouraging results, but about twenty of these studies are now suspected to be fraudulent. More recently, rigorous trials have emerged and shown that spiritual healing is associated with a large placebo effect – but with nothing more.

Conclusion

Spiritual healing is biologically implausible and its effects rely on a placebo response. At best it may offer comfort; at worst it can result in charlatans taking money from patients with serious conditions who require urgent conventional medicine.

Traditional Chinese Medicine

An ancient healing system which employs various treatments to restore the balance of Ch’i, the vital energy that governs health.

Background

According to Traditional Chinese Medicine (TCM), all ill-health is viewed as an energy imbalance or blockage, while optimal health is a state of perfect balance, often symbolized by the yin–yang image. The aim of any therapy must be to restore the balance or to prevent any imbalance in the first place. For this purpose, TCM offers a range of treatments, including herbal mixtures, acupuncture, cupping, massage and diet, which are all discussed in more detail elsewhere in this book. All conditions are said to be treatable with TCM.

A TCM consultation will involve diagnostic techniques, such as tongue and pulse diagnoses. Although these techniques are also part of conventional medicine, TCM practitioners make un reasonably ambitious claims about their diagnostic power. Treatment will be tailored to the individual. One session would typically last 30–60 minutes, and treatment can be long-term, if not for life.

What is the evidence?

The TCM system is complex and not easy to evaluate. Thus its various elements are usually tested separately (see acupuncture in Chapter 2, for instance). Chinese herbal medicines usually contain a multitude of herbs which are individualized according to the specific needs of every patient. This approach has recently been tested in cancer patients and shown to be no better than placebo in alleviating symptoms. In another rigorous study, Chinese herbal medicine was tested in patients with irritable bowel syndrome against a standardized herbal prescription and against a placebo. The results suggested that individualized treatment is better than placebo in controlling symptoms, but not better than a (much simpler) standardized herbal medicine.

Some individual herbs used in TCM (e.g. liquorice, ginger, ginkgo) undoubtedly have pharmacological effects; some have even provided the blueprint for modern drugs. On the other hand, some Chinese herbal medicines are toxic (Aristolchia) and others may interact with prescription drugs. Chinese ‘herbal’ preparations may also contain non-herbal ingredients (e.g. endangered animal species), contaminants (e.g. heavy metals) or adulterants (e.g. steroids).

Conclusion

TCM is difficult to evaluate. Some elements may be effective for some conditions, while other elements (e.g. cupping) are unlikely to offer any benefit above placebo. Many aspects of TCM are potentially harmful.

Further Reading

The following books, articles and websites offer readers more information about the topics discussed in each chapter. Many of the references are books aimed at the general reader, but we have also included some key research papers, which can either be downloaded from the web or ordered at your local library. We have deliberately listed only a few of the main research papers relating to each alternative therapy, but these papers include references to many other pieces of research mentioned in this book.

Chapter 1: How Do You Determine the Truth?

Wootton, David,
Bad Medicine: Doctors Doing Harm Since Hippocrates
, OUP, 2006.

Porter, Roy,
Blood and Guts: A Short History of Medicine
, Allen Lane, 2002.

Harvie, David,
Limeys: The Conquest of Scurvy
, Sutton, 2005.

Evans, I., Thornton, H., Chalmers, I.,
Testing Treatments: Better Research for Better Healthcare
, British Library, 2006.

Doll, R., Hill, A. B., ‘The mortality of doctors in relation to their smoking habits’,
British Medical Journal
1954; 228:1451–5.

Moore, A., McQuay, H.,
Bandolier’s Little Book of Making Sense of the Medical Evidence
, OUP, 2006.

Chapter 2: The Truth About Acupuncture

Kaptchuk, T. J.,
The Web That Has No Weaver: Understanding Chinese Medicine
, McGraw-Hill, 2000.

Ernst, E., White, A.,
Acupuncture: A Scientific Appraisal: A Scientific Approach
, Butterworth-Heinemann, 1999.

Evans, D.,
Placebo: Mind Over Matter in Modern Medicine
, OUP, 2004.

Linde, K., et al., ‘Acupuncture for Patients with Migraine: A Randomised Controlled Trial’,
JAMA
2005; 293:2118–25.

White, A., Rampes, H., Campbell, J. L., ‘Acupuncture and related interventions for smoking cessation’,
Cochrane Database of Systematic Reviews
, 2006.

Ernst, E., ‘Acupuncture – a critical analysis’,
J Intern Med
2006; 259:125–37.

Chapter 3: The Truth About Homeopathy

Shelton, J. W.,
Homeopathy: How It Really Works
, Prometheus, 2003.

Hempel, S.,
The Medical Detective: John Snow, Cholera and the Mystery of the Broad Street Pump
, Granta, 2007.

Ernst, E., ‘Evaluation of homeopathy in Nazi Germany’,
Br Homeopath J
1995; 84:229.

Maddox, J., Randi, J., Stewart, W. W., ‘High-dilution experiments a delusion’,
Nature
1988; 334: 287–91.

Linde, K., ‘Impact of Study Quality on Outcome in Placebo-Controlled Trials of Homeopathy’,
Journal of Clinical Epidemiology
1999; 52:631–636.

Shang, A., et al., ‘Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy’,
Lancet
2005; 366:726–32.

Ernst, E., ‘A systematic review of systematic reviews of homeopathy’
Br J Clin Pharmacol
2002; 54:577–82.

Chapter 4: The Truth About Chiropractic Therapy

Salsburg, D.,
The Lady Tasting Tea: How Statistics Revolutionized Science in the Twentieth Century
, Owl, 2002.

Ernst, E., Canter, P. H., ‘A systematic review of systematic reviews of spinal manipulation’,
J R Soc Med
2006; 99:192–6.

Benedetti, P., MacPhail, W.,
Spin Doctors: The Chiropractic Industry Under Examination
, Dundern, 2002.

Schmidt, K., Ernst, E., ‘MMR vaccination advice over the Internet’,
Vaccine
2003; 21:1044–7.

Jonas, W. B., Ernst, E., ‘Evaluating the safety of complementary and alternative products and practices’, published in Jonas, W., Levin, J. (eds),
Essentials of Complementary and Alternative Medicine
, Lippincott, Williams & Wilkins, 1999.

Chapter 5: The Truth About Herbal Medicine

Hurley, Dan,
Natural Causes: Lies and Politics in America’s Vitamin and Herbal Supplement Industry
, Broadway, 2006.

Fugh-Berman, A.,
The 5-minute herbal and dietary supplement consult
, Lippincott, Williams & Wilkins, 2003.

Herr, S. M., Ernst, E., Young, V. S. L.,
Herb-drug interaction handbook
, Church Street Books, 2002.

Ulbricht, C. E., Basch, E. M. (eds),
Natural Standard Herb & Supplement Reference: Evidence-Based Clinical Reviews
, Elsevier Mosby, 2005.

Whyte, J.,
Bad Thoughts: A Guide to Clear Thinking
, Corvo, 2003.

Chapter 6: Does the Truth Matter?

Goldacre, B.,
Bad Science
, Fourth Estate, 2008.

Ernst, E., Pittler, M. H., ‘Celebrity-based medicine’,
MJA
2006; 185:680–81.

Colquhoun, D., ‘Science degrees without the science’,
Nature
2007; 446:373–4.

Weeks, L., Verhoef, M., Scott, C., ‘Presenting the alternative: cancer and complementary and alternative medicine in the Canadian print media’,
Support Care Cancer
2007; 15:931–8.

Appendix

Ernst, E., Pittler, M. H., Wider, B., Boddy, K.,
The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach
(2nd edition), Mosby, 2006.

Ernst, E., Pittler, M. H., Wider, B., Boddy, K.,
Complementary Therapies for Pain Management: An Evidence-Based Approach
, Mosby, 2007.

Jonas, W. (ed.),
Mosby’s Dictionary of Complementary and Alternative Medicine
, Mosby, 2005.

Hendler, S. S., Rorvik, D. (eds),
PDR for Nutritional Supplements
, Blackwell, 2001.

Useful Websites

The James Lind Library:
www.jameslindlibrary, org

The Cochrane Collaboration:
www.cochrane.org

Bandolier (evidence-based healthcare website):
www.jr2.ox.ac.uk/Bandolier

Focus on Alternative and Complementary Therapies (FACT) website:
www.medicinescomplete.com/journals/fact/current/

NIH, National Center for Complementary and Alternative Medicine (NCCAM):
www.nccam.nih.gov

Healthwatch:
www.healthwatch-uk.org

Exeter University, Complementary Medicine Department:
www.pms.ac.uk/compmed/

Simon Singh’s homepage:
www.simonsingh.net

Trick or Treatment? homepage:
www.trickortreatment.com

Acknowledgements

The conclusions presented in this book are based on decades of research conducted by thousands of medical researchers around the world. Without their efforts, it would be impossible to separate the effective from the bogus, and the safe from the hazardous.

We would like to offer particular thanks to the entire staff of the Department of Complementary Medicine, part of the Peninsula Medical School at the University of Exeter. They have supported this project from the outset and have always been generous with their advice and encouragement.

Despite the importance of the subject, there were times when it was unclear that this book would ever be published. We are indebted to our editors at Transworld and Norton, who had faith in our ambitions when others thought that alternative medicine was not a subject worthy of investigation. Sally Gaminara and Angela von der Lippe have been helpful and kind during a very intense eighteen months. Of course, we are also grateful to our literary agent Patrick Walsh, who is both a brilliant colleague and an excellent friend.

Last, and probably not least, our wives have both been remarkably wonderful, patient and lovely during the birth of this book. Anita and Danielle have shared our joys and our anxieties, our hopes and our fears. Thank you.

Picture Credits