Initially dismayed that two incisive analyses of the current state of complementary and alternative medicine (CAM) should be almost simultaneously published (Rose Shapiro's "Suckers" and Singh and Ernst's "Trick or Treatment"), I was delighted to read both and to find them truly complementary, although drawing identical conclusions: CAM acts through the placebo response alone. For example, randomised trials prove acupuncture, homeopathy and chiropractic and to some extent, herbalist medicine to show no benefit above and beyond the placebo response. Worryingly, some claims, such as open heart surgery performed in China with acupuncture anaesthesia alone, are shown to be fraudulent. Traditional Chinese Medicine is a post-revolutionary ragbag and does not represent 5,000 uninterrupted years of medical practice as claimed, although the pharmaceutical industry is exploring the efficacy of some of the traditional herbs used both in China and in India. If they work and survive phase I and II clinical trials, no international conspiracy will prevent their development: the paranoia in CAM about the "Cancer Industry" imagines that any herb or practice curing cancer would be suppressed to protect profits. This is absurd - cynically, the rewards would be too great.
The approaches of the two books are different, though both add enormously to CAM understanding. I couldn't pick out one over the other: Shapiro is perhaps the more entertaining - and Singh and Ernst perhaps the more comprehensive, with a useful postscript analysis of many different CAM practices. Both are eminently readable; both expose the serious lack of evidence that CAM works above and beyond the placebo response, which nevertheless can relieve some symptoms in up to 32% of sufferers. Edzard Ernst was originally a homeopath himself, and now finds that homeopathy and other CAM practices do not stand up to scientific inspection, in particular from randomised clinical trials, brilliantly espoused, first introduced by Lind in the eighteenth century to prove that vitamin C in the form of lemon or lime juice prevents scurvy. Both discuss the vexed question as to whether evidence-based doctors who recognise that CAM merely achieves a placebo effects should pretend to their patients that CAM works in order to gain the maximum benefit of the placebo response: both decide that this would be dishonest, operating against the modern, truthful doctor-patient relationship. (The placebo effect can be observed only if the patient thoroughly believes in the practice.)
Some placebos work better than others: acupuncture perhaps has the strongest impact, its lack of real benefit only demonstrated by using special placebo needles which retract on pressure, like a stage dagger, instead of piercing the skin. Furthermore, both question whether the NHS exercised by tight budgets should be running 5 NHS homeopathic hospitals in the UK, diverting money from other desperately challenged services that might offer improved quantity and quality of life above and beyond the placebo response. Many GPs love CAM, because they can refer on their heartsink patients (classically middle aged, middle class women) who benefit from the long consultation times of over an hour, a luxury for both patients and doctors denied elsewhere in the NHS. However, homeopaths are notable by their absence from Casualty and Intensive Care Units. Why does their placebo effect not work on broken legs? Instead they choose a tranquil clinic setting.
With the exception of a few herbal remedies, (herbs that work become established: some cancer cures for example are based on periwinkles and yew trees), reading both books will doubly convince you that the multi-billion pound industry supported by Prince Charles is based on nothing but sugar pills. Singh and Ernst dedicate their book to him, hoping that his foggy precepts will be honed.
