Suckers: How Alternative Medicine Makes Fools of Us All [Paperback]

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.

It was a delight to read this book and see the emperor's new clothes of 'alternative' medicine exposed for the con they really are. There are many, many examples within this text of alleged "therapies" revealed as howling cons. Quite why people are mug enough to fall for some of this stuff eludes me. The credulity of some people is truly astonishing, and most amazing of all is that they manage to not spot that they are paying through the nose for this stuff. The alternative therapy apologists complain about "big pharma" and the medical establishment, yet rake in millions for cures that in some cases amount to little more than water with rocks dipped in them.

Particularly interesting are the chapters on the "respectable" alternative therapies, particularly chiropractic and osteopathy. These two have done a fine job of making themselves look serious and official with fancy looking training schemes and regulatory bodies, but when you realise where their roots lie it becomes obvious that they are little more than nice massages and a little everyday rubbing and stretching at best. Unfortunately, in the case of chiropractic, there seems to be sound evidence they can be deadly as well. The histories of these pseudo-medicines are apparently fairly accurately reported by Shapiro, and can be verified elsewhere.

Homeopathy gets its ritual and thoroughly deserved spanking (has there ever been such a con outside of organised religion?) as does that silly old fool Prince Charles, particularly for his horribly self-indulgent and potentially outright dangerous foundation dedicated to merging unproven and plain bonkers money-making alternative junk into proper medicine.

Entertaining and educational, this book provides an excellent general grounding and contains some excellent links to further more detailed material.

Not to say that modern medicine is perfect: the time that some complementary practitioners spend on their patients, sometimes triggering enhanced placebo responses, is something the NHS really should learn from. However, most of this junk has no clinical effect, so hopefully before long mumbo-jumbo like Reiki, Kinesiology and Homeopathy will at least be banished from the NHS and millions of pounds diverted to treatments that actually do something.

"Suckers" should be commended as a great service to common sense.

Suckers is an easy read and very well researched. I must admit that I rarely read "popular science" books, since I find them brushing over details and ultimately getting facts wrong. This book however, has the facts and backgrounds of a whole host of "alternative" "treatments" down to a T, teaches you how to recognise a quack by the language they use and will ultimately save you money, because you will not fall for their promises. I just got a copy for my mum.

Did you know that "Traditional Chinese Medicine" is barely over 50 years old?

Did you know the origins of chiropractise and osteopathy?

This book is an essential read for the parent who constantly needs to defend their decision not to use a naturopath and for the health professional who has preserved their ethics and is not offering unproven treatments to satisfy the modern trend for supposedly ancient healing methods.