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65 of 75 people found the following review helpful
3.0 out of 5 stars Interesting and useful, but by no means unbiased, 22 Dec. 2012
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This review is from: Trick or Treatment?: Alternative Medicine on Trial (Paperback)
Trick or Treatment is a very interesting read about the evidence that exists for the effectiveness (or not) of various complementary and alternative therapies (CAM). The book focuses especially on acupuncture, homeopathy, chiropractic and herbal medicine, with an appendix covering many more treatments in brief. I enjoyed reading the anecdotes on the history of CAM and conventional medicine, and there was a lot of useful information in there, but the authors' tone and approach left me questioning whether they were as unbiased as they claimed to be. Incidentally, I'm a big believer in the principles of evidence-based medicine (EBM), and I'm sceptical about many alternative therapies, so I didn't expect to have a problem with this book.

The main reasons I found myself distrusting Singh and Ernst are as follows:

1. Trick or Treatment claims to be a neutral presentation of the facts, but it is written in a very persuasive tone, with disparaging language used for anything the authors disapprove of. I really felt they were giving me the 'hard sell', which seems at odds with the concept of EBM. Much is made of the fact that Ernst used to be a homeopath, which supposedly makes him less biased, but to me the book seemed to have been written by someone who had become disillusioned by his former profession and therefore had strong feelings about it. On its own, this is not necessarily a problem, but in comparison with the points below it made me wary.

2. Throughout the book, the authors imply that modern conventional medicine is always better than CAM and that it always it has better evidence. They do not acknowledge any of the problems with research in conventional medicine, such as publication bias, or the fact that poor-quality trials exist here too. Anecdotal evidence for the effectiveness of CAM treatments is rightly dismissed as unreliable, but then they present anecdotal evidence in support of conventional medicine or to 'demonstrate' the risks of alternative therapies.

For example, they describe the case of a woman with mental health problems who killed her children after switching from the psychiatric drug Tegretol to St John's wort. This is a devastating tragedy and of course questions should be asked about whether the herb could have been responsible. However, it is wrong of the authors to state unequivocally that being 'deprived' of her usual medication and adverse effects from the St John's wort were the cause. We simply cannot know this, which is why scientific studies are needed. It could equally be that Charlene Dorcy's mental health was already deteriorating and that was what motivated her to change her treatment - it is so hard to tell from one individual case. Similar tragic cases have in fact occurred on conventional antidepressants such as Prozac, but the authors do not mention this.

3. The authors position themselves as experts, rather than presenting the facts and allowing readers to make up their own minds. For me, this contrasted sharply with Ben Goldacre's Bad Science (a book I love). Goldacre frequently provides details of clinical trials and other studies and encourages readers to look at them for themselves; he is also outspoken about the dangers of looking to so-called experts for information rather than examining the evidence. Singh and Ernst tell the reader what to believe, give advice on which type of treatment to seek, and the vast majority of the facts they cite are not referenced, so there is no way of checking them. I was, for example, surprised to read that evidence suggests meditation is dangerous for those with mental illness and therefore should be avoided by this group of patients. Given that one in four of us experience mental ill health, and mental health problems are a very common reason for people to try meditation, I wanted to know more about how the authors define 'mental illness' and what the specific evidence is. But as no details of trials or sources are provided, it will be difficult for me to do that.

If you'd like an overview of the evidence for CAM, peppered with interesting anecdotes, then Trick or Treatment is definitely worth a read. However, if you consider yourself intelligent and capable of drawing your own conclusions, you may find the tone and the amount of repetition a little patronising. It can also be quite difficult to find the information on specific treatments for specific problems, because not only do your have to sift through all the rhetoric, the book's structure is somewhat confusing, with information on the risks of acupuncture and homeopathy in the chiropractic chapter, for example.

This probably reads like a very harsh review. In fairness to the authors, I agree with much of what they're saying (in terms of content) and I don't seriously doubt most of the facts they've presented. But I feel Singh and Ernst failed to show the scrupulous fairness that a book on evidence-based medicine demands. Knowing whether complementary and alternative therapies are safe and effective is such an important issue, and I am disappointed they did not tackle it in a more even-handed way.
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Showing 1-10 of 11 posts in this discussion
Initial post: 30 Jan 2013 10:01:42 GMT
John Tosco says:
Your comment is very good but it shows some contradictions. You say: "and the vast majority of the facts they cite are not referenced, so there is no way of checking them" and talking about meditation "But as no details of trials or sources are provided, it will be difficult for me to do that"
And then you go on to say: "If you'd like an overview of the evidence for CAM, peppered with interesting anecdotes, then Trick or Treatment is definitely worth a read"
How you can reconcile the fact that they show no evidence for their claims (not even when you email them asking about it, as I have done)
with talking about an overview of the evidence is puzzling.
Secondly, you forget to mention one thing, it is not only a case of them not tackling the subject in a more even-handed way, it is a question of them misleading the readers.
They say: "so who is right? the critic or the mother who entrusts her child's health to alternative medicine?" just after talking about surveys.
Well, anyone who reads those surveys knows that the mother doesn't entrust the child's health to alternative medicine, she goes there for problems for which conventional medicine doesn't offer any solutions like bedwetting. Most people who use CAM don't use it instead of medicine (as the authors suggest ad nauseam) but for problems like chronic back pain or tendonitis, for which doctors only prescribe drugs or suggest operations (which cost much more money than the figures they give for CAM), many of which don't solve the problem, as surveys also reveal.
So part of the problem is how they twist the facts, use only part of the evidence, and they talk about practitioners who dupe, when they fail to mention - on purpose - that the money for all those painkillers, operations and consultations with doctors that offer no solutions, come from our taxes.

In reply to an earlier post on 30 Jan 2013 12:06:32 GMT
Last edited by the author on 30 Jan 2013 12:07:28 GMT
You're right, my review is a bit contradictory in the second-last paragraph, and I don't think I worded it very well there. The authors present an overview of what they say is the evidence, but they don't make it easy for readers to look at that evidence for themselves, so we can't check how accurate it is. It is frustrating to hear that the authors weren't willing to share details of their sources with you, as I would have thought anyone serious about EBM would be willing to do that! I think your other comments are good illustrations of the very judgemental attitude the authors seemed to have towards anyone who uses CAM, and their apparent rose-tinted view of modern conventional medicine. It was this that made me start to question how much I could trust them, even though I'm sceptical about many CAM treatments myself.

In reply to an earlier post on 9 Jul 2013 22:37:19 BDT
John Tosco says:
I have been doing some research about your words "surprised to read that evidence suggests meditation is dangerous for those with mental illness".
I certainly wonder why on earth you have given the book three stars. ALL, and I mean ALL (100% in case it is not clear) the scientific studies show meditation is GOOD (the opposite of what they say) for mental health problems. Please check
If 265 scientific studies from 1975 to our present day show that what they say is not true, why three stars?
Are they lying? Have they made it up?
I, unlike most people, have tried contacting the authors about 25 times. Mr Singh replied once and I'm sure he regrets it. Why? Because he explained clearly his "research" method. He googles the word or words (in this case meditation) and takes the negative bits (or fears from some practitioners) from commercial websites to write THIS (supposedly scientific) book. In my opinion, it is not only unscientific, but immoral, because they are telling people that it is evidence-based.
Let's see if your conscience allows you to change the rating.

Posted on 13 Aug 2013 11:56:29 BDT
[Deleted by Amazon on 13 Aug 2013 14:24:46 BDT]

Posted on 25 Sep 2013 11:20:39 BDT
Ben says:
Reading point 3, it's somewhat ironic to criticise a lack of citations and the follow up with your own unreferenced opinion presented as fact (i.e. "mental health problems are a very common reason for people to try meditation"). Perhaps this shows you how difficult it is to build a steadfast evidence-based argument; if you can't hold the line for the duration of a short review, it's no wonder there are occasional shortcomings in book-length prose.

In reply to an earlier post on 25 Sep 2013 19:27:15 BDT
John Tosco says:
What is ironic Ben is how it seems that all those who support the book don't seem to be able to read properly.
Not only they haven't read the book critically - which means checking whether the supposed "facts" in the book are borne out by scientific evidence (they're not, in most instances), but, on top of that, you REFUSE to even acknowledge my reference in my previous post: (Since then, I've found many more studies that show how beneficial meditation is for mental health problems, including one by the university of Exeter:
Why have you failed to notice the reference for 265 - repeat - 265 studies?
Why say "occasional shortcoming" when the book is so full of shortcomings is impossible to know where to start?
Your beliefs? I think so. When someone like you refuses to acknowledge the referencing and the evidence, just because it goes against the beliefs of the book, what else can I say?
Why make something up about an unreferenced opinion?
Just like Ernst and Singh, making things up. Bravo!

In reply to an earlier post on 7 Dec 2014 17:33:38 GMT
Last edited by the author on 7 Dec 2014 17:37:33 GMT
Brad Crooker says:
John, I appreciate your critical analysis of the critic, Ernst, and his associate Singh. I have benefitted throughout my entire adult life from alternative therapies when MDs failed or refused to help me. (Now, I haven't read this book, but I'm researching Ernst.) Ernst's "attitude" of superiority overlooks the evils of Big Pharma and the $$ involved in the medical establishment's orthodox approach. In my experience, I have found that the so-called scientific medical method treats symptoms, and neglects the many factors which may have contributed to the CAUSE of an illness. Whereas, chiropractic and holistic mind-body therapies address the origin of a problem, and treat it without drugs or surgery. Isn't that BETTER? Isn't that more responsible?! More ethical?! One would think so! If modern medicine were indeed so successful, we would have a nation of healthy citizens, but that is sadly not the case. Modern medicine, despite being "scientific" is not preventive, but "reactive/responsive". It treats people who are sick, instead of keeping people well; and in many case, making people sicker---with drugs. ALL areas of a person's life must be taken into consideration: diet, nutrition, sleep, work, family, spirituality, psychology, emotions (especially repressed emotions), genetics, etc., et. al.; and the person much be treated as whole living organism, not merely a body, as in the traditional medical view, established by Descartes.

I applaud you for your challenge to the reader(s) who might take Ernst's book as gospel and neglect further scrutinized research on their own.

There is so much we don't know, and so much that science has not yet proven, but that doesn't mean that all alternative medicine is a placebo effect!

In reply to an earlier post on 8 Dec 2014 11:46:48 GMT
Last edited by the author on 8 Dec 2014 13:09:40 GMT
John Tosco says:
Hi Brad, this book doesn't really deal with Big Pharma. The books by Jackie Law and Ben Goldacre are very good. But this book is full of lies, all possible biases (in the scientific meaning of the term), prejudices and lots and lots of half-truths. A few more examples:
1) They say that acupuncture was invented in Europe, and cite ÷tzi the iceman, who is tatooed. Acupuncture means needle insertion. So tatooing is not acupuncture. That in a chapter entitled the truth about acupuncture. But it gets better.
2) In relation to this they say: Bahr came to the conclusion that the markings were made ... as a guide for applying needles to the correct sites. You read Bahr's exact words, it says: "Clearly there is a methodological difference between tattooing and needle acupuncture"
And: "the tattoos could be viewed... POSSIBLY as a guide to self-treatment marking where to puncture."Concluded? Nothing of the sort. They distort the truth (continuously I should say) and the words of scientists. But it gets better.
3) They say that illnesses in acupuncture are due to imbalances or blockages in the flow of Ch'i (their spelling). You check THEIR source (The web that has no weaver) and first they mention metereological factors such as wind, cold, etc (12 pages). Second they mention emotional factors (4 pages), then lifestyle with diet, physical activity, etc (5 pages), then you go to specific patterns of disease and a tiny minority are called blockage of qi (the book's spelling). This is called cherry-picking bias. Just taking the bit that interests you. Exactly what they have done with their meditation entry. They have chosen one single study contradicted by over 200 studies. Any clearer proof of abundant - and pathetic - bias?

But the question is why? Why would they ignore all these other causes in their book? Maybe because they know that most people think that emotions and climate influence health? Probably because they wanted to cherry-pick the bit they knew they could use to slag acupuncture off (and therefore mislead readers)

No wonder they refuse to reply when you ask for references for their claims!
No wonder Harriet A. Hall refused to appear in front of cameras to defend the book when she saw the type of questions I was going to ask! (She reviewed the book in the NEJM, and in her emails she insisted that these two charlatans were right because they are scientists)
No wonder the journalists who have reviewd the book positively refuse to reply when I point out certain things about the book!

But the best, the best of the best, is their entry for alternative diets. They mention a few (the least well-known for obvious reasons) and they say that when there is evidence for the merits of some of these diets, it is usually seriously flawed.
As I said, unbeatable, unnamed evidence for diets they don't mention is seriously flawed for reasons they don't explain. And some people believe this unscientific load of rubbish.
In fact, I have never heard so much unscientific rubbish since someone tried to convince me that Nostradamus' predictions were scientific.

But you should go to the website of the book, set up in 2010, where they promise to include references for the book "in the next few weeks" .True to their "truthful nature" when they say the next few weeks, they mean the next few centuries. They are a couple of charlatans, who, unfortunately, have a lot of influence.

Posted on 27 Jul 2015 18:47:05 BDT
Cruciada says:
I found this a very fair and unbiased critique of a book I had considered buying. But yes, I am capable of making up my own mind about the claims of CAM, so I won't bother. Thank you for going to the trouble of composing such a model review.

In reply to an earlier post on 27 Jul 2015 22:59:56 BDT
Last edited by the author on 27 Jul 2015 23:03:20 BDT
John Tosco says:
The problem is that most people are capable of making their own mind about the claims of CAM, but very few people seem to be able to check the claims of two of the biggest swindlers and charlatans who pass themselves off as scientists, yes, the two liars I have emailed lots of times, and who refuse to provide evidence or case studies for their "evidence-based" book.
The point is not whether you can make your mind up about CAM. The point is whether you can see through the deception of these two charlatans.
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