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68 of 88 people found the following review helpful
5.0 out of 5 stars clarity, 10 May 2008
This review is from: 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.
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Tracked by 2 customers

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Showing 1-10 of 20 posts in this discussion
Initial post: 29 Aug 2008 11:25:29 BDT
J. Wills says:
Trick or treatment concluded that there was a lack of evidence to support certain alternative treatments. However, by stating that CAM acts on placebo alone is just wrong. If you had read the book fairly, you will have seen that there is evidence to support osteopathy and chiropractic for certain musculo-skeletal problems. There is some evidence to support the use of acupuncture for nausea and pain. There is clearly evidence to support certain herbal remedies. And yes, some of these treatments do hold a certain risk but in nearly all cases, the risks are very small. I haven't yet read Rose Shapiro's book but if her conclusion is that all CAM treatment is a waste of time, then we are not really having a serious or fair debate.

Posted on 3 Aug 2009 10:27:32 BDT
K. M. Vernon says:
EBM (Evidence Based Medicine) is now considered the golden mean. It was never meant to overshadow empirical clinical evidence. CAM methods are person-centered, one size Does Not Fit All. This basic treatment method reduces the ability to use the EBM methods of testing. You cannot ignore the power that pharmaceutical companies have, they now largely control WHO (World Health Organisation) and they most likely control your local GP. WHO did a massive report on Homeopathy 2 years ago, threatening it's demise with it's findings. They never have and refuse to publish the report...Why? Because it works. Ask the governments of Cuba, Argentina, India, etc. Countries without the money to pay Big Pharma, countries that use Homeopathy on thousands of their occupants. Read *those* reports. Or better yet, go see a reputable homeopath youself, work with them honestly and I have no doubt that you'll feel the benefits.

Posted on 8 Dec 2009 15:42:30 GMT
R. A. Hardy says:
Ernst claims to be a herbalist, acupuncturist, and a homeopath. Where has he received his training? I phoned Exeter University for the information but did not receive any useful information. Have you seen any recognised documented qualifications? Check out Quack Watch's payroll.

In reply to an earlier post on 17 Jun 2010 15:51:58 BDT
Jimbo Jones says:
I've personally benefitted greatly from Osteopathy after gaining next to nothing through physiotherapy, and a great many modern drugs are synthesised from natural discoveries, but to leap from Osteopathy to the whole of Homeopathy is just a nonsense as is the idea that personal experience with a reputable homeopath would some how 'prove' their worth in itself. Thr ability to self-deceive is the whole basis for double blind placebo testing.

In reply to an earlier post on 25 Jul 2010 10:17:06 BDT
Here here! It is all too easy to lump all forms of complementary and alternative medicine together into "CAM" and then jump to the conclusion that "CAM" doesn't work. It is lazy thinking and I personally think we should be beyond this now.

Its time now for each mainstream therapy to be considered independently and for a serious discussion about the contribution of all forms of healthcare resarch, not just RCT's in isolation.

Importantly too, readers should remember that "lack of evidence" is a VERY different thing to "evidence of ineffectiveness".

In reply to an earlier post on 1 Aug 2010 01:50:19 BDT
The basic timeline is a 4.5 billion year old Earth, with (very approximate) dates:

3.8 billion years of simple cells (prokaryotes),
3 billion years of photosynthesis,
2 billion years of complex cells (eukaryotes),
1 billion years of multicellular life,
600 million years of simple animals,
570 million years of arthropods (ancestors of insects, arachnids and crustaceans),
550 million years of complex animals,
500 million years of fish and proto-amphibians,
475 million years of land plants,
400 million years of insects and seeds,
360 million years of amphibians,
300 million years of reptiles,
200 million years of mammals,
150 million years of birds,
130 million years of flowers,
65 million years since the non-avian dinosaurs died out,
2.5 million years since the appearance of the genus Homo,
200,000 years since humans started looking like they do today,

And how long since evidence based medicine?

Who is delusional now?

In reply to an earlier post on 1 Aug 2010 23:33:48 BDT
Last edited by the author on 1 Aug 2010 23:34:27 BDT
Jimbo Jones says:
Apart from trying to tie-in an unrelated timeline you're not really adding anything to the debate. If I understand the underlying point you seem to be trying to make, then that in itself is based on basic logical fallacies whether I agreed with your view point or not?

In reply to an earlier post on 28 Mar 2011 22:08:53 BDT
M Kelly says:
Interesting... you could also add to your list President Mbeki era South Africa when the government promoted the power of lemon juice and beetroot to cure AIDS. "Reputable Homeopath"!?! Not the ones in the UK promoting homeopathic malaria prophylaxis I trust? The NHS is stretched enough without paying for these services. By all means take the worried well, make them feel whole, realign their energies (and take their money) but take your sick to the doctor. I am not trying to generalise across all forms of alternative medicine here, nor am I claiming that western medicine can heal / cure / relieve all disease. What upsets me is blind faith in a dangerously flawed practice, sometimes at the cost of effective early medical help.

In reply to an earlier post on 2 Jun 2011 15:38:33 BDT
Who is delusional now?

I am afraid that it is you!

Most human knowledge in most subjects has been acquired in the last 250 years.

(Superstition & mythology is of course as old as man!)

Posted on 21 Sep 2011 11:51:05 BDT
Last edited by the author on 21 Sep 2011 15:16:17 BDT
Damaskcat says:
Interesting review - thank you.

I've never understood why people knock the placebo effect - it works in at least some cases so why not use it instead of dismissing it as not worth bothering with? Conventional medicine is not 100% effective in all cases as opponents of alternative medicine would have us believe which is why there are many different drugs for the same illness or condition.

High blood pressure is a good example. I tried more than half a dozen different drugs and combinations of drugs before finding one which worked for me and didn't have horrendous side effects. My doctor said this is not unusual. Now if an alternative practitioner had needed 6 attempts to treat someone would those who are agaist CAM have criticised the practictioner? You bet they would!
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