July 11, 2008

Pricking the Balloon of Alternative Medicine

By EWAN, John

Trick or Treatment: Alternative medicine on trial, by Simon Singh and Edzard Ernst. Bantam Press. $39.99. 342 pages. Reviewed by John Ewan. --------------------

The next time you take a pill, one or more of the following things will happen:

You will get better in spite of the pill (you were recovering anyway).

You will get better because you think you are going to get better (placebo effect).

You will have a reaction to the treatment.

You will recover.

If that sounds like a cynical view of conventional medicine, wait till you hear what the authors have to say about the alternatives. Nothing is sacred, not even the power of prayer.

Ernst is well placed to comment. He was a clinical doctor, practised homeopathy and is now professor of complementary medicine at Exeter University. His collaborator is a PhD and a science writer.

According to the authors, conventional medicine has had a chequered history. They trace its development through the well rehearsed stories of George Washington being bled to death by doctors and of hospitals being unsafe until Florence Nightingale turned things around.

They also comment on more recent developments such as doctors smoking heavily until someone studied the effects of smoking. Doctors were the guinea pigs and the results were so dramatic that many immediately turned against smoking.

Ernst and Singh save their most strident criticism for four alternative practices. Herbal medicine "can claim a few successes, but the majority of herbs appear to be overhyped", they say. Chiropractic therapy has some marginal benefit for back pain but they recommend not letting chiropractors work on the neck region.

Acupuncture may offer marginal relief from some types of pain and nausea "but the effect is so borderline that there is also the strong possibility that acupuncture is worthless". Worst of all is homeopathy, "an implausible theory that has failed to prove itself after two centuries and some 200 clinical studies".

As an appendix, the two writers briefly review some lesser-known treatments. Most have little to offer, although the authors are mildly enthusiastic about those that lead to relaxation.

If there is a placebo effect in many of the treatments described in this book, why don't doctors prescribe placebo pills? Such a move, the authors hasten to comment, would be unethical. However, what they don't say is that the placebo effect shows the role positive thinking can play in recovery. Surely it would be in the country's and the individual's interest to have ongoing public education on positive thinking.

If there is another criticism of the book, it is that the authors are scathing of the use of anecdotal evidence to justify alternative treatments but they themselves use anecdotes to prove the danger of such treatments proceeding without accompanying conventional medicines.

Nevertheless, there is plenty to think about. Evidence-based trials have shown there is some benefit to be derived from St Johns Wort and fish oil in given circumstances. So much so that these once alternative treatments are now prescribed by medical doctors.

The alternative medicines market is huge. Ernst and Singh quote a worldwide figure of (PndStlg)40 billion ($NZ105 billion). A portion of it is spent by public health. The amount spent by government may not be large, they say, but it could be used to pay a lot of additional nurses.

It's the sort of book that everyone concerned with health issues - either as a provider or as a consumer - should read. Singh and Ernst realistically state that much of what they have written about will not be read by the public.

If New Zealand medical professionals are serious about maximising their future funding, they should club in to send a copy to every candidate standing in the next election.

- John Ewan is a Nelson-based reviewer and contract feature writer.


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