Book Review

Trick or Treatment: The Undeniable Facts about Alternative Medicine

N Engl J Med 2008; 359:2076-2077November 6, 2008

Article

Trick or Treatment: The Undeniable Facts about Alternative Medicine
By Simon Singh and Edzard Ernst. 342 pp., illustrated. New York, W.W. Norton, 2008. $25.95. ISBN: 978-0-393-06661-6

The authors of this book state in their introduction: “Our mission is to reveal the truth about the potions, lotions, pills, needles, pummeling and energizing that lie beyond the realms of conventional medicine.” Their goal is to answer the question of whether alternative therapies provide any benefits — or only a placebo effect.

Simon Singh is a physicist and science journalist, and his coauthor, Edzard Ernst, is a physician and professor of complementary medicine. Ernst is one of the best qualified people to summarize the evidence on this topic. After graduating from medical school, he practiced at a homeopathic hospital in Munich, Germany. He later became the world's first professor of complementary medicine — at the Peninsula Medical School in England — and for the past 15 years his group has conducted research and written numerous systematic reviews of alternative therapies.

The book is written for the general public. In the first chapter, “How Do You Determine the Truth?,” the scientific method is explained, and in each of the next four chapters analysis of a popular alternative therapy is given. An appendix at the end of the book contains one-page summaries of 36 other therapies. In chapters 2 through 5, information about specific therapies is interwoven with accounts of medical quackery as well as descriptions of clinical trials that illustrate scientific methodology.

In the chapter on acupuncture, for example, the authors relate the ancient origins of the practice and its recent rise in popularity in the West. After consideration of the principles of Chinese medicine and the concept of meridians, Singh and Ernst discuss the absence of an appropriate control for acupuncture in early clinical trials. They then summarize the development of evidence-based medicine and systematic reviews and provide an introduction to placebo effects. Finally, they cite recent trials in which it was found that several types of sham or unconventional acupuncture — using unconventional points or telescoping needles, for example — were as effective as traditional acupuncture for the relief of pain. They conclude that there is no scientific basis for the concept of meridians and no high-quality evidence testifying to the benefits of acupuncture beyond a placebo effect. The authors also conclude in their reviews of homeopathy and chiropractic therapy that there is little evidence to support the efficacy of the treatments.

Chinese Acupuncture Chart, Undated.

The writing is clear and vivid, and the historical anecdotes provide a valuable perspective on the subject. Although the interweaving of subjects may help lay readers appreciate the need for scientific evaluation of therapies, some may find the shifts in subject matter distracting.

The topic of herbal medicines is more complex than some of the other topics covered because herbal medicines may contain active ingredients. The quality of evidence that supports the efficacy of herbal treatments is summarized in a table that rates each herb. I believe that the many “medium” and “good” ratings of evidence that appear in this table are overstated and do not take into account recent high-quality clinical trials. The authors make clear that some herbal medicines are adulterated or toxic, and they also point out the potential for interactions between herbs and drugs. However, there is no consideration of the problems inherent in taking remedies for which the content of active ingredients is unknown. The authors list cautions for those who are considering the use of herbal medicines but make no recommendations about their use.

The final chapter, “Does the Truth Matter?,” discusses the ethical problems posed by physicians endorsing the use of placebo alternative therapies and advises against that deception. The authors also consider the reasons why alternative therapies are so popular despite their hazards and lack of efficacy. They provide a list of the “top ten culprits in the promotion of unproven and disproven medicine.” In addition to the usual suspects — celebrities and the media — they point to the failure of biomedical scientists to speak out, as well as the complicity of the World Health Organization and some universities. They cite data indicating that in 2007 in the United Kingdom, 61 degree courses in alternative medicine were offered at 16 universities, 5 of which offered Bachelor of Science degrees in homeopathy. Singh and Ernst also propose that alternative treatments be subjected to the same scientific standards, evaluation, and regulation as conventional medical treatments.

This book meets the need for a current, evidence-based survey of alternative therapies to balance the widespread misinformation about them. Physicians should recommend the book to their patients, and it will help health practitioners provide patients with sound advice. (Since the book contains few references, readers interested in a more extensive bibliography on the subject should consult R.B. Bausell's Snake Oil Science: The Truth about Complementary and Alternative Medicine [New York: Oxford University Press, 2007]).

Donald M. Marcus, M.D.
Baylor College of Medicine, Houston, TX 77030
dmarcus@bcm.tmc.edu