Trick or Treatment: The Undeniable Facts about Alternative Medicine

by Simon Singh, Edzard Ernst

The truth about the potions, lotions, pills and needles, pummelling and energizing that lie beyond the realms of conventional medicine. Whether you are an ardent believer in alternative medicine, a skeptic, or are simply baffled by the range of services and opinions, this guide lays to rest doubts and contradictions with authority, integrity, and clarity. In this groundbreaking analysis, over thirty of the most popular treatments―acupuncture, homeopathy, aromatherapy, reflexology, chiropractic, and herbal medicines―are examined for their benefits and potential dangers. Questions answered include: What works and what doesn't? What are the secrets, and what are the lies? Who can you trust, and who is ripping you off? Can science decide what is best, or do the old wives' tales really tap into ancient, superior wisdom?In their scrutiny of alternative and complementary cures, authors Simon Singh and Edzard Ernst also strive to reassert the primacy of the scientific method as a means for determining public health practice and policy.

Genres: Science, Nonfiction, Medicine, Health, Medical, Skepticism, Popular Science

352 pages, Hardcover

First published January 1, 2008

About the author

Simon Lehna Singh, MBE is a British author who has specialised in writing about mathematical and scientific topics in an accessible manner. He is the maiden winner of the Lilavati Award.

His written works include Fermat's Last Theorem (in the United States titled Fermat's Enigma: The Epic Quest to Solve the World's Greatest Mathematical Problem), The Code Book (about cryptography and its history), Big Bang (about the Big Bang theory and the origins of the universe) and Trick or Treatment? Alternative Medicine on Trial (about complementary and alternative medicine).

He has also produced documentaries and works for television to accompany his books, is a trustee of NESTA, the National Museum of Science and Industry and co-founded the Undergraduate Ambassadors Scheme.

Reviews

[Alasse · Rating 5 out of 5]

DIE, HOMEOPATHY, DIE!!

This book is perfect. I've been thinking I had to write this book eventually, but now I don't have to because it exists and it's exactly as I imagined it. Now all I have to do is have a child and plant a tree.

It's a fact that otherwise smart people have a tendency to believe weird stuff. It's always there, right under the surface. My own mom just came in to tell me I have to be careful tomorrow (11/11/11), because the number 11 scares her. I don't understand it, but there it is. And being afraid of the number 11 probably won't hurt her, but there are people out there who will find ways to take advantage of her fear.

This is why this book is so important. People need to know why alternative medicine doesn't work, and they need to know how we can tell that it doesn't work. And if I had to write a book for non-sciency folks to understand how we've come to that conclusion, well, this is exactly the book I would write. (Except it's already been written. I'll have to find something else to do with my time).

The book is at the same time ruthlessly scientific and ridiculously accessible. It flat out refuses to make any assumptions, choosing instead to revise from scratch all the evidence we have on alternative therapies. Except you can't do that without first explaining the method you're using, so that's what the authors do - they intertwine all the acupuncture talk with scientific method talk.That is, they start out by laying out the origins of the clinical trial, and before you know it they're explaining the concept of publication bias and the Cochrane initiative.

The result is a rigorous, honest and well-researched book, and the fact that it's a little lightweight is probably its greatest strength.

[Sheri · Rating 1 out of 5]

Wow. The authors treat their readers as if we are unintelligent. I really thought this book was going to take a more neutral, and scientific based approach to exploring the efficacy of alternative medicines. I am also surprised to see some of the reviewers on here saying things like "this book just confirmed all my beliefs" and " I was already suspicious of alternative medicines". Why even read it if you have already made up your mind? It's always easy to convince you of something you already believe.
The book stereo-typed users and practitioners of alternative medicine, and even said that conventional medical doctors take a more holistic approach to treating patients than alternative practitioners. Don't you think that's always going to depend on who your doctor or alternative practitioner is?
It pointed out all the rare, isolated cases and possible side effects and drug interactions of many herbs, but failed to mention that most pharmaceutics have just as many side effects possible interactions and rare cases in which something went wrong. It had a chart giving ratings of good, medium and poor to about 35 different herbs. On page 204 the authors write "If a herbal remedy does not appear in the table, then it is probably safe to assume that there is no convincing evidence to support its use". Really? So you've covered everything worthwhile here in just a couple of pages huh?
Do your research, be smart about your decisions, and never "assume" anything, I say. There are many books, scientific journals, articles, etc out there to read. LOTS of scientific studies done. No, I haven't read them all. No one possibly could, including the authors. But I personally would never tell you what to assume, nor would I make the assumption that just because something is mainstream that makes it the correct way to do it. I'm not jumping off that bridge.
I do have to admit, however, that it did have some fun historical facts on the origins of alternative medicines, and a few nice quotes. I guess my time wasn't entirely wasted.

[Lena · Rating 4 out of 5]

This is the third book I've read this year that examines the evidence for and against alternative medicine, so much of the ground it covers was already familiar to me. Despite that fact, I enjoyed this book a great deal and think it is likely to be the most accessible to those who have personal experience with alternative medicine.

The authors take an in-depth look at the four most popular modalities in the alternative medicine world: acupuncture, homeopathy, chiropractic and herbal medicine. They briefly discuss the history and public perception of each before they analyze what science has to say about the true effectiveness of these techniques.

The authors are not shy about stating those cases in which science does indicate possible effectiveness of these modalities, such as acupuncture for pain and nausea, chiropractic for low back pain, and certain herbs for various specified conditions. They take things a step further, however, by comparing these treatments with their conventional counterparts in terms of both cost and risk. While chiropractic may be effective for certain types of back pain, it has not been shown to be more effective than conventional therapies, is usually much more expensive, and carries a rarely discussed but very real risk of stroke, leading the authors to recommend against it.

Though the bulk of the book is spent on the four most popular CAM treatments, the appendix contains brief summary of their findings for 36 other CAM modalities from Ayuveda to spiritual healing that I found particularly informative.

I hope that the authors' willingness to give credit to those therapies that do warrant further study will make this book more likely to be read by those who could best benefit from this information. Unlike the authors of Suckers and Snake-Oil Science, Ernst knows this world from the inside. He is world's first professor of complementary medicine and also a former homeopath.

As the authors discuss, the placebo effect, the empathetic nature of CAM practitioners, and the preference we give to anecdotal over scientific evidence are likely to continue keeping the public confused about the true effectiveness of some of these methods. Those who would like to make certain they are getting good value for their hard-earned cash before trying one of these treatments, however, will find this book an invaluable resource.

[Jennifer · Rating 2 out of 5]

Super biased in favor of conventional medicine, which shouldn't be a shock since it's written by an MD.
Not well cited at all, very anecdotal in the examples that prove how useless alternative medicine is (other than the super diluted homeopathic drugs).
Mentioned a FEW people have even been harmed with natural cures, but failed to mention the over 100,000 people who die in the US every year from correctly prescribed, properly taken conventional medicine (not including overdoses and illegally used prescriptions drugs)

I was hoping for a book that gave detailed info on some natural cures and some clinical evidence to back it up, but nothing was detailed-

a waste of time...

[Cynnamon · Rating 5 out of 5]

This book investigates the claims alternative medical treatments make based on a scientifically acknowledged methodology.

The book starts with a description of the scientific methods, studies have to be based on to have any value. They also evaluate some well known studies.

The next chapters look thouroughly on acupuncture, homeopathy, chiropractic therapy and herbal medicine.

The last chapter, which I found particularly interesting, discusses if the placebo effect of alternative treatments is something that should be used as an addition to school medicine.

In the appendix you find an overview and short evaluation of many more alternative treatments.

I don’t think it is a spoiler when I tell you that most alternative treatments have turned out as ineffective with a placebo effect in best case, a few have a slight positive impact and some are not only ineffective, but also dangerous. The authors’ evaluation is based on a clear and well described scientific methodology, their conclusions are comprehensively described.

This is a book for readers who appreciate a rational and scientific approach to things. Readers who prefer gut feeling and a strong belief over facts will not be happy with this book.

[Ross Blocher · Rating 5 out of 5]

This is essential reading on the topic of alternative medicine, and I'm a little embarrassed to admit that it's been sitting unread on my shelf for over a decade. Trick or Treatment: The Undeniable Facts about Alternative Medicine is a practical, balanced, and evidence-based guide to the legitimately confusing world of complementary and alternative medicine (CAM). The authors are well-qualified on the topic: Dr. Edzard Ernst is a now-retired academic physician and the first Professor of Complementary Medicine at Exeter, and Simon Singh is a science journalist and gifted explainer. This is the sort of book that, if everyone could read and appreciated it, would save consumers billions of dollars annually. It could save a lot of lives as well.

Alternative medicine is filled with grey areas when it comes to testing, support, effect, harm, cost, consistency, and a host of other factors. Singh and Ernst wade into this murky state of affairs to demonstrate why science is so essential, and clinical trials so powerful, in establishing the truth of what works and what doesn't. With historical examples, they show how careful, blinded testing among large sample sizes have cut through pet theories, testimonials, placebo, and wishful thinking. Anything that proves effective becomes part of medicine (whatever its origin), and everything else remains "alternative": either not proven effective, or proven ineffective.

The book primarily focuses on the four largest categories of CAM: acupuncture, homeopathy, chiropractic therapy, and herbal medicine. The authors walk us through the origins and practice, early success stories, ways they've been tested over time, people who have been harmed, and the narrowly prescribed situations in which they may prove helpful. The full treatment is worth reading for its context, history, and nuanced arguments, but I'll summarize with these proposed warning labels for each product (the first is from Dylan Evans in his book Placebo):

Homeopathy: Warning: this product is a placebo. It will work only if you believe in homeopathy, and only for certain conditions such as pain and depression. Even then, it is not likely to be as powerful as orthodox drugs. You may get fewer side-effects from this treatment than from a drug, but you will probably also get less benefit.
Acupuncture: Warning: this treatment has shown only very limited evidence that it can treat some types of pain and nausea. If it is effective for these conditions, then its benefits appear to be short-lived and minor. It is more expensive than conventional treatments, and very likely to be less effective. It is likely that its major impact is as a placebo in treating pain and nausea. In the treatment of all other conditions, acupuncture has no effect other than a placebo effect. It is a largely safe treatment when practiced by a trained acupuncturist.
Chiropractic: Warning: this treatment carries the risk of stroke and death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.

A host of alternative modalities are discussed along the way, and there's an incredibly helpful appendix at the end that gives one-page summaries of dozens of additional diagnostics/treatments/diets/methods: some you may have heard of, and others you'll know to look out for. It reads like a list of former (and future) investigations for my podcast, in which I've subjected myself to many of these treatments. This book will serve as a constant reference for me to return to. You'll also learn a bunch of fun facts along the way. For example, who knew that the e-meter (Scientology's famed spiritual technology device) was originally invented in the 40s by chiropractor Volney Mathison? Or that the word drug comes from the Swedish word druug meaning "dried plant"? Or that Viagra was initially a failed treatment for angina until researchers found that male participants didn't want to give their pills back? Or that homeopathic remedies have started with materials as absurd as fragments of the Berlin Wall?

This is a book chock-full of valuable information and reasoned argument that will sharpen anyone's understanding of medicine and science. It's dense, but rewardingly so. Highly recommended.

[Brian Clegg · Rating 5 out of 5]

This book takes an objective look at alternative medicine. The outcome is electrifying to everyone who thinks and has used or considered using anything like homeopathy or acupuncture. Singh and Ernst don’t set out with any malice – Ernst has worked for many years in alternative medicine – but they show devastatingly how proper trials have shown these alternative treatments to rarely be better than a placebo, and often to have negative or even life-threatening consequences.

It really is striking – the vast majority of alternative medical treatments are proved to be on a par with snake oil. Apart from anything else, this ought to be required reading for doctors -a surprising number encourage alternative treatment – for celebrities who endorse this kind of medication and particularly the media which all too often is wide-eyed and idiotic on the subject of alternative treatments. In the UK, Prince Charles who has bumbled on about the subject for many years, ought to be forced to copy this book out by hand until he gets the point.

All in all, a really important book which wasn't given the coverage it deserved when it came out, and what’s more it’s very readable too. By combining Ernst’s expertise on the subject and Singh’s superb science writing we have a book that is as entertaining as it is informative, and the emphasis on real testing will be a delight to anyone who enjoys the saying ‘data is not the plural of anecdote.’ More than recommended – essential.

[Kathryn · Rating 2 out of 5]

In my continued exploration of alternative medicine, I turned to Drs. Edzard Ernst and Simon Singh’s Trick or Treatment. While rife with medical history and science, unfortunately it reads somewhat like stereo instructions.

Trick or Treatment is simply too tedious for the casual reader. I’m sure medical professionals will find this text fascinating. Laypeople? Not so much. It’s too academic.

Further, I find it irritating that the doctors denigrate alternative medicine practitioners for relying on anecdotal experience when they do the same. It's story after story of the negative effects a certain complementary treatment had on one (or a few) person. Basically, the definition of an anecdote. I was looking for the science (or lack thereof) behind why specific alternative remedies are pure quackery. Give me the science. I WANT THE SCIENCE.

The one highlight of Trick or Treatment is the synthesized glossary. It covers a wide variety of alternative treatments and rates them based on efficacy and risk factor. It’s entirely possible to simply read the glossary and skip the remainder.

Summary: Read if you’re a medical professional or avid fan, disregard otherwise.

[Tiffany · Rating 1 out of 5]

So, Trick or Treatment: The Undeniable Facts About Alternative Medicine was written by Simon Singh, who I used to respect, and Edzard Ernst, MD, who calls himself "the world's first professor of complementary medicine" and immediately relative to this I have heard people who know him clear their throats and add: "Although, I have never heard where he studied any complementary medicine." (See what I just did there? I cast aspersions upon one of the authors by relating an anecdotal and therefore spurious source.)

The book has a single goal to prove through repetition that complementary medicine is invalid because it can not be proved through that golden standard of medicine the double blind trial to lead to "evidence-based medicine". The introduction states:

The contents of this book are guided entirely by a single pithy sentence, written over 2,000 years ago by Hippocrates of Cos. Recognized as father of medicine he stated: 'There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.'

which says it all and I need explain nothing further. From the outset, science is the only thing that is important in the field of medicine. Anything else is opinion. Which illustrates the delightful paradox in that this book is positively chock full of opinion. For example, the first first chapter "The Truth About Acupuncture" begins with the bold statement that it was not the Chinese who invented it because in 1991 two German tourists Helmut and Erika Simon discovered a frozen corpse 5,000 years old covered in tatoos that resemble conventional acupuncture points.

"Scientists began examining him... he was covered in tattoos consisting of lines and dots, ... 80 percent of the points correspond to those used in acupuncture today."

Voilà, case proved, ipso facto Europeans invented acupuncture. For two men who profess to loathe anecdotes they have no compunction about pulling them out to prove one of their batty theories.

Next the authors discuss "ch'i" and frankly, anybody who studies Chinese medicine knows that what they say is wrong wrong wrong. The character for ch'i (or qi) rarely if ever exists alone in Chinese text books; it is always modified because, and this is the difference between Chinese medicine and biomedicine: qi describes a process or function, not a structure or a measurable substance. See, Westerners like tangible, measurables in medicine. When the Chinese talk about yuan qi (vitality) or wei qi (immune robustness) or gu qi (nutrient absorption) it is all relative. The Chinese philosopher-doctors use their language to describe how systems function in relative terms, not how they compare from one human to another. In other words: how is someone handling all of their basic functions: digestion, elimination, breathing, sleep ... not: what are your values? To talk about Chinese medicine without understanding this most basic concept is the equivalent of saying: I English good speak. By the way, the photo on page 45 of illegal, non clean-needle technique in which a patient has 16 needles in his face makes me wonder: what's going on there? A face lift by acupuncture? Because, jeez-loueez, it's not recognizable acupuncture I've ever seen.

Next, there are all the scary stories about infections, death, and so on. C'mon you guys. In my 15 years in the biz. I've heard of one case of pneumothorax--caused by an untrained MEDICAL doctor. The explanation he gave to his patient was, get this: "Your lungs are too big." See, I can use anecdotes, too!

Actually, this book continues along just more of the same. The "scientific" part of the book turns out to be a selective review of some of the scientific studies. Conclusions are drawn, but they are wifty. Here are some thoughts about the difficulties posed by studies of acupuncture efficacity:

1) Double blind tests with acupuncture protocols where there are no reduction of symptoms don't prove acupuncture doesn't work they just prove that that protocol doesn't work;

2) The first thing a student of Chinese medicine learns is: "Same symptoms different treatment, different symptoms same treatment." This means that even when the symptoms are same over a group of people you treat them differently because they have different presentation, age, sex, robustness. In order for any treatment to be successful it must be tailored for each subject. Thus, for obvious reasons the double-blind test for acupuncture efficacy is not viable--there would always be too many variables;

3) Sham needling is SHAM study. The Japanese-style of acupuncture called Toyohari, for example, developed by blind practitioners, do not (for obvious reasons) insert the needle into the dermis--they just use needles to stimulate the surface of the skin. Toyohari has been shown to have tremendous therapeutic value. Therefore, the idea of using sham (retractible) needles that contact the surface of the skin means there still has been treatment;

By the way, I had a Toyohari treatment when I was in Japan. At the time didn't think I'd gotten any treatment at all. Later on, do you know how I felt? Like a million freakin' bucks, that's how I felt! When was the last time you left a doctor's office and felt like a million freakin' bucks?

Let's not go into that rat's nest of placebo, but frankly, do you think acupuncturists are talking dogs, cats and horses into feeling better with acupuncture? A veterinarian with an equine practice in Middleburg, VA, came to acupuncture school after he successfully treated a horse with a dripping eye. The key is that conventional treatment had not been effective--it was only after he had tried acupuncture that he had positive results. Do you think he persuaded the horse into stopping his eye from dripping?

Ernst and Singh do the same thing for chiropractic therapy (thank god for chiropractors, my "doctor" wanted to cut open my back for exploratory surgery. When I declined he offered me physical therapy--didn't work--and Oxy, no thanks. My chiropractor, bless him, fixed me.) However, Ernst points out that you are taking your life into your hands any time you step into a chiropractic office (despite the fact mine pays about $900 a year in malpractice whereas my G.P. pays $50,000) and that chiropractors are 9 times more likely to be brought up for charges for sexual misconduct. Oh you randy randy chiropractors! What will we do with you? I guess Ernst and Simon have forgotten all those years when female patients were given unauthorized pelvic exams by residents and students while under anesthesia--a practice that continues today. Google: "Unauthorized practice: teaching pelvic examination on women under anesthesia" and

http://www.theglobeandmail.com/life/h...

I guess only chiropractors fall under the bright light of scrutiny--medical doctors sticking their hands into anesthetized women's parts doesn't rate mention.

The authors continue to find hoaxes within homeopathy, herbal medicine, meditation, naturopathy, Alexander technique, leech therapy (why do they not call it "hirudotherapy" and why do they not acknowledge it is now used for over a dozen approved post surgical therapies in North America?), etc.

They conclude with a chapter entitled: "Does the truth matter?" ... Well, hah, of course it doesn't. Smart people know this is all bunk. Those stupid people who head to acupuncturists and chiropractors in droves are not to be blamed for being hood-winked. Oh, and "the Prince" to whom the book is dedicated, is a Royal fool, gullible and weak-minded.

In short, the Prince of Wales ought to start listening to scientists rather than allowing himself to be guided by his own prejudices.

They ask: who is to blame for all this nonsense? Well, celebrities are, especially pretty ones like Pamela Anderson and Goldie Hawn; medical researchers are, here they may be talking about people like a man diagnosed with M.S. while he was finishing his PhD in Biostatistics at Johns Hopkins University, upon receiving the diagnosis he set his considerable mind to pursuing available information about treatment protocol outcomes and concluded there was no pharmaceutical on the market that actually performed better than placebo. He decided to go holistic and is now a teacher of qi gong of national renown (and has had no further exacerbations.); universities are ... bad universities! bad, bad, down boy. By awarding profitable degrees in these alternative therapies they are creating false hope and real profits; alternative gurus are, e.g. charismatic MDs like doctor Oz. This really cheeses me off: when I've been telling patients for four years their Raynaud's symptoms would improve if they stopped smoking inevitably they come back to me and and say Dr. Oz says such and such!; the media, well look at the bullshit that's happened in the last 16 months there. who can believe anybody any more; the World Health Organization; the National Institutes of Health; and so on.

When the authors talk about biomedicine moving out of the "dark ages" I think they refer to biomedicine moving away from: "how are you today?" towards an Orwellian world where your physician faces a screen (Electronic Health Records, anyone?) instead of her patient. To a world where the patient's numerical values are the end all be all and outside of those values he, as a patient, has no value himself.

One area the authors never touch upon is the importance alternative medicine has for society: in a world in which doctors are priests standing between a man and his own health, and only care about that small slide from ill health to death, alternative medicine allows for a place in which a person can go to learn about self care to augment the quality of his healthy life and prevent an odd situation from becoming a chronic situation.

As a final statement, I'd like to mention the Starfield report, published by Barbara Starfield, MD, in JAMA 2000; it stated that the third leading cause for untimely death in the US is iatrogenic in nature. This is in direct conflict to the CDC's list of top ten killers, in which lung disease is third after cardiovascular disease and cancer. Please note that alternative medicine doesn't figure in the top 100 causes of untimely death. Draw your own conclusions.


Written for:
Stephen--dead at 23, from a fatal drug interaction prescribed by a medical doctor

Elizabeth--currently blind, crippled and brain-damaged by a routine allergy shot administered incorrectly by a medical doctor

Egan--survived pneumo-thorax caused by medical doctor using acupuncture (incorrectly) while attempting to treat his shingles

William--saved from sepsis by a phenomenal surgeon and an extraordinary team of physicians, nurses, and techs at Yale Teaching hospital


We need each other, guys.

[David Dinaburg · Rating 3 out of 5]

I once watched a pigeon, waddling around on the sidewalk, launch into the air and bounce off a pedestrian’s chest. It shattered the illusion that the natural world is some sort of flawless, mystical place—that animals are so in tune with their surroundings that they never make mistakes or have poor judgments. “Yeah, I can totally achieve escape velocity before that giant lumbering treetrunk or whatever crosses my flightpath,” thinks the pigeon. No. You didn’t.

This sort of magical thinking—or perhaps magical unthinking, since I often either consider squirrels or pigeons as fuzzy automatons running their behavioral scripts, or as exterior décor, like leaves or sunlight—permeates the world of self-proclaimed alternative medicine: “

Alternative therapists continue to wear the name ‘alternative’ as a badge of honour, using it to give substandard treatments an undeserved level of dignity. They use the term ‘alternative’ to promote the notion that they somehow exploit alternative aspects of science. The truth, however, is that there is no such thing as alternative science, just as there is no alternative biology, alternative anatomy, alternative testing, or alternative evidence.

Trick or Treatment: The Undeniable Facts about Alternative Medicine falls into the title-construction format the I find personally aggravating; a clever title and then an aggressive subtitle that cannot be denied. Outside of the feeling of being punched in the face with the subtitle, I knew—because I’ve read articles and books by Simon Singh before—that I was already in the same boat about homeopathy, acupuncture, chiropractic, and herbal medicine as the authors:

Chiropractors who manipulate the neck can cause stroke, which can be fatal. Some herbs can cause adverse reactions or can interfere with conventional drugs, thereby leading to serious harm. Acupuncture practised by an expert is probably safe, but minor bleeding is common for many patients and more serious problems include infection from re-used needles and the puncturing of major organs. Even homeopathic remedies, which of course contain no active ingredient, can be dangerous if they delay or replace more orthodox treatment.

Basically, it’s hokum.

If anything, I became more accepting of herbal medicine; I had dismissed it out of hand, because, well, herbal medicine. But Trick or Treatment isn’t ideological, it just dumps facts on your face: “There have been attempts to isolate the key active ingredient in St John’s wort, thought to be either hyperforin or hypericin, but when these have been tested, however, it appears that they are not as effective as the plant itself. In this particular instance, the herbalist’s view appears correct. In other words, it seems that the benefits of St John’s wort are due to a combination of chemicals, each one working to enhance the effect of the others.” My expectation of constant, confirmation-bias-based personal validation was brought up short, but it is affirming to be reminded that scientific testing—conventional medicine—will check whatever alternative bunkum spills forth from the mantra-and-placebo industry and use what is proven to be relatively safe and effective. Replicable results—that’s pretty much science, in a nutshell.

Scientists focused their attention on willow bark, which had been used to reduce pain and fevers for thousands of years. They successfully identified the active ingredient, this time naming is salicin, based on salix, the Latin word for willow. In this case, however, chemists took nature’s drug and attempted to modify and improve it, driven by the knowledge that salicin was toxic. Taken in either pure form or in willow bark, salicin was known to cause particularly harmful gastric problems, but chemists realized they could largely remove this side-effect by transforming salicin into another closely related molecule known as acetylsalicylic acid. The Bayer company in Germany started marketing this new wonder drug under the name of aspirin in 1899.

That’s science, in a willowbark.

The opening sections give a strong run-down of the historical context and comprehensible principles of the scientific method, the clinical trial, and the placebo effect. Simply having a working understanding of these three concepts is required to form an educated opinion on the actual content regarding the specific alternative medicine chapters. Having the historical background makes learning the necessary practical definitions and current applications more memorable; it is nice to be reminded this is a book, after all, not a white paper.

The word placebo is Latin for ‘I will please’, and it was used by writers such as Chaucer to describe insincere expressions that nevertheless can be consoling: ‘Flatterers are the devil’s chaplains that continually sing placebo.’ It was not until 1832 that placebo took on its specific medical meaning, namely an insincere or ineffective treatment that can nevertheless be consoling.

The ethical discussions contained near the tail end of Trick or Treatment are predicated on a working comprehension of the placebo effect:

For some conditions, such as back pain, conventional medicine struggles to offer a reasonably good solution, which means that a homeopathic remedy might be as good as anything else. After all, it will garner whatever psychological strengths the patient can bring to bear.... Our position—that the routine use of placebos is unacceptable because doctors should never lie to their patients—might seem draconian. Indeed, those who oppose our view would argue that the benefits of lying outweigh the ivory-tower ethical arguments. These opponents would feel that white lies are acceptable if they improve the health of patients.

I can’t really tell you how an ardent supporter of alternative medicine would view Trick or Treatment, but if you want to know more about acupuncture, homeopathy, herbal medicine, and chiropractic, this is a reliable place to become informed. Even if you dismiss the conclusions—that alternative medicine is often outright dangerous, or, at the least obfuscatory in finding effective treatment—the historical background and functional detailing is informative and at times fascinating.

By the start of the twentieth century, acupuncture was extinct in the West and dormant in the East. It might have fallen out of favour permanently, but it suddenly experienced a revival in 1949 as a direct result of the communist revolution and the establishment of the People’s Republic of China. Chairman Mao engineered a resurgence in traditional Chinese medicine. His motivation was partly ideological, inasmuch as he wanted to reinforce a sense of national pride in Chinese medicine. However, he was also driven by necessity...to deliver affordable healthcare in both urban and rural regions. Mao did not care whether traditional Chinese medicine worked, as long as he could keep the masses contented.

The medical data, mostly from clinical trials and meta-analyses of clinical trials, is pretty straightforward. It’s hard to dismiss the conclusions without succumbing to willful ignorance, and any book that closes out on a Carl Sagan quote is worth reading:

It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish useful ideas from worthless ones. If all ideas have equal validity then you are lost, because then it seems to me, no ideas have any validity at all.

[stefano · Rating 5 out of 5]

Mi hanno sempre affascinato le medicine alternative e tra le tante prediligo l'omeopatia. Certo, senza nulla togliere alla cristalloterapia, alla tuocuginopatia, all'osteopatia, alle terapie ayurvediche, alla naturopatia, ai fiori di Bach. Tutte discipline degne di essere derise apprezzate, ma nessuna raggiunge il livello dell'omeopatia. Io amo particolarmente l'omeopatia, gli omeopati e financo gli omeopatici. Sono affascinato dalla diluizione, dalla succussione, dalla dinamizzazione. Adoro la dinamizzazione. Sono rapito da stronzate profondissimi concetti quali la memoria dell'acqua. Ammiro gli omeopati, medici alternativi che si fanno in quattro (in dieci, in cento, in mille, diluendosi e succussandosi) per i loro pazienti. Mi piacciono i prodotti omeopatici: imbrogli farmaci costituiti di sola memoria, talvolta un po' di zucchero, di solito tanta acqua (memorabile). E allora non posso che stimare gli omeopatici, intesi come pazienti dell'omeopatia: ci vuole una mente succussata aperta, apertissima succussatissima per pagare fior di soldi (quelli non succussati, né dinamizzati, tantomeno diluiti, ma tutti interi, fruscianti, tanti) per una pastiglina di zucchero o due goccioline d'acqua.

Insomma, non leggete questo libraccio brutto e cattivo che sparge solo tanto fango su discipline che ci garantirebbero la salute (e pure il bene e la virtù, già che ci siamo), ma che sono di continuo ostacolate dalle multinazionali cattive, dai pennivendoli al loro servizio, dal club Bilderberg, dalla Cia, da Big Pharma e da chi volete voi.

Tutto questo scrivere mi ha fatto venire sete. Vado a bermi un bicchiere d'acqua. Speriamo che non abbia memoria delle caprette che hanno pascolato vicino alla sorgente.

[Jeanne · Rating 3 out of 5]

‘Minds are like parachutes. They only function when open.’ – Thomas Dewar

Trick or Treatment examines and evaluates the evidence for four alternative medicines: acupuncture, homeopathy, chiropracty, and herbal medicine. By and large, Singh and Ernst, a journalist and a physician with a background in homeopathy, trash what they see. The research, when present, is weak, overstated, and poorly controlled. Repeatedly, they conclude that there is little evidence that these treatments are little better than a placebo, except for a scattering of herbal remedies and in more limited circumstances than often articulated (e.g., chiropracty for back pain).

Singh and Ernst argue that even treatments that are useful, such as St. John's wort, should not be taken uncritically. St. John's wort can interfere with many medicines, including many medicines used for HIV and cancer, some oral contraceptives, and immunosuppressants. Unfortunately, many people believe that herbal remedies are inherently safe because they are natural. Singh and Ernst argue natural does not mean safe, nor that conventional medicine is necessarily unsafe.

My favorite parts of the book were the first two chapters focusing on research design – and bloodletting. (Did you know that George Washington had been drained of half his blood in less than a day?) Singh and Ernst discuss the difficulties of using single cases as "proof," the importance of blinding patients and doctors to treatments during clinical trials, the dangers of uncritical acceptance of endorsements, and more. For example, in 1854, patients at the London Homoeopathic Hospital had a survival rate of 84%, compared to just 47% for patients receiving more conventional treatment at a nearby hospital. This difference seems to clearly indicate that homeopathy was more effective than conventional medicine, but Singh and Ernst argue that this difference could be attributable to differences in hygiene, the typical levels of illness at each hospital, or how ineffective conventional medicine was during that period (think bloodletting, vomiting, and "medicines" such as arsenic and mercury).

Interesting read.

‘I believe in an open mind, but not so open that your brains fall out.’ – Arthur Hays Sulzberger

[Tanja Berg · Rating 4 out of 5]

This book aims to explain the most common alternative therapies - acupuncture, chiropractic therapy, homeopathy and herbal medicine - and analyze their usefulness based on the same method as mainstream medicine is rigorously tested. The book details the history of clinical trials based on scientific method and explains simply and thorougly. It is thanks to clinical trials that medicine profession began to emerge from the dark ages 150 years ago and that we can now see our GP's without risking our lives. However, alternative therapy somehow escapes the normal laws applied to drugs and treatments as they are "natural" and "traditional".



The authors are very open minded in presenting the evidence. However, the evidence clearly states that at best, alternative medicine has some mild positive benefits mostly due to the placebo effect and down-right lethal at worst. At the end of the book, ten most important sources of alternative medicine misinformation get a bashing - inlcuding the WHO. This only confirms my suspicion that the WHO has been lead astray and is now too profit-oriented for its own good. Alternative medicine is a billion dollar industry. Money spent on things that mostly do not work. For example, homeopathic medicine contain not a molecule of active ingredient, so how can anyone be surprised that it does not work? Acupuncture and chiropractic therapy have fuzzy mystical origins, as do many other alternative therapies. This book confirmed that alternative medicine is little better than witch-craft and psychic mumbo-jumbo. I would rather spend my money on therapy and medicine which has been proven to work, than rely on alternative therapies which is all hype, mostly placebo effect, relatively uncontrolled by legislation and potentially dangerous.



This book is superbly written, riddled with fascinating facts and an absolutely must-read for anyone who has ever taken as much as an aspirin. Clear, concise, easy to read and highly entertaining.

[Mz · Rating 5 out of 5]

https://bookpress.gr/kritikes/epistim...

[Alex Givant · Rating 5 out of 5]

Если вы планируете прочесть всего одну книгу в этом году - прочтите эту, возможно она спасет вашу жизнь или жизнь ваших близких/друзей.

[Eva · Rating 1 out of 5]

I was really frustrated by this book. So frustrated that I returned it with about 50 pages left to read. I'm not even sure I can tell you exactly why I didn't like it, but I found the attitude of the authors some what holier-than-thou, and not really very helpful or useful. It's particularly ironic that I didn't like the book, since I agree with most of what they said.

[Kamile · Rating 3 out of 5]

Skaitesi gerai, daug idomiu faktu. Bet galejo but bent ketvirtadaliu trumpesne, nes nemazai vietu informacija kartojosi + jautesi labai negatyvus autoriu nusiteikimas alternatyviosios medicinos atzvilgiu. Dalis irodymu tradicines medicinos pirmenybei pagristi atrode pritempti, o veiksmingos alternatyviosios medicinos terapijos tebudavo trumpai paminimos taip sudarant vaizda, kad apskritai si medicinos atsaka yra neverta demesio.

[Jenny · Rating 5 out of 5]

I'd been hoping to find a book like this. It was well done and interesting. The introductory chapter and explanation of the history of clinical trials was well done. Then the meat of the book (brief history of alternative therapy, and review of it's merit and/or risks based on trials and studies to date) was excellent reading. Acupuncture, Homeopathy, Chiropractic, and Herbal Medicine are examined in detail, and there is a nice appendix with summaries on a plethora of other alternative therapies.

I would say it's a must read for anyone interested in alternative medicine, and if you do read it, I'd love to talk to you about it or just hear a note about what you thought about it. The discussion on the placebo effect and the ideas about why alternative medicine is increasing so hugely in popularity were also very interesting.

Here are a couple of the things that stuck out to me:

I had no idea that homeopathic remedies were THAT dilute, or that the practice had gained such a huge following in Europe. (Homeopathic hospitals? Wow.)

I found the chiropractic chapter surprisingly negative. Makes me want to dig a little deeper. If all they said was true, I'm surprised it's not making headlines. (Basic summary was Chiropractic is useful for back pain but not much else, and neck adjustments can be fatal(!))

One of the shining examples of "alternative" medicine triumphs over "conventional" medicine was echinachea. It really does shorten the duration of the common cold. (But, naturally, taking too large a dose for too long is not without some negative side effects.) It's neat that this plant (used appropriately) can do what no over the counter drug can.

And with my pro-natural-birth leanings I would have appreciated a little side note (by the way, maternity care is not very evidenced based), but I suppose the topic must be curtailed to fit in a single volume book, and the authors did the job of addressing the subject quite nicely.

The only critique I had that they should have indexed or footnoted their book with the studies they cited. It would add a little more weight to their work to say "We read all the clinical trials and mega studies, and they said x, and by the way here are the references" and to just say "Trust us, we did the research and the results are this." There was a recommended reading section at the end with some information, but not the detail that study by study footnotes would have provided.

[Jennifer · Rating 2 out of 5]

I only read the section of this book that related to chiropractic care. The authors seem to make the fatal assumption that the double-blind study it the only valid test of a medical treatment. Although the book seemed well researched and accurate in the facts presented, it was written with a clear bias against non-allopathic medicine. Since they claim that they are presenting a scientific and unbiased view, they have clearly failed in their goals. I actually believe that the time I spent on this book was wasted.

[Justin Chiu · Rating 5 out of 5]

Simon Singh is a brilliant science author who makes difficult concepts easy to understand. In this book, he examines the evidence for and against alternative medicine as well as diving into the history of medicine and the randomised control trial. Very easy to read and he's very direct with his analysis, not pulling any punches if he feels a particular therapy lacks evidence.

[Mike · Rating 4 out of 5]

So a while back a friend of mine used acupuncture to help with some nausea issues. I teased her about it and said it was just the placebo effect. Then I heard that some studies indicated that acupuncture may truly be useful for certain kinds of pain and nausea. In order to confirm this, I wanted to find a trusted source. I'm rather new to the skeptical community, but I have already heard much about Simon Singh and his battles with British libel laws to tell the truth about chiropractics. So I thought he would be a good person to trust.

I was very happy with my choice. The book is quite well written. It's not just a dry account of peer-reviewed studies. It tells the stories of how various forms of alternative medicine became so popular, some of which are very strange and interesting. The book also weaves in stories of how evidence-based medicine came to take hold in Western society. It's amazing how far medicine has come in just a couple centuries. So many people contributing in small ways that add up to change the world. And Florence Nightingale is so much cooler than they bothered to teach me in high school.

As for my friend's acupuncture, well I guess it's still unclear whether or not acupuncture works beyond placebo for nausea. Further evidence may well show that it's useless, but at the time of her treatment, there was some apparently legitimate positive evidence. So it was a legitimate choice and I should probably go apologize.

[Angela Gentile · Rating 5 out of 5]

The Truth Is – Alternative Therapies Provide Nothing More than Placebo Effects

Dr. Simon Singh and Professor Edzard Ernst team up in "Trick or Treatment: Alternative Medicine on Trial" (2008) to bust the myths of the effectiveness of some of the most popular complementary and alternative treatments. Ernst’s impressive occupational and education history make him far more than qualified to be the one to take on this task. He was formerly a clinical doctor and studied homeopathy. Singh has a Ph.D. in particle physics and is a "New York Times" bestselling author. Trick or Treatment was written in response to His Royal Highness, The Prince of Wales’ request to have alternative treatments examined closely for their efficacy based on scientific testing. Ernst and Singh put together an impressive lineup of reasons why unorthodox and ancient treatments such as acupuncture, homeopathy, chiropractic and herbal medicine are mainly nothing more than a placebo and also come with risks.

This controversial stand on alternative treatments has me convinced, as I am a scientific-based kind of believer – especially when it comes to healthcare, risks and providing false hope. I am a cancer survivor and have done my due diligence of researching treatments and cures, both orthodox and integrative. I do sway sometimes into the “fantasy” and “wishful thinking” camp when it comes to some of the energy healing modalities, such as Spiritual, Reiki, Chakras and Pendulum (or dowsing) healing. I consider myself very open-minded, and if there are little costs and little risks involved, I am willing to give anything a try.

The book is quite repetitive on some points, mainly, that alternative therapies don’t work. It also seemed to be one big advertisement for St. John’s Wort, an herbal medicine that has been proven to treat mild to moderate depression. There was also some support for “fish oil” to combat inflammation in arthritis.

I liked the fact that Ernst has a history in homeopathy and he took the time to research many of the alternative and complementary therapies according to scientific-based evidence. Many of these therapies have been studied and he has dug up the dirt and given us a couple quick reference tools to refer to. For example, he has two pages of “Herbal Medicine Ratings” and cautions people that even though these are categorized as “natural” remedies, they are not always safe. He also strongly urges people to let their doctor know what herbs they are taking as they can interfere with pharmaceuticals. His second guide will be discussed below.

There are many references throughout the book giving examples of how people with cancer often seek alternative therapies (or at least are recommended by others to seek them). For example, the often-recommended “natural anti-cancer” treatment of laetrile (apricot pits) has been used and promoted since the nineteenth century. Due to scientific rigors, laetrile has since been labelled as “quackery” due to its ineffectiveness and risky side effects. Although this information is out there, people continue to use it to this day. This is true for many other alternative treatments.
The authors list ten culprits why these unproven and disproven treatments continue to be used, promoted and wrongfully touted as effective. It is an actual eye-opener, especially when we realize the power of the media, universities and alternative gurus such as Deepak Chopra and Dr. Andrew Weil.

There is an impressive “Rapid Guide to Alternative Therapies” which has about 35 different modalities covering many popular and not-so-popular techniques and gadgets people are using (e.g., crystals, magnets, special diets). The authors include a definition, background, evidence and conclusion and reassure the reader these therapies have been rigorously investigated against scientific evidence and meta-analyses where available.

This is a well-written book which has helped me open my eyes to the reasons why these alternative therapies are still around, despite the truth, that they are nothing more than placebos (and some come with risks that are rarely talked about). Placebos that are harmless offer nothing more than psychological benefits. Where there is belief and hope that something will work, it most likely will. That’s the power of the mind at work. If nothing else, it will provide the person with a sense of hope for the future, a feeling of wellness and a certain level of comfort that there is something “magical” at work. As long as there are little risks, little costs and big rewards, people will continue to seek out these treatments. Unfortunately there are some very expensive “treatments” as well, and charlatans and quacks are taking advantage of people when they are vulnerable.
Some people feel that doing something is better than doing nothing – as the placebo effect works in mysterious ways.

I would recommend this book to anyone who wants to know the truth about alternative medicine and would rather put their efforts, resources and hope into reliable, scientific-based, effective medical treatments and cures.

The other book I read on this topic came up with the same conclusion about the placebo effect – "Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine" by Paul A. Offit.

Angela G. Gentile, M.S.W., R.S.W.

[Robyn · Rating 2 out of 5]

This book gives accurate, scientifically tested facts about complementary and alternative medicine and the surrounding community. It includes some very interesting anecdotes and comparisons, as well as some excellent suggestions for the future of medicine.

That being said, the writing style is atrocious.

Don't get me wrong, Simon Singh can undoubtedly write very well. However, he uses a scathing, critical style when discussing alternative medicine, whether he is discussing treatments that work or treatments that don't. His tone can come across as patronising and derogatory at times in a way that is extremely offputting.

I am very glad I read this book because of the scientific research and facts. I just wish it had been written in a less cutting manner.

[Baal Of · Rating 5 out of 5]

Extremely thorough, even-handed overview of the current state of alternative medicine from a scientific viewpoint. In depth coverage of acupuncture, homeopathy, chiropractic, and herbal medicine, with an excellent supplemental section giving single page overviews of a whole laundry list of alternative approaches. The authors fulfill their intent to approach the subjects with an attitude of determining what actually works, what has been shown not to work, and where the research is lacking or uncertain. The fact is that most of these so-called alternative therapies do not meet most of their claims, but in the few cases where there does seem to be evidence, the authors are clear and fair.

[Wrenn1]

The ratings here on this book appear to reflect the opinion of the "choir".

If you believe strongly in something find a book that confirms your belief so you can tell yourself you were right.

[Filip Ligmajer · Rating 4 out of 5]

page 8 | location 112-115 | Added on Sunday, 2 November 2014 23:58:01
Everything we know about the universe, from the components of an atom to the number of galaxies, is thanks to science, and every medical breakthrough, from the development of antiseptics to the eradication of smallpox, has been built upon scientific foundations. Of course, science is not perfect. Scientists will readily admit that they do not know everything, but nevertheless the scientific method is without doubt the best mechanism for getting to the truth.

page 20 | location 296-299 | Added on Tuesday, 4 November 2014 23:39:36
Although there had been a few reports of lemons relieving symptoms of scurvy as far back as 1601, late-eighteenth-century doctors would have viewed fruit as a bizarre remedy. Had the term ‘alternative medicine’ existed in Lind’s era, then his colleagues might have labelled oranges and lemons as alternative, as they were natural remedies that were not backed by a plausible theory, and thus they were unlikely to compare well against the more established medicines.

page 28 | location 424-428 | Added on Tuesday, 4 November 2014 23:51:58
However, people outside the medical establishment sometimes find the concept of evidence-based medicine cold, confusing and intimidating. If you have any sympathy with this point of view, then, once again, it is worth remembering what the world was like before the advent of the clinical trial and evidence-based medicine: doctors were oblivious to the harm they caused by bleeding millions of people, indeed killing many of them, including George Washington. These doctors were not stupid or evil; they merely lacked the knowledge that emerges when medical trials flourish.

page 29 | location 444-450 | Added on Tuesday, 4 November 2014 23:54:24
evidence-based medicine is occasionally treated with suspicion. Some people perceive it as being a strategy for allowing the medical establishment to defend its own members and their treatments, while excluding outsiders who offer alternative treatments. In fact, as we have seen already, the opposite is often true, because evidence-based medicine actually allows outsiders to be heard – it endorses any treatment that turns out to be effective, regardless of who is behind it, and regardless of how strange it might appear to be. Lemon juice as a treatment for scurvy was an implausible remedy, but the establishment had to accept it because it was backed up by evidence from trials. Bloodletting, on the other hand, was very much a standard treatment, but the establishment eventually had to reject its own practice because it was undermined by evidence from trials.

page 60 | location 907-908 | Added on Wednesday, 5 November 2014 20:46:43
In other words, a genuine medicine offers a benefit that is largely due to the medicine itself and partly due to the placebo effect, whereas a fake medicine offers a benefit that is entirely due to the placebo effect.

page 62 | location 943-947 | Added on Wednesday, 5 November 2014 20:50:24
Indeed, the placebo effect was so great that it allowed patients in both groups to reduce their intake of medication. Although this suggests that the placebo effect is a force for good, it is important to remember that it can have negative consequences. For example, imagine a patient who feels better because of a placebo response to an otherwise ineffective treatment – the underlying problem would still persist, and further treatment might still be necessary, but the temporarily improved patient is less likely to seek that treatment.

page 65 | location 991-996 | Added on Wednesday, 5 November 2014 20:54:50
the actual placebo effect for a particular patient depends entirely on the belief system and personal experiences of that individual. This variability of placebo effect among patients, and its potentially powerful influence on recovery, means that it can be a highly misleading factor when it comes to assessing the true efficacy of a treatment. In fact, the placebo effect is so unpredictable that it could easily distort the results of a clinical trial. Therefore, in order to test the true value of acupuncture (and medicines in general), researchers somehow needed to take into account the quirky, erratic and sometimes strong influence of the placebo effect. They would succeed in this endeavour by developing an almost foolproof form of the clinical trial.

page 83 | location 1261-1262 | Added on Wednesday, 5 November 2014 22:37:58
Aside from bedwetting, the only positive conclusions relate to acupuncture in dealing with some types of pain and nausea.

page 88 | location 1343-1348 | Added on Wednesday, 5 November 2014 22:46:31
Acupuncturists would argue that this industry is legitimate, because there is some evidence that acupuncture works. Critics, on the other hand, would point out that the majority of acupuncturists treat disorders for which there is no respectable evidence whatsoever. And, even in the case of treating pain and nausea, critics would argue that the benefits of acupuncture (if they exist at all) must be relatively small – otherwise these benefits would already have been demonstrated categorically in clinical trials. Moreover, there are conventional painkilling drugs that can achieve levels of pain relief with reasonable reliability, which are vastly cheaper than acupuncture sessions. After all, an acupuncture session costs at least £25 and a full course may run to dozens of sessions.

page 91 | location 1387-1392 | Added on Wednesday, 5 November 2014 22:56:01
This is a point that was well made by the British Nobel Prize-winning scientist Sir Peter Medawar: Exaggerated claims for the efficacy of a medicament are very seldom the consequence of any intention to deceive; they are usually the outcome of a kindly conspiracy in which everybody has the very best intentions. The patient wants to get well, his physician wants to have made him better, and the pharmaceutical company would have liked to have put it into the physician’s power to have made him so. The controlled clinical trial is an attempt to avoid being taken in by this conspiracy of good will.

page 111 | location 1702-1704 | Added on Thursday, 6 November 2014 19:26:32
In short, we can conclude two things about a patient seeking treatment before the twentieth century. First, the patient would have been better off opting for no treatment rather than heroic medicine. Second, the patient would have been better off opting for homeopathy rather than for heroic medicine. The important question, however, was whether homeopathy was any better than a lack of treatment?

page 122 | location 1862-1865 | Added on Thursday, 6 November 2014 19:44:44
but there is a major difference between homeopathy and vaccination. The amounts of active ingredient used in vaccines might be tiny, perhaps just a few micrograms, but this is still vast compared to a homeopathic remedy. A vaccine contains billions of viruses or virus fragments, whereas most homeopathic remedies do not contain a single molecule of the active ingredient. The flawed analogy between vaccines and homeopathy has been promoted by homeopaths since the nineteenth century,

page 140 | location 2146-2149 | Added on Thursday, 6 November 2014 20:07:23
The contrast between the homeopathic trials and the conventional drug trials was striking. Homeopathy had failed to show a clear benefit for patients and the result was compatible with homeopathy acting as a placebo, whereas conventional drugs had shown a clear benefit for patients, which suggested that they do indeed have a genuine physiological impact on the body. This illustrates the stark difference between pseudo-medicine and real medicine.

page 181 | location 2772-2775 | Added on Sunday, 9 November 2014 22:48:10
we have stated that chiropractic therapy can sometimes help with back problems, and therefore short-term treatment from a mixer chiropractor can be helpful, but we have also stated that chiropractors tend to be no better than conventional physiotherapists at treating such conditions. Hence, because physiotherapeutic exercise is a much safer treatment than chiropractic manipulation, we would strongly recommend the former rather than the latter as the first choice.

page 197 | location 3011-3013 | Added on Sunday, 9 November 2014 23:14:14
By contrast, plants contain a complex cocktail of pharmacologically active chemicals, so it is not surprising that some of them can impact on our wellbeing. Consequently, herbal medicine has been embraced by science to a far greater extent than the other treatments mentioned above.

page 210 | location 3205-3207 | Added on Monday, 10 November 2014 20:51:25
Hence, our advice would be to avoid individualized herbal remedies – at worst they are an expensive placebo and at best an expensive option compared to straightforward herbal medicines, such as peppermint bought over the counter.

page 252 | location 3863-3865 | Added on Wednesday, 12 November 2014 00:39:58
In short, the doctor would have to reinforce the patient’s misplaced faith in the extraordinary power of homeopathy or perhaps even instil such a false belief. The question is simple – do we want our healthcare to consist of honest, evidence-based treatments or do we want it built upon a foundation of lies and deceit?

page 282 | location 4315-4318 | Added on Sunday, 16 November 2014 09:18:18
In his book Bad Medicine, the historian David Wootton writes, ‘For 2,400 years patients believed that doctors were doing them good; for 2,300 years they were wrong.’ In other words, for most of our history, most medical treatments have failed to treat most of our diseases effectively. In fact, most of the doctors from previous centuries harmed rather than healed our ancestors.

page 297 | location 4550-4552 | Added on Sunday, 16 November 2014 10:17:22
They use the term ‘alternative’ to promote the notion that they somehow exploit alternative aspects of science. The truth, however, is that there is no such thing as alternative science, just as there is no alternative biology, alternative anatomy, alternative testing, or alternative evidence.

[Prakash · Rating 3 out of 5]

First off, lets discuss the good.

The authors start with the introduction of gold standard "randomized, placebo-controlled, double-blind trials" of modern medicine. The book does a good job of discussing its history, evolution and the advantages. Afterwards four major topics of Accupuncture, Homeopathy, Chiropractic and Herbal medicines are discussed. Three are debunked.

There are two very strong arguments that made sense to me:
1. More than a 100 years have passed since the advent of medical trials yet there is still no conclusive proof of their effectiveness. In case of some trials bearing positive results, no one is able to prove their efficacy with repeatable results. There are so many doctors across various countries of the world. So it has to be either the biggest coordinated conspiracy by doctors to suppress these alternative forms of medicine or they are highly ineffective.
2. The second argument is that forget the science of homeopathy or acupuncture for example. Let's examine the efficacy and let that guide the argument and conclusion.

I like how authors have a clear unapologetic stand on most of the topics. There is no effort to make their arguments sound diplomatic or politically correct (except in the case of a nauseous camaraderie shown to their professional brothers and sisters who practice pseudo-science - we are told that they are not self-aware and are only trying to help. All of them?)

Some of the interesting things discussed briefly were whether homeopathy et al should be allowed if they have the potential to benefit via placebo effect, the political / diplomatic nature of WHO etc. I l also found the section discussing the side effects of herbal medicine good.

I also feel very sad how practices like homeopathy continue to be prevalent despite there being any evidence for it. There are so many schools in India that offer this degree. We are wasting careers of our youth.

However I do have some major criticisms of the book:

1. The authors make some very weak arguments sometimes. Sirs, you have already presented data on the basis of medical trials, you spent so much time discussing how individual cases should be completely disregarded yet then you use negative individual examples to what effect - further strengthen your argument? I do not think there was any need for this since the data and research was enough. There is no place of making such weak arguments in a book that aims to discuss science. It only weakens your main argument.

2. The first four chapters of the book are very focused which is maybe around half of the book. The latter half is very unstructured and was not really required or should have been summarized. At 352 pages, I think the book was 170 pages too long. The authors make repetitive arguments. Medical trial is brought again and again and discussed even though the first chapter was solely dedicated to it. It bores you.

3. The chapter about herbal medicines is an interesting and curious one. Authors do not start here with the history. Indian and Chinese civilizations made use of herbs thousands of years ago. Yet the discussion starts at around 200 years ago. Perhaps laziness to explore the topic, a lack of research or outside their area of expertise? Moreover since it did not fit with the findings of the previous chapters, the attempts to generalize the arguments later felt a bit weird and out of place.

I find merit in discussing side effects of herbal medicines which I think are generally ignored in India, yet no acknowledgement from the authors comes around the side effects of modern medicine. It only weakens their arguments. There are deaths caused by side effects of modern drugs. I would have loved to see a comparison with % rates. The data may not be available, so explore the argument and acknowledge it.

The side effects of ginger and garlic are laughable at best. They are part of almost every Indian recipe, so almost 1.4 billion people consume it daily. Was the argument against some concentrated extracts of garlic and ginger in high doses? The authors themselves admit that the side effects of herbal medicines (the ones that were presented in the table) are based on one or two observed cases. That is not the scientific method and should have no place in a book based on science. (I mean consider the counter argument a pro-alternative medicine proponent will make to list advantages on the basis of one or two isolated cases).

Take the below ambitious take from the book:
"If a herbal remedy does not appear in the table, then it is probably safe to assume that there is no convincing evidence to support its use". No scientist in the world would make such a definitive argument. Even the book has multiple examples of how good scientists examined everything and did not make arguments like these.

4. The time spent on herbal medicines especially Ayurveda is limited to appendix in total of 2-4 pages worth. Either there is lack of studies, research and trials on the topic in which it makes sense or it was outside their area of expertise. But no such information is provided to us. Consider how prevalent it is and how many people are effected by it (potentially in a good or bad way), I am not sure how one can write a book on the topic of alternative medicines and not examine the topic in more detail.

[Mike · Rating 5 out of 5]

This one gets 5 stars because it has valuable information that I think everyone should know.

Otherwise, I give it 4 stars because the authors repeat themselves too much toward the end and I think some of the chapters could be shorter (I often have this complaint. Why are books so long! In this case, it might be because they are not sure if the reader will skip around or only read certain chapters so they felt like they needed to repeat context for each topic).

Now, having made that minor complaint let me affirm my admiration for Simon Singh. I think his is an absolutely fantastic writer (I am even amazed that he could say the same thing so many times in so many different ways!). Actually, I came across this book when I saw he had written Fermat’s Last Theorem, which I absolutely loved. That book catapulted me into my engineering degree and on to my PhD.

**Spoiler Alert**
Trick or Treatment succeeds with its intentions: it lays out in clear, concise, and unequivocal, terms that there are only a few alternative medicines that can be clinically said to be either unproven or marginally effective; the rest are demonstrably just a placebo; furthermore, most are reprehensibly expensive and often dangerous.

Simon and his co-author Edzard Ernst, MD, begin by reviewing the scientific method and tell a number of very interesting stories about historical events that helped pave the way to the gold standard of medical research: the randomized, double blind, placebo-controlled clinical trial. Their story telling is as a great as their stories. Did you know that George Washington was essentially killed by his doctors through bloodletting?

I think the authors do a fine job easing the facts onto their readers (who might be believers). They are carefully sensitive and help explain why the large misconception persists. Each chapter covers a major alternative medicine.

-Acupuncture is marginally effective for minor muscle pain and nausea, but no more than conventional medicine, and for everything else it is absolutely just a placebo.
-Chiropractic is marginally effective for minor muscle and back pain, but no more than conventional medicine, and for everything else it is absolutely just a placebo.
-Homeopathy is unequivocally useless (they are really harsh on this one. I think because they believe the claims of this multi-billion dollar industry are often knowingly dishonest.) After hundreds of clinical trials homeopathy does not demonstrate absolutely any benefits, besides the placebo effect. Furthermore, the underlying theory of homeopathy defies all modern understanding of biology, physics, and chemistry.
-Some herbal medicines are useful.

In addition to these main chapters, the appendix provides a quick summary for 36 other alternative medicines and therapies. All of these have undergone extensive clinical tests. Some have been subjected to hundreds of scientific tests. Here are few I cared about:

Aromatherapy – clinically shown to provide effective short term calming, but everything else is just a placebo
Cleansing diets – not useful for any illnesses
Detox (through various means) – not useful for any illnesses
Ear candling – proven to be useless
Hypnotherapy – useful for pain, anxiety, irritable bowl syndrome, stress, and insomnia, but nothing else
Magnet therapy – useless
Massage therapy – useful for musculoskeletal pain, anxiety, and depression, but nothing else
Meditation – clinically proven to be effective for pain, anxiety, stress, and lowering blood pressure, but nothing else
Muscle testing – useless
Naturopathy – the associated lifestyle change is useful for anxiety, stress, and overall well being
Reflexology – a foot massage can help with pain, anxiety, and stress, but everything else is rubbish
Reiki – useless

I think my favorite part of the book was learning about the phenomenal power of the placebo. They don’t deny that people get better when taking alternative medicine, but this is mainly because of the placebo. It is also because many of these therapies (like chiropractic and acupuncture) require multiple visits over extended time periods, so the body heals itself anyway. In the case of homeopathy and herbal remedies, it is often because the manufacturer has dishonestly laced the medicine with conventional medicine.

They dedicate a chapter to the question of whether or not these therapies should be continued and even encouraged since they provide an effective placebo. Basically, they conclude that the answer is no because it would require blatant dishonesty in order to “keep the secret” plus the treatments are often very expensive when there are sometimes more effective conventional methods (or maybe people should just learn to wait out a sickness).

They also discuss the frustration people have with conventional medicine. They admit that for thousands of years, up until the era of modern medicine which is only about 100 years ago, medicine actually did more harm than good. Furthermore, most people in their day-to-day lives face a set of illnesses that modern medicine hasn’t figured out yet, namely the common cold, back pain, and irritable bowel syndrome. Modern medicine does not actually claim a cure for these illnesses, so instead is admittedly treats only the symptoms. Alternative medicine advocates often say “modern medicine only treats the symptoms not the problem.” Tell that to someone cured of malaria, meningitis, measles, bronchitis, chicken pox, polio, diphtheria, or typhoid to name a few (I just googled curable diseases).

Unfortunately, people also don’t like it when their doctors just advise to go home, drink plenty of liquids, and rest. They would much rather have the alternative medicine specialist spend a long time with them asking all kinds of questions about their “whole” self and then prescribing a bunch of stuff that it just a placebo. For this reason, the authors argue that one thing that could improve the situation is if conventional doctors would start giving a little better TLC. And also take time to remind patients about the importance of good nutrition, exercise, rest, and relaxation.

Here are a few other interesting things I learned.

Mao Zedong revised acupuncture from near obsolescence in order provide a cheap medical treatment that could be prescribed by his government run health care program. Adolf Hitler did the same with homeopathy.

Different colored pills give a stronger placebo for different ailments. For example, green is best for anxiety and white for indigestion. Bigger pills are more powerful. Shots are better than pills. Doctors in white coats are more effective. Placebo treatment is more effective if it is exotic, mystical, ancient, natural, applied so as to felt, or visually interesting when applied. Notice that acupuncture has all these things.

[Víctor Paredes · Rating 5 out of 5]

Leerlo encerrado durante una pandemia abre otras perspectivas.
Creo que es un libro que esperaba hace mucho tiempo. Está muy bien escrito, responsablemente documentado, lleno de anécdotas interesantes (como el rol de los nazis en el crecimiento de la homeopatía, ponte tú) y súper bien estructurado para poder volver a consultarlo en cualquier momento.

Los autores -entre ellos Simon Singh, de quien me declaro ya el presidente del club de fans- toman las ideas de la medicina alternativa y las someten a pruebas de eficacia serias y respetuosas.

Y la palabra respeto es especialmente importante. Los autores aceptan ideas curiosas sin discutirlas, como que manipular peligrosamente la columna puede curar cualquier enfermedad o como como que el agua memoriza y activa propiedades medicinales de un elemento diluido en proporciones astronómicas (y lo astronómico es literal acá: muchos diluidos homeopáticos necesitarían que nos bebiéramos una esfera del tamaño del sol para que recibamos una sola molécula del ingrediente que nos mejoraría).

Aceptan estas ideas y las someten a pruebas que muchas veces llevan años y un montón de recursos. Y el resultado es casi siempre el mismo: lo único que agrega la idea de 'alternativa' es que es medicina que no funciona, no tiene sustento y sus resultados no superan a los del placebo.

La medicina vista como un mercado a explotar es un problema grave, pero es un problema político que no puede socavar el valor del conocimiento y de la inteligencia puesta al servicio de entendernos y curarnos.

La medicina alternativa se ha colgado de este problema político y su solución ha sido negar a la ciencia y crear un mercado oscurantista aun peor que el anterior. Uno de pomadas y amuletos mágicos y carísimos que por ser alternativos no deben darles explicaciones a nadie.

Esta gente horrible se está enriqueciendo con engaños, está matando a personas que podrían recibir tratamientos probados y está malgastando recursos públicos en tratamientos probadamente inútiles.

Quería escribir una crítica más amorosa, pero cuesta no enojarse, la verdad.

Por mientras, recomiendo infinitamente este libro, sigo manteniendo distancia, usando mascarilla y esperando a que ojalá me toque pronto la vacuna :)

[Anastasia · Rating 4 out of 5]

get wrecked 😏

I thought this was thorough and fair. Got more snarky as the book went on. I'd like to see an updated edition, since this was written a while ago