As the doctor of a small Appalachia community, Grand Dad heard, dealt with, and saved people from more than his share of old wives' tales, folk remedies, and traditional cures. In this effort, he was assisted by the much-maligned, paternalistic role of the physician in his day. His patients trusted him to know better than they did what was best for them. Dismissing an unproven remedy was as simple as making a pronouncement from on high. He will be the first to admit that this system has strengths and weaknesses, which, for anyone who has met my Grand Dad, is notable due to the rare admission that he might be associated with a weakness.
In this modern day and age, the whole "patronizing physician" thing is passe. We are all supposed to be informed consumers working in partnerships with our human body mechanics, oops, I mean doctors. It is a shame, then, that we are inundated with continuous scientific progress in biomedicine along with countless "heal thyself" gurus and books promising "wellness" through complementary and alternative medicine (CAM). How is an educated, 21st Century supposed to decide betwen effective therapy and woonackery?
Cue Simon Singh and Edzard Ernst. In their new book, Trick or Treatment, Singh and Ernst go looking for the scientific evidence, if any, that supports the use of CAM.
Simon Singh brings a PhD in particle physics, but is best known for his science journalism, including The Code Book and Big Bang. He is known (unlike yours truly) for his clear explanations of complex topics and ringing to life the personal stories involved in the science.
Edzard Ernst is an MD, was a pracitiving homeopath, and was the first professor of complementary medicine. He also wrote The Oxford Handbook of Complementary Medicine. Ernst is arguably the world's foremost expert on CAM.
Trick or Treatment begins with a primer on the use of the scientific method and its applicability to medicine. This first section is unnecessary for readers familiar with the scientific method and randomized clinical trials. Skipping it would deprive the expert reader of, if not later understanding, several of Singh's trademark gripping personal stories that helped to define the transition to modern, scientific medicine.
Subsequent chapters deal with the scientific evidence, or lack thereof, in most cases for acupuncture, homeopathy, chiropractic therapy, and herbal remedies. While the book appears to have a modular structure, skip ahead at your own peril. Each section builds upon concepts established in earlier sections. Although the final section of Trick or Treatment provides a reference book style list of 36 other treatments, using the main text like a reference book for the four treatments discussed there will only be confusing.
Those with a previous, scientific interest in CAM will not find much new in the information provided in Trick or Treatment. It does consolidate a great deal of information in one place. If you are looking for a single, accessible (this does not include Ernst's The Oxford Handbook of Complementary Medicine) resource for arguments to convince your aunt to lay off the chiropractic, Trick or Treatment is for you.
Singh and Ernst are scrupulously honerst in their examination of the literature, finding in most, but not all, cases that the evidence does not support the claims of CAM. It bears mentioning that Ernst has a documented and continuing history of being optimistic that CAM will produce some effective treatments. Unlike many authors of books about medical remedies, Singh and Ernst are not selling the treatments or alternatives they discuss. Overall, Trick or Treatment is a trustworthy and excellent introduction to CAM therapies.
As you could probably tell from my use of the word "overall," Trick or Treatment is not without flaws.
First, Singh and Ernst refer repeatedly to the unimpressive history of medicine prior to the randomized clinical trial. This inaccurately gives mainstream medicine a long and mostly negative history, while CAM has a short and unclear history. Scientific medicine is the new kid on the block. It is more accurate to refer to everything that came before the randomized clinical trial as CAM.
Second, Trick or Treatment frequently uses anecdotes to illustrate the dangers of certain CAM therapies. While these stories pack a dramatic punch and play to Singh's style, anecdotes are not evidence. Trick or Treatment purports to be a book examining the evidence for CAM. Anecdotes are frequently used by CAM practioners to support their therapies. Using anecdotes to illustrate the evidence against CAM strikes me as both disingenuous and weakens the argument that anecdotes are not scientific evidence.
Trick or Treatment will help you become a better informed patient. Perhaps more important than the information contained within, it will help you learn the kinds of questions you should be asking any health care provider about any therapy they recommend. And, if that review does not help you decide whether or not to read Trick or Treatment, bear in mind that it also contains the following phrase in reference to pseudo-scientific mechanistic explanations for CAM therapies:
the jargon is gobbledygook
That's right, "gobbledygook."
