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Book Review: Trick or Treatment? by Simon Singh and Edzard Ernst

I've just posted my revies of Trick or Treatment? by Simon Singh and Edzard Ernst. They do much the same for alternative medicine as Richard Dawkins does for religion, and similar comments apply to both. The book is dedicated, tongue in cheek, to HRH The Prince of Wales.

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Lenka on :

If it's all placebo maybe conventional medicine should start using its wonderful effects more. I have just listened to interview with Simon on Guardian website, he says that conventional medicine was not really helping in the past, only in the last decades there was a great progress. My question is: Do we see this progress in number of people who are healed or cured or at least helped? BTW, nothing like sham acupuncture can exist, during locating point you use on of powerful tools of alternative medicine - touch and person who needles knows if they use real acupuncture or not.

Anthony Campbell on :

You make a couple of good points here. There is a lot of argument about whether it is ever ethical to use a placebo deliberately. The main objection is that it involves deceit, although there is actually some evidence that a placebo can still work even when the patient is told it is a placebo!

At least in the case of homeopathy, I suggest (in my book "Homeopathy in Perspective") that it is best thought of as a form of psychotherapy.

As for sham acupuncture, you are right. The process of examining a patient for trigger points, and even the use of light pressure via a dummy needle, may have a therapeutic effect. But this is not simply due to the placebo. In the last 10 years or so it has been discovered that there is a system of light touch, subserved by the unmyelinated C fibres (usually thought of as only responsible for pain) that acts on the limbic system in the brain and gives rise to feelings of calm and well-being. I have published papers on this myself and it is discussed on my website acupuncture page. See my Updates to "Acupuncture in Medicine".

Lenka on :

Thanks for your reply, Anthony. I think that there are different ways how we can look at alternative therapies, including homeopathy. Thinking of it as a form of psychotherapy is one way ( I find it very interesting), understanding it as 'memory of water' another one. The same with acupuncture, there are some quite sophisticated explanations fitting into Western frame of thinking, but I think that the Eastern explanation is equally valid. Doesn't matter how we explain the force behind it, important is that it works. Anyway, I think that we all talk about the same thing, just using very different terminology and frame of thinking. On the placebo note, what really upsets me is that there is a lot of argument about whether it is ethical to use placebo effect deliberately, but there is not much discussion about whether the techniques used by pharmaceutical companies are ethical. I mean the way in which they approach doctors. I have evidence of some really nasty tactics, causing obvious harm to patients. That's why I think that there is no point in fight between alternative and allopathic medicine, what we all should fight for is the right of our patients to choose the treatment that is most suitable for them and to receive truthful information about benefits and possible side effects of treatment.

Espresso Frog on :

except that "water memory" has absolutely no scientific basis whatsoever. You can take 5 homoeopathic bottles from the same laboratory, remove the stickers and any identification, put your own numbers on them and send them back to Laboratoire Boiron or any of the makers with a note saying "identify those" and you'll see the response. Even the pharmaceutical industry knows it's a complete placebo. So while we are talking about ethics, is it ethical for them to manufacture water that has been shaken 10 times in each of the 3 dimensions as cure ? If it's unethical for a lab to sell placebos then why are they already doing it in the form of a 1800's pseudo-science that hasn't progressed ever since ?

Rob Wheeler on :

I enjoyed this review and the article on your website on Alternative Medicine. It's so refeshing to find someone who takes a cool, critical view of these practices.

Just one observation I'd like to make on CAM and how it is distiguished from orthodox medicine.

It appears that with orthodox medicine if you fail to apply treatments correctly you can do harm. For instance if you mistakely prescribe too much of a powerful drug you can make a patient even more ill or even kill them. This does not appear to be the case in the practice of CAM: either the treatment is ineffective (due to incorrect application by the practitioner or the multitude of variables interferring with the efficacy of the treatment). If you ask a CAM practitioner whether it is possible to do harm by application of their treatment they nomally look puzzled by the question -- as it is one they are rarely asked.

To me this looks suspicious. How can you have an efficacious treatment that cannot under any circumstances do harm when applied incorrectly?

Anthony Campbell on :

This is correct; the only treatments that are risk-free are those that are ineffective.

Homeopaths generally believe in 'aggravations'. Samuel Hahnemann taught that a correctly chosen remedy would always produce at least a slight temporary worsening of the patient's condition. But I think myself that this is nearly always due to suggestion and patients' expectations. Many homeopaths regularly warn of the possibility of an aggravation, but if warnings are omitted aggravations are hardly ever seen.

Invasive treatments such as acupuncture do cause injury or, very rarely death on occasion. Aggravations - temporary worsening of symptoms - is not unusual with this form of treatment.

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