Trick or Treatment?
Cover of the first edition
|Author||Simon Singh, Edzard Ernst|
Trick or Treatment? Alternative Medicine on Trial (North American title: Trick or Treatment: The Undeniable Facts about Alternative Medicine) is a 2008 book about alternative medicine by Simon Singh and Edzard Ernst. Singh is a physicist and the writer of few popular science books. Ernst was previously an ex-professor of complementary medicine but however, he accepted an early retirement due to stoppage of funding after he antagonised with the Royal family of Britain and United Kingdom. Due to stoppage of funds, the university department had since been closed down and now-defunct. 
The book evaluates the scientific evidence for acupuncture, homeopathy, herbal medicine, and chiropractic, and briefly covers 36 other treatments. It finds that the scientific evidence for these alternative treatments is generally lacking. Homeopathy is concluded to be completely ineffective: "It's nothing but a placebo, despite what homeopaths say".
Although Trick or Treatment presents evidence that acupuncture, chiropractic and herbal remedies have limited efficacy for certain ailments, the authors conclude that the dangers of these treatments outweigh any potential benefits. Such potential risks outlined by the authors are contamination or unexpected interactions between components in the case of herbal medicine, risk of infection in the case of acupuncture and the potential for chiropractic manipulation of the neck to cause delayed stroke.
The book is very critical of Prince Charles' advocacy of alternative medicine and the actions of his now-defunct The Prince's Foundation for Integrated Health. Trick or Treatment is dedicated, in an ironic fashion, to the Prince.
A More In-Depth Background
The book is dedicated to the Prince of Wales, Prince Charles, who has called for studies of alternative medicine but disregards them. The first chapter explains the scientific method, and what people regard as the truth. Four chapters are dedictaed to explaining scientific evidence for acupuncture, homeopathy, chiropractic, and herbal medicine. The authors give examples of utilizing traditional scientific methods and evidence based medicine to approach issues in the field. Dr. Silverman was frustrated by seeing premature babies go blind with retinopathy of prematurity, and tried to make breakthroughs in the field by changing their treatment options. Lind’s experiments on British sailors with scurvy and Benveniste’s homeopathy study in Nature are also examples Lind’s experiments on British sailors with scurvy and Benveniste’s homeopathy study in Nature are also examples Lind’s experiments on British sailors with scurvy and Benveniste’s homeopathy study in Nature are also examples.
The book contains six chapters:
How do you determine the truth?
- This chapter describes the methods and history of clinical trials, such as the trial to determine a proper treatment for scurvy by James Lind and the story of Florence Nightingale. James Lind was a British physician who pionereed naval hygeine. He recommended that citrus fruit and lemon juicde should be included in the diets of seamen to eradictate the illness of scurvy. Lind was able to come to the conclusion that these remdies may reduce this particular illness through the various clinical trials he performed taht were successful. Florence Nightingale is another example used in the novel as someone who practiced the scientific medicine and evidence based medicine as she pioneered the profession of nursing.
The truth about acupuncture
- This chapter discusses the evidence surrounding acupuncture, a form of alternative medicine in which acupuncturists place needles in the body for the purpose of blocking Ch'i meridians throughout the body, thus encouraging full health. The authors examine the recent history of acupuncture and several various trials of the technique. The authors conclude that acupuncture is essentially a placebo.
The truth about homeopathy
- This chapter discusses the evidence surrounding homeopathy, an alternative medicine technique which consists of finding a substance (which causes symptoms similar to the condition needing to be treated in a healthy person), then diluting that substance to an extreme degree. The chapter examines the history of homeopathy and reviews various trials regarding the technique, especially the trial done by Jacques Benveniste, a French researcher. The authors conclude that homeopathy is a placebo. The authors offered a £10,000 prize for anyone who could prove homeopathy was effective.
The truth about chiropractic therapy
- This chapter discusses the evidence surrounding chiropractic, an alternative medicine technique which aims to cure illness by manipulating the spine, based on the theory that almost all conditions and diseases are caused by misaligned vertebrae in the spine block the body's vital force. The history of chiropractic, as well as several of the trials on chiropractic are described. The authors conclude that there is no evidence to support most of chiropractic's claims. However, the authors state that chiropractic might be beneficial in certain limited situations concerning back pain. As well, the authors find that chiropractic can be very dangerous, especially when it comes to the manipulation of the neck, and state that patients should "try conventional treatments before turning to a chiropractor for back pain."
The truth about herbal medicine
- This chapter discusses the evidence surrounding herbal medicine, such as the use of St. John's Wort and Aloe vera. The authors conclude that several herbal medicines can be effective to treat illness, while others, such as billberry, chamomile, and ginseng, are ineffective.
Does the truth matter?
- This chapter discusses the state of alternative medicine in society, focusing on Prince Charles's endorsements of alternative medicine.
- "While there is tentative evidence that acupuncture might be effective for some forms of pain relief and nausea, it fails to deliver any medical benefit in any other situations and its underlying concepts are meaningless. With respect to homeopathy, the evidence points towards a bogus industry that offers patients nothing more than a fantasy. Chiropractors, on the other hand, might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks. Herbal medicine undoubtedly offers some interesting remedies, but they are significantly outnumbered by the unproven, disproven and downright dangerous herbal medicines on the market."
These strong words against the alternative medicine community has brought up many controversies against the book. This is because many individuals rely on these alternative treatments to lessen the pain of their illnesses, not necessarily cure it. The authors seem to acknowledge that although these treatments may bring about some form of relief, they can not be proven to be as effective as scientifically based evidence.
2. "Indeed, our definition of an alternative medicine is any therapy that is not accepted by the majority of mainstream doctors, and typically this also means that these alternative therapies have mechanisms that lie outside the current understanding of modern medicine. In the language of science, alternative therapies are said to be biologically implausible."
This critical quote is said at the beginning of the book, and it is one of the most critical quotes because it characterizes the novel as an opinion based piece. The opinions of both authors, one who is a phycisist and well renowned scientist, and the other a practicing physician, are that these alternative based treatments lack sufficient evidence and undertanding and shouldn't be the main practice in reducing ailments.
The book received generally good reviews. The New England Journal of Medicine's review said this about the authors: "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." The Daily Telegraph found the book to be "a clearly written, scrupulously scientific examination of the health claims of key areas of alternative medicine: acupuncture, homeopathy, chiropractic therapy and herbal medicine. The results are stark. In no case, apart from in some limited ways in herbal medicine, do any of these 'therapies’ work. On the contrary, they can be life-threatening." The journal Nature tempered a generally positive review with a concern that the authors' sense of certainty "mirrors that of the proponents of alternative therapies, leaving each position as entrenched as ever."
Trick or Treatment drew criticism from consumers and practitioners of alternative therapies. The British Journal of General Practice published a review by Jeremy Swayne (former dean of the Faculty of Homeopathy) that was critical of the book and its argument.
A review by Harriet A. Hall on Quackwatch stated that some negative reviews of Trick or Treatment demonstrated "an appalling poverty of thought"; articulating that since the reasoning behind the author's conclusions is solid, critics instead deny the methods of science, misrepresent the book's contents and use ad hominem attacks against the authors.
Subsequent libel case and freedom of speech
Singh was sued for libel by the British Chiropractic Association for comments he wrote in a column in The Guardian about the book. In 2010, after 2 years, the BCA dropped the case after the court of the appeal found that Singh was expressing opinion, rather than stating facts. The presiding judges commented that "this litigation has almost certainly had a chilling effect on public debate which might otherwise have assisted potential patients to make informed choices about the possible use of chiropractic".
- Suckers: How alternative medicine makes fools of us all, 2008 book by Rose Shapiro
Additional Links Used
- ISBN 0-393-06661-4
- Murcott, Toby (2008-06-12). "Complementary cures tested". Nature. 453 (7197): 856–857. doi:10.1038/453856a. Retrieved 2009-01-21.
- Metcalf, Fran (2008-06-20). "Alternative medicines draws fire". The Courier-Mail. Retrieved 2009-01-21.
- Marcus, Donald M. (2008). "Trick or Treatment: The Undeniable Facts about Alternative Medicine". New England Journal of Medicine. United States: Massachusetts Medical Society. 359 (19): 2076–2077. doi:10.1056/NEJMbkrev0805020. Retrieved 2009-01-21.[permanent dead link]
- Leggatt, Johanna (2008-11-08). "Complementary medicine: seeking out alternatives". The Daily Telegraph. Retrieved 2009-01-21.
- Singh, Simon & Edzard Ernst. Trick or Treatment. 2008. Page 170.
- Marcus, D. M. (2008-11-06). "Book review of "Trick or Treatment: The Undeniable Facts about Alternative Medicine". The New England Journal of Medicine. 359 (19): 2076–2077. doi:10.1056/NEJMbkrev0805020. Archived from the original on 2009-03-09. Retrieved 2009-11-21.
- Owen, K; Cousins S (2009-05-10). "Paperbacks: reviews". The Daily Telegraph. Retrieved 2009-11-21.
- Murcott, T (2008-06-12). "Complementary cures tested". Nature. 453 (7197): 856–857. doi:10.1038/453856a. Retrieved 2009-10-23.
- Kapp, John (2008). "Book Review: Trick or Treatment? Alternative Medicine on Trial" (PDF). Forschende Komplementärmedizin. 2008 (15): 238–239. Retrieved 24 Oct 2009.
- Swayne J (April 2008). "CAM". Br J Gen Pract. 58 (549): 280, author reply 280–1. doi:10.3399/bjgp08X279841. PMC 2277119. PMID 18387236.
- Swayne, Jeremy (1 October 2008). "Book review: Trick or Treatment? Alternative Medicine on Trial". British Journal of General Practice. 58 (555): 738–739. doi:10.3399/bjgp08X342525. PMC 2553545.
- Hall, Harriet (2008-08-27). "Trick or Treatment: The Undeniable Facts about Alternative Medicine (book review)". Quackwatch. Retrieved 2009-11-21.
- Singh, Simon (2008-04-19). "Beware the spinal trap". The Guardian. Archived from the original on 2008-04-23. Retrieved 2009-01-21.
- Eden, Richard (16 Aug 2008). "Doctors take Simon Singh to court". Mandrake. The Daily Telegraph. Retrieved 12 December 2008.
- Boseley, Sarah (15 April 2010). "Simon Singh libel case dropped". The Guardian.