Trick or Treatment 713
brothke writes "The recent collapse of financial companies occurred in part because their operations were
run like a black box. For
many years, alternative medicine has similarly operated in the shadows with
its own set of black boxes. In Trick or Treatment: The
Undeniable Facts about Alternative Medicine, Simon Singh and
Edzard Ernst, MD, break open that box, and show with devastating clarity and
accuracy, that the box is for the most part empty." Keep reading for the rest of Ben's review.
I first encountered co-author Simon Singh at the
2005 RSA
Conference. In his
presentation, he included a demonstration of the human brains unique
capability for pattern matching when specific patterns are expected, and used
Led Zeppelins Stairway to Heaven as an
example. Stairway has long been rumored to have
subliminal satanic messages. When played backwards,
it is impossible to decipher any message. But when
the message is known in advance, one can then hear
the message imploring the listener to go to Satans tool shed.
Once Singh put the subliminal lyrics on the overhead, the
subliminal message was now clear, not due to a subliminal message, rather via
pattern matching.
| Trick or Treatment: The Undeniable Facts about Alternative Medicine | |
| author | Simon Singh and Edzard Ernst |
| pages | 352 |
| publisher | W. W. Norton |
| rating | 9 |
| reviewer | Ben Rothke |
| ISBN | 978-0393066616 |
| summary | Peels away the fallacies of acupuncture, homeopathy, chiropractic and herbal medicine |
While no reasonable person can believe in Stairways subliminal lyrics, far too many people do believe in equally implausible things in the realm of alternative medicine. In the book, the authors tackle four main areas: acupuncture, homeopathy, chiropractic and herbal medicine. The books conclusion is that acupuncture, homeopathy, chiropractic are essentially worthless, while herbal medicine has limited value.
Chapter 1 starts with an overview of evidence-based medicine (EBM), of which the authors are staunch believers. EBM applies evidence gained via the scientific method and assesses the quality of the evidence relevant to the risks and benefits of the treatments. The foundation of EBM is the systematic review of evidence for particular treatments via mainly randomized controlled trials. In the chapter, the authors reiterate the concept that the plural of anecdote is not data. Acupuncture, homeopathy, chiropractic have plenty of first-person anecdotes, but a lack of controlled studies with real data to back up their spurious claims.
EBM shows that homeopathy and other bogus cures are of no value, yet the public is oblivious to those facts. In a piece I wrote on this topic, New York News Radio" The voice of bad science, its shows that cheap radio advertising (with its mishmash of pseudo-scientific claims) combined with a public that is ignorant of basic scientific facts, creates a perfect storm for the continuation of homeopathy and other bogus cures.
A recurring theme the book stresses is that acupuncture, homeopathy, chiropractic and other alternative therapies are scientifically impossible, and often will violate fundamental scientific principles. A perfect example of this implausibility is with homeopathy. Contrary to what common sense and basic science, in homeopathy, a solution that is more diluted is considered stronger and as having a higher potency. The issue is that the end result is a product that is so diluted, that its contents when in solid form is pure sugar, and when in liquid form; 100% H20. When a homeopathic liquid is in its most diluted state, there is not a single molecule of the active ingredient. Therein lays the scientific implausibility of homeopathy.
Chapter 1 also asks one of the books fundamental questions: how do you determine the truth? The authors answer that it is via the scientific method. This is determined only after strict and careful analysis of a clinical study, of which the most effective is double-blind and randomized.
In chapter 3, the book jokingly notes that since homeopathic liquid remedies are so diluted that they contain only water; their only use would be for dehydration. And since homeopathy is based on the fact that the strength of a remedy is based on its dilution, one could conceivably overdose on a homeopathic remedy by forgetting to take a dose.
The chapter concludes with perhaps the strongest indictment against homeopathy; namely its content. If one looks at the content of oscillococcinum, a homeopathic alternative marketed to relieve influenza-like symptoms, the packaging states that each gram of medication contains 0.85 grams of sucrose and 0.15 grams of lactose. Sucrose and lactose are simply forms of sugar, of which oscillococcinum is nothing more than am expensive sugar pill.
In chapter 4, the authors write that while homeopathy is nothing more than a placebo, the added danger with it is that patients will often forgo real medications to take a homeopathic one. It reports of a study in Britain, which demonstrated that the most benign alternative medicine can become dangerous if the therapist who administers it advises a patient not to follow an effective conventional medical treatment. The study demonstrated that alternative medical practitioners often recommend homeopathic remedies for malaria, and ignore proven conventional medicines. Such an approach can often mean a death sentence for the person taking the homeopathic remedy.
Chapter 5 deals with herbal medicine. The chapter is somewhat different in that the previous chapters about acupuncture, homeopathy and chiropractic showed them to be useless, herbal medicine does have value. The book notes that herbal medicine has been embraced by science to a far greater extent than acupuncture, homeopathy and chiropractics. The chapter lists over 30 herbal medicines and their levels of efficacy. An irony of herbal medicine is that some exotic ones, such as those with tiger bone or rhino horn are pushing the species to the brink of extinction, due to their level of popularity in certain parts of the world.
Chapter 5 concludes with on why smart people believe such odd things? Alternative medicine has failed to deliver the health benefits that it claims, so why are millions of patients wasting their money and risking their lives by turning towards a snake-oil industry? The authors provide numerous reasons for this, from the concepts such as natural, traditional and holistic, to attacks on the scientific method by the alternative medical community and more.
The appendix is a rapid guide to alternative therapies and lists over 30 new treatments with their benefits and potential dangers. The appendix gives single page summaries of the plethora other alternative therapies, from ear candles, colonic irrigation, reiki, to leech therapy and more. The authors write that most of these are bogus, many violate fundamental laws of sciences, and but a few have real, but limited value.
Alternative medicine operates in the shadows, blithely touting that their products have not been evaluated by the Food and Drug Administration, and that they are not intended to diagnose, treat, cure or prevent any disease. While these products are not intended to diagnose, treat, cure or prevent any disease; consumers nonetheless spends billions of dollars per year on unproven supplements. Consumers can be quite fickle. On one side they are furious at the SEC for their lack of oversight around Madoff Investments Securities. Yet when the FDA requires products use their disclaimer of how ineffective the item is, consumers will throw billions of dollars on ineffective products.
Trick or Treatment: The Undeniable Facts about Alternative Medicine is an incredibly important and eye-opening book. While Singh is a physicist and Ernst a medical doctor, the book is written in a clear and compelling style, avoids technical jargon, and sticks to the facts. In the spirit of the scientific method, the authors scrutinize alternative and complementary cures and the results show that the snake oil is still selling.
Ben Rothke is the author of Computer Security: 20 Things Every Employee Should Know.
You can purchase Trick or Treatment: The Undeniable Facts about Alternative Medicine from amazon.com. Slashdot welcomes readers' book reviews — to see your own review here, read the book review guidelines, then visit the submission page.
It isn't all a trick (Score:2, Interesting)
http://www.military.com/features/0,15240,164071,00.html [military.com]
"In the beginning, many people were skeptical, but after seeing it demonstrated on patients and the benefits achieved -- especially in the area of pain -- the majority of physicians embraced it and learned how to use it in their practice as an adjunctive therapy," said Colonel Niemtzow, who is the consultant for alternative and complimentary medicine to the Air Force surgeon general.
If the Army is embracing acupuncture, I wouldn't be so quick to lump it in with the sugar pills and diluted solutions.
Self Deception and bias (Score:5, Interesting)
In the mean time, I simply have utterly given up, I think we would need 3 or 4 generation of basic scientific education from the 1st grade onward to change the trend. The way it is now, people as a whole will never be able to recognize homeopathy for the pathetic scam it is. Even if you rub their nose in it.
Re:Herbal medicine has limited value (Score:4, Interesting)
Re:Acupuncure? (Score:3, Interesting)
My recollection differs from the book (Score:5, Interesting)
I looked into these things at various points when I was feeling bored. My recollection is that
- The placebo effect is a real effect, and can make you feel better, especially if you are more invested in the outcome (either financially (spend $$$$) or socially (there are doubters but you *know* it works); simply wanting to be better for health reasons is less useful).
- Homeopathy is useless except as a placebo (but one could argue that generating belief in homeopathy is the best way to deliver the placebo effect because you don't have to give the person anything but water).
- Chiropractors on average do not generate an improved outcome for their patients (possibly beyond a short initial time when the patient feels worked on) on *average*, but there exist some chiropractors who perform at well above chance on helping people with certain types of problem. It was unclear to me at the time whether this was due to the mechanical manipulations or to the placebo effect.
- Acupuncture has mixed success, but can have reliable if small-on-average effects on certain types of problem. I am pretty sure that there was a control group here, so this is above and beyond what one gets from the placebo effect.
- Herbal medicine runs the entire spectrum from harmful through better than established commercial drugs for some things. Knowing which is which is difficult if you listen to the people who like herbal medicine.
- Commercial drugs usually (but not always) work well on average, but insufficient attention is paid to whether they give small benefits to everyone or large benefits to only a small subgroup, and they very often have long-term side effects that are insufficiently characterized. Using older products it therefore more safe than using new exciting ones.
But I'm afraid I don't have references for any of these vague recollections. Perhaps someone knows of studies to the contrary (or which support these tentative beliefs)?
Re:Herbal medicine has limited value (Score:3, Interesting)
Yup it's obvious to any reasonable scientific person that it's the corporate logo stamped on the pill that confers the magic powers.
Well what that assures you is that the pill will dissolve correctly and the dosage and freshness will not vary beyond certain bounds. Delivery of medicine at high does means those factors are non-trivial.
Now I think most alternative medicine is bunk. But the concept that if something is toxic in large doses that a small dose might have medicinal effects is not crazy at all. It is crazy to assume that is a good rule of thumb, but anything that has a strong influence on your body probably is worth considering as a drug. The idea of infinite dilution seems to carry the concept too far.
One form of alternative medicine that gets too much abuse is Vedic medicine which hold that natural based drugs are best delivered not in pure isolated forms but delivered in the context in which they are natually found. The more we learn about proteins and their interaction with small molecules the more that actually makes scientific sense. Although the vedic medicine scheme was not developed with that understanding, in hindsight it may lead to new ways to increase a drugs effectiveness at smaller dosages.
the problem with ostracizing branches of boogie-wooggie medicine is that this allows them to start mixing good and bad practices since no matter what they do they will be osctracized. A good example of this is chiropracty. those doctors know a lot more about muscle skeletle injury diagnosis that the orthopedic surgeons I have been to. But they also then reccomend all kinds of crazy cures like aroma therapy and magnets. SO the quality of their patient asseement skills gets tossed out with the bathwater of their bullshit cures. Orthopedists could learn a lot from the accumulated science of chiropracty but it wont since its too hard to sift through the dross.
Re:Chiropractic treatment worked for me (Score:5, Interesting)
Straight snag from Wikipedia: [ emphasis mine]
Chiropractic... emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[1]... Chiropractic treatment focuses on manual therapy including spinal manipulation and other joint and soft tissue manipulation, and includes exercises and health and lifestyle counseling.[4] Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself. [5]
The bold stuff is the bunk. Complete garbage. But if they just said.. "Chiropractic.. we fix back problems." I think it would be a solid medical practice. Even evidence based. There is no doubt that electro-therapy applied to muscles relaxes spasms and reduces inflammation, that manipulating a sacroiliac joint for instance, back into alignment, definitely works.
I have recurring problems with my sacroiliac joints. I walk into a chiropractor so crooked and bent I look like I have severe scoliosis, with one leg longer than the other, in severe pain. I walk out straight and tall, with soreness instead of debilitating pain. Every time.
So yeah, mostly Chiropractic is bunk. But it can fix your back, "kinks" and spasms in your neck, a "thrown out" lower back, etc.
My anecdote isn't evidence. But a physical therapist will do the same thing: http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/sacroiliac.htm [sportsinjuryclinic.net]
They just charge a lot more and don't call it Chiropractic.
Re:The author is wrong about accupuncture (Score:3, Interesting)
On the whole I think you're right about acupuncture. But bear in mind that PubMed doesn't say anything. PubMed indexes articles published in many journals, many of which are decidedly shoddy. Many more people do medical research than actually know how to do it properly. Also, trying to adjudicate any dispute about efficacy with a cursory look at PubMed is dangerous, not least due to publication bias, but also due to the aforementioned shoddiness of the indexed journals.
I have a question for anyone who's read this book. In general, do the authors argue that we have high-quality studies concerning these four treatment modalities, and that we therefore know with pretty good certainty that they're not much good? Or do they downplay the quality of the existing data?
Re:Acupuncure? (Score:3, Interesting)
The studies in question use several different control groups, including 'sham accupuncture' (i.e. sticking needles randomly), massage, laying in the prone possition, and sugar pills. Usually, the sham accupuncture is shown to have nearly the same effects as 'true accupuncture', which would seem to indicate that being stuck with needles to the problem muscles is the important part. More recently, studies using fMRIs have shown that 'dry needling thearapy' (the research euphamism for accupuncture) temporarily changes the way the brain interpets pain.
Just becasue accupuncture has been around for a long time and has words like 'chi', 'life energy', and 'chakra' associated with the traditional practice doesn't mean that the practice doesn't have merit. The evidence is sufficient that the National Institute of Health has issued a statement that there "is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value."
It's important to remember that chemistry had its infancy in alchemy; Astronomy grew out of Astrology; Medicine began as a hodge podge of home remedies.
Re:My recollection differs from the book (Score:3, Interesting)
Re:Chiropractic treatment worked for me (Score:2, Interesting)
"...if otherwise completely hogwash..."
I've seen that phrase (or similar) a few times here, and I don't understand it. To me, the purpose of a chiropractor is to relieve pain, and they do that for me. (In fact, they were able to nearly eliminate chronic migraines that a series of conventional doctors were not able to diagnose.) I understand that many chiropractors seem to also believe in alternative therapies - but those therapies aren't chiropractic. So I don't understand what the "otherwise" is referring to.
So far, the five randomly-chosen chiropractors I've been to (as I moved between cities) have been strictly-business - just focused on relieving my pain through physical adjustments. And they've all succeeded. Maybe it isn't a "cure," but that's not what I'm looking for. (And conventional medicine doesn't offer a cure, either.)
Re:you can thank Patron Saint Orrin Hatch for this (Score:2, Interesting)
Can you provide a link with info about this?
I have always been confused why there is this medicine -vs- alternative medicine thing. It never made sense to me. If someone claims that tongue of newt cures a flu, then go get 100 people with the flu, and give 50 of them tongue of newt, and publish the results.
But you just implied that there might be a legislative reason why no one seems to research this. I'd like to know where to get more info.
From my experience (Score:3, Interesting)
As someone who has dealt with depression and anxiety: 9-10 of meditation, exercise and healthy eating have helped far more than my doctors singular advice to take 3 different medications for over a year.
I've dealt with more than a few doctors who seem more interested in, to borrow a phrase, treating the illness and not the patient. I really do think that our drugs are over prescribed. In emergencies, no doubt would I want the latest and greatest; but for every day living your average person probably doesn't need a medicine cabinet full of prescriptions.
I'm as skeptical as the next guy when it comes to "alternative" medicine and down right dismissive of religious quackery from which of it stems. Conversely I can't help but feel there is a disconnect between modern medicine and patient care. There is more to being a doctor than telling people "Take two of these and call me in the morning.". A school of thought I immediately align authors of books like this to.
I haven't started it yet, but I am looking forward to cracking open this book [amazon.com] as well as digging deeper into Zen & the Brain [amazon.com]. Both also written by MD's.
Re:It isn't all a trick (Score:5, Interesting)
Because german health insurers made a very big double blind test (314,000 probants) with three settings: 1. acupuncture, 2. something that looked like acupuncture but was in fact lots of handwaving and poking people with needles, and 3. traditional painkillers.
Acupuncture helped about 82 percent of all people where it was applied and relieved chronic pain. Traditional painkillers only helped about 25 percent. So acupuncture looks like the sure winner, right?
And now comes the big surprise: Handwaving and poking people with needles proved to be about as efficient as acupuncture: 81 percent of all people to whom it was applied reported it relieved their pain.
So it looks as if acupuncture is an effective painkiller, but not for the reasons stated. It seems that we need to know more about the actual mechanisms and effects of acupuncture.
For reference here [charite.de] the (german) report about the study.
Re:Exploitations? (Score:5, Interesting)
***If "legit" pharmaceuticals were so great, They'd learn what "standard deviation" means and stop using stats that fall within standard deviation as "proof" of efficacy.***
They don't actually do that -- at least not that I've encountered. But they approach it by using an absurdly low standard of proof (p=0.05) then designing seriously flawed experiments that increase the chances of meeting that low standard. And then repeating the flawed experiments with minor variations until they get the answer they want. There are people seriously studying all this. Google John P. A. Ioannidis, a Greek researcher who has published several widely distributed papers on the low quality of research.
Re:Typical Organized Medicine slams (Score:2, Interesting)
Goddamn it, why isn't anyone giving you any 'Insightful' or 'Interesting' mod points?
This whole thread is pretty much being embraced by every reply I read except for the far and few in between (such as the parent) as "wholesome pure scientific proof that anything but medicines from drug companies and approved by FDA are effective".
It seems that the vast majority of the community is easily scared of the "unknown medical methods" and you would rather side with "what you know method" without actually doing any research of your own.
I thought that this is what lobbyists try to take advantage of in Washington to influence the mind of politicians. Scare tactics and bullshit research to side one way or another. I don't see this book as anything different from that.
Oh, do any of you recall the "Eggs are good for you" research? I thought a recent research said that now "Eggs are bad for you" but I guess a NEW research changed it to "Eggs are good for you!"
Those were also scientific research studies!
Oh, and the coffee research, yeah. That had the same kind of sea-saw kind of research and publicity.
Anyone can do a research and make it sound like they did real actual scientific work, but even "research" can be misleading and many companies rely on misleading information to prove a point. They may not be necessarily lie to you, but I doubt that they always tell you the WHOLE STORY.
As always, don't be so damned quick to judge. Read peer-reviewed journals, do your own work, don't just allow outside information to persuade you passively. Ask the hard questions!!
For example, why did the review spend (at least) 3 fuckin' chapters on homeopathy and only half of a chapter (chapter 5) on Herbal Medicine? Where is the review against Chiropractic therapy? Where is the review against Acupuncture?
Why does every paragraph of the review slams homeopathy and then quickly follows with "homeopathy and other bogus cures" ? Could it be that they're just trying to feed you their strongest opinion and make you believe it applies to ALL alternative medicine?
Whatever.
Apologies to the parent, for my reply morphed into a different argument.
To modern *Western* medicine (Score:5, Interesting)
Without adding that key word "Western" in there, you're missing an important point -- the whole concept of Chi is based on a complete medical theory independent of Western medical thought. So basically yes, describing Chi flows to someone trained only in Western medicine would be about as productive as talking in Chinese to someone who only understands English. Both languages deal with information, but in radically different ways. Both may be perfectly valid, but analyzing the one from the perspective of the other is going to be an arduous affair.
The main problem I see with the book, based just on the review here, is that it lumps many different things together. What exactly do they mean by "herbal medicine"? (And what the heck is "herbal" about tiger bone or rhino horn? Those are animal products, not herbs.) "Herbal medicine" is an exceedingly broad category, and could potentially include Native American shamanistic practices, experimental hippie salad recipes, strictly controlled German and Swiss herbal pharmacopoeia, doobie brownies, and Chinese apothecary traditions all in one big indiscriminate mess.
Likewise, what is "alternative medicine" as the authors intend? It sounds from the review like they mean everything that doesn't normally happen in a Western hospital, which again is an obscenely broad over-generalization. Some things are probably completely la-la -- "oh sure, my neighbor ate nothing but oranges while standing on his head for two days and it cured his sinus cold!" -- while other things are backed by many centuries of refinement (Chi theory, yoga, etc.).
The reviewer also notes, ...alternative therapies are scientifically impossible, and often will violate fundamental scientific principles. "Scientifically impossible" suggests a misunderstanding of science -- science is about looking into things as objectively and quantifiably as possible, and deriving theories that best fit the observed phenomena. "Theoretically impossible" would certainly make sense -- but it would also imply the need for more study, and if XYZ "alternative" treatment were shown to be effective, then perhaps existing theories need modification. But that is a matter for further research, and thus lies outside the scope of this book.
Frankly, although the reviewer mentions a disdain for garbage science, such indiscriminate verbiage in the book sounds to me like a big factor in producing garbage science. Clearly defined terminology is a must for any productive hypotheses or research.
Just my two bits as a professional translator. Sloppy terminology just bugs the bejeezus out of me.
Cheers,
Re:We already knew this (Score:2, Interesting)
What I'm getting at is, however useful studies and papers might be, the ultimate test is really our own personal experience. And, if you're not dealing with something life threatening (and you have the financial means), I don't see why you wouldn't give the old alternative approach a try. If, in the end, you feel better that way, does it really matter if it's 'proven' to be bunk?
Re:I agree. But that's a different problem (Score:3, Interesting)
Then why can't you actually provide any links to any findings? Your first link isn't a finding - it's a suggestion that further study may be warranted. Your second is to an abstract study which indicates that the alternative treatment *may* produce results - but only when combined with existing (non alternative) treatments.
Hardly ringing endorsements. More like damming with faint praise.
Re:It isn't all a trick (Score:5, Interesting)
Seems like the placebo effect of acupuncture outweighed the placebo+drug effect of traditional painkillers. Seems the painkillers are the real scam here.
Re:But I *know* alternative medicine is real!!! (Score:5, Interesting)
Re:Herbal medicine has limited value (Score:3, Interesting)
Have either of you Avoidant Personality Disorder sufferers looked into or tried "Constructive Living"? It is based on Morita and Naikan Japanese therapies and seems to really help some people. I've found just listening to the tapes insightful and useful although I don't (that I know of) suffer from any serious disorders (although I been told that my excessive use of parens (a bad habit from writing too much scheme) is really annoying (perhaps someone can coin a creative name for that)).
Re:Herbal medicine has limited value (Score:3, Interesting)
The active ingredient in willow bark is salicylic acid. The active ingredient in Aspirin is, and always has been acetylsalicylic acid.
Yes, yes. Details. Aspirin was discovered through deliberate experiments on salicilin to create a more easily usable drug and rediscovered years later in an attempt to find something useful to do with plant dye wastes. Though it's not exactly the same chemical found naturally in willow bark, it's clearly the safe end result of an attempt to use willow bark's properties in medicine.
+1, Pedantry.
Re:Herbal medicine has limited value (Score:3, Interesting)
Overall I have a lot of faith in science but when there are multi billion-dollar markets involved like the one pharmaceutical companies are in, there tend to be some less than scrupulous people around and as a result it wouldn't surprise me if results are skewed for the sole purpose of maintaining their hold on the market.
This was exactly the case with Synthroid. In the 1990s the patent had run out on levothyroxine (the generic name for Synthroid.) Knoll Pharmaceuticals, the maker of Synthroid, suppressed a study that proved the generic forms were equally as effective as the brand name, and convinced many doctors to tell their patients to only purchase Synthroid-brand drugs. Knoll finally settled in 2000 for about $100 million dollars [about.com], which was a bargain considering the business they get from people who are still afraid of the generics, driven by doctors who still don't know the difference.
The difference between this case and the alternative medicine believers [hocus-pocu...es-chokeus] is that the case revolved around legitimate science on both sides of the issue, and it was humans tampering with the data that made the difference (just as you speculated above.) The alternative medicine purveyors, on the other hand, have no such data but tries to claim the same types of protections. Without actual studies, though, they deserve nothing. It's just a shame that some people believe that because they're mocked it gives them some kind of moral high ground, when they truly deserve nothing but mockery.