Alternate Medicine Leads to Darkness

Prabhakar Nanawaty

Exaggerated claims, misleading advertisements, and false information about complementary and alternative medicine (CAM) make it virtually impossible to protect the public from today’s snake oils readily available, interalia, by Internet, TV, radio, and pharmacy shelves. Prince Charles of  UK is a staunch defender of Homeopathy and millions of people swear by it. The books shaking his belief on such medicines will never find their way to Prince Charles’s bedside table.

In the book, Trick or Treatment? subtitled ‘The undeniable Facts About Alternative Medicine’ the truth about the efficacy of alternative medicine is rigorously addressed by the scientists uniquely qualified to do so.  Written by a best selling science author and a journalist,  Simon Singh, who boasts a PhD in particle physics, and Edzard Ernst, a professor in complementary therapy, clearly hope to set a standard in the genre.   Having spent over a decade at Exeter University meticulously analyzing the bewildering evidence for and against alternative therapies, Edzard Ernst, this former practitioner of both traditional and complementary medicine brings no bias to the subject.

In fact they introduce their book by quoting Hippocrates as providing their guiding path:

There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.

Any treatment which cannot stand up to the rigours of scientific enquiry, by which Singh and Ernst mean a well conducted controlled clinical trial, has no place calling itself medicine and is simply hocus-pocus with good PR.  At best such therapy is simply no better than placebo; at worse it is positively dangerous.  But even if it is harmless, it is far from costless, as the annual global spend on alternative medicine is in the region of £40 billion, money that could be spent on more fruitfully, should alternative therapies prove to be ineffective.

To explain this, Singh and Ernst take a historical approach, building the notion of the clinical trial as the gold standard for evaluating medical interventions.  They start by telling us of one of the casualties of the ancient regime; on December 13 1799 former President George Washington awoke with the symptoms of a cold.  He thought nothing of it, but by the following night he was gasping for air; serious, but potentially survivable, until bloodletters drained Washington of half his blood in less than a day.  These men weren’t witchdoctors, but Washington’s personal physicians.  They thought that they were working in the great man’s best interests, but alas the medical profession had yet to work out how to distinguish interventions that worked from those that didn’t.

Typically, it was a British man who first came up with the randomized control trial, even more typically he then totally failed to capitalize upon his insight. The man was a naval surgeon called James Lind. Britain at this time was the world’s greatest seafaring nation, but any journey lasting more than a few weeks was blighted by scurvy, a disease we now know is caused by a deficit in vitamin C. Lind split twelve scurvy sufferers into six pairs, and gave each a different treatment.  He also observed another group of sailors who received no treatment; these acted as a control.  As a shot in the dark, to one pair he gave oranges and lemons; this group made a miraculous recovery.

Just as interesting, Singh and Ernst tell us about Florence Nightingale and her penchant for statistics.  Feeling a divine calling to become a nurse, Nightingale decided to work in the hospitals of the Crimean war, having read reports of the large numbers of soldiers dying there from cholera and malaria.  Upon her arrival at her chosen hospital she embarked on the mother of all spring cleans and within one week removed 215 handcarts of filth, had flushed the sewers nineteen times and buried the carcasses of two horses, a cow and four dogs all of which were found in the hospital grounds.  But amazing to us now the officers and doctors who were previously in charge, felt that these changes were an insult to their professionalism.  Fortunately Nightingale also had a statistical education and used this to demonstrate that soldiers under her new order fared much better than those hospitalized in less salubrious conditions. By telling this Ernst and Singh also seek to demonstrate that, quite opposite to what alternative practitioners believe, scientists are willing to accept ideas which run contrary to the current received wisdom.  The clinical trail is such a strong instrument that it forces them to do so.

In the next four chapters of their book, the authors take four of the main branches of alternative medicine to task: Acupuncture, Homeopathy, Chiropractic therapy and Herbal Medicine.  They take us through the history of each approach, its theory of action and assess the evidence for its efficacy. In fact Chiropractic therapy is not practiced much in India. However, it will soon take over the other therapies and allopath.

Acupuncture, is an ancient treatment, whereby the body’s ‘Ch’i’, its vital energy or life force flows through our bodies in channels called meridians.  Illnesses are due to imbalances or blockages in the flow of Ch’i and the goal of acupuncture is to tap into the meridians at key points to rebalance or unblock the Ch’i.  Ernst and Singh cite the experience of James Reston, who was reporting on Nixon’s 1973 Chinese visit as key for acupuncture’s introduction into the west.  Whilst in China he suffered from appendicitis and was treated by acupuncture, bringing news of his treatment and recovery home. Unlike Reston, Ernst and Singh are unconvinced.  They demolish positive papers published by the WHO as having included too many trials, some of which used poor methodology, and conclude that the science behind acupuncture is implausible and totally without evidence.  They finish by saying that Acupuncture has inconsistent evidence to suggest that it has a use in pain and nausea control.

If acupuncture gets one point, then Homeopathy gets null.   This was the work of a German physician Samuel Hahnemann at the end of the 18th century.  Hahnemann correctly realised that he and his medical colleagues knew nothing about how to treat people, but he then moved away from the then conventional medicine and contrived to establish his own brand of treatment.  Having taken quinine one morning he found himself having the same symptoms as if he had malaria.  From this he extrapolated a universal principle

‘That which can produce a set of symptoms in a healthy individual can treat a sick individual who is manifesting a similar set of symptoms’.

Even better, he went on to say that the potency of a cure could be greatly enhanced by diluting them.  Not just a little bit either; some homeopathic remedies are at the sort of concentration you might expect from putting a teabag in Lake Superior.  Singh and Ernst find this all highly improbable, and put any positive effects attributed to this brand of alternative medicine down, amongst other things, to the body’s ability to heal itself.

{In fact Ernst and Singh challenge homeopaths to demonstrate that homeopathy is effective by showing that the Cochrane Collaboration has published a review that is strongly and conclusively positive about high dilution homeopathic remedies for any human condition. They cite

“The conclusion in our book (Trick or Treatment) suggests that there is no convincing evidence to show that homeopathic remedies are effective in the treatment of any conditions, except as a placebo. However, our conclusion has been met by criticism from many homeopaths, who claim that homeopathy is effective and who accuse us of ignoring or misunderstanding the evidence. So who is right, us or the homeopaths? We are so confident in our conclusion that there is no convincing evidence to support the use of homeopathy that on 16 June 2008 we announced a £10,000 reward for anybody who could prove us wrong.”)

The founders of chiropractic therapy argue that ill health in the body is due to subluxations, slight misalignments of vertebrae in the spine.  These subluxations interfere with the flow of innate intelligence (a bit like Ch’i).  They are corrected by spinal manipulation, whereby the practitioner flexes of extends the neck beyond its normal range of movement.  There are some chiropractors called ‘mixers’, who are basically back specialists, however their ’straight’ colleagues believe that their techniques can cure the body of ills seemingly unconnected with the bony structures. It is reported in the book that it is not unusual for chiropractors to spinally manipulate patients without their consent on their first appointment, and furthermore that this spinal manipulation has lead to vertebral artery dissections and death in patients.

(When Simon Singh wrote an article on bogus claims of chiropractic therapy for the Guardian, The British Chiropractic Association, prefered reality to bend to their will. They’ve been making some outrageous claims lately about the efficacy of their “treatment”, things that are clearly wrong. Simon wrote about this in a column, saying,

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

Unsurprisingly, the BCA took a dim view of this. Instead of producing the results of variable-controlled double blind studies with statistically significant testing procedures to back up their claim, they sued him instead. In the US that would be a dumb thing to do, as US libel laws put the burden of proof on the claimant (in this case, the BCA), as things should be. However, the UK is very different: when party A sues party B for libel, it’s up to party B to prove their innocence.

The ramifications of this are obvious: a chilling effect on dissent in the media against, well, anything. If you call someone on the carpet for making fallacious claims, they can basically shut you up by suing you. Not surprisingly, there are many people dissatisfied with this approach to libel, but it’s what Simon is dealing with currently.

Worse, in Simon’s case, a judge ruling in the preliminary hearing agreed with the BCA, citing Simon’s use of the word “bogus” to mean that the BCA knowingly is perpetrating fraud. The judge is obviously wrong here; Simon went to some pains to indicate in that very article that his use of bogus did not mean intentional fraud, but instead to mean wrong, as in chiropractic techniques cannot be used to cure the ills the BCA claims.)

Before their finger pointing and conclusions and an interesting section entitled ‘Why do smart people believe such odd things?’ Singh and Ernst take as their fourth case study Herbal Medicine.  This is a more tricky area for them, as unlike their previous three methodologies, some herbal remedies, for example St John’s Wort, actually work.  Here the problems are more subtle.  There’s worse too, as herbal remedies can interact with conventional drugs with unpredictable consequences and if they are taken in preference to conventional medicines they won’t get you very far, as the authors tell us was discovered by several unfortunate, but trusting, cancer victims.  And beware; some herbal remedies are effective because they actually contain conventional medicines.

So whose fault is this?  Ernst and Singh propose that most alternative remedies trade on being more natural, traditional and holistic, three ideas they quickly dispatch.  Uranium is natural, bloodletting was traditional, and holistic medicine is not a preserve of alternative practitioners – GPs regularly give lifestyle advice. According to authors, there should be warning messages on alternative medical treatments like cigarettes they say, accurately reflecting the current evidence.  For Homeopathy this would read


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 get less benefit.

A “rapid guide to alternative therapies” attached as  appendix to this book summarizes the background, the evidence, and scientific conclusion for 36 additional popular therapies, including aromatherapy, Ayurvedic tradition, colonic irrigation, food supplements, hypnotherapy, magnet therapy, massage therapy, spiritual healing, and traditional Chinese medicine. In fact it is interesting to know that how these therapies were involved, who got benefits out of them. A therapy called Alexander Therapy is nothing but a process of relearning correct postural balance and coordination of body movements. How any one can believe that sitting position will cure recurring loss of voice? Authors describe many fake gadgets which were developed to fool the public. These entrepreneurs generally claim that their gadgets cure this disease or prevent that disease and make money. While commenting on Indian Ayurveda tradition authors comment that the whole system of Ayurveda has not been submitted to clinical trials, but elements of it have. Except for a few remedies none of them have the evidence sufficiently strong to warrant a positive recommendation.

In this way, in their hard-hitting scrutiny of alternative and complementary cures, authors also strive to reassert the primacy of the scientific method as means for determining public health and policy. In fact authors point out at ten culprits in the promotion of unproven and disproven medicine. The list includes celebrities,  sham medical researchers, Universities, the media, hungry of sensationalizing news, medical professionals who are not honest to their profession and plethora of alternative medicine societies and lastly WHO. They go onto blame celebrities for endorsing alternative treatments, universities for providing alternative medicine courses to make money and thus legitimizing alternative approaches, the media for inaccurately reporting the benefits of alternative therapies and many doctors for prescribing alternative medicine to get difficult patients out of their consulting rooms.

TRICK OR TREATMENT: The Undeniable Facts about Alternative Medicine

Authors:  Simon Singh and Edzard Ernst, MD

Published by W. W. Norton & Company, New York, pp 342