As the worlds first professor of complementary medicine, Dr. Edzard Ernst set out to apply rigorous scientific standards of evidence to find out which alternative medicine treatments worked and which didnt. After 25 years of research and a torrent of published studies, he had determined that most of them didnt. A lot of people were unhappy about his conclusions, and Ernst was forced into early retirement. If his enemies were hoping to silence him, their plan backfired. He no longer has to worry about political correctness or unhappy employers. Retirement freed him to devote all his time to thinking about all he had learned and communicating his findings to the public. In a profusion of books, articles, blogs, and public talks, he has become ever more willing to speak out strongly and call a spade a spade.
Recently he teamed up with a medical ethicist, Kevin Smith, to writeMore Harm than Good: The Moral Maze of Complementary and Alternative Medicine. In it, they argued that complementary and alternative medicine (CAM) is unethical. Now he has written another book,SCAM: So-Called Alternative Medicine, showing that the very term alternative medicine is itself a scam. He explains,
Whatever it is, it isnotan alternative:
- if a therapy does not work, it cannot be an alternative to medicine;
- if a therapy does work, it does not belong to alternative medicine but to medicine.
Ernst has been accused of doing nothing but debunking SCAM. Not true. He lists 20 CAM interventions that are backed by positive and sound evidence, and he rates most of these as probably more effective than conventional options.
The chapter on The Basics alone is worth the price of the book. It is a concise distillation of wisdom about the principles of evaluating medical claims. It covers evidence vs. experience, how clinicians can fool themselves, how even clinical trials can give false results, the direct and indirect risks of using ineffective treatments, weighing risks against benefits, placebo effects, specific vs. nonspecific treatment effects, eminence-based and celebrity-based medicine, ethical issues, and informed consent.
SCAM claims to understand the root cause of diseases, and SCAMs are often promoted as cure-alls. Ernst calls these claims not just misleading but demonstrably wrong. The SCAMs that are effective are only effective for relieving symptoms. Ernst has never been able to identify a single disease that can be cured by SCAM.
He points out that SCAM practitioners often instill fear by telling people they have a nonexistent problem (like toxins or subluxations). They claim to be holistic but much of SCAM is exactly the opposite of holistic. They spread paranoid conspiracy theories about Big Pharma, the FDA, and the medical establishment. They have many of the features of a cult. He points out that doctors can face reprimands for inadvertent errors while SCAM practitioners can get away with intentional harm.
The chapter on research shows that SCAM research is lacking in both quantity and quality. It is a morass of poor research design, promotion masquerading as research, scientific misconduct, nonsensical investigations, and results that are too good to be true. Ernst describes how pseudo-researchers are seduced by personal epiphanies and by what he calls the gravy train. He says the line between wishful thinking and overt fraud is often blurry. He lists clear guidelines on how to differentiate good research from bad. He points out the role of criticism in scientific progress and shows that both criticism and progress are glaringly missing in the world of SCAM.
There is more in the book, much more. There is a chapter devoted to SCAM practitioners and the ways they mislead and impress patients. Another chapter is devoted to patients and consumers and the reasons they are attracted to SCAMs. SCAM proponents claim that SCAM steps in to fill the void when orthodox medicine has nothing more to offer. Thats not only false but despicable. Orthodox medicinealwayshas more to offer; if a cure is not possible, pain relief and supportive and palliative care are always available. And of course, SCAM cant offer a cure either. And then theres the wellness mania; Ernst says wellness is one of the most abused terms in the realm of CAM.
The final chapter is titled The Funny Side. Ernst provides instructions showing readers how they could invent their own SCAMs and become charlatans. He has some choice words for ignorant politicians and for SCAM advocate Prince Charles, quoting Christopher Hitchens: We have known for a long time that Prince Charles empty sails are so rigged as to be swelled by any passing waft or breeze of crankiness and cant. The heir to the throne seems to possess the ability to surround himselfperhaps by some mysterious ultramagnetic force?with every moon-faced spoon-bender, shrub-flatterer, and water-diviner within range.
Ive always had trouble remembering the difference between efficacy and effectiveness. Ernst explains that eff-I-cacy refers to the treatments performance under I-deal conditions and eff-E-ctiveness refers to its performance under E-veryday conditions; a great mnemonic that I wont forget.
I laughed out loud at his description of how a homeopathic manufacturer prepared the homeopathic remedy Uranium 200X. They had no legal way of obtaining uranium, so they went on a tour of the Hanford nuclear facility and they held a vial of water up against a glass wall in front of the cooling chamber. They called that their mother tincture of uranium. Back in their lab, they diluted it 200 times with ethanol to make a 200X dilution, and then had the problem of getting rid of all the leftover ethanol. It was illegal to dump it down the drain, and the disposal service refused to take it because it said uranium on the label, even though they tried to explain that it couldnt possibly contain a single atom of uranium. They ended up surreptitiously burying it in the backyard.
In a Postscript, Ernst says the book is not intended as a textagainstbut a pleaforsomething. His aim was to stimulate the readers ability to think critically about SCAM and about healthcare in general. He hopes that the SCAM boom will do some good. It might induce conventional healthcare professionals to remember that time, compassion, and empathy are some of their core values which cannot be delegated to others.
Its a gem of a book. I highly recommend it.