Book Review
The Jury Is Still Out
Two new books attempt but fail to end the debate about the efficacy of complementary and alternative medicine.
Review by Charles R. Meyer, M.D.
Like a fortune teller reading tea leaves, the medical profession looks into the world of medical science and tries to tell patients what is truth. Yet searching for scientific truth can be like looking into a hazy crystal ball. Science arrives at its conclusions tentatively, at times agonizingly and, for all its appearances of certitude, can reverse its course abruptly. Patients untrained in the scientific method struggle with the apparent inconsistencies emanating from the medical establishment and frequently abandon classic medicine to find cures or comfort in alternatives. For decades, conventional medical practitioners dismissed acupuncturists, naturopaths, chiropractors, and other alternative medicine practitioners as outright quacks and their clients as gullible victims. But patients have ignored the name-calling. Their standard of proof of the effectiveness of alternative care is whether they feel better. Appeals to scientific evidence may or may not be influential.
Two recent books, Snake Oil Science: The Truth about Complementary and Alternative Medicine by biostatistician R. Barker Bausell and Trick or Treatment: The Undeniable Facts about Alternative Medicine by science journalist Simon Singh and physician Edzard Ernst, M.D., attempt to demystify the scientific method and then use it to evaluate the claims of complementary and alternative medicine’s (CAM) efficacy.
Ernst and Singh explore the historical roots of evidence-based conventional medicine, bemoaning the evidence-lacking practice of bloodletting with leeches during the time of George Washington, detailing the work of Florence Nightingale, which anticipated the scientific method, and heralding the investigations of Sir Austin Bradford Hill and Sir Richard Doll, who marshaled the early evidence for smoking as a cause of lung cancer. They contrast this march toward evidentiary support with what they believe is flimsy support for alternative techniques including acupuncture, homeopathy, chiropractic, and herbal medicine. For example, they dismiss a World Health Organization report concluding that acupuncture had demonstrated effectiveness for 20 conditions with the allegation that the report commission was a “group of believers” who “prioritize[d] political correctness above truth.” They endorse the Cochrane Reviews’ conclusions on acupuncture as being effective only in the treatment of postoperative nausea, chemotherapy-induced nausea and vomiting, and pelvic and back pain. They finally advise the reader that, “if you see acupuncture being advertised by a clinic, then you can assume that it does not really work, except possibly in the treatment of some types of pain and nausea.” Their analyses of homeopathy, chiropractic, and herbal medicine reach similar negative conclusions.
Bausell is no less scathing in his critique of CAM, which he started evaluating as director of research at the University of Maryland’s NIH-funded complementary medicine program (now called the Center for Integrative Medicine), where he designed and supervised randomized clinical trials to ascertain whether acupuncture and mind-body modalities reduced pain and increased physical functioning for patients with several medical conditions. Concluding that much of what he observed was placebo effect, he began an in-depth study of the placebo effect. In his introduction, he states clearly that he seeks “to demonstrate how millions of intelligent people could be correct when they conclude that their symptoms were relieved as soon as they received a complementary and alternative medical treatment, but incorrect when they conclude that this relief was due to the treatment itself.”
He spends the first 100 pages of Snake Oil almost painfully detailing the principles of controlled experimentation and placebo effect. When he finally gets around to presenting the evidence for or against alternative medicine, he does so as a list of studies in prominent journals with a brief (+) or (-) rating for their conclusions. At the end of 294 pages, he reiterates the conclusion he stated on p. 24 (and really in his title): “There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo.”
Will these books help adjudicate the debate between conventional and alternative medicine? They do summarize some research, but the authors’ bias compromises their conclusions. Bausell became disillusioned as a researcher investigating CAM. Ernst is called the “world’s first professor of complementary medicine” on the dust jacket of Trick or Treatment, but he evidently lost the faith. And neither of these books acknowledges how much of what we currently do in conventional medicine lacks a sound base of evidence. It seems like we’re still a long way from eliminating the tea leaves from either conventional or alternative medicine. MM
Charles Meyer practices internal medicine in Edina and is editor in chief of Minnesota Medicine.