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Healing, Hype Or Harm? A Critical Analysis of Complementary Or Alternative Medicine

Healing, Hype Or Harm? A Critical Analysis of Complementary Or Alternative Medicine Media reviews devotion to evidence-based medicine which, that later. There is a thought-provoking MEDIA REVIEWS despite repetition, progressed in a logical and piece by Bruce Charlton on the difference informative manner. The writing was easy between ‘‘healing’’ and ‘‘curing’’ and how Trick or treatment? Alternative to absorb and pitched at the right level for a complementary therapists have tried to medicine on trial curious patient. Now you know what is in claim the mantle of ‘‘healers’’ from conven- the book, can you risk recommending it to tional practitioners. By Simon Singh, Edzard Ernst. Published by London, Bantam Press, 2008. £16.99. ISBN 978-0-59306-129-9 your patients? The second section of the book aims to deal with some specific issues, and in the main It’s time to hang up my hat as a medical Guess what? There is turns unashamedly on homeopathy and acupuncturist and reinvent myself as a very little scientific chiropractic techniques. There is also a bespoke ‘‘placebopractor’’. The book sug- evidence to support discussion about the concept of what is really gests that I could do rather well. complementary and meant by ‘‘patient choice’’ and ‘‘integrated alternative medicine Colin Lewis medicine’’. There was repetition here, as (CAM). It is poten- might be expected by having a series of essays Correspondence to: aim.bmj.com tially dangerous but from different authors in one volume, but booming and the pub- surprisingly, perhaps, not edited out. How lic is being misled by Healing, hype or harm? A critical many ways are there of expressing a view, expensive techniques that homeopaths are charlatans? As a regular analysis of complementary or that probably work referrer to the Royal London Homoeopathic by placebo mechan- Hospital I was shocked by the implied alternative medicine isms anyway! This is the tone of this book. criticism of the work that goes on there and By Edzard Ernst (author and editor). Published by Imprint If there is no controlled trial or evidence to apparent lack of understanding of the com- Academic; 1 edition (1 June 2008), 178 pages, £8.95 support the complementary therapy then (paperback). ISBN 1845401182 plexity and variety of clinical expertise, which beware, dear patient! has certainly benefitted many of my patients This is a book aimed To a certain extent the authors are right. over the years. I also reflect on the varying at the general public Culling the evidence is the ultimate goal — if ‘‘therapies’’ that are available to patients setting to counter only it were that easy. The book jumps on the attending our local hospices, and how many some of the recent need for evidence before accepting any treat- of these provide comfort and symptom relief press that is seen as ment, going back to the days of scurvy, and when time is short. These in no way pretend being biased and the death of George Washington to prove the to offer a ‘‘cure’’ or try to replace ‘‘orthodox’’ uncritically in favour point. The authors delight in tearing homeop- treatments. This is the reality of my day-to- of complementary or athy apart, finding no scientific evidence to day work and for me, here lies the major flaw alternative medicine. support the effect of a remedy that is devoid of this book — there is not a single mention of It is presented as a of any active ingredient. Ernst having prac- primary care, where over 90% of NHS series of essays by dif- tised and received homeopathy now takes the consultations take place. I am reminded of ferent authors with a view that this therapy is nothing more than an excellent article in the BMJ published in well-written foreword by TV presenter Nick an elaborate placebo. 1997 entitled ‘‘Medicine based evidence, a Ross and significant contributions from The big four — Acupuncture, Homeopathy, prerequisite for evidence based medicine’’, Edzard Ernst (as Editor), who holds the title Chiropractic and Herbal Medicine — make up where the importance is discussed of accom- of Chair in Complementary Medicine at the the bulk of the book, with single page r´s e um´s e modating this clinical reality into research Peninsula Medical School (Exeter of 36 further therapies. Acupuncture leads with rather than ignoring it. It remains an impor- University). I know from his media appear- 1 49 pages starting with reference to Otzi the tant and salutary read over a decade later. ances and extensive writing on the subject iceman, China, gate theory, and the power of Surprisingly, there is only a cursory that he is not afraid to be critical and has placebo. It is conceded that acupuncture works mention of acupuncture, and there is abso- for pain and nausea but the World Health justifiably exposed many so-called ‘‘thera- lutely no distinction made between Western Organization is attacked for the large number pies’’ as scams. His critique here, however, is medical and traditional Chinese practices. I of conditions ‘‘recommended’’ for acupunc- so fearsome that he would appear to have found this very sad, particularly when the ture. Cue for the Cochrane Collaboration and a done himself out of a job — you would be BMAS has over 2000 regulated health long list of conditions where there is no left feeling that there is surely nothing left to professionals as members. We certainly evidence to support acupuncture, and a tiny say on the matter other than perhaps don’t have all the answers but there is a list where there may be some benefit. Bring on arranging a gathering up of complementary growing scientific understanding of how the decent trials but be wary of the Germans as therapists and burning them at the stake! acupuncture might work and we have seen their trials show that sham acupuncture is The book initially focuses on general a growth in rigorous clinical studies and almost as good as the real stuff! issues, with an attempt to define comple- positive outcomes, but none of this is ‘‘Acupuncture works only because the mentary medicine and analyse why it is so deemed worthy of mention. Finally, I don’t patients have faith in the treatment… If the popular. It then sets out to tackle what is think that Western medical acupuncture, as patients paid attention to the latest research meant by ‘‘evidence-based medicine’’ and we understand it, actually fulfils any of the then they would lose confidence in acupunc- questions of research and legal aspects of definitions of complementary or alternative ture and the placebo effects would largely complementary medicine, including the medicine quoted here and maybe this poses the melt away.’’ More advice is forthcoming in debate over regulation. David Colquhoun, a greatest future challenge to the BMAS in terms recommending a chiropractor only if there is a pharmacologist at University College of how we present and market ourselves. problem with your back but to watch out for London, delivers a damning critique of all the dangers and remember that conventional universities where complementary medicine Jonathan Freedman treatments should be tried before chiroprac- modules are taught. I noticed that the Correspondence to: jonathan.freedman@nhs.net tice and are likely to be cheaper. Hertfordshire University MSc in Western The book is wonderfully critical and Medical Acupuncture was not mentioned, depressingly negative about most aspects of despite being well established and supported REFERENCES CAM. I rather enjoyed it. There were lots of by the British Medical Acupuncture Society 1. Knottnerus A, Dinant GJ. Medicine based evidence, a stories and explanations of medical history, (BMAS), which is also not worthy of a prerequisite for evidence based medicine. BMJ the evolution of medical research and the mention throughout this book, but more of 1997;315:1109–1110. Acupunct Med March 2009 Vol 27 No 1 39 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acupuncture in Medicine SAGE

Healing, Hype Or Harm? A Critical Analysis of Complementary Or Alternative Medicine

Acupuncture in Medicine , Volume 27 (1): 1 – Mar 1, 2009

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References (1)

Publisher
SAGE
Copyright
© 2009 British Medical Acupuncutre Society
ISSN
0964-5284
eISSN
1759-9873
DOI
10.1136/aim.2008.000109
Publisher site
See Article on Publisher Site

Abstract

Media reviews devotion to evidence-based medicine which, that later. There is a thought-provoking MEDIA REVIEWS despite repetition, progressed in a logical and piece by Bruce Charlton on the difference informative manner. The writing was easy between ‘‘healing’’ and ‘‘curing’’ and how Trick or treatment? Alternative to absorb and pitched at the right level for a complementary therapists have tried to medicine on trial curious patient. Now you know what is in claim the mantle of ‘‘healers’’ from conven- the book, can you risk recommending it to tional practitioners. By Simon Singh, Edzard Ernst. Published by London, Bantam Press, 2008. £16.99. ISBN 978-0-59306-129-9 your patients? The second section of the book aims to deal with some specific issues, and in the main It’s time to hang up my hat as a medical Guess what? There is turns unashamedly on homeopathy and acupuncturist and reinvent myself as a very little scientific chiropractic techniques. There is also a bespoke ‘‘placebopractor’’. The book sug- evidence to support discussion about the concept of what is really gests that I could do rather well. complementary and meant by ‘‘patient choice’’ and ‘‘integrated alternative medicine Colin Lewis medicine’’. There was repetition here, as (CAM). It is poten- might be expected by having a series of essays Correspondence to: aim.bmj.com tially dangerous but from different authors in one volume, but booming and the pub- surprisingly, perhaps, not edited out. How lic is being misled by Healing, hype or harm? A critical many ways are there of expressing a view, expensive techniques that homeopaths are charlatans? As a regular analysis of complementary or that probably work referrer to the Royal London Homoeopathic by placebo mechan- Hospital I was shocked by the implied alternative medicine isms anyway! This is the tone of this book. criticism of the work that goes on there and By Edzard Ernst (author and editor). Published by Imprint If there is no controlled trial or evidence to apparent lack of understanding of the com- Academic; 1 edition (1 June 2008), 178 pages, £8.95 support the complementary therapy then (paperback). ISBN 1845401182 plexity and variety of clinical expertise, which beware, dear patient! has certainly benefitted many of my patients This is a book aimed To a certain extent the authors are right. over the years. I also reflect on the varying at the general public Culling the evidence is the ultimate goal — if ‘‘therapies’’ that are available to patients setting to counter only it were that easy. The book jumps on the attending our local hospices, and how many some of the recent need for evidence before accepting any treat- of these provide comfort and symptom relief press that is seen as ment, going back to the days of scurvy, and when time is short. These in no way pretend being biased and the death of George Washington to prove the to offer a ‘‘cure’’ or try to replace ‘‘orthodox’’ uncritically in favour point. The authors delight in tearing homeop- treatments. This is the reality of my day-to- of complementary or athy apart, finding no scientific evidence to day work and for me, here lies the major flaw alternative medicine. support the effect of a remedy that is devoid of this book — there is not a single mention of It is presented as a of any active ingredient. Ernst having prac- primary care, where over 90% of NHS series of essays by dif- tised and received homeopathy now takes the consultations take place. I am reminded of ferent authors with a view that this therapy is nothing more than an excellent article in the BMJ published in well-written foreword by TV presenter Nick an elaborate placebo. 1997 entitled ‘‘Medicine based evidence, a Ross and significant contributions from The big four — Acupuncture, Homeopathy, prerequisite for evidence based medicine’’, Edzard Ernst (as Editor), who holds the title Chiropractic and Herbal Medicine — make up where the importance is discussed of accom- of Chair in Complementary Medicine at the the bulk of the book, with single page r´s e um´s e modating this clinical reality into research Peninsula Medical School (Exeter of 36 further therapies. Acupuncture leads with rather than ignoring it. It remains an impor- University). I know from his media appear- 1 49 pages starting with reference to Otzi the tant and salutary read over a decade later. ances and extensive writing on the subject iceman, China, gate theory, and the power of Surprisingly, there is only a cursory that he is not afraid to be critical and has placebo. It is conceded that acupuncture works mention of acupuncture, and there is abso- for pain and nausea but the World Health justifiably exposed many so-called ‘‘thera- lutely no distinction made between Western Organization is attacked for the large number pies’’ as scams. His critique here, however, is medical and traditional Chinese practices. I of conditions ‘‘recommended’’ for acupunc- so fearsome that he would appear to have found this very sad, particularly when the ture. Cue for the Cochrane Collaboration and a done himself out of a job — you would be BMAS has over 2000 regulated health long list of conditions where there is no left feeling that there is surely nothing left to professionals as members. We certainly evidence to support acupuncture, and a tiny say on the matter other than perhaps don’t have all the answers but there is a list where there may be some benefit. Bring on arranging a gathering up of complementary growing scientific understanding of how the decent trials but be wary of the Germans as therapists and burning them at the stake! acupuncture might work and we have seen their trials show that sham acupuncture is The book initially focuses on general a growth in rigorous clinical studies and almost as good as the real stuff! issues, with an attempt to define comple- positive outcomes, but none of this is ‘‘Acupuncture works only because the mentary medicine and analyse why it is so deemed worthy of mention. Finally, I don’t patients have faith in the treatment… If the popular. It then sets out to tackle what is think that Western medical acupuncture, as patients paid attention to the latest research meant by ‘‘evidence-based medicine’’ and we understand it, actually fulfils any of the then they would lose confidence in acupunc- questions of research and legal aspects of definitions of complementary or alternative ture and the placebo effects would largely complementary medicine, including the medicine quoted here and maybe this poses the melt away.’’ More advice is forthcoming in debate over regulation. David Colquhoun, a greatest future challenge to the BMAS in terms recommending a chiropractor only if there is a pharmacologist at University College of how we present and market ourselves. problem with your back but to watch out for London, delivers a damning critique of all the dangers and remember that conventional universities where complementary medicine Jonathan Freedman treatments should be tried before chiroprac- modules are taught. I noticed that the Correspondence to: jonathan.freedman@nhs.net tice and are likely to be cheaper. Hertfordshire University MSc in Western The book is wonderfully critical and Medical Acupuncture was not mentioned, depressingly negative about most aspects of despite being well established and supported REFERENCES CAM. I rather enjoyed it. There were lots of by the British Medical Acupuncture Society 1. Knottnerus A, Dinant GJ. Medicine based evidence, a stories and explanations of medical history, (BMAS), which is also not worthy of a prerequisite for evidence based medicine. BMJ the evolution of medical research and the mention throughout this book, but more of 1997;315:1109–1110. Acupunct Med March 2009 Vol 27 No 1 39

Journal

Acupuncture in MedicineSAGE

Published: Mar 1, 2009

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