Resident Fellow  Scott Gottlieb, M.D.

Scott Gottlieb, M.D. reviews Trick or Treatment by Simon Singh and Edzard Ernst, M.D. The book evaluates the efficacy of many alternative medicine treatments and cautions against the use of alternative medicine in place of conventional therapies.

When I was practicing medicine in the Elmhurst section of New York about five years ago, my colleagues and I confronted an epidemic of liver damage among the recently arrived Chinese immigrants who live there. We put these patients through an exhaustive battery of tests for conventional sources of hepatitis, the most likely culprit, but found none. The mysterious illness, we decided, must have been caused by the folk therapies, usually herbal, that our patients often used but rarely disclosed to their doctors. There was little we could do but counsel them to stop. Instead of following our professional advice, though, they usually just added new herbs to their regimen, hoping to solve their liver problems but sometimes making themselves even more ill.

The Elmhurst epidemic was a classic example of the clash--both cultural and scientific--between "alternative" and conventional medicine. In this case, the inability of doctors to treat a liver ailment strengthened the false faith of patients in other cures. Usually, alternative medicine is a harmless distraction. And some treatments actually do offer benefits. But going outside modern medical practice also carries dangers.

Luckily, hundreds of studies have examined the purported benefits of various alternative-medicine treatments. In Trick or Treatment, Simon Singh and Dr. Edzard Ernst report on the results. Ginseng has been proposed as a cure-all for everything from cancer to common colds, but there's no evidence that it does any good. Shiatsu massage appears to be a "waste of effort and expense," the authors say. Many aspects of traditional Chinese medicine, like the use of the herbs aristolochia and liquorice, are potentially harmful. Aromatherapy can relieve stress, but there is not a lick of evidence that it can treat a specific illness. Chelation therapy--a legitimate method of removing heavy metals such as lead or mercury from the body, but now pitched in alternative-medicine circles as a cure for heart disease and other ailments--is "disproven, expensive, and dangerous," according to Mr. Singh and Dr. Ernst. They urge patients "not to use this treatment."

Some alternative remedies, it should be said, do appear to have value. There is evidence that St. John's Wort can help mild depression, although probably not as well as conventional antidepressants. Echinacea may be able to help relieve symptoms of the common cold, and perhaps reduce the length of illness, but so can many better understood conventional remedies that are sold over the counter. "It seems bizarre," the authors note, in light of the disappointing results, "that alternative treatments are touted as though they offer marvelous benefits."

Dr. Ernst is not a dispassionate observer. He is a pioneer in the field of complementary medicine--a branch of the medical profession whose practitioners prescribe selective alternative treatments. But he is also a scourge of too-large claims made for his field. Based at the University of Exeter in England, he leads a research group that has spent 15 years studying alternative remedies, trying to separate snake oil from science. Mr. Singh, his co-author, is a science journalist whose books include Fermat's Enigma and Big Bang. Together they conclude, after cataloging the evidence, that most of the popular forms of alternative medicine are "a throwback to the dark ages." Too many alternative practitioners, they say, are "uninterested in determining the safety and efficacy of their interventions."

And safety is a real concern. "Chiropractors who manipulate the neck can cause a stroke . . . some herbs can cause adverse reactions or can interfere with conventional drugs." The authors are particularly hard on homeopathy, the practice of using ultradilute solutions of common substances. The solutions are so dilute, though, that they are often little more than water. "Homeopathic remedies, which of course contain no active ingredient, can be dangerous if they delay or replace a more orthodox treatment," Mr. Singh and Dr. Ernst write, calling homeopathy "the worst therapy encountered so far--it is an implausible therapy that has failed to prove itself after two centuries and some 200 clinical studies."

Trick or Treatment includes a brisk history of our evidence-based approach to medicine, tracing the development of the modern clinical trial from its earliest days, when scurvy was shown to be caused by insufficient vitamin C and bleeding was debunked as a medical cure. Unfortunately, the evidence of clinical trials is largely ignored when it comes to alternative medicine.

So the treatments persist: Americans spend an astonishing $3 billion annually on chiropractors and about $1.5 billion on homeopathy, not to mention billions more for herbal remedies. Government is complicit: Most states mandate health-insurance coverage for chiropractic visits, and many states direct insurers to cover the cost of acupuncture--another remedy with far fewer benefits than are commonly claimed for it.

Why is there so much blind faith? Mr. Singh and Dr. Ernst blame media hype, celebrities and even certain doctors--complementary-medicine doctors for shading facts but also, importantly, conventional doctors whose high-handedness breeds patient frustration, opening the door to the seductions of alternative medicine.

"Alternative medicine is not so much about the treatments we discuss in this book," the authors write, "but about the therapeutic relationship. Many alternative practitioners develop an excellent relationship with their patients that helps to maximize the placebo effect of an otherwise useless treatment." To bring all treatments in line with rigorous science, an "excellent relationship" between doctor and patient is a good place to start.

Scott Gottlieb, M.D., is a resident fellow at AEI.