Trick or Treatment: The Undeniable Facts about Alternative Medicine

Science and opinion. This book is the former.

There are other good reviews here, so I will try not to repeat what others have said and keep this brief and to the point. This book is an excellent review of some of the most common "alternative" treatments available. As the authors point out, the very use of the term "alternative" is misleading. A treatment either works, or it does not, its just that simple. In evidence based medicine, if a treatment works, it will be incorporated into "mainstream" medicine. If it does not work, no matter how good its past pedigree may be, it will be discarded.

Two cases in point illustrated by the authors are the treatment of scurvy and bloodletting. When it was first discovered that scurvy could be avoided by eating limes (hence the reference to British sailors as "limeys"), this was an "alternative" treatment. It was not known how it worked, and based on current medical practice it was thought to be fairly ridiculous. However, it worked. Studies that were done quite plainly revealed that it worked, and that was all that was required for its ultimate acceptance by the medical community.

The flip side of this is bloodletting. Bloodletting was advocated by "mainstream medicine" since the time of Hippocrates ca. 400 BC. For over 2,000 years this treatment was used by the very best doctors on the very wealthiest and most powerful people: princes, queens, presidents, etc. It was used on George Washington, very likely hastening his death. It was almost universally accepted by all learned physicians. And yet, its pure and unadulterated quackery. Bloodletting is helpful in only an extremely specific set of circumstances when there is fluid around the heart. In all other cases, about 99% of cases, it is harmful and even fatal. And yet, it was routinely practiced for thousands of years for a vast array of conditions moderate and severe, and well meaning and well educated doctors routinely killed their patients. It wasn't until evidence based medicine forced this treatment to undergo well conducted studies that the truth was revealed: this treatment is not helpful and is almost always harmful. In response, the "medical establishment" abandoned the treatment. Some abandoned it kicking and screaming, but it was abandoned. (at least it was in the Western world)

In these two stories lie the only thing a lay person needs to know about medical treatments: If a treatment works, it will be accepted. If it doesn't work, it will be rejected. The method for determining if a treatment works is a well controlled clinical study. Any treatment which cannot show an effect in such studies almost surely has no effect above placebo and may in fact by harmful to you.

The reason that the vast majority of so-called "alternative" treatments are rejected is that they just do not work. Well controlled clinical studies show this time after time. A few do appear to have an above placebo effect for certain conditions, and these will and are being incorporated into "mainstream" medicine (St. John's Wort for mild depression for example). But the hard truth is that many simply have no effect. There is no conspiracy, there is no inherent bias against "alternative" medicine, its simply that they fail to show any positive effect above placebo and in fact, many of them are inherently dangerous. For example, Ma huang (a common delivery agent for ephedrine) has caused numerous deaths.

The bottom line is if a treatment works above placebo, there is no reason it should not show an effect in well controlled studies. However, the vast majority of "alternative" treatments show the same track record: initial positive results in poorly conducted studies, a much smaller effect in better controlled studies, and then no effect above placebo in well controlled studies. This is exactly what one would expect from a treatment that has a placebo effect and is not just confined to "alternative" therapies; all new treatments have to undergo these types of studies. These studies are the reason we know limes (vitamin C) prevent scurvy and why we know bloodletting doesn't work. It's the reason we know why any accepted treatment works, they all have to pass muster in carefully controlled clinical studies.

At the end of the day, a treatment should be able to show its effectiveness in clinical trials. If it cannot, it is almost certain that it simply doesn't work and that it may in fact be harmful. And no matter what its historical pedigree or how emotionally satisfying its use may be, it should be discarded in the scrap heap of history, just as was done for bloodletting.

There's nothing biased or conspiratorial about this approach. In fact, its just a refinement of every day common sense.

I perused this book at the bookstore. As a Chiropractor I was especially interested in the information on Chiro and their suggestions. One statement was that Chiros commit more malpractice than medical doctors. That is an absolute lie. If that were true than insurance rates would reflect that. I pay $96.08 per month for 3 million dollars worth of malpractice coverage. They are either very poor researchers of the literature or they are purposely being dishonest. They also neglected to include some very important data on the use of Chiropractors as primary care physicians in Illinois and published in the peer-reviewed journal JMPT May 2007. Here is a summary statement from Richard I. Sarnat, M.D. (An honest medical doctor) "My research, conducted over a ten-year period utilizing clinical and cost outcomes data from one of the largest insurance underwriters, suggest that the regular utilization of chiropractic could reduce the need for hospitalization, pharmaceutical usage and overall global healthcare costs by almost 50%" The 10 year study showed that using Chiropractors as primary care physicians resulted in a 60.2% decrease in in-hospital admissions, 59% decrease in hospital days, 62% decrease in outpatient surgeries and procedures and an 85% decrease in pharmaceutical costs. If all these patients saw the MD first (as they suggest you should) then these savings would not be realized. It's so easy to paint any picture they want by conviently leaving out vital information. Let's also look at who utilizes Chiropractic care. Tiger Woods, Lance Armstrong, Tom Brady, Joe Montana, Dan Marino, Peyton Manning etc. All the NFL, NBA and MLB teams have staff chiro's. These athletes would not subject their million dollar bodies to Chiro care if it wasn't safe and effective. These authors need to get together with Michael Moore and make a fake-u-mentary. They can leave out facts such as prescription drugs being the 3rd leading cause of death or that medical errors are the fourth leading cause of death (Facts that are well documented in PubMed and books written by other honest MD's). They can convince everyone that the only solution to your health problems are man-made patented, synthetic toxic substances and that everything natural is "unscientific". Americans consume more prescription drugs than the rest of the world combined but the US is rated 37th in health. Using logic, and common sense, it is apparent that drugs do not equal health. I could go on and on about these bozo's but that should suffice. The fact is that most of their undeniable facts are in fact deniable.

It would be almost impossible to review this book properly at amazon.com. It would take more than words that what we are supposed to write, and I try not to exceed the limit. Also, I don't work in the healthcare profession, but I have studied many topics related to healing for years. In order not to repeat the same qualification over and over, many of the statements in this review are based on my experience, as someone who has experienced both conventional and alternative treatments, from extensive reading and other research, and also from discussing health problems that people I know have dealt with.

Before I state many criticisms of "Trick or Treatment," I do think that people should read it, and I appreciate what I think are valid criticisms of some alternative treatments. Because this book either in detail or in summary covers so many alternative treatments, I think that it would be fascinating to use this book as a reference to really get to the truth of which treatments do and don't work, and when applicable, specifically for which maladies.

As I read many of the reviews at amazon and others on the Internet, I can only assume that these reviewers haven't had serious health problems that were not solved by conventional treatments, and haven't spent huge sums of money on conventional treatments that did not work. Alternative treatments work, and at least in the US they are usually far less expensive. Changing one's diet can make a huge difference in one's health, whatever the authors believe. Their knowledge of supplements also leaves a lot to be desired. I can attest to that from experience, and what is really lacking in their writing is the fact that ingredients in supplements often work *together*, so stating that a supplement is not effective can sometimes be quite misleading.

The authors make the point over and over that alternative treatments don't pass clinical trials, and that's fine as far as it goes, but let me ask the reader of this review: if someone you know tried an alternative treatment for a condition you knew was very serious, and the treatment worked, would you care if that treatment had passed clinical trials, assuming you or someone you wanted to help needed to be cured of this illness? In a similar vein, on p. 286 the authors write that "conventional medicine has no prejudice against any alternative treatment that can prove its worth, both in terms of safety and efficacy." This is such bunk it's hard to know how to react. There are many, many books written by physicians and healthcare professionals that refute this very false statement. A book called "The Medical Mafia," written by a Canadian physician, comes to mind. The Rife treatment from the 1930's was falsely and unfairly suppressed by the medical establishment. Dr. Burzynski had years of legal troubles because his cancer treatment didn't put money in the controllers' pockets. That the US medical establishment is overwhelmingly controlled by the pharmaceutical industry is beyond question.

People are not nearly as stupid as the authors obviously believe. They try alternative treatments because they have given up with the time and expense of conventional treatments that don't work, and they've decided either through research or from word of mouth that an alternative treatment works. The authors want us to believe that overall if an alternative treatment works, it's only because of the placebo effect or the "normal" course of an illness resolving itself. My comment to this is: if you can't explain something, explain it away.

Over and over we read that huge amounts of money are spent on alternative treatments. Surely this isn't a fraction of what is spent on conventional treatments. What world are these authors living in? I've read differing accounts of what it costs for an average cancer patient in the US to receive the "slash and burn" chemo and radiation treatments, but it is at least hundreds of thousands of dollars. And that brings up another problem with the book. They make cost assessments using data from what are clearly countries with socialized medicine when they choose to, but never refer to the unbelievable costs of healthcare in the US when it doesn't suit their agenda.

They cherry pick incidents of someone taking St. John's Wort when their mental problems require more serious medication, or someone else taking too much vitamin B6. So what? I found this reference: "according to the groundbreaking 2003 medical report Death by Medicine, by Drs. Gary Null, Carolyn Dean, Martin Feldman, Debora Rasio and Dorothy Smith, 783,936 people in the United States die every year from conventional medicine mistakes." But we get only vague snippets of problems with conventional medicine. Referring back to the St. John's Wort case mentioned above, the problems with people's behaviors when taking conventional psychiatric medications surely dwarf the authors' selective use of data. Anyone can look these things up on the Internet.

Referring to comments page on p. 243, I challenge anyone to look into the Gerson Therapy and say that it doesn't work. Watch a video called "Dying To Have Known" and decide for yourselves. The documentary claims, for example, that 446 of 450 people with TB were cured. Are the authors of this book going to tell us that the Gerson people are lying? Many people who were cured of cancer are interviewed. A clinic in Japan uses the treatment. It was built by doctors who are interviewed, and at least one of the doctors was helped by the therapy. Are these all lies? What is wrong with doctors who say that such evidence is "anecdotal" or not supported by clinical trials, and thus not true?

I will conclude this review at this point, but I would advise anyone to check what I am saying and find your own truth. And I can tell you from experience, sometimes conventional treatments are best, and sometimes they are not, and you do not get this impression at all from reading this book, regardless of the fact that the authors do say this in certain places.

The book arrived promptly in exactly the advertised condition. The price was reasonable and the service was good.

Is alternative medicine bad? Well, the authors of this book certainly think so. And they have a strong belief that scientific reasoning will prove it is bad. Unfortunately, while they spend a lot of time explaining "science", they spend very little time using it to back up their arguments.

The book focuses on four alternative medicines: Homeopathy, Acupuncture, Chiropractors and herbal remedies. Homeopathy is viewed as purely bogus, while the others are seen as having some very limited value. Significant space is devoted to the history of each of these alternatives (as well as a history of modern scientific medicine.) These histories are easily the best part of the book. Their biggest fault is the writing style, which comes across as juvenile and condescending.

The analysis of alternative medicine is where the book really falls apart. A typical analysis will provide some anecdotes that appeared to show it worked. Those will be brushed off as "anecdotes", and then some studies showing success. Those will then be brushed of as "invalid" and a "metastudy" will then show that the "alternative" is of very little value. Finally anecdotes will be used to show that harm can occur when using the alternative remedy. Very little data is given to back up the statements given (not even a footnote with a paper citation!) Do the metastudies include studies by alternative medicine practitioners? Or are these studies filtered out in favor of studies by conventional doctors? How would a more conventional treatment stand up to similar scrutiny? (Is a study with a doctor performing "fake" acupuncture any more reliable than one with an acupuncturist performing "fake" surgery?) The over-reliance on anecdotes is also problematic, as it could just as easily be switched to provide negative anecdotes for conventional medicine, with positive ones for the alternatives.

It is obvious that the authors have a distaste for much of alternative medicine and have produced this book in an attempt to persuade a large audience of their belief. Unfortunately, by using the "snake oil" arguments that they claim to be fighting, they provide very little of value to the debate.