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Pain Management

by Simon Singh and Edzard Ernst
W.W. Norton, 2008
Review by Sue Bond on May 19th 2009

Trick or Treatment

This outstanding book aims to show how science and evidence-based medicine are much better at providing effective and safe treatments for our ailments than anecdote and opinion. The arguments of the authors are thorough, fair and convincing, and the presentation clear, well-organized and easy to understand, making it an especially valuable book for the lay person interested in complementary medicine and health care in general.

  Simon Singh has a PhD in particle physics, is a journalist, television producer and author of such books as The Code Book, Fermat's Last Theorem, and The Big Bang. Edzard Ernst is a medical doctor with a PhD, and the first Professor of Complementary Medicine in the United Kingdom, which makes him extremely well-placed to co-author a book on this topic. He has also co-authored The Oxford Handbook of Complementary Medicine, amongst others.

People the world over spend enormous amounts on alternative therapies (up to £40 billion is suggested), and yet do we know for certain whether or not they help and not harm us? The regulations on these therapies and products are often surprisingly poor, unlike those that control conventional medicine and pharmaceuticals.

Singh and Ernst do not set out to comprehensively condemn alternative therapies, but rather to emphasize the importance of evidence. Properly conducted clinical trials (double blind, randomized, placebo-controlled) are the best way to ascertain whether or not a therapy or product provides benefit beyond the placebo, and this applies to all therapies, not only complementary ones. It seems obvious, but as the authors state, the 'plural of anecdote is not data'; it seems that some alternative therapists rely on anecdote to 'prove' their success.

The book's structure consists of six major chapters, the first and last dealing with truth in medicine (its determination and its importance), and the other four each taking a major alternative therapy in turn and explaining its history and its efficacy according to clinical trials performed to date. Acupuncture, homeopathy, chiropractic therapy and herbal medicine are all discussed, and conclusions drawn from the evidence collected.  

The last section of the book, an appendix, is a 'rapid guide' to three dozen or so complementary therapies, diagnostic tools, and diets, including crystal therapy, cupping, meditation and reiki. There is a relatively short but useful list of further reading (books, journals and websites), and an index.

The authors quote a line from a book by the historian David Wootton: 'For 2,400 years patients believed that doctors were doing them good; for 2,300 years they were wrong'. Before the advent of science and clinical trials, neither patients nor doctors had much consistent evidence for whether or not treatments such as bloodletting, purging and arsenic (so-called heroic medicine) actually worked. Until our knowledge of science and medicine increased, and treatments for disease became effective rather than dangerous, it was more likely that a patient would die from the treatment than recover. Under these circumstances, at least therapies such as homeopathy did not harm the patient, and so were viewed as better than the conventional methods of the time.

The authors show, through the testing done to date, that many, but not all, alternative therapies have no basis in science, and sometimes are harmful, either because they have risks (e.g. chiropractic therapy has a risk of causing stroke when the cervical spine is manipulated) or because they replace effective conventional treatment or otherwise interfere with therapies that would help the patient. Of the major therapies presented for examination, certain herbal medicines hold the most promise. St John's Wort, for example, has been shown to ease mild to moderate depression, but it must be used with caution because it interacts with other medications.

There are people who will dismiss this book as being unfairly biased against alternative therapies, or obviously funded by pharmaceutical companies (neither of which is true), but I cannot stress enough that the intention of the authors is to emphasize the importance of gathering evidence. And whether it is conventional or alternative medicine that is being examined, that evidence for efficacy and safety is equally vital. Just because some of the conclusions from the evidence may be inconvenient or uncomfortable does not make them wrong.

© 2009 Sue Bond

Sue Bond has degrees in medicine and literature and a Master of Arts in Creative Writing. She reviews for online and print publications. She lives in Queensland, Australia