CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.26 REVIEWS OF ‘TRICK OR TREATMENT? ALTERNATIVE MEDICINE ON TRIAL’

by Simon Singh and Prof Edzard Ernst, published 2008 by Bantam Press £16.99

John Kapp, 22, Saxon Rd, Hove BN3 4LE, East Sussex
  johnkapp@btinternet.com   Tel: 01273 417997


Review 5 dated 27.7.08

Ernst and Singh come from the materialist, reductionist, mechanist paradigm, (underlying belief system) so understand and represent only conventional medicine. This sees only the body and recognises only interventions which change the body directly with surgery or drugs. The authors do not understand the language of alternative therapy (holism) whose interventions change the body indirectly, through the mind and spirit. They are in denial of mind (‘placebo effect – little white lies or fraudulent falsehoods’ p 244) and spirit (‘there is no evidence whatsoever for the existence of a vital force p104). As articulate Neanderthals, the authors are not qualified to pass judgement on alternative medicine, but they are ideally suited to expose the enormity of the gulf between it and conventional medicine. Their book is hence a brilliant exposition of the urgent need for the healing of medicine itself through a paradigm shift to holism.


Review 4 dated 15.7.08

By this book, Ernst and Singh become the Gilbert and Sullivan of medicine, for they parody the absurdities of their science in a hilarious way. Under their materialist paradigm, matter is the only reality, so only ‘things’ exist. This is fine with illness, which manifests in the body as a pathological ‘thing’ which can be observed, say under a microscope.

However, the authors have a problem with subjective phenomena, such as life and intelligence. They say that ‘there is no evidence whatsoever to support the existence of a vital force’ (p104) ‘and innate intelligence, and its role in health’ (p147) To them, life and intelligence cannot be observed by science, so they do not exist. Would you go to a doctor who could not tell whether or not you are alive?

They have a similar problem with mind. ‘Many bogus therapies from the nineteenth century turned out to be nothing but placebo-based treatments…the impact of the cure was on the mind, not the body.’ (p55) And although they mention that Pavlov won a Nobel prize in 1904 for his ‘conditioned dogs that would salivate at the sound of a bell’ (p60) they do not recognise mind/body effects, such as placebo, except to dismiss them as ‘little white lies, or fraudulent falsehoods’ (p244). Has no talking therapy any place in medicine?

About life, mind, and alternative therapies, the authors have the absolute confidence of complete ignorance. However, they still deserve our gratitude for an easily readable book ridiculing conventional medicine and showing the necessity for a paradigm shift to holism.

Review 3, dated 7.7.08

We see reality, not as it is, but as projected through the lens of our belief system (paradigm) which is coloured and distorted by our emotions. Our personal horror stories make all of us emotionally prejudiced one way or the other about health.

The authors are in love with (and paid by) conventional medicine, so it is the good guy who can do no wrong. They therefore hate alternative medicine, so it is the bad guy who can do no right. If you are prejudiced in the same way, you will love this book. If the other way, you will hate it.

However, if you can take 3 deep breaths, swallow hard, rise above prejudice and concentrate on the policy issues in healthcare regulation that the book discusses, you will find that it raises them in a clear and helpful way. The book is therefore a must-read for health policy makers and taxpayers throughout the world who are concerned about the 10% of GNP of public money that is spent on healthcare. .

The authors believe that the health budget is misallocated, and that governments are paying for the wrong treatments. ‘We argue that it is now time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress, and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatments that demonstrably generate more harm than good.’ (p288)

That is the punchline of the book, (the penultimate paragraph) and it is as unexceptional as mother’s milk and apple pie, apart for the Freudian slip in switching ‘harm’ and ‘good’. That indicates that the authors know deep down, but cannot say, that medicine has become the single biggest killer, having overtaken heart disease. (source ‘Death by Medicine’ by Dr Gary Null www.garynull.com)

About the money, they say: ‘One might argue that every individual has the right to spend money according to his or her own wishes, but if alternative practitioners are making unproven, disproven, or vastly exaggerated claims, and their treatments carry risks, then we are being swindled at the expense of our good health.’ (p240) Of course the authors could not say that this should also be applied to conventional practitioners.

Their coded message is that taxpayers throughout the world are being swindled to finance (conventional) therapies which are harming and killing them; a genocide which all doctors, health authorities, governments and taxpayers are unwitting accomplices.

Issues Raised in the Book
Issue 1 Placebo effect.

This is the same issue as the opening sentence above. It is the joker in the conventional pack, because it is not objective but subjective.. It challenges the authors’ need for certainty in life (what they call the ‘truth’) and pops up in every chapter. The following are quotes, showing how the placebo effect is a red rag to the authors’ bull, and how they impale themselves on the horns of its dilemma.

Placebo is latin for ‘I will please’ … insincere or ineffective treatment that can be consoling….Any form of treatment that relies heavily on the placebo effect is fraudulent. Many bogus therapies from the nineteenth century turned out to be nothing but placebo-based treatments… the impact of the cure was on the mind, not the body…p55

‘Although the patient will derive benefit from the aspirin largely due to the pill’s biochemical effect, there can be an added bonus due to the placebo effect, which is a result of the patient’s confidence in the aspirin itself or the physician who prescribes it. A genuine medicine offers a benefit that is largely due to the medicine itself, and partly due to the placebo effect, whereas a fake medicine offers a benefit that is entirely due to the placebo effect.’ (p57)

‘Many physicians throughout history have been quick to hype their reputations, link high cost with medical potency and emphasise the novelty of their cures, so perhaps were aware of the placebo effect. (p57)

Sure enough, after a while, the conditioned dogs would salivate at the sound of the bell alone. The importance of this work is best reflected in the fact that Pavlov went on to win the Nobel prize for health in 1904. (p60)

‘The placebo effect is particularly good at addressing issues such as pain, swelling, fever, lethargy, loss of appetite, so perhaps the placebo effect is partly the consequence of an innate ability to block the acute phase at a fundamental level, possibly by the power of expectation. (p61)

Issue 2 Confirmation bias (Tolstoy syndrome)
Men can seldom accept the simplest and most obvious truth if it would oblige them to admit the falsity of conclusions which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives…. . Practitioners are highly prone to confirmation bias as they have vested interests, both emotional and financial, in seeing therapy work. (p234)

Exaggerated claims for the efficacy of a medicament are very seldom the consequences of any intention to deceive; they are usually the outcome of a kindly conspiracy in which everybody has the best intentions. The patient wants to get well, his physician wants to have made him better, and the pharmaceutical company would have liked to have put it into the physician’s power to have made him so. The controlled clinical trial is an attempt to avoid being taken in by this conspiracy of goodwill. (p87)

Perhaps the clinical trial is part of an establishment conspiracy cooked up by doctors and scientists to protect themselves from meddling outsiders. (p148)

The statistical approach was anathema to free-wheeling doctors who resented any doubt being expressed about the effectiveness of their untested treatments. (p152)

Compare ten sessions with a chiropractor at £50 each, with regular exercise or ibuprofen which are both relatively cheap, and the price difference is obvious. (p156)

‘How do we resolve this conflict between personal experience and scientific research? If a particular alternative treatment were proven effective tomorrow, then scientists would accept it and immediately attempt both to apply it and to understand its mechanisms….The scientific community lovingly embraces those mavericks who can find evidence to support their claims.(p225)

Issue 3 How does alternative therapy work?
The goal of homeopathy is ‘trying to restore a patient’s vital force to its usual healthy balance. Hahnemann proposed that this vital force, something akin to spirit, permeated the body and entirely determined a person’s wellbeing…(p104) … Not surprisingly, modern science struggles to accept homeopathy …..there is no evidence whatsoever to support the existence of a vital force.’ (p105)

..describes how chi, a vital energy or life force flows through our body via channels known as meridians. Illnesses are due to inbalances or blockages in the flow of chi, and the goal of acupuncture is to tap into the meridians at key points to rebalance or unblock the chi (p43)…..scientists are still unable to find a shred of evidence to support the existence of meridians or chi. (p53)

Palmer (1845-1913, the father of chiropractic) viewed God as the Universal Intelligence guiding the totality of existence, which meant that innate intelligence represented God’s guiding influence within the human body….(p161) …but there is no evidence for the existence of innate intelligence or its role in health (p147)

Conventional doctors were annoyed by Palmer’s boast that chiropractic is a science of healing without drugs (p161)

Alternative therapists use the term holistic to imply that their approach is superior to conventional medicine, but this ‘more holistic than thou’ attitude is unjustified. Holistic merely means taking a whole person approach to medicine, and conventional doctors will also treat their patients holistically……If anything, conventional medicine takes a more holistic approach than alternative medicine (p223)

Issue 4 Government regulation against vested interests
Even the most benign alternative medicine can become dangerous if the therapist who administers it advises the patient not to follow a conventional medical treatment. (p188)

The medical establishment had several reasons for despising chiropractic. These included their belief in the unscientific notions of innate intelligence, their denial that bacteria and viruses cause many diseases, and their conviction that realigning a patient’s spine could cure every ailment. (p163)

The American Medical Association (AMA) had engaged in a massive disinformation campaign to discredit and destabilise the chiropractic profession, and engage in many other activities to maintain a medical physician monopoly over healthcare in this country. (1987 judgement p165)

Perhaps acupuncture would turn out to be as useless as bloodletting, or perhaps as effective as lemons. ….In ‘Acupuncture; the WHO view’ Bannerman stated that there were more than twenty conditions which lent themselves to accupuncture treatment, ….. By 1990, Europe had 88,000 acupunturists, and over 20 million patients had received treatment. Many were independent practitioners, but slowly the therapy was becoming part of mainstream practice….roughly half of all practicing doctors had arranged acupuncture sessions for their patients. (p52)

For 2,400 years (since Hippocrates) patients believed that doctors were doing them good; for 2,300 years they were wrong. For most of our history most medical treatments have failed to treat most of our diseases effectively. In fact, most of the doctors from previous centuries harmed rather than healed our ancestors. (p273)

It would seem obvious that governments ought to be playing a more active role, by banning dangerous or useless alternative therapies, and properly regulating those that are harmless and beneficial…..British authorities are moving in the opposite direction, as they seem keen to encourage the use of largely unproven treatments…to return to the Dark Ages… (p275)

Conclusion
The authors deserve public praise for raising the hot potato in health in a clear and amusing way. They write with the paternalistic attitude of the medical establishment - standing on a pedestal telling us where we get off, but with the desperation of the captain of the Titanic who knows that his ship is sinking. They attack alternative therapy as if it is the iceberg, whereas it is really the lifeboat. The book aptly demonstrates the urgent need for a paradigm shift in government from materialism, reductionism, and mechanism to holism.

Review 2 dated 28.6.08

This book is a must-read for every doctor and health authority policy maker throughout the world, because the authors purport to speak for you in the name of science. It is the most significant book on world health policy that I have come across to date. However, to obtain the true significance of this book, you should mentally switch two words. For ‘alternative’ read ‘conventional’, as every sentence brilliantly epitomises what is wrong with conventional medicine.

The scope of the book is stated on the cover: ‘Welcome to the world of alternative medicine. Prince Charles (to whom the book is dedicated) is a staunch defender, and millions swear by it. Most UK doctors consider it to be little more than superstition and a waste of money. But how do you know which treatments are effective and which are potentially harmful?’

Now you can at last find out, thanks to the authors….Together they have written the definitive book on alternative medicine. It is honest, impartial, hard-hitting, and provides a thorough examination of more than thirty of the most popular treatments, ……and delivers the ultimate verdict with clarity, scientific rigour and absolute authority.

Our mission is to reveal the truth about the potions, lotions, pills, needles, pummelling and energizing that lie beyond the realms of conventional medicine, but which are increasingly used supposedly to heal patients. We want to find out: what works and what doesn’t? What are the secrets and what are the lies? Who can you trust and who is ripping you off? Do today’s doctors know what is best or do the old wives tales indeed tap into the ancient wisdom? All these questions will be answered in this book, the world’s most honest and accurate examination of alternative medicine.’

The book consists of 342 pages of which 47 are devoted to acupuncture, 50 to homeopathy, 42 to chiropractic, 42 to herbal medicine, and an appendix giving one page to each of 36 other alternative therapies.

The authors write clearly and give a good historical account of the development of western medicine over the last 4 centuries. For example, it quotes how James Lind did a clinical trial in 1747 to prove the efficacy of lemon juice against scurvy, (p19) and how Dr John Snow cured the local cholera epidemic in Soho, London in 1854, by taking off the handle of the Broad St water pump, thereby proving that its cause was contamination of that well. (p112)

They define ‘heroic’ medicine as ‘aggressive practices that dominated healthcare up until the mid 19th century…The label reflected the role played by the supposedly heroic doctor, but anyone who survived the treatment was the real hero.’ (p108) For example, bloodletting was the standard treatment for most diseases until the mid 19th century until clinical trials showed that it had no curative effect and killed many patients including George Washington in 1799 (p23).

They quote Voltaire: ‘Doctors are men who prescribe medicine of which they know little, to cure diseases of which they know less, to patients of whom whey know nothing… A good physician is one who keeps his patient amused while nature does the healing.’ (p109)

They are admirably clear in their conclusions. ‘The bottom line is that none of the above treatments is backed by the sort of evidence that would be considered impressive by the current standards of medical research. Those benefits that might exist are simply too small, too inconsistent and too contentious. Moreover, none of these alternative treatments (apart from a few herbal medicines) compare well against the conventional options for the same conditions. This dismal pattern is repeated in the appendix where we examine many more alternative therapies.’ (p238)

What about life, health, mind?
The authors rightly identify the goal of homeopathy (and all alternative therapies) as: ‘trying to restore a patient’s vital force to its usual healthy balance. Hahnemann proposed that this vital force, something akin to spirit, permeated the body and entirely determined a person’s wellbeing…(p104) … Not surprisingly, modern science struggles to accept homeopathy (and all alternative therapy) …..there is no evidence whatsoever to support the existence of a vital force.’ (p105) (my italics)

This shows that the authors are stuck in the materialistic paradigm (underlying belief system), that matter is the only reality, with its correspondingly reductionist belief that the whole is the sum of its parts, and the mechanistic belief that people are machines, like tinmen.

If the authors do not believe in a vital or life force, do they believe that they are alive? If so, what makes them alive, or gives them life? The evidence for the life force in the authors is that they have written this book. Or do they think that machines, tinmen, or corpses can write books? Of course not. Saying that they do not believe in a life force simply means that they are blind to life, and in denial of the life force which flows through them and everybody else.

Many people are in denial of many things, so the authors are not alone in their life-blindness, and life-denial. However, they have written a book on alternative therapy, which is about health. What do the authors know about health? Do they even know what health is?

Their only quote about health is the above mentioned one on p104-5, and they only quote Hahnemann’s statement to deride him and it. This shows that they are also in denial of health. Furthermore, they make no mention of the science of psycho-neuro-immunology, (PNI) which for half a century has been studying how the mind effects the body’s chemistry, (known as mind/body medicine) This shows that they are in denial of mind, too.

Can authors who are in denial of life, health and mind write anything useful about alternative therapy? No. Unless you accept Hahnemann’s premise that ‘therapy is trying to restore a person’s vital force, akin to spirit, to its normal healthy balance’, you cannot say anything meaningful about health or therapy. So the authors’ conclusions about alternative therapies are simply rubbish.

However, I am not rubbishing their book. Far from it. By writing this book in this somewhat perverted way, I believe that the authors are doing the health sector of society an immense service. It is a brilliant exposition of why society needs to change the paradigm of medicine from materialism (treating just bodily sickness) to holism, (creating health).

The awful truth is that the authors do indeed speak for most doctors and health policy makers throughout the world. But would you put your life in the hands of someone who is life-blind, life-denying, and who has no idea what health or mind is? Furthermore, would you put into their hands the determination of the health of your family and your nation, and give them 10% of GNP with which to get on with it?

Such people might well kill you, as the authors graphically described as happened to George Washington. Although they say ‘these doctors were not stupid or evil; they merely lacked the knowledge that emerges when clinical trials flourish’. (p25) that statement is not necessarily true, as Dr Shipman proved. If you do not believe in life, you may well be on the slippery slope of believing that you and your patients might as well be dead, and as the world is overpopulated genocide is a good idea.

The scary thing about this book is that the authors accurately reflect the underlying belief (paradigm) of government policy not only in UK since the nationalisation of health in 1948, but throughout the world. For the last 60 years the UK government delegated the health of the nation to people like the authors, and gave them carte blanche to do as they liked, funding them with taxpayers money to pay for it. (currently £100 billion pa)

Not surprisingly, this has enabled the drug companies to feather their nests to the tune of $trillion pa. That industry could more accurately be described as a mafia, or a cancerous tumour in society. Before the war, conventional medicine was a life-saving blessing to society, but nationalization has gradually made it into a genocidal curse

Iatrogenic medicine (doctor-induced disease)
This book is really a much-needed indictment of conventional (not alternative) medicine. Conventional medicine, under the materialist paradigm, has always been a sickness service, not a health service. As it is in denial of life and mind, how can it know what health is, or how mind affects the body?

It is therefore doomed to have only have one tool in its kit, namely a hammer. All it can do is hammer the body by cutting, burning or poisoning it with drugs. If all you have is a hammer, everything and everybody in society looks like a nail. Every sentence in the book exudes the proselytising, paternalistic, control-freak, attitude of conventional medicine, hammering us to death with useless advice and treatments which do not work and make us ill.

Thanks to unmonitored taxpayer’s money, that hammer has grown into a sledge hammer. Indeed conventional medicine has become a mortal disease in its own right which has now overtaken cancer and heart disease to become the world’s biggest killer. (see Dr Gary Null’s report ‘Death by medicine on www.garynull.com)

The book should be judged by its punchline at the end: ‘We argue that it is now the time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress, and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatments that demonstrably generate more harm than good.’

Apart from their Freudian slip in switching ‘harm’ and ‘good’, I wholeheartedly agree with the authors, and believe that every good-hearted citizen would support their conclusion. That slip indicates that the authors know well (but have suppressed into their unconscious) that it is conventional, not alternative, medicine that needs to be exposed to the light of truth.

Quoting the authors again (p240), ‘One might argue that every individual has the right to spend money according to his or her own wishes, but if alternative practitioners are making unproven, disproven, or vastly exaggerated claims, and their treatments carry risks, then we are being swindled at the expense of our good health.’ This admirable statement should be applied to conventional as well as alternative practitioners.

All people throughout the world are being forcibly swindled through their taxes to finance conventional therapies which are killing them. This is effectively genocide, to which all doctors, health authorities and governments are accomplices.

The first duty of government is to protect their people through their regulatory bodies, but no government honours that except in the breach. Hippocrates would turn in his grave to see the harm that doctors do today in contradiction of their oath. The authors deserve our praise in drawing attention to this swindling genocide. It is now up to all of us to take political action to stop it.

Review 1 dated 16.6.08

Cover
This book claims to be ‘the definitive book on alternative medicine….and delivers the ultimate verdict with clarity, scientific rigour and absolute authority. …Most UK doctors consider it to be little more than superstition and a waste of money…..Our mission is to reveal the truth about the potions, lotions, pills, needles, pummelling and energizing that lie beyond the realms of conventional medicine, but which are increasingly used supposedly to heal patients. We want to find out: what works and what doesn’t? What are the secrets and what are the lies? Who can you trust and who is ripping you off? Do today’s doctors know what is best or do the old wives tales indeed tap into the ancient wisdom? All these questions will be answered in this book, the world’s most honest and accurate examination of alternative medicine.’

The introduction and chapter 1 ‘How do you determine the truth?’
give a historical resume of conventional cures. It shows ‘what the world was like before the advent of clinical trials and evidence based medicine; doctors were oblivious to the harm they caused by bleeding millions of people, indeed killing many of them, including George Washington in 1799. These doctors were not stupid or evil; they merely lacked the knowledge that emerges when medical trials flourish.’ (p25) It describes how four mavericks took on the medical establishment, as quoted below:

The cure for scurvy (lemons and limes) had been documented in 1601. James Lind did a clinical trial in 1747 and confirmed its efficacy. However, the medical establishment was promoting all sorts of other remedies, and millions of sailors died of it until 1795 when three quarters of an ounce of lemon juice was added to the standard diet of British sailors. (48 years later) (p19)

Alexander Hamilton did a clinical trial in 1809 which showed that the death rate for patients treated with bloodletting was ten times greater than those who avoided it. Nevertheless bleeding continued to be a standard procedure. France imported 42 million leeches in 1833. As each decade passed rationality began to take hold amongst doctors, and dangerous and useless therapies such as bloodletting began to decline. (half a century later) (p23)

Florence Nightingale was prioritizing hygene in 1854 when everybody else was focussed on other things, such as surgery and pills. The officers and doctors felt that these changes were an insult to their professionalism, and fought her every step of the way, but she pushed ahead regardless. The death rate fell from 43% to 2%. (p27)

Hill and Doll showed in 1954 that smoking was a surprisingly deadly indulgence, and moreover produced data that stood up against the powerful interests of the cigarette industry. (p36) In 2007 was smoking banned in public buildings. (63 years later)

Chapter 2 ‘The Truth about Acupuncture’
is 47 pages long. The tortuous arguments concluded that ‘the placebo effect can be a very powerful and positive influence in healthcare, and acupuncture seems to be very good at eliciting a placebo response. Hence can acupuncturists justify their existence by practicing placebo medicine and helping patients with essentially fake treatment? (p87)

Chapter 3 ‘The Truth about Homeopathy’
is 50 pages long. Its conclusion is stated in the last two sentences: ‘Occilococcium is a self declared sugar pill. This has to be the ultimate form of medical quackery.’ (p143) A news report on 25.2.08 said that Prozac was no better than placebo, but that doctors are not allowed to prescribe placebo. The authors say that homeopathy is pure sugar, implying that homeopaths are prescribing placebo. I do not find anything unethical in that as it cannot do the patient any harm . However, Prozac has side-effects, which can harm the patient, so to prescribe it knowing it to be no better than sugar is unethical. 16 million prescriptions for Prozac were written last year. How many will be written this year?

Chapter 4 ‘The Truth about Chiropractic’
is 42 pages long, The conclusion is: ‘In short, the scientific evidence suggests that it is only worth seeing a chiropractor if you have a back problem.’ (p168)

Chapter 5 ‘The Truth about Herbal Medicine’
is 42 pages long. It concludes: ‘The evidence outlines so far in this book suggests that the majority of alternative therapies in most cases have very little to offer aside from the placebo effect.’ (p235)

Chapter 6 ‘Does the Truth Matter?’
is 51 pages long. It concludes: ‘ The bottom line is that none of the above treatments is backed by the sort of evidence that would be considered impressive by the current standards of medical research. Those benefits that might exist are simply too small, too inconsistent and too contentious. Moreover, none of these alternative treatments (apart from a few herbal medicines) compare well against the conventional options for the same conditions. This dismal pattern is repeated in the appendix where we examine many more alternative therapies.’ (p238)

The book concludes with this recommendation: ‘We argue that it is now the time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress, and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatments that demonstrably generate more harm than good. (This is copied exactly as printed, and appears to be a Freudian slip, see ‘Iatrogenic medicine’ below)

If such standards are not applied to the alternative medicine sector, then homeopathy, acupuncture, chiropractors, herbalists and other alternative therapists will continue to prey on the most desperate and vulnerable in society, raiding their wallets, offering false hope, and endangering their health.’ (p288)

The Appendix ‘Rapid Guide to Alternative Therapies’
is 36 pages long, and devotes one page to each of 36 therapies. A few (aromatherapy, exercise, food supplements, hypnotherapy, massage, meditation, osteopathy, relaxation) are acknowledged to be helpful to some patients. Most are dismissed as scientifically implausible, irrational, and with no convincing evidence. A few (colonic irrigation, oxygen therapy) are said to be potentially harmful or dangerous. The reader is often warned against charlatans taking money from patients with serious conditions who require conventional medicine urgently.

Integrated medicine
The book is dedicated to the Prince of Wales, founder of the Foundation for Integrated Health in 1993, which exists in order ‘to encourage greater collaboration between conventional and complementary health practitioners and to facilitate the development of integrated healthcare.’

However, the authors do not praise his efforts, but castigate him for promoting Gerson therapy, which they say ‘ has been discredited and is known to be potentially harmful. Gerson therapy starves already undernourished patients, depriving them of vital nutrients. Moreover, adopting Gerson therapy often means that patients abandon their conventional treatment, thereby jeopardising their main hope of recovery. ‘. (Gerson was an eminent German doctor about a century ago.)

They go on to castigate the Smallwood report (2005) which concluded that ‘CAM offers the possibility of significant savings in direct health costs’.They say: ‘In the light of all the negative evidence contained in our book, Smallwood’s conclusion seems utterly absurd.’ (p242)

Annual spend
They say that the annual spend on alternative medicine is £40 billion globally, £5 billion in Britain, of which £0.5 billion is spent by the NHS. They say: ‘One might argue that every individual has the right to spend money according to his or her own wishes, but if alternative practitioners are making unproven, disproven, or vastly exaggerated claims, and their treatments carry risks, then we are being swindled at the expense of our good health.’ (p240)

Placebos
Under a subheading ‘Placebos –little white lies or fraudulent falsehoods?’ they say: ‘We have shown that the majority of alternative treatments are wholly or largely ineffective in treating the majority of conditions. The term ‘ineffective’ however, does not mean that such treatments are of no benefit to patients, because there is always the placebo effect, which we know can offer varying levels of relief. …..Can large parts of the alternative medicine industry justify their existence by offering relief through belief? (p244) They rephrase the same question: ‘do we want our healthcare to consist of honest, evidence based treatments, or do we want it built upon a foundation of lies and deceit?’ (p245) They answer ‘no’ but I would answer as follows:

Truth.
The authors are confusing truth with facts. Everyone’s truth is different because it is their individual experience. There are many people whose experience (their truth) is that they obtained significant healing benefit from alternative medicine. The authors do not acknowledge that. The evidence base for the efficacy of alternative medicine is that it is a growing industry in the market place, despite playing uphill against the free NHS.

Belief.
The authors have a strong (I would say a religious) belief in conventional medicine, and the materialistic, reductionist, and mechanistic paradigm on which it is based. They believe that matter is the only reality, that the whole is the sum of its parts and that people are basically machines. Alternative therapists, and an increasingly large proportion of people have personal experience (known as holistic) that conflicts with that paradigm. Holists know that they are receiving a life force (chi, prana) which gives them life all their life, and health and dis-ease at different times. They know that it is not material, but spiritual. Science (quantum physics, psycho-neuro-immunology, consciousness studies) is increasingly confirming holism as a more rational belief system. (1)

Clinical trials.
The autors castigate alternative medicine for not doing more clinical trials, but fail to acknowledge the cost, which drug companies can afford, but alternative practitioners cannot. Furthermore, drug trials are increasingly shown to be flawed, with drugs such as Vioxx and Seroxat being taken off the market. (2) The evidence for statins is under serious attack (3)

Iatrogenic medicine
(doctors mistakes, mostly through adverse drug reactions) are increasing, and are said to have become the biggest single killer. (4) with 800,000 Americans being killed by it each year, compared with 700,000 who die of heart disease. The authors’ title ‘Trick or Treatment’ would therefore be more appropriately applied to conventional medicine.

Conclusion
The authors write with a tone of desperation to stop a flooding tide. Their belief system is threatened by alternative medicine and they are trying to save their religion. They write projecting paternalistic arrogance as those who know what is best for everyone, and whose advice should be taken. They rightly praise the mavericks (Lind, Hamilton, Nightingale, Doll) for taking on the medical establishment of their day, but cannot see alternative practitioners as the mavericks of today. While I do not agree with their conclusions or recommendations, they deserve praise for bringing a vital subject to the attention of the public in a clear and readable way.

References
1 See paper ‘A Holistic (non-emergent) Theory of Consciousness’ by John Kapp, www.reginaldkapp.org section9.16
2 Book Food is Better Medicine than Drugs by Jerome Burne
3 Book The Great Cholestrol Con – The truth about what really causes heart disease, and how to avoid it by Dr Malcolm Kendrick
4 Report ‘Death by Medicine’ by Dr Gary Null et al. See www.garynull.com


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