SOUL + BODY: Pioneer Makes About-Face on Alternative Medicine

Edzard Ernst, M.D., perhaps the world's first professor of complementary medicine at the University of Exeter, has changed his mind about alternative medical treatments. Ernst, who began his medical career at a homeopathic hospital in Munich, recounts his reasons in a copiously researched, hard-hitting examination of the scientific efficacy of acupuncture, homeopathy, chiropractic, herbal medicine, and 36 other modalities in Trick or Treatment: The Undeniable Facts about Alternative Medicine (W.W. Norton, August 2008). Cowritten with science writer Simon Singh, the book includes a comprehensive history of various modalities, as well as a readable explanation of testing and clinical trials, why they work, and the ways they can be compromised.
The authors' question for each treatment is simple: does it deliver the physiological cure or change that it promises better than or as well as a placebo or allopathic medicine? To find the answer, they examined clinical trials, studies, meta-analyses, and systematic reviews of some 4,000 investigations and came to believe that, aside from some limited positive effects (see sidebar), most alternative treatments have no curative value, and when they appear to be curative, it's a placebo effect or coincidence (a disease resolves itself).
The authors claim there is no scientific evidence of the qi or chi employed in acupuncture, meridians, life-force energy, or the extreme dilutions claimed in homeopathy. They refer to the history of plant (aka herbal) medicine as "haphazard," and they label anything unprovable as "implausible" or "meaningless." Anecdotal evidence to the contrary is wishful thinking.
In the case of acupuncture, Singh and Ernst examined 293 research papers, including studies where placebo acupuncture was delivered by needling patients too shallowly for it to be effective by acupuncture's standards or by needling them in non-acupuncture points. Homeopathy and herbal medicine were studied the same way as allopathic drugs. And chiropractic was evaluated through three reviews of back pain, two reviews of neck pain, and one review of neck and back pain, as well as 10 systematic reviews based on the best-quality 70 trials for chiropractic's effectiveness as a treatment for non-musculoskeletal maladies (headaches, menstrual period pains, infantile colic, asthma, and allergies). Repeatedly, alternative modalities were shown to be ineffective or of limited effectiveness. (It's important to note that Singh and Ernst studied evidence-based "cures," not the "healing" that we attribute to finding spiritual wholeness, regardless of medical outcome.)
Since the most positive results of alternative treatments were attributed to placebo effect, the authors also grappled with the ethics of doctors prescribing placebos and concluded that honesty between patient and doctor is paramount, so placebo therapies should be discouraged.
Since Trick or Treatment's publication in the U.K. in April, Ernst says he's been shocked by the backlash from the alternative health industry. "Alternative health is not just another form of healthcare but a form of religion," he says. Proponents "are believers . . . and any type of doubter is a sinner." To answer the backlash, he's offered £10,000 to anyone who can prove that homeopathy works in a double-blind clinical trial. Ironically, the book has the passion of people who have had a conversion experience; Singh and Ernst are "true dis-believers" . . . with some very important findings.
Betsy Robinson

Treatments with evidence-based Benefits

Acupuncture / for pelvic and back pain during pregnancy, low-back pain, headaches, post-operative nausea and vomiting, neck disorders, bedwetting
Chiropractic / for back pain, practiced by chiropractors who are called "mixers"
Herbal Medicine / the book lists a table of herb-specific treatments, rating them from poor to good
Other Modalities / of those studied, the following were found to have possible qualified benefits for specific problems: Alexander Technique, alternative exercise therapies, aromatherapy, Ayurvedic tradition, some food supplements, hypnotherapy, leech therapy, massage therapy, meditation, osteopathy, relaxation therapies, Chinese medicine