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Adelaide Festival Ideas 2009: health « Previous | |Next »
July 10, 2009

One of the Sunday sessions at the Adelaide Festival Ideas is entitled Trick or Treatment? Alternative medicine on trial---It's a talk by Simon Singh, one of the authors of Trick or Treatment? Alternative Medicine on Trial. The session is in the form of a lecture not a debate.

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The book is in the debunking tradition as the authors state in their introduction that "Our mission is to reveal the truth about the potions, lotions, pills, needles, pummeling and energizing that lie beyond the realms of conventional medicine."

The authors say their goal is to answer the question of whether alternative therapies provide any benefits — or only a placebo effect Truth’ is understood in the sense of the fundamental question: ‘is alternative medicine effective for treating disease?’ This article by Singh in The Guardian with respect to chiropractic care is an example of the approach.

The book evaluates the scientific evidence for acupuncture, homeopathy, herbal medicine and chiropractic, and briefly covers 36 other treatments. It finds that the scientific evidence for these alternative treatments is generally weak, but finds that the acupuncture, chiropractic and herbal remedies have some evidence of limited efficacy for certain ailments. Homeopathy is concluded to be completely ineffective.

Their judgement is that this book delivers the ultimate verdict on alternative medicine. What they call conventional medicine is not under scrutiny because that falls under science, knowledge and truth whereas alternative medicine falls under opinion, ignorance and superstition.

According to a review in Frontier Psychiatristthis standard Enlightenment duality is defended in the following way:

Any treatment which cannot stand up to the rigours of scientific enquiry, by which Singh and Ernst mean a well conducted controlled clinical trial, has no place calling itself medicine and is simply hocus-pocus with good PR. At best such therapy is simply no better than placebo, at worse it is positively dangerous. But even if it is harmless, it is far from costless, as the annual global spend on alternative medicine is in the region of £40 billion, money that could be spent on more fruitfully, should alternative therapies prove to be ineffective.

The position of the book is that anything that works and can be shown to do so in a properly conducted clinical trial is no longer actually alternative medicine, and anything which cannot pass these rigorous tests should be treated with great suspicion, since they are little more sugared placebo's.

Several quick points. The boundaries between orthodox and unconventional treatments are less precise than they suggest; complementary medicine has also become increasingly legitimised in the past decade; many people suffer from chronic illnesses that respond poorly to conventional treatments by orthodox medicine or from a constellation of symptoms that are not easily diagnosed or treated by mechanistic medicine; the randomized controlled trial is not the only way of gaining evidence in everyday clinical care, community health or building a knowledge base; no mention is made of the harm and deaths caused by orthodox medicine's interventions.

The appeal to well conducted controlled clinical trial is an appeal to the positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine, and this overlooks the conflict within the long-standing “paradigm war” in the philosophy of science between positivist, interpretivist, and critical approaches.

| Posted by Gary Sauer-Thompson at 3:04 PM |