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Dr. Simon Singh talks Alternative Medicines

Published: October 9, 2010

Many Americans rely on “alternative medicine” treatments. There have always been doubts about the efficacy of such therapies. Studies have been undertaken in recent years to test them. In some cases the jury is in. A few years ago I interviewed the co-author of a book which summarized what can be said about such treatments. Dr. Simon Singh is a science journalist, and best selling author. With Dr. Edzard Ernst, the world’s first professor of complimentary medicine he wrote Trick or Treatment: The Undeniable Facts About Alternative Medicine.

“Alternative medicine” means many things to people. Please talk about the practices you examined.

It is a hard term to define. One must look at such treatments one-by-one. Some are effective, some not. We focused on acupuncture, chiropractic, homeopathy, and herbal medicine. Towards the end of the book we looked at two to three dozen others including crystal therapy, rake, magnetic healing and so on.

Your book looks back at the practice of medicine before the present era, concluding that prior to modern medical science doctors were bad at diagnosis and worse at treatment.

Even 150 years ago doctors didn’t understand the workings of the body. They didn’t understand disease and they didn’t understand how to treat, let alone cure patients. Doctors quite possibly did more harm than good. What transformed medicine was the idea of scientific testing. Let’s take a therapy, give it to 100 patients and NOT give it to another 100, and see which group does better. If the patients receiving the treatment do better then the treatment is effective. If not then it is ineffective perhaps even dangerous. This simple approach – that of the clinical trial – was invented primarily by James Lind, a Scottish surgeon. It revolutionized medicine. We say in the book that this approach needs to be applied to alternative medicine too. Alternative medicines need to be tested. In some case there have been some rigorous tests. We looked at them and their results.

You mention some classic examples of this learning process, namely the now discarded treatment of “bleeding”. It might not be known to some that George Washington got a nasty throat infection and was, unfortunately bled as a “cure.” Not only did this bleeding fail to cure him, it led to his death.

Bleeding was very common. The idea was that whatever was making you sick was “stagnating” in your blood. By cutting that patient and releasing that blood you could cure them. Sometimes they would pierce the skin with a blade; sometimes with leeches. A common technique was to chop the end off a leech so it would keep sucking and never get full. Bleeding was a cruel approach, but one that doctors practiced often. To the physicians of the time it seemed a sensible treatment. Their forefathers had used it. Their professors had taught them to do it. They tried it on patient and sometimes it seemed to work. A patient with a terrible fever would be thrashing about in bed, and bloodletting would sedate them. This gave the effect of it being a positive treatment.
In the 19th century, French doctors actually gave this a clinical trial. In patients with pneumonia some were bled while some were not. The patients not bled did better. It was hard for many doctors to accept this, however. They remembered those patients who had recovered and forget those that died. In fact, they were literally draining the lifeblood out of patients. Only clinical testing stopped what we now consider to be a barbaric practice.

Homeopathy seems be the alternative treatment with the least to offer.

Homeopathy is an alternative treatment that is widespread and at the heart of a billion dollar industry. It has no evidence whatsoever to back it up. There have been over 200 clinical trials and yet there is still no convincing evidence suggesting that homeopathy is effective. To remind people about what homeopathy is – its theory is that “a little of what harms you can cure you”. That is the first principle. If you suffer from hay fever, maybe pollen can cure you. How? Per its second principle you dilute the pollen over and over. The less you have of an ingredient, the higher the chance (supposedly) that it can cure. This seems bizarre, but science is full of bizarre ideas; so you test them all. But when you test homeopathy the results don’t back up the claims.

Curious to note, about a decade ago The Lancet, a distinguished British medical journal, published a meta-analysis which mathematically combines studies in an attempt to magnify the effect of what the study can tell you. It concluded that homeopathic practices were more likely to improve people than controls, but as you note in the book there were some major problems with those studies that rendered them invalid.

Scientific studies are the way to get the truth, but there are good trials and bad. You can look at a trial and assess its quality. If a trial is conducted poorly it is worse than no trial at all. The results can be misleading and unreliable. Look at the good quality trials – and by good quality I mean, using a large number of patients, assigning patients randomly to being treated or untreated, and the patients are blinded, meaning they don’t know whether they are getting homeopathy or a placebo sugar pill – that’s when homeopathy seems to fail to register any positive evidence for itself.

When Trick or Treatment was published in Europe we got huge amounts of criticism from homeopaths. They said we didn’t know what we were talking about. We were being selective or in the pockets of the pharmaceutical industry. They said horrible things about us. We told our critics, we would give them a check for $20,000 if you can show convincing evidence that homeopathy is effective. To date, no one has made a claim for the money, because the truth is, no such evidence exists.

In 1988 there were some studies showing that homeopathic preparations could affect white blood cells. This caused quite a stir in the scientific community. In your book you deduced where researchers went wrong. Could you tell us a bit about this?

A French researcher named Jacques Benveniste was trying to understand homeopathy at a fundamental level. Instead of looking at the patients, he looked at individual cells and how homeopathic preparations might affect them. According to homeopaths less is more; so much so that there is no active ingredient left in a final remedy, yet a “memory” of the agent is supposedly active. Jacques’ assistant seemed to observe that these cells were affected by remedies with no active ingredients left in them. It was such a revolutionary discovery, that it made the most prestigious journal in the world, Nature. At the time I was astonished. Here was evidence for homeopathy, which almost broke the laws of science.

Nature did something unusual, however. They said they were publishing the paper with the right to go back and repeat the experiment. When they did revisit the experiment they realized that bias had crept in. The observer wanted to see the effect that she was looking for. She hoodwinked herself. It was subconscious. We have to be careful with falling for our own prejudices, and seeing what we want to see, instead of what is really there. When one removed those biases and did an independent analysis, the effects on white blood cells disappeared. I wish Nature had never published that paper, or done the proper research before publishing it, because you still see this flawed study being quoted by homeopaths to back up their methods.

We are being negative about homeopathy, but we apply the same rigorous testing to conventional medicine. Many conventional medicines fail in the research phase too. We have to apply a rigorous, brutal technique at research to filter treatments that won’t work or are harmful. Although we are negative about homeopathy, there are some alternative therapies that do pass the test. We say in the book: let’s look at the evidence. If it is positive let us embrace the therapy and try to understand it. Then we may get the most out of it.

In the next installment of this interview, Dr. Singh talks about acupuncture, scientific testing, and some alternative medicines that have passed muster. Keep an eye out for this conclusion next week, and for alerts to updates on this blog, please follow @DougDesallesMD on Twitter, or search for Sacramento Men’s Health on Facebook.