Beachbooks 1: Trick or Treatment

Just before heading off on holiday I gave notice of my intended reading matter. Pedalo-duty permitting, I hoped to get through all four books.

Holiday read

The wind and currents of the French Atlantic coast precluded any pedalo action so the kids had to settle for surfing lessons instead, and were placed in the capable hands of an instructor. And so I turned first of all to Singh’s and Edzard’s Trick or Treatment, an analysis of complementary or alternative medicine.

The book is clearly and meticulously written – I found it an easy read. The authors are at pains to explain the necessity for an evidence-based approach when evaluating any proposed treatment of human ailments. Acupuncture, homeopathy, chiropractic and herbal medicine are covered in the greatest depth, each getting a chapter to themselves. All the remaining known ‘alternative’ therapies are given much briefer treatment in the appendix.

Singh and Ernst lack the irreverent humour of Ben Goldacre, whose excellent Bad Science covers some of the same territory, and their tone may be a bit too didactic for some. But I appreciated the attention to detail. The authors drilled carefully into the core of alternative medicine and, almost invariably, came up with… snake oil. They found that none of the treatments has much to offer beyond the placebo effect or the benefits of more conventional therapies.

Ultimately what struck me most about the book was the sense that emerged of the intellectual poverty of alternative medics. They might tacitly admit the primacy of the scientific approach to the evaluation of treatment efficacy by trying to clothe themselves in science, but they’re like children who can’t dress themselves properly. Trick or Treatment (like Bad Science before it) is very good on explaining the inequalities of different types of evidence. A great recent example of this is the fabulous blogospheric dissection of the evidence that the British Chiropractic Association finally produced in response to the criticism of its libel case against Singh. Much of it, argued the bloggers, was irrelevant or cherry-picked.

The other, more depressing realisation I came away with, is that alternative medics aren’t about to disappear anytime soon. Alas, they’re usually quite happy to get into the ring with science and go a full 15 rounds. Lacking the skill to land much of a punch, their aim appears to be to duck and weave until the scientists are finally exhausted. So I’m afraid it’s up to us to keep trying to knock some scientific sense into the alternative medicine community.

We have to keep on questioning the evidence for alternative medicine. It not a matter of arrogant condescension but of quietly and firmly pointing out how the methodology of science and its resolutely critical culture are so essential for understanding how the world — and good health — works. I don’t want to get all po-faced about this but more of us need to stand up to counter the seepage of fanciful medical practices into modern life. With Trick or Treatment now in my back catalogue (and I reckon I’ll be returning to it frequently for points of reference) I’ll be able to do my little bit more confidently.

(Parenthetically, anyone looking for an opportunity to step up to the mark should head over to Improbable Science where David Colquhoun is calling for people to respond to the Department of Health’s consultation on the Pittilo Report. The report has recommended that practitioners of acupuncture, herbal medicine, traditional Chinese medicine should be subject to statutory regulation by the Health Professions Council. All very innoucuous sounding perhaps but, as David explains, it opens the way for untested treatments to acquire an official-looking seal of approval.)

Having finished Trick or Treatment I launched straight into astronaut Buzz Aldrin’s Magnificent Desolation. A confirmed moon-nut, I had been really looking forward to the book but, oh dear me, what a shambles…

(To be continued, soon.)

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28 Responses to Beachbooks 1: Trick or Treatment

  1. Jennifer Rohn says:

    Thanks, Stephen – Trick or Treatment sounds like something I should definitely read!

  2. Stephen Curry says:

    @Jenny – I’ll say this quietly since Brian might be listening, but you are welcome to borrow my copy.
    Mind you (I really shouldn’t say this), Singh might appreciate the royalty…

  3. Richard P. Grant says:

    <loud voice>Ooh, can I borrow it too?

  4. Stephen Curry says:

    Sure thing.

  5. Heather Etchevers says:

    How are you getting any R&R if you’re writing enormous, thoughtful book reviews?!

  6. Stephen Curry says:

    Thanks Heather but the R&R is over for now and I am back at work, more’s the pity.

  7. amy charles says:

    Christ. I feel obliged now to buy the book since ALL OF YOU ARE FREELOADERS. Except you, Stephen. (Enabler.)
    Ahem. My crackpot idea of the day: Legitimate scientists have freak training in the idea that they don’t know things. The training includes coaching in maintaining face and self-esteem when confronted with the reality of not knowing something. It makes clear the penalties for not knowing certain things while confirming that not knowing other things is relatively safe. It also provides articulation in the definition of “to know”, so that one can know when one doesn’t really know, but is only hazarding a guess based on inadequate information. The training is, in fact, a standardized education in how not to know things. Most people don’t get it, scientists do, and this bolloxes up attempts at communication.
    Why do I say this? Because I think it’s true that the voodoo and chiropractic will be around forever. People like magic, and they like it better than science in part because science intimidates. I interviewed Carole and Richard Rifkind recently about their three-grad-students movie Naturally Obsessed, which does a very interesting thing in not explaining the science. On purpose. They’re molecular biologists, they’re trying their damnedest to grow useful crystals, but the usual didactic section with graphics isn’t there. Both the Rifkinds and a schoolteacher they put me on to told me that the mere presence of the science made some people in various audiences very uncomfortable (bad news, Stephen: Carole told me that the word that did it for one crowd was “diffract”). I’d guess the thing that drives them off is that they’re confronted with something tony that they don’t know and can’t keep up with, and it makes them feel stupid.
    You aren’t supposed to know how magic works or deal with how to be magic-ignorant without blushing. With magic, you can just appreciate the mystery and the guru, or you can parrot uncritically whatever nonsense you’ve heard about convection lines. In fact you’ll get some oohs and ahs for your good parroting show. No embarrassment, you’ll never be left feeling stupid in front of the class of smart kids. So I think science will have a very long way to go in beating guff, as far as the public goes.

    • cromercrox says:

      Your crackpot idea has a lot of mileage and is in fact the basis of my next book.

      Legitimate scientists have freak training in the idea that they don’t know things


      The training is, in fact, a standardized education in how not to know things. Most people don’t get it, scientists do

      Well, scientists ought to get it, but they actually don’t. What scientists often do is set themselves up as secular priests and dictate to the great secular unwashed the things they ought to know.

  8. amy charles says:

    Incidentally, it’s my birthday.

  9. amy charles says:

    My birthday wish this year is to stop sounding like Mole.

  10. Stephen Curry says:

    That’s a really interesting comment Amy – I’m going to have to mull it over (and sleep on it, since it’s so late now). However, let me at least wish you a belated happy birthday! And what’s wrong with sounding like mole?

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  12. cromercrox says:

    Stephen – have you read Snake Oil by John Diamond?

  13. Stephen says:

    No, but it’s now on my Amazon wish-list… thanks.

  14. cromercrox says:

    You can always borrow it 😉

    • Snake Oil is a great book. Very readable, and especially astute on reasons why people get into CAM. Also funny. Terribly sad John D never got to finish it.

      • cromercrox says:

        Pity that it had to have a preface from Dawkins, though. Real downer, that.

        • I’m trying to decide if RD is your bete noire, Henry, or whether it’s the other way round. Or both…

          • cromercrox says:

            The first. Quite apart from his boycotting activities, I really, honestly don’t think the man has a clue about how science works. The second? RD doesn’t know I exist. I am too far below his lofty cognizance I am sure.

        • Stephen says:

          I promise to read the preface with my eyes closed, Henry!

          • It’s more that Oxford (and more specifically North Oxford and the University) is a terribly small world, and everybody knows everybody else – or at least did then. It’s one of the reasons I find the Inspector Morse re-runs so amusing, as they paint this world so deftly, albeit in a mildly exaggerated way.

        • Here’s something that might amuse Henry. About twenty years ago my mother met RD at an Oxford luncheon party. They got into conversation and he asked her if she was celebrated author Jilly Cooper. She says he seemed rather disappointed when she said she wasn’t.