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EDZARD ERNST — a RESPONSE We, Even in Much Detail Digest the publication of Trick or Treatment? EDZARD ERNST — A RESPONSE we, even in much detail. The difference is Alternative Medicine on Trial .2 But here the that we try to apply just one standard while possibility of what might be learned from Trick or Treatment? Alternative Medicine on Swayne uses two. The placebo-effect is CAM about our ability to stimulate self- Trial is not a book against alternative clearly powerful, thankfully we both agree regulating and self-healing mechanisms medicine, it is a book in favour of good on that. Swayne believes this justifies the whose pervasive role in medicine Ernst and evidence and single standards in health routine use of homeopathy and other Singh acknowledge, is tragically neglected. care. Jeremy Swayne admits that ineffective treatments. We point out that Dismissing the results of the Bristol ‘truthfulness is an essential attribute’ but you don’t need to administer a placebo to Homeopathic Hospital clinical outcome study criticizes our book for lack of ‘wisdom and generate a placebo response — effective on the grounds of explanations other than the discernment’, ‘lack of … balance’, treatments do that too and they convey effect of homeopathic medicines (some of neglecting ‘the positives’ and disregarding specific effects as well. The logical which are tendentious and don’t reflect a ‘the power and importance of non-specific conclusion therefore is that, by using pure diligent study of the research paper), they and placebo effects’. He concludes by placebos, we do our patients a grave ignore the core fact that for whatever reason accusing us of ‘scientific tunnel vision’. disservice. many patients with a long and continuing These are strong words which require a So who is suffering from ‘tunnel vision’? history of significant illness despite robust response. We suggest the readers of this debate go to conventional treatment did remarkably well. 3 Using our chapter on acupuncture as an their library, take out our book Trick or The question is not ‘do CAM treatments example, we can effortlessly demonstrate Treatment? Alternative Medicine on Trial show efficacy in formal trials’, but ‘do they that we bend over backwards to present and make up their own mind. enhance patients’ whole wellbeing and the current evidence as balanced and quality of life?’ And if so how? And by what truthfully as possible. We discuss the Edzard Ernst means can we make better use of whatever history and complexities of clinical trials is the answer to ‘how’? And what more can and the best current scientific evidence in REFERENCE we learn about health, illness, and the much detail. The truth is that, according to 1. National Institute for Health and Clinical Excellence. Osteoarthritis NICE version — draft guidance for human condition in the process? Surely this this evidence acupuncture might be consultation . NICE: London, 2007. should be the agenda of an academic effective for some types of pain and http://www.nice.org.uk/guidance/index.jsp?action=d ownload&o=35844 (accessed 9 Sep 2008). department of complementary medicine? nausea. The truth is that even this evidence Surely its original remit to investigate the is not fully convincing (NICE recently DOI: 10.3399/bjgp08X342534 scientific basis of CAM did not preclude recommended against using acupuncture this? Surely it was not merely to investigate for knee osteoarthritis, the flag-ship 1 whether CAM can be fitted into the same indication of acupuncturists!). The truth is box as conventional medicine; made to fit that it is not free of risks. The truth is that it the prevailing medical model? is expensive compared to many other To conclude, this book offers a salutary effective treatments. critique of the problems that beset the The truth we present is based on the best investigation and integration of CAM in available evidence, which means that relation to conventional medicine, but by a sometimes we endorse therapies (for more genuinely truthful and truly scientific example, several herbal treatments) and examination of its subject it could have sometimes we have to be very critical enlarged our vision of health care. about them (for example, magnet therapy). Unfortunately it only serves to perpetuate a But Swayne does not appreciate this type kind of scientific tunnel vision. of truth. Why? Presumably because, when our truth is applied to his pet therapy, Jeremy Swayne homoeopathy, this form of treatment appears like a sick joke. REFERENCES In his endeavor to promote his type of 1. Healthwork UK. National Occupational Standards for ‘truth’, Swayne wants us to discuss the Homeopathy. Bristol: Healthwork UK, 2000. failings and faults of conventional medicine. 2. Godlee F. Reclaiming the placebo effect. BMJ 2008; 336(3 May): doi:10.1136/bmj.39567.551181.47 We do not deny that these exist. Maybe, http://www.bmj.com/cgi/content/full/336/7651/0?rss=1 one day, when we write a book about (accessed 5 Sep 2008). 3. Spence DS, Thompson EA, Barron SJ. Homeopathic conventional medicine, we will discuss treatment for chronic disease: a 6-year, university- them in detail. But, writing about alternative hospital outpatient observational study. Journal of Alternative and Complementary Medicine 2005; 11(5): medicine, we think it is fair to mention them 793 –798. only in passing. And finally, Swayne points to the DOI: 10.3399/bjgp08X342525 importance of the placebo effect. But so do British Journal of General Practice, October 200 8 739.
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