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British Journal of General Practice, October 2008 739

Digest

the publication of Trick or Treatment?
Alternative Medicine on Trial.2 But here the
possibility of what might be learned from
CAM about our ability to stimulate self-
regulating and self-healing mechanisms
whose pervasive role in medicine Ernst and
Singh acknowledge, is tragically neglected.
Dismissing the results of the Bristol
Homeopathic Hospital clinical outcome study
on the grounds of explanations other than the
effect of homeopathic medicines (some of
which are tendentious and don’t reflect a
diligent study of the research paper), they
ignore the core fact that for whatever reason
many patients with a long and continuing
history of significant illness despite
conventional treatment did remarkably well.3

The question is not ‘do CAM treatments
show efficacy in formal trials’, but ‘do they
enhance patients’ whole wellbeing and
quality of life?’ And if so how? And by what
means can we make better use of whatever
is the answer to ‘how’? And what more can
we learn about health, illness, and the
human condition in the process? Surely this
should be the agenda of an academic
department of complementary medicine?
Surely its original remit to investigate the
scientific basis of CAM did not preclude
this? Surely it was not merely to investigate
whether CAM can be fitted into the same
box as conventional medicine; made to fit
the prevailing medical model?
To conclude, this book offers a salutary

critique of the problems that beset the
investigation and integration of CAM in
relation to conventional medicine, but by a
more genuinely truthful and truly scientific
examination of its subject it could have
enlarged our vision of health care.
Unfortunately it only serves to perpetuate a
kind of scientific tunnel vision.

Jeremy Swayne

REFERENCES
1. Healthwork UK. National Occupational Standards for

Homeopathy. Bristol: Healthwork UK, 2000.

2. Godlee F. Reclaiming the placebo effect. BMJ 2008;
336(3May): doi:10.1136/bmj.39567.551181.47
http://www.bmj.com/cgi/content/full/336/7651/0?rss=1
(accessed 5 Sep 2008).

3. Spence DS, Thompson EA, Barron SJ. Homeopathic
treatment for chronic disease: a 6-year, university-
hospital outpatient observational study. Journal of
Alternative and Complementary Medicine 2005; 11(5):
793–798.

DOI: 10.3399/bjgp08X342525

EDZARD ERNST — A RESPONSE

Trick or Treatment? Alternative Medicine on
Trial is not a book against alternative
medicine, it is a book in favour of good
evidence and single standards in health
care. Jeremy Swayne admits that
‘truthfulness is an essential attribute’ but
criticizes our book for lack of ‘wisdom and
discernment’, ‘lack of … balance’,
neglecting ‘the positives’ and disregarding
‘the power and importance of non-specific
and placebo effects’. He concludes by
accusing us of ‘scientific tunnel vision’.
These are strong words which require a
robust response.
Using our chapter on acupuncture as an

example, we can effortlessly demonstrate
that we bend over backwards to present
the current evidence as balanced and
truthfully as possible. We discuss the
history and complexities of clinical trials
and the best current scientific evidence in
much detail. The truth is that, according to
this evidence acupuncture might be
effective for some types of pain and
nausea. The truth is that even this evidence
is not fully convincing (NICE recently
recommended against using acupuncture
for knee osteoarthritis, the flag-ship
indication of acupuncturists!).1 The truth is
that it is not free of risks. The truth is that it
is expensive compared to many other
effective treatments.
The truth we present is based on the best

available evidence, which means that
sometimes we endorse therapies (for
example, several herbal treatments) and
sometimes we have to be very critical
about them (for example, magnet therapy).
But Swayne does not appreciate this type
of truth. Why? Presumably because, when
our truth is applied to his pet therapy,
homoeopathy, this form of treatment
appears like a sick joke.
In his endeavor to promote his type of

‘truth’, Swayne wants us to discuss the
failings and faults of conventional medicine.
We do not deny that these exist. Maybe,
one day, when we write a book about
conventional medicine, we will discuss
them in detail. But, writing about alternative
medicine, we think it is fair to mention them
only in passing.
And finally, Swayne points to the

importance of the placebo effect. But so do

we, even in much detail. The difference is
that we try to apply just one standard while
Swayne uses two. The placebo-effect is
clearly powerful, thankfully we both agree
on that. Swayne believes this justifies the
routine use of homeopathy and other
ineffective treatments. We point out that
you don’t need to administer a placebo to
generate a placebo response — effective
treatments do that too and they convey
specific effects as well. The logical
conclusion therefore is that, by using pure
placebos, we do our patients a grave
disservice.
So who is suffering from ‘tunnel vision’?

We suggest the readers of this debate go to
their library, take out our book Trick or
Treatment? Alternative Medicine on Trial
and make up their own mind.

Edzard Ernst

REFERENCE
1. National Institute for Health and Clinical Excellence.

Osteoarthritis NICE version — draft guidance for
consultation. NICE: London, 2007.
http://www.nice.org.uk/guidance/index.jsp?action=d
ownload&o=35844 (accessed 9 Sep 2008).

DOI: 10.3399/bjgp08X342534