Read Trick or Treatment Online
Authors: Simon Singh,Edzard Ernst M.D.
Because a link between cigarettes and lung cancer would affect smokers around the world, it was important that the work of Hill and Doll was replicated and checked. The results of another study, this time involving 190,000 Americans, were also announced in 1954, and the conclusion painted a similarly stark picture. Meanwhile, research with mice showed that half of them developed cancerous lesions when their skin was coated in the tarry liquid extracted from tobacco smoke, showing that cigarettes definitely contained carcinogens. The picture was completed with more data from Hill and Doll’s ongoing fifty-year study – it reinforced in explicit detail the deadly effects of tobacco. For example, the analysis of British doctors showed that those born in the 1920s who smoked were three times more likely to die in their middle age than their non-smoking colleagues. More specifically, 43 per cent of smokers compared to 15 per cent of non-smokers died between the ages of 35 and 69 years.
Doll was as shocked as anyone by the damning evidence against smoking: ‘I myself did not expect to find smoking was a major problem. If I’d had to bet money at that time, I would have put it on something to do with the roads and motorcars’. Doll and Hill did not start their research in order to achieve a specific result, but instead they were merely curious and concerned about getting to the truth. More generally, well-designed scientific studies and trials are not engineered to achieve an expected outcome, but rather they should be transparent and fair, and those conducting the research should be open to whatever results emerge.
The British Doctors Survey and similar studies were attacked by the tobacco industry, but Doll, Hill and their colleagues fought back and demonstrated that rigorous scientific research can establish the truth with such a level of authority that even the most powerful organizations cannot deny the facts for long. The link between smoking and lung cancer was proved beyond all reasonable doubt because of evidence emerging from several independent sources, each one confirming the results of the other. It is worth reiterating that progress in medicine requires independent replication – i.e. similar studies by more than one research group showing similar findings. Any conclusion that emerges from such a body of evidence is likely to be robust.
Hill and Doll’s research ultimately led to a raft of measures designed to persuade us not to smoke, which in turn has resulted in a 50 per cent decrease in smoking in many parts of the developed world. Unfortunately, smoking still remains the single biggest cause of preventable deaths worldwide, because significant new markets are opening up in the developing world. Also, for many smokers the addiction is so great that they ignore or deny the scientific evidence. When Hill and Doll first published their research in the
British Medical Journal
, an accompanying editorial recounted a very telling anecdote: ‘It is said that the reader of an American magazine was so disturbed by an article on the subject of smoking and cancer that he decided to give up reading.’
While we were writing this book, the
British Medical Journal
reminded the world of the contribution made by Hill and Doll – it named the research that established the risks of smoking among a list of the fifteen greatest medical breakthroughs since the journal was launched 166 years ago. Readers had been asked to vote for their favourite breakthrough in what seemed like the medical equivalent of
Pop Idol
. Although this high-profile popularity contest might have seemed vulgar to some academics, it made two important points, particularly in the context of this chapter.
First, every breakthrough on the list illustrated the power of science to improve and save lives. For example, the list included oral rehydration, which helps recovery from diarrhoea and which has saved 50 million children’s lives in the last twenty-five years. The list also included antibiotics, germ theory and immunology, which together have helped to cure a whole range of diseases, thereby saving hundreds of millions of lives. Vaccines, of course, were on the list, because they have prevented many diseases from even occurring, thereby saving hundreds of millions more lives. And awareness of the risks of smoking has probably saved a similar number of lives.
The second point is that the concept of evidence-based medicine was also recognized among the top fifteen breakthroughs, because it too is a truly great medical achievement. As mentioned earlier, evidence-based medicine is simply about deciding best medical practice based on the best available evidence. It lacks the glamour and glitz of some of the other shortlisted breakthroughs, but it is arguably the greatest one because it underpins so many of the others. For example, the knowledge that vaccines and antibiotics are safe and protect against disease is only possible thanks to evidence gathered through clinical trials and other scientific investigations. Without evidence-based medicine, we risk falling into the trap of considering useless treatments as helpful, or helpful treatments as useless. Without evidence-based medicine we are likely to ignore the best treatments and instead rely on treatments that are mediocre, or poor, or useless, or even dangerous, thereby increasing the suffering of patients.
Even before the principles of evidence-based medicine were formalized, Lind, Hamilton, Louis, Nightingale, Hill and Doll, and hundreds of other medical researchers used the same approach to decide what works (lemons for scurvy), what does not work (bloodletting), what prevents disease (hygiene) and what triggers disease (smoking). The entire framework of modern medicine has emerged thanks to these medical researchers who used scientific methods such as clinical trials to gather evidence in order to get to the truth. Now we can find out what happens when this approach is applied to alternative medicine.
Alternative medicine claims to be able to treat the same illnesses and diseases that conventional medicine tries to tackle, and we can test these claims by evaluating the evidence. Any alternative treatment that turns out to be effective for a particular condition can then be compared with conventional medicines to decide if the alternative should be used partially or wholly to replace the conventional.
We are confident that we will be able to offer reliable conclusions about the value of the various alternative therapies, because many researchers have already been conducting trials and gathering evidence. In fact, there have been thousands of clinical trials to determine the efficacy of alternative therapies. Some of them have been conducted with great rigour on large populations of patients and then independently replicated, so the overall conclusions can be relied upon. The remaining chapters of this book are devoted to analysing the results of these trials across a whole range of alternative therapies. Our goal is to examine the evidence and then tell you which therapies work and which ones fail, which ones are safe and which ones are dangerous.
At this early stage of the book, many alternative therapists might feel optimistic that their particular therapy will emerge triumphant when we analyse the data concerning its efficacy. After all, these alternative therapists can probably identify with the mavericks that have populated this chapter.
Florence Nightingale would have been perceived as a maverick during her early career, because she was prioritizing hygiene when everybody else involved in healthcare was focused on other things, such as surgery and pills. But she proved that she was right and that the establishment was wrong.
James Lind was also a maverick who turned out to be right, because he showed that lemons were effective for scurvy when the medical establishment was promoting all sorts of other remedies. Alexander Hamilton was another maverick who knew more than the establishment, because he argued against bloodletting in an era when bleeding was a standard procedure. And Hill and Doll were mavericks, because they showed that smoking was a surprisingly deadly indulgence, and moreover they produced data that stood up against the powerful interests of the cigarette industry.
Such heroic mavericks pepper the history of medicine and they also act as powerful role models for modern mavericks, including alternative therapists. Acupuncturists, homeopaths and other practitioners rail against the establishment with theories and therapies that run counter to our current understanding of medicine, and they loudly proclaim that the establishment does not understand them. These therapists predict that, one day, the establishment will acknowledge their apparently strange ideas. They believe that they will earn their own rightful place in the history books, alongside Nightingale, Lind, Hamilton, Hill and Doll. Unfortunately, these alternative therapists ought to realize that only a minority of mavericks ever turn out to be on the right track. Most mavericks are simply deluded and wrong.
Alternative therapists might be excited by a line from George Bernard Shaw’s play
Annajanska, the Bolshevik Empress
, in which the Grand Duchess points out: ‘All great truths begin as blasphemies.’ However, they might be less encouraged by the caveat that should accompany this line: ‘Not all blasphemies become great truths.’
Perhaps one of the best reasons to categorize a medical treatment as alternative is if the establishment views it as blasphemous. In this context, the aim of our book is to evaluate the scientific evidence that relates to each alternative treatment to see if it is a blasphemy on the path to revolutionizing medicine or if it is a blasphemy that is destined to remain in the cul-de-sac of crazy ideas.
2 The Truth About Acupuncture
‘There must be something to acupuncture
– you never see any sick porcupines.’
Bob Goddard
Acupuncture
An ancient system of medicine based on the notion that health and wellbeing relate to the flow of a life force (Ch’i) through pathways (meridians) in the human body. Acupuncturists place fine needles into the skin at critical points along the meridians to remove blockages and encourage a balanced flow of the life force. They claim to be able to treat a wide range of diseases and symptoms.
MOST PEOPLE ASSUME THAT ACUPUNCTURE
,
THE PROCESS OF PUNCTURING
the skin with needles to improve health, is a system of medicine that has its origins in China. In fact, the oldest evidence for this practice has been discovered in the heart of Europe. In 1991 two German tourists, Helmut and Erika Simon, were hiking across an alpine glacier in the Ötz valley near the border between Italy and Austria when they encountered a frozen corpse. At first they assumed it was the body of a modern hiker, many of whom have lost their lives due to treacherous weather conditions. In fact, they had stumbled upon the remains of a 5,000-year-old man.
Ötzi the Iceman, named after the valley in which he was found, became world famous because his body had been remarkably well preserved by the intense cold, making him the oldest European mummified human by far. Scientists began examining Ötzi, and soon a startling series of discoveries emerged. The contents of his stomach, for instance, revealed that he had chamois and red-deer meat for his final meals. And, by examining pollen grains mixed in with the meat, it was possible to show that he had died in the spring. He carried with him an axe made of 99.7 per cent pure copper, and his hair showed high levels of copper contamination, implying that he may have smelted copper for a living.
One of the more unexpected avenues of research was initiated by Dr Frank Bahr from the German Academy for Acupuncture and Auriculomedicine. For him, the most interesting aspect of Ötzi was a series of tattoos that covered parts of his body. These tattoos consisted of lines and dots, as opposed to being pictorial, and seemed to form fifteen distinct groups. Moreover, Bahr noticed that the markings were in familiar positions: ‘I was amazed – 80 per cent of the points correspond to those used in acupuncture today.’
When he showed the images to other acupuncture experts, they agreed that the majority of tattoos seemed to lie within 6mm of known acupuncture points, and that the remainder all lay close to other areas of special significance to acupuncture. Allowing for the distortion of Ötzi’s skin in the past 5,000 years, it was even possible that every single tattoo corresponded with an acupuncture point. Bahr came to the conclusion that the markings were made by an ancient healer in order to allow Ötzi to treat himself by using the tattoos as a guide for applying needles to the correct sites.
Whilst critics have suggested that the overlap between the tattoos and acupuncture points is nothing more than a meaningless coincidence, Bahr remains confident that Ötzi was indeed a prehistoric acupuncture patient. He points out that the pattern of tattoos indicates a particular acupuncture therapy – the majority of tattoo sites are exactly those that would be used by a modern acupuncturist to treat back pain, and the remainder can be linked to abdominal disorders. In a paper published in 1999 in the highly respected journal
Lancet
, Bahr and his colleagues wrote: ‘From an acupuncturist’s viewpoint, the combination of points selected represents a meaningful therapeutic regimen.’ Not only do we have an apparent treatment regime, but we also have a diagnosis that fits the speculation, because radiological studies have shown that Ötzi suffered from arthritis in the lumbar region of his spine, and we also know that there were numerous whipworm eggs in his colon that would have caused him serious abdominal problems.
Despite claims that Ötzi is the world’s earliest known acupuncture patient, the Chinese insist that the practice originated in the Far East. According to legend, the effects of acupuncture were serendipitously discovered when a soldier fighting in the Mongolian War in 2,600
BC
was struck by an arrow. Fortunately it was not a lethal shot, and even more fortunately it supposedly cured him of a longstanding illness. More concrete evidence for the origins of acupuncture has been found in prehistoric burial tombs, where archaeologists have discovered fine stone tools apparently intended for needling. One line of speculation is that such tools were fashioned because of the ancient Chinese belief that all disease was caused by demons within the human body. It may have been thought that the insertion of needles into the body could kill or release such demons.