Simon Singh – Trick or Treatment

This is point of inquiry for Friday, January 2nd, 2009. 

Welcome to Point of Inquiry, MDG growthy point of inquiries, the radio show and the podcast of the Center for Inquiry, a think tank advancing reason, science and secular values in public affairs. Every week on this show, we try to look at some of the big questions facing our culture and we look at them through the lens of scientific naturalism. We focused mostly on pseudoscience and the paranormal or alternative medicine, secularism and religion. And we look at these questions by having conversations with some of the leading minds of the day, people sometimes connected with the Center for Inquiry or authors and scholars who care about the issues the show cares about. Before we get to this week’s guest, I want to invite all of our listeners, especially those of you who appear to be getting something out of the show every week. People who have sent us emails and kind of celebrate the show, please become a friend of the center. That’s the best indication we have at the effectiveness of the show as a method of outreach for the Center for Inquiry. We were a nonprofit educational organization, and we’re only able to have impact to the extent that our supporters allow that to happen with their support. I’m happy to have best selling author and science journalist Simon Singh on points of inquiry. His books include the code book and Big Bang. He’s joining me on the show to talk about his new book. He’s coauthored with complementary medicine professor Edzard Ernst called Trick or Treatment The Undeniable Facts about Alternative Medicine. Simon Singh, welcome to Point of Inquiry and Happy New Year. 

Good to be with you. It’s Asabi. 

Is this book trick or treatments? It’s a book that you kind of, as a skeptic, wrote with a professor of complementary medicine, whom I’d imagine would be a believer. And I think that, you know, writing this book from the perspective that both of your writing, it could get each of you some flack, both from the skeptics and from the believers, since neither of you are really party line in the book. 

I think we both have a very moderate view. I think I I’m a skeptic, but I’m a scientist. And I think part of being a scientist is being open minded. But at the same time say, look, I’ll believe anything if he can show me the evidence to the point of view that I come from. I’m a journalist on a science writer. I just want to see the evidence. Whether the evidence is favorable, unfavorable, indicates dangers, indicates that something is perfectly safe. That’s the view that I come from. And it’s solid. Professor Owens, my coauthor, is a professor of Complementary Medicine. But that doesn’t mean that he’s in favor of it. It just means he spent his life studying it. And again, that means studying it to show that something might be effective or studying something to find out it is anything. 

He did spend some time as a homeopath at one point, though, right? 

I thought it is. I was born in Germany and in Germany. Herbal medicine is very popular and homeopathy is very popular, in fact, that the find of homeopathy was German. So I thought grew up in a household where the mother would give him homeopathic remedies, where his local doctor would give him herbal remedies. And when he became a medical student and graduated from medical school, he even had a job. And in the most prominent homeopathic hospital in Germany, I think it was in Munich. And so as adult, he was just using the techniques that he’d been taught and that he was aware of. Then he made a step change from being a medical practitioner to being a medical researcher. So that suddenly meant that he wanted to know if what he was using was actually effective. He worked in rehabilitative medicine and he also now moved into alternative and complementary medicine. The challenge now is not to be an advocate, not to be a champion, not to be an abstract critic, but just to get to the truth. 

Jim Underdown right that point about being really an open minded skeptic. I mean, you guys don’t reject any of these claims out of hand. You follow the evidence where it leads. In fact, you say some of these treatments may work. You argue that others are dangerous. 

Yeah. You’ve got to look at them on an individual basis. So you can’t use the umbrella term and says, all right, this was all fantastic. You have to distinguish acupuncture from herbal medicine. And even within herbal medicine, you have to differentiate all the different herbs and ask each time. Is it effective? And even with a particular herb, you might say, well, it’s effective at this, but it’s not effective for that condition. 

We just celebrated New Year’s. One big kind of all mad treatment is detox for, you know, people are drinking a lot. They have a lot of toxins in their system or they’ve partied a little too hard. And you take these remedies to kind of clean out your system. What’s your what’s your take on all that stuff? 

Yes, it’s a very big thing in Britain. In fact, I’ve worked with an organization called Tense about Science. And for the last year or two years following the Christmas holidays or the holiday season, we run quite a selective campaign to make people aware about detox and the fact that the best detox you can have is just to get plenty of rest, to eat moderately, drink moderately. And your body is designed over the course of a million years. And the volt of natural detoxing mechanisms. And therefore, we just don’t need any of the fancy kids, the fancy supplements, colonic irrigation, acupuncture, you know, all of those things are really just very expensive. Detox, so-called detox treatments, which really do nothing to add to your body’s natural detoxing mechanism. So that’s one of things that we’re really quite negative about. 

One of the subjects you treat in your book that I was really interested in is chiropractic. I’m interested in it because my grandmother, who’s been going to a chiropractor for, what, over 30 years, a couple months ago, she got into this contraption at her chiropractor, this machine, I don’t know what it’s called or anything, but, you know, I’m just going by what she said. And this gizmo stretched her and pulled. Her. And as a result, she could barely walk for days. And she hasn’t been back. This is a big ordeal in our family. Right. I also note that in Canada, there’s really strict regulation about senior citizens going to chiropractors because of strokes or whatever that can be brought on by spinal adjustments. So the question about chiropractic. Is it dangerous or is it just something that doesn’t work or what’s what’s the deal there? 

Yeah, I think the first thing before we consider the safety is whether or not it’s effective. And most people have seen the chiropractors treat back problems, musculoskeletal conditions. And it’s true that I think the majority of chiropractors focus the majority of their time on treating back problems. And they’re they’re they’re moderately successful back. And the tourists are difficult to treat. Chiropractors do as well or as badly as anybody else. 

But a lot of chiropractors try to do more than just help a person’s back pain or something, right? 

Yes. In fact, if you go back to the origins of chiropractic, Daniel Palmer in Iowa, back in the 19th century, he believed he could cure anything because the spine carries the nervous system to the rest of the body and therefore, the nervous system is a key element in helping us get better. So if you manipulate the spine, you can improve the nervous system to your kidney and that can cure a kidney complaint. That was his belief in the first treatment he ever made, were a cure for deafness and then a cure for heart problems. All based on manipulation of spine. And that’s really where chiropractic goes over the edge into the sort of really claims that what we would say biologically implausible, even though belief in chiropractics efficacy is so widespread. 

Most people don’t realize that it is based on this belief in kind of this well, the supernatural belief, really, that spinal adjustments clear up blockages in the floor of a person’s energy or life force or something like that. It’s it’s kind of like Chey in acupuncture. Right. 

Yeah. In a way, it is slightly difficult because they go back to palmist time. Parmer maybe didn’t necessarily know about the electrical flow through the nervous system, although go Varshney. I think the French biologists, chemists had studied these kinds of electrical effects in nervous systems. But Parmer very much with interest in the flow of what he called innate intelligence. Maybe that’s what the Chinese have called Chey made it what we would call energy today in some vague sense. But whatever it is he was talking about, his ambitions for it were really overblown. So we’ve never established that chiropractic may work for that problem, probably doesn’t work for much else. Now, is it safe? And that’s the really important thing with any medical treatment, conventional or alternative. Do the benefits outweigh the risks with any manipulation of the spine? There are always going to be some risks. They range from minor bruising or minor pain, transient problem through to possibly damaging the artery that takes the blood up through the spinal column into the brain. And that’s why I wouldn’t recommend I recommend anybody to go to a chiropractor for something that wasn’t connected to the bat. And if it was a problem that was connected to the back, then I’d have to make a careful judgment as to whether or not I recommended. I’d certainly discourage the chiropractor from manipulating the top of my neck because that’s perhaps the most vulnerable region. 

Simon, we were talking about your coauthor, Edzard Ernst, being involved in homeopathy. What? This is the notion that a little bit of poison cures the effects of that poison in a person’s body. 

Yes. There are two principles of homeopathy. Go back to Samuel Hahnemann. About 200 years ago, he noticed that if you just take root quinine, it can cause fever. 

Now, he knew that quinine was supposed to cure malaria. So he had a substance which can treat malaria. And yet, if you take it in a healthy state, it gives you the sort of symptoms that you associate with malaria. At least that’s what he observed. So he built a philosophy that what can give you a certain set of symptoms can also cure those symptoms. How does it cure the symptoms? Well, what you do is you dilute the substance over and over again. So, for example, if we take these out of hay fever, hay fever gives you runny eyes. Well, onions giving runny eyes. So if I’m going to use onions as a treatment for hay fever, I would dilute unhinges over and over and over and over again. I would delete it to such an extent that my final remedy would have no no trace of the onion lieutenant whatsoever. Not a single molecule left of the onion in the final remedy because a dilution is so utterly extreme. So homeopaths end up giving patients. In the majority of cases, a treatment that contains no active ingredient. Now they will claim that it’s a memory of the unhinges where memory is acquired nine. 

That is helping the patient in terms of science. This is this is nonsense and make no sense at all. But in science, you even have to test some of the most outrageous claims. So over the last 200 years, and particularly the last 30 or 40 years, there’ve been over 200 clinical trials of homoeopathy to test whether all this outrageous theory might actually work. But unfortunately, the bad news is the bad news for homeopathy is that after 200 trials, after 200 years, there is still no convincing evidence. And the Occy worth any condition whatsoever. Jim Underdown. 

That raises an interesting point. When for science is enough enough? When is it legitimate for scientists who should be open minded, declaims and follow the evidence where it leads? When is it okay for them to say, look, we’ve looked into that question now we can reject it now we can dismiss that claim? 

Well, I think in the case of homeopathy, the research has been done. And I think as a fight, a funding body, I would say, you know, we’ve we’ve done pretty much everything we can. Now, homeopathy will say, well, you know, if you’ve tested homeopathy and the treatment of flu, which you haven’t tested homeopathy in the treatment of bruises and you have severe bruises, maybe, but not with the right dosage, how you pass will always argue that there’s more research needs to be done. At which point I would say, well, okay, you did the research homeopathy. That is a multi billion dollar industry. It’s a global industry. Somebody is making a lot of money from it. It would be great if some of that money, instead of going into marketing, went into research and whether or not these treatments actually work in the first place. I’d I’d push the onus onto them now that science has actually done its responsibility in having conducted what I would say, sufficient research to show that homeopathy is really struggling to find any evidence to back it up at all. 

And in fact, you got such negative feedback from homeopaths because this book that rather than you calling for science to continue setting this, you offered a prize for homeopathy to just show you the evidence. 

Yeah. We said, look, you know, if you think we’ve got it wrong in the book, if you think this evidence is out there that’s compelling and convincing, then we’ll write you a check for 15 thousand dollars straight away. And as yet, there have been no take-up of that prize, and I don’t think they will be in the foreseeable future. But one of the interesting things I mentioned a second ago, that this is a homeopathy, like many alternative therapies, is a global industry yielding billions of dollars. And at the same time, I’m saying homeopathy and some of the other alternative therapies are pretty much ineffective. So then the question is, why do people spend so much money when the treatments are not backed by any evidence? And if anything, they’re backed by evidence to show that they don’t work. And I thought and I looked into this. We wrote about this to some extent because the people use homeopathy often very caring. They care about their own health or their family’s health. They’re well-educated. They’ve got good jobs and interest in science and other things. White people spend money on homeopathy and we find a range of reasons. One is that the marketing is so good team. There are so many positive articles on the Internet that cherry pick the data. Three, the press, I think, is generally overly positive towards alternative therapies because they’re they’re natural and they’re traditional and they give us a kind of warm feeling inside for, you know, people do take alternative remedies and they do get better. And then they tell their neighbors and they tell their friends. So why do people get better therapies if they if they really don’t seem to work? 

Well, people get better in general. Yes, exactly. Exactly. I mean, one of the expressions I’ve heard is that if you have a cold, it will get better in seven days and homoeopathy. But without homeopathy, it’ll take a whole week. 

But the basic thing is you’re going to get better anyway. And then, you know, do you attribute it to the homeopathy you tricked into your own body the tributes to other medicines you may be taking at the same time? And then there’s the placebo effect. The simple action of taking a remedy would boost our psychology and boost our outlook and the view of our own symptoms. So all of these factors can confuse patients into making their choices and evaluating their own response. So that’s it. That’s why I think alternative medicine often is perceived to be much better than it really is. Well, when I was writing this book, I deliberately avoided all forms of alternative therapies because I didn’t want if I had a positive experience, I. Back to color, my writing. If I had a negative experience, I didn’t want that to color my writing. I wanted the conclusions in the book to be based on the research conducted on thousands of patients all over the world. 

And you took great pains to be this kind of open minded skeptic. We were talking about you just mentioned the placebo effect. One treatment that you cover in the book is acupuncture. And you talk about the placebo effect in that context. You’re kind of open minded about acupuncture. You say, well, it might well work, but not for these reasons. You know, people believing in and the energy that’s supposed to be balanced by acupuncture, but because of the placebo effect. So here’s the question. If acupuncture works, if you allow that, it does, even if it’s because of the placebo effect or let’s say homeopathy works because of the placebo effect. What’s the harm if it’s actually working with acupuncture? 

There’s some evidence that it may actually have a genuine effect in the treatment of some types of pain. Beyond placebo live, the jury’s still out. The evidence is not convincing, but there’s some tentative evidence, as I’m slightly ever minded, that there might be a real effect. But what about if it is just the placebo effect? If it is just our own psychology that fooling us into making us think we’re feeling better or I think genuinely making us feel better? What’s wrong with just having the placebo effect? 

Well, alternative therapies are very good at provoking the placebo effect. What’s wrong with that? Well, I think it’s almost the most important question. In the end, it’s art. And I were against the idea of supporting treatments that are just placebos. And the reason that followed. First of all, the placebo effect involves misleading the patient. And we think that’s ethically wrong. If I’m going to make somebody feel better as a result of homeopathy, I’ve got to make them believe homeopathy is effective, which means I have to mislead them about the current state of the evidence. And in fact, the more I mislead the patient, the bigger the placebo effect. So do we really want to engender a culture of of of essentially like Jim Underdown? I don’t think we do want to go down that road. Secondly, if homeopathy can sell off placebos, then what’s stopping the big pharmaceutical companies selling US placebos? We’d hate that idea. If the big pharmaceutical companies are selling us pills, that actually did us no good at all. And sometimes they do do that and we rail against it. And it’s a huge scandal. But in mainstream pharmaceuticals, placebos are the exception. In some alternative therapies, placebos are the rule. And again, I just think that bad across the board because they involve this level of deceit. Thirdly, you don’t need to have a placebo to get a placebo effect. And by that, I mean if I got a fever, I take a homeopathic pill. I just got a placebo effect. If I take an antihistamine, I get a real effect. Plus the placebo effect as well. 

Because you believe you’re going to get better as a result. 

That’s right. Conventional treatments have a placebo effect because we been told that the pharmaceuticals help us. The marketing, the branding. The fact that I had to pay money, if I have it, goes the chemist and feel that I’m taking control of my condition and so on. So just giving a placebo in the form of a homeopathic pill is shortchanging the patient. Lastly, there is a risk, I think, with placebos. 

You know, if you’ve got a cold, as I say, a cold is not a big problem, you’re gonna get better anyway. But for some serious conditions, people end up taking placebos. The way I got into this was well, I’d heard that some students were using homeopathy to protect themselves against malaria while traveling to tropical countries. And I thought surely homeopathy wouldn’t get homeopathic remedies sought for protecting against malaria. So I cook up a story with a young student. We made up a story that she was going to go to West Africa for 10 weeks, West Africa, because it has the most severe strain of malaria. You can be dead within three days. She went to 10 homeopath and said, you know, I’m looking for something instead of conventional malaria protection. She had a 10 homeopathic kind of homeopathy you might find on it on any high street and every single homeopathic. Ten out of ten of them were willing to sell her a homeopathic remedy instead of conventional treatment. And no placebo is going to protect you against malaria. So for all of those reasons, I’m not happy with the idea of people just selling and profiting from selling placebo Jim Underdown. 

Simon, we’ve talked about some of these treatments. You cover so many others in your book, you know, herbal remedies, et cetera. But I want to switch gears a bit and talk to you about the approach of science to complementary and alternative medicine kind of in general. Has science gotten it wrong in any instance that you’ve covered? In other words, has the skeptic community ever wants changed its mind about an alternative therapy that actually does end up working, even though they thought it didn’t? 

Oh, yes. I mean, many times. But I think the scientific community is just being fair. It’s just saying, look, if you want us to accept you, then you’ve got to jump over this hurdle. And the hurdle is the same for any therapy. So a few years ago, about a decade or so ago, an Australian scientist came up with a radical new therapy for stomach ulcers. He discovered that stomach ulcers were caused by a bacteria called helicopter back Tour pylori. And nobody believed him. People really laughed at this idea that ulcers were caused by a bacterial infection. But he jumped over the hurdle. He conducted trials. He came up with the evidence. Other people double tracked the evidence and that his theory is accepted and his treatment is sold worldwide. Now, if we look at alternative therapies, there are some alternative therapies that have also jumped over that hurdle. For example, there’s broadly positive evidence that things like hypnotherapy are good for treating anxiety or irritable bowel syndrome. We know that Devils Claw, the herb devil’s claw is good for muscular pain. 

St. John’s Wort for depression. 

Yeah, St John’s Wort for depression a bit. But again, I think the same rule applies here as with a conventional medicine where there are some risks associated with them. There are also risks associated even with the alternative therapies that were Jim Underdown. 

So even if St John’s Wort works, it’s dangerous. If if you’re not taking it under the care of a physician because of contra indications with other medicines or or something. 

Exactly. St John’s Wort in particular, because it’s being used to treat mild to moderate depression, says, well, that’s one very good reason why you should do it under the supervision of a doctor. Second, it can also interact with the impact of other drugs. He may be taking at the same time. In fact, about half of prescription drugs are affected. If you take St John’s Wort also, you need to know the doses that you’re taking. You need to be monitored. So I’m not really keen on these things being sold on Main Street or on your local shopping mall. I really want them to be sold. I want it to be supervised by medically trained doctors and patients really get the best out of them. 

So science has been wrong on occasion about some alternate treatments. But it’s not just that. It’s wrong sometimes about Alzner treatments, but sometimes it’s been wrong about scientifically argued medical treatments as well. If you look at the recent research that says antioxidants, slow aging, wasn’t there just evidence in the past month? There’s something arguing that that is a false belief. You know, for decades, science has taught antioxidants slow aging, and there just isn’t a lot of evidence for that. So all the fresh blueberries that I consume every day really amount just to some expensive homemade fruit smoothies. Right. 

Science can only ever make judgments based on the best available evidence. And I would always trust what the scientific consensus tells us because it’s based on the best available evidence. And that means that in general, it’s right, but it’s always willing to accept new evidence and maybe change its mind. That’s what complicates that is when somebody comes up with some new research and says a substance, a might be good for condition, B, suddenly the newspapers run away with it and certainly say miracle cure for A condition. B. And a scientist in breakthrough condition B and suddenly the marketing people jump on this. The radios and TV shows hype this and so on. And before, you know, the public thinks is certain. But there is no research. Only ever said it might do that. Mm hmm. So what scientists wanted to do was go away and do more research. But it’s kind of too late because the media has run away with the message already. So sometimes when science seems to be chopping and changing his mind all the time, it’s not really doing that. I think the science has always been a bit uncertain and waiting for more information Jim Underdown. 

So that applies to recent research about, say, ginkgo biloba. The herb that, you know, people take is a cognitive enhancer. But UC Davis researchers say it doesn’t work. Contre, other evidence previously? 

Yeah, I think in the book we’re mildly positive about Dinko. But the most recent evidence slightly goes against that view. And so when we come to the next edition of the book, we’re going to have to bear that in mind. I think that’s an important part of science. There’s this idea that there is an establishment, but that establishment should be open and I think is open to new evidence and new research. Also, the really critical thing is the quality of the evidence. You know, when evidence comes in. Is it a study? Firefighters and patients, some of the acupuncture trials that have been conducted in Germany have been such a trial done in high quality with large patients. It really you’ve got to take it seriously, as opposed to a small study involving 10 patients, which was maybe conducted quite poorly. So it’s not just any old evidence, but the quality of evidence. 

So throughout this book, your take is, as we’ve been talking about, a skeptical one, but open minded. You’re following the evidence where it leads. Let me ask you kind of a bigger picture question about these two camps, the believers and the skeptics. Why do you think both sides are so passionate about complementary and alternative medicine? I’ve seen debates on this kind of stuff that are every bit as emotional and bombastic as any debate about God or abortion, gay rights, any of those other big issues. 

I went to Ireland about a month ago and took part in a debate in a pub every month. I have a big pub debate on a scientific issue and this one was, as you say, very heated. Now I’m you know, I think acupuncture may work for some types of pain. I don’t think homeopathy works at all. I think yoga has a lot to offer in enhancing wellbeing in general. I think Reiki is a waste of time. I think St John’s Wort may be effective in the treatment of modern moderate depression. I think Canadia is possibly too. 

But Evening Primrose Oil, I think is in ineffective. So I think I’ve got a very broad approach where I’m willing to accept some things and deny other things, that in that room there were natural healers that were homeopathy, that were herbal practitioners who really dig their heels in. And I think the reason they dig their heels in is because they committed their lives to. If you’re a homeopathic practitioner and you’ve studied for two years and you’ve been working for 10 years, to admit that what you’re doing does not work mean denying what you’ve been doing for the last decade. 

It’s like giving up a religion or something. 

Exactly. You’re effectively saying, I’ve wasted my time. Now, I would say actually what you might have done when you spoke to those patients who may have given them lifestyle advice, you may have given them emotional support, you may have helped them through all sorts of techniques that had nothing to do with homeopathy directly. So these people have a method to waste their lives. But what I would say is move out of homeopathy now and move into lifestyle advice or life coaching or counseling or whatever it is the real deal that you have, because whatever that skill is, it’s nothing to do with homeopathy. 

As Simon, as we finish up here. You’re speaking out in a sense. You’re speaking out against the old med world view, that community. You’re not a hard line kind of knee-jerk skeptic. You’re not an ideologue by any measure. Ere you’ve talked about some of these things working, some not. And that will make some skeptics, you know, it’ll get their hackles up. Still, I can imagine some members of the ultimate community, the complementary and alternative medicine industry, almost will see you as public enemy number one. Last question, then. What’s a skeptic to do when you realize you can get so much negative opposition for just trying to educate the public about the pluses and minuses about Aultman? 

I mean, I’ve been very fortunate in coauthoring the book with Professor Ernst that he’s been going through this the 15 years that he’s been criticized and had his credentials questioned and all sorts of smear tactics. And yet, you know, adsorb is the first to say that the medical establishment needs to be more open minded about alternative medicine or he’s the first to say that particular treatments do work. It was very interesting to me to learn from that side about what might happen and what I need to prepare myself in terms of the attacks that we would get from practitioners from their field. I think that’s no reason not to continue writing about these subjects. You know, whenever I write about this, I always get a few emails saying, look, Simon, you’re wrong. You don’t understand this and you know it. People accuse me of being paid by pharmaceutical companies and all sorts of city things. 

But it’s not just a couple emails, too. I mean, people have gotten sued over this sort of stuff. 

Yeah, I’m fine. Right now, I’m being sued for libel by chiropractors here in Britain over something I wrote just last year. Well, and that should come to trial in the spring. And and that’ll be really interesting opportunity to, one talk about chiropractic and whether or not it’s effective and to to talk about what journalist can write without being sued for libel. But my advice more generally would be that people have to continue speaking out. And that sometimes means saying, look, is also has a venue that does actually work and sometimes say. 

Here, a therapy that actually might even be dangerous, particularly academics. I think sometimes academics can become so focused on their research and their Grahm and their teaching that they forget there’s a wider world out there of people who don’t necessarily understand science in the way that a medical researcher might. And they need to have an accurate view which therapies work, which ones don’t. Which ones are safe and which ones are downright dangerous. 

Thank you very much for this discussion, Simon Singh. 

I enjoyed great in my place a good story. 

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