clarity - Rated 
Initially dismayed that two incisive analyses of the current state of complementary and alternative medicine (CAM) should be almost simultaneously published (Rose Shapiro's "Suckers" and Singh and Ernst's "Trick or Treatment"), I was delighted to read both and to find them truly complementary, although drawing identical conclusions: CAM acts through the placebo response alone. For example, randomised trials prove acupuncture, homeopathy and chiropractic and to some extent, herbalist medicine to show no benefit above and beyond the placebo response. Worryingly, some claims, such as open heart surgery performed in China with acupuncture anaesthesia alone, are shown to be fraudulent. Traditional Chinese Medicine is a post-revolutionary ragbag and does not represent 5,000 uninterrupted years of medical practice as claimed, although the pharmaceutical industry is exploring the efficacy of some of the traditional herbs used both in China and in India. If they work and survive phase I and II clinical trials, no international conspiracy will prevent their development: the paranoia in CAM about the "Cancer Industry" imagines that any herb or practice curing cancer would be suppressed to protect profits. This is absurd - cynically, the rewards would be too great.
The approaches of the two books are different, though both add enormously to CAM understanding. I couldn't pick out one over the other: Shapiro is perhaps the more entertaining - and Singh and Ernst perhaps the more comprehensive, with a useful postscript analysis of many different CAM practices. Both are eminently readable; both expose the serious lack of evidence that CAM works above and beyond the placebo response, which nevertheless can relieve some symptoms in up to 32% of sufferers. Edzard Ernst was originally a homeopath himself, and now finds that homeopathy and other CAM practices do not stand up to scientific inspection, in particular from randomised clinical trials, brilliantly espoused, first introduced by Lind in the eighteenth century to prove that vitamin C in the form of lemon or lime juice prevents scurvy. Both discuss the vexed question as to whether evidence-based doctors who recognise that CAM merely achieves a placebo effects should pretend to their patients that CAM works in order to gain the maximum benefit of the placebo response: both decide that this would be dishonest, operating against the modern, truthful doctor-patient relationship. (The placebo effect can be observed only if the patient thoroughly believes in the practice.)
Some placebos work better than others: acupuncture perhaps has the strongest impact, its lack of real benefit only demonstrated by using special placebo needles which retract on pressure, like a stage dagger, instead of piercing the skin. Furthermore, both question whether the NHS exercised by tight budgets should be running 5 NHS homeopathic hospitals in the UK, diverting money from other desperately challenged services that might offer improved quantity and quality of life above and beyond the placebo response. Many GPs love CAM, because they can refer on their heartsink patients (classically middle aged, middle class women) who benefit from the long consultation times of over an hour, a luxury for both patients and doctors denied elsewhere in the NHS. However, homeopaths are notable by their absence from Casualty and Intensive Care Units. Why does their placebo effect not work on broken legs? Instead they choose a tranquil clinic setting.
With the exception of a few herbal remedies, (herbs that work become established: some cancer cures for example are based on periwinkles and yew trees), reading both books will doubly convince you that the multi-billion pound industry supported by Prince Charles is based on nothing but sugar pills. Singh and Ernst dedicate their book to him, hoping that his foggy precepts will be honed.
Science or magic? - Rated 
The fact that Rose Shapiro's book 'Suckers' beat this one into print detracted somewhat from my enjoyment, as both cover pretty much the same territory. That said, the authors' credentials lend this book a credibility that Shapiro's lacks, and while it can't quite avoid a certain smug self-righteousness, Singh & Ernst's book manages to avoid the outright spitefulness of hers.
I was slightly uneasy at how the credibility of those therapies with equivocal outcomes was revised downwards with each re-telling, but this emphasises that the authors are not impartial. To claim that they are is disingenuous and merely gives critics a convenient straw man to attack. The work ought to stand or fall on its merits, and if the authors' research is as conscientious as they claim, it is fairly convincing.
Ultimately these are quibbles, and the book went down like a smooth milk-shake. I work in the NHS, and in a climate where I can be threatened with redundancy even as state-sponsored magic prospers, I applaud those who stand up for clear thinking.
A Fair Trial - Rated
Trick or Treatment? is a very readable account of the evidence for and against a wide range of alternative medicines. The book is written in the same engaging style as Simon Singh's other books. I found the discussions about the development of evidence based medicine and clinical trials, and the discovery of the placebo effect particularly interesting. The authors present well chosen and significant historical episodes that illuminate the points that they are discussing.
The book takes a detailed look at a number of the most widespread alternative medicines: acupuncture, herbal medicine, homeopathy, chiropractic. The bizarre history of chiropractic therapy and the extraordinary claims of some its more enthusiastic practitioners was new to me and would make valuable reading for anyone who is considering undergoing this treatment. The book could be viewed as an effort to combat the rising tide of pseudoscience, but it should also be welcomed by any practitioners of alternative medicine who genuinely want to give their patients the best possible treatment. Where the evidence suggests that an alternative therapy has some benefit for patients, the authors say so.
Overall the material is thorough and balanced. If you want to be informed about how modern medicine operates, both alternative and conventional, then you should take a look at this book.
A really helpful, much-needed book. - Rated
I was really pleased to find a review of complementary and alternative medicine (CAM) techniques and therapies, as this is something I feel is sorely needed at present.
I am well educated and intelligent, but have little knowledge about medicine and and biology, and hence although it is fairly obvious to me that some CAM is nonsense (homoeopathy - cure all your ills with sea water! After all, it must have a bit of everything in it diluted to ridiculously minute levels, so it must be the ultimate homoeopathic remedy, right? No sense in paying for the homoeopaths or the pills, then...), some others are more difficult to figure out - I know plants can contain significant quantities of chemicals which can have effects on our bodies, so is there really something to herbal medicine? It seems eminently plausible. What about the Chinese variety - how is that different? Is it better or worse? And what about something like acupuncture - it seems perfectly reasonable that sticking needles in someone could have an effect on them, but does it actually have a significant impact on the problems that acupuncturists claim to treat? Someone like myself has no way to tell - without books like these....
I was particularly pleased to feel that the authors were people I could trust to give an unbiased view. I thought it was fascinating that one of them, Edzard Ernst, has been a practising homoeopath and is now a professor of CAM - consequently I had expected him to be biased in favour of homoeopathy in particular, and CAM in general, and yet in spite of this the book's conclusions are, on the whole, unfavourable for most flavours of CAM, homoeopathy included. Neither he nor the other author, Simon Singh, have any sort of vested interest in destroying the CAM business as far as I can tell, unlike many authors of pro-CAM books who are often telling you how great the evidence for CAM is on one hand and trying to sell you their CAM therapies on the other...
I also thought it was reassuring that they concluded that the main reason that there is little evidence in favour of most CAM techniques is not necessarily that all CAM is bad, or nonsense, but rather that "conventional" medicine is so good at picking up and making use of anything which can be shown to be genuinely beneficial. If proper evidence emerges that a treatment is effective, it soon becomes a part of conventional medicine, which is willing to make use of any effective tool. Consequently, things which have been around for a while, but have not become part of the mainstream, have either been shown not to work or have not had enough good trials done on them to allow a determination to be made either way. I think this is an important point - it means that most CAM, by definition, is at best unproven so may well not work, and at worst may be harmful, simply because if it had been proven to be beneficial and safe it wouldn't be the alternative any more! The authors give some cases where things which would originally have been considered CAM were proven to work and are now part of conventional medicine - this often happens with herbal remedies, where the active ingredient in a plant is identified, and safe, purified forms of it then distributed as tablets in controlled doses by doctors or pharmacists - and several examples of current CAM techniques which have some promising evidence in their favour and which are consequently being investigated with a view to them becoming a mainstream treatment.
Personally, I think I will allow the researchers to do their experimentation in controlled conditions, rather than randomly experimenting on myself using whatever CAM sounds good this week, and take advantage of all that research to pick the safest, most effective treatments for me!
They would attack this book wouldn't they... - Rated
Alternative therapy can be a matter of almost cultish commitment and, as you can see from some of the reviews here, don't read this book if you are a believer: if you are passionate it will infuriate you, and if you are at all open-minded it will dishearten you. Despite assertions from defenders of the faith, Trick or Treatment is packed with evidence. Another complaint from complementary devotees - that the author hates all complementary medicine and endorses conventional medicine - is flat wrong. Singh is equally critical of conventional medicine which hasn't proved its worth. He evidently likes good science and he plainly knows his stuff. In fact if you really want to know what works and what doesn't I reckon this is about as good as it gets. He's actually fairly readable too.
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