How much should you pay for nothing?

Uh-oh, what happens when you find out that a $60-billion global industry is based on things that do not work? What if the industry is alternative medicine? Those are the most natural questions anyone should ask if they read the article about the work of Edzard Ernst, professor of Complementary Medicine in the Peninsula Medical School in England. The article came out in the May 19, 2011 online issue of The Economist.

The studies on alternative medicine he analyzed included but were not limited to herbal medicine, homeopathy, chiropractor services, acupuncture, crystal healing and even something I have not met in my “unscience” adventures yet — Reiki channelling. After 18 years and 160 publications detailing his findings, often under attack from alternative medicine groups, this is the verdict: an overwhelming 95 percent of the so-called alternative medicine treatments do NOT work any better than a placebo; and the remaining five percent just worked slightly above the placebo effect.

Dr. Ernst spent almost two decades putting together the big picture from many small puzzle pieces. In scientific jargon, this is called a meta-study. This meant that he and his group made sense of all the other smaller studies that scientifically test the effectiveness of different kinds of alternative medicine. Those little studies, by themselves, may be statistically insignificant, but taken together, they could give a statistically meaningful perspective. Statistics is important when you make a claim because you can say for example, that your remedy worked in 100 individual cases but this does not make sense if it did not work in 10 million other cases who took the said remedy. Understanding statistics is also a way of not being carried away by dramatic stories of people who claim to have found cures in alternative medicine. One story of healing is of course very important to the person who healed and to his loved ones but to another person looking at his options, it is still very important to know about the cases where it also dramatically did NOT work.

The placebo effect is a wonder phenomenon in medicine. It is a kind of medical intervention wherein patients are given a pill, an injection or surgery and told that these may work. These pills, injections or surgery are only “pretend treatments.” They don’t contain the active ingredient present in the real pill, injection or surgery designed to treat the illness. Throughout the history of medical testing, it has been shown that people who are given placebos do get better in numbers that would not have been by chance alone. Some experts think that just knowing that you are taking something that may make you better releases chemicals in your brain that help you get better. Studies have also shown that the placebo effect is busiest in illnesses that involve “perception” like depression or pain. That is what Dr. Ernst’s verdict says — that alternative medicine, at best, works like the placebo.

Dr. Ernst was mentioned in the article as having said that the providers of alternative treatment appeal to people’s romantic sense of “tradition.” I think there is something about tradition, about the past, that lures us to think that the ancients must have known so much better. There were geniuses in the past as in any age. But the past were also inhabited by more ancients who thought that the Earth was the center of the solar system and that it was on top of a turtle which was on top of another turtle and so forth, but we forget that. Somehow, “tradition” holds some genius for us just because it has survived time. It rarely occurs to us that it may have survived not because it was real but because people simply wanted to cling to beliefs at whatever cost. I am also reminded by that religious sect that designated May 21 as the world’s final day. That was not the first time the world “ended” but people, time and again, always find reason to justify why the last one did not happen and why the next one will really be it. So to those who are attracted to these announcements, do not throw away your doomsday costumes yet.

I am surrounded by people I love dearly who believe in alternative medicine. Belief, like in religion, has more power over our action than reason does which could get us stuck. A study, no matter how much it sparkles with clarity and brilliant reasoning showing you that something does not work, will have extreme difficulty changing minds if our minds are marinated in pure belief. I understand how alternative medicine gives us hope and no one can put a price on hope. But is it just me who thinks that maybe $60 billion is too much of a price for something that should be free?

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