Edzard Ernst - Dont Believe What You Think

There are many ways to arrive at an irrational belief. We can simply make a mistake by misjudging a piece of evidence or drawing an unwarranted conclusion, or we can fail to detect a false or unsubstantiated claim. Despite the efforts of regulatory agencies, the consumer marketplace is filled with charlatans, fake experts, and modern-day snake oil salespeople, and the responsibility to navigate this maze of good and bad information falls on the consumer. Caveat emptor. When it comes to health and medicine, the consequences of a bad decision can be severe, and yet, for a number of reasons, the consumer cannot be blamed for being confused.

Making consumer medical decisions involves a number of special challenges. For example, for all but the simplest problems, when we are sick or injured, we are forced to rely on an authority. In todays world, medicine is a highly technical enterprise, and the average person has a primitive understanding of how their body works. We are only slightly better off than people living in a pre-scientific agenot because our physicians have limited knowledge of health and disease but because we do. Because medical science is esoteric and impenetrable for most of us. When we depend on a medical authority, we assume their knowledge is based in some kind of reality. We dont always know the basis of their claim to authoritythe amount and quality of training theyve hadbut, if we accept their prognosis and remedy, we grant them a kind of authority. Being able to find the good authorities and avoid the false prophets is a substantial challenge.

In addition, although medical science has evidence on its side, doctors often recommend procedures that patients are reluctant to undergo. Surgery and chemotherapy are painful and can be disfiguring. Physicians would not offer these methods if there were equally effective and less onerous options, but often this is not the case. The only methods that work involve substantial discomfort. If an alternative medical procedurewhat Edzard Ernst calls a SCAM: so-called alternative medicineis more gentle and palatable, some consumers will be drawn to it. In addition, when there is no effective treatment or when the best available evidence-based treatment is incompletely effective, SCAMs run in to fill the void. In the early days of the HIV/AIDS crisis, a number of SCAM therapies were promoted for the treatment of HIV. Now that effective, evidence-based therapies have arrived, the alternative treatments for this disease have largely fallen away.

As Ernst suggests, once we have adopted a belief, cognitive biases kick in to help us sustain our position in the face of conflicting evidence. It always feels better to be right than to be wrong, and once we have committed to an idea, wed prefer it be right. This book demonstrates how those biases can operate to maintain false ideas about health and medicineoften with serious consequences for the individual.

Another powerful tool for the maintenance of belief is simple rationalisation. When confronted with conflicting information X, we pivot to, Yes, but what about Y? Unfortunately, in the case of SCAMs, there is a long list of Yscounter-arguments and justifications that have been promoted in support of often ineffective and potentially harmful treatments. This is where Ernsts many years of research on SCAM treatments shines. In the following pages, he takes on the many justifications for the use of SCAMs and examines each claim under the cool light of evidence. The result is an extremely valuable guide to all manner of SCAM treatment. In addition, Ernst recounts his personal experiences as a researcher in an often contentious field. In todays world of rampant misinformation, Dont Believe What You Think is an entertaining and essential guide to the often bewildering world of SCAM therapies.

Stuart Vyse

Stonington, Connecticut