Snake Oil Science: The Truth about Complementary and Alternative Medicine [Hardcover]

Why?

Because Bausell's position on complementary and alternative medicine (CAM) is simply this: it's no more effective than a placebo. This is not something that millions of people want to hear. Regardless, he puts together a compelling case to support this contention. In fact I would call his conclusion inescapable.

R. Barker Bausell is a research methodologist or biostatistician, a professor at the University of Maryland, and has had many years experience in evaluating research studies. It knows the ways researchers can fool themselves, leading to biased results, and he spells them out in elaborate detail. To demonstrate a point, he recalls the work of famed research psychologist Joseph Banks Rhine at Duke University who seemed to establish statistically that people can indeed demonstrate clairvoyance by guessing face down cards, and telepathy by reading other people's minds. Rhine conducted so many experiments over so many years that the above average success of his subjects could not happen by chance. Unfortunately one day he innocently revealed that he had "a filing cabinet filled with results of experiments that had produced only chance results or lower." He explained that "these particular results were produced by people who were deliberately guessing incorrectly just to spite him." (p.270)

Bausell's point is that if studies are selected, then the statistical evaluation of the effectiveness of card guessing or some kind of treatment, is invalid. Bausell notes that this selective process occurs not just from decisions made by researchers but by peer review journals and by the results that research sponsors may suppress as not helping the sales of their product or treatment. All studies done in China for example on the effectiveness of acupuncture are positive! Studies sponsored by CAM companies are also almost universally positive, and those that are not, are typically not published.

Bausell has analyzed thousands of studies and finds that most do not fall within what he considers good research guidelines. The most frequent fault is the lack of a placebo control group. Without such a group it is impossible to say whether the results of the study exceed what would be expected from the placebo effect. Bausell goes into a lot detail on this and other research methodological points and makes what seems to me to be an air-tight case for rejecting the results of studies that do not meet good research guidelines. He even demonstrates the probable mechanism for the placebo effect: endogenous opioids induced in the subject's brain by belief in the effectiveness of the treatment.

This brings me to the question, what's wrong with improvement that comes from the placebo effect? Nothing, is Bausell's answer, although placebo improvements usually are relatively short-lived and of moderate effectiveness. And there is nothing wrong with using CAM therapies if conventional methods are exhausted. If. The problem is that people shell out a lot of money for very little benefit, and in some cases neglect using conventional medicine or treatments that would work.

A curious conundrum arose in my mind as I read this book. What if everybody were as sophisticated as Professor Bausell and knew that CAM therapies were no more effective than placebos? Wouldn't they then be without even the hope of a placebo benefit?

This book will be read by few true believers or practitioners of such CAM therapies as homeopathy, acupuncture, distant healing, therapeutic touch, etc. And those trained in Ayurvedic or traditional Chinese medicine will be appalled at how blithely Bausell dismisses the efficacy of their ancient traditions. Personally I was surprised to learn that acupuncture really isn't effective beyond the placebo level. Certainly the theoretical basis of the Ayurvedic and Chinese healing arts is in conflict with the way modern science understands the human body. Still I wonder if these venerable bodies of knowledge can be completely discounted as Bausell seems to discount them.

The people who will read this book, and should, are practitioners of medical research who want to be sure that they understand how such research should be conducted, and others who want the unvarnished truth about CAM. From this point of view--and I think it is the proper one--this is an outstanding book, probably destined to become the recognized work on the effectiveness of CAM research methods and results for some time to come.

I found this to be a splendidly well-written, comprehensive and fair-minded book. It is also witty. It's long enough to cover the ground, but not too long.
The publisher has done the author a disservice by using a hard-to-read sans-serif typeface and very light printing, which made the book hard to read. I hope they will go over to a conventional typeface for the paperback edition (and I'll buy a copy if they do).

I have enjoyed reading 3/4'ths of this book, I haven't gotten around to finish it. But this far it has been a detailed and informative introduction to the field of medical research and particularly placebo. One gets an intriguing glimpse into the difficulties that comes forward as to how one can separate placeboeffects from the effects intended by administering the actual drug/method that is on test. Somehow, placebo seems to have a peculiar ability to influence the subjects even when the researchers think they have taken every possible precaution to avoid its introduction. The book is important for all interested in complemantary or alternative medicine, and in debunking those that only offer dogmatic or lacking evidence for their "medicine". The author also has a sense of humour and uses it. A good or excellent read.