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

R. Barker Bausell
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Book Description

Oct. 2 2007
Millions of people worldwide swear by such therapies as acupuncture, herbal cures, and homeopathic remedies. Indeed, complementary and alternative medicine is embraced by a broad spectrum of society, from ordinary people, to scientists and physicians, to celebrities such as Prince Charles and Oprah Winfrey. In the tradition of Michael Shermers Why People Believe Weird Things and Robert Parks's Voodoo Science, Barker Bausell provides an engaging look at the scientific evidence for complementary and alternative medicine (CAM) and at the logical, psychological, and physiological pitfalls that lead otherwise intelligent people--including researchers, physicians, and therapists--to endorse these cures. The books ultimate goal is to reveal not whether these therapies work--as Bausell explains, most do work, although weakly and temporarily--but whether they work for the reasons their proponents believe. Indeed, as Bausell reveals, it is the placebo effect that accounts for most of the positive results. He explores this remarkable phenomenon--the biological and chemical evidence for the placebo effect, how it works in the body, and why research on any therapy that does not factor in the placebo effect will inevitably produce false results. By contrast, as Bausell shows in an impressive survey of research from high-quality scientific journals and systematic reviews, studies employing credible placebo controls do not indicate positive effects for CAM therapies over and above those attributable to random chance. Here is not only an entertaining critique of the strangely zealous world of CAM belief and practice, but it also a first-rate introduction to how to correctly interpret scientific research of any sort. Readers will come away with a solid understanding of good vs. bad research practice and a healthy skepticism of claims about the latest miracle cure, be it St. John's Wort for depression or acupuncture for chronic pain.

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From Publishers Weekly

A biostatistician, author and Senior Research Methodologist at the University of Maryland, Bausell looks at the alternative methods used by more than 36 percent of Americans to treat pain and illness by posing the question, "Is any complementary and alternative medical therapy more effective than a placebo?" In short, his answer is no; what, then, is actually happening in patients (and professionals) who swear by the medical utility of such complementary and alternative medicines ("CAMs") as acupuncture, deep breathing exercises and megavitamin therapy? Step by step, Bausell builds a rigorous case against CAM, beginning with a look at the history of CAMs and placebos, then the "poorly trained scientists" and flawed studies (among more than 300 analyzed for this book) that have historically supported CAM's efficacy. A breakdown of the placebo effect's hows and whys follows (are people hardwired for susceptibility?), along with a look at "high-quality studies" and "systematic reviews" (including an Italian study that finds natural opioid secretion in the brain responsible for the perceived benefits of placebos) which largely support Bausell's answer. Entertaining and informative, with plenty of diverting anecdotal examples, Bausell offers non-professionals and pros a thorough look at the science on CAM, along with a complementary lesson in the methods of good medical research.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Review

"Hang up your lantern Diogenes, an honest man has been found. Barker Bausell, a biostatistician, has stepped out of the shadows to give us an insider's look at how clinical evidence is manipulated to package and market the placebo effect. Labeled as "complementary and alternative medicine," the placebo effect is being sold not just to a gullible public, but to an increasing number of health professionals as well. Bausell knows every trick, and explains them in clear language." --Robert L. Park, Ph.D., Professor of Physics, University of Maryland, and author of Voodoo Science: The Road from Foolishness to Fraud

"At Skeptic magazine there is no topic for which we receive more requests to comment on than alternative and complementary medicine. It is big business with big claims and big demands on it to produce, but there is very little science behind most of it. Unfortunately, what has long been lacking is a well-written, clear, and concise analysis of its major claims to which we can direct our readers. That problem has now been remedied by R. Barker Bausell's authoritative and highly readable analysis Snake Oil Science, which should be read by anyone contemplating the use of any of the hundreds of alternative and complementary medical treatments out there that promise hope but usually deliver disappointment."--Michael Shermer, publisher of Skeptic magazine, monthly columnist for Scientific American, and the author of Why People Believe Weird Things

"Anyone who reads Bausell's rigorous scientific analysis of the risks and benefits of complementary and alternative medicine will be left wondering why they are spending so much on so many useless products."--Jerome P. Kassirer, M.D., Tufts University School of Medicine, Editor-in-Chief Emeritus, New England Journal of Medicine, and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

"The book is aimed at the consumer, and it is written in a simple, entertaining style such that the consumer will understand it and enjoy reading it. So the consumer should and, I'm sure, will buy this book. But in addition I would also warmly recommend it to healthcare professionals who work in CAM or have an interest in this area. They will not easily find a harder hitting, more eloquent, or smarter critique of CAM!"--Edzard Ernst, M.D., Ph.D., Complementary Medicine, Peninsula Medical School, UK

"Readable, entertaining and immensely educational...[Bausell] writes with a sense of humor and palpable compassion for all involved."--Science Times

"Readable, entertaining and immensely educational...[Bausell] writes with a sense of humor and palpable compassion for all involved."--New York Times

"...An overview of alternative and complementary treatments. [Bausell] explains why most such treatments can't possibly do what their proponents claim, but he rarely takes on the scoffing tone that many skeptics use when discussing these issues."--ScienceNews

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2 of 3 people found the following review helpful
4.0 out of 5 stars Alternative Medicine and the Placebo Effect Aug. 1 2012
By G. Poirier TOP 50 REVIEWER
Format:Hardcover
I have not read many books in which the authors are as meticulous as this one in explaining the proper functioning of the scientific method, with particular emphasis on the placebo effect - what it is and what it can do. Through this book, the author, a biostatistician, shares his explorations with the reader regarding whether there is any solid experimental evidence supporting the beneficial use of complementary and alternative medicines (CAM).

After a very quick overview of CAM therapies and their popularity in our society, the author carefully, and at length, describes the placebo effect and how it can influence the results of randomized trials conducted to evaluate the effects of such therapies. He also warns of the several possible pitfalls that the investigators must look out for in conducting their work and in interpreting their results. Having selected published reports of trials that he considers to be of the highest quality, he critically examines them in order to see if the reported effects are real, once the placebo effect has been taken into consideration. Overall, his conclusions are not very encouraging for the proponents of alternative medicine.

The author writes very clearly in a prose that is generally lively but occasionally a bit dry, quite serious although friendly and occasionally light-hearted, and often quite engaging. This book should attract anyone with an interest in complementary and alternative medicine - either as a user or as a practitioner - as well as anyone interested in the rigorous application of the scientific method.
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Amazon.com: 4.2 out of 5 stars  45 reviews
39 of 40 people found the following review helpful
4.0 out of 5 stars An Outstanding Book to Explain How Science Works and How CAM Doesn't Oct. 23 2008
By Kevin Currie-Knight - Published on Amazon.com
Format:Kindle Edition|Verified Purchase
R. Barker Bausell is a biostatistician who worked for the NIH's Complimentary Medicine Program, which was designed to test the efficacy of Contemporary and Aleternative Medicine (CAM). As a biostatistician, Bausell is the one who designs studies so that they are as fair and unbiased as possible. His big "beef" with CAM? That the less biased the study, the less effective CAM seems to be.

This book has several strenghts and several weaknesses. I will go into the strengths first.

STENGTHS:
First, while the book suggests that it is primarily about 'debunking' alternative medicines, the bulk of the book is spent talking about how effective studies are designed and different things that can undermine the validity of studies (small sample sizes, shoddy control/placebo treatments, attrition). In short, this book offers a VERY good explanation of how science works. (Only after explaining how good studies are designed does our author go on to suggest that most CAM studies are quite poorly designed.)

This book spends a lot of time talking about the 'placebo effect,' a large player in CAM research. The placebo effect is a (generally) psychological effect where the person experiences betterment SOLELY from having any kind of treatment at all (even a sugar pill). Our author's point with explaining the placebo effect is to suggest that well-designed CAM studies point to one conclusion: that most CAM treatments are only as effective as any other placebo (incorrectly performed accupuncture is as effective as 'legitimate' acupuncture, not because accupuncture works, but because the subject wants or expects it to work).

The author is very far from biased. Despite its outragous title, Snake Oil Science is not a 'gotcha' book written by a mean-spirited and fun-poking author. The discourse is very professional and fair. The author never 'slams' CAM, but only suggests that CAM has ALOT of work to do in order to prove itself, assuming that it can.

WEAKNESSES:
For those wanting a comprehensive discussion 'debunking' CAM treatments and remedies, this book - again, despite its title - will not be satisfying. The author, a biostatistician, spends so much time talking about how to design a good study, how to spot a bad one, and adding caveat after caveat, that only one (and a half) chapters really discuss what the research actually saya. Really, the book should have been subtitled, "A primer on the methodology of clinical studies."

For those who want a somewhat friendly and relatively non-academic read, this book probably is not it. The author certainly tries to bring it down to non-specialist language, but when talking about statistics, controls, variables, and confounds, technical jargon and dry verbiage ls unavoidable. While this book is certialy informative about how clinical trials are designed, the placebo effect, and explaining why most CAM studies are poorly and hastily done, it is a somewhat dry read.

So, there you have it. If you want to become more familiar with how the medical profession tests their treatments (and compare it to how CAM proponents 'test' their treatments) this is a very good and exciting book. If you are looking for a good old-fashioned Shermer and Randi style 'debunking' of CAM, there are several other books you are better to read than this one. (Try "Trick or Treatment: The Undeniable Facts About Alternative Medicine.")
45 of 51 people found the following review helpful
5.0 out of 5 stars An excellent treatise on the science of clinical trials July 12 2008
By Ronald P. Ng - Published on Amazon.com
Format:Hardcover
I am a practicing physician in Singapore and at one time, on staff teaching hematology in University College Hospital Medical School, London University and then Hong Kong University. Many years ago, while sitting on the Singapore National Medical Research Council, there was one grant applicatioin that asked for money to do a piece of research on "Acupuncture for the relief of osteoarthritic knee pain." There was no sham acupuncture control group mentioned. When I said in order to make the trial valid, there must be a control group. The answer came back, "We know no matter where we stick the needle, the pain will improve." That started me on my quest for more knowledge regarding acupuncture and other forms of Complementary and Alternative Medicine (CAM).

This book by R. Barker Bausell is the best one I have ever read. Bausell is a biostatistician, a Professor at the University of Maryland and at one time Research Director of an NIH funded CAM Specialized Research Center. The structure of the book could roughly be outlined as an attempt to finding answers to the following questions:
1. Is there such a thing as a therapeutic placebo effect?
2. Is there a plausible biochemical analgesic mechanism of action that could explain such an effect?
3. Is there such a thing as a CAM therapeutic effect over and above what can be attributed to the placebo effect (assuming that there is such a thing as the latter)?
4. Are there plausible biochemical mechanisms of action that could explain these CAM therapeutic effects (assuming there are such things)?

In the process of answering those questions, he explained in very clear terms the necessity for Randomized Control Trials (RCT), and preferably Double blinded RCT, where neither the physician nor the patient knew whether the patient was receiving the treatment or just a placebo, was necessary. As an aside, his book could be an introductory treatise on running RCTs for the rookie clinical research working planning his/her first clinical trial. Towards the end of the book, having laid out the criteria of what were meant to be good clinical trials, he found virtually nothing in the literature that pointed to the efficacy of CAM other than that due to placebo effects.

In summary his answers to those four questions posed at the beginning are:
1. The placebo effect is real and is capable of exerting at least a temporary pain reduction effect. It occurs only in the presence of the belief that an intervention (or therapy) is capable of exerting this effect. This belief can be instilled through classical conditioning, or simply by the suggestion of a respected individual that this intervention (or therapy) can reduce pain.
2. The placebo effect has a plausible, biochemical mechanism or action (at least for pain reduction), and that mechanism of action is the body's endogenous opiod system.
3. There is no compelling credible scientific evidence to sugges that any CAM therapy benefits only medical condition or reduces any medical symptom (pain or otherwise) better than a placebo.
4. No CAM therapy has a scientifically plausible biochemical mechanism of action over and above those proposed for the placebo effet.

FINAL CONCLUSION: CAM therapies are nothing more than cleverly packaged placebos.

Those of you who are old enough to remember the hu-ha that surrounded the stories regarding acupuncture anaesthesia that came out of China at the time of the Nixon-Mao meeting in the 70's perhaps would like to know what a professor of medicine in Beijing told me. They are no longer using that, and the party leaders, when they go for surgery of any form, inevitbaly would choose anaesthesia given conventionally over acupuncture.

I think that says it all.
50 of 60 people found the following review helpful
5.0 out of 5 stars A great explanation of why so many get hoodwinked Jan. 26 2008
By J. Seidman - Published on Amazon.com
Format:Hardcover
Bausell does a great job in this book of explaining why Complementary and Alternative Medicine (CAM) is so popular, even though there's no good evidence that it works. To do this, he goes through several steps.

He explains how both consumers and medical practitioners could be convinced of the efficacy of CAM when it's not there. He explains the basics of good research, especially using a placebo control. He shows how bad most CAM research is. He provides compelling evidence that the placebo effect, at least for pain relief, is a real, physiological phenomenon. And he pulls this all together to show that CAM is no more effective than placebo.

I've seen criticisms that he lumps all CAM together. That's true, because every CAM technique suffers from the same two characteristics: there is no scientific basis for why it should work, and the research on it lousy. Most CAM therapies don't lend themselves towards placebo controls - how do you do a sham chiropractic adjustment? In fields such as homeopathy and acupuncture where there are good placebos, placebo-controlled trials are overwhelmingly negative. That's probably why most trials don't use placebos.

Note that Bausell doesn't say that CAM doesn't work. On the contrary, he just says it's no more effective than placebo. Since placebo effects are real, CAM effects are real, and CAM practitioners can provide some real relief. Does that put them on a par with mainstream Western medicine, which can provide treatments that greatly exceed the placebo effect? Of course not.

The book would have benefited from a discussion of how any CAM treatment that can survive quality research then ceases to be CAM. For example, he talks briefly about willow bark, which contains aspirin, and how it used to be an herbal remedy. There are other medicines or treatments that started as CAM and have moved into mainstream medicine as they were proven. This condemns CAM perpetually to be a wasteland of ineffective treatments. But Bausell doesn't really make that point, which I'm sure will leave some readers wondering if their local practitioner may this time have the miracle cure that's the one exception.

But that's a minor criticism for a book that tackles a very ambitious topic. I heartily recommend this book to anyone who cares about their health or their health care dollar.
32 of 39 people found the following review helpful
5.0 out of 5 stars Understand how smart people support support questionable medical solutions Dec 17 2007
By Tom N - Published on Amazon.com
Format:Hardcover|Verified Purchase
This book helped me understand why some very smart people I know spend so much money on products I thought were of questionable value. The author minimizes the emotional and subjective by focusing on facts that have only recently been established, with emphasis on why alternative medical solutions help some individuals.
I highly recommend to anyone trying to find a solution for complex, lingering medical problems. It will be a tremendous help for discussions with your medical advisor.
Also recommend to anyone involved with friend and family considering new medications where you are concerned about their medications (whether recommended by a licensed physician, alternative medical advisor or from self help reading).
44 of 55 people found the following review helpful
5.0 out of 5 stars Expect a bi-modal rating for this book Dec 25 2007
By James V. Porto - Published on Amazon.com
Format:Hardcover
Those who appreciate any effort to improve critical thinking within the public will rate this book highly.

Those who are CAM practitioners, researchers, or devotees will say that this is a simplistic book because it doesn't take into account the sophistication that their particular CAM therapy requires to understand its effect.

Its worth repeating Bausell's conclusion: "CAM therapies are nothing more than cleverly packaged placebos." This is sure to annoy about 36% of the population.
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