Snake Oil Science: The Truth About Complementary and Alternative Medicine Paperback – Aug 2 2009
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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. --This text refers to the Hardcover edition.
"Mr. Bausell has emerged with a book about his true intellectual passion-- how we teach, how kids learn, and what would give us better results... His vision of the learning lab -- with students touching computer screens as they follow computerized lessons, each of them learning at his or her own pace, and with tutors providing individualized instruction as necessary-- suggests a more efficient model for learning, particularly for children already behind the curve, and real urgency about the future." --Dan Rodricks, The Baltimore SunSee all Product Description
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Top Customer Reviews
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.
Most Helpful Customer Reviews on Amazon.com (beta)
This book has several strenghts and several weaknesses. I will go into the strengths first.
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.
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.")
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.
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.
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 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).