Snake Oil Science: The Truth about Complementary and Alternative Medicine
by R. Barker Bausell
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Book Summary Information
Author: R. Barker BausellEdition: Hardcover
Audio: English (Original Language); English (Unknown); English (Published)
Published: 2007-10-31
ISBN: 0195313682
Number of pages: 352
Publisher: Oxford University Press, USA
Book Reviews of Snake Oil Science: The Truth about Complementary and Alternative Medicine
Book Review: An excellent treatise on the science of clinical trials
Summary: 5 Stars
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.
Summary of Snake Oil Science: The Truth about Complementary and Alternative Medicine
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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