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R. Barker Bausell

Snake Oil Science: The Truth about Complementary and Alternative Medicine 1st Edition

by R. Barker Bausell PhD (Author)

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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.

ISBN-10

9780195313680
ISBN-13

978-0195313680
Edition

1st
Publisher

Oxford University Press
Publication date

October 31, 2007
Language

English
Dimensions

8.52 x 6.28 x 1.19 inches
Print length

324 pages
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Edzard Ernst
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Editorial Reviews

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

"'Inside' Complementary and Alternative Medicine (CAM), we see embarrassingly little critical evaluation. Barker Bausell most certainly comes from the 'inside' and he is definitely critical about CAM; this makes his book unusual, ground-breaking and, I think, important...his book is highly informative, easy to read and full of entertaining wit and humour...aimed at the consumer...but too good a book to be read by the lay audience only. I warmly recommend it to healthcare professionals who work in CAM or have an interest in this area." - Focus on Alternative and Complementary Therapies

Product details

ASIN ‏ : ‎ 0195313682
Publisher ‏ : ‎ Oxford University Press; 1st edition (October 31, 2007)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 324 pages
ISBN-10 ‏ : ‎ 9780195313680
ISBN-13 ‏ : ‎ 978-0195313680
Item Weight ‏ : ‎ 1.33 pounds
Dimensions ‏ : ‎ 8.52 x 6.28 x 1.19 inches

Best Sellers Rank: #1,510,555 in Books (See Top 100 in Books)
- #1,442 in Medical Test Preparation & Review
- #1,735 in Psychiatry (Books)
- #28,384 in Alternative Medicine (Books)

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Smith's Rock

Incongruous Title For a Deeply Informative Book

Reviewed in the United States 🇺🇸 on September 12, 2010

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R. Barker Bausell is the Immanuel Kant of research methodologists, albeit with a considerably better sense of humor and lucidity of prose than Kant displayed in his writings. With the implacability of a Sherman tank, Bausell does an amazing, and possibly unparalleled, job of categorizing and describing the various treatments and theories that comprise complementary and alternative medicine, then relentlessly applies the highest methodological standards of research to examine the effectiveness of CAM therapies. Result? Many CAM therapies DO work, with no more and no less effectiveness than placebos. It's a fine but important distinction that Bausell makes in this somewhat dry, somewhat repetitive, and nonetheless highly informative book: he is NOT saying that CAM therapies don't work, he is saying that they work as well as, and probably because of, the placebo effect. And placebos do give relief of symptoms in often dramatic, but time-limited fashion.

Bausell, as an employee of the National Center for Complementary and Alternative Medicine, notes that the insistence on funding only high quality scientifically rigorous controlled clinical trials of CAM therapies induced "a crisis that has occurred many times in the history of science: a collision between science and belief". This book tells that tale.

Snake Oil Science is superlative when respectfully discussing the many unconscious biases that distort the pursuit of verifiable medical knowledge. Contrary to the negative connotations of the title of his book, Bausell is quite respectful of the practitioners of CAM, and those who seek such treatments. His quest has nothing to do with the vilification of those who believe in CAM related arts, and everything to do with whether or not CAM offers anything beyond the placebo effect. A highly qualified juggernaut in his field of research methodology, Bausell's description of the history of the scientific method, and the excellent methods that have been developed to rate the quality of any given study that is published, is fascinating. Though I'm a family physician that reads studies by the bushel, I had never heard of the Jadad Quality Scale, or the CONSORT standards, both of which can be used as standards for the evaluation of the quality a given study. Though I do use the invaluable Cochrane reviews in attempts to separate valuable medical wheat from the profligate chaff of industry sponsored research, readers unfamiliar with the historical significance of the Cochrane Collaboration will get a warm and thorough introduction to it in Snake Oil Science.

Bausell's book is highly unusual, if not unique, in the gentility with which the powder keg subject of complementary and alternative medicine is approached. The author eschews sarcasm and condescension in his quest for the truth about CAM, though his frustration with demands that CAM be applied to a different (less rigorous) standard of evaluation than other areas of medicine is sometimes evident.

Weaknesses? I have to think that Bausell's editor was asleep at the switch, allowing the book to derail into a sometimes tiresome repetitiveness as well as a pacing that plods when the average reader has grasped the point and has sprinted onward. The title of the book belies its contents: the use of words "snake oil" strongly implies shysterism and fraud, while the contents of the book barely touch on this subject. Though the field of CAM certainly has its share of shysters, so does my own allopathic branch of medicine. Why is this important? Snake Oil Medicine, shortened and retitled, has the capacity to change the minds of many people that lack a scaffolding to use when evaluating the worth of any particular medical therapy. The ideal way to spread knowledge is not to preach to the choir, but to reach people where they intellectually live. This book has some unrealized potential in this respect.

It is probably fair to say that all humans seek some form of the truth. It is also without question that humans use very different standards when they apply the word "TRUE" to a hypothesis. Our everyday lives are filled with examples of the resulting confusion. Using one standard of verifiability allows authors to write many volumes (which happen to sell fairly well) about angels, without having to bother about the distinction between fiction and non-fiction. Using a more rigorous standard of verifiability, the only non-fiction thing one can say about angels is that there is no evidence for their existence that would conform to CONSORT standards, or any studies documenting the existence of angels that can get out of the basement on the Jadad Quality Scale.

Humans that seek truth with their metaphorical hearts, and then reason backward to a conclusion, best not bother with this book. Those who have sworn allegiance to scientific method, or are inclined to lean on scientific method to temper the yearnings of the heart, will find richness in this book despite its flaws. Health care providers that have felt shackled by the political incorrectness of asking whether CAM is pseudo-science will feel freed to speak again. Those that lack an agenda, but are simply seeking a reliable way of establishing efficacy of treatments will be deeply rewarded by the effort expended in reading this highly valuable book.

5 people found this helpful

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Adam Shomsky

Highly educational and provides genuine understanding

Reviewed in the United States 🇺🇸 on March 5, 2010

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Despite the book's aggressive title, I found Bausell to be refreshingly objective and understanding. Some would (and do) rush to condemn CAM practitioners as frauds and their patients as fools, but Bausell shows how reasonable, intelligent, and honest patients and practitioners can come to believe that a treatment is effective even if it is actually nothing but a placebo. In fact, it's fair to say that it is very difficult to determine if an ineffective treatment is useful or not due to these principles and more:

- The natural history of pain: many chronic medical conditions naturally vary over time, getting better or worse without any apparent rhyme or reason. Since people are most likely to seek treatment when their pain is at its worst, regression to the mean makes it likely that their pain will decrease no matter what treatment is given. Also, many problems are self-limiting, meaning they will heal by themselves even if no treatment is given.
- The Placebo effect: The placebo effect is (crudely put) the tendency to feel better after receiving a treatment that you believe will help you, even if it does nothing. There is a whole chapter about research on the placebo effect, in which it is revealed that there is a physiological basis for it - the brain releases opioids, a natural painkiller that is the body's equivalent of morphine. So the placebo effect isn't just imaginary - it is very real, suggesting that no matter how intelligent you are or how much you know about the placebo effect, you will still be subject to its effects.
- Psychological factors, such as cognitive dissonance, respect for authority, and "a conspiracy-oriented view of the world." "In CAM [a conspiracy-oriented view] is epitomized by Keven Trudeau, author of the best-selling book Natural Cures `They' Don't Want You To Know About, which revels that the only reason his natural cures for just about every conceivable human ailment aren't in wider use is government and industry cover-ups."

Bausell also shows how a very reasonable and intelligent doctor with genuine concern for his patients could be fooled by these same factors plus some additional ones. And once he makes a public stand in favor of a treatment, dissonance theory predicts (and experience shows) that he is unlikely to recant no matter how strong the evidence is against that treatment.

Later chapters analyze the existing research on CAM therapies, which is of overwhelmingly poor quality, meaning the methods used do not rule out the possibility that positive results were due to the above-mentioned factors. He explains why poor-quality research has a strong bias to produce positive results, IE conclude that a treatment (either CAM or conventional) is effective, even when it isn't. Bausell describes the factors that indicate high quality research and explains why studies with these qualities are more accurate. He then provides a review of high-quality CAM research, which overwhelmingly shows that the CAM methods studied are no better than placebos.

And here's a neat (non-conspiracy based) explanation for why CAM therapies are not more widely studied by mainstream scientists: "Medicine...has now reached a point where the biochemical mechanisms for just about all of its more effective therapies are understood...it is practically unheard of for a major clinical trial to be conducted involving a treatment for which there is not an already known biochemical mechanism capable of explaining why a specific health outcome should occur." Why? Because those handing out the checks want to fund something that is likely to work, and they know that a treatment with no plausible biochemical mechanism is not likely to work (not better than a placebo, anyway).

CAM procedures do actually work, at least for a short time - they just have not have not been shown to work better than a placebo. The placebo effect has been amply demonstrated to be real and a biological mechanism has been established. Conventional medicine, by the way, also has a placebo effect, which is always present whenever the expectation of effectiveness exists; but conventional medicine (usually) also provides benefits above and beyond placebo effects. CAM therapies, by Bausell's definition, do not have a plausible biological mechanism, and high-quality studies consistently show they are no more effective than a placebo.

Bausell does not go so far as to conclude that every CAM therapy is a placebo; there is no proof of that. But the high-quality research conducted so far has failed to prove that any CAM therapy has therapeutic effects beyond the placebo effect. If such research existed, and other high-quality research independently confirmed this result, it would cease to be CAM and would become conventional medicine (although baffled scientists would be searching for a biochemical mechanism and may be rightly skeptical of the results until one is found, just as one has been found for most other effective medical treatments). But don't expect a whole lot of breakthrough research proving the effectiveness of CAM therapies anytime soon, given their lack of plausible biochemical mechanisms.

2 people found this helpful

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kb

Wirkt Alternativmedizin, und wie finden wir's raus?

Reviewed in Germany 🇩🇪 on June 2, 2009

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Warum glauben so viele - durchaus kluge - Menschen an so viele verschiedene (und oft widersprüchliche) Alternativmedizin-Methoden, egal wie gut ihre Wirkungslosigkeit belegt ist, und egal wie unplausibel ihre behauptete Funktionsweise ist? Das ist eine Frage, die sehr stark mit unserer Wahrnehmung und dem Wesen von Krankheiten und Behandlungen zu tun hat.

Prof. Bausell, Statistiker und Spezialist für klinische Studien, baut sein Buch sehr gut strukturiert und sorgfältig auf, vergisst aber nie auf plastische Beispiele und eine Prise Humor. Medizinische Vorkenntnisse sind nicht nötig, trotzdem sollte das Buch auch für Ärzte interessant sein. Die Hauptfragen sind:

- Warum glauben Laien und Mediziner an die Wirksamkeit von Alternativtherapien?
- Welche Effekte vernebeln unsere Wahrnehmung und hindern uns, seriöse Urteile zu treffen?
- Wie sieht ein Studiendesign aus, das diese Effekte vermindert? Was macht eine gute klinische Studie aus, woran erkennt man eine schlechte?
- Was hat es mit dem Placebo-Effekt auf sich? Alles nur Einbildung, oder mehr?
- Was sagt nun die wissenschaftliche Evidenz für Alternativmedizin? Wie ist die Qualität der verfügbaren Studien? Was sagen die (sehr) wenigen methodisch guten Studien, die es gibt?

Ein Vergleich zu Singh/Ernsts Trick or Treatment drängt sich auf: beide Bücher handeln vom selben Thema, beide sind ungefähr zur gleichen Zeit erschienen, beide "populärwissenschaftlich" ausgelegt. Der Unterschied? Snake Oil Science ist sicherlich der trockenere Text und geht bei seinem Hauptthema - dem Design und der Interpretation aussagekräftiger klinischer Studien und den vielen Fallen, die dabei lauern - deutlich mehr in die Tiefe. Während Ernst und Singh ihr Buch als spannende Rundreise durch die Alternativheilungs-Landschaft mit historischen Anekdoten und Lehren aufbauen, versucht Bausell stärker das Allgemeine und Wiederverwendbare herauszuarbeiten. Also weniger Unterhaltung und Konsumentenservice, dafür mehr Stoff zum Nachdenken.

Ein Kritikpunkt zum Schluss: der knallige Titel lässt einen polemischen Rundumschlag gegen Alternativmedizin und ihre Anhänger befürchten. Davon kann aber gar keine Rede sein. Obwohl Bausells Urteil über die (spezifische und anhaltende) Wirksamkeit von CAM fast uneingeschränkt negativ ausfällt, bleibt er sachlich und mitfühlend gegenüber jenen Menschen, die sich an die Hoffnung klammern.

13 people found this helpful

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Strider

Essential reading for all research interested CAM therapists

Reviewed in the United Kingdom 🇬🇧 on January 4, 2013

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I found this book a terrifically good read. It clearly explains the issues of researching CAM, through illustrating the poor quality 'research' which has already been done, and which does not support the wild claims of some CAM modalities. It tackles the issue of placebo control in CAM in a balanced way, and is written in a light hearted and amusing style without dodging the issues. I loved it. By the way, I'm a CAM therapist and researcher, with an enquiring mind, frustrated by the waffle and desperate to raise the bar in CAM research. This book should be required reading for anyone serious about researching CAM properly.

One person found this helpful

Victoria Guy

Finally

Reviewed in Canada 🇨🇦 on December 9, 2015

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I found Bausell's analysis of CAM refreshing and well considered. Although I have used the physiological question to decide for myself whether a therapy sounds plausible or not, I didn't think of it as part of an overall process, but just common sense. It truly amazes me, and likely always will, the numbers of individuals that "believe" in treatments (amongst other thing) that are simply a form of smoke and mirrors. Thank you for your effort in educating the public, and attempting to bring the world (kicking and scream no doubt) into the present.

One person found this helpful

Caroline Richmond

Cogent and fair-minded

Reviewed in the United Kingdom 🇬🇧 on May 20, 2008

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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).

16 people found this helpful

The One Who Talks

Hard but rewarding.

Reviewed in Germany 🇩🇪 on January 4, 2018

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This book is hard read especially the later chapters where a lot of research is presented about big amount of alternative medicines. If you read all of it you will be rewarded with new insights about health and even deception.

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