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.
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Top reviews from other countries
- StriderReviewed in the United Kingdom on January 4, 2013
Essential reading for all research interested CAM therapists
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kbReviewed in Germany on June 2, 2009
Wirkt Alternativmedizin, und wie finden wir's raus?
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- Caroline RichmondReviewed in the United Kingdom on May 20, 2008
Cogent and fair-minded
