Customer Reviews: Snake Oil Science: The Truth About Complementary and Alternative Medicine
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VINE VOICEon October 23, 2008
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.

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.")
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on July 12, 2008
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.
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on January 26, 2008
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.
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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.
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on December 17, 2007
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).
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on December 25, 2007
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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on December 18, 2007
Don't let the provocative title fool you - this book is not an emotional rant against CAM. Instead, the author explains - in wonderfully simple and convincing terms - the importance of reliable research, and the current lack thereof in the relatively new field of CAM. Bausell carefully reviews the common causes of false inferences, researcher and publication biases, and the placebo effects that can result in false positive results. He carefully explains the ways in which any research may be flawed, and how (to the untrained eye) it can be used to justify inappropriate conclusions.

You will learn more about research pitfalls from this book than you will in medical school - and it is invaluable for those interested in determining the validity of research findings for themselves.

The author carefully and methodically sets up the reader for his striking conclusion - that to date there have been no randomized, placebo-controlled trials published in top tier medical journals demonstrating that any CAM therapy is superior to placebo. Don't believe it? Better read the book for yourself. You won't regret it.
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on November 28, 2014
First of all, the title of this book is more inflammatory than Dr. Bausell's actual tone in the book. He does get a little sarcastic, but the bulk of the book is him laying out the scientific evidence and explaining how it was gathered and how to evaluate it. I skimmed some of his explanations of methodology and statistics, because he goes into a lot of detail that didn't mean much to me as a layperson, but I appreciate that he tried to explain those things to give as transparent a look at the evidence as possible. He sets out to answer four questions: Is there such a thing as a placebo effect? Is there a physical explanation for how it works? Is CAM demonstrably better than a placebo? and Is there a physical explanation for how CAM works? (Spoilers: yes, yes, no, no.) The value of this book is in how he reaches those conclusions.
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on August 21, 2011
The book is really a more eloquent treatise on the placebo effect than on anything else. If I had to summarize, I'd say the book is, "this is the placebo effect; all CAM treatments are placebo," without necessarily providing the requisite science to make said connection. In other words, I found the conclusion to be as tenuous as many of the claims made by "snake oil salesmen." It's almost as if the author suffers from excessive "post hoc ergo propter hoc" - "'after' the placebo, therefore because of placebo," to paraphrase inelegantly. I thought, for example, the hypothetical statistics given in his examples to be rather misleading. The sample statistics could easily be applied to a drug trial, along with many (maybe even most) of the criticisms. And I think that unduly biases the reader. Confirmation bias - you look for things that support what you believe. I think the author should spend more time reading Dr. Shermer's books.

Generally, I think what's misleading is that many of the problems that plague clinical trials in general are presented in such a way that it seems as if CAM is the only place they occur. One only needs to look at the recent findings about bias in a significant number of pharmaceutical trials, or even the entire anti-depressant pharmacological debate to see that the troubles with clinical trials are something that plagues all science.

Also, not the author's fault, but it's very interesting to read the book in light of Kaptchuk's recent study that showed that placebos are effective even when the recipient knows they are receiving a placebo. Kaptchuk's research is obviously preliminary, but if it is supported by further study, that will undercut a major stanchion of Bausell's argument.

Ultimately, I think the book should have been called, "The Placebo Effect" or something along similar lines. I think the tenuous connection is made when the author leaps to group CAM - especially *ALL* CAM medicine - into a single group, and to then state that the group - as a whole - is just placebo. I think it's a good book about the perils of research and the power of the mind, but I think it's perhaps a more damning indictment of medicine *in general* than specifically CAM medicine.
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on July 23, 2009
As a former Chiropractor, I can say that this author puts together a killer argument backed with logic and data to kill the idea that CAM is superior to standard medical care. Better yet, CAM hasn't even be proven to show any effect apart from placebo and lots of researchers have looked and spent lots of your tax-payer dollars in the process.

This book is laid out in a very logical manner and even sprinkled with some humor.

My prediction is that reviewers of this book will be at either extreme, they love it or hate it. I love it because its shows the best of science; how we separate the sense from the non-sense. Those that have a vested interest in CAM will, of course, hate it.
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