Snake Oil Science: The Truth about Complementary and Alternative Medicine

by R. Barker Bausell

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.

Genres: Science, Nonfiction, Medicine, Health, Skepticism, Psychology, Medical

324 pages, Hardcover

First published October 2, 2007

Reviews

[Carrie Poppy · Rating 4 out of 5]

Very useful

[Scott · Rating 4 out of 5]

For the attention-deprived, Bausell succinctly summarizes his thesis and conclusion at the end of Chapter 13: "CAM therapies are nothing more than cleverly packaged placebos."

There is significant depth to this book for those who want to know a little more than that. After all, other reviews have noted aptly that Bausell is likely preaching to choir. Those who disagree likely did not get past the front cover.

The beauty of Bausell’s book is the journey, not the destination. Bausell starts by discussing the rise in the use of CAM therapies. Conventional medicine has not always had a great track record in curing illness or alleviating pain. Can one be blamed for wanting to try alterntives remedies for chronic pain or anincurable illness - even if most have been proven complete bunk?

The most insightful portions of Snake Oil Science discuss some shoddy research practices in the CAM world. Most positive CAM studies tend suffer from one of several flaws including publication bias and poor research practices such as low participation and high dropout rates. Bausell teaches the skeptic how to notice these flaws so that one has a response the next time a CAM advocate starts a defense with “studies show that.”

Bausell’s logic is sound. But, there are some items that are naturally open to criticism just by the nature of the debate. Critics will dismiss Bausell’s findings as Anglo-centric due to his skepticism of European and Asian studies that are more sympathetic to CAM. And, Bausell’s style sometimes is patronizing to CAM advocates. His sometimes sarcastic, albeit amusing, demeanor is not likely to win friends and influence people.

Snake Oil Science is most helpful for those who want to learn about research methodologies – or lack thereof – behind CAM therapies. Bausell provides numerous citations for those who want to learn more about individual specific types of treatments.

[Ken · Rating 5 out of 5]

The author wanted to see if alternative medical treatments are any better than placebos. In any test of medicine, the placebo effect has to be taken into account, but in most research done on things like accupuncture, herbal medicines, chiropracty and others, they fail to do this.



The author leads us through the history of the placebo effect, how to test for it, the difficuties of testing for it so that we are well prepared to think about what might be a properly controlled test. Few actually seem to be, but the author is able to find some 22 that were properly controlled and were accepted by the JAMA or the New England AJournal of medicine. You can guess from the title what his results were.



I haven't gone in for alternative medicines too much and I am glad I haven't because it probably saved me some cash. I tried glocosamine for my aching knees a few years back and it seemed to work for awhile (The placebo effect?), and I paid 60,000 won for two bottles in Seoul. Peter Ryan recommended it and it seemed to have worked for him (The placebo effect?). I read some negative stuff on the Internet about it and stopped. The best thing for my knees turns out to be not playing basketball.



My wife blows a lot of money on this stuff and has no desire to read this book. I guess I have a hard time convincing her that black goats are not that beneficial for osteoporosis. She also likes "bo-yak" which is a traditional Chinese medicine. Sometimes new knowledge doesn't have the impact on OTHERS you would like it to have.

[Atila Iamarino · Rating 5 out of 5]

Surpreendentemente bom. Escrito com bom humor, explica muito bem os conceitos, dá exemplos e mantém um tom bastante sóbrio ao descrever com o que não concorda, sem deboche. O autor foi um dos estatísticos responsáveis pelo centro de estudo de terapias alternativas do NIH e pode dar uma perspectiva bem única sobre as terapias e sobre os estudos delas. Recomendo a qualquer interessado no tema.

[Pam Reeder · Rating 3 out of 5]

Kind of dry writing. And, heck, I kind of like the placebo effect of a number of therapies -- why knock 'em if people feel better.

[Lloyd Downey · Rating 5 out of 5]

Occasionally, One comes across a book which really inspires and this is one of them. The author is a biostatistician (we called it Biometry when I studied it at University). And he has spent a considerable portion of his life investigating the impact of complementary and alternative medicines on our various ills and aliments. It more or less comes down to an investigation of the placebo effect but his great skill is in pointing to the difficulties in administering and interpreting double blind studies where the treatment involves some sort of procedure (rather than just taking a pill)....a procedure such as acupuncture or meditation. I must confess that I found his throughly scientific approach really stimulating and refreshing. But that also confirms my pre-existing biases so one has to proceed with caution. But Bausell DOES proceed with caution and seems to me to be exceptionally well balanced in all of his work and conclusions. For me it is a "tour de force". An exceptional work. Not only does he demonstrate that none of the various CAM procedures have an impact that is greater than the placebo effect; he also explains how the placebo effect occurs and the biochemistry behind (at least some of) it. I've extracted a few nuggets from the book as follows:This book's pivotal question: whether or not CAM therapies work......... And, while the placebo effect does not provide the complete answer to issues such as why so many people can be so sure that therapies such as homeopathy or acupuncture work for them (or why science is so impotent in supporting or refuting these beliefs), it does provide a starting point for their consideration.
We can examine the actual scientific studies that address four specific issues:
1. Is there such a thing as a placebo effect?
2. Is there something that has been demonstrated to take place within the body that could explain how a placebo effect occurs
3. Is there such a thing as a CAM effect over and above what can be attributed to the placebo effect?
4. Is there something that has been demonstrated to take place within the body that could explain how one or more of these CAM effects occurs?
Is any complementary and alternative medical therapy more effective than a placebo?
We have entered an era of consumer dissatisfaction with conventional medicine's inability to treat, much less fix, chronic, sometimes disabling aches and pains. But, for better or worse, dissatisfaction tends to create demand, which in turn is met by supply. And in this case, what was being supplied was a truly bewildering variety of therapies, the vast majority of whose practitioners approached medical care from a holistic, nonbiological, non-pharmacological, non-invasive, non-evidence-based, non-scientific perspective.
.... in 2002, a governmental survey found that 36 percent of the American public had used some form of non-prayer-based CAM therapy during the past twelve months.
The field includes:
(1) indigenous medical systems,
(2) recently developed (nonindigenous) medical systems,
(3) spiritual or energetic healing techniques,
(4) methods of relaxation, and
(5) extensions of conventional scientific findings.
In general most medical practitioners believe in the scientific process and value the evidence that it produces......CAM therapists simply do not value (and most, in my experience, do not understand) the scientific process.
With a few notable exceptions the placebo effect itself escaped serious scientific scrutiny until 1955...... Beecher's research was relatively simple. He re-analyzed the results of fifteen clinical trials that had employed a placebo control group and concluded that 35 percent of the patients who had received a placebo responded positivel. The article became an instant classic,...... If patients participating in a clinical trial can improve simply because they believe they are receiving an effective medical intervention, how can anyone have any confidence in the results of any clinical trial that did not employ a placebo control group?.... Called "double blinding," this strategy soon became a scientific requirement for serious clinical trials and has since been employed for almost all types of medical interventions.
The bottom line for us here is that the placebo effect, in conjunction with factors such as the natural history of our symptoms, conspires to produce false positive conclusions.
Psychological factors impeding our ability to draw correct causal inferences
Thre is a reluctance to admit when we are wrong (cognitive dissonance). And simple optimism (possessing an internal locus of control).
Dr. Smith's continued belief in his CAM therapy of choice really is quite .....understandable, He, was forced to rely upon his patients' truthfulness, plus he had many patients to monitor and he saw them only periodically. Even more problematic, physicians' judgments regarding their successes and failures have a serious built-in bias: patients who do not believe they are being helped tend not to come.
Test subjects who guess they are in a placebo group and leave the trial will bias the results. So randomized, placebo-controlled trials can be worse than useless And evaluating a CAM therapy that involves a procedure, as opposed to a pill, is far from the best of circumstances.
And as bad as this situation is in conventional medicine, it is far worse in CAM. There are many CAM therapies that have never been evaluated via a randomized, placebo-controlled trial. And there are therapies that have been evaluated multiple times so poorly... It has been estimated, in fact, that more than 500 RCTs (Randomised Controlled Tests) have been conducted to evaluate acupuncture alone, half of which have been placebo-controlled, yet the number of high-quality acupuncture trials could probably be counted on one's fingers.
All CAM experiments are not created equally, as illustrated by the following hierarchy:
1. Randomized clinical trials (RCTs) are more credible than nonrandomized ones.
2. Large RCTs are more credible than small ones.
3. Large double-blinded RCTs employing placebo control groups are more credible than RCTs not employing placebos.
4. Large double-blinded randomized, placebo-controlled trials with relatively minor experimental attrition are more credible than large randomized, placebo-controlled trials with high experimental attrition.
5. Large double-blinded randomized, placebo-controlled clinical trials with low attrition rates published in high-quality journals are more credible .... than trials published in, say, complementary and alternative journals.
Research has provided a definitive answer to the question of whether acupuncture is capable of relieving acute dental pain (in this case pain following dental surgery) over and above what can be attributed to the placebo effect. ....The results were quite definitive: there was no statistically significant difference between the real acupuncture group and the two placebo groups with respect to the average pain experienced following dental surgery. But Dr Lao then conducted a second, larger study... these two trials were of extremely high quality for CAM research...... Lao also instituted a check to see if his placebo groups really did indeed trick people.
Question:
Which treatment do you think you received?
1. Real acupuncture?
2. Fake acupuncture?
3. Not sure?
There was virtually no difference between the placebo group and the treatment group but a significant difference between those who believed they were getting treatment and those who thought they were getting a placebo. In the final analysis, it doesn't much matter what the real" explanation for these results is since we know that patients didn't make their guesses based upon the effects of acupuncture. Why? Because there weren't any effects for acupuncture. The participants made their guesses based upon their personal beliefs and expectations..... This relationship can be summed up as follows: If we believe in CAM therapies, then they will most likely work for us. If they don't work for us, then we will find a reason for this failure and continue to believe in them-thereby prohibiting reality from conflicting with our beliefs.
Is there really such a thing as an analgesic placebo effect?
There is a considerable amount of research that demonstrates that humans can be conditioned, just as Pavlov's successors did with dogs, to respond to placebos through repeated administrations of active drugs. In one study using healthy women, for example, two researchers administered nitroglycerin in distinctively flavored tablets over the course of several weeks. Then, following the administration of the same flavored pill without nitroglycerin (Le., a placebo pill), a change in heart rate similar to (but less dramatic than) the response for nitroglycerin was observed.3
Similarly, humans apparently will respond physiologically to placebos they think are caffeine, nicotine, alcohol, and a wide variety of drugs (e.g.. interferon, bronchodilators and bronchoconstrictors, stimulants and sedatives, and chemotherapeutic agents) via conditioning based upon their past experiences with those substances.*
The conditioned responses to the placebo drugs, while substantial, are almost never as strong as the initial responses to the real drug itself.
There is some evidence that people's desire (which can be conceptualized as motivation or perceived need for pain relief also contributes to the magnitude of the placebo effect.
There is also an intriguing genre of research suggesting that the desire or motivation to improve one's health may be an important factor in eliciting placebo effects..... patients who conscientiously take their placebo tablets tend to improve more than those who don't, even though there is absolutely no medical reason why this should happen.
More-over, some evidence exists (although it is based on findings that haven't been replicated) to show that placebos affect postoperative swelling, movement disorders, vital signs such as oral temperature and pulse....
Donald Price and Henry Fields concluded from a set of studies that there are three primary factors involved in placebo analgesia:
1. classical conditioning effect that occurs without the subject's conscious awareness of the conditioned stimulus-unconditioned stimulus association;
2. a desire for a given treatment or agent to significantly relieve pain; and
3. the level of expectation that pain will be significantly relieved by such treatment or agent. Although we think that classical conditioning is a major determinant of the magnitude of the placebo effect, we propose that a combination of desire and expectation can be of equal if not greater importance?
Principle 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.
We have all been conditioned to expect our physicians to help us based upon the fact that they really have helped us in the past. (Or at least we think they did, based upon natural history and the other inferential artifacts discussed earlier.) We have, in other words, been conditioned, à la Pavlov's dogs, to expect the medications they give us to work. Second, these findings explain how CAM therapists could inadvertently trick their patients into believing that their pain has been relieved. And then, based upon their patients response, these very real placebo effects could reinforce the CAM therapists' belief in the effectiveness of their therapies.
Principle 2: The placebo effect has a plausible, biochemical mechanism of action (at least for pain reduction), and that mechanism of action is the body’s endogenous opioid system.
Andrew Vickers and his colleagues set out to ascertain if the nationality of the principal authors influenced the results of the trials they undertook..... What I think these results demonstrate very definitively is that CAM investigators' countries of origin must be considered in the interpretation of CAM effectiveness trials. Chinese-speaking countries, for example, simply did not produce anything but positive acupuncture trials, while parts of Europe did not lag that far behind. And when Vickers and his colleagues repeated the analyses with a much larger sample of trials involving treatments other than acupuncture (most of which involved conventional medical treatments), they basically came up with the same results: 98 percent of conventional Chinese trials produced positive results, as did 97 percent of Russian trials. Reports from Canada, Australia and NZ averaged 30% positive responses to acupuncture; US Studies 53%, Scandinavia 55%, UK 60%, Other European 78%, Asia 98%.
There is another source of bias.... publication bias, and it refers to a well documented tendency for research journals to favour positive results (e.g., acupuncture helps arthritis sufferers) over negative results (acupuncture doesn't help arthritis sufferers) when deciding which articles they will publish.
For every twenty randomized, controlled trials conducted, one will be blessed as statistically significant when the differences between the experimental group (CAM therapy, in the present context) and the control group (or placebo here) in fact occurred by chance alone and were not real. What this means, in turn, given our current task of coming up with a definitive answer to the question of whether or not CAM therapies work better than a placebo, is that 5 percent of those trials judged to be positive really weren't.....
Our results so far indicate that when high-quality, placebo-controlled trials in high-quality, selective journals are considered, the preponderance of the evidence suggests that CAM therapies do not produce beneficial effects over and above those that can be explained by the placebo effect......But the bottom line is that there just isn’t enough of this sort of evidence to arrive at a truly convincing conclusion about this question.
Bausell has attempted to objectively classify the ninety-eight systematic reviews he located as providing either a positive (+) or negative (-) and goes through all the 98 studies with comments and a plus or minus and came up with 21 reviews that found positive impacts but then discounts a lot of them for various reasons (including later better studies that showed negative results) and ends up with a figure of 5% which, as he points out, is the figure which Ronald Fisher said would show up as false positives even where there was no real effect.
So is there sufficient evidence to conclude that any CAM therapies are more effective than a placebo? Based upon the evidence presented in both the previous chapter and this one, the bottom-line answer is no.
And this conclusion will now be elevated to the status of the book's third principle:
Principle 3: There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo.
Unfortunately, there is practically no plausible evidence supporting any biochemical mechanisms for CAM therapies. What we'll have to do, therefore, is to concentrate upon the hypothesized biological mechanisms of action proposed for CAM therapeutic effects by their proponents.
He briefly treats a range of different alternative systems: Traditional Chinese medicine, ayuvedic medicine, Tibetan medicine, osteopathic medicine, homeopathy, and some individual therapies; yoga herbalism, chiropractic, spiritual, chelation therapy, hydrotherapy, meditiation/mindfulness, massage, magnetic therapy et. etc.
So what's the bottom line? What we have here is a wide assortment of extremely creative therapies with even more diverse and creative hypothesized mechanisms of action. In some cases, these therapies ostensibly work by accessing energies, physiological pathways, and/or dimensions of existence that have not yet been observed, documented, or measured. In some cases we have therapies that borrow mechanisms of action from scientifically verifiable phenomena but stretch them far beyond anything recognizable by conventional science...... In no cases, however, do we have anything that would survive William of Occam's parsimony principle if we use the placebo effect as the comparator...... the one thing their use shares in common with the sole triggering mechanism for the placebo effect is belief.
Principle 4: No CAM therapy has a scientifically plausible biochemical mechanism of action over and above those proposed for the placebo effect.
Which regretfully leads me to conclude that: CAM therapies are nothing more than cleverly packaged placebos.
And that is almost all there is to say about the science of CAM.
CAM believers number well above 50 percent of the population, so the discipline may never fall to "oblivion" and its positive effects can be easily reproduced as long as a credible placebo control group isn't employed.
Based upon [my] admittedly limited experiences, it is my opinion that many reporters (scientific or otherwise) have not received a very good scientific education and have an absolute aversion to dealing with statistical concepts. Which probably lead to the three characteristics of the press' coverage of science:
1. "Superficiality is easier [to present] than depth" (and people who have something to sell have an exceedingly simple agenda to get across).
2. "The media cannot deal with ambiguity, subtlety, and diversity"
3. "The bizarre always gets more attention than the usual"
One thing I have saved you is the futile experience of going online to find out what does and does not work, which is the electronic equivalent of consulting a Ouija board. What you'll find there in the way of research evidence is a plethora of breathlessly positive studies conducted primarily by (or selected for presentation by) CAM proponents.
As mentioned above. I really liked this book. Have already recommended it to a couple of my academic statistical friends. Five stars from me.

[Bob Colwick · Rating 4 out of 5]

When my older son was diagnosed with autism, the first thing I latched on to was a cure...'it is the natural reaction to other health ailments', I thought, 'why shouldn't it work with autism?' As I quickly found out, autism has no known cure through traditional medicine, so I began the long and uncertain path down CAM (complementary and alternative medicine)...in doing so, I had to shuck my understanding of basic physiology and the interworkings of the various functions within a human body in order to become better acquainted with various theories (chelation, hydrotherapy, etc) that could cure my son of autism. When none of these methods worked, I found myself wanting to learn why they didn't work...'Snake Oil Science' is an incredible reference for others who share similar questions and want to know more about CAM therapies. Although CAM therapies are discussed in detail, Bausell's real focus in the book is to investigate the reality of placebos and attempt to discover why they are effective; 'Snake Oil Science' does a great job in viewing CAM therapies through the lenses of medical science and statistical probability to determine why they work in spite of little/no scientific background or statistical backing...in doing so, they helped answer a lot of my questions (although my son will never be "cured" of autism, I now better understand why CAM therapies work for others...it all boils down to the biochemical reactions that occur in others when they truly have faith that the CAM therapies occur. They never worked for my son because they would have required for HIM to believe that they would work...it doesn't work if OTHERS have to believe for the patient). Highly recommended for others who are going through (or who have loved ones going through) chronic health conditions and need to better understand the machinations behind CAM therapy.

[Kenneth Sherman · Rating 5 out of 5]

The author wanted to see if alternative medical treatments are any better than placebos. In any test of medicine, the placebo effect has to be taken into account, but in most research done on things like accupuncture, herbal medicines, chiropracty and others, they fail to do this.



The author leads us through the history of the placebo effect, how to test for it, the difficuties of testing for it so that we are well prepared to think about what might be a properly controlled test. Few actually seem to be, but the author is able to find some 22 that were properly controlled and were accepted by the JAMA or the New England AJournal of medicine. You can guess from the title what his results were.



I haven't gone in for alternative medicines too much and I am glad I haven't because it probably saved me some cash. I tried glocosamine for my aching knees a few years back and it seemed to work for awhile (The placebo effect?), and I paid 60,000 won for two bottles in Seoul. Peter Ryan recommended it and it seemed to have worked for him (The placebo effect?). I read some negative stuff on the Internet about it and stopped. The best thing for my knees turns out to be not playing basketball.



My wife blows a lot of money on this stuff and has no desire to read this book. I guess I have a hard time convincing her that black goats are not that beneficial for osteoporosis. She also likes "bo-yak" which is a traditional Chinese medicine. Sometimes new knowledge doesn't have the impact on OTHERS you would like it to have.

[Alexander Miles · Rating 5 out of 5]

When I first heard about this book, I figured it would be an all-out one-sided argument against alternative medicine, but the narrative wasn't quite as aggressive as I would have suspected. While the conclusion reached is indeed that all presently tested CAM (complementary and alternative medicine) therapies are no more effective then placebo, it doesn't feel like a foregone conclusion. Indeed the final chapters even encourage the reader to find a CAM therapy that works for them, with the caveats that we know they work for a limit range of applications (e.g. pain) and under limited circumstances (e.g. belief). The entire CAM debate is actually a shell for this book, as the substantive meat of it, at least for me, was the idea that good medical studies are really really hard to do. Bausell goes through the common confounding factors, and what it actually means for a study to be done well. Coming from the hard sciences side, where physical quantitative measurements are easy and essentially always repeatable, there were a lot of ideas that I had simply never wrestled with before. The writing style is a lot drier than the other pop-science books I've been reading lately, and that is perhaps because this isn't actually for general audiences. I'd recommend this book primarily to scientists, but if anyone has ever asked, "How do we know X doesn't work?!" where X is a CAM therapy (acupuncture, reiki, etc), this would be a great introduction into how we attempt to know things about the human medical condition.

[Jon Allen · Rating 4 out of 5]

I really enjoyed this book, because it provided a different viewpoint on Complementary and Alternative Medicine than what I've read in other books.

The majority of the book is focused not on how effective any particular CAM practice, but on experimental artifacts that create false impressions of its effectiveness, e.g. publication bias and the Hawthorne effect. A great deal is centered on a in-depth look at the Placebo effect and how its effects compare to the various CAM schools and criticism of many studies about CAM, i.d. lack of control/placebo groups and improper blinding.

While the conclusion is that CAM is probably no more effective than placebos, the author does not universally dismiss CAM, attesting that such an act would be an over-statement of the science and some people might be helped by the practices. He advises that CAM is best begun only after a frank discussion with a doctor about severity and duration of symptoms and should not be used in place of conventional medicine, e.g. chemotherapy or antibiotics.

All it was a fresh and illuminating new outlook on an area of medicine that I had never given great thought to.

[Dennis Littrell · Rating 5 out of 5]

Outstanding book that should be widely read, but won’t be

Why?

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.

--Dennis Littrell, author of “The World Is Not as We Think It Is”

[Stephanie · Rating 3 out of 5]

I read this book to challenge myself as a Chemistry graduate and a person who uses different CAM therapies.

Early in the book, Bausell states "None of this will be relevant to people whose beliefs are more important to them than whether or not those beliefs are correct. Discussions such as this are relevant only for those individuals who are willing to consider the possibility that science represents a reasonable path toward providing specific answers to exceedingly specific questions - people, in other words, who believe that science has its place in the world of thought and that one of those places is in the protection, restoration, and maintenance of our health." This challenged me to think about where I fall and to try to understand my thoughts.

Things I appreciated from this book: Bausell states what quality research should include and not include when being performed when examining different CAM therapies providing framework to account for the placebo effect. He discusses the reality of research bias - he doesn't limit this to CAM therapies and explains how even conventional medicine research has it's faults (Adam Ruins Everything has a great episode on research integrity). Bausell mentions early in the book that even conventional practitioners prescribe different drugs to act as a placebo (which, while this is very true and needs to be recognized by the public - he does not explain that the drugs are active enough to affect the human bodies in different ways due to side effects).

Things I didn't appreciate: Bausell frequently discusses his feelings or analysis with tongue in cheek statements. The first section of the book also presents some of his theories of natural history of pain with how the placebo effect exists. Bausell basically makes up scenarios but presents his theory as fact - I can't surmise that this part is factual. Bausell admits that it's fictional but the degree and way it's explained, it seems the reader is to take it as factual but is actually just his theory.

Bausell does present that the placebo effect does exist and claims any relief felt from CAM therapies is just the placebo effect acting in disguise. To this I say - does it matter? If people are able to have their bodies relax and heal because they feel they are getting quality care, does it matter? Does it matter if my brain is actually prompting my body to heal, with no side effects, versus possibly pumping my body full of drugs? To that I answer - No. Maybe I am partial because I do feel some of the CAM therapies I still partake in are worth my money. Number one reason I believe in Medical Freedom (mind you I still have to pay for Medical Insurance that does not cover my therapy of choice).

Things that are missing from this book: From all of the examined research cases, the length of the cases are never discussed. Does anyone really believe that certain herbs that are used to treat different conditions really just instantly relieve pain? To me, certain studies should be conducted over a longer period of time to examine long term effects and see if there are any changes. I also think, although Bausell is knowledgeable on different times of CAM, he might not know exactly the complexities of the medicine and does not seem to understand that some CAM (Chinese Medicine and Homeopathy come to mind quickly) do not have just one-size-fits all medicine for each person; the body is treated as a whole. For example, you cannot just give everyone in a trial one medicine that is supposed to treat one symptom.

It's amazing that our species survived for hundreds of thousands of years using primarily herbal medicines and other ancient therapies (now classified as CAM)!

[Jules Grant · Rating 3 out of 5]

I must admit, this book was a little bit above my reading level but I very much enjoyed it. Snake Oil Science is valuable reading if you wish to better understand how to read scientific studies and judge their quality. Especially now, as we are bombarded with flashy studies that prove the worth of this or that product, it’s important to be able to actually understand the information being given so as not to be led astray. I appreciate that he doesn’t insult the intelligence of alternative medicine followers or their practitioners, the author takes a gentle but thorough approach to dismantling the flaws in both alternative medicines and their studies. This book is not an attack but a soft invitation to better understand how things work. Absolutely recommend.

[Stephanie Bates · Rating 2 out of 5]

The information in this book is very interesting, which kept me reading (albeit in very short intervals). My issue with the book is the author's tone. Maybe he was attempting to be funny and simply missed the mark. I found the writing to be condescending toward the reader and incredibly dismissive and demeaning to researchers he decided didn't do thorough work. I recommend looking elsewhere for information on the research into CAM therapies, as the overall takeaways are far overshadowed by the constant condescension.

[Andrea Berardi · Rating 4 out of 5]

I found the foundation of this book to be fascinating. As someone who has always been interested (but never pursued) natural/homeopathic remedies, I was eager to read about the physiological mechanisms behind the placebo effect.

The author’s overall conclusion is that there is no scientific research proving that any alternative medical therapy is more effective than a placebo but that the placebo effect can “trick” many patient into healing.

[Mehmet · Rating 3 out of 5]

This book's content is so important, especially in the first couple of chapters, but its quality of argument deteriorates so thoroughly near the end, that I cannot fully endorse it. Read the arguments in the later parts with full skepticism (not that one should ever drop that guard), and use this book in conjunction with others (such as Trick or Treatment).

[Chad Schultz · Rating 5 out of 5]

It's ok. It's an extremely important topic. It goes into the details of the differences between well and poorly run scientific studies, reminding us that not every study is accurate or useful. It touches on a wide variety of specific alternative medicines. I think I enjoyed "Trick or Treatment: The Undeniable Facts about Alternative Medicine" more though.

[Jon Ross · Rating 4 out of 5]

Informative book with a good sense of humor. The scientific aspects are easy to follow for anyone. However I was hoping this book would get in to more specifics about the different types of alternative medicine, but instead this is a book about the concept of alternative medicine

[Quratulain · Rating 5 out of 5]

ExB

[Temnospondyli · Rating 3 out of 5]

A bit of a slog in places. Bausell really digs deep into the methods of a proper scientific study, which isn't necessarily good reading, while being absolutely invaluable in evaluating Complementary and Alternative "medicine". The book spends much of its time focused on how the placebo effect works, what it is, and how it can make a mess of poorly controlled studies. Trust me, if you want to know about the placebo effect, this book is for you (how odd that it wasn't mentioned in the title or subtitle of the book...publishers fault, I am willing to bet). I wish more time had been spent going in-depth with several of the CAM's mentioned in the book, taking apart specific studies (98 studies were mentioned in one chapter, but given only a cursory sentence or two), although that would have made a much longer book by far. Some of the book seems a bit repetitive as Bausell really hammers home the important aspects of scientific evaluations but it is worth the effort. I was disappointed that the book did not take the time to discuss such commonly used medicines/alt. medicines such as vitamins and related pills, or the anti-vax movement, especially since the cover appears to be of rows and rows of fish oil capsules, but that would have been a major endeavor in and of itself (and I can't blame the author; publishers for no good reason insist on taking control of the cover art no matter what the author wants it to be). Overall, this is a good book, if not always an easy read and is well worth the effort for anyone who is interested in the placebo effect and learning the weaknesses of so many highly-touted CAM studies.

[Ariadna73 · Rating 2 out of 5]

This book discusses a set of different techniques called "complementary medicine", and then goes on to give advice on how to lead better lives by eating smart, breathing well and getting some exercise.

This is the jacket of the book I read. The author is a PHD, professor of the University of Maryland.

This is the editorial page. Dr. Bausell published it 10 years ago, in 2007. I found it interesting even today. So, it has passed a little bit of the test of time.



This is the table of contents; as you can see, the discussion in the book focuses with great rigour in the validity of the science behind the CAM (Complementary Alternative Medicine).



This is part of the prologue, when this doctor says that his book will prove that there is no evidence behind CAM, and that people are just under some kind of spell related to the placebo effect. For some reason this reasoning does not apply to traditional medicine.



Here is part of the introduction:



And some statistics:



In conclusion, I found this book interesting, but obviously very biased towards the author's own beliefs. Which is not bad at all.



Well, I hope you liked this review. Did you know that I also have a blog? Take a look here: http://lunairereadings.blogspot.com

[Margot · Rating 5 out of 5]

I thoroughly enjoyed this book. I would highly recommend it to anyone interested in the methods of scientific research (it makes science exciting!). Although the topic is specifically complementary and alternative medicine, biostatician Bausell takes the reader on a comprehensive and comprehensible tour of the scientific process, explaining what goes into good research, and the possible confounding factors. The biggest factor in this type of research is the placebo effect, and the section in which Bausell cites evidence for the biological existence of the placebo effect was incredibly enlightening.

My friend send me a link for an infographic on the same topic after I raved to her about this book. Although some of the research used to create the infographic is refuted by Bausell, it's interesting to look at: http://www.informationisbeautiful.net....

Here are a few samples:
"Even as late as the 1950s and early 1960s it was not uncommon for hospital pharmacies to stock both placebo pills (sugar) and injections (saline)--conveniently available in selected colors."(24)
"This, dear reader, is really where our story begins. For at some point in our history we, as humans, began adapting our environment to our own needs rather than the other way around, to the extent that it is now against our nature to accept our fate without a struggle--which in turn means that we as a species have become inveterate experimenters. In other words, we are all scientists. We have to be. If a serious problem arises, it is written in our genes that we must try to solve it."(42)
"By now you probably desperately wish that you had chosen either science or statistics as a profession. If you'll bear with me for just a page or two longer, however, I'll make you even more jealous."(159)
"When research journals receive an article for potential publication, their editorial staff typically gives it a cursory screening to ensure that it is appropriate for the journal, then they send it out to three to five researchers in the author's field (often including a biostatician) for review. These reviews provide a judgment regarding whether or not the paper should be published as well as extensive revisions and comments. This is sometimes called the peer review process in science, and while imperfect, it is the best we've come up with yet."(305)

[Lena · Rating 4 out of 5]

As someone who spent years traveling through the offices of acupuncturists, chiropractors, naturopaths and homeopaths, I found Barker Bausell's thorough examination of the science behind these practices extremely valuable. Biostatistician Bausell has undertaken the enormous task of looking at this diverse industry through the objective eye of solid scientific research. Along the way, he provides an excellent education into such issues as what differentiates high-quality scientific research from poor quality research, publication bias, the natural history of pain, and the psychological and physiological mechanisms behind the placebo effect.

Bausell's conclusion is that there is effectively no high-quality scientific research proving that any alternative medical therapy is more effective than a placebo. Many of these therapies do seem to provide temporary placebo relief, however, ensuring ongoing devotion by their adherents. Bausell's conclusion is likely to be disputed by adherents who point to anecdotal evidence or poor quality studies that affirm their treatment's efficacy, yet my own extensive experience of these treatments (all of which were undertaken as a true believer) leads me to agree with Bausell's findings.

Though I found the subject matter of this book to be fascinating, Bausell may be a bit too detailed in laying out his arguments for the less patient reader. I found the writing easy enough for a non-scientist to understand, however, and he does punctuate the text with the occasional biostatistician joke.

Having spent years of my life and money I couldn't afford pursuing these kinds of treatments, I closed this book with some rather mixed emotions. On the one hand, I am relieved to think of the money I shall save by not running after the latest treatment-du-jour. In addition, I feel I am much more capable of understanding what does and doesn't qualify as good research. On the other hand, I am disappointed to realize that there are certain annoying health issues I may just have to live with. As Bausell points out, "...the nourishment of hope is [alternative medicine's] greatest strength." But once you're in on the secret that it's all placebo, it doesn't tend to work anymore.

[Marshall · Rating 4 out of 5]

This book explores the scientific research on alternative medicine. The best part is at the beginning. It has the best explanation I've seen so far of the placebo effect. He explains what it is, how it works physiologically, and how to control for it. He also explains the many other confounding variables and biases good research must control for if they want to claim to have scientific results supporting their treatments.

The verdict is pretty bad. He goes through dozens of the best research that exists on the subject. The only ones that showed positive results failed to control sufficiently for all of the variables and biases. The biggest culprit was always that pesky placebo effect. The placebo is so powerful and so pervasive and so hard to control for that it always rears its head in research of this kind.

It's not that the placebo is a bad thing. It's an amazing gift our brains have given us--just by believing a treatment will work, it so often does, even when it doesn't. But alternative medicine practitioners claim that their treatments are more than just fancy placebos. This is an empirical claim, so it should be explored empirically.

The author tends to pick on acupuncture. He never explained why, whether is was because it was the worst culprit (it seemed to be), or whether he has a personal grudge against it.

[Dave · Rating 4 out of 5]

More than just a scientific look at alternative medicine. Bausell explains the placebo effect and several related factors that you may not have heard of. Taking these effects into account in a clinical trial is tough. He discusses in depth what it takes to run a rigorous clinical trial, the kind you should base your medical decisions on. The last section of the book explores studies on alternative medicine. How nearly all of them fail to meet the criteria for a good clinical trial and the few that do show no benefit from alternative therapy.

When I picked up this book I was hoping to read some specifics on debunking clinical trials of alternative medicine. It definitely has that in abundance. However, I was more intrigued by material on placebos and designing clinical trials. The way your mind can affect your body (and vice versa) is amazing.

[Lauren · Rating 4 out of 5]

A bit technical and dense, but still highly readable. Lots of information on why exactly it is that peer-reviewed research and science-based medicine do not support the claims of CAM. After all, if "alternative medicine" were on par with medicine, it would just be called MEDICINE.

Anyone who has been paying any attention to the science and the studies (as opposed to the hype and the rhetoric) can probably already guess the conclusion of this book. CAM, for the most part, is not supported by the evidence (ie: DOES NOT WORK).

Please talk to your doctor before trying ANY alternative therapy or supplement or herbal or treatment. Please. Your doctor went to medical school for a reason: to be able to help you sort the wheat from the chaff.

[Kirsten · Rating 5 out of 5]

I loved this book. It was such an enlightening read. Bausell definitely has a bit of a snarky and sarcastic way of writing which I thoroughly enjoyed. It made the material much more entertaining to read and his small jokes helped get me through some of the more boring parts of the book.

I will say that this book is really more for those who are sort of the fence regarding CAM therapies as opposed to those who believe in them. Bausell, as mentioned above, comes off as very snarky and sarcastic and this may not go over well with those who firmly believe in these therapies.

This is definitely a book I will keep and reference often and I already have referenced it multiple times for use in my grad courses.

[Melanie Meyer · Rating 4 out of 5]

Although this wasn't the most interesting thing I have ever read,research methodology can be a little "dry", the information contained in this book is incredibly valuable. This is a thorough, systematic review of the high-quality, empirical scientific evidence for complimentary and alternative medicine, and comparison of how CAM therapies stack up against the placebo effect. The conclusion after reviewing years of research from around the world into a variety of alternative medicines: Go see your M.D. for you medical concerns, or find a CAM therapy you really believe in, because the placebo effect will not work without the expection of benefit and the placebo effect is all that CAM therapies have been shown to offer.

[David · Rating 4 out of 5]

A research methodologist's view of complementary and alternative medicine. Strict, rigorous, and utterly devastating to those who still hold hope for these kinds of methods. The final section is a little patronizing, however, giving advice on how to choose the right placebo for you. Those placebos would only work if you didn't believe anything you read in the book beforehand, so few people will find that useful.

[Sue · Rating 3 out of 5]

Entertainingly written & very informative. The author not only goes through the rationale behind placebo controls, double-blinding (when possible), &c. He also investigates some of the science behind the placebo effect itself. He has an unusual perspective, having been personally involved in some research on the effectiveness of "CAM" (complementary & alternative medicine) in his own career as a biostatistician.