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SNAKE OIL SCIENCE: THE TRUTH ABOUT COMPLEMENTARY AND ALTERNATIVE MEDICINE PDF, EPUB, EBOOK R. Barker Bausell | 320 pages | 27 Aug 2009 | Oxford University Press Inc | 9780195383423 | English | New York, United States Snake Oil Science: The Truth about Complementary and Alternative Medicine by R. Barker Bausell Last year she wrote about the wonders of glucosamine and chondroitin sulfate supplements, a common CAM treatment for joint pain , and how both she and her dog are avid users of these substances. In a column , she wrote about her "arthritic spaniel's dramatic improvement" and her own "30 percent improvement," i. He walks two hours a day, goes up and down stairs easily and regularly climbs a mountain road with me. None of the studies would qualify as high quality, large scale, randomized, placebo controlled studies, however. Yet, when a high quality study involving 1, participants was published in the New England Journal of Medicine by Daniel Clegg et al. Yet, rather than reject the unbiased science in favor of her biased understanding of her personal experience, she offered this bit of rationalization and appeal to authority: "While not everyone who has tried this supplement has seen improvement, my sports medicine physician reports that at least a third of his patients have benefited. If cartilage has completely worn away, it cannot be rebuilt. On average, about half of those who try the supplements report reduced pain and stiffness. What is required of a high caliber study, the reader might wonder? According to Bausell, the most credible type of evidence available to us comes from "large [at least 25 in each group], double-blinded randomized, placebo-controlled clinical trials with low experimental attrition published in high-quality scientific journals that have been independently validated by other investigators" Unfortunately, that eliminates most CAM studies from consideration. Even so, for the period February to January , Bausell found twenty-two such studies involving such things as using acupuncture to treat cocaine addiction, St. In every case but one, the results were negative Bausell wonders out loud if the one positive isn't the one-in-twenty false positive expected given the statistical standards used in these studies 0. Perhaps taking their cue from Dean Radin, many CAM supporters have turned to meta-analysis to try to make their case, although they seem to prefer the term systematic review. In any case, Bausell made his way through 98 systematic reviews of everything from using acupuncture to treat asthma to using therapeutic touch to heal acute wounds pp. Bausell thinks he can reconcile the lack of high quality scientific studies supporting the efficacy of CAM with the fact that billions of people have been swearing by these remedies for thousands of years. The answer, he says, is in people's ignorance of the placebo effect and a few other artifacts that accompany most CAM studies and treatments. Placebo effects "are ultimately built upon human frailty and they depend upon ignorance or misconceptions for their continued effectiveness" Thus, we can probably count on CAM being around for a few more millennia. While many CAM researchers either "totally disregard" or are "totally ignorant of" methodological quality, according to Bausell, research establishing the reality and the mechanism of the placebo effect has been first class. One such study was published in the journal Pain. It was conducted by Antonella Pollo et al. Other researchers, such as Donald Price, have shown that placebos work to reduce pain only when the subject believes that the therapy is capable of reducing pain. Martina Amanzio et al. That is, we can be conditioned to release such chemical substances as endorphins, catecholamines, cortisol, and adrenaline. One reason, therefore, that people report pain relief from both acupuncture and sham acupuncture is that both are placebos that stimulate the opiod system, the body's natural pharmacy. According to Bausell, complementary and alternative medicine CAM practitioners' greatest asset is their nourishment of hope For billions of people everywhere, that seems to be enough. While it may be unethical to knowingly package, prescribe, or sell placebos as magical cures, the CAM folks seem to think they are ethical because they really believe in their chi , meridians , yin, yang, prana , vata, pitta, kapha, auras , chakras , energies , spirits , succussion , natural herbs , water with precise and selective memory , subluxations , cranial and vertebral manipulations , douches, body maps , divinities , and various unobservable processes that mysteriously carry out every sort of analgesic and curative function imaginable. Packaging placebos is big business and, for the reasons given by Bausell that have been outlined above, is likely to get even bigger. The only thing that could slow down CAM atavism would be the sudden appearance of horrible side effects issuing from toxic treatments like aura cleansings or homeopathic douches. I'd say that there's only about a one in twenty chance of that happening any time soon. And in this contradiction lies the genesis of R. All these departures from scientifically validated therapies tend to be accompanied by a disdain for the statistics supporting them, and Dr. But a stint directing research into alternative medicine has familiarized him with the thought patterns of those who use it, those who are inclined to prescribe it and those whose research seems to support it. He writes with a sense of humor and palpable compassion for all involved, and in the regrettably likely event that he winds up preaching exclusively to the choir, his book will be no less of a tour de force. Bausell starts out with the story of his late mother-in-law, Sarah, a concert pianist who developed painful arthritis in her old age and found her doctors to be generally useless when it came to satisfactory pain control. What ensued, according to Dr. Bausell, was a predictable pattern. Unfortunately, each miracle cure was regularly replaced by a different one, in a cycle her son-in-law ruefully breaks down for detailed analysis. He makes it crystal clear exactly how the natural history of most painful conditions conspires with the immensely complex neurological and psychological phenomenon known as the placebo effect to make almost any treatment appear to work, so long as the recipient hopes and believes it will. 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. John's Wort for depression or acupuncture for chronic pain. The Rise of Complementary and Alternative Therapies 2. A Brief History of Placebos 3. Natural Impediments to Making Valid Inferences 4. Judging the Credibility and Plausibility of Scientific Evidence 8. Some Personal Research 9. Barker Bausell , Ph. He has also served as a consultant to Prevention and Discover magazines. Barker Bausell, a biostatistician, has stepped out of the shadows to give us an insider's look at how clinical evidence is manipulated to package and market the placebo effect. Labeled as "complementary and alternative medicine," the placebo effect is being sold not just to a gullible public, but to an increasing number of health professionals as well. Bausell knows every trick, and explains them in clear language. Park, Ph. It is big business with big claims and big demands on it to produce, but there is very little science behind most of it. Unfortunately, what has long been lacking is a well-written, clear, and concise analysis of its major claims to which we can direct our readers. That problem has now been remedied by R. Barker Bausell's authoritative and highly readable analysis Snake Oil Science, which should be read by anyone contemplating the use of any of the hundreds of alternative and complementary medical treatments out there that promise hope but usually deliver disappointment. Kassirer, M. So the consumer should and, I'm sure, will buy this book. Snake Oil Science: The Truth About Complementary and Alternative Medicine | JAMA | JAMA Network CAM therapists, writes Bausell, "simply do not value and most, in my experience, do not understand the scientific process" p. Fortunately for the CAM healers, most of their clients don't understand the scientific process, either. Since the mids, when H. Beecher published a study that claimed that more than one-third of patients participating in clinical trials benefit without receiving any active treatment, medical researchers who understand what this means have designed their experiments to account for the placebo effect. New drugs or therapies might work, but if they don't work any better than a placebo then that's what they are: a placebo. This fact seems very difficult for many people to grasp. Acupuncture, for example, is currently enjoying a surge of popularity in the U. I'll return to this point later in a brief discussion of the scientific experiments described by Bausell that demonstrate this fact. Many CAM researchers seem oblivious to the requirement to rule out the placebo effect and not only don't use placebo groups, they don't use controls at all.