In my previous post, Year of the Snake Oil, I gave an introduction to the book Snake Oil Science by R. Barker Baussel, and indicated that I learned much from this federally-funded acupuncture researcher’s book. This year, in honor of the Snake, I’ll go through this book and share insights and questions it raises.
I went to get a link to the Kindle version on Amazon so readers could at least read the Introduction and beginning as a free sample, and was thrilled to see that it is now just $1.99 for the whole book via Kindle. Even though I have the paper book, I now prefer reading on my iPad, so I just bought this digital copy as well to help with my posts. I don’t get any royalty on this, here’s the link: http://www.amazon.com/Snake-Oil-Science-Complementary-ebook/dp/B003ULNSAU
You can’t Click to Look Inside on my image, so go to Amazon and download the free sample or buy the whole book for just $1.99.
This post is a review of the Introduction and also shares the Table of Contents so you can get an overview of how the book is laid out.
Bausell starts by referencing another book I just finished, _Voodoo Science: The Road from Foolishness to Fraud_ by Dr. Robert Park. Park noted that since Complementary and Alternative Medicine (CAM) fans feel, as a group, besieged from the outside, they tend to stick together and not criticize each other. This is despite the fact that there are many contradictory claims which can’t all be true at the same time (such as the subluxation theory of chiropractic and the psora theory of homeopaths). Bausell notes that another CAM characteristic is a feeling that the validity of their practices is above scientific methods. As the Office of Alternative Medicine became the National Center for Complementary and Alternative Medicine, growing in funding for research, it “provided the conditions for a crisis that has occurred many time sin the history of science: a collision between science and belief.”
Beliefs which do not line up with actual reality can lead to harmful decisions. Sometimes this is done for cultural/religious reasons with good intentions, but Bausell also mentions that some people mislead others (and perform bad research) for personal gain. Good science minimizes the influence of beliefs and biases as claims are tested and causes are elucidated. ”What this book is about, then, is the evaluation of the scientific research that has been conducted to assess the effectiveness of a large, catchall category of medical therapies variously referred to as complementary and alternative, unconventional, or integrative, such as acupuncture, herbs, and homeopathic remedies.”
Bausell describes himself as a research methodologist or a biostatistician. ”…I specialize in the design of research studies that allow us to try out different approaches to problems, assign numbers to what happens, and then interpret these numbers in an objective manner.”
As he investigated and designed research on acupuncture as director of the University of Maryland’s Complementary Medicine Program, Bausell found the most interesting piece to be the placebo effect. He notes that the placebo effect holds the key to the question of whether or not CAM therapies work, and sums up his 30 year career as the attempt to circumvent the confounding influence of the placebo effect in medical research.
I received my Master’s Degree in Acupuncture & Oriental Medicine in 1997. I’ve said a few times that the internet, state of scientific research, and knowledge of the placebo effect have improved so much since then that it is a different world today. It was reassuring to learn that Bausell also feels this way:
Because of its emphasis upon high-quality scientific evidence, this book could not have been written in April 1999, when I assumed my position at the aforementioned Complementary Medicine Program. Now, however, enough evidence has accumulated to permit the first scientific evaluation of complementary and alternative medicine. And that is what this book is about.
This book is also about explaining how such scientific evidence is generated in the first place, because without an understanding of the logic of experimentation, it is impossible to make sense of the huge morass of conflicting evidence with which the media is constantly barraging us about any number of therapies, CAM or conventional. Fortunately, this logic is simple, involving nothing more than comparing one group of individuals who receive a therapy with another group who think they are receiving that therapy.
It is exciting to live in a time of so much scientific progress and also such improved access to information; it does take constant effort to keep learning and, if one is interested in aligning beliefs with reality, letting go of disproven beliefs.
When stating that, for example, research has found acupuncture to be no better than placebo for smoking cessation, it is very common to hear people say “but it worked for my friend” or an acupuncturist say “I’ve seen results in my own clinic, so I believe it.” I like the way Bausell addresses this in the Introduction:
What I seek to do in this book, then, is to demonstrate how millions of intelligent people could be correct when they conclude that their symptoms were relieved as soon as they received a complementary and alternative medical treatment, but incorrect when they conclude that this relief was due to the treatment itself.
Because of the impressive and elusive nature of the placebo effect, Bausell points out that personal experiences of both patients and therapists are largely irrelevant for determining whether a CAM treatment is more effective than a placebo. Answering this question is not as easy as it may seem at first glance. As someone who started studying acupuncture and Traditional Chinese Medicine (TCM) in 1993, I would certainly hope that many of the claims of acupuncture would have been shown to be clearly superior to placebo. Apparently, in the mid 1990s it appeared that was the case. However, with the advances in understanding the placebo effect and good research design, Bausell explains step-by-step why this is no longer a valid conclusion. I still hope that acupuncture will be shown by good research to be better than placebo for at least some conditions, but I am also unwilling to fool myself by remaining in ignorance of the power of the placebo and the importance of well-done research studies.
Thus concludes the introduction. Here is the Table of Contents so you can see the gist of the book:
The Rise of Complementary and Alternative Therapies
A Brief History of Placebos
Natural Impediments to Making Valid Inferences
Impediments That Prevent Physicians and Therapists from Making Valid Inferences
Impediments That Prevent Poorly Trained Scientists from Making Valid Inferences
Why Randomized Placebo Control Groups Are Necessary in CAM Research
Judging the Credibility and Plausibility of Scientific Evidence
Some Personal Research Involving Acupuncture
How We Know That the Placebo Effect Exists
A Biochemical Explanation of the Placebo Effect
What High-Quality Trials Reveal About CAM
What High-Quality Systematic Reviews Reveal About CAM
How CAM Therapies Are Hypothesized to Work
Tying Up a Few Loose Ends