R. Barker Bausell PhD - Snake Oil Science: the Truth about Complementary and Alternative Medicine

SNAKE OIL SCIENCE

The Truth About Complementary and Alternative Medicine

R. BARKER BAUSELL

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Copyright 2007 R. Barker Bausell

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Library of Congress Cataloging-in-Publication Data Bausell, R. Barker, 1942
Snake oil science : the truth about complementary and alternative
medicine / by R. Barker Bausell.
p. cm.
Includes bibliographical references.
ISBN 978-0-19-531368-0
1. Alternative medicine. 2. Placebo (Medicine) I. Title. R733.B29 2007 615.5dc22

1 3 5 7 9 8 6 4 2

Printed in the United States of America
on acid-free paper

To Rebecca Barker Bausell

CHAPTER ONE
The Rise of Complementary and Alternative Therapies

CHAPTER TWO
A Brief History of Placebos

CHAPTER THREE
Natural Impediments to Making Valid Inferences

CHAPTER FOUR
Impediments That Prevent Physicians and Therapists from Making Valid Inferences

CHAPTER FIVE
Impediments That Prevent Poorly Trained Scientists from Making Valid Inferences

CHAPTER SIX
Why Randomized Placebo Control Groups Are Necessary in CAM Research

CHAPTER SEVEN
Judging the Credibility and Plausibility of Scientific Evidence

CHAPTER EIGHT
Some Personal Research Involving Acupuncture

CHAPTER NINE
How We Know That the Placebo Effect Exists

CHAPTER TEN
A Biochemical Explanation for the Placebo Effect

CHAPTER ELEVEN
What High-Quality Trials Reveal About CAM

CHAPTER TWELVE
What High-Quality Systematic Reviews Reveal About CAM

CHAPTER THIRTEEN
How CAM Therapies Are Hypothesized to Work

CHAPTER FOURTEEN
Tying Up a Few Loose Ends

I would like to acknowledge the efforts of Allison Hewitt for her help in acquiring many of the references used in this work, Sue Warga for copyediting the text, and Lelia Mander for supervising the books production. Most of all I owe a debt of gratitude to Marion Osmun, my editor, who believed in the project and turned it into a far better book than it would have been otherwise. I am convinced that this project never would have come to fruition without her help, guidance, and encouragement.

In his delightful book Voodoo Science: The Road from Foolishness to Fraud, Dr. Robert Park provides an amusing firsthand account of a press conference called by the National Institutes of Healths then nascent Office of Alternative Medicine to lay out its scientific agenda. After describing some introductory remarks by a senator who had been instrumental in pressuring the NIH to establish the office in the first place (after reputedly having been cured of his allergies by bee pollen purchased from an individual who had claimed, among other things, that the risen Jesus Christ, when he came back to Earth, consumed bee pollen), Park went on to describe a type of behavior that I observed numerous times during my own involvement in an NIH-funded center for complementary and alternative research:

Perhaps the strangest part of the press conference consisted of brief statements by individual members of the editorial review board of what they saw as the most important issues for the Office of Alternative Medicine [OAM]. One insisted that the number-one health problem in the Unites States is magnesium deficiency; another was convinced that the expanded use of acupuncture could revolutionize medicine; and so it went around the table, with each touting his or her preferred therapy. But there was no sense of conflict or rivalry. As each spoke, the other would nod in agreement. The purpose of the OAM, I began to realize, was to demonstrate that these disparate therapies all

In my opinion Parks observations regarding the bonds that hold this community together are quite perceptive. I would add that another of the groups shared beliefs is that the validity of their therapies transcends conventional scientific methods altogether. As things turned out, however, the OAM (one of whose early directors was an unabashed advocate of homeopathy) mutated into the more prestigious National Center for Complementary and Alternative Medicine, which began funding high-quality, scientifically rigorous controlled clinical trials of complementary and alternative medical (CAM) therapies, which in turn helped introduce the evaluation of the effectiveness of CAM therapies into mainstream scientific thought. All of which, not unlike a metaphoric particle accelerator, provided the conditions for a crisis that has occurred many times in the history of science: a collision between science and belief.

Belief itself is a very personal human attribute that is extremely important to all of us. We believe in things for many reasons: because we want to, because we need to, because certain beliefs fit our worldviews or religious tenets, because the majority of our acquaintances share them, because of the advocacy of someone we respect, and perhaps most frequently of all because of how we interpret our personal experiences.

All of these can constitute perfectly reasonable bases upon which to found ones beliefs. All of these are also perfectly capable of leading to incorrect decisions about what is beneficial, what is ineffective, and what is downright harmfulespecially when we are misled by those we trust.

This book describes another basis upon which to found certain types of beliefs, specifically those involved in ascertaining the cause of things. That basis depends on performing carefully controlled experiments designed to ascertain what helps us, what does not, and why. It is a wondrous process with one serious weakness: it is performed by people who are themselves sometimes unavoidably influenced by their beliefs, who sometimes arent sufficiently trained, andalaswho sometimes deceive the rest of us for their personal gain.

Still, of all the reasons people believe things, science is the most objective and the most immune from those logical and emotional frailties that define our humanityespecially when we take the quality of this scientific evidence into consideration. 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. Millions of people are increasingly using these therapies to supplement or replace an equally large category of therapies such as pharmaceuticals and surgery that are now considered to be the province of conventional medicine.