Snake Oil Science: the Truth about Complementary and Alternative Medicine
By R. Barker Bausell
Reviewed by Ray Ward
Bausell covers the rise of CAM, the history of placebos, impediments to valid inferences, why randomised placebo controls are necessary in CAM research, judging scientific evidence, personal research on acupuncture, how we know the placebo effect exists, a biochemical explanation for the effect, what trials and reviews reveal about CAM, and how CAM is hypothesised to work.
He begins by quoting Robert Park’s experience of seeing CAM advocates nodding in agreement despite giving differing views on the field’s most important issues: in a body which regards itself as embattled and besieged there can be no internal dissent. In a new area, poorly conducted research is the norm, and almost invariably produces false positive results. Patterns are often very difficult to distinguish from coincidence. CAM therapists do not value (and most, in Bausell’s experience, do not understand) the scientific process. There is the “file drawer” problem, familiar from other areas of paranormal research: negative results are less likely to be published, and the problem of attrition: subjects who feel they are not being helped tend to drop out.
The nature and quality of the publishing journal is particularly important in CAM research; a homeopathy or acupuncture journal is unlikely to publish a trial that suggests homeopathy or acupuncture doesn’t work. Small studies tend to produce distorted results. Good news is always preferred to bad, and there are always people whose beliefs are more important to them than whether or not they are correct.
Bausell relates how his mother-in-law’s experience with CAM treatments for pain demonstrates the post hoc ergo propter hoc fallacy, the mother of all superstitions: the fact that one thing follows another is not evidence of cause and effect. His mother-in-law attributed pain relief to the treatment, when in fact her pain pattern shows that it would have diminished anyway. Our old friend the principle of parsimony appears, and Occam’s Razor is vigorously plied.
Bausell summarises well over a hundred CAM trials and discusses all the well-known CAM therapies, and his conclusion is unequivocal: “CAM therapies are nothing more than cleverly packaged placebos.”
