The Skeptic Next Door

I have finished reading  Snake Oil Science: The Truth about Complementary and Alternative Medicine by R. Barker Bausell.  It is a carefully constructed examination of alternative medicine by one of the National Institute of Health’s scientists.  Dr. Bausell was Research Director of a National Institutes of Health funded Complementary and Alternative Medicine Specialized Research Center.

I am very impressed by this book it is written almost like a court case against many forms of alternative medicine.  Bausell manages to do this in a way that is not tedious or boring.  It helps if you appreciate self-deprecating humor.

The book provides an nice overview of various alternative medicines as well as the rise of usage of such therapies.  It also discusses the numerous problems in evaluating the efficacy of such treatments. The author describes his involvement in a number of acupuncture trials, where an attempt was made to create a placebo acupuncture treatment to be used as a control in subsequent experiments.

The best experiments are ones that are double blind.  This is almost impossible to do with some types of therapies.  Double blind means that neither the practitioner nor the subject know if the treatment is the real treatment or a fake treatment.  With pills this is fairly easy, when the treatment is sticking pins into someone this is extremely difficult.   Single blinding acupuncture is done by using needles in tubes attached to the skin.   The needles may or may not penetrate the skin, in locations that may or may not be the correct location.  In the placebo version, pressure on the tubes may be used to simulate insertion of the needle.   This is done on subjects who have never received acupuncture.  However, the acupuncturist still knows if the treatment is real and many subjects are able to correctly guess if they where receiving the placebo.

There are several chapters of the book dedicated to placebos, ranging from history, controlling for it in experiments, proof that it exists and determining the biochemical explanation for such an effect.  It is the chapter on physiological explanations for the placebo effect that has stayed with me.  In it there is a description of a fascinating experiment where a placebo effect was induced and then chemically blocked using an opiate blocker, indicating a physiological mechanism for the placebo effect for pain.

Much of the book walks the reader through the various mechanisms that can create biases in the published results.  I have heard that as many as 80% of all published studies are incorrect (I wish I could find a reference).  Examples of this problem are, studies that find a positive result are more likely to be submitted for publication than those that do not.  Studies that demonstrate a positive result are more likely to be published than those that do not.  Journals that focus on particular alternate therapy that are unlikely to publish a negative result.  Some cultures never publish a negative result. Studies may not be randomized, they may not be single or double blinded.  The list goes on.

When the very high quality experiments in the most prestigious journals are evaluated, there are very few alternative therapies that show positive results.  The book summaries these result and the final conclusion is that the various forms of alternative medicine are rarely if every better than a placebo.  Personally I find it odd that people who have to have the latest in technology often expect the oldest forms of medical technology to work well for them.