So-called "complementary and alternative" medicine (or CAM) is a big business these days, and a great many people, some of them doctors and scientists, are thoroughly convinced that these unconventional treatments really work. But do such things as acupuncture and homeopathy truly treat anything, or are they just placebos with good PR? R. Barker Bausell attempts to answer this question.

Actually, although the focus here is on CAM, I think the usefulness of this book is much broader than that: it's a good, thorough, detailed look at what it takes to determine with any reasonable degree of confidence whether something has a real, non-placebo-based medical effect or not. And that's not nearly as easy as it looks. There are a whole host of factors that can make it seem, or even make it seem obvious that something is working when it's not. And not all scientific studies are created equal when it comes to controlling for those factors. Bausell explains the hows and whys of all this clearly and in depth, and applies it towards an evaluation of various CAM fields.

There are a few things here I'm inclined to quibble with, notably his disturbingly off-hand dismissal of non-English-language studies and his suggestion that people with chronic problems might as well go out and get some scientifically unsupported CAM-based treatments, anyway, for the power of the placebo effect. I also think he does best when he concentrates on specific treatments, such as acupuncture, as CAM is almost too broad a subject to take on all at once. Still, overall it's a very worthwhile read, and provides some excellent lessons about how science works in medicine, how good science and sloppy science differ, and why that difference is so important. ( )

Very readable and engaging. However, on this subject, Edzard Ernst's book Trick or Treatment is much more authoritative (and equally fun to read). Ernst has iron-clad credentials, to boot, and is far more sympathetic to CAM than Bausell. Yet Ernst is first and foremost in search of what helps his patients, and to do that he must truly seek the truth about CAM. In that, he excels. ( )

Subtitled “The Truth about Complementary and Alternative Medicine”

In short, the truth is all the effects can be explained by the placebo effect, and there are negative results universally when well controlled and blinded studies are done. The author is a bio-statistician, writes amusingly, and takes pains to define all current major alternative therapies. He recounts his own experiences working with the office of complementary and alternative medicine at NIH, designing well constructed trials. He writes on page 3 “We have, in short, entered an era of consumer dissatisfaction with conventional medicine’s inability to treat, much less fix, chronic, sometimes disabling aches and pains. But, for better or worse, dissatisfaction tends to create demand, which is in turn met by supply. And in this case, what was being supplied is a truly bewildering variety of therapies, the vast majority of whose practitioners approached medical care from a holistic, nonbiological, nonpharmacological, noninvasive, non-evidence-based, non-scientific perspective”. The text exhaustively and usefully reviews sources of bias in experimental results, and a long section reports on all the double blinded studies the author could find of alternative medicine, with virtually no positive studies. A very useful book. ( )

R. Barker Bausell sets out to write a pithy account of how he and his team debunked acupuncture. As a good scientist, he builds his case carefully, explaining for the uninitiated how the scientific method is supposed to work and going into great detail in describing the placebo effect. This is interesting stuff and may come as something of a revelation to non-scientists. Unfortunately, having demonstrated his case with respect to one type of CAM (complementary and alternative medicine), he uses it as the basis for generalizing to anything that might be classified as CAM. Here we have a fine scientist indulging in some grave errors of logic, and so undermining his own credibility. In the last third of "Snake Oil Science", Bausell flippantly dismisses anything he labels CAM, including some treatments that arguably are not. He does this not through an appeal to fact but by resorting to fallacies that most careful thinkers have learned to avoid. First, Bausell defines CAM circularly: a CAM technique is anything which is practiced by CAM practitioners. Then, having earlier shown that many CAM proponents justify their practice with faulty research, Bausell argues that any research produced by CAM practitioners is therefore faulty and discredited. Erroneously affirming the consequent in this way, instead of taking the time and trouble to build a logical case against these other forms of CAM, shows a glib and facile side to this work that serves to cast more doubt on the author than on the CAM therapies he purports to refute.

Many critical thinkers, scientists, and clinical researchers are eager for well written, logically and scientifically rigorous refutations of CAM, which is viewed as a useless drain on the health care system and a source of false hope to sick people. This book makes a good start, but sadly finishes badly by playing a game of "gotcha" that doesn't quite work out.