Terra Sigillata

A former research director for a complementary and alternative medicine program at a major academic medical center has just released a book that I must get my hands on. I just learned about "Snake Oil Science" by R. Barker Bausell from a Jerry Adler article in the current issue of Newsweek (10 Dec 2007).

To set the proper context, med bloggers like Orac, Dr. R.W., Panda Bear, MD, Sid Schwab, and we here at Terra Sig have been increasingly expressing concern about the seemingly uncritical integration of alternative medicine programs into some of North America's most respected medical schools and academic medical centers. (Orac's recent post is a particularly excellent resource in that it aggregates links to those centers.).

Well, the University of Maryland Center for Integrative Medicine actually has a pretty good reputation among such centers as having one of the most active research programs. Bausell, a biostatistician, was director of research there from 1999 to 2004 and wrote "Snake Oil Science" to provide insights into how clinical trials of alternative therapies are conducted and interpreted. From Adler's article:

Bausell thought the least you could ask of an actual treatment was that it work better than a fake one, but when he examined the studies critically, hardly any did. So he wrote "Snake Oil Science" to educate journalists and the public that "just because someone with a Ph.D. or M.D. performs a clinical trial doesn't mean that [it] possesses any credibility whatsoever ... The vast majority are worse than worthless."

.....Researchers, even those without a direct financial stake in the outcome of a trial, often have a psychological investment in what they're testing. Their papers get published because the editors of journals in fields like homeopathy start from the premise that the whole thing isn't a preposterous hoax, as Bausell and most mainstream doctors believe. If someone really does cure cancer--whether a drug company researcher or a Tibetan herbalist--The New England Journal of Medicine or The Journal of the American Medical Association will be happy to publish the news.

What Adler seems to infer in the article is that the proliferation of scientific journals has led to many publications that appear to be peer-reviewed but are actually vehicles for Kool-Aid drinking peers who don't question the validity of the modalities being studied. Indeed, if reiki cured cancer you can guarantee, as Adler says, that top-tier medical journals would fight to publish such a finding.

In scientific defense and objectivity regarding modalities labeled as "complementary and alternative medicine" or CAM, one must recognize that this term is used to describe an incredibly wide ranging spectrum of therapies from the ludicrous principles of homeopathy to the more intellectually accessible areas of herbal medicines and nutrition. The real goal of CAM research should be to test therapies possessing at least a plausible mechanism, discard those that don't work and keep those that do. Those that do work in randomized, blinded, and properly controlled studies should then be incorporated into "medicine," as some omega-3 fatty acid supplements are now recommended for elevated triglycerides and as an adjunct to antidepressant medications.

But even more than Adler's article are some of the reviews of Bausell's book that compel me to go and buy it today:

"Anyone who reads Bausell's rigorous scientific analysis of the risks and benefits of complementary and alternative medicine will be left wondering why they are spending so much on so many useless products."--Jerome P. Kassirer, M.D., Tufts University School of Medicine, Editor-in-Chief Emeritus, New England Journal of Medicine, and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

"The book is aimed at the consumer, and it is written in a simple, entertaining style such that the consumer will understand it and enjoy reading it. So the consumer should and, I'm sure, will buy this book. But in addition I would also warmly recommend it to healthcare professionals who work in CAM or have an interest in this area. They will not easily find a harder hitting, more eloquent, or smarter critique of CAM!"--Edzard Ernst, M.D., Ph.D., Complementary Medicine, Peninsula Medical School, UK

Dr Ernst is a particularly open-minded researcher of alternative therapies and I greatly respect him because he judges all therapies on the exact same playing field, with a willingness to discard and denounce (PDF) those that prove ineffective or dangerous.

So, I'm really looking forward to delving into Bausell's "Snake Oil Science."

If you choose to read it as well, please come on back on comment on your insights.