Book Review: Snake Oil Science

Oxford University Press (New York) 2009

Perhaps this volume should have been titled “Snake Oil Science: The Truth About Scientific Skepticism and Bad Methodology.”

This book's author is a biostatistician and professor at the University of Maryland and was research director of an NIH-funded study of various complementary and alternative medical modalities. In writing "Snake Oil Science: the Truth About Complementary and Alternative Medicine," Professor Bausell attempts to answer the questions "how is it possible that many millions of people, living over the course of countless centuries, could be wrong about the effectiveness of the "bizarre practices that we variously term CAM (complementary and alternative medicine), new age, integrative medicine and snake oil therapies?" and "is there any credible or plausible evidence to suggest that CAM medical therapies are anything more than cleverly packaged placebos?"

While engagingly written, this work suffers seriously from two fundamental defects, both reflecting the scientific and philosophic bias of the author. The first is his near total lack of acquaintance with even the most basic premises of the modalities his book attempts to "debunk.". The second is Professor Bausell's selection of research data clearly "cherry picked" to demonstrate the lack of therapeutic efficacy of the modalities chosen.

In respect of the author's lack of familiarity with the substance of his chosen targets, his explanation of Ayurvedic medicine (whose treatment according to the author consist of "therapeutic vomiting, purgatives, laxatives, medicated enemas, bloodletting, herbs, yoga and chromotherapy") is illustrative: "while the evaluation of the philosophic basis of Ayurvedic medicine is no more a province of science than is a consideration of the merits of Buddhism, nothing remotely similar to the energies of vata, pitta and kapha has ever been documented in biology. And outside of the use of leeches by some scientists … Bloodletting has fallen from favor as a medical strategy."

One wonders if the author is aware (inter alia) of the 1950′s research of University of Texas physiologist Roger Williams in demonstrating a trifurcated somatotype based on endocrine function and it's virtual confirmation of the tridoshic approach, or of the range of disorders which - according to Western biomedical protocols - are ameliorated by therapeutic phlebotomy.

In respect of the author's selection of research data supporting his propositions about CAM, pages 210 to 244 list 98 studies of a wide spectrum of modalities from acupuncture to herbal medicine to music therapy, selected according to the author on the basis of their quality as measured by the duration of the study, numbers of subjects, quality of materials utilized, etc. Readers should note however that one of the indicators employed to mark a "lack of quality" is that there is "no English language speaking (sic) confirmation of positive results."

Thus by virtue of their language of publication, the countless thousands of research projects being undertaken by university-affiliated colleges of Ayurvedic medicine in India and throughout South Asia are rendered relatively worthless (to say nothing of the vast quantity of research on traditional Chinese medicine and acupuncture unfolding in China).

The authors conclusions are, as stated on page 275: "no CAM therapy has a scientifically plausible biochemical mechanism of action over and above those proposed for the placebo effect … CAM therapies are nothing more than cleverly packaged placebos … And that is almost all there is to say about the science of CAM.”

Almost all there is to say, that is, except for the oceanic quantity and superlative quality of much of the research demonstrating the effectiveness of the therapies Professor Blausell derides; therapies whose placebo effect would, one could reasonably assume, be diminished or absent in preverbal infants or animal recipients of the therapies (who I suspect would be less amenable to suggestion) which has demonstrably not been the case.

Almost all there is to say, except for the traditional use of similar or identical materials or protocols by widely separated, mutually isolated ethnic enclaves to treat similar pathologies with similar outcomes over very great lengths of time, in some cases centuries and even millenia.

Such traditional knowledge (TK) is not simply overlooked by Western science as a source of data - rather, its validity is rejected outright. And, of course, Western science is very much the poorer, very much less "scientific" for that reason.

It will be apparent to any practitioner of, say, traditional Chinese medicine or Ayurveda, that this book is written based on a massively deceptive oversimplification. Contrary to the conceptual framework of conventional Western biomedicine there exists no precise correspondence between a treatment (whether that is an herbal formula, a lifestyle regimen, a set of yoga postures or an acupuncture protocol) and a symptom. For different patients with varying psychophysical constitutions having the same symptom, there can be varying causal events or processes and therefore different treatment protocols to be implemented. So (for example) to achieve the clinical result that a particular Ayurvedic strategy is able to achieve, the research trial should first of all be designed with an eye toward the selection of patients based on doshic type, a typology unrecognized by and unknown to Western science. This is a problem.

Snake Oil Science is an engaging, well-written and highly interesting work, that while deeply flawed in its understanding of CAM and of the true nature of the placebo effect affords it's reader a valuable insight into the patterns of thought and rationale of the so-called "scientific skeptic."

Review provided by William Courson, BVSA, D. Ayur., an Ayurvedic Practitioner, faculty member and the College Dean of Institutional Development at Sai Ayurvedic College & Ayurvedic Wellness Center.

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