Confirmation Bias

[The following is a copy of the review of R. Barker Bausell’s Snake Oil Science: The Truth about Complementary and Alternative Medicine which I posted on Amazon. Let’s hope now that taper for Ironman is over, I can write about more interesting things than the books I’m reading while I try not to go crazy waiting for race day to arrive.]

The book is really a more eloquent treatise on the placebo effect than on anything else. If I had to summarize, I’d say the book is, “this is the placebo effect; all CAM treatments are placebo,” without necessarily providing the requisite science to make said connection. In other words, I found the conclusion to be as tenuous as many of the claims made by “snake oil salesmen.” It’s almost as if the author suffers from excessive “post hoc ergo propter hoc” – “‘after’ the placebo, therefore because of placebo,” to paraphrase inelegantly. I thought, for example, the hypothetical statistics given in his examples to be rather misleading. The sample statistics could easily be applied to a drug trial, along with many (maybe even most) of the criticisms. And I think that unduly biases the reader. Confirmation bias – you look for things that support what you believe. I think the author should spend more time reading Dr. Shermer’s books.

Generally, I think what’s misleading is that many of the problems that plague clinical trials in general are presented in such a way that it seems as if CAM is the only place they occur. One only needs to look at the recent findings about bias in a significant number of pharmaceutical trials, or even the entire anti-depressant pharmacological debate to see that the troubles with clinical trials are something that plagues all science.

Also, not the author’s fault, but it’s very interesting to read the book in light of Kaptchuk’s recent study that showed that placebos are effective even when the recipient knows they are receiving a placebo. Kaptchuk’s research is obviously preliminary, but if it is supported by further study, that will undercut a major stanchion of Bausell’s argument.

Ultimately, I think the book should have been called, “The Placebo Effect” or something along similar lines. I think the tenuous connection is made when the author leaps to group CAM – especially *ALL* CAM medicine – into a single group, and to then state that the group – as a whole – is just placebo. I think it’s a good book about the perils of research and the power of the mind, but I think it’s perhaps a more damning indictment of medicine *in general* than specifically CAM medicine.