Despite their ubiquity in pharmacies, it may surprise that complementary and alternatives medications (CAM), are, for the most part, not part of the undergraduate pharmacist curriculum. We don’t pay that much attention to them, focusing instead on science-based therapies.
After I graduated pharmacy and stated my career, I realized that in order to be truly evidence-based, I had to go beyond reviewing the data supporting the latest and greatest drug from the pharmaceutical industry. I had to look at the data for CAM, and understand it in the context of what my patients were telling me: “It worked for me.”
It’s an ongoing challenge for a pharmacist to stay evidence-based. We speak with hundreds of patients a day, monitoring response to treatments and giving health advice for a wide variety of ailments. And because we’re so accessible, patients don’t hesitate to tell us what works, and what doesn’t. Our heads are filled with thousands of these anecdotes. And these anecdotes can influence what we believe works.
But if there’s no evidence to support CAM, why do so many people (patients and pharmacists) insist it works? Snake Oil Science helped me answer that question.
If there’s one statement you see repeatedly tossed at CAM by science advocates, it’s that any typical CAM therapy “is no more effective than placebo”. But exactly does that mean? What is the placebo response? This is the central question of Snake Oil Science:
Is any complementary and alternative medicine more effective than a placebo?
This book answers that question. The book is not a ‘debunking’ of pseudoscience. Nor does it talk about those that deliberately choose to ignore facts, like antivaccinationists. Rather, this book is about how data is collected and evaluated: How do we do the science, to arrive at answers that are accurate?
Now don’t let that statement intimidate you. The book is written in an approachable, straightforward style that does not require any statistics or clinical trial knowledge. R. Barker Bausell was the Research Director of the National Institutes of Health CAM Specialized Research Center, where he read, designed, and evaluated hundreds of clinical trials of CAM therapies. It’s given him a unique perspective in understanding the data supporting CAM therapies.
Bausell introduces the book with a history of placebos, and then moves on to discussing impediments that patients or health professionals face which prevent them from making valid inferences. He then discusses the importance of the randomized, placebo-controlled trial, arguing convincingly that this is the only appropriate format to test CAM. Subsequent chapters discuss credibility, plausibility, and the biochemical nature of the placebo response. Designing the appropriate placebo can be challenging, and an entire chapter is devoted to acupuncture research, an area of research Bausell has personal expertise with.
Bausall ends the book with a summary of what high-quality trials actually say about CAM.
I strongly recommend this book to anyone with an interest in CAM or those that want a better understanding of just what the “placebo response” is. By reading it, you’ll have a much better understanding of why, when it comes to CAM, so many people will say, “It worked for me.”