R. Barker Bausell says he arrived at the University of Maryland's alternative medicine center with an open mind toward exploring the potential of acupuncture, herbal remedies and other unconventional treatments.
But after five years as research director, he quit the Center for Integrative Medicine in 2004, convinced of one thing: None of the alternative treatments he has seen works any better than a placebo.
"They can go on forever" conducting studies, Bausell said recently in his office at UM's School of Nursing, where he is a professor. "They'll eventually find some positive results by chance alone."
In a book released late last year, Bausell laid out his case against alternative medicine, which even 15 years ago was considered little more than quackery.
But his book is making only a few ripples as it bumps up against the juggernaut that has become alternative medicine, which is backed by a U.S. government agency with an annual budget of more than $121 million, has a foothold in hallowed medical schools such as Harvard and Columbia, and attracts tens of millions of followers nationwide who spend billions on it.
Bausell gets no book tour. He has heard from few colleagues who have read his tome. A favorable review in The New York Times has barely registered.
Complementary and alternative medicine - known as CAM - has gone legit. "It's the hidden mainstream," said Ted Kaptchuk, an associate professor at Harvard Medical School who studies the placebo effect and CAM.
Critics say those who choose unorthodox treatments typically don't rely on the latest research: They often prefer word of mouth and continue their treatments if they feel better, regardless of whether science backs them up.
When patients respond favorably to a treatment with no known medical benefit, researchers call it the placebo effect. The very knowledge that he is getting treatment can be enough to make a patient feel better, at least in the short run. So comparisons with placebos have become an integral part of rigorous clinical trials for both conventional and alternative treatments.
Critics have long said alternative medicine too often capitalizes on the placebo effect and the wishful thinking of patients.
"Snake oil is here to stay," said Dr. John Hickner, a professor at the University of Chicago's medical school who has studied the use of placebos by family doctors. "We're humans, and belief is a powerful thing. Belief can promote a person's health."
Bausell's book, Snake Oil Science: The Truth about Complementary and Alternative Medicine, hasn't made much of a stir at UM's alternative medicine center.
Dr. Brian Berman, who founded the institution in 1991, said he skimmed the book, calling its arguments "misleading about what the state of research is." He called any conclusions about the value of CAM premature.
"It's not being given a whole lot of credibility," Berman said of the book. "Maybe if this was 15 years ago, it possibly could have had more of an effect.
"People are paying for this therapy," he added. "We're trying to figure out what's working and what's not. We'll find certain things don't work or are harmful. When the evidence is shown, we won't be using these therapies."
Kaptchuk, who sits on the advisory council of the National Institutes of Health's National Center for Complementary and Alternative Medicine, praised Bausell for "taking a critical and unbiased look at the field."
"His critical attitude and knowledge about CAM is refreshing," Kaptchuk said. "We either get people who attack CAM who don't know anything about CAM, or we get people who really advocate CAM stuff but don't really follow the research. His critical attitude is not inaccurate."
The world of alternative medicine is populated largely by believers, but Bausell, 65, is not one of them. He said he took the job with Berman to get back into the gold standard of scientific research: randomized, placebo-controlled clinical trials. That he would be testing alternative medicine didn't matter.
"There was a possibility we'd learn something of interest," he said. "Why would you go there if you thought all this stuff is bogus?"
So Bausell went and learned and decided that it was "bogus," which he said "isn't a great scientific term, but it's as good as any."
He was soon convinced that much of the research into alternative medicine was shoddy, biased and rarely proved any benefit beyond a placebo.
At UM, Bausell said, he saw high-quality studies of therapies that fell flat. One of the best, he said, tested the use of acupuncture for dental pain. Those who believed they were receiving acupuncture (some patients received elaborately staged sham acupuncture) felt better than those who didn't think they were receiving acupuncture - regardless of who got the actual therapy.
In Bausell's analysis, there is no biological reason for any of it to be effective. Still, millions swear by CAM.
"Just about everyone I've ever talked to about the subject believes in one or two alternative therapies and are sure they work," he said. "The question is - and it's a big question - what if all these people were wrong? What could explain that?"
In Bausell's book, the answer in most cases is the placebo effect. But some scientists say that's too simplistic a response in an age when much of the mind-body connection remains a mystery.
In fact, the placebo effect shows up in studies of conventional medicine, too. Berman cited a recent Harvard analysis of different treatments for irritable bowel syndrome. More than 40 percent of the patients responded positively to the placebo, whether the treatment tested was conventional or alternative.
Some studies have shown alternative treatments work, he said. For example, acupuncture works for lower back pain, Berman said. Meanwhile, he said, the science is still new, and the body of evidence for most alternative therapies remains small.
"In most cases, there's not enough data from quality trials," Berman said. "We need more research."
He said conventional medicine is often "in the same boat."
"We very rarely hit a home run in any research. It's more trying to get singles or doubles, trying to build upon" existing knowledge, he said.
In some cases, definitive studies have proved that therapies don't work - yet people continue to use them. For example, glucosamine and chondroitin supplements, promoted to improve joint pain, don't work better than placebos - yet the tablets are big sellers. Echinacea, the purple cone flower, remains popular even though a major study found that it doesn't shorten a cold.
And, experts say, some patients flock to alternative medicine when they think conventional treatment has failed them.
"What people get from CAM is an immersion in a world of hope, an immersion in a world of possible improvement for people who have chronic [problems]," Kaptchuk said.
Dr. Robert L. Park, a physics professor at the University of Maryland, College Park who has served as an adviser to the national center on alternative medicine, said he tried to write a book like Bausell's a few years back. His publisher told him that people didn't want to hear bad news about treatments they feel passionate about or learn how their minds could be tricked into thinking a treatment works when it doesn't.
"People really want to believe it," he said. "It's disconcerting to anyone who tries to battle this."