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Complementary medicine: an integrated approach
64
Complementary Therapies in Medicine
consumption of complementary therapies suggests that, in practice, the risks attendant upon their use are assessed by patients in relation to their perception of risks attendant on use of orthodox drugs. All in all, this book represents a worthwhile project, but the articles would have benefited from more contextualization (if this could have been done without detracting from the general and international perspective that the book aims for). This could have been provided through editorial commentary or in some other form. Without this, I imagine that those who profess the naive enthusiasms which the book sets out to question will be inclined to dismiss it as yet another medical attack on the complementary therapy movement, which would be a pity.
Ursula Sharma, Professor in Sociology, University of Derby, Derby, UK Complementary medicine: an integrated approach by G. Lewith, J. Kenyon and R Lewis Oxford: OUR 1996. viii+277pp. £25(paper) ISBN: 0 19 262565 9 This eagerly awaited book in the popular Oxford series is disappointing, especially as two of the authors are in the forefront of complementary medicine in the UK. It is subtitled 'an integrated approach' but unfortunately fails to address any of the sociological or historical contexts that would give this claim some substance (Michael Saks does not appear in the bibliography). This omission and lack of depth leads the authors to describe the main therapies as if complementary medicine is an unscientific and inappropriate term, for it is a definition of therapies by what they are not, i.e. those therapies not taught in western medical schools. Any serious clinical discussion has to begin by deconstructing the term 'complementary medicine' and acknowledging that health belief systems, models of cause and effect, treatment modality, diagnostic methods and the natural history of disease cannot be subsumed under one heading. The big question facing the integration of some of the therapies into UK mainstream medicine (other than whether they are effective) is whether they should be viewed as belonging to the secondary care system, i.e. specialist, or whether they can be delivered in the primary-care sector alongside mainstream general practice. The authors, not having recent experience in general practice, do not attempt to cover this point. This limits the usefulness of this volume to a reference book of published and anecdotal clinical experience, mostly collected from journals unfamiliar to the general reader. The largest section of the book is a descriptive account of sixteen diseases from asthma to upper
respiratory tract infections. Here the general practitioner (GP) will find some answers to the questions often asked by patients and useful information is given with regard to self-help organizations, referral centres and more detailed texts. A useful 'ready reckoner' is given at the end of each chapter, indicating the level of evidence currently available, 5 - good evidence with clear randomized controlled trials to 1 - no evidence. To their credit, the authors dismiss the 'disreputable claims' made by some complementary therapists in the treatment of cancer. They also outline the pitfalls and dangers of the scientific studies on this topic that become overly political, as did the Chilvers study on the Bristol Cancer Centre. The field of complementary medicine is of particular relevance to the GR So much of the undifferentiated symptom presentation, 'tired all the time', 'acopia', the minor and recurrent symptom presentation, chronic catarrh, minor aches and pains, episodic headaches, menstrual irregularities and others are far better understood, and managed, by the various approaches focused under the umbrella term 'complementary medicine'. The clinicians practising complementary medicine have rarely developed the psychological sophistication found with experienced general practitioners, whilst experienced GPs rarely have the breadth of knowledge found in the field of complementary medicine. The integration of these two areas of human endeavour has still to occur. This book is the beginning of this process and we will look forward to a more detailed text that builds on the experience of both general practice and the appropriate clinical fields of complementary medicine.
Professor Patrick Pietroni, Marylebone Health Centre, London, UK Handbook of complementary and alternative medicine (3rd edn) edited by Stephen Fulder Oxford: Oxford University Press, 1996. xxiii+317pp. £25 ISBN: 0 19 262669 8 Stephen Fulder's book has been highly successful ever since it first came out in 1984. Its present third edition is extensively updated, extended and revised. The general outline, however, has remained largely unaltered. About 100 pages are dedicated to general information on complementary medicine. The subsequent 150 pages deal with specific treatment modalities; 15 complementary treatments or groups of treatments are thus discussed in some detail. The choice of which to include and which to omit cannot have been easy and reflects the preference of the author more than an
Complementary Therapies in Medicine
consumption of complementary therapies suggests that, in practice, the risks attendant upon their use are assessed by patients in relation to their perception of risks attendant on use of orthodox drugs. All in all, this book represents a worthwhile project, but the articles would have benefited from more contextualization (if this could have been done without detracting from the general and international perspective that the book aims for). This could have been provided through editorial commentary or in some other form. Without this, I imagine that those who profess the naive enthusiasms which the book sets out to question will be inclined to dismiss it as yet another medical attack on the complementary therapy movement, which would be a pity.
Ursula Sharma, Professor in Sociology, University of Derby, Derby, UK Complementary medicine: an integrated approach by G. Lewith, J. Kenyon and R Lewis Oxford: OUR 1996. viii+277pp. £25(paper) ISBN: 0 19 262565 9 This eagerly awaited book in the popular Oxford series is disappointing, especially as two of the authors are in the forefront of complementary medicine in the UK. It is subtitled 'an integrated approach' but unfortunately fails to address any of the sociological or historical contexts that would give this claim some substance (Michael Saks does not appear in the bibliography). This omission and lack of depth leads the authors to describe the main therapies as if complementary medicine is an unscientific and inappropriate term, for it is a definition of therapies by what they are not, i.e. those therapies not taught in western medical schools. Any serious clinical discussion has to begin by deconstructing the term 'complementary medicine' and acknowledging that health belief systems, models of cause and effect, treatment modality, diagnostic methods and the natural history of disease cannot be subsumed under one heading. The big question facing the integration of some of the therapies into UK mainstream medicine (other than whether they are effective) is whether they should be viewed as belonging to the secondary care system, i.e. specialist, or whether they can be delivered in the primary-care sector alongside mainstream general practice. The authors, not having recent experience in general practice, do not attempt to cover this point. This limits the usefulness of this volume to a reference book of published and anecdotal clinical experience, mostly collected from journals unfamiliar to the general reader. The largest section of the book is a descriptive account of sixteen diseases from asthma to upper
respiratory tract infections. Here the general practitioner (GP) will find some answers to the questions often asked by patients and useful information is given with regard to self-help organizations, referral centres and more detailed texts. A useful 'ready reckoner' is given at the end of each chapter, indicating the level of evidence currently available, 5 - good evidence with clear randomized controlled trials to 1 - no evidence. To their credit, the authors dismiss the 'disreputable claims' made by some complementary therapists in the treatment of cancer. They also outline the pitfalls and dangers of the scientific studies on this topic that become overly political, as did the Chilvers study on the Bristol Cancer Centre. The field of complementary medicine is of particular relevance to the GR So much of the undifferentiated symptom presentation, 'tired all the time', 'acopia', the minor and recurrent symptom presentation, chronic catarrh, minor aches and pains, episodic headaches, menstrual irregularities and others are far better understood, and managed, by the various approaches focused under the umbrella term 'complementary medicine'. The clinicians practising complementary medicine have rarely developed the psychological sophistication found with experienced general practitioners, whilst experienced GPs rarely have the breadth of knowledge found in the field of complementary medicine. The integration of these two areas of human endeavour has still to occur. This book is the beginning of this process and we will look forward to a more detailed text that builds on the experience of both general practice and the appropriate clinical fields of complementary medicine.
Professor Patrick Pietroni, Marylebone Health Centre, London, UK Handbook of complementary and alternative medicine (3rd edn) edited by Stephen Fulder Oxford: Oxford University Press, 1996. xxiii+317pp. £25 ISBN: 0 19 262669 8 Stephen Fulder's book has been highly successful ever since it first came out in 1984. Its present third edition is extensively updated, extended and revised. The general outline, however, has remained largely unaltered. About 100 pages are dedicated to general information on complementary medicine. The subsequent 150 pages deal with specific treatment modalities; 15 complementary treatments or groups of treatments are thus discussed in some detail. The choice of which to include and which to omit cannot have been easy and reflects the preference of the author more than an