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MOSBY’S COMPLEMENTARY AND ALTERNATIVE MEDICINE: A RESEARCH-BASED APPROACH
Media Reviews ESSENTIAL CHEMISTRY FOR SAFE AROMATHERAPY Sue Clarke, Published by Churchill Livingstone, 2002, 231 pp, PB, ISBN 0 443 06485 7 This book provides a basic understanding of the chemistry of essential oils enabling an appreciation of their composition, safety and effective use. It is aimed at students that have little or no scientific background and who are taking aromatherapy courses. Essential oils are complex mixtures of many organic compounds and some derived from a defined species of plant may differ significantly in their chemical composition. It is obviously beneficial for medical treatments that there be uniformity between different batches of each oil so that safety and efficacy may be ensured. Essential oils have provided challenges for analysts for many years and present problems for the setting of standards for pharmacopoeial and regulatory authorities. This book explains the underlying chemistry of these complex mixtures and provides an understanding of their preparation, constituents, analysis and practical handling. The first chapter of 17 pages clearly defines some of the fundamentals of chemistry (e.g. elements, atoms, molecules and bonds) and the text is well interspersed with short statements entitled “Aromafact”. These statements relate the chemistry specifically to essential oils so that the reader may immediately see the relevance of the science to essential oils (e.g. oils occurring as chemotypes). In the second chapter on Organic Chemistry (16 pages), it is stressed that natural substances may well be toxic and that the role in Nature of some components of essential oils is to repel invading organisms. In very simple terms the reader is led through carbon chains and rings to isomerism and functional groups with plenty of “aromafacts” to illustrate relevance. By the third chapter I would imagine that the shaky chemist, or even the non-chemist, would be able to grasp the differences between the families of compounds that make up essential oils, e.g. mono-, sesqui-, and diterpenes, oxygenated compounds, ethers, aldehydes, esters, etc. In considering processing, extraction and purity in Chapter 4, the reader is suddenly made aware of the complexity of essential oils when faced with two gas chromatograms of a genuine oil and a fake oil. Immediately, it becomes obvious that without a background in chemistry these complex chromatograms would be unintelligible. We are now prepared for Chapter 5 on analytical techniques (19 pages). The basics of gas chromatography, infrared spectroscopy, mass spectrometry, optical rotation, specific gravity, refractive index and the human nose are outlined with examples of applicability to quality assurance of essential oils. Complementary Therapies in Medicine (2002), 10, 185–187
© 2002 Elsevier Science Ltd. All rights reserved.
With the basic science simply explained, the reader can now concentrate on the remaining half of the book which is concerned with the composition of essential oils including information on 12 popular oils used in aromatherapy, popular carriers, safe handling, storage, first aid, administration, cautions and contraindications. A bibliography, glossary and a comprehensive index are provided. This book is clearly presented and by starting with basic chemistry, it builds up to a good introduction to the use of essential oils in aromatherapy. I recommend it to all students and users of essential oils in aromatherapy. You may never run a gas chromatogram or take an optical rotation of an oil, but you can now appreciate and understand why such techniques are necessary for ensuring that high quality oils are available for safe and effective use.
185
doi: 10.1016/S0965-2299(02)00051-1, available online at
J. D. Phillipson
http:/ /www.idealibrary.com on
MOSBY’S COMPLEMENTARY AND ALTERNATIVE MEDICINE: A RESEARCH-BASED APPROACH Freeman LW, Lawlis GF (Eds.) Published by Mosby Inc., St. Louis, MO, 2001, 532 pp, HB, ISBN 0 323 00697 3 I did not find it easy to review this book. On the one hand, one has to admire the huge amount of work that Freeman and Lawlis put into it. On the other hand, I cannot help feeling distinctly underwhelmed with the result. The book was written as a true textbook, i.e. to guide courses in complementary/alternative medicine (CAM) and has clearly a very North American perspective in trying to achieve its goals. More than half of this sizeable text is devoted to mind–body matters. The rest deals with chiropractic, acupuncture, homeopathy, massage, herbal medicine, exercise (I don’t regard this as CAM!), electromagnetic medicine, spiritual medicine and therapeutic touch. Here lies my first problem with this book—it tries to give the impression of being comprehensive, but where are the dozens of other CAM interventions? My other and more important problem is the lack of a systematic approach. The book claims to take a “research-based approach” (whatever that is—can one actually write a medical book without research?). The book has neat little tables showing us the results of clinical trials. But how do we know these tables are complete? There is no section that explains what evidence was admitted and what was excluded. Most importantly, there is no attempt to critically evaluate the primary studies. Whenever I see such compilations of evidence I suspect selective
186
Complementary Therapies in Medicine
citation which almost immediately converts evidence into pseudoevidence. In fact, all the examples that I tested for completeness confirmed my suspicion. The authors seem to cite the evidence they happened to have at hand and, as far as I can see, there is no systematic approach that guided them. This, in turn, means that the general conclusions regarding efficacy and safety may well be right; they may also be wrong—we simply cannot tell. And this is why I found it difficult to review the book. It is almost a recommendable text, but sadly not quite. Freeman and Lawlis should be applauded for the amount of work they put into this volume. I think it gives a good introduction to CAM and could even be a reasonable guide for teaching CAM. Yet its incompleteness and lack of a systematic approach are, in my view, serious flaws. doi: 10.1016/S0965-2299(02)00053-5, available online at
E. Ernst
http:/ /www.idealibrary.com on
HERBAL MEDICINES: A GUIDE FOR HEALTHCARE PROFESSIONALS (2ND EDITION) Joanne Barnes, Linda A. Anderson, J. David Phillipson, Published by Pharmaceutical Press, 2002, 530 pp, ISBN 0 85369 474 5, HB £39.95夽 This second edition of what is rapidly becoming a standard reference text for pharmacists and other healthcare professionals dealing with herbs for medical treatment represents a substantial revision. The increasing availability of information in the literature, together with additional knowledge on the quality, safety and efficacy and legal requirements for herbal medicinal products has led to the need to update the book. As with the former edition the aim is to supply scientifically rigorous, impartial information on medicinal herbs sold in UK pharmacies. Presented in monographical style (148) these include 7 new (Bilberry, Cat’s Claw, Cranberry, Ephedra, Java Tea, Melissa, Milk Thistle), 10 extensively revised and rewritten, and 33 updated monographs. The number of general texts quoted has risen from 35 to 65, and 23 Appendices group herbs by their specific actions and highlight potential interactions with conventional medicines. In addition, Tables, now emphasised by shading, detail examples of adverse or potentially adverse effects of herbal ingredients and of those best avoided or used with caution in pregnancy. The Introduction contains helpful sections on Regulatory Controls, Quality, Safety and Efficacy, and Products of Current Interest (Echinacea, Garlic, Ginger, Ginkgo, Ginseng, Saw Palmetto, Valerian). As before, each 夽 Also available as a single user CD-ROM (£75 +VAT) and Book with CD ROM package (£99 + VAT).
Monograph includes sections on species, synonyms, part used, Pharmacopoeial and other Monographs available, legal category, constituents, food use, herbal use, dosage, pharmacological actions, including animal and clinical studies, side effects and toxicity, contra-indications and warnings, and a summary pharmaceutical comment. These facts alone speak for the value of the book to the targeted readership. Authorship has changed with Carol Newall being replaced by Joanne Barnes, Research Fellow at the Centre for Pharmacognosy and Phytotherapy of the School of Pharmacy, University of London, who is now firmly established as an expert on the clinical efficacy and safety of herbal products (phytomedicines), and the implications of complementary medicines use for pharmaceutical care. It should be noted that, despite the new cover, now nicely illustrated with botanical images from a Kew Gardens collection, this is not recommended as a “coffee table” book. That is not to say it has no instant appeal to a more general audience (my wife and the administrative staff of my department have been caught foraging in its pages!), but rather that it is aimed to inform not amuse. Nonetheless, many will find themselves drawn to its pages, if only because it will save them an enormous amount of time researching elsewhere. Who can keep up with the pace of publication on herbs other than those whose full time pursuit this has become—and even they struggle! Whilst the rationale for choice of the herbs is clear (UK and European use), I remain doubtful as to the value, for most pharmacists at least, of the (rather thin) monograph on Corn Silk and find the warning on excessive use of the plant, whilst reasonable, unlikely to be found necessary. Do many people overdose on Zea mays stigma? How often do we meet with Avens, Burnet, Cowslip? The age of the references relating to these tends to portray a story of fading interest—although some herbal practitioners may know different? On the positive side these should alert others to the need for research on these herbs. It could also be argued that to include herbs such as Liferoot is to grant them a status as a medicinal herb which is now no longer warranted, despite the warnings given in the monograph. It is admittedly hard for authors to know the boundary for “comprehensive coverage”. The book could undoubtedly be made more relevant to the practitioner pharmacist by the inclusion of the names of specified manufactured products containing the herbs. This could lead to enormous listings, or none at all. The cover does, however, refer to herbal “products” which in common parlance would seem to imply something other than the crude drug or its extracts. How many of us are now likely to dispense the liquid extract or tincture? It must, however, be granted that the increasing number of Herbal Practitioners would find this useful, though they probably have other readily available sources for such information.
© 2002 Elsevier Science Ltd. All rights reserved.
With the basic science simply explained, the reader can now concentrate on the remaining half of the book which is concerned with the composition of essential oils including information on 12 popular oils used in aromatherapy, popular carriers, safe handling, storage, first aid, administration, cautions and contraindications. A bibliography, glossary and a comprehensive index are provided. This book is clearly presented and by starting with basic chemistry, it builds up to a good introduction to the use of essential oils in aromatherapy. I recommend it to all students and users of essential oils in aromatherapy. You may never run a gas chromatogram or take an optical rotation of an oil, but you can now appreciate and understand why such techniques are necessary for ensuring that high quality oils are available for safe and effective use.
185
doi: 10.1016/S0965-2299(02)00051-1, available online at
J. D. Phillipson
http:/ /www.idealibrary.com on
MOSBY’S COMPLEMENTARY AND ALTERNATIVE MEDICINE: A RESEARCH-BASED APPROACH Freeman LW, Lawlis GF (Eds.) Published by Mosby Inc., St. Louis, MO, 2001, 532 pp, HB, ISBN 0 323 00697 3 I did not find it easy to review this book. On the one hand, one has to admire the huge amount of work that Freeman and Lawlis put into it. On the other hand, I cannot help feeling distinctly underwhelmed with the result. The book was written as a true textbook, i.e. to guide courses in complementary/alternative medicine (CAM) and has clearly a very North American perspective in trying to achieve its goals. More than half of this sizeable text is devoted to mind–body matters. The rest deals with chiropractic, acupuncture, homeopathy, massage, herbal medicine, exercise (I don’t regard this as CAM!), electromagnetic medicine, spiritual medicine and therapeutic touch. Here lies my first problem with this book—it tries to give the impression of being comprehensive, but where are the dozens of other CAM interventions? My other and more important problem is the lack of a systematic approach. The book claims to take a “research-based approach” (whatever that is—can one actually write a medical book without research?). The book has neat little tables showing us the results of clinical trials. But how do we know these tables are complete? There is no section that explains what evidence was admitted and what was excluded. Most importantly, there is no attempt to critically evaluate the primary studies. Whenever I see such compilations of evidence I suspect selective
186
Complementary Therapies in Medicine
citation which almost immediately converts evidence into pseudoevidence. In fact, all the examples that I tested for completeness confirmed my suspicion. The authors seem to cite the evidence they happened to have at hand and, as far as I can see, there is no systematic approach that guided them. This, in turn, means that the general conclusions regarding efficacy and safety may well be right; they may also be wrong—we simply cannot tell. And this is why I found it difficult to review the book. It is almost a recommendable text, but sadly not quite. Freeman and Lawlis should be applauded for the amount of work they put into this volume. I think it gives a good introduction to CAM and could even be a reasonable guide for teaching CAM. Yet its incompleteness and lack of a systematic approach are, in my view, serious flaws. doi: 10.1016/S0965-2299(02)00053-5, available online at
E. Ernst
http:/ /www.idealibrary.com on
HERBAL MEDICINES: A GUIDE FOR HEALTHCARE PROFESSIONALS (2ND EDITION) Joanne Barnes, Linda A. Anderson, J. David Phillipson, Published by Pharmaceutical Press, 2002, 530 pp, ISBN 0 85369 474 5, HB £39.95夽 This second edition of what is rapidly becoming a standard reference text for pharmacists and other healthcare professionals dealing with herbs for medical treatment represents a substantial revision. The increasing availability of information in the literature, together with additional knowledge on the quality, safety and efficacy and legal requirements for herbal medicinal products has led to the need to update the book. As with the former edition the aim is to supply scientifically rigorous, impartial information on medicinal herbs sold in UK pharmacies. Presented in monographical style (148) these include 7 new (Bilberry, Cat’s Claw, Cranberry, Ephedra, Java Tea, Melissa, Milk Thistle), 10 extensively revised and rewritten, and 33 updated monographs. The number of general texts quoted has risen from 35 to 65, and 23 Appendices group herbs by their specific actions and highlight potential interactions with conventional medicines. In addition, Tables, now emphasised by shading, detail examples of adverse or potentially adverse effects of herbal ingredients and of those best avoided or used with caution in pregnancy. The Introduction contains helpful sections on Regulatory Controls, Quality, Safety and Efficacy, and Products of Current Interest (Echinacea, Garlic, Ginger, Ginkgo, Ginseng, Saw Palmetto, Valerian). As before, each 夽 Also available as a single user CD-ROM (£75 +VAT) and Book with CD ROM package (£99 + VAT).
Monograph includes sections on species, synonyms, part used, Pharmacopoeial and other Monographs available, legal category, constituents, food use, herbal use, dosage, pharmacological actions, including animal and clinical studies, side effects and toxicity, contra-indications and warnings, and a summary pharmaceutical comment. These facts alone speak for the value of the book to the targeted readership. Authorship has changed with Carol Newall being replaced by Joanne Barnes, Research Fellow at the Centre for Pharmacognosy and Phytotherapy of the School of Pharmacy, University of London, who is now firmly established as an expert on the clinical efficacy and safety of herbal products (phytomedicines), and the implications of complementary medicines use for pharmaceutical care. It should be noted that, despite the new cover, now nicely illustrated with botanical images from a Kew Gardens collection, this is not recommended as a “coffee table” book. That is not to say it has no instant appeal to a more general audience (my wife and the administrative staff of my department have been caught foraging in its pages!), but rather that it is aimed to inform not amuse. Nonetheless, many will find themselves drawn to its pages, if only because it will save them an enormous amount of time researching elsewhere. Who can keep up with the pace of publication on herbs other than those whose full time pursuit this has become—and even they struggle! Whilst the rationale for choice of the herbs is clear (UK and European use), I remain doubtful as to the value, for most pharmacists at least, of the (rather thin) monograph on Corn Silk and find the warning on excessive use of the plant, whilst reasonable, unlikely to be found necessary. Do many people overdose on Zea mays stigma? How often do we meet with Avens, Burnet, Cowslip? The age of the references relating to these tends to portray a story of fading interest—although some herbal practitioners may know different? On the positive side these should alert others to the need for research on these herbs. It could also be argued that to include herbs such as Liferoot is to grant them a status as a medicinal herb which is now no longer warranted, despite the warnings given in the monograph. It is admittedly hard for authors to know the boundary for “comprehensive coverage”. The book could undoubtedly be made more relevant to the practitioner pharmacist by the inclusion of the names of specified manufactured products containing the herbs. This could lead to enormous listings, or none at all. The cover does, however, refer to herbal “products” which in common parlance would seem to imply something other than the crude drug or its extracts. How many of us are now likely to dispense the liquid extract or tincture? It must, however, be granted that the increasing number of Herbal Practitioners would find this useful, though they probably have other readily available sources for such information.