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This is a collection of essays on the topic of Complementary/Alternative Medicine (CAM) written by specialists from a wide range of backgrounds. The editor has given the contributors free rein to express their views. Since they come from a wide variety of angles from extremely anti-CAM to moderately supportive, the book contains widely different perspectives ranging from virulent attacks to thoughtful analyses. At first sight this may seem strange but in practice this book represents the very best of contemporary albeit on the whole skeptical scholarship. It is highly refreshing to find a collection that does not toe a line but instead gives a wide range of pros and cons and includes some new and stimulating ideas.
Edzard Ernst is the professor of CAM at the medical school of the Universities of Exeter and Plymouth in the U.K. Anyone who is familiar with his work knows that, although he is qualified and experienced in homeopathy, acupuncture and a wide range of other CAM techniques, he is also a traditionally qualified physician in the western tradition. His main aim has for many years now been to subject CAM claims to rigorous scientific analysis. He insists that CAM should be evidence-based rather than faith-based. He is passionate about honesty and transparency and feels strongly that many CAM practitioners at best are duping themselves and at worst are charlatans making a fast buck out of their patients' gullibility. This explains why most articles in this collection are at the skeptical to negative end of the spectrum.
The book's introductory section contains two fairly balanced articles. The first, 'What is Complementary and Alternative Medicine?' by Barbara Wider and Kate Boddy is an attempt to give the reader an understanding of what CAM is and its relationship with the mainstream medical tradition. We get our first glimpse of CAM's uneasy relationship with the scientific method -- an issue that will be covered in detail in the first article in the next section -- but on the whole the authors give us a fairly unbiased view. The second article, 'Why is CAM so popular?' by Stéphane Lejeune, is a very fair attempt to give us the philosophical framework within which CAM is flourishing. The author uses the materialist versus spiritual dichotomy to explain how it is that people find a purely mechanical explanation for human illness very unappealing and hence they feel a need for something more 'holistic'.
The next section, entitled 'General issues', contains seven articles. The first, 'Evidence in Healthcare: What it is, and how we get it' by Leslie B. Rose, is extremely good in explaining how clinical trials work and how important the various stages are -- using a control group in addition to the experimental group, removing the possibility of bias, getting the results independently checked, having the research reviewed by peers, replicating the experiment, etc. Unfortunately, very few CAM trials come anywhere near meeting these criteria. The second article, 'Reclaiming Compassion' by Michael Fitzpatrick, is a strong defense of traditional medicine. The author argues well that various social and economic factors have led to a weakening of many people's trust in traditional medicine but, he thinks, bio-medicine has the power to really cure people whereas CAM offers only illusions. So long as doctors try to use their knowledge to treat the whole person and not just the disease, he thinks that traditional medicine has all the cards stacked in its favor. The third article, 'Alternative Medicine in UK Universities' by David Colquhoun, is a hard-hitting attack of those British universities that are offering CAM course, especially those that are awarding a B.Sc. degree for such a course because, the author argues, there is not one scrap of genuine science in any of them. The fourth article, 'Healing but not Curing: Alternative Medical Therapies as Valid New Age Spiritual Healing Practices' by Bruce G. Charlton, is a sympathetic appraisal of CAM and seeks to place CAM within a broader search for spirituality that marks contemporary society. The fifth article, 'Research on Complementary or Alternative medicine: The Importance and Frailty of Impartiality' by Asbjørn Hróbjartsson, is a plea that all CAM researchers should be impartial i.e. that they should be open to the possibility that any trial may come up with a negative result. As in Leslie B. Rose's article, this author emphasizes the need for proper trial procedures to be followed. It is not just CAM researchers, of course, who are prone to failing the impartiality test. One is reminded of the American and British professors who thought that they had discovered cold fusion and rushed into print before they had followed all the correct procedures and were subsequently ousted from their posts. The sixth article, 'An Amateur's View of the CAM Scene' by James Randi, is an unadulterated attack on homeopathy in particular and CAM in general. It exposes many of the shenanigans engaged in by CAM exponents. The seventh article, 'CAM in Court' by John Garrow, is an attack on many of the false claims made by CAM practitioners. The author argues that bio-medicine is subject to very strict rules but that many if not most CAM claims go untested in court even though, if they were to be legally tested, they would be found to be nothing but deliberately deceptive flummery.
The final section, entitled 'Specific issues', contains ten articles of which the first, 'Ethics and Complementary or Alternative Medicine' by Michael Baum and Edzard Ernst, is an attack on much CAM research which, the authors argue, is unethical because it deliberately avoids the hard issues that would be exposed by proper quantitative research and, instead, tends to adhere to soft qualitative approaches. The second article, 'CAM and Politics' by Leslie B. Rose and Edzard Ernst, exposes the strange links between, on the one hand, the British Royal Family, Prince Charles in particular, and politicians of all persuasions with, on the other hand, the CAM movement. The authors find it strange that those in positions of power are so susceptible to the overtures of the CAM movement and so reluctant to apply rigorously scientific criteria to CAM claims. The third article, 'Integrated Medicine?' by Edzard Ernst, is an appeal for people not to think of CAM as being the only 'holistic' approach. Traditional bio-medicine is or should be 'holistic' and people should not be duped into reading more into CAM than is actually there. The fourth article, 'Homeopathy in Context' by G.V.R. Born, is a strong attack on homeopathy in view of the fact that homeopathic remedies have consistently failed to achieve better than chance results in any properly conducted clinical trials. The fifth article, "Chiropractic: Science, Religion or Political Movement?' by Terry Polevoy, is an equally stringent attack on chiropractic which, the author argues, is quackery of the worst sort based as it is on the existence of so-called 'subluxations' -- supposed misalignments of the spine that have never been seen or proved to exist by science. The sixth article, 'Concepts of Holism in Orthodox and Alternative Medicine' by Michael Baum, is a rather beautiful plea for physicians working in the traditional medical sector to see their work as very much holistic i.e. concerned with the whole person and in touch with all the moral and personal issues involved in so many medical decisions. It is also a plea for everyone to see traditional medicine and not just CAM as being holistic. The seventh article, 'Vitalism and other Pseudoscience in Alternative medicine: The Retreat from Science' by P.H. Canter, is an attack on beliefs in unsubstantiated presuppositions such as the existence of some vital force that 'magically' underlies our material existence. The eighth article, 'Placebo and other Non-specific Effects' by Edzard Ernst, is an argument that many and perhaps even most CAM therapies appear to be effective simply because the placebo effect kicks in. He argues that trials in such therapies do not appear to control for the placebo effect even though that is precisely what is producing the result. If one were to remove the placebo effect then most if not all CAM remedies would be revealed as ineffective. The ninth article, 'CAM in the media -- An easy Ride?' by Ben Goldacre, questions why the media are so easy on CAM practices and concludes that the need to generate income is much more important than publishing the truth. He argues that the profit motive is seriously distorting media coverage. The final article, 'Patient Choice' by Hazel Thornton, ends the book in a questioning tone. She raises the issues connected with choice -- the need to have full information, for example, if one is to make a fully informed choice. She concludes that in the present climate of misinformation it is impossible for patients to make an informed choice.
The book as a whole is packed with cautionary tales that make for rather sad reading. For those people actively researching in the field of CAM this book is a 'must have.' It raises many of the most pressing concerns -- people's search for a holistic view of life, the distorting effect of a 'profit first and truth second' climate, the misuse of statistics, etc. One may not agree with everything that is written in this book but it is wonderful that academic honesty is still alive and well.
© 2009 Kevin M. Purday
Kevin M. Purday has just completed his fortieth year as a teacher and has recently returned to the U.K. after being principal of schools in the Middle East and Far East. His great interests are philosophy and psychology.