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The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach FREE TO VIEW

John Doggett, MD
Chest. 2002;121(2):670. doi:10.1378/chest.121.2.670
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By Edzard Ernst, Max H. Pittler, Clare Stevinson, and Adrian White, eds. London, UK: Harcourt Publishers, Ltd., 2001; 459 pp; $34.95

Alternative medicine is a growing influence in health care today. More and more of our patients are utilizing both traditional (conventional) medicine and some combination of alternative treatments in their search for better health and wellness. Unfortunately, many physicians have relatively little knowledge or experience with the various forms of alternative medicine that are practiced. Whether you plan to recommend alternative therapies to your patients or you cringe when your patients admit to taking herbs, every physician should have at least a basic understanding of the types of treatments that are being used and their potential interactions with our more traditional therapies. This book serves as a very useful guide to the various types of alternative medicine that are available to the public.

The editors of this desktop guide are physicians and scientists from the United Kingdom and United States who have taken on the task of attempting to bring the light of science to bear on the widely disparate practices of alternative medicine providers. There is increasing scientific study of these previously unscientific methods of diagnosis and treatment. Some therapies have clinical merit, while many apparently do not. The authors review the relevant literature in the same way that a peer-reviewed journal would, assessing the scientific strengths and weaknesses of the various studies that have been published on the benefits of alternative medical therapies.

The book is organized not as a definitive textbook, but as a quick reference guide, with sections devoted to the diagnostic processes, the specific types of alternative therapies, and several common diagnostic groups for which various alternative therapies might be used. For example, if your patient asked you about how the herbs he was taking might interact with the medications you are about to prescribe, you could first go to the section on “Therapies,” and look up“ Herbalism,” then go to the section “Herbal and NonHerbal Medicine” and look up each type of herbal product your patient is taking. There are also chapters discussing the legal and cultural influences on the practice of alternative medicine in Europe, Canada, and the United States The final two chapters deal with safety concerns and economic issues. While many consumers of alternative medical treatments may assume that such interventions are inherently safe, this assumption is false, and one of the chapters deals with the many potential problems associated with alternative therapies, not the least of which is their almost completely unregulated and unsupervised status, particularly in the United States.

Section two gives a brief review of the various forms of diagnostic procedures that are utilized by alternative medicine practitioners, such as chiropractic, kinesiology, reflexology, and others. The premise behind the diagnostic method is explored briefly, and the scientific basis, including any relevant research, is discussed. Essentially, all of the diagnostic methods reviewed were found to have little or no scientific validity.

Section three is a compilation of various forms of therapies, including chiropractic manipulation, relaxation training, aromatherapy, homeopathy, biofeedback, and others. Each form of therapy is analyzed with respect to its origins, the concepts behind the development of the therapy, the types of disorders that are commonly treated with it, the course of treatment, the clinical evidence for and against effectiveness, risks, adverse effects, and, finally, a risk/benefit analysis. Some of the therapies discussed, such as biofeedback and progressive muscle relaxation, are commonly utilized in the United States by psychologists and psychiatrists for the management of psychosomatic complaints, such as anxiety, insomnia, and chronic pain, and it is not entirely clear why these are considered alternative therapies. The authors review the relevant literature regarding each method of treatment and issue a conclusion based on the potential benefit, as supported by literature, and the likelihood of side effects or complications.

Section four is a listing of some commonly used herbal and“ natural” products. For each product, a summary is given of the sources, constituents, presumed pharmacologic action, types of disorders commonly treated, clinical evidence for and against the effectiveness of the therapy, adverse effects and potential medication interactions, and a final risk/benefit analysis.

Section five presents a discussion of common disorders that may be treated by alternative therapies and a review of relevant trials addressing the effectiveness of the various forms of alternative therapy that are in common use for that disorder. For example, in the case of congestive heart failure, several herbs are commonly used (not counting digitalis), such as garlic, ginger, and parsley. It turns out that hawthorn and Terminalia actually do have significant benefits for mild-to-moderate congestive heart failure, as supported by randomized, placebo-controlled trials. There is some risk in using these herbs without medical supervision. For instance, hawthorn in high doses is said to cause hypotension and arrhythmias, and may have interactions with prescribed medications such as nitrates and cardiac glycosides. Other supplements may have benefits with relatively little risk.

The Desktop Guide also comes with a CD-ROM that is a searchable version of the text. You can read the text page by page, skip through the text using the table of contents, or search for specific topics with the electronic index.

Overall, The Desktop Guide succeeds in its goal of being a quick reference manual for the busy physician who needs to get an overview of the types of alternative therapies in common use, the conditions for which they are used, and the issues relating to patients’ decisions to seek out alternative forms of treatment. It is easy to read, constructively organized, and holds up a reasonably high expectation for the scientific validity of these forms of therapy.




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