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The Alternative Medicine Handbook, by Barrie R. Cassileth, is organized as a reference on the most commonly used complementary and alternative therapies. Cassileth brings to this work an appropriate base of experience; she holds teaching appointments at Harvard University and Duke University, is a founding member of the advisory council to the National Institutes of Health Office of Alternative Medicine, and has published extensively on the subject in peer-reviewed medical journals. Dealing with a broad range of material, from the use of shark cartilage to the traditions of ayurvedic medicine and the tenets of shamanism, she summarizes each therapeutic approach -- its history, the beliefs on which it is based, and the therapeutic claims made for it -- and analyzes any research-based evidence of its efficacy. For the physician who wants to advise a patient, Cassileth offers a balanced approach, providing information on certain treatments that appear to be safe and of possible benefit, as well as caveats against the indiscriminate use of others.
Discussing herbal remedies and nutritional supplements, for example, Cassileth notes that few physicians and patients are aware that the Dietary Supplement Health and Education Act of 1994 eliminated the requirement that these products be reviewed by the Food and Drug Administration. As a consequence, she cautions, they are no longer evaluated for either safety or purity; sometimes they contain none of the advertised components, and they are not evaluated to determine whether they support a promoter's claims. Furthermore, labels on these products rarely include information about risks, side effects, or possible harmful interactions with other substances. This lack of federal oversight is, appropriately, currently under review. Following the lead of H.L. Mencken, who observed that for every complex problem, there is a simple solution -- and it is wrong, Cassileth suggests that physicians should remain open to unconventional ideas but must help their patients understand the need for a scientific approach to complementary and alternative medical practices and products.
With the growing dominance of economically driven managed care in American medicine, decisions about treatment are subjected to greater scrutiny by parties outside the traditional doctor-patient relationship. The second book reviewed here, Alternative Medicine and Ethics, focuses largely on issues facing policy makers. The six essays in this book vary in their clarity and insight. Stephen Barrett argues forcefully that although the science-based medical community tests its theories and practices in order to develop a coherent body of reproducible experience and knowledge, the alternative-medicine community has no such commitment. Vimal Patel, whose essay supports alternative therapies, attacks organized medicine for its "befriending relationships" with the tobacco and pharmaceutical industries, cites examples of contraindicated surgeries performed to enrich surgeons, hails the 1994 Dietary Supplement Health and Education Act, and stresses the importance of "healing" the patient without necessarily curing the patient's illness.
The remaining essays deal with ethical challenges alternative medications pose for the pharmacist, the legal and ethical dilemmas surrounding prayer as a method of alternative healing for children, and the ramifications of the increasing insistence that complementary and alternative therapies be covered by health insurance. Discussing the issue of insurance coverage, S. Mitchell Weitzman argues that, on the one hand, complementary therapies such as yoga, meditation, and dietary modifications can reduce the cost of surgical or medical treatment of heart disease, but on the other hand, reimbursement for such approaches will reduce the resources available for established methods of care.
As we deal with the issues raised by complementary and alternative medicine, we must be prepared to give credence where it is due. Many of the currently approved remedies originated, after all, in folk traditions: digitalis, chloroquine, and aspirin are examples. Other treatments that may have originated as alternative approaches include use of a form of vitamin A to treat acute promyelocytic leukemia, application of electric currents to speed the regrowth of bone, and use of high-intensity light to treat some forms of depression.
As philosopher Carlyle Marney wisely cautioned, "A window stuck open is as useless as a window stuck closed. In either case, you've lost the use of the window." We must continue to insist on the painstaking accumulation of evidence in the scientific testing of each new breakthrough, especially since, according to a recent article from the National Institutes of Health Office of Alternative Medicine, complementary and alternative approaches are amenable to the same testing used for standard medical treatments (J.S. Levin, et al. "Quantitative Methods in Research on Complementary and Alternative Medicine." Medical Care 1997, vol. 35, pp. 1079-1094).
Reviewed by Avrum Bluming, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Most Helpful Customer Reviews
17 of 19 people found the following review helpful:
5.0 out of 5 stars
a GOOD book on alternative/complementary medicine,
By A Customer
This review is from: The Alternative Medicine Handbook (Hardcover)
As both a scientific researcher and a cancer patient who has greatly benefitted from mainstream medicine, about the last thing anyone would expect me to do would be to endorse a book on nontraditional medical approaches. However, I found this book to provide a comprehensive and critical evaluation of the science behind several alternative and new-age approaches to healing. It covers everything from acupuncture to Zen philosophy and discusses the scientific studies that have been conducted to determine whether various approaches actually work (she also devotes several pages to the placebo effect).As a scientist, I am very critical of "pop science", "miracle cures" and unproven alternative medicine. I also know just because something is published in a book (or on the internet), there is no guarantee that the information is accurate or true. However, I trust Dr. Cassileth's professional credentials. In addition to the professional history mentioned in the editorial review, Memorial Sloan-Kettering Cancer Center (one of the top cancer centers in the country) just opened a new department of Integrative Medicine devoted to "addressing the body, spirit and mind" and Dr. Cassileth was made the head of this new department. Despite the title of the book, much of the book focuses on complementary (rather than alternative) therapies that can help patients get through physically and psychologically difficult medical treatment (such as cancer treatment). She also debunks several trendy but scientifically invalidated or unvalidated cancer treatments. She also discusses the potential dangers in the lack of regulation of the herb and supplement industry, while pointing out which of the herbal remedies and vitamins have been shown to have some health benefits. The book is written for the nonscientist, which means that the info is accessible and easy to understand. Science junkies like myself may be left wanting more info on mechanism, and I was quite disappointed by the lack of a reference list citing the various studies of alternative/complementary therapies that have been published in scientifically credible journals. Anyway, if any of you are interested in complementary therapies and ways to reduce stress in your life, I highly recommend this book. I think it's one even your doctor would approve of :-)
3 of 6 people found the following review helpful:
5.0 out of 5 stars
Great Basic Resource for Alternative Medicine Users,
By vadengroup@juno.com (Truro, MA) - See all my reviews
This review is from: The Alternative Medicine Handbook (Hardcover)
This is a believable, well--researched book about the growing field of alternative medicine. Its a great book to have as a "second opinion" when one is considering going outside of traditional medicine to seek treatment or cure for medical and heaslth problems.
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