The Pharmaceutical Journal
Vol 270 No 7236 p241
15 February 2003

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Probably better and certainly cheaper than most of its competitors

'Understanding complementary medicine', by Dr George Lewith. Pp 111. Price £3.50. Poole: Family Doctor Publications Ltd in association with the British Medical Association; 2002. ISBN 1 903474 05 1

Looking at high street bookshops, there seems to be no need for yet another complementary medicine (CM) book but there is an urgent need for a good CM book for the lay audience — a book that is informative, critical and balanced. Does this book fulfil these criteria?

Is it informative? Informing the public about CM, a truly vast subject, is not an easy task. In only about 100 pages, Dr Lewith deals with acupuncture, healing, herbal medicine, manipulation, massage and related therapies, mind-body therapies, nutritional medicine and therapeutic diets. Given the constraints on space, this book is condemned to merely scratching the surface of numerous important subjects. My particular disappointment relates to the information regarding potential herb-drug interactions. The information provided is not nearly enough considering the vital importance of this subject.

Is the book critical? Refreshingly, some elements of critical thinking have entered this text. In particular, Dr Lewith states that CM has no monopoly on holism; good physicians are often more holistic than the average CM provider. He also stresses repeatedly that CM practitioners must never interfere with treatments prescribed by other health care providers. But he also states that "most CM therapists are now over-cautious and are more likely to over-refer you to your GP...". This does not reflect my impression. Where is his evidence? Dr Lewith also states that "about a quarter to a half of patients who have had manipulation experience some increased pain or discomfort...". The figure is actually between 40 and 50 per cent and only refers to chiropractic spinal manipulation.

Is the book balanced? By and large it is. Yet in many places I detect a pro-CM bias. One example: Dr Lewith states that "a large number of clinical trials" have looked at healing techniques. The truth is that only a few rigorous trials are presently available. Dr Lewith then cites a large study that produced an impressively positive result thus justifying his overall positive tone. A balanced approach would clearly need to include a mention of at least one of the rigorous clinical trials of healing that produced a negative result.

Despite my comments, I conclude that this book is probably better and certainly cheaper than most of its competitors. Writing on complex issues for the lay public can be exceedingly arduous — I wish publishers would give experts sufficient space. What is really needed, in my view, is a British Medical Association series critically assessing individual CM therapies — "Understanding acupuncture", "Understanding healing", etc.

Edzard Ernst