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Healing, hype or harm? A critical analysis of complementary or alternative medicine
  1. Jonathan Freedman
  1. jonathan.freedman{at}nhs.net

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Edzard Ernst. (author and editor)Published by Imprint Academic 1 edition (1 June 2008) 178 £8.95 (paperback) 1845401182

This is a book aimed at the general public setting to counter some of the recent press that is seen as being biased and uncritically in favour of complementary or alternative medicine. It is presented as a series of essays by different authors with a well-written foreword by TV presenter Nick Ross and significant contributions from Edzard Ernst (as Editor), who holds the title of Chair in Complementary Medicine at the Peninsula Medical School (Exeter University). I know from his media appearances and extensive writing on the subject that he is not afraid to be critical and has justifiably exposed many so-called “therapies” as scams. His critique here, however, is so fearsome that he would appear to have done himself out of a job — you would be left feeling that there is surely nothing left to say on the matter other than perhaps arranging a gathering up of complementary therapists and burning them at the stake!

The book initially focuses on general issues, with an attempt to define complementary medicine and analyse why it is so popular. It then sets out to tackle what is meant by “evidence-based medicine” and questions of research and legal aspects of complementary medicine, including the debate over regulation. David Colquhoun, a pharmacologist at University College London, delivers a damning critique of all universities where complementary medicine modules are taught. I noticed that the Hertfordshire University MSc in Western Medical Acupuncture was not mentioned, despite being well established and supported by the British Medical Acupuncture Society (BMAS), which is also not worthy of a mention throughout this book, but more of that later. There is a thought-provoking piece by Bruce Charlton on the difference between “healing” and “curing” and how complementary therapists have tried to claim the mantle of “healers” from conventional practitioners.

The second section of the book aims to deal with some specific issues, and in the main turns unashamedly on homeopathy and chiropractic techniques. There is also a discussion about the concept of what is really meant by “patient choice” and “integrated medicine”. There was repetition here, as might be expected by having a series of essays from different authors in one volume, but surprisingly, perhaps, not edited out. How many ways are there of expressing a view, that homeopaths are charlatans? As a regular referrer to the Royal London Homoeopathic Hospital I was shocked by the implied criticism of the work that goes on there and apparent lack of understanding of the complexity and variety of clinical expertise, which has certainly benefitted many of my patients over the years. I also reflect on the varying “therapies” that are available to patients attending our local hospices, and how many of these provide comfort and symptom relief when time is short. These in no way pretend to offer a “cure” or try to replace “orthodox” treatments. This is the reality of my day-to-day work and for me, here lies the major flaw of this book — there is not a single mention of primary care, where over 90% of NHS consultations take place. I am reminded of an excellent article in the BMJ published in 1997 entitled “Medicine based evidence, a prerequisite for evidence based medicine”, where the importance is discussed of accommodating this clinical reality into research rather than ignoring it. It remains an important and salutary read over a decade later.1

Surprisingly, there is only a cursory mention of acupuncture, and there is absolutely no distinction made between Western medical and traditional Chinese practices. I found this very sad, particularly when the BMAS has over 2000 regulated health professionals as members. We certainly don’t have all the answers but there is a growing scientific understanding of how acupuncture might work and we have seen a growth in rigorous clinical studies and positive outcomes, but none of this is deemed worthy of mention. Finally, I don’t think that Western medical acupuncture, as we understand it, actually fulfils any of the definitions of complementary or alternative medicine quoted here and maybe this poses the greatest future challenge to the BMAS in terms of how we present and market ourselves.

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