Complementary Medicine: A Research Perspective

  • Charles Vincent &
  • Adrian Furnham
Wiley: 1997. Pp.305 £24.95, $44.95<

There continues to be widespread interest in complementary medicine both from consumers and from their vocal providers. But how do these groups handle the frequent criticism that there is little robust evidence that their therapies actually work?

Additions to the blossoming literature that reiterate the same message — that the research evidence for clinical effectiveness is poor — are always welcome. This new book is especially valuable because it aims to educate the interested researcher or critical analyst about other research aspects of complementary medicine. It includes welcome introductory sections on why people use complementary medicine and the sociology of illness.

But the section on research methods for evaluating effectiveness misses two opportunities. The first is to develop the model best suited for evaluating effectiveness when the randomized controlled trial is deemed either inappropriate or impractical. Many believe that a modification of the n= 1 trial approach, beloved of psychologists, is one way forward. It is a shame that the arguments for such radical alternatives to the randomized clinical trial are not developed more fully, particularly as practitioners of complementary medicine need to be encouraged to embrace the need for research, appropriate research training and systematic high-quality, outcome-led, clinical audits.

The second missed opportunity is that the authors could have said more about appropriate outcome measures. These measures are important in the evaluation of most therapies, and basic points about their development and use should be made.

The book does not include all complementary therapies. Notable deliberate omissions include aromatherapy (the panacea for midwifery problems), hypnotherapy and counselling (the panacea for the 1990s). What is more, its focus on particular therapies does not always help in condition-based prescribing — that is, in deciding which therapies might be best for which condition. Even that approach, however, would probably still be contentious.

As with all new textbooks, this one is already out of date. For example, there is nothing on the use of St John's wort (hypericum) for depression; the summary table comparing orthodox and complementary medicine does not take into account the policy drive for evidence-based medicine and cost-effectiveness; and there is no mention of the recently funded UK Medical Research Council trial on manipulative therapies for chronic back pain in primary care or of UK moves to form a central chiropractic register, similar to that being put in place for osteopaths.

It is always easy to point out acts of omission when reviewing a book: it is almost like saying “Well, if I had written it, then…”. This book is easy to read, free of overt values and jargon, and sensibly referenced and laid out. It is a clear account of some of the key issues facing both researchers into complementary medicine and their friends and critics. Although probably lacking in depth for most seasoned observers, it is ideal for beginners or those with a casual interest in the field.