Fundamentals of Complementary and Alternative Medicine targets a wide audience; students, health care practitioners and “other individuals with the intellectual foundations and tools” to understand its complexity. Although interest in complementary and alternative medicine is growing among consumers, practitioners, insurers and policy makers, the tenor of the book (which contains a free CD-ROM version) is academic rather than practical. Hence, while the reader acquires a solid introduction to the field, many of the specific and practical issues in which one would be most interested — exactly what the treatments are, what benefits and risks patients can expect, who is qualified to administer the treatments and their cost — are not covered. In many cases, unfortunately, the reader will close the book without the ability to make decisions regarding the relevance of these approaches and skeptics of alternative medicine will likely come away from the book just as skeptical. Perhaps the field is just not mature enough to present the unambiguous answers which most scientists and clinicians expect.

Nevertheless the book fills a void in the literature by focusing on the conceptual and empirical foundations of the field and putting the alternative medicine movement in perspective. There is no other text that provides such a comprehensive overview of the components and goals of alternative medicine. In some important ways, interest in alternative medicine approaches is a by-product of the failure of conventional biomedicine to deal effectively with the major health care challenges confronting western society. This newfound interest is not due to increases in the demonstrated effectiveness of these approaches. Rather, their routine integration into clinical care is simply an idea whose time has come. Yet most of the available literature regarding alternative care is written by practitioners of particular disciplines. These writings, frequently self-serving and lacking in scientific rigor, often prompt rebuttals from mainstream practitioners. What was lacking until now was a comprehensive text which deals with most of the major interventions in alternative and complementary medicine and puts these interventions in context. Context is crucial.

Both the historical trends and the current circumstances that have set the stage for the growing interest in this field must be appreciated. Surprisingly, many individuals affiliated with alternative medicine cannot adequately define the field or discuss its relationship to biomedical care. The first section of the book provides a very readable yet sophisticated review of these issues by addressing the definitions and the cultural and historic context of the field. However, the final chapter of this section, which deals with mind/body integration, reveals a significant problem with both the field and the text: For the field, the relationship between behavioral or mind/body medicine (interventions typically integrated with traditional biomedical care) and alternative medicine is uneasy, and for the book, unfortunately this issue is largely ignored. Just as interest in alternative medicine is growing, interest in behavioral medicine is also on the rise. Behavioral medicine has a more extensive scientific foundation than most alternative interventions and, while the two overlap, they are often considered distinct endeavors by many traditional biomedical practitioners. When practitioners, insurance companies and patients think about alternative care, they frequently consider interventions such as changes in diet, exercise or stress management. Although teaching patients to alter the way they eat, exercise or handle stress has become a part of mainstream medical care, many still consider this as alternative or complementary to routine biomedical care. Yet, such interventions are not covered at all in the text. The terms “exercise” and “stress” do not appear in the index while the term “diet” appears only as it relates to Chinese medicine, Maharishi Ayurveda and naturopathy. Many practitioners of alternative approaches consider the triad of diet, exercise and stress as something of a cornerstone, and it should have been addressed in some detail but was not.

The text presents systems (homeopathy, osteopathy, chiropractic and Western herbalism), approaches (healing touch, aromatherapy, light therapy) and integrated/traditional systems (naturopathic medicine, Chinese medicine including traditional approaches and Qigong, traditional and Maharishi Ayurveda, curanderismo and global health traditions). Sadly, there is no integration among these chapters. Even more disappointing, while some of the chapters present excellent reviews with reasonable presentations of the literature regarding efficacy, others read more like advertisements for professional organizations. The uncritical nature of some chapters and the failure to provide an authoritative summary of the literature leaves the reader confused. The conflict is between the belief in the intervention and the data supporting its efficacy. For example, in the chapter on homeopathy, we read that “there is no scientific explanation for the mechanisms of action of homeopathic medicines”, but speculative theories regarding quantum physics, “memory of water” and chaos are offered as possibilities. The lack of any coherent theory regarding mechanism of action does not prevent the authors from making specific recommendations regarding which diseases are most likely to be treated successfully by homeopathy. This list however is not derived from any conceptual framework nor does it seem to be related to the data in the section labeled clinical research. Similarly, in the chapter on healing touch, the author indicates that much of the evidence regarding efficacy is based on anecdote which is no better than “wishful thinking.” Yet, the author also states that therapeutic touch has changed the lives of many patients for the better.

In the foreword, former Surgeon General C. Everett Koop indicates that this is an opportune time to examine alternative treatments. After all, he contends, physicians must rely on empirical data when deciding on a treatment strategy. Those looking for a definitive presentation of the scientific data supporting alternative and complementary treatments may be disappointed in the volume. Those looking for a conceptual framework for understanding the field will find it very important.