Understanding complementary medicine

George Lewith
Family Doctor Publications (in association with the
British Medical Association), Poole, UK 2002
Price: £3.50 ISBN 1903474051.

This is an excellent addition to the generally excellent Family Doctor series. George Lewith writes clearly, and explains the sometimes complex principles of complementary therapies simply but not simplistically. I suspect that the reader will obtain as good a perspective and understanding of the nature and scope of complementary medicine (CAM) from this little A5 size book as from other more substantial texts. I am only slightly tentative in making that assertion because I am obviously not competent to judge the sections dealing with therapies that I do not know well, but I would judge that it can be confidently recommended to patients considering CAM or seeking a basic understanding of the treatment they are receiving.

There are three chapters dealing with issues that apply to CAM in general; two introductory chapters, an actual introduction and a chapter titled ‘CAM versus conventional medicine’, and a final chapter, ‘Who provides complementary therapies?’. In between there are nine succinct but perfectly adequate chapters on the principles and application of Acupuncture, Healing, Herbal Medicine, Homeopathy, Manipulative Medicine (embracing Chiropractic and Osteopathy), Massage, Aromatherapy and Reflexology (in one chapter), Mind–body therapies, Hypnosis and other relaxation techniques (one chapter), Nutritional Medicine, and Therapeutic Diets. There is a list of useful addresses at the end of the book, which unfortunately, having identified the Faculty as the organisation for doctors does not include its address or make explicit the link with the British Homeopathic Association whose address is included.

The three chapters (1, 2 and 12) that deal with CAM in general are particularly good. From the start Lewith emphasises the principle of ‘integrated medicine’ and the importance of placing CAM within the wider spectrum of health care, so that the patient receives whatever treatment or support is necessary and appropriate, but later bemoans the actual lack of integration between CAM practitioners and clinics and local medical services. The ‘indirect risk’ that arises when a patient uses a CAM therapy to the exclusion of some other essential form of treatment is clearly stated, though he also believes that, ‘ … most CAM therapists are now over cautious and are more likely to over-refer you to your GP rather than under-refer you if they are in any doubt’. The problem is in those last six words. I suspect many of us have encountered CAM therapists, (as well of course as doctors!), who are unwilling to admit to doubt. There is good advice on how to establish the competence of the therapist (as far as it is possible to do so), with a very good two page boxed and coloured check list, ‘How do I know my therapist is competent?’, in Ch 12. Advice, too, on establishing appropriate expectations of the timescale and outcome of treatment.

Lewith reflects on the reasons for the popularity of CAM. … ‘Patients who seek CAM feel the whole consultation process is more equal and therefore more satisfying than consultation with a GP or consultant. … They feel empowered by CAM whereas their perception of conventional medicine is that they have less input and indeed less control …. An important part is … understanding why (the symptoms) may occur and then receiving a treatment that is based on that understanding. In general the models of illness and thinking processes within complementary medicine are often far closer to our own intuitive models and processes. This is why we may find them easier to accept, even though they may be scientifically unproven.’ In this manner and in a few words he makes important insights easily accessible. The empirical basis of most CAM practice and the problems of research are mentioned, again simply and clearly. The growing acceptance of CAM, both by conventional doctors and within undergraduate medical education is discussed briefly. And, importantly, Lewith disposes of the misconception that CAM is invariably holistic while conventional medicine is not—‘good conventional medicine does take into account the whole person, and some CAM therapies are very narrow and specialised’.

There are a few errors in the chapter on homeopathy. One or two of them would lose marks in the Primary Health Care Exam (PHCE), but they do not detract from its value for the general reader. The use of aspirin to suppress a fever is ‘antipathic’, not ‘allopathic’, because it directly opposes the symptom. (Though I hesitate to mention it because the same error occurs in the glossary of my own book.) There is a familiar PHCE-level confusion about exactly how many drops are added to how many in the decimal and centesimal dilution scales. And the implication that all homeopathic medicines are made from natural substances is not strictly true. But in this context such quibbles are somewhat pedantic. I do think, however, that the assertion that ‘homeopathy cannot be recommended for any specific conditions’ is misleading. Although formal studies do not, indeed, prove the specific efficacy of homeopathy in specific conditions, effectiveness studies, such as the clinical outcome studies from our hospital outpatient departments, tell a different story. This point could perhaps be clarified in a future edition. The chapter ends with a necessary restatement of the ‘indirect risk’ theme—the potentially dangerous advice given by some homeopaths to stop conventional medication because it can interfere with the action of homeopathic medicines. To this point could be added the reassurance that, on the contrary, experience demonstrates that homeopathy can be used very effectively in patients using conventional medication and does not carry a risk of adverse interaction with conventional drugs. The importance of liaison between homeopath and general practitioner in these circumstances is, however, appropriately reiterated.

I made a particular test of three chapters—Healing, Nutritional Medicine, and Therapeutic Diets; the first out of personal interest, the other two because I find those therapeutic approaches confusing. Lewith will perhaps not be surprised that I would have liked to see a distinction made between healing in a whole person sense, perhaps in the context of his brief reference to the Christian healing ministry, and the treatment of specific, often local ailments (‘the particular areas requiring healing’) by some of the techniques he described. But apart from that I found the chapter well balanced and helpful.

I find it very difficult to discern the role of nutritional medicine and therapeutic diets in patient care, and which regime is appropriate to whom. There is a plethora of different approaches, and the provision of nutritional supplements, often combined with herbal preparations, is a huge industry, although I know through personal contacts that they are usually underpinned by a high degree of professional integrity. Therapeutic diets are to me even more of a minefield. I was prepared to believe that my attitude to these methods was largely prejudice based on ignorance, but Lewith makes it plain that while many patients do obtain real benefit from them there is in fact a considerable degree of uncertainty and difference of opinion about the diagnosis of individual patient needs and the appropriate remedy for them.

One of the things I particularly admire about George Lewith's work is his uncompromising attitude to what can and cannot legitimately be claimed for and said about CAM. It is this attitude that lends credibility to his role as a proponent of it. And it certainly makes this little book both informative and reliable.