The Mainstreaming of Complementary and Alternative Medicine. Studies in Social Context

This collection of articles is concerned with sociological issues surrounding CAM, such as the role of health consumers as activists, the professionalisation process and contested boundaries in the workplace. Chapter 3, by Evan Willis and Kevin White, is a sociological analysis of the impact on, and challenges of, EBM for CAM, and may be of particular interest to readers of FACT. Apparently, the hierarchy of evidence used in EBM is not something based on good scientific logic but rather a ‘hierarchy of authority’ to be explained by its social history and context. The point is made that what EBM actually means for health policy is complex, unresolved and varies considerably between countries. For example, in some contexts EBM is able to incorporate a consumer-focused element: hopefully consumer choice will be informed by evidence and restricted to the M but not the EB of EBM. In considering the rise of CAM the authors point out that there is a growth in the use of both orthodox and CAM medicine perhaps related to the general ageing of the population and increase in chronic disease. Also interesting is the example of homoeopathy, which these authors argue can never be complementary to allopathic medicine: it cannot be true that a medicine both becomes more potent with increasing concentration (allopathy) and with decreasing concentration (homoeopathy). The impact of EBM on CAM is, it is argued, both good and bad. If a particular modality is supported by clinical evidence of benefit from RCTs then there can be little argument against offering it to patients even though its underlying principles may be incommensurable with orthodox science. The drawbacks are not only that more esoteric modalities will fail the evidence test: these authors are sceptical of the term ‘integration’ because they believe that it will mean the takeover of proven CAM therapies by mainstream medicine and restriction of practice to the medically qualified. This is an entirely different objection to my own as a scientist, to whom it appears that, in the UK at least, the politically correct agenda of integration is by-passing the evidence test. Annoyingly, the chapter contains some very selective quotes from the scientific literature on homoeopathy.

I have dipped in and out of the other chapters and found some points of interest. For example, Chapter 2 by Kahryn Hughes on health as individual responsibility starts by discussing an assumption of new age culture: ‘every human individual is essentially capable of perfect health and mental adjustment if only s/he is prepared to take responsibility for her/his own health.’ I find it mind-boggling that the sociological ins and outs of this can be discussed for page after page without once considering the distinct possibility that this assumption is utter nonsense and totally at odds with genetic and evolutionary science.

I am not qualified to judge the merits of this book in terms of its sociological quality but those associated with CAM will probably find that it offers some interesting perspectives on the debates surrounding the field. At the very least it offers an entertaining glimpse into the bizarre world view of sociologists.