Integrating Complementary and Conventional Medicine

The title suggests a methodology to integrate complementary therapies into a biomedical programme. The intent is a practical guide for integration aimed at GPs and medical students. It aims to describe benefits of complementary therapies, to demonstrate a holistic approach, and ‘the potential to reduce GP workload’. One author is a GP principal who has trained in homoeopathy and the co-author is his wife, who is trained as a nurse and midwife, as well as in energy healing. An introductory chapter covers psychological distress, followed by chapters on specific complementary healing disciplines and specific diseases. It finishes with a section on one of the authors’ study of patient outcomes, and a description of perceived economic advantages.

The book is mainly an inspirational text for patients. Coverage of psychological issues is well written. The description of techniques and their indication is disappointing, with non-specific references (often to descriptive books) and minimal evidence-based studies. For example, it appears that every condition can be treated with homoeopathy. I am not convinced that even the pragmatic advice on homoeopathic remedies is useful because dilutions are not mentioned. Perhaps that is not relevant when any potential benefits are probably placebo-induced. In the section on depression, I commend the references to psychotherapy and exercise, but would like to see pharmaceutical antidepressants at least mentioned. To the authors’ credit, there is a warning not to combine St John’s wort with selective serotonin reuptake inhibitors (which can lead to a serious serotonin reaction). The book finishes with the one author’s study on patient outcome, from which he concludes that there is a reduction in consultation rate following the introduction of complementary therapies. The study is seriously flawed because it is not randomised or controlled, and the likely cause is simply regression to the mean. The author’s conclusion for cost-effectiveness is solely based on the 2005 Smallwood Report, which is flawed by selectivity.

In conclusion, the book adds nothing to the current literature. It is poorly evidence-based, and at times misleading. The book would have benefited from incorporating the many studies summarised in FACT, and taking a more critical approach. However, it does emphasise whole person care and humanistic attributes of the therapeutic relationship, which is the message that medical students should take home.