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Resource Corner

The Desktop Guide to Complementary and Alternative Medicine: An Evidence-based Approach

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ACP J Club. 2002 May-June;136:A14. doi:10.7326/ACPJC-2002-136-3-A14



More than $25 billion is spent annually on complementary and alternative medicine (CAM) therapies in the United States, which indicates their popularity with the public (1). Increasingly, health care providers are being confronted with patients who are using these alternative therapies, and the providers have to determine their potential benefits and harms. In light of this trend, The Desktop Guide to Complementary and Alternative Medicine: An Evidence-based Approach is a welcome new resource. This book has the ambitious objective of summarizing a wide range of CAM interventions and of providing information on whether evidence exists to support their application. It also seems to be aimed at both health care providers and consumers.

The Desktop Guide to Complementary and Alternative Medicine is divided into 6 sections and includes a CD-ROM version. Section I, “Using This Book,” provides a useful summary of the organization of the book and the methods used to summarize research. Section II, “Diagnostic Methods,” describes several CAM diagnostic techniques and the evidence supporting their use. Section III, “Therapies,” provides an overview of such CAM disciplines as chiropractic, homeopathy, and naturopathy, including evidence supporting their application. Section IV, “Herbal and Non-Herbal Medicine,” provides a summary of the clinical evidence supporting the use of herbal and nonherbal medicines and their potential harms. Section V, “Conditions,” is perhaps the most useful to readers because it summarizes evidence for the effectiveness of CAM interventions organized by health care condition (e.g., the effectiveness of several CAM therapies for HIV and AIDS). This section is the most thorough in evidence presentation and provides summary tables of the evidence for each health condition. It also highlights critical pieces of evidence and gives a visual summary of the weight of evidence, direction of the evidence, and the potential harms of the product. Section VI, “General Topics,” examines several aspects relating to CAM, including legal, safety, and economic issues.

The editors of The Desktop Guide describe comprehensive techniques for summarizing and appraising information. A broad search strategy of 4 medical databases is provided in the appendix. The editors state that they primarily rely on evidence compiled in systematic reviews. They have attempted to balance provision of detailed references and evidence with readability. To assist with this, they use a simplified scoring system for grading the weight (level, quality, and volume) and direction of the evidence. The book lacks information on how it will be kept up-to-date, although the editors state their intention to do so. Keeping this resource up-to-date is particularly important given the increasing volume of research evidence that examines the effectiveness of CAM and the potential for interactions and harms of the therapies.

The editors state that a precautionary approach has been taken in reviewing the specific CAM therapies. Unless evidence to support the safety of a substance exists, it is not considered risk free. This cautious approach is warranted given the absence of the strict regulations that govern much of conventional medicine. However, even this strict approach is not fail-safe because of the variability in production and manufacturing of many of the CAM products. For example, at the time of writing this review, regulatory agencies were investigating a potential link between the use of kava-containing substances and serious liver toxicity (2). In the book, kava is considered to be generally safe because of the absence of documented harm at the time of publishing.

In reviewing this book, I took the perspective of a traditional health care provider who desires to learn more about the field of CAM. From this perspective, the book met most of my expectations. I believe readers will be surprised at the number of studies done on alternative medicine, although many are small, short, and of suspect quality. The Desktop Guide to Complementary and Alternative Medicine provides interesting information on specific therapies that have good evidence for benefit (e.g., hawthorn for congestive heart failure) as well as other widely used therapies for which evidence exists showing lack of benefit. The book is easy to use, and the CD-ROM allows for quick searches for specific CAM products.

This book is a valuable resource for health care providers seeking to acquaint themselves with the “black box” of CAM as long as the reader exercises caution and judgment.

Kumanan Wilson, MD
University Health NetworkUniversity of Toronto
Toronto, Ontario, Canada


References

1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-75. [PubMed ID: 9820257]

2. Kava linked to liver damage. National Center for Complementary and Alternative Medicine. nccam.nih.gov/fcp/kava/kava.htm.

Ratings

Methods/Quality of Information: 4 of 5 stars

Clinical Usefulness: 5 of 5 stars

The Desktop Guide to Complementary and Alternative Medicine: An Evidence-based Approach can be purchased online at www.harcourthealth.com/fcgi-bin/displaypage.pl?isbn=0723432074 for US $34.95. The table of contents and sample entries can be viewed at www.harcourt-international.com/ernst/default.cfm.