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232 pp Price $22.99(pb) ISBN 0-521-83429-5
Cambridge: Cambridge University Press.
To Mary Ruggie the rise of complementary/alternative medicine (CAM) is a 'social transformation' of healthcare. As indicated by the title, she focuses on the USA—a pity, since most of CAM originates elsewhere. Her book covers such matters as the relation of CAM to conventional medicine, types of evidence, reasons for CAM usage, patterns of growth, research, and the future of CAM— often by asking questions rather than providing answers.
Ruggie sees the growth of CAM in terms of a power struggle: 'CAM poses huge challenges not only to the dominance of biomedicine, but also to the fruits of dominance—status and power in decision making about health care and in the livelihood of physicians'. I can never bring myself to seeing things quite as petty as that. The 'struggle', I always thought, is to find treatments that do more good than harm, and all healthcare providers are united in it. The 'dominance' of biomedicine stems from the evidence rather than Machiavellian intrigues. But this is where we obviously differ: healthcare professionals work to help patients, while medical sociologists watch us doing it and interpret according to their particular prejudices.
Annoyingly, Ruggie perpetuates the notion that 'only about 15% of medical interventions are supported by evidence'. It fits her bill and she is in good company: the Chair of the NHS Alliance recently stated that 'people argue against complementary therapies on the basis of a lack of evidence. But I'd say only 10 percent of what doctors do in primary care is evidence based'. The argument comes from a BMJ editorial of 13 years ago, and even then it was not supported by good data. More recent evidence shows that 70–80% of our treatments are based on evidence. Isn't it time that we all buried this counterproductive myth?
What is the impact of this sort of book? Sadly, I am not sure that it is negligible. When writing about CAM, sociologists sometimes endorse treatments that are not necessarily safe or effective and can have disadvantageous consequences. For instance, Ruggie declares about meditation: 'There is a large and growing literature on the biology of meditation and, despite the inevitable methodological inconsistencies, there is mounting evidence of health benefits'. The truth is that the evidence is unconvincing. Her final conclusion is less than arresting: 'If patients continue to use and demand CAM, if research proves the safety and efficacy of CAM, if physicians accept CAM, if the benefits of CAM extend to cost savings, and if insurers and healthcare plans offer CAM coverage, integrative clinics will prosper and grow.' So is this book all bad? Taken with several pinches of salt, it can serve as a reasonable, mostly well-written, introduction to CAM. And it allows intriguing insights into the often strange logic of sociologists who dabble in the subject.