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Complementary and Alternative Medicine, 2nd ed.

Complementary and Alternative Medicine, 2nd edition by Steven B. Kayne. London, England: Pharmaceutical Press, 2009. Paperback; 624 pages. ISBN: 978-0-085369-763-3. $59.00.

Complementary and alternative medicine (CAM) is widely seen in all disciplines of today’s healthcare. Whether you are a pharmacist educating patients about potential adverse interactions between nutritional supplements and prescription medications or a primary care physician seeing a patient interested in alternative treatments for anxiety disorder, basic knowledge of CAM is important to the healthcare professional. With a gradual increase in interest and awareness within both the medical community and general population, fundamental and in-depth knowledge of alternative medicine is crucial but often difficult to obtain. Complementary and Alternative Medicine, 2nd edition provides a comprehensive and succinct introduction to all aspects of the topic. For each different type of therapy and diagnostic method, Dr. Kayne explores the history, underlying theory, evidence of efficacy and safety, and practice concerns.

In this second edition, Dr. Kayne reorganized his book and includes 3 new important chapters, written with the collaboration of highly qualified experts on the topics of integrative medicine, pharmacovigilance, and marketing of CAM products in the United States. Many sections have been updated with new data and evidence-based guidelines, as well as legal issues associated with each different therapy method.

In Part 1, Dr. Kayne defines different terms used in the field, such as complementary, alternative, traditional, and holistic medicine. He describes how visits with CAM practitioners involve an extensive history-taking process that uses easily understandable, patient-friendly terminology. The patients take a more conscious and participatory role in the entire visit, including the decision-making process. He emphasizes that the main difference in CAM is a whole-person approach, with the focus on prevention and an individualized plan of management, whereas conventional medicine is a disease-centered approach with symptom-specific treatment options.

In a newly added section, Iris Bell, MD, PhD, discusses the concept of integrative medicine, a patient-centered, whole-person care approach provided by mainstream healthcare providers who use both conventional and CAM modalities to treat conventionally diagnosed conditions. Dr. Bell emphasizes that the ultimate goal of integrative medicine is not merely to resolve a disease process or render the absence of disease but to promote a complete physical, mental, and social well-being for the patient. She also raises valid concerns and controversies regarding current integrative treatment modalities, the most important being the safety concerns of the consumable products. Dr. Bell discusses concerns regarding under-regulation of supplement and herbal products used in integrative medicine, as well as other concerns such as adverse side effects, interactions with other prescription medications, frequently unknown pharmacokinetics, frequently unknown pharmacodynamics, and inconsistent quality control.

The rest of Part 1 addresses the growth in demand for CAM and the products used in the United States. CAM is taking a larger part of US healthcare spending with a 9.7% annual increase in CAM-related product sales, exceeding $29.97 billion in 2006. CAM topics have also increased in scientific literature and National Institutes of Health (NIH) research funding, although criticism remains regarding CAM’s inability to meet evidence standards acceptable within orthodox medicine. Dr. Kayne discusses several roadblocks in alternative medicine research that have resulted in scant evidence-based data in the field as compared with conventional medicine. Main reasons include lack of financial support and research skills, difficulty in research design, variable quality of research, and quality control of the products used, as well as the practitioner’s use of therapy based on anecdotal evidence.

In Part 2, the author examines homeopathy, anthroposophy, medical herbalism, aromatherapy, and flower remedy therapy. He discusses the background philosophy, unique approach, preparation methods, medicines used, and most commonly treated conditions for each specific modality. He includes in-depth safety concerns, evidence-based results regarding efficacy, and resource lists for further information on each of the therapies.

Traditional medicine, which includes Chinese medicine (Chinese herbal medicine, acupuncture, dietary therapy, and martial arts therapy) and Indian Ayurvedic medicine, are discussed separately in Part 3. Each chapter covers basic theory and history of the modalities, including descriptions of the unique diagnostic and treatment methods. Both Traditional Chinese Medicine (TCM) and Indian Ayurvedic medicine use natural products and herbs as a major part of the treatment plan. Pertinent to this is a discussion of the increasing concerns of bioavailability and sustainability of the raw materials for these natural products, as well as safety concerns.

Part 4 explores various other therapies, including naturopathy, nutritional therapy, nutraceuticals, and other diagnostic therapies (e.g., iridology and kinesiology). In addition, manual therapies discussed in this section include chiropractic, reflexology, rolfing, and osteopathic manipulation. Mind-body therapies such as yoga, music therapy, and relaxation therapy are also covered in this section.

I recommend this book to all healthcare professionals, as well as to students in related healthcare fields who have had no prior exposure to the subject. Although this book may not be a practical reference guide for practitioners using CAM to treat patients in a clinical setting, it is an excellent source for acquiring a fundamental understanding of the subject. More suited for a basic or introductory course in CAM, this book is one I wish I had a chance to read during my medical school education. Academic centers should consider adding Kayne’s book as required reading as demand for open-minded, non-judgmental, well-educated, and compassionate integrative practitioners continues to grow.

—Sungmi Lian, MD Clinical Assistant Professor Department of Family Medicine University of Texas Medical Branch Galveston, TX