Well written and informative critique of the Complementary and Alternative Medicine (CAM) community/industry. Rather preaching to the converted in my case, but some good facts in here.

Shapiro starts off with an account of the development of medicine with Hippocrates and Galen, who are known for articulating the idea of health as a function of the balance between the four humours; dyscrasia being the term used when an imbalance was present, which would cause illness. She says that this idea of balance/harmony is one that underlies many of the early systems of medicine, and its influence in medicine was present until the 19th century, when bloodletting was still used as a means of curing certain illnesses (it is thought that this was what led to the death of George Washington).

But although Western medicine has moved on, and discarded the idea that health is a function of "inner harmony" or "balance", these concepts are still appealed to in CAM. Notably, Traditional Chinese Medicine (TCM) has a similar idea, albeit with five instead of four humours; Indian (Ayurvedic) medicine was influenced by a translation of Galen's work, and blood-letting is still practised in large parts of India.

In almost all cases, Shapiro reckons that CAM has no value whatsoever. Acupuncture, she says, may in some cases be helpful for some types of pain and nausea, but most of the claims made for it have no supporting evidence. Claims that operations are carried out with only acupuncture for pain relief are shown to be exaggerated or misleading: either patients have had conventional anaesthetic, or they've forgone it for reasons of cost, and have spent the operation shouting political slogans in an attempt to divert their attention from the pain.

In the case of TCM, "Marxist T'an Chuang [described] Traditional Chinese Medicine as 'the collected garbage of several thousand years' in 1941" (p53). Shapiro says that following the communist revolution, Mao made a decision that while modern medicine was preferable to TCM, there were not sufficient trained doctors, and so pragmatism dictated that TCM should be promoted and practised because it provided a way of satisfying the nation's health needs. Mao himself is quoted "Even though I believe we should promote Chinese medicine, I personally don't believe in it. I don't take Chinese medicine" (p54). The acupuncture diagrams of the time (which were an attempt to consolidate the many pre-existing mutually contradictory acupuncture maps) also present "administrative and political metaphors to the extent that 'a direct image of the Chinese Communist Party has been superimposed on the body'" (p54).

Chinese herbal medicine is also given short shrift: studies show that preparations of supposedly similar treatments contain varying quantities, qualities and combinations of active ingredients. In some cases there is evidence that the herbs could have medicinal benefit, and it is these which tend to be the subject of intense research efforts by pharmaceutical companies hoping to isolate and synthesize active ingredients, but in many cases the preparations are either of no use or contain constituents which may be actively harmful.

Chiropractic and Osteopathy are counted as CAM (I sort of thought that these had some scientific basis, but from the description here I can see not). These too have definite down-sides: "Canadian neurologists have estimated that as many as 20 per cent of strokes in the under forty-fives are due to neck manipulation" (p151). Public funding for chiropractors has been withdrawn in Ontario.

Homeopathy is obviously tosh. I knew that Hahnemann come up with the idea of "like cures like" when he noticed that exposure to quinine (at the time, a treatment for malaria) provoked in him symptoms that were characteristic of the same disease. But what I didn't know was that Hahnemann's reaction was "highly unusual, leading one sceptic to say 'it can be concluded that Hahnemann suffered from hypersensitivity to quinine. If so, this means the fundamental doctrine of homeopathy is based on a pathological condition of its founder'" (p81). But Hahnemann and his followers went on to develop a complex system for curing disease, which again has echoes of the appeal to "harmony" and "balance".

Shapiro says that the prime users of CAM are "middle-aged, middle-class, educated women with a high disposable income". She discusses why it should be that we are so in thrall to CAM, and gives various reasons. One study in the 1920s polled American households and "reported 82 episodes of illness from all causes per 100 of the population". In the 1980s, a similar study reported 212 illnesses per 100 (p195). This after significant developments in health-care in the intervening period. Rightly or wrongly, the threshold for believing you're "ill" seems to have changed, and CAM has taken up plenty of the demand that's been generated. Especially as many of these illnesses, or "dis-eases" are difficult for modern medicine to diagnose. And what CAM does well is to give patients time and attention: compared to a five minute visit to your GP, a session with a CAM practioner, who says that you need to be treated as a unique individual, with a unique set of needs, is obviously a tempting proposition for many people who've been led to believe that they should expect to be able to leave a life free from any "dis-ease" and full of "inner harmony".

The advance of CAM should be resisted, says Shapiro. It's influence is insidious as well as overt: as an example she cites the exhortation that we should drink eight glasses of water a day (which leads to "8x8" - 8 glasses of 8oz). By drinking so much, we are told that mental and physical performance will be improved. Where does this advice come from? "After reviewing a collection of scientific studies and surveys of food and fluid intake on thousands of adults, Dr Valtin could find absolutely no evidence in support of 8x8...he concluded that the advice might have originally stemmed from a misreading of guidelines issued as long ago as 1945...[which] stated that 'a suitable allowance of water for adults is 2.5 litres daily...most of this quantity is contained in prepared foods'. For some reason, the last sentence was either forgotten or ignored, leading, over the years, to the idea that an extra eight glasses of water should be drunk every day" (p225).

All in all very good, but a bit depressing.

Completed : 19-Jun-2008