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Book reviews

Ernst et al - The desktop guide to complementary and alternative medicine
Claire Foster - The ethics of medical research on humans
Margaret Rees and David Purdie - Management of the menopause

The desktop guide to complementary and alternative medicine. E Ernst, MH Pittler, C Stevinson, A White. Mosby, Edinburgh, 2001. more than 400 pp, plus CD-ROM. Price not known. ISBN 0-7234-3207-4.

The problem with complementary and alternative therapy is two fold. First, there is so much of it. Who said "Give me a needle, and I will invent yet another form of acupuncture"? Probably nobody, but most of us feel that way when we read another silly article in the newspapers, or when a patient expects us to know the ins and outs of another herb.

Hands up, who can write a five minute essay on the synonyms, trade names, constituents, background, uses, pharmacological action, conditions treated, clinical evidence, dosage, risks and risk-benefit assessment of Mary thistle? Sneakily, Bandolier can.

But that's just because we opened a page at random from this terrific book by Edzart Ernst and his chums. It is a veritable BNF of alternative medicine, but an alternative BNF with evidence.

And there's the rub, evidence. The trouble is that there is too often no evidence for most complementary or alternative therapy. What evidence there is, is in the pages of this book. Bandolier is sceptical when it comes to most complementary therapy, having wasted more hours than needed delving in these murky pools. This book makes it easy. If there's no evidence, Ernst tells us so. There are also some choice bits of information, like the link between homeopathy and Naziism.

Bandolier doesn't agree with every interpretation, but this is a valuable book for the shelf, and the CD-ROM that accompanies it is a whizz on your computer. It works on Macs above G3 using OS9.

Management of the menopause. The handbook of the British Menopause Society. Margaret Rees and David Purdie. BMS Publications, Marlow, 2002. 127pp, £15. ISBN 0-9536228-1-9.

Human females are just about the only mammals with significant post-menopausal survival. This book describes most of the things we are interested in, and describes them well, in accessible language, and with much wisdom.

It takes us in simple steps through physiology, acute symptoms, long-term consequences, treatments, management and assessment and investigations. HRT is obviously examined in great detail, but so are treatments other than oestrogen and even complementary therapies.

The style is direct, uncluttered with references, though each chapter has lists of key references handily structured under particular headings. Readability is only compromised by an occasional reliance on odds ratios and relative risks when absolute risks would be so much more helpful. Knowing the odds ratio for endometrial cancer with HRT is not as useful than knowing that a small risk is still small. This is balanced by other terrific information, like calcium contents of common foods, or the cause of death in women over 50 years.

Quibbles aside, this is a useful book, not just for the shelf, but to read through and then keep on the shelf, knowing that there's help on hand when you need it. It's a steal at £15. It's accessible to patients as well as professionals.

The ethics of medical research on humans. Claire Foster. Cambridge University Press, Cambridge, 2001. 159 pp, price not known. ISBN 0-521-64573-5.

Ethics. It's one of those words that can cause brain ache without really trying. It's so complex, with so many different issues, and with overtones of emotion and belief. Evidence is a much more simple word, as long as we talk about medical evidence, and not a court of law, when evidence can take on the same overtones as ethics in medical research.

Of course we want to be ethical, and we can usually spot what's not ethical, but which of us would react with joy to being asked to serve on a research ethics committee?

For those of us who do, or may, or even aspire to examine the ethics of research, then reading this book is a must. Not because it's easy, because it isn't. That's not Claire Foster's fault, because she does a great job of making us think. It is the nature of the beast. She gives us a framework of three approaches to thinking about ethics: a goal-based approach (moral worth deriving from actual or expected outcome), a duty-based approach (rules of conduct not related to the goals), or a right-based approach (autonomy). She then examines these approaches from first principles, to practice, and through case studies. Importantly the end is a framework for research ethics committees.

Does it work? Well mostly. If there is a problem, it may be in the choice of case studies, where some examples of poor evidence are used to develop thinking. Perhaps it is a good choice, because it makes us think. Perhaps it is a bad choice, because poor evidence clouds the salience of discussions on ethics. Perhaps the fact of thinking makes the point.

No-one serving on an ethics committee should not read this book, and perhaps no-one thinking of submitting a proposal to an ethics committee should not read it too.
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