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Book reviews

NHS plc. Allyson Pollock. Verso, London, New York, 2004, ISBN 1-84467-011-2 260pp; £15.
The whole story: alternative medicines on trial. Toby Murcott. Macmillan, Basingstoke & New York, 2005, ISBN 1-4039-4500-4 167pp; £16.99

NHS plc. Allyson Pollock. Verso, London, New York, 2004, ISBN 1-84467-011-2 260pp; £15.

Though not badged as such, Allyson Pollock has written a history of the National Health Service in the UK, concentrating on the latter half of its 50 years or so of life. She documents increasing privatisation, regulation, and proscription, leading, she thinks, to its eventual demise as a cradle to grave service with equal access to all. She doesn't like the change.

While there is little doubt that this is a partisan view, even those with a pro-market view of the world might understand why market forces and healthcare organisation do not make good bedfellows. Bandolier 103 and 107 contained reviews showing how for-profit organisations did less well than not-for-profit organisations in the USA. One is unaware of any review with an opposite finding.

Large organisations may be inherently difficult to manage, and have patchy funding or quality of performance, but revolution might not be the answer, attractive though it may seem. Revolution, like Saturn, may devour its children, and every revolutionary ends up either by becoming an oppressor or a heretic. Try starting with the most important chapter, the penultimate one about overcoming opposition. It reads more like something from 18 th century France or 20 th century Russia or Germany than the urbane and tolerant Britain in which we used to live.

Revolving doors would have made a good chapter heading. Supporters of change frequently reappear in new guises, while opposers disappear. Scary stuff. But perhaps it is all the product of too fervent an opposition, too fertile an imagination. Then read the other chapters and see what you think.

It could be better. Bandolier would have liked to have seen more evidence about fraud and distortion in for-profit healthcare systems, and more evidence about poorer performance by for-profit over not-for-profit organisations. And you need to have a more than the usual number of neurones plugged in to get the best of it, because it is intense.

This is a book that should be read by every NHS employee, and every patient or prospective patient, and there are lessons for those outside the UK as well.

The whole story: alternative medicines on trial. Toby Murcott. Macmillan, Basingstoke & New York, 2005, ISBN 1-4039-4500-4 167pp; £16.99

This is a fun little book about complementary and alternative therapies. It is not about what works, or what does not work, and remains impishly neutral. Perhaps that reflects how Toby Murcott, a biochemist and science journalist feels after speaking to experts on different sides of the argument, and reading around the subject.

He gets quickly to the point: that complementary therapy is about making people with chronic conditions feel better (about themselves?), and not about curing the sick. He points out that complementary therapies never have been able to help with major problems, whether infectious diseases or trauma. It didn't, and couldn't, help a Bandolier uncle who died in the pre-antibiotic era with blood poisoning from a simple foot injury.

Murcott's suggestion is that chronic conditions are not modern medicine's strong suit, and that it is the time therapists have that can make a difference. He delves into evidence, and trials, and systematic reviews, and placebo effects, and whether any of these are relevant to complementary therapies. But when so many people use it, and when the monetary value is $60 billion globally and rising fast, the questions have to be asked.

This little book doesn't really come to any particular conclusion, and is no worse for that. Whichever side of the argument you start, you will shout "rubbish" at some point, but at least you will have been exposed to a different point of view, and be no worse for that. The book ends with an Iain Chalmers quote about humility, never a bad thing in as complicated an area as medicine.

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