Book Review  |   August 2009
The ACP Evidence-Based Guide to Complementary & Alternative Medicine
Author Affiliations
  • Frederick J. Goldstein, PhD
    Philadelphia (Pa) College of Osteopathic Medicine; Book Review Section Editor, JAOA—The Journal of the American Osteopathic Association, Chicago, Ill
    Professor of Clinical Pharmacology
Article Information
Book Review   |   August 2009
The ACP Evidence-Based Guide to Complementary & Alternative Medicine
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 400-401. doi:10.7556/jaoa.2009.109.8.400
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 400-401. doi:10.7556/jaoa.2009.109.8.400
Decades ago, undergraduate students majoring in pharmacy were required to take a 1-year course in pharmacognosy, a scientific branch of learning devoted to studying plants that have pharmacologic activity. Included in this requirement was a weekly 4-hour laboratory component in which students examined such plants both grossly and in microscopic detail. I was one of those undergraduate students. However, after I moved into my graduate program to specialize in pharmacology, I paid little attention to pharmacognosy. 
Over the years, undergraduate exposure to pharmacognosy was truncated to one semester, and ultimately the subject became an elective as those in control of curricula deemed this discipline to be anachronistic. As I continued my career in medical research, some of my classmates went on to become osteopathic physicians. None of us paid much attention in our respective careers to the almost defunct discipline of pharmacognosy. 
During the past 15 years, however, many adults in the United States and other countries have increased their use of dietary supplements, including herbal products.1,2 Many of us in the healthcare professions now clearly recognize that many patients presenting for office-based treatment or surgery are using such items on a daily basis.3 Thus, I have now come full circle, because today I give a required presentation on herbal products to second-year osteopathic medical students. 
As defined by the National Center for Complementary and Alternative Medicine (NCCAM),4 “Complementary and alternative medicine [CAM] is a group of diverse medical and [healthcare] systems, practices, and products that are not generally considered part of conventional medicine.” These CAM systems include acupuncture, Ayurvedic medicine, chiropractic, homeopathy, naturopathic medicine, traditional Chinese herbal medicine, and various manual procedures. 
Researchers have suggested that the expanding use of CAM, often in the absence of efficacy studies, may be related to the high cost of conventional medical care,5 the ineffectiveness of that care for patients with some chronic conditions and life-threatening illnesses,6 or the wellness movement—aiming, as it does, to improve and enhance health through “natural” means.1 
However, are herbal products toxic? Do they interact with medicines prescribed by physicians? In regard to dietary supplements, some of these products are actually nothing more than placebos, while others do exhibit clinical activity. Certain kinds of dietary supplements are more likely to produce toxicity or interactions that can affect the activity of prescription medications. The fact that dietary supplements are sold on an over-the-counter basis makes the problem of detecting such interactions more difficult than it is for prescription medications. 
How can we know which supplements are clinically useful and which are merely acting as placebos? How can we readily evaluate their potential toxic effects, which range from minor events to life-threatening interactions with routinely prescribed drugs? Such evaluations are difficult because the US Food and Drug Administration does not require premarket clinical trials for dietary supplements or “herbal remedies.” 
Clinicians might evaluate the efficacy and safety of dietary supplements by routinely reviewing evidence-based, postmarket clinical studies that have been published in peer-reviewed journals. In fact, that is exactly what I do to develop relevant information for my lectures to osteopathic medical students. However, for the busy osteopathic physician, such extensive routine examination of published clinical data is usually not practical. Fortunately, assistance for this important task can now be obtained from The ACP [American College of Physicians] Evidence-Based Guide to Complementary & Alternative Medicine—an excellent text that provides extensive facts on the efficacy of not only herbal products and other dietary supplements, but also many of the CAM systems noted above. This book is an outstanding source to guide physicians through such evaluations. 
The ACP Evidence-Based Guide to Complementary & Alternative Medicine is edited by Bradly P. Jacobs, MD, MPH, and Katherine Gundling, MD. Dr Jacobs is founder and director of the Institute for Healthy Aging at Cavallo Point in Sausalito, Calif. Dr Gundling is associate clinical professor of allergy and immunology in the Department of Medicine at the University of California-San Francisco. More than 20 contributors, including the editors, authored chapters in the book. 
A total of 15 chapters are divided into two sections. Part I, “Fundamentals of Complementary and Alternative Medicine,” consists of a chapter on CAM definitions and patterns of use and a chapter on the framework for addressing CAM in clinical encounters. Part II, “Evaluation of Complementary and Alternative Medicine Systems and Therapies,” is divided into 12 chapters on CAM as it relates to specific medical conditions. These conditions—in the order presented in the book—are allergic disorders, asthma, cancer, general medicine, gastrointestinal health, coronary heart disease, human immunodeficiency virus, men's health, women's health, musculoskeletal disorders, obesity and overweight, and depression. The final chapter in the book is devoted to drug-supplement interactions. 
The book's introduction explains medical research terminology, such as “effect size” and “magnitude of the effect.” This material may be challenging for readers with minimal research backgrounds. However, two tables at the end of the introduction serve as guides for how data from efficacy and safety evaluations are presented throughout the book. Thus, understanding this material does not require extensive knowledge of statistical methodology. 
The “summary evidence” tables in each chapter contain dosing information, when appropriate and available, as well as effectiveness grades ranging from A (high level of effectiveness) to D (very low level of effectiveness). Clinical recommendations and special comments are also provided. I found these tables extremely helpful for obtaining a quick understanding of important clinical pharmacologic data and other medical information about CAM. 
Several examples serve to indicate the clinical value of this text. In chapter 6, “General Medicine,” the authors summarize results from a recent Cochrane Database System Review study of 10 randomized clinical trials examining the effects of cranberry juice and supplements on urinary tract infections. The reviewers concluded that cranberry juice and related supplements “are associated with a 35% reduction in the frequency of urinary tract infections when compared to placebo.” Chapter 10, “Men's Health,” has study information indicating that saw palmetto causes a “small but definite shrinkage of the prostate gland, which means that [saw palmetto] is not just treating symptoms but may be used to both prevent and alleviate BPH [benign prostatic hypertrophy].” In chapter 11, “Women's Health,” the author reports in the one-sentence section on “osteopathic and chiropractic manipulation” that there is “insufficient evidence to support or refute the use of spinal manipulation as an effective treatment for dysmenorrhea.” 
I recognize that osteopathic physicians do not view osteopathic manipulative treatment as a type of CAM. Nevertheless, according to the NCCAM,4 types of CAM used in “manipulative and body-based practices” include “osteopathic manipulation” along with “chiropractic manipulation,” “massage therapy,” “Tui Na,” “rolfing,” and several other kinds of interventions. And yet, in reviewing The ACP Evidence-Based Guide to Complementary & Alternative Medicine, I found only a couple references (dysmenorrhea, hot flashes) to the use of “osteopathic manipulation” as CAM in the treatment of patients. 
The book ends with two appendices. One appendix contains descriptions and reviews of safety and efficacy of the following “systems of practice”: Ayurvedic medicine, homeopathy, spinal manipulation, chiropractic, naturopathic medicine, and acupuncture and oriental medicine. The other appendix is a glossary of CAM terms. 
In conclusion, I view The ACP Evidence-Based Guide to Complementary & Alternative Medicine as an excellent database of clinical pharmacologic information, not only on herbal products but also on the efficacy of other CAM treatments, including acupuncture, traditional Chinese medicine, and Ayurvedic medicine. 
 Edited by Bradly P. Jacobs, MD, MPH, and Katherine Gundling, MD. 452 pp, $69.95. ISBN: 978-1-934465-04-2. Philadelphia, Pa: ACP Press; 2009.
The use of complementary and alternative medicine in the United States. National Center for Complementary and Alternative Medicine Web site. Accessed July 23, 2009.
Kelly JP, Kaufman DW, Kelley K, Rosenberg L, Anderson TE, Mitchell AA. Recent trends in use of herbal and other natural products. Arch Intern Med. 2005;165:281-286. Accessed July 23, 2009.
Marinac JS, Buchinger CL, Godfrey LA, Wooten JM, Sun C, Willsie SK. Herbal products and dietary supplements: a survey of use, attitudes, and knowledge among older adults. J Am Osteopath Assoc. 2007;107:12-23. Accessed June 24, 2009.
What is complementary and alternative medicine? National Center for Complementary and Alternative Medicine Web site. Accessed June 24, 2009.
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246-252. Accessed July 22, 2009.
Elder NC, Gillcrist A, Minz R. Use of alternative health care by family practice patients. Arch Fam Med. 1997;6:181-184. Accessed July 22, 2009.