More Harm than Good?: The Moral Maze of Complementary and Alternative Medicine

by Edzard Ernst, Kevin Smith

This book reveals the numerous ways in which moral, ethical and legal principles are being violated by those who provide, recommend or sell ‘complementary and alternative medicine’ (CAM). The book analyses both academic literature and internet sources that promote CAM. Additionally the book presents a number of brief scenarios, both hypothetical and real-life, about individuals who use CAM or who fall prey to ethically dubious CAM practitioners. The events and conundrums described in these scenarios could happen to almost anyone. Professor emeritus of complementary medicine Edzard Ernst together with bioethicist Kevin Smith provide a thorough and authoritative ethical analysis of a range of CAM modalities, including acupuncture, chiropractic, herbalism, and homeopathy. This book could and should interest all medical professionals who have contact to complementary medicine and will be an invaluable reference for patients deliberating which course of treatment to adopt.

Genres: Science

248 pages, Paperback

Published January 18, 2018

Reviews

[Toby Katz · Rating 4 out of 5]

I have long been a fan of Ernst and Ernst and Smith put compelling ethical arguments forwards condemning the use of almost all complementary medicine.

The book was enjoyable but I was left frustrated as many of the grey areas I was hoping they would cover have been left untouched. It seems they reverted to condemning many of the disproven subjects (homeopathy, chiropractic, TCM) that they have previously covered at length. As much as i believe these things are necessary, I wanted more.

I wanted more about the areas modern medicine is yet to solve:

- Chronic MSk pain and why people turn to complementary therapies (a high percentage of GP appointments)
- Chronic skin problems not solved by conventional therapy
- Should we deny people a possibly effective therapy just because it seems implausible? I feel as though this eludes to a double standard in modern medicine where we know little about the pharmacological action of many a drug
- What is the alternative to not having CAM? People may have nowhere to turn for their chronic back pain and feel let down by the system. This doesn’t add to society’s utility.

Overall: enjoyable but I wanted more

[Pablo · Rating 4 out of 5]

Es un excelente libro que aborda los conflictos éticos en torno a las medicinas alternativas y/o complementarias (MAC). Hace una breve, pero útil revisión de algunos ejemplos de éticas consecuencialistas (utilitarianismo) y no consecuencialistas (deontológicas y de la virtud) para abordar el problema de las interpretaciones en los resultados de estudios que intentan probar—a menudo con sendas contradicciones en sus premisas y lógica interna. Así como también en otras áreas normalmente que no se abordan: ¿Qué ocurre con instituciones de educación que promueven títulos o postitulos?

Encontré destemplado el ataque al posmodernismo y demás visiones que escapan de la epistemología positivista muy al estilo de Bunge. Que si bien, sus vicios son usados por los apologistas de las MAC para intentar justificar su falta de sistematicidad, olvida que el extremo empirismo (y positivismo) de la medicina basada en la evidencia nos tiene encontrando relaciones espurias. En otras palabras, todo paradigma tienen vicios que pueden ser explotados, no son inherentes a sus premisas.

[Warreni · Rating 4 out of 5]

Interesting dissection of CAM modalities from a philosophical perspective

Ernst and Smith review the evidence in favor of a variety of so-called complementary and alternative medicine (CAM) techniques from a largely utilitarian (to put it in Salvation Army terms—“doing the most good”) perspective. Unsurprisingly, given the lead author’s previous body of work surrounding this topic, they draw the conclusion that in virtually all cases, there is no real utility in these methods nor is there an ethical justification for their use. The volume loses one star for two reasons: one, there are a prodigious number of grammatical and mechanical errors in the text itself; and two, the authors dance around but never forcefully endorse the obvious conclusion from their work—that these practices, far from being given the mask of legitimacy by being provided a veneer of regulatory oversight and being taught in degree-granting institutions, should for the sake of decency and the public good, be banned forthwith.

[Alexandra · Rating 4 out of 5]

I understand what the authors wanted to do with this book and I fully support it. However, some sections were so oversimplified that they ended up kind of not being true. Some of these sections even offered arguments against some sound research and research designs (i.e: everything that is not an RCT isn't bad, you can have very legitimate reasons for not using a placebo, you can have legitimate reasons for using historical controls, all of those don't discredit a study, you have to take them into account as limits when interpreting the study). Having worked in clinical trials for the past 10 years, I can say that if I used the stringent criterias used in this books, a lot of the study design that I see would be considered bad, which they are not.
Still giving it 4 stars because of the, in my opinion, fresh perspective on CAM by interpreting it through recognized ethical guidelines/theory and for the overall arguments/points of the book.

[Andrea Palmieri]

Probably the most comprehensive book i've read on all alternative medicine with a philosophical lense. Challenging read but it is a very extremely thoroughly researched and presented. I will have to read it again to retain the information.