150 COMPLEMENTARY MEDICINE: AN OBJECTIVE APPRAISAL. This is a collection of ten articles commissioned from centres of learning in Europe and America. Each of these examines an aspect of complementary ‘medicine from what is described in the Preface as a itical and constructive viewpoint. The editor perceives a great public interest and uptake of ‘complementary medicine but deplores the absence Of critical examination in the many books devoted to the subject. The studies in this volume are held to be balanced and informed and written neither by proponents nor by adversaries. No practitioners of complementary medicine are amongst the Contributors, though most ofthe latter hold a degree inmedicine. The book is not written from the point of view of specific therapies; ines of index entries may give a crude estimate of the coverage in the text, as follows: acupuncture 15; aromatherapy | 3; chiropractic 10; ‘herbalism’ 10; homoeopathy 18; ‘osteopathy 8; orthodox medicine 7 The first article is by Andrew Vickers, a Director of the Research Council for Complementary Medicine, and aims to loosen adherence to the word ‘paradigm’ as a useful and meaningful term within the context of research methods. He argues his case extremely well and may offend those who would use the concept of paradigm shift to advocate alternative kinds of research methodologies for complementary medicine. The tone of the piece may be a guide to the writers irritation with the debate so far. None of the contributors admits to an explicit personal agenda in this ‘objective appraisal’, but this first chapter ends with a call for pluralism and discourse—a position which none of ‘our readers, surely, would wish to oppose. The second article comes from the Department of Complementary Medicine at the Postgraduate Medical School at Exeter University. Apart from anything else, for those of us who would like a primer of terms and procedures, it is a concise introduction to the subject and its assumptions. The authors conclude that research methodologies in complementary medicine should meet all the Conventional criteria as well as satisfying the subject of the research, but admit that this requirement will challenge the imagination of the designers of the investigations. Epidemiologists from the Netherlands British Journal of Phytotherapy, Vol. 4, No. 3 appear to take up this call in the third piece, which argues that the placebo response itself calls for better research effort and the findings need to be incorporated into the designs of clinical trials. ‘Efficacy beyond the Placebo Effect’ is the title of the fourth and largest of the essays. It comes from Ted Kaptchuk and two of his colleagues at Harvard Medical School. They give a detailed historical analysis of the clinical trial and try to answer the question from three theoretical perspectives, those of (1) fastidious efficacy, (2) pragmatic efficacy and (3) performative efficacy. The first of these assumes that verum-specific and non-specific effects are separable, and that the relationship between them is linear. The second questions the central tenet of the first and regards the outcome of a treatment as dependent upon the interaction between the verum and placebo effects. The third is a synthesis of anthropological and cultural studies, from which few if any generalizations can be made and which do not offer replicability in the strict sense; however, it questions the validity of the scientific method in this context as the sole arbiter of truth. The authors do not gravitate to one of the three, but rather propose a fourth which derives from the work ofan eighteenth-century statistician, Thomas Bayes. They certainly make the case well thatthe fastidious model is, after all, an extrapolation of laboratory methodology into the human clinical sphere, and thatthe others more closely reflect the experience of clinicians, of whatever persuasion, ‘Why Do People Use and Choose Complementary Therapies?’ is the question asked next, by Adrian Farnham, Professor of Psychology at University College, London. n his very readable discussion, he sives a detailed literature review and, in listing the very few real conclusions to be made, demolishes at least the simpler-minded and stereotypic responses to the question. The therapies which dominate the several studies that are cited are acupuncture, osteopathy, and homoeopathy; herbal medicine is barely mentioned. ‘Do Complementary Therapies Offer Value for Money?’ is a question that had to be asked in post- Thatcher Britain, and is attempted by a Research Fellow at Exeter University. In another article, an editor from the Consumers’ Association covers the same ground from an entirely different perspective, Cone that reinforces the myth that tllich identified in the mid-1970s (Medical Nemesis, London, 1975}—