A Physician in Spite of Himself

This text, published in late 2009, presents an excellent guide to herbal pharmacotherapies and is well laid out. Evidence is graded from A (Strong scientific), B (good), C (unclear or conflicting), through to D (fair negative). A series of chapters on relevant organs and diseases including Parkinson's disease, insomnia, and pain, are very comprehensive. Several diseases had some commendable and also some interesting treatment suggestions. For rheumatoid arthritis, I was interested to see Borage; and for osteoarthritis, avocado and rose hip, all listed as grade B evidence. Willow is listed as grade A (due to its aspirin effect), so some potential help for sufferers wishing to avoid mainstream treatment or as an adjunct. A helpful section on each treatment gives the mechanism of action, and lists the evidence and dose for treatment, along with potential side effects. Each chapter ends with some case studies and an integrative therapy plan. There are review questions to test the reader's knowledge. The chapter on cancer was particularly helpful as most therapies listed have negative effects and the remainder have no real benefit and the evidence base (or lack of it) may be reassuring to show to patients who are conned into potential purchases of remedies because of desperation. Not many listings for Grade A are in the book, but there are a few. I noticed with interest that kava has a grade A recommendation for insomnia and anxiety if used for <1-2 months, and this reminded me of when I worked in Vanuatu in the South Pacific, in the mid 1980's, of the ritual kava ceremonies which often induced relaxation if not overt sleep in the participants. The colour plates in the centre of the book enhance it considerably with several excellent pictures, and the appendices on adverse effects, and pregnancy and lactation are very useful. General Practitioners and general hospital physicians will be interested in having a copy of this book in the surgery or ward to check whether a remedy that a patient has taken is of any use. Obstetricians will also find this useful in determining the safety and efficacy during pregnancy and lactation. The website linked to the book has some good references and additional information. This is an excellent book which fills the large gap in evidence that existed in this area. This high quality hardback publication from the Royal Society of Medicine Press is the first volume …