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John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
A. Mauskop & M. Abrams Brill, Dell Publishing, New York, 1997, 411 pages, $13.95 (softcover), ISBN 0-440-50820-7
This is an interesting, puzzling, and potentially either useful or harmful volume aimed at the intelligent headache sufferer. The relative contributions of the two authors--a physician and a medical writer--are not clear.
The first five chapters are a relatively standard presentation of the traditional medical aspects of headache diagnosis and treatment. The next 10 chapters cover nutritional, environmental, physical, mind-body, botanical, and homeopathic therapies. There is an excellent glossary, a listing of references and resource organizations, and an index.
The authors have nicely described a wide array of nonallopathic treatment strategies; this is one of the strongest aspects of the book. Another strength is the clear implication that the headache sufferer is responsible for making decisions and implementing strategies to manage his or her symptoms. The weakest aspect is the totally noncritical presentation of therapies--from chiropractic to osteopathic to Rolfing to colonic irrigation to increased magnesium intake (the author's favorite) to acupuncture to meditation to cognitive/behavioral strategies to aromatherapy to herbal therapy, ad infinitum. The problem, in my opinion, is the implication that all of these are of equal merit, in terms of both scientific data on mechanisms and outcomes-based data. Having made the statement that the patient must participate in remedying headache, the authors for the most part discuss therapies that are, in fact, passive and nonparticipatory--save, of course, for the meditation, the cognitive/behavioral strategies, and some of the physical therapies that involve exercise rather than having providers do things to one's body.
The theories underlying these treatments are presented briefly and completely uncritically. The authors present useful information on certification or the lack thereof for each type of provider. The concept of nonspecific treatment effects cannot be found anywhere in this volume! The book contains good data on meditation, biofeedback, and cognitive/ behavioral therapies, but it does not provide data on most of the treatments. I do not believe that the psychological strategies discussed in this book are really alternative, because their application is based on concepts of mental functioning validated by scientific inquiry and their inclusion in medical practice is widespread. Will headache sufferers benefit from this book? Is it true that aromatherapy, homeopathic remedies, and colonic irrigation have a beneficial effect? Will the money spent on these treatments benefit the patient as much as the provider? Is a politically correct approach appropriate for a book on the care of headache?
I predict that our medical descendants will laugh as much at these alternative therapies as we do at the bleeding and purging of past centuries. The limitations of allopathic therapy are real, especially when physicians ignore the role of environmental and psychosocial factors. Through scientific inquiry, the diagnostic and therapeutic strategies of allopathic medicine may be improved. This is what distinguishes the allopathic approach from most of the therapies described in this book, which are based on concepts of bodily function and disease that cannot be validated. Furthermore, their proponents have no desire to undertake such endeavors. The apparent endorsement of these alternatives by a well-known neurologist specializing in headache management should be of concern to the medical community. Placing the patient in an active role in planning treatment and assuming responsibility for his or her health is a noble and desirable goal--that should not in any way imply the healthcare provider's endorsement of these alternative treatment strategies.
The book's good parts do not outweigh its implied acceptance of politically correct but clinically useless alternatives. Perhaps we should, as the authors suggest, get rid of the term alternative medicine. A good new name might be placebo therapy. I am, however, not sure that these treatments even qualify as placebos, for we do not know if they alter the natural history of the illness. These reservations explain my lack of enthusiasm for this book.
John Loeser is a professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu
