Mark Kane Churchill Livingstone, 2004, Paperback, 215 pages, £12.99
(Reviewed by Mark Bovey, EJOM Vol. 4 No. 6)
This introductory research book is aimed at students and practitioners of complementary and alternative medicine (CAM), not just to give them an understanding of the subject but also as a guide to developing small practice-based research projects. The latter is the mission that grew out of Mark Kane’s experiences teaching CAM MSc students at Westminster University: What research is relevant to practitioners and how do you go about doing it? He is a qualified osteopath, naturopath and acupuncturist and has worked both independently and in the research-focused, integrated Marylebone Health Centre.
For me, the book came out at an opportune time, as I was preparing my lessons for a new undergraduate acupuncture course. Amidst the numbers of other basic research textbooks here was one geared specifically to CAM issues. At a stroke this provided me with a ready made framework for the course and filled various gaps in my own knowledge. It looked to be an ideal standard text for the students – a likelihood endorsed by George Lewith in his forward to the book. He uses the adjective ‘superb’ three times in one page and describes it as ‘an essential introduction to a research career’. It is indeed difficult to criticise.
The structure, both overall and within each chapter, is clear and well thought out. The writing is authoritative yet not ponderous. There is a light feel to the book – it is slim, comes in digestible chunks and is studded with examples, check boxes and cartoons. The references are relevant and up to date.
The book starts with a robust defence against the point of view ‘why should we (practitioners) bother with research at all?’. There follows three further introductory chapters: project design (from topic choice through to written proposal), how to search, use and critique the literature and ethical issues. Choice of topic and research question is firmly anchored to practitioner experience and needs – and thus to the stated aims of the book. The practical steps are well chosen and organised. Subsequent sections cover:
• strategies, i.e. what sort of research, using which general methodologies (6 chapters) • data collection methods (4) • analysis and presentation (3) • writing up (1).
My first moment of reflection came in the ethics chapter, where the author advises that all researchers should seek to have their proposed projects evaluated by a research ethics committee. On the one hand this is sensible and helps safeguard against both lousy research and harm to its subjects. On the other hand there is plenty of research that does not need ethical scrutiny, or needs it at a lower level than the usual ethics committee. Outside of universities and the NHS there is little provision and it may be too daunting a hurdle for many practitioner-researchers. It would be nice to have seen a list of suggestions/examples for types of studies that would require no or only low-level ethical clearance. For undergraduate student dissertations, with no access to clinical data of their own, the ethical restrictions are even greater.
There is a fundamental issue here for CAM research: as much as we would like to see multitudes of practitioners sharpening their activities by doing research, the infrastructure of the research world is not set up to encourage this. It is in the ‘Strategies’ section that Mark Kane’s book most reflects this, for none of the illustrative examples come from small-scale, practitioner research and nor is there any attempt to put forward ideas for such studies. Of the approaches described, the two most appropriate for practitioners are probably action research and case studies. For the former he uses the example of the research tied to the development of the Marylebone Health Centre, where CAM has been integrated into NHS primary care. For case studies he also looks at integrative service provision, a study of 10 primary care schemes that led to a 178 page report for the Department of Health. The ethnography chapter gets away from the NHS but uses examples where CAM clinics are studied by professional researchers armed with a battery of sociological theories. Again, for survey methodology, it is an outside researcher who does the business. Systematic reviews are well covered though not a feasible research option for the vast majority of practitioners.
What this book does superbly well is to marshal the material that would allow people to understand the (clinical) research that has been, and is being, done. Also, to be a knowledgeable participant in projects that are guided and supervised by a researcher. But I do not think that it will have many independent practitioners (away from universities and other institutions) dashing off to write their proposals. Likewise, undergraduate students will find little to propel them beyond library-based dissertations. This is not so much a fault of the book as a reflection of the research realities.
One particular criticism that I have concerns the treatment of randomised controlled trials (RCTs) in the chapter on experiments. The so-called fastidious RCT, where the therapy is compared against a placebo or sham group, is given an easy ride, with no mention of the problems inherent in finding an appropriate control and interpreting the results. The placebo/sham problem bedevils much acupuncture research (and presumably other CAM interventions too). Aside from this there is a good presentation of the range of clinical trial approaches that are most appropriate for evaluating CAM – but no indication as to whether any of the designs would be suitable for small-scale researchers (e.g. n=1, simple outcome studies).
I believe that the aims of the book are over-optimistic and hence only partially realised. There is too much emphasis on the establishment viewpoint despite the bottom-up beginnings. Nevertheless, as an introductory CAM research text it is indeed essential reading, without competition and well worth the money.
Mark Bovey Mark Bovey is co-ordinator of the Acupuncture Research Resource Centre, now located at Thames Valley University, and a faculty member of the College of Integrated Chinese Medicine. He has been in acupuncture practice since 1983.