Integrative Medicine. Edited by David P. Rakel. 821 pp, illustrated. Philadelphia, W B Saunders, 2003. $69.95. ISBN 0–7216-9288–5.

Integrative Medicine is an innovative, ground-breaking effort to assist primary care providers in guiding their patients to health through the utilization of a broad range of therapies. Using a disease-oriented format, the numerous coauthors, many of whom are graduates of the Program in Integrative Medicine at the University of Arizona, provide a well-balanced approach to the prevention and treatment of common problems in primary care. Each chapter focuses on a single disease or symptom complex and offers a selection of management choices ranging from lifestyle changes to nutritional, botanical, and pharmaceutical therapies; mind-body and spiritual techniques; traditional Eastern medicine; and Western surgical therapy. Scattered throughout the book are several “black box” notes, specific facts that are often immediately useful in clinical practice.

The first half of the book covers the philosophy of integrative medicine and approach to illness, the last sections are devoted to disease prevention, and 24 chapters offer practical “tools for your practice,” which can be used as patient handouts.

As with any multi-authored textbook, there are some problems with inconsistencies. In one chapter, omega-3 fatty acids are said to be effective in controlling hypertension, according to “sixty double-blind studies” (none listed); in another chapter, omega-3 fatty acids were noted to be not effective in lowering the blood pressure in those who are normotensive. I was left wondering why. Some authors led me on a walk down the health food store vitamin and supplement counter as a possible strategy; others warned that this approach might be expensive and occasionally dangerous.

I kept the book available in the office, and I found several chapters helpful in daily practice. The section on post-term pregnancy offered the usual options, some new ideas, and some appropriate warnings about botanical treatment. The chapter on nausea and vomiting in pregnancy was an excellent teaching tool. I used the advice in the chapter on premenstrual syndrome to give some options to a patient who did not want medication to treat her symptoms. A neurologist mentioned that he was taking coenzyme Q-10 to prevent Parkinson’s disease; the pertinent chapter mentioned that a study was underway. A popular news magazine named Rhodiola rosea as a botanical useful in reducing stress. Alas, I could not find it in the index, but the chapter on prescribing relaxation techniques offered a solution for the patient.

In summary, the book has a considerable amount of material gathered into a useful and readable format. It will appeal to any primary care provider who is interested in moving beyond conventional pharmacotherapy. Many patients are already practicing integrative therapy. We owe it to them to educate ourselves in a holistic approach to health and illness.