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Research Intelligence - Alternative outcomes

As the first professor of complementary medicine retires, he recalls a rough ride. Paul Jump reports


Edzard Ernst


Edzard Ernst admits he is pleased to be retiring as professor of complementary medicine at the University of Exeter - although his departure will be welcomed even more avidly by the numerous enemies he has made during his 18 years of subjecting complementary and alternative medicine (Cam) to scientific scrutiny.

The 63-year-old officially retired at the end of last month after producing well over 1,000 papers assessing the evidence for the efficacy of alternative treatments.

But although his outspoken conclusion is that only about 5 per cent of such treatments are "solidly based on positive evidence", he admitted in an interview with Times Higher Education that he had started out as a "friend" of Cam.

His first job after graduating from medical school was in Germany's only homeopathic hospital, the Hospital for Natural Healing in Munich, where he was so impressed by the efficacy of some treatments that he continued to practise them "on and off" during his subsequent rise through the medical establishment.

That rise culminated with his appointment in 1990 as chair of the department of physical medicine and rehabilitation at the University of Vienna, where he had 120 people working under him. But his abiding interest in Cam convinced him to apply to become the world's first professor of complementary medicine when he saw the Exeter position advertised in 1993.

The £1.5 million to fund the position had been donated by construction magnate and Cam supporter Sir Maurice Laing. But although the philanthropist, with whom Professor Ernst became "good friends" before his death in 2008, was happy for him to subject Cam to rigorous analysis, practitioners remained opposed to his sceptical approach - despite the 700 invited lectures Professor Ernst gave on the scientific method.

"It looks to them as if we are always trying to disprove their beliefs. And in a way we are, because we are scientists. They understand alternative medicine as alternative to science, so to apply science to their field is quite upsetting for most of them," he said.

Support disappeared

His unit's growing reputation as "quackbusters" meant grants from Cam-supporting charities began to dry up. Nor were mainstream medical funders interested in funding medical trials for alternative therapies, forcing Professor Ernst to switch his emphasis to the cheaper tasks of literature reviews and disseminating information to both lay and professional audiences.

But it took two particularly upsetting incidents to convince Professor Ernst to abandon his efforts at bridge building and to make it unequivocally clear where he stood. One was the unsuccessful attempt by the British Chiropractic Association to sue science writer Simon Singh for libel over a 2008 article he wrote as part of a promotion campaign for a book on Cam that he co-wrote with Professor Ernst.

The other was the "very unpleasant" investigation to which he was subjected by the University of Exeter after he was accused by Prince Charles' private secretary of having breached a confidentiality agreement on a 2005 report into the cost-effectiveness of funding alternative treatments on the NHS. The study, by economist Christopher Smallwood, was personally commissioned by the Prince.

Professor Ernst was initially enlisted as a "collaborator" on the report, but asked for his name to be removed after a sight of the draft report convinced him that Mr Smallwood had "written the conclusions before looking at the evidence".

He was also concerned about the potential damage to public health that could occur if ministers acted on the report's claim that significant savings could be made by replacing some conventional treatments with alternative ones.

"I was boiling inside because it was complete misleading rubbish going straight to health ministers, and I couldn't do anything about it," he said.

Hence, when that draft was leaked to a Times journalist and Professor Ernst was telephoned for comment, he "did not mince" his words about its methodology - although he insisted that he did not disclose any of its contents.

After 13 months of being "treated as guilty until proven innocent", the university accepted his innocence but continued, in his view, to treat him as "persona non grata". All fundraising for his unit ceased, forcing him to use up its core funding and allow its 15 staff to drift away.

He was also given to understand that the unit would close when he retired. However, a rethink will now see him employed on a half-time basis for a further year to help recruit a successor. He hopes the successful candidate will be more "diplomatic" than he was, and will be more successful in attracting funding for clinical trials.

But he is adamant that the appointee must not "misunderstand the job as promoting alternative medicine", a failing, he believes, to which all the other professors of complementary medicine that have been appointed around the world since 1993 have succumbed.

"They present themselves as scientists but they are all using science as a drunk man uses a lamp post: for support and not for enlightenment," he said. "My unit is the only one that actually understands critical assessment as it should be."

paul.jump@tsleducation.com.

Readers' comments (7)

  • This article presents Ernst's career without checks, taking the professor's word for everything. Here is a selection from among the many questions a rigorous journalist might have checked on: What were the actual circumstances of Ernst's departure from Vienna? How long did Ernst go around claiming homoepathic qualifications he did not possess? What about the other CAM 'training' he's supposed to have had? What about the qualifications of some of the people who worked for him at Exeter? Needless to say, these are among the many aspects of Prof Ernst's professional life that are known to be, shall we say, 'problematic'. Strangely, until the German Homeopathic Doctors' Associaton had it out of him in an interview only last year, Ernst's lack of actual training and qualifications in homeopathy was continuously ignored by his employers, the scientific establishment and the media - even though it was an open secret. Even now, he is managing to gloss over this and other unsavoury highlights of his career. How about entrapment as a 'research method'? Yes, really, he even published the paper (http://www.ncbi.nlm.nih.gov/pubmed/12559777). Who, one wonders, gave ethical approval for this (take a look at the methodology)? Please take another look, THE, and perhaps add a slightly more realistic post-script on Prof Ernst's credentials as a scientist. Thank you.

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  • Edzard's story is sad, it is an enduring sate. Ad hominem attacks are just part of it. We must also be concerned byt those who stay silent and do not support Edzard. They are acomplices. For more http://braillon.net/alain/whistleblowing_reward_protection.pdf Alain Braillon M.D., Ph.D. http://braillon.net/alain/ Senior consultant (tenured at the national exam, score 150/150) sacked for whistleblowing by the French Dept of Health against the vote of more than 70% of the members of the National Statutory Committee. Meanwhile my boss, chairman of the addiction committee at the National academy of medicine, is being sued for libel by the tobacconists’ union.

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  • Read Mark Tanaka's paper 'From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious' Plos One April 2009. [http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0005192] "This study offers a simple, novel and counter-intuitive hypothesis for the prevalence of ineffective medical treatments: unbiased copying of new treatments can frequently lead to the prevalence of ineffective practices because such treatments are demonstrated more persistently than efficacious alternatives, even when there is enhanced abandonment of ineffective cures." I think this goes for most CAM treatments. I'm glad Prof Ernst put much effort in using sound methodology showing CAM is not more effective than placebo. Still homeopathy and other baloney will stick around since people and even princes need some form of magic to believe in. We cannot blame them.

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  • Ernst writes here: "homeopaths like kaplan only accept research that confirms their prior belief" First of all I am a fully qualified medical doctor who happens to use homeopathic medicine as one of the tools in my practice but generally subscribe to the ethics and values of my peers in conventional medicine. I do accept research and but don't accept that research has 'refuted' homeopathy. I also consider it significant that it is the subjective experience fo hundreds of millions of people that homeopathy worked for them and consider this an important fact from a democratic as well as a health-orientated point of view. How does Ernst know what I believe? What EVIDENCE does he have to say that I believe the nonsense he has written here about me? I have heard him claim (on the radio) that the Government decision to retain NHS homeopathy was influenced by the meddling of Prince Charles. Presumably he has EVIDENCE for this rather outrageous claim. If so where is it? Or is EVIDENCE something he demands from other people? As far as EVIDENCE and EBM are concerned, I subscribe to the BMJ handbook of Clinical Evidence which shows that of commonly used CONVENTIONAL approaches 11% are definitely beneficial 23% are likely to be beneficial 7% trade off between harm and good 51% unknown effect 5% unlikely to be beneficial 3% likely to be ineffective or harmful Ernst and the detractors of CAM hate the simple chart showing these figures which can be seen here: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp The reason they hate this chart is that it shows that huge swathes of orthodox medicine are NOT evidence based. (Much of the use of anti-depressants falls into this category but I digress)This is very unhelpful to their cause as their attack on CAM is very much based on the accusation of 'lack of evidence' of CAM which disingenuously implies that conventional medicine on the NHS MUST obviously all be evidence based. I have called on Ernst many times simply to state the LEVEL OF EVIDENCE that he considers ALL interventions should attain before being included on the NHS but apparently this is 'not his job' - even though he was happy to make an embarrassing testimony to the Science and Technology Committee at the House of Commons and call for the abolition of NHS homeopathy on the grounds of 'lack of evidence'. Double standards? You bet! Fortunately the Government kicked ALL the (anti-NHS homeopathy) recommendations of this generally discredited committee (signed by only 3 MPs) into touch. This political decision was taken very badly by Ernst and particularly badly by his fellow anti-homeopath (Prof Michael Baum) who wrote a ranting letter steaming with rage at how democracy prevailed against his views to the BMJ very soon after writing a letter (in answer to a letter from me about an article written by himself and Edzard Ernst in which I claimed to be misquoted) to the American Journal of Medicine calling for this debate on homeopathy to go 'back into the realm of polite disputation' (http://goo.gl/T8yjg) :-) Edzard Ernst made a name for himself by being the Professor of Complementary Medicine who attacked CAM and particularly homeopathy. He was successful in this attack with regard to the media and writing a book but fortunately, despite his efforts, democracy was dignified enough to protect NHS homeopathy and state that doctors ie GPs and local health authorities were in a better position to make clinical decisions about THEIR patients than Edzard Ernst of Exeter.

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  • William, You are assuming people like me object to scepticism for the reasons you have outlined. I have been a left wing activist all my life, so its fair to call me a sceptic. I object to SK skepticism for only one reason their obvious prejudice against a group that does not conform to the SK skeptics erroneous belief; that all clinical interventions have been published in peer reviewed journals and trying interventions based on a practitioners experience is “quackery”. The analogy you use is an expremly limited way of looking at the needs of people in poor health and easily rebutted. Take people who pray. I dont belive in God so praying was not going to help me much when I was diagnosed with cancer in March and should be described as a “useless treatment” for me. To exprapolate from that it would be usless for everyone is foolish and not in patients best interests. I knew improving my diet and reducing my stress would help as I prepared my body for the treatment of chemotherapy, radiation and surgery I faced. However a diagnosis of cancer is obviously going to increase stress, what was I to do, anti depressants and more toxic chemicals in a body trying to cope with cancer growth. I got hypnotised to think of Popey the Sailor man ( my favourite cartoon character when I was a child) eating spinach, getting strong and triumphing over adversity. You may think this is ridiculous, however the fact remains, I have not had a sleepless night since, I started focusing on Popey. Were I to recommend Popey to someone with cancer who could not relate to him it would be of little value. However if that person was a catholic they might find St Perigrine the patron saint for cancer useful, or a muslim might turn to Allah for a good nights sleep. Thats one of the things that makes me different from the SK Skeptics, I can respect other peoples beliefs and values that dont necessarily conform with my own. No doubt this was why Sackett et all included "patient values" as one of the three pillars of best practice in "evidence based medicine". If you are interested in how I have got on with Popey, I have stared doing a retrospective blog on my experience with cancer at www.rectalcancer.me Next week I am going to the Penny Brohn Cancer Care Centre in Bristol to experience some really touch feely interventions. However I wont be blogging about the experience for a few months when I can talk about how it affected my general wellbeing as I approach my surgery.

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  • Brian Kaplan repeats an error that is often made by CAM proponents about the treatments assessed by Clinical Evidence. The figures he gives include CAM treatments. On the page he refers to it is clearly stated that, "Included within the category of Unknown effectiveness are many treatments that come under the description of complementary medicine, for example, acupuncture for low back pain and echinacea for the common cold..." You cannot make any meaningful claims about the efficacy of conventional medicine using figures that refer to a mixture of conventional medicine and CAM. Another study that only looked at conventional medicine alone found that "an average of 76% of interventions are supported by some form of compelling evidence". http://www.ncbi.nlm.nih.gov/pubmed/10859606 (you can find the full text of this study here: http://www.veterinarywatch.com/CTiM.htm )

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  • William Collective worship is compulsory in all state schools. A Reverend came into my kids assembly and had them join their hands, bow their heads and pray to God. They were told in RE God made the world in six days etc etc. Prayer is being promoted to children every day and most parents are happy to go along with it on the basis people get some benefit from it. I read the RE curriculum and removed my children from all activity in the school. That is my choice and no one is forcing anybody to visit a quack, if they dont want to. Patients go in the hope CAM may help sometimes it does sometimes it does not. Health care is not an exact science. I would argue Christians make “inflated and misleading claims” every day which are “contradicted by the weight of scientific evidence” but many people seem to find comfort from these claims so I dont get angry. Now were these “inflated and misleading claims” shown to be used to exploit people, I would get angry and report them to trading standards and the police would step in. Skeptics are implying CAM practitioners are providing a risk to public health on the basis of anecdotal evidence, have there been any arests? I practice chiropractic and people come to my because they have heard from others that I am very good, and know my stuff, otherwise they would go to the GP who is free. What Ernst states about what I do has very little relevance to what I see in practice every day, so chiropractors like Stefaan and myself question his conclusions. For example in his latest blog on "Pulse" he states chiropractors should stop claiming “ spinal joint maintenance” is of value, based on a small study (he did not even read properly) of 90 subjects. His, was not the conclusion of the researchers, it was Ernsts spin on another CAM study. You ask how responsible practitioners should respond to negative appraisals, I have never responded to Ernsts criticisms as you describe, this is how I responded to an article of his in 2009 http://www.chiropracticlive.com/is-professor-edzard-ernst-disingenuous-or-just-ignorant-about-chiropractic-article-in-the-new-scientist/ . I ask Ernst if he believes his credibility was damaged by his involvement in a TV programme that misled viewers about acupuncture, I disagree. He has called me a “Plonker”, a “Twit”, and most recently a “fundamentalist”. So William with regard to your final question; Do responsible scientists react to negative appraisals by name calling, or are such reactions to negative criticism more characteristic of bigots and their disciples? Perhaps this may explain some of the responses you are referring to from CAM practitioners.

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