A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble, by Edzard Ernst

In Central London, on the corner of Queen Square and Great Ormond Street, stands the Royal London Hospital for Integrated Medicine, formerly the Royal London Homoeopathic Hospital. Queen Square houses the National Hospital for Neurology and Neurosurgery, and Great Ormond Street the eponymous Hospital for Children. Neurological disorders are among some of the most frustrating and intractable conditions; often chronic in their course, their debilitating effects chip away at patients’ life quality, morale and dignity. The plight of sick children, of course, needs little embellishment. Anything that can be done to help these people (and everyone else who is suffering) should be done. In a decent society, treatment should be part of a universal healthcare system available free at the point of use, as is currently the case in the UK under the NHS. So where does the building on the corner fit in? What does the medicine offered by the RLHIM offer to those in need?

In 1993, academic physician Edzard Ernst arrived at the University of Exeter to take up a new endowed chair in complementary medicine, and his job, as he saw it, was to answer just that sort of question. But by 2011, he had retired from his post. The position would remain unfilled, and what remained of a highly successful research unit that Ernst had run for 18 years was subsequently shut down. It is a chastening story for anyone who cares about academic medicine.

Maybe they liked to give sugar pills because they struggled with introducing an intravenous needle or taking a liver biopsy sample

Prior to 2011, Ernst was already a curiously controversial public figure, renowned for his measured stance against untested complementary or alternative medicine (CAM). For, as Ernst writes in this forthright memoir, “there is no such thing as alternative medicine; there are just treatments that work, and those that don’t. Those that work will find their way into the standard armamentarium of medicine, while those that don’t are destined to remain in the realm of quackery.” These views would bring him into conflict with CAM practitioners and advocates, including members of the British Establishment, notably the Prince of Wales, and the second half of this book is about this ultimately unsatisfactory period in his life.

But, like the King in Alice’s Adventures in Wonderland, let us begin at the beginning of Ernst’s painstaking account. In its opening pages, he thoughtfully explains how he gained the skills and tools that qualified him to make credible judgements about medicine and science. He also shares his attitudes to those he came across in various situations who abused their positions of power.

Born in 1948 in Germany, he was a child of the fraught immediate post-war period, and here he describes the general and personal baggage that this accident of birth brought to his life. Although more jazz musician than doctor by inclination, he followed his mother’s advice and studied hard enough to qualify in medicine in case a musical career didn’t work out.

Ernst’s first job after qualification was in a homeopathic hospital in Munich. Germany is much more open to homeopathy than the UK – its founder Samuel Hahnemann was German, after all – and its homeopathy practitioners tend to be medically qualified too. During his six-month stay at the hospital, Ernst says, he learned the “incredible power of the placebo”. He also learned the basics of some other therapeutic schemes, and from watching his colleagues drew some harsh conclusions about their clinical abilities. Perhaps they preferred the obfuscation of alternative medicine because they couldn’t deal with the rigour of conventional medicine. Maybe they liked to give sugar pills because they struggled with techniques such as introducing an intravenous needle or taking a liver biopsy sample.

Jazz would bring Ernst to London as a visiting musician, and the love he found with his future wife Danielle made a move inevitable. He found a permanent job at St George’s Hospital in a research laboratory investigating the factors that impeded blood flow. Ernst writes with real joy about the pleasure he found in scientific research and in developing his ability as an analytical and critical thinker. He would take these skills back to Germany, where he became a specialist in rehabilitation medicine. From Hanover, he moved to Vienna to head up a vast department in the same field, his final stop before Exeter.

There is a decidedly different feel to the second half of this excellent book, which deals with Ernst’s Exeter years. (A brief coda explains that friends who read early drafts of A Scientist in Wonderland urged him to preface this account with details of his earlier life.) It is, in essence, a perfectly pitched meditation on the fallacies of CAM and what Ernst rightly argues are his reasonable attempts, in an age of evidence-based medicine, to subject its practices to rigorous scientific study in the same way orthodox treatments are trialled. Why, he asks repeatedly, should CAM’s advocates and practitioners not wish to see their ideas tested in randomised, placebo-controlled, double blind trials?

In Ernst’s view, the original aim of the £1.5 million endowment for the chair at Exeter was not to facilitate the design and execution of such thorough trials, but instead to bolster the reputation of CAM in other ways – so it is perhaps hardly surprising that his research would run counter to some expectations. Moreover, Ernst’s account of his elegant study of the effects of spiritual healing on chronic pain, which showed no benefit over placebo, attests to his concern not just with efficacy but also with patient safety. If a treatment works via placebo it may still not be the best option, he argues, because a better-than-placebo orthodox treatment may be available. He is rightly horrified by the prevalence of what he characterises as an artificial middle ground, the “zeitgeist of cultural relativism”, where scientific data must be “balanced” by less rigorous and merely qualitative personal experience or belief.

But for all its trenchant arguments about evidence-based science, the second half of A Scientist in Wonderland remains a very human memoir, and Ernst’s account of the increasingly personal nature of the attacks he faced when speaking to CAM practitioners and advocacy groups is disturbing. He also offers his side of a public disagreement with Sir Michael Peat, the Prince of Wales’ private secretary, over the Smallwood report, The Role of Complementary and Alternative Medicine in the NHS, in 2005. An accusation that Ernst had broken a confidentiality agreement led to a lengthy investigation at Exeter, as he outlines, and although he was cleared of wrongdoing, he was scarred by the experience. Significantly, as he reports, funds for his Exeter research unit dried up, and led to its eventual closure.

We are in no doubt, reading this account, that Ernst believes his university let him down and that what was at stake was more than simply a professorial chair. While the NHS grapples with rising costs and growing patient expectations, it is also charged with delivering evidence-based quality care. If it is to offer CAM, these practices must be subject to the same criteria as orthodox medicine. For Ernst, it is more than a matter of economics; it is an ethical principle. Ben Goldacre’s 2012 book Bad Pharma created a storm via its exposure of the pharmaceutical industry’s unhealthy links with mainstream medicine. Ernst’s book deserves to do the same for the quackery trading under the name of complementary and alternative medicine.