MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Having disclosed in my previous post that, on 1 October, I have been in full-time alternative medicine research for exactly 20 years, I thought it might be interesting to briefly reflect on these two decades. One thing I ought to make clear from the beginning: I truly enjoy my work (well, ~90% of it anyway). When I came to Exeter, I never expected it to get so fascinating, and I am surprised to see how it gripped me.

A PERIOD OF TWO HALVES

One could divide these two decades in two periods of roughly equal length. The first half was characterised by defining my aims, assembling a team, getting the infrastructure sorted and doing plenty of research. I had made it very clear from the beginning that I was not going to promote alternative medicine; my aim was to critically evaluate it. Once I realised how controversial and high profile some of our work could become, I made a conscious effort to keep out of any disputes and tried to avoid the limelight. I wanted to first do my ‘homework’, analyse the evidence, produce own results and be quite sure of my own position before I entered into any public controversies. During this time, we therefore almost exclusively published in medical journals, lectured to medical audiences and generally kept as low a public profile as possible.

The second half was characterised by much more research and my increasing willingness to stick my head out and stand up publicly for the findings I had reasons to be confident about. The evidence had reached a point where it was simply no longer possible nor ethical to keep silent. I felt we had a moral duty to speak up and present the evidence clearly; and that often meant going public: after all, alternative medicine is an area where the public often make the therapeutic decisions without consulting a health care professional – so they need accurate and reliable information. Therefore, I began publishing in the daily papers, lecturing to lay audiences more regularly and addressing the public in many other ways.

THE PLEASURE OF SUPPORTING YOUNG SCIENTISTS

One of the most gratifying aspects of directing a research team is to meet and befriend scientists from all over the world. When several independent analyses had shown that our team had grown into the most productive research unit in alternative medicine worldwide, we started receiving numerous requests from young scientists across the globe to join us. Many of those individuals later went back to their home countries to occupy key positions in research. Our concept of critical evaluation thus spread around the world – at least this is what I hope when I feel optimistic about our achievements.

Amongst the ~90 staff who have worked with me during the last 20 years, we had many enthusiastic and gifted scientists. I owe thanks to all of those who advanced our research and helped us to make progress through critical evaluation.  Unfortunately, we also had a few co-workers who, despite of our best efforts, proved to be unable of critical thinking, and more than once this created unrest, tension and trouble. When I analyse these cases in retrospect, I realise how quasi-religious belief  must inevitably get in the way of good science. If a person is deeply convinced about the value of his/her particular alternative therapy and thus decides to become a researcher in order to prove his/her point, serious problems are unavoidable.

THE THREE MOST IMPORTANT MESSAGES

But generally speaking, my team worked both very well and extremely  hard. Perhaps the best evidence for that statement is the fact that we published more than 1000 articles in the peer review literature, including ~30 clinical trials and 300 systematic reviews/meta-analyses. If I had to extract what I consider to be the three the most important messages from these papers, I might make the following points:

  • The concepts that underpin alternative treatments are often not plausible and must be assessed critically.
  • Most claims made for alternative medicine are unproven and quite a few should be regarded as disproven.
  •  Very few alternative therapies demonstrably generate more good than harm.

Looking back to those 20 years, I am struck by the frequency with which I encountered intellectual dishonesty and denial of facts and evidence. Medical research, I had previously assumed is a rather dry and unemotional business – not so when it comes to research into alternative medicine! Here it is dominated by people who carry so much emotional baggage that rational analysis becomes the exception rather than the rule.

GROWING OPPOSITION

The disappointment of alternative medicine apologists had been noticeable virtually from the start; they had quickly realised that I was not in the business of promoting quackery. My remit was to test hypotheses, and when you do that, you have to try to falsify them. To those who fail to understand the rules of science – and that is the vast majority of alternative medicine fans – this process can appear like a negative, perhaps even destructive activity. Consequently, some people began to suspect that I was working against their interests. In fact, as a researcher, I had little patience with such people’s petty interests; all I wanted is to do good science, hopefully for the benefit of the patient.

These sentiments grew dramatically during the second decade when I began to go public with the evidence which often failed to confirm the expectations of alternative medicine enthusiasts. To see the truth published in relatively obscure medical journals might have already been tough for them; to see it in the daily papers or hear it on the radio from someone whom they could not easily accuse of incompetence was obviously more than the evangelic believers could take. Their relatively cautious attitude towards our work soon changed into overt aggression, particularly after our book ‘TRICK OR TREATMENT…‘. The second decade was therefore also characterised by numerous attacks, challenges, defamations and conflicts, not least the ‘run ins’ with Prince Charles and his sycophants. Unfortunately, my own University as well as my newly formed Medical School had no stomach for such battles; the top officials of both institutions seemed more concerned about their knighthoods than about defending me against obviously malicious attacks which could only have one aim: to silence me.

OUTLOOK

But silence they did me not! It is simply not in my character to give up when I know that I have done nothing wrong and fighting ‘the good fight’. On the contrary, each attack merely strengthened my resolve to fight harder for what I knew was right, ethical and necessary. Eventually, my peers became so frustrated with my resilience that they pulled the plug: they stopped all support. This meant my team had to be dismissed and I had to go into early retirement.

Since about a year, I am ‘Emeritus Professor’, a status which has disadvantages (no co-workers to help with the research, no salary) but also important advantages. I can finally speak the truth without fearing that some administrator suffering from acute ‘knighthood starvation syndrome’ is going to try to discipline me for my actions.

This blog, I think, is pretty good evidence for the fact that I continue to enjoy my work in alternative medicine. I cannot promise to do another 20 years but, for the time being, I continue to be research-active and am involved in numerous other activities. Currently I am also writing a book which will provide a full account of those remarkable last 20 years (almost finished but I have no publisher yet) and I am working on the concept of another book that deals with alternative medicine in more general terms. They did not silence me yet, and I do not assume they will soon.

46 Responses to My 20 years in alternative medicine research

  • fedup says:

    LOL Prof Ernst, so far you have blamed politicians, journalists, other researchers, Other scientists, Nurses, Midwives, doctors, your own university,All Cam practitioners and their associations, Prince Charles, your own bosses, the list goes on and on, Infact you have pointed the finger at everybody and said they are WRONG, they are providing the public with misinformation and providing useless treatments.!!!!! You constantly tell us that its your research that matters but then you try to sell your books! Seriously, I think you need to take a long hard look in the mirror.

      • Pete says:

        Best reply to a troll ever—I’ll have to remember that one! :-)

        I understand if you don’t have time to respond to these sorts of questions, but I was wondering if there has been any attempt to study the overall public health impact of CAM. Supposedly Steve Jobs died because he used a bogus cancer treatment instead of the one recommended by his doctors. He probably isn’t alone, but is it possible to put a figure on the number of people who are dying for this kind of reason? What about people who don’t die but stay sick because they don’t get effective treatment for their condition?

        I imagine the numbers are substantial if you include the beetroot-based HIV ‘treatment’ that was being promoted in South Africa. Many people must have died because of not taking anti-retroviral therapy.

        Thanks for reading!

        • Edzard says:

          I agree, that would be really important to have data on; alas I do not know any and guess it would be very difficult to generate anything beyond the anecdotal level.
          DOES ANYONE KNOW OF ANY RELIABLE EVIDENCE?

  • Alan Henness says:

    fedup said:

    LOL Prof Ernst, so far you have blamed politicians, journalists, other researchers, Other scientists, Nurses, Midwives, doctors, your own university,All Cam practitioners and their associations, Prince Charles, your own bosses, the list goes on and on, Infact you have pointed the finger at everybody and said they are WRONG, they are providing the public with misinformation and providing useless treatments.!!!!! You constantly tell us that its your research that matters but then you try to sell your books! Seriously, I think you need to take a long hard look in the mirror.

    …says a chiro! Oh sweet irony.

    • Edzard says:

      I did not know that FEDUP was a chiro; perhaps he wants to tell us which of my three main points do not apply to chiropractic? not the one about bogus claims, is it?

  • fedup says:

    I actually do quite like you Prof.Ernst. I may not agree with you, I may think you sometimes have double standards regarding how you work, I may think you rely on certain negative publicity to sell your books, but I wouldn’t say I don’t like you. One day I hope to speak to you personally. I would like that.

    • Edzard says:

      my comment was meant to show you how little more than an ad hominem attack yours was. tell me where my errors are in pointing out the misinformation, or tell me where my own research is wrong, or even just tell me where I claimed that only my research is sound…and I might respond reasonably.

      • fedup says:

        Prof Ernst, Have you not noticed that you have blamed everybody else? Is this normal in any walk of life or research field? I have often pointed out where your research (IMO) has been wrong, biased or cherry picked, here and on pulse. I have offered articles and links to research that contradicts your opinions. You may not claim that your research is sound but you constantly only cite your own work. If I remember in one piece of the 13 references 11 where from yourself.

          • fedup says:

            “During this time, we therefore almost exclusively published in medical journals, lectured to medical audiences and generally kept as low a public profile as possible.” except when you published a book in 1998 “Back Pain: Practical Ways to Restore Health Using Complementary Medicine”. Low profile eh?
            “alternative medicine is an area where the public often make the therapeutic decisions without consulting a health care professional” Where is your evidence for this? Is it your opinion? In my experience over 22 years in CAM I am often the last person to be consulted, long after the person has seen many Healthcare professionals. If you have no evidence to support this statement then your whole argument of “I began publishing in the daily papers, lecturing to lay audiences more regularly and addressing the public in many other ways.” is based on a fallacy.

          • Edzard says:

            1) this book was anything but high profile.
            2) you have just provided reason to suspect that you have little idea what evidence really is.

          • fedup says:

            ” Unfortunately, we also had a few co-workers who, despite of our best efforts, proved to be unable of critical thinking, and more than once this created unrest, tension and trouble. When I analyse these cases in retrospect, I realise how quasi-religious belief must inevitably get in the way of good science.” What? a reseaech scientist that didn’t agree with you?Had a mind of their own? I would love to have been a fly on that wall. So a research scientist who didn’t agree with your research findings has a quasi-religious belief system? As Zeno has said the Irony of it.
            “If a person is deeply convinced about the value of his/her particular alternative therapy and thus decides to become a researcher in order to prove his/her point, serious problems are unavoidable.”

            I could easily read this “If a person is deeply convinced that alternative therapy has no value and thus decides to become a researcher in order to prove his/her point, serious problems are unavoidable.” But again, THEY must be wrong. Not Prof Ernst.

  • L. Barton says:

    When I first heard that Exeter University, my own alma mater, was going into the complementary medicine business, I groaned. I thought as did most others that it was going to be a case of supporting strange ‘therapies’ – no doubt supported by their chequebooks. Eventually I was pleased to see that it was in fact a case of honest investigation and reporting, and was proud of the University. When the crunch came and the unit was disbanded for not coming up with what the powers that be wanted, I was once again horrified. So for me, and I know quite a lot of other Exeter graduates, it has been a journey of three rather than two parts.

    I an still waiting to see how long it will take for the NHS to stop pouring money into homeopathic hospitals when scientific hospitals are starved of cash and resources.

    • Edzard says:

      thank you!
      I had many similar comments from colleagues at Exeter when we had lost the support from ‘above’. what puzzles me to the present day is, why was there no protest? I had plenty of vocal support from around the world but, as far as I can see, nobody in Exeter opened his/her mouth.

  • fedup says:

    Lets not forget , Depression: Practical Ways to Restore Health Using Complementary Medicine 1998 or Sleep: Practical Ways to Restore Health Using Complementary Medicine 1999. Come on Prof, you were selling CAM more than any therapist.

    • Edzard says:

      yes, let’s not forget my books aimed at accurately informing patients. it is my job to do that. what is wrong with it? when did I ever advertise these books?
      you are in a hole and should stop digging.

      • fedup says:

        Prof Ernst, did you make any sort of financial gain from the sale of these books about CAM and common ailments. We have discussed some parts of the back pain book in the past and you blamed the editors, even though the book has your name on the cover. I’m not saying you are wrong in publishing a book but you and your followers often describe how CAM therapists are merely out to make money or if we worked ethically we would not have a business. I’m simply saying that you have probably made more money out of CAM book sales than many therapists, you have benefitted financially from CAM followers (believers if you wish) by using such titles as back pain, Depression and Sleep followed by the words Complementary medicine.

        • Edzard says:

          you are totally out of order.
          1) you make innuendo after innuendo without ever getting factual;
          2) with your ‘Reader’s Digest’-psychology, you depict me as some sort of maniac suffering from a persecution complex;
          3) now you ask me how much I earned writing a book.
          I am having a reasonably good day [the lawnmower broke down twice and I (not normally very gifted at such things) managed to repair it twice - much more important to me than someone who does not even have the guts to give his/her own name harassing me], and therefore I will give you an answer which I do NOT owe you.
          this book generated exactly £2000 [as a very rough estimate, this is £20 per hour of my work done mostly during weekends], and these funds went straight to university for our research.
          happy?
          AND NOW YOU APPOLOGISE OR BE BANNED FROM THIS BLOG.

          • fedup says:

            Prof Ernst, I did not mean to spoil your day. I apologise. I have had many conversations with you in the past using my real name.
            1. I have given you facts, the fact is you make claims without evidence, ” alternative medicine is an area where the public often make the therapeutic decisions without consulting a health care professional” you have no evidence to support this sweeping statement.
            2-Again you said “Here it is dominated by people who carry so much emotional baggage that rational analysis becomes the exception rather than the rule.” So its OK for you to analyse somebody, ie emotional baggage and brandish them irrational, without a shred of proof, but when I do it it’s just not on?
            3. I did not ask you how much you made, I said did you benefit financially from these books. You decided to give me a number. And as you have given a number was that per book? back pain, sleep etc? And was that per book in the other languages? I’m not bothered really, just find it a touch hypercritical that CAM therapists are brandished as charlatans out to make money, but CAM researchers can make as much as they like. As long as its educating the public right? If thats the case why has “using complementary medicine” ever appeared in a title by you?

  • fedup says:

    “But silence they did me not! It is simply not in my character to give up when I know that I have done nothing wrong and fighting ‘the good fight’. On the contrary, each attack merely strengthened my resolve to fight harder for what I knew was right,”

    “Eventually, my peers became so frustrated with my resilience that they pulled the plug: they stopped all support. This meant my team had to be dismissed and I had to go into early retirement.”

    “Unfortunately, my own University as well as my newly formed Medical School had no stomach for such battles; the top officials of both institutions seemed more concerned about their knighthoods than about defending me against obviously malicious attacks which could only have one aim: to silence me.”
    ” this process can appear like a negative, perhaps even destructive activity. Consequently, some people began to suspect that I was working against their interests. In fact, as a researcher, I had little patience with such people’s petty interests”.

    You cannot see the wood for the trees can you? Is everybody getting at you? Is everybody out to get you? Is everybody that doesn’t agree with you wrong? Hold on while I do a google search for research on such thought patterns. After all thats what most of your other readers do regarding CAM.

    • Edzard says:

      I thought you were a chiro, not a shrink!
      now that you have shown the world how well you master the ‘cut and paste’ task, can you show us which of the quotes is incorrect, please?

      • Anti-skeptik says:

        XD, Ernst is a cute/paste myth master!. In the huge papers of Ernst repeat the mantras, many examples:

        Ernst mantras:

        a) Extraordinary claims requires extraordinary evidence, —> CSICOP ideology, not science
        b) Important caveats preclude definitive conclusion, —> In the Systematic Reviews, Double blind RCT,
        c) Homoepathy is implausible, —> In the “blogs” and the propaganda journals (Yes, the same natue!, Biologist..)

        Ernst is a fraud and copy/paste master.

  • Irene says:

    When I saw 22 comments listed, I thought many people must be sending congratulatory messages; only to find that “fedup” is (feeble) attempting to discredit you. I don’t think you should ban him–his work speaks for itself and is a lesson in faulty logic for all to see. It is futile to ask “fedup” if he thinks “…that belief gets in the way of science?” for he has no idea what the difference is between the two.

  • Anti-skeptik says:

    “The second half was characterised by much more research and my increasing willingness to stick my head out and stand up publicly for the findings I had reasons to be confident about.”

    LOL!:

    a) The bad “reanalysis” of Linde in Journal of Clinical Epidemiology,
    b) The bad paper in Biologist, “Testing the water”,
    c) The support of the CSICOP and James Randi – Martin Bland, fraud (false replication of Brown-Ennis experiment) in Horizon Program in 2002, debunked by D. Ullman and M. Ennis,
    d) The Trick or treament book, debunked by William Alderson,
    e) The difamation of the authors of the “pamplhet”, HTA swiss,
    f) Political and corrupt activitism in the pseudoskeptik and pseudoscientist Psyop´s complex: Sense About Science-Cfi-CSICOP-GWUP
    g) The bad “systematic review” of the homotoxicology, and misinterpretations of the studies (i.e. P. Klein and Menachem Oberbaum),
    h) The double standard in “Homeopathy: Critical appraisal”, omiting the multicenter experiment by Peter Christian Endler,
    i) The coalltion whit the liars pseudoscientists: GuyChapman, AlanHenness, Andy Lewis, “Orac”, Robert L. Park, Simon Sigh, Tracey Brown, Ben Goldacre,
    j) The reductionism of the hierachy of evidence in one paper,
    k) Double standard with the Homeopathy journal.

    Orthodoxy and ultra capitalized poser dawkinianan “atheism” : GET OUT THE PSEUDOSKEPTIKS! FIGHT!

    • Björn Geir says:

      d) The Trick or treament book, debunked by William Alderson,

      http://www.quackometer.net/blog/2009/04/homeopaths-attempt-to-rubbish-ernst-and.html

      c)…debunked by D. Ullman…

      Tell me another joke

      e) The difamation of the authors of the “pamplhet”, HTA swiss,

      As it happens it was also “defamed” by Swiss authorities

      f) Political and corrupt activitism in the pseudoskeptik and pseudoscientist Psyop´s complex: Sense About Science-Cfi-CSICOP-GWUP
      g) The bad “systematic review” of the homotoxicology, and misinterpretations of the studies (i.e. P. Klein and Menachem Oberbaum),
      h) The double standard in “Homeopathy: Critical appraisal”, omiting the multicenter experiment by Peter Christian Endler,
      i) The coalltion whit the liars pseudoscientists: GuyChapman, AlanHenness, Andy Lewis, “Orac”, Robert L. Park, Simon Sigh, Tracey Brown, Ben Goldacre,
      j) The reductionism of the hierachy of evidence in one paper,
      k) Double standard with the Homeopathy journal.

      Tell us Mr.(?) Antiseptik (joke), are you sober? (serious question!)

      • Irene says:

        @Bjorn Geir

        You beat me to it! I nearly died laughing that anyone would consider a “rebuttal” from Dana Ullman something to be taken seriously. It’s like asking the Tooth Fairy to review a paper on “Does the Tooth Leave More for Molars”, which has already been reviewed (and debunked) by a team of dentists.

    • CapuchinSeveb says:

      >> debunked by D. Ullman

      Ullman couldn’t debunk his way out of a paper bag.

      People like you show me how important it will be to pass on my science and critical thinking background to my children, should I ever have any.

  • Weronica says:

    Dear mr. Edzard

    First of all congratulations, second – thank you!

    And third; the comments here make me sick but still – it´s interesting how some people don´t smell their own stink.

  • Prof Ernst, I am a science popularizer in Brazil (I already translated one of you articles to my blog) and I am very pleased to read this post today. Congratulations for 20 years of great work and to speak out for science.

    I don’t think you deserve any of those hate comments. It looks like, some people does only want to make ad hominem without offering any real critique with evidence.

    A new study suggests that just ad hominem attack is enough to change readers impression about the content of the text itself. Recently, Popular Science site had shut down comments because of that: http://www.popsci.com/science/article/2013-09/why-were-shutting-our-comments. I do think some comments can be good, so maybe, filtering comments is an option.

  • Irene says:

    Yes! Many congratulations Dr. Ernst! Trick or Treatment was my “Aha!”, and brought me fully around from a brief flirtation with woo. Ernst, Singh, and Goldacre have given me a good basic grounding in Skepticism. James Randi probably first got me thinking when I saw him on a PBS program where he debunked cold remedies and astrology before a class of college students.

    Keep up the good work and I hope to see the new book before too long.

  • Heinz Joachim Mensing says:

    Hello Dr. Ernst,
    are you aware of the fact that “blood-letting” is the textbook standard therapy for hemochromatosis? (That is the most common genetic disease, as far as I know, up to ca. 1% in Ireland.) What is that: “alternative” therapy?

    Are you aware that the standard therapeutic phlebotomy is identical to a blood donation? Do you think blood donations are dangerous (shorten life (expectancy)), since you have been warning against blood-letting for more than 2 decades? Contrary to what I remember from you work on blood rheology in Germany before…

    (This is also a test, since a couple of hours ago I posted a reply / comment and nothing “happened” – the comment did not appear, no error message…)

    • Mojo says:

      Bloodletting is a science-based therapy for hemochromatosis. It is not science-based if used a,s it was 200 years ago as a routine treatment for almost any condition.

      • Heinz Joachim Mensing says:

        You should differatiate between quacks and knowledgable doctors. One of the latter was Christian Wilhelm Hufeland, who started phlebotomies in G.W. Goethe in his early years in Weimar (18th century). That was continued by other doctors after Hufeland left Weimar when he became a professor in Jena.
        Goethe was fond of this therapy and lived 82 years, without dementia. I speculate that, by phlebotomy, getting rid of iron (which, among other things, promotes neurodegeneration) was of importance. Of course there are lots of modern studies supporting this interpretation.

        Millenia ago it was recognized that blood-letting would alleviate “red hypertension” (pulsus durus with well perfused skin), so it became a valid indication and was successfully used into the 20th century, e.g. O.Müller & Parisius, “Die Blutdruckkrankheit” 1931, or W. Zidek et al. 1985. (Zidek now is “Ordinarus” at the Carité in Berlin, but seems to have forgotten his phlebotomy study, as is my impression with Prof. Ernst, who did a lot of work of this type at the same time.)
        Lots of other evidence on request.

        If you can more or less cure uncomplicated “essential” hypertension by depletion of stored iron, and that has been a clear indication for knowledgeable doctors over at least 2 millenia, how / where could a line be drawn between rational medical therapy and “alternative” practice? (Of course quacks can kill people by unqualified blood-letting, just as you can kill yourself by ingesting lots of salt. But that’s no argument against phlebotomies to get rid of surplus iron or substitution of NaCl in hyponatriaemia.)

        When Ernst and Singh in their book “Trick or Treatment” state that blood-letting does not work that is not true. it depends…

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