MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Some of the recent comments on this blog have been rather emotional, a few even irrational, and several were, I am afraid, outright insulting (I usually omit to post the worst excesses). Moreover, I could not avoid the impression that some commentators have little understanding of what the aim of this blog really is. I tried to point this out in the very first paragraph of my very first post:

Why another blog offering critical analyses of the weird and wonderful stuff that is going on in the world of alternative medicine? The answer is simple: compared to the plethora of uncritical misinformation on this topic, the few blogs that do try to convey more reflected, sceptical views are much needed; and the more we have of them, the better.

My foremost aim with his blog is to inform consumers through critical analysis and, in this way, I hope to prevent harm from patients in the realm of alternative medicine. What follows, are a few simple yet important points about this blog which I try to spell out here as clearly as I can:

  • I am not normally commenting on issues related to conventional medicine – not because I feel there is nothing to criticise in mainstream medicine, but because my expertise has long been in alternative medicine. So commentators might as well forget about arguments like “more people die because of drugs than alternative treatments”; they are firstly fallacious and secondly not relevant to this blog.
  • I have researched alternative medicine for many years (~ 40 clinical studies, > 300 systematic reviews etc.) and my readers can be confident that I know what I am talking about. Thus comments like ‘he does not know anything about the subject’ are usually not well placed and just show the ignorance of those who post them.
  • I am not in the pocket of anyone. I do not receive payments for doing this blog, nor did I, as an academic, receive any financial or other inducements for researching alternative medicine (on the contrary, I have often been given to understand that my life could be made much easier, if I adopted a more promotional stance towards my alternative medicine). I also do not belong to any organisation that is financed by BIG PHARMA or similar power houses. So my critics might as well abandon their conspiracy theories and  focus on a more promising avenue of criticism.
  • My allegiance is not with any interest group in (or outside) the field of alternative medicine. For instance, I do not see it as my job to help chiropractors, homeopaths etc. getting their act together. My task here is to point out the deficits in chiropractic (or any other area of alternative medicine) so that consumers are better protected. (I should think, however, that this also creates pressure on professions to become more evidence-based – but I see this as a mere welcome side-effect.)
  • If some commentators seem to find my arguments alarmist or see it as venomous scare-mongering, I suggest they re-examine their own position and learn to think a little more (self-) critically. I furthermore suggest that, instead of claiming such nonsense, they point out where they think I have gone wrong and provide evidence for their views.
  • Some people seem convinced that I have an axe to grind, that I have been personally injured by some alternative practitioner, or had some other unpleasant or traumatic experience. To those who think so, I have to say very clearly that none of this has ever happened. I recommend they inform themselves of the nature of critical analysis and its benefits.
  • This is a blog, not a scientific journal. I try to reach as many lay people as I can and therefore I tend to use simple language and sometimes aim to be entertaining. Those who feel that this renders my blog more journalistic than scientific are probably correct. If they want science, I recommend they look for my scientific articles in the medical literature; I can assure them that they will find plenty.
  • I very much invite an open and out-spoken debate. But ad hominem attacks are usually highly counterproductive – they only demonstrate that the author has no rational arguments left, or had none in the first place. Authors of insults also risks being banned from this blog.
  • Finally, I fear that some readers of my blog might sometimes get confused in the arguments and counter-arguments, and end up uncertain which side is right and which is wrong. To those who have this problem, I recommend a simple method for deciding where the truth is usually more likely to be found: ask yourself who might be merely defending his/her self-interest and who might be free of such conflicts of interest and thus more objective. For example, in my endless disputes with chiropractors, one could well ask: do the chiropractors have an interest in defending their livelihood, and what interest do I have in questioning whether chiropractors do generate more good than harm?

33 Responses to Let me remind you what this blog is about

  • Thank you for your blog in general and this blog post in particular. As a student and practitioner of Chinese Medicine I follow your blog closely because you have always a clear and reasoned view of research and other happenings in the alternative/complimentary, or however you want to call it, medicine field.

    I may not always share your views but at least it gives me an alternative view on my field of expertise and learn from that. It’s way better than other articles/blogs etc. run by people that are against the complementary medicine field not as much from reason but from a, in my view, more biased look on things or carrying a clear agenda.

    Thank you for the time you put in this blog and thank you for keeping us on our toes.

    NB: This reply reflects purely my personal view

    Nico

  • Much appreciate your blog and for the understanding and interest that it brings to this (now better informed) layman.
    Long may it continue. Many thanks.

    Ed

  • Wow. I can believe that people would disagree with you, because I’ve seen the arguments in comment sections here and elsewhere… but I have some difficulty with the concept of people [making themselves ridiculous by] claiming you’re ignorant of the field. That’s just going to excess to prove how little such a commenter knows. Good grief.

  • “and my readers can be confident that I know what I am talking about. Thus comments like ‘he does not know anything about the subject’ are usually not well placed and just show the ignorance of those who post them.”

    I am sorry prof. Ernst but this statement is false, especially regarding the “dangers” of chiropractic. If you have researched chiropractic as well as you make out you could answer me the one simple question I have asked you on many occasions.
    That is ” which type of chiropractic adjustment can your research show is more likely to cause an injury?”

    • do you know how silly this comment is?
      you claim that I don’t know what I am talking about because I refuse to talk about a specific issue you want me to talk about. Brrrrrrrrrrrr!!!

      • I am not asking you to talk about a specific issue, I am asking you to provide evidence. You say chiropractic neck manipulation is dangerous. I ask which type of chiropractic manipulation is dangerous, using your research and all the evidence gathered, surely you could answer such a simple question and supply the readers of this blog with guidance as to what, according to the evidence, should be avoided.

        • you ask me to supply the evidence and I have provided plenty of it.

          • You have done no such thing. You have merely provided a bias towards all chiropractic. You have, at no point, provided evidence as to WHICH chiropractic adjustment may cause harm. I have asked you this question many times over many years and you still fail, because you can’t, provide evidence to show to your readers, which chiropractic adjustments should be avoided.
            Or is it just all chiropractors?

          • oh dear, oh dear!
            I have shown you the evidence that neck manipulations are associated with serious risks.
            I did not attempt to define any specific types of manipulations implicated; this is for the chiro-profession to tell us.
            are you thick or what?

          • So from fedups’ comments are we to take that he agrees that cervical manipulation IS associated with risks and the stance is which type of manipulation it is that is causing those risks?

          • CLEARLY YES

  • You should put a synopsis of this prominently on your home page. Then you can point the idiots at it, and save yourself a lot of typing.

  • I appreciate your blog, Prof. E. And I’m sorry a lot of the comments have been steadily drifting more in the direction of ad hominem attacks. The theme throughout your posts is pretty self-evident: you hope to raise the ability of your readers to take a (self-) critical approach to the many and bizarre claims made by proponents and practitioners of complementary (definitely NOT complimentary!) medicine.

    Humans seem to be hard-wired to trust in magic, and the many forms of alternative medicine pretty much amount to magic at their hearts. Unless a person has a reasonably thorough grounding in biological (and other) science, they’re not likely to begin to comprehend the often hilarious nature of the approaches of the medical alternatives. But it is definitely funny to watch people imagining their health will be in any way affected by ingesting nothing (homeopathy), having their feet tickled (reflexology), having pins stuck in them (acupuncture), or just praying to one of the thousands of manmade gods (all the other modalities effectively require similar supernatural inputs because they don’t actually DO a darn thing!).

    One thing that appears often in this blog is the expression “big pharma”. The pharmaceutical industry behaves no better than any other in their drive to sell things at a profit (that includes the CAM industry) and I have no intention to rise to its defence. But why is “big surgery” never mentioned? The cost per patient of almost every surgical procedure is pretty massive; exorbitant when it comes to e.g. transplantation. So when your critics are out to denigrate the progress of genuine medicine, let’s hope they bring in surgery for attack from time to time, just to avoid the monotony of the “big pharma” complaint.

  • Keep irritating Edzard, from a small questioning grain something grows, that is how pearls are formed!

  • Psychologist David Dunning explains why incompetent people are so sure of themselves in his article in the Pacific Standard and in the podcast with David McRaney…

    “What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.”
    http://www.psmag.com/navigation/health-and-behavior/confident-idiots-92793/

    http://youarenotsosmart.com/2014/11/10/yanss-podcast-036-why-we-are-unaware-that-we-lack-the-skill-to-tell-how-how-unskilled-and-unaware-we-are/

    One of the great things about Edzard’s blog is that it enables readers to shift from a position of inappropriate confidence (unfounded belief) in alt-med to a position of “I don’t know.”, which implants the seeds of critical thinking skills — perhaps the most valuable gift that anyone can receive.

    • One of the great things about Edzard’s blog is that it enables readers to shift from a position of inappropriate confidence (unfounded belief) in alt-med to a position of “I don’t know.”

      Unfortunately a lot of them seem to shift to a position of “fingers in ears” and go “LALALALALALA”.

  • ” and several were, I am afraid, outright insulting”
    “My foremost aim with his blog is to inform consumers through critical analysis and, in this way, I hope to prevent harm from patients in the realm of alternative medicine.”
    “but because my expertise has long been in alternative medicine.”
    “I have researched alternative medicine for many years (~ 40 clinical studies, > 300 systematic reviews etc.) and my readers can be confident that I know what I am talking about.”
    “My task here is to point out the deficits in chiropractic (or any other area of alternative medicine) so that consumers are better protected.”
    “they point out where they think I have gone wrong and provide evidence for their views.”

    “I recommend they look for my scientific articles in the medical literature; I can assure them that they will find plenty.”

    “But ad hominem attacks are usually highly counterproductive”

    “and what interest do I have in questioning whether chiropractors do generate more good than harm?”

    Prof Ernst, this was all taken from blog. I’m not thick. Just havent had an answer from you.
    I understand you want to prevent patients from harm so why don’t you supply evidence as to which technique may cause harm.
    as you say, your expertise is CAM so surely you must understand the differences in chiropractic techniques. So again which ones are more likely to cause harm. Evidence please. You have been researching for years, you know what you are talking about. Did you not question which chiropractic technique is liable to cause harm? Did you even know about the differences? Expertise?
    Please point out the deficits in chiropractic, its what I’m asking you to do. Show me evidence which aspects of chiropractic are best avoided. Which aspects are worth trying. tell your readers, give the evidence.

    “With the notable exception of the manual Diversified technique, which involves high velocity and low amplitude (HVLA) thrusting spinal manipulative therapy (SMT) (also commonly referred to as spinal adjustments), the therapeutic intervention most commonly used for patient care by chiropractors is instrumented-adjusting using the Activator Adjusting Instrument (AAI). According to the 2005 National Board of Chiropractic Examiner’s (NBCE) Job Analysis1 51.2% of American chiropractors report using the AAI for patient care,”

    51.2% use activator, do you have any evidence to suggest this adjusting tech causes more harm than good?

    • …and I did not say you were thick!!!
      I asked you whether you were! and for good reason!
      I have told you often enough that I will not answer your question – not because I don’t want to but because I lack the reliable knowledge to do so, and probably anyone else does too.
      until chiros come up with the necessary facts, I advise to be cautious with all types of neck manipulation. that is the best I (and most likely anyone else) can do at present.

  • Thank you Prof Ernst, that was all I wanted to hear.

  • @fedup,
    Your diatribe distills down to: It is you who cannot provide the solid evidence required to support your claims for efficacy; it is you who cannot provide the solid evidence required to demonstrate that the harms from the treatments are adequately documented.

    Shifting the burden of proof is such a pathetic response — why do you persist in making a fool of yourself and your ‘profession’?

  • Neil, my stance is that to make sweeping statements about a profession based on your own research that isn’t actually able to discern between different aspects of chiropractic is useless as a tool to inform the public about anything.

    • but this is precisely the wrong message. if we know there might be a risk, we must [as responsible health care professionals] warn consumers and patients – even if there is still a degree about the details.

    • The research that is damning for all professions who use forceful techniques (lets include surgery) under the umbrella of health care is plain to see and not just provided by Edzard Ernst.

      If there are different types of manipulations that fall under that category and the research is not sensitive enough to identify which technique is culpable (if not all) then surely it is totally ethical to stop all treatment until we can identify what is and isn’t the cause. i.e duty of care. So if people rely on these techniques (for their livelihoods) its up to them to research rigorously to identify what is safe. If that doesn’t happen and people keep on using potentially dangerous techniques then sweeping statements are the least of our worries.

      We cannot blame the messengers, even if we don’t like the information.

    • Different aspects of pseudoscience and pseudo-treatment don’t change the fact that the whole kit and kaboodle are based on nothing more than the ravings of some fellow named Palmer, who thought up the most utterly ridiculous things and called it chiropractic.

      The Danger lies in people not getting proper treatment and paying for what can only be placebos at best. If you really want to help, try training to be a Physical Therapist (physiotherapist, I believe in UK). PT’s only work with rx from a real doctor and know their limitations. They are supervised and go to real colleges which openly publish their requirements and coursework. They use evidence-based treatments which are well-defined in scope and duration.

  • If you or chiros are concerned about a possible risk then any research done should be to establish that risk. The mechanism involved. Not simply say don’t see a chiropractor. “the risks outweigh the benefits” that is possibly preventing certain consumers from benefiting from chiropractic because you are throwing the baby out with the bathwater. The risk is extremely small and can be lessened even further with screening and certain treatment protocols, patients and consumers should be given information they can use not carpet bomb the whole profession just because you can’t establish a definite link or mechanism.

    • 1) until the risk is fully known, we have to act according to the precautionary principle which governs all health care.
      2) benefit? what is the proven benefit of upper spinal manipulation?
      3) how do you know that the risk “is extremely small” – there is no monitoring system whatsoever!!!
      4) screening? which screening method has been shown to identify high risk individuals?
      5) to compare sensible warning od consumers with “carpet bombing”, reflects very poorly on your intellectual capacities.
      MY ADVICE TO YOU: WHEN YOU ARE IN A HOLE, STOP DIGGING.

  • “The risk is extremely small and can be lessened even further with screening and certain treatment protocols”
    No one know. And you see, people are obsessed with extremely tiny risk : see the anti-vax, anti-GMO, anti-EM wave, anti-whatever nonsense. But, in all those case, the benefit is very clear : no doubt that vax diminished some disease (eradicated other), that GMO can be very useful and very productive for less cost, that wi-fi or mobile phone are one of the post powerful advance in the last decade. Here we got a ‘treatement’ with absolutely no proven benefit and maybe a risk, this risk can be tiny or great we don’t give a damn !
    Now just think rationnaly :
    – Chiro : small risk (or maybe more) – no benefit
    WHY IN THE WORLD WOULD YOU USE IT ? It’s not that hard to understand the point, is it ? Even if 1 in million get a bad side-effect it’s too much because you got nothing in return.

    I know that non-scientific people have very -hard- time to get that it mean nothing to speak about something in an ‘absolute’ point of view. Saying ‘Chiro only kill one people in a million is not bad” have no sense at all . What’s mean something is ‘Chiro kill one person in a million and heal 0 in a million’.

  • Chiropractic is excellent for:
    (a) Patients who want their ‘innate intellegence’ released.
    (b) Patients who want a health care system which works in a different way from that of medicine. (D.D. Palmer’s own statement).
    (c) Patients and practitioners who do not understand why there is controversity over chiropractic.
    (d) Patients and practitioners who do understand why there is controvery, but do not care.
    (e) Practioners who have failed to train and qualify in one of the orthodox healthcare professions such as medicine or physiotherapy.
    (f) Practitioners who for some reason do not want to qualify in an orthodox healthcare profession.
    (g) Patients who benefit from experiencing a theatrical and thaumaturgic placebo.

  • Thank you for doing this. In a recent discussion with close friends of mine I found out they were absolutely prepared to defend the idea homeopathy might be efficient in treating Ebola. We’re talking here about German grownups with college degrees. The views expressed by my otherwise well educated friends convinced me our education system (and our media) must be utterly broken in respect to science. So anybody who steps in here and devotes time and effort to provide fact based information on the whole field has my sincerest gratitude.

  • The problem with saying that you are addressing CAM only and not discussing modern medicine…is that you have repeatedly said that anything must meet the rigorous standards of evidence based medicine with controlled studies. And because modern medicine is backed by evidence based studies, your entire blog is essentially a paean to Drug/surgery based medicine.

    Sadly, there are deep problems inherent in the practice of modern medicine that dwarfs the adverse problems/reactions found when using CAM. An estimated 400,000 people died last year from allopathic iatrogenic injury. Can you tell me how many died from using CAM?

    There are many reasons people are turning to CAM, but one of them is that the comparable risk of injury is minute. You simply can’t critique CAM without examining what people are likely to receive from modern medicine and its costs/benefits.

    For some areas (gunshot wounds, broken legs, appendicitis), modern medicine can be miraculous. For chronic conditions, modern medicine (polypharmacy with neuroleptics and benzodiazapenes for emotional issues), can often be deeply problematic.

    Sadly, the tools that modern medicine tends to offer (drugs/surgery) are simply far too risky and potentially damaging. Again, I’d ask, how many people died from CAM last year compared to the 400,000 that died from iatrogenic harm?

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