Medical ethics are central to any type of healthcare – and this includes, of course, alternative medicine. The American Medical Association (AMA) have just published their newly revised code of ethics, AMA Principles of Medical Ethics.
It has long been my impression that, in alternative medicine, ethics receive no or far too little attention. Some alternative practitioners thrive to be able to call themselves ‘physicians’. Therefore, it seems interesting to ask whether they would also be able to comply with the ethical duties of a physician as outlined by the AMA.
The following 9 points are taken without change from the new AMA code; in brackets I have put my own, very brief comments pertaining to alternative practitioners. There is much more to be said about each of these points, of course, and I encourage my readers to do so in the comments section.
- A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. [Most alternative practitioners use unproven treatments; I doubt whether this can be called ‘competent medical care’.]
- A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. [Treating patients with unproven therapies in the absence of fully informed consent is arguably unprofessional, dishonest and deceptive. Crucially, alternative practitioners never object to even the worst excesses of quackery that occur in their realm.]
- A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. [Treatment with unproven therapies can hardly be in the best interest of the patient.]
- A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. [The right of patients includes full informed consent which is, according to my impression, rare in alternative medicine.]
- A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. [Alternative medicine is frequently out of line with or even opposed to medical knowledge.]
- A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
- A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. [Some activities of some alternative practitioners are directly opposed to public health, for instance when they advise against immunising children.]
- A physician shall, while caring for a patient, regard responsibility to the patient as paramount. [Arguably this is not possible when using unproven therapies.]
- A physician shall support access to medical care for all people. [Some alternative practitioners advise their patients against accessing conventional healthcare.]
As I stated above, medical ethics are neglected in alternative medicine. The 9 points of the AMA together with my comments go some way towards explaining why this is so. If ethical principles were applied to alternative medicine, much of it would have to stop instantly.
In part one, we have dealt with three common tricks used by quacks to convince the public to consult them and to keep coming back for more. It has been pointed out to me that some of these tricks are used not just by alternative practitioners but also by real physicians. This is, of course, absolutely true. A quack can be defined as “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.” Therefore real doctors can be real quacks, of course. I happen to have an interest mainly in alternative medicine; that’s why I write about these type of quacks (if it helps keeping you blood pressure within the limits of normal, I can tell you that I occasionally also published about quackery in mainstream medicine, for instance here).
Anyway, now it is time to continue this series of posts by discussing three further common deceptions used by quacks.
A CURE TAKES A LONG TIME
Imagine a scenario where, even after, several therapy sessions, a patient’s condition has not improved. Let’s assume the problem is back pain, and that it has not improved a bit despite the treatments and the money spent on it. Surely, many patients in such a situation are sooner or later going to give up. They will have had enough! And this is, of course, a serious threat to the practitioner’s cash flow.
Luckily, there is a popular ploy to minimize the risk: the practitioner merely has to explain that the patient’s condition has been going on for a very long time (if, in the above scenario, this were not the case, the practitioner would explain that the pain might be relatively recent but the underlying condition is chronic). This means that a cure will also have to take a very long time – after all, Rome was not built in one day!
This plea to carry on with the ineffective treatments despite any improvement of symptoms is usually not justifiable on medical grounds. It is, however, entirely justifiable on the basis of financial considerations of the practitioners. They rely on their patients’ regular payments and will therefore think of all sorts of means to achieve this aim.
Take my advice and see a clinician who can help you within a reasonable and predictable amount of time.
IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU
In the pursuit of a healthy cash-flow, almost all means seem to be allowed – even the fabrication of the bogus notion that the reasons for the patient’s problem were the poisonous drugs prescribed by her doctor who, of course, is in cahoots with BIG PHARMA. Alternative medicine thrives on conspiracy theories, and the one of the evil ‘medical mafia’ is one of the all-time favourites. It enables scrupulous practitioners to instil a good dose of fear into the minds of their patients, a fear that minimises the risk of them returning to real medicine.
My advice is that alternative practitioners who habitually use this or any other conspiracy theory should be avoided at all costs.
The notion that alternative medicine takes care of the whole person is a most attractive and powerful ploy. Never mind that nothing could be further from being holistic than, for instance, diagnosing conditions by looking at a patient’s iris (iridology), or focussing on her spine (chiropractic, osteopathy), or massaging the soles of her feet (reflexology). And never mind that any type of good conventional medicine is by definition holistic. What counts is the label, and ‘holistic’ is a most desirable one, indeed. Nothing sells quackery better than holism.
Most alternative practitioners call themselves holistic and they rub the holism into the minds of their patients whenever and however they can. This insistence on holism has the added advantage that they have seemingly plausible excuses for their therapeutic failures.
Imagine a patient consulting a practitioner with depression and, even after prolonged treatment, her condition is unchanged. Even in such a situation, the holistic practitioner does not need to despair: he will point out that he never treats diagnostic labels but always the whole person. Therefore, the patient’s depression might not have changed, but surely other issues have improved… and, if the patient introspects a little, she might find that her appetite has improved, that her indigestion is better, or that her tennis elbow is less painful (some things always change given enough time). The holism of quacks may be a false pretence, but its benefits for the practitioner are obvious.
My advice: take holism from quacks with a pinch of salt.
We were recently informed that Americans spend more than US$ 30 billion per year on alternative medicine. This is a tidy sum by anyone’s standards, and we may well ask:
Why do so many people opt for alternative medicine?
The enthusiasts claim, of course, that this is because alternative medicine is effective and safe. As there is precious little data to support this claim, it is probably not the true answer. There must be other reasons, and I could name several. For instance, it could be due to consumers being conned by charlatans.
During the 25 years or so that I have been researching alternative medicine, I got the impression that there are certain ‘tricks of the trade’ which alternative practitioners use in order to convince the often all too gullible public. In this series of posts, I will present some of them.
Here are the first three:
TREAT A NON-EXISTING CONDITION
There is nothing better for committing a health fraud than to treat a condition that the patient in question does not have. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will in all likelihood receive a diagnosis of ‘subluxation’. See a TCM practitioner and you might be diagnosed suffering from ‘chi deficiency’ or ‘chi blockage’ etc.
Each branch of alternative practitioners seem to have created their very own diagnoses, and they have one thing in common: they are figments of their imaginations. To arrive at such diagnoses, the practitioner would often use diagnostic techniques which have either been found to lack validity, or which have never been validated at all. Many practitioners appreciate all of this, of course, but it would be foolish of them to admit it – after all, these diagnoses earn them the bulk of their living!
The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it and treat it…until the client has run out of money or patience. Then, one day, the practitioner can proudly announce to his patient “you are completely healthy now”. This happens to be true, of course, because the patient has been healthy all along.
My advice for preventing to get fleeced in this way: make sure that the diagnosis given by an alternative practitioner firstly exists at all in the realm of real medicine and secondly is correct; if necessary ask a real healthcare professional.
As I just stated, practitioners like to treat and treat and treat conditions which simply do not exist. When – for whatever reason – this strategy fails, the next ‘trick of the trade’ is often to convince the patient of the necessity of ‘maintenance’ treatment. This term describes the regular treatment of an individual who is entirely healthy but who, according to the practitioner, needs regular treatments in order not to fall ill in future. The best example here is chiropractic.
Many chiropractors proclaim that maintenance treatment is necessary for keeping a person’s spine aligned – and only a well-serviced spine will keep all of our body’s systems working perfectly. It is like with a car: if you don’t service it regularly, it will sooner or later break down. You don’t want this to happen to your body, do you? To many ‘worried well’, this sounds so convincing that they actually fall for this scam. It goes without saying that the value of maintenance treatment is unproven.
My advice is to start running as soon as a practitioner mentions maintenance treatments.
IT MUST GET WORSE BEFORE IT GETS BETTER
Many patients fail to experience an improvement of their condition or even feel worse after receiving alternative treatments. Practitioners of alternative medicine love to tell these patients that this is normal because things have to get worse before they get better. They tend to call this a ‘healing crisis’. Like so many notions of alternative practitioners, the healing crisis is a phenomenon for which no or very little compelling evidence was ever produced.
Imagine a patient with moderately severe symptoms consulting a practitioner and receiving treatment. There are only three things that can happen to her:
- she can get better,
- she might experience no change at all,
- or she might get worse.
In the first scenario, the practitioner would obviously claim that his therapy is responsible for the improvement. In the second scenario, he might say that, without his therapy, things would have deteriorated. In the third scenario, he would tell his patient that the healing crisis is the reason for her experience. In other words, the myth of the healing crisis is little more than a ‘trick of the trade’ to make even these patients continue supporting the practitioner’s livelihood.
My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.
In a previous post, I asked this important question: how can research into alternative medicine ever save a single life?
The answer I suggested was as follows:
Since about 20 years, I am regularly pointing out that the most important research questions in my field relate to the risks of alternative medicine. I have continually published articles about these issues in the medical literature and, more recently, I have also made a conscious effort to step out of the ivory towers of academia and started writing for a much wider lay-audience (hence also this blog). Important landmarks on this journey include:
Alternative medicine is cleverly, heavily and incessantly promoted as being natural and hence harmless. Several of my previous posts and the ensuing discussions on this blog strongly suggest that some chiropractors deny that their neck manipulations can cause a stroke. Similarly, some homeopaths are convinced that they can do no harm; some acupuncturists insist that their needles are entirely safe; some herbalists think that their medicines are risk-free, etc. All of them tend to agree that the risks are non-existent or so small that they are dwarfed by those of conventional medicine, thus ignoring that the potential risks of any treatment must be seen in relation to their proven benefit.
For 20 years, I have tried my best to dispel these dangerous myths and fallacies. In doing so, I had to fight many tough battles (sometimes even with the people who should have protected me, e.g. my peers at Exeter university), and I have the scars to prove it. If, however, I did save just one life by conducting my research into the risks of alternative medicine and by writing about it, the effort was well worth it.
END OF QUOTE FROM MY PREVIOUS POST
Just now, I received an email from someone who clearly and vehemently disagrees with any of the above. As this blog is a forum where all sorts of opinions can and should be voiced, I thought I share this communication with you. Here it is:
Having been out of chiropractic practice for a while, I was thrilled to hear that you have been forced into early retirement on today’s Radio 4 programme. You have caused so many good people anguish and pain and your tunnel-visioned arrogance is staggering and detrimental to humanity. You REALLY think modern science has all the answers? Wow.
The question I ask myself is who is correct, the (ex-)chiropractor or I?
- Have I caused anguish and pain to many?
- Do I suffer from tunnel-vision?
- Am I arrogant?
- Is my work detrimental to humanity?
- Do I believe that modern science has all the answers?
Here is what I think about these specific questions:
- I have probably caused anguish (but no pain, as far as I am aware). This sadly is unavoidable if one seeks the truth in an area as alternative medicine.
- I am not the best person to judge this.
- Possibly; again I cannot judge.
- I truly don’t see this at all.
- No, not for one second.
In case you wonder what programme the author of the above email had been listening to, you can find it here.
Is there a bottom line? I am not sure. Perhaps this: whenever strong believes clash with scientific facts, some people are going to be unhappy. If we want to make progress, this seems to be almost unavoidable; all we can try to do is to minimize the anguish by being humble and by showing human decency.
Lots of people are puzzled how healthcare professionals – some with sound medical training – can become convinced homeopaths. Having done part of this journey myself, I think I know one possible answer to this question. So, let me try to explain it to you in the form of a ‘story’ of a young doctor who goes through this development. As you may have guessed, some elements of this story are autobiographical but others are entirely fictional.
Here is the story:
After he had finished medical school, our young and enthusiastic doctor wanted nothing more than to help and assist needy patients. A chain of coincidences made him take a post in a homeopathic hospital where he worked as a junior clinician alongside 10 experienced homeopaths. What he saw impressed him: despite of what he had learnt at med school, homeopathy seemed to work quite well: patients with all sorts of symptoms improved. This was not his or anybody else’s imagination, it was an undeniable fact.
As his confidence and his ability to think clearly grew, the young physician began to wonder nevertheless: were his patients’ improvements really due to the homeopathic remedies, or were these outcomes caused by the kind and compassionate care he and the other staff provided?
To cut a long story short, when he left the hospital to establish his own practice, he certainly knew how to prescribe homeopathics but he was not what one might call a convinced homeopath. He decided to employ homeopathy in parallel with conventional medicine and it turned out that he made less and less use of homeopathy as the months went by.
One day, a young women consulted him; she had been unsuccessfully trying to have a baby for two years and was now getting very frustrated, even depressed, with her childlessness. All tests on her and her husband had not revealed any abnormalities. A friend had told her that homeopathy might help, and see had therefore made this appointment to consult a doctor who had trained as a homeopath.
Our young physician was not convinced that he could help his patient but, in the end, he was persuaded to give it a try. As he had been taught by his fellow homeopaths, he conducted a full homeopathic history to find the optimal remedy for his patient, gave her an individualised prescription and explained that any effect might take a while. The patient was delighted that someone had given her so much time, felt well-cared for by her homeopaths, and seemed full of optimism.
Months passed and she returned for several further consultations. But sadly she failed to become pregnant. About a year later, when everyone involved had all but given up hope, her periods stopped and the test confirmed: she was expecting!
Everyone was surprised, not least our doctor. This outcome, he reasoned, could not possibly be due to placebo, or the good therapeutic relationship he had been able to establish with his patient. Perhaps it was just a coincidence?
In the small town where they lived, news spread quickly that he was able to treat infertility with homeopathy. Several other women with the same problem liked the idea of having an effective yet risk-free therapy for their infertility problem. The doctor thus treated several infertile women, about 10, during the next months. Amazingly most of them got pregnant within a year or so. The doctor was baffled, such a series of pregnancies could not be a coincidence, he reasoned.
Naturally, the cases that were talked about were the women who had become pregnant. And naturally, these were the patients our doctor liked to remember. Slowly he became convinced that he was indeed able to treat infertility homeopathically – so much so that he published a case series in a homeopathic journal about his successes.
In a way, he had hoped that, perhaps, someone would challenge him and explain where he had gone wrong. But the article was greeted nationally with much applause by his fellow homeopaths, and he was even invited to speak at several conferences. In short, within a few years, he made himself a name for his ability to help infertile women.
Patients now travelled from across the country to see him, and some even came from abroad. Our physician had become a minor celebrity in the realm of homeopathy. He also, one has to admit, had started to make very good money; most of his patients were private patients. Life was good. It almost goes without saying that all his former doubts about the effectiveness of homeopathic remedies gradually vanished into thin air.
Whenever now someone challenged his findings with arguments like ‘homeopathics are just placebos’, he surprised himself by getting quite angry. How do they dare doubt my data, he thought. The babies are there, to deny their existence means calling me a liar!
OUR DOCTOR HAD BECOME AN EVANGELICALLY CONVINCED HOMEOPATH, AND NO RATIONAL ARGUMENT COULD DISSUADE HIM.
And what arguments might that be? Isn’t he entirely correct? Can dozens of pregnancies be the result of a placebo effect, the therapeutic relationship or coincidence?
The answer is NO! The babies are real, very real.
But there are other, even simpler and much more plausible explanations for our doctor’s apparent success rate: otherwise healthy women who don’t get pregnant within months of trying do very often succeed eventually, even without any treatment whatsoever. Our doctor struck lucky when this happened a few times after the first patient had consulted him. Had he prescribed non-homeopathic placebos, his success rate would have been exactly the same.
As a clinician, it is all too easy and extremely tempting not to adequately rationalise such ‘success’. If the ‘success’ then happens repeatedly, one can be in danger of becoming deluded, and then one almost automatically ‘forgets’ one’s failures. Over time, this confirmation bias will create an entirely false impression and often even a deeply felt conviction.
I am sure that this sort of thing happens often, very often. And it happens not just to homeopaths. It happens to all types of quacks. And, I am afraid, it also happens to many conventional doctors.
This is how ineffective treatments survive for often very long periods. This is how blood-letting survived for centuries. This is how millions of patients get harmed following the advice of their trusted physicians to employ a useless or even dangerous therapy.
HOW CAN THIS SORT OF THING BE STOPPED?
The answer to this most important question is very simple: health care professionals need to systematically learn critical thinking early on in their education. The answer may be simple but its realisation is unfortunately not.
Even today, courses in critical thinking are rarely part of the medical curriculum. In my view, they would be as important as anatomy, physiology or any of the other core subjects in medicine.
MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:
“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”
Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”
What do these arguments amount to, I ask myself.
The answer is NOTHING.
The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.
The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.
There is, of course, a bright side to this:
IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.
When the British Medical Journal (BMJ) asked me for an interview, I felt very honoured and obliged with great pleasure. The result was published in the BMJ earlier this year. I take the liberty of re-publishing it here on my blog because many of my readers do not see the BMJ, and I think it’s rather fun. Moreover, I hope it might provide my critics with more diverse material for ad hominem attacks – the constant allegations that I am in the pocket of ‘Big Pharma’, that I have never done any original research etc. etc. are getting just too boring.
HERE IT IS
Edzard Ernst is a champion of clear thinking in the often murky waters of alternative medicine. As Britain’s first professor of the subject at Exeter, he investigated claims made by its practitioners and found many to be devoid of supporting evidence. He was productive and highly visible and became a bit of an embarrassment to a craven university administration when he took on the Prince of Wales. He was frozen out, as he explains in his book A Scientist in Wonderland (subtitled A Memoir of Searching for Truth and Finding Trouble). Despite it all he, a German by birth, remains a phlegmatic Anglophile.
What was your earliest ambition?
As a young man I wanted to become a jazz musician. I practised enthusiastically—first on the clarinet, then on the drums—and if it had not been for my mother I might have ended up as a (not all that brilliant) drummer.
Who has been your biggest inspiration?
Hans and Sophie Scholl, two Munich University students and members of the White Rose resistance group who opposed Hitler by distributing leaflets at the university. On 23 February 1943, only five days after their arrest, they were executed.
What was the worst mistake in your career?
Most of my friends thought that leaving my chair in Vienna to become a researcher of alternative medicine was a grave error.
What was your best career move?
Leaving Vienna and becoming a researcher of alternative medicine.
Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?
Bevan is an undisputed hero who, in my view, cannot possibly be surpassed by the Lansleys of this world. The worst heath secretary will be the one who finally completes the Tory sell off of the NHS.
Who is the person you would most like to thank and why?
My mother for bringing me into this world and for steering me in the right direction with love and determination.
To whom would you most like to apologise?
To all the patients who, day in, day out, become victims of some form of quackery. It should have been my job to warn them and to point them towards treatments that actually work.
If you were given £1m what would you spend it on?
I might start a charity dedicated to counterbalance the overwhelming amount of misinformation about alternative medicine that consumers constantly have to endure.
When are you happiest?
When I manage to give to others in a way that is truly appreciated.
What single unheralded change has made the most difference in your field in your lifetime?
The intervention of the self proclaimed “enemy of the enlightenment” who advocates “integrated medicine” for the NHS that, for the most part, is unmitigated quackery. Prince Charles certainly made a difference in my field, albeit not in a positive way.
Do you support doctor assisted suicide?
Doctors should be able (but not obliged) to assist their patients in this way.
What book should every doctor read?
My memoir, A Scientist In Wonderland, of course. But not really—I find the idea of one book for all doctors a little bizarre.
What poem, song, or passage of prose would you like mourners at your funeral to hear?
When they are about to go home I’d like them to listen to the Bonzo Dog Doo-Dah Band performing “I’m Going to Bring a Watermelon to My Girl Tonight.”
What is your guiltiest pleasure?
Research! During the past 20 years pen pushers of various kinds have managed to make it feel like a guilty pleasure.
If you could be invisible for a day what would you do?
I would try to do some mischief that benefits all of us, such as transferring all bankers’ bonuses to the NHS or vaccinating the children of “anti-vaxxers.”
Clarkson or Clark? Would you rather watch Top Gear or Civilisation? What television programmes do you like?
I have to admit that I do sometimes watch Clarkson, mostly to learn how to avoid coming across like a middle aged chauvinist. If, however, I want to have a good time in front of my TV I watch a Bond film, only to doze off after the opening sequence.
What is your most treasured possession?
My memories of friends and family, of good times and tears of laughter.
What, if anything, are you doing to reduce your carbon footprint?
Wearing one or, if necessary, two extra layers (sometimes even thermal skiing underwear) when an icy wind makes our Suffolk home too cold for comfort.
What personal ambition do you still have?
To be on the BBC Radio 4 programme Desert Island Discs. It would be such a fun way to link life, medicine, and music.
Summarise your personality in three words
Stubborn, compassionate, rational.
Where does alcohol fit into your life?
As a collector of fine Bordeaux wines, I can hardly deny that it often fits very well indeed.
What is your pet hate?
Administrators who seem to think that the prime role of everyone else is to accommodate their whims.
What would be on the menu for your last supper?
As long as the wine for the main course is a Chateau Latour from a good year, I don’t mind.
Do you have any regrets about becoming a doctor and academic?
If you weren’t in your present position, what would you be doing instead?
I would probably be sitting behind a drum kit making even more disturbing noises.
A recent article in the LIVERPOOL ECHO caught my eye. It is about the possibility that the NHS in Liverpool might stop funding their homeopathy service . Maybe I should read the LIVERPOOL ECHO more often, because the short article is most revealing.
It first cites the chairman of the local NHS Clinical Commissioning Group, Dr Nadim Fazlani saying that “There is little evidence that homeopathy has a clinical benefit so, as a governing body, our preferred option would be to stop commissioning this service. However, it is important that the people have an opportunity to provide their views before a decision is made.”
I would like to mention, however, that health care is not a beauty contest or a supermarket shelve. We don’t have popular votes for bone marrow transplants or bypass surgery either. Why? Not because we don’t believe in democracy but because the general public cannot possibly understand medicine well enough. This is why we send some of our kids to medical school and other institutions to help us comprehend and eventually take responsible decisions for us. It is, I think, an ethical imperative to base important health care decisions of this nature on the best evidence and expertise, and it seems foolish to expect the public to have either.
Then the article in the LIVERPOOL ECHO quotes a statement of the Liverpool homeopathy service which is run by GPs Dr Hugh Nielsen and Dr Sue de Lacy: “The patients we see generally have long-standing, complex conditions that are often difficult to treat with conventional medicine. Yet regular audits of our clinic show a very high level of patient satisfaction, with patients consistently reporting an improvement in their health. As experienced doctors trained in homeopathy we see it working every day and that is why we believe Liverpool CCG – and more importantly the patients the CCG serves – is getting excellent value for the relatively small amount of funding the service receives.”
I find this interesting, not least because the arguments used by these two GPs are, in my view, miles better than those we have seen on this blog recently by Christian Boiron, Dana Ullman, Dr Michael Dixon or the Queen’s homeopath Dr Fisher all put together. At least they do not contain blatant lies!
This does not mean, however, that the arguments of the two homeopaths from Liverpool are convincing. They are not – for the following 4 reasons:
- True, long-standing, complex conditions are often difficult to treat with conventional medicine. But if they are difficult to treat with real medicine, they surely are even more difficult to treat with fake medicine.
- I have no problem believing that their audits show high level of patient satisfaction, with patients consistently reporting an improvement in their health. But we need to be quite clear that these effects are not brought about by the homeopathic remedies which contain zero active ingredients. They are due to the compassion shown by these homeopath. If they prescribed real medicine in addition to providing compassion, their results would in all likelihood be even better.
- It is also true that an experienced doctor trained in homeopathy will see it working every day. But the ‘it’ refers not to the remedy, it relates to the compassion – and to convey compassion, we do not need bogus treatments.
- It is a little misleading to claim that homeopathy is ‘excellent value’. The remedies contain nothing but lactose, and £ 5-10 for a gram or two of lactose is jolly expensive! So, the remedies are over-priced placebos, and the consultations might be good value.
Despite these counter-arguments, I must congratulate these two GPs from Liverpool: they seem to be so much more honest and intelligent than the defenders of homeopathy mentioned above.
Regular readers of this blog will have noticed: I recently published a ‘memoir‘.
Of all the books I have written, this one was by far the hardest. It covers ground that I felt quite uncomfortable with. At the same time, I felt compelled to write it. For over 5 years I kept at it, revised it, re-revised it, re-conceived the outline, abandoned the project altogether only to pick it up again.
When it eventually was finished, we had to find a suitable title. This was far from easy; my book is not a book about alternative medicine, it is a book about all sorts of things that have happened to me, including alternative medicine. Eventually we settled for A SCIENTIST IN WONDERLAND. A MEMOIR OF SEARCHING FOR TRUTH AND FINDING TROUBLE. This seemed to describe its contents quite well, I thought (the German edition is entitled NAZIS, NADELN UND INTRIGEN. ERINNERUNGEN EINES SKEPTIKERS which indicates why it was so difficult to put the diverse contents into a short title).
Then a further complication presented itself: at the very last minute, my publisher insisted that the text had to be checked by libel lawyers. This was not only painful and expensive, following their advice and thus changing or omitting passages also took some of the ‘edge’ off it.
Earlier this year, my ‘memoir’ was finally published; to say that I was nervous about how it might be received must be the understatement of the year. As it turned out, it received so many reviews that today I feel deeply humbled (and very proud), particularly as they were all full of praise and appreciation. In case you are interested, I provide some quotes and the links to the full text reviews below.[Ah, yes! Some people will surely claim that I did all this for the money. To those of my critics, I respond by saying that, had I done paper rounds or worked as a gardener or a window-cleaner during all the time I spent on this book, I would today be considerably better off. As it stands, the costs for the libel read are not yet covered by the income generated through the sales of this book.]
AND HERE ARE THE PROMISED QUOTES
Times Higher Education Book of the Week
Times Higher Education – Helen Bynum, Jan 29, 2015
“[F]or 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… 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.”
The Spectator – Nick Cohen, Jan 31, 2015
“If you want a true measure of the man, buy Edzard Ernst’s memoir A Scientist in Wonderland, which the Imprint Academic press have just released. It would be worth reading [even] if the professor had never been the victim of a royal vendetta.”
The Bookbag review
The Bookbag – Sue Magee, Jan 28, 2015
“Ernst isn’t just an academic – he’s also an accomplished writer and skilled communicator. He puts over some quite complex ideas without resorting to jargon and I felt informed without ever struggling to understand, despite being a non-scientist. I was pulled into the story of his life and read most of the book in one sitting… I was impressed by what Ernst had to say and the way in which he said it.”
Science-Based Medicine review
Science-Based Medicine – Harriet Hall, Feb 3, 2015
“Edzard Ernst is one of those rare people who dare to question their own beliefs, look at the evidence without bias, and change their minds… In addition to being a memoir, Dr. Ernst’s book is a paean to science… He shows how misguided ideas, poor reasoning, and inaccurate publicity have contributed to the spread of alternative medicine… This is a well-written, entertaining book that anyone would enjoy reading and that advocates of alternative medicine should read: they might learn a thing or two about science, critical thinking, honesty, and the importance of truth.”
Nature – Barbara Kiser, Feb 5, 2015
“[T]his ferociously frank autobiography… [is] a clarion call for medical ethics.”
The Times – Robbie Millen, Feb 9, 2015
“A Scientist in Wonderland is a rather droll, quick read… [and] it’s an effective antidote to New Age nonsense, pseudo-science and old-fashioned quackery.”
AntiCancer.org.uk – Pan Pantziarka, Feb 19, 2015
“It should be required reading for everyone interested in medicine – without exception.”
Mail Online review
Mail Online – Katherine Keogh, Feb 28, 2015
“In his new book, A Scientist In Wonderland: A Memoir Of Searching For Truth And Finding Trouble, no one from the world of alternative medicine is safe from Professor Edzard Ernst’s firing line.”
James Randi Educational Foundation review
James Randi Educational Foundation – William M. London, Mar 9, 2015
“The writing in A Scientist in Wonderland is clear and engaging. It combines good storytelling with important insights about medicine, science, and analytic thinking. Despite all the troubles Ernst encountered, I found his story to be inspirational. I enthusiastically recommend the book to scientists, health professionals, and laypersons who like to see nonsense and mendacity exposed to the light of reason.”
The Pharmaceutical Journal review
The Pharmaceutical Journal – Andrews Haynes, Mar 26, 2015
“This engaging book is a memoir by a medical researcher whose passion for discovering the truth about untested therapies eventually forced him out of his job… [This] highly readable book concentrates on fact rather than emotion. It should be required reading for anyone interested in medical research.”
Skepticat – Maria MacLachlan, Apr 18, 2015
“A Scientist in Wonderland is more than an autobiography and I’m not sure I can do justice to the riches to be found in its pages. Sometimes it’s reminiscent of a black comedy, other times it’s almost too painful to read.”
Spiked! – Robin Walsh ,May 15, 2015
“Ernst’s book is a reminder of the need to have the courage to tell the truth as you understand it, and fight your corner against those in authority, while never losing a compassion for patients and a commitment to winning the debate. ”
Australasian Science review
Australasian Science – Loretta Marron, Jun 10, 2015
“Edzard Ernst is a living legend… The book is easy to read and hard to put down. I would particularly recommend it to anyone, with an open mind, who is interested in the truth or otherwise of CAM.”
Journal of the Royal Society of Medicine Review
JRSM – Michael Baum, June 2015
“This is a deeply moving and deeply disturbing book yet written with a light touch, humour and self-deprecation.”
THE BUFFALO NEWS
These enlightening books await summer readers. 21 June 2015
“Medical researcher Edzard Ernst spent most of his career stepping on toes. He first exposed the complicity of the German medical profession in the Nazi genocide. Then he accepted appointment as the world’s first chairman of alternative medicine at England’s University of Exeter. There he studied systematically the claims of the proponents of complementary medicine, a field dominated by evangelic and enthusiastic promoters, including Prince Charles. Needless to say, they did not take kindly to his exposures of many of their widely accepted therapies. His book, “A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble,” is a charming account of a committed life.”
“The book is first and foremost a memoir. Even those of us who have long followed Ernst’s research may well find a few surprises here…[Ernst] did not quite behave as many people expected him to after taking up his post in Exeter. He was committed to carrying out high-quality research into the efficacy and safety of CAM, not simply promoting its use in an uncritical manner. This admirable attitude won him much respect in the eyes of fellow scientists and the wider skeptical community.
Dear Professor Robinson,
please forgive me for writing to you in a matter that, you might think, is really none of my business. I have been following the news and discussions about the BLACKMORE CHAIR at your university. Having been a professor of complementary medicine at Exeter for ~20 years and having published more papers on this subject than anyone else on the planet, I am naturally interested and would like to express some concerns, if you allow me to.
With my background, I would probably be the last person to argue that a research chair in alternative medicine is not a good and much-needed thing. However, accepting an endowment from a commercially interested source is, as you are well aware, a highly problematic matter.
I am confident that you intend to keep the sponsor at arm’s length and plan to appoint a true scientist to this post who will not engage in the promotional activities which the alternative medicine scene might be expecting. And I am equally sure that the money will be put to good use resulting in good and fully independent science.
But, even if all of this is the case, there are important problems to consider. By accepting Blackmore’s money, you have, perhaps inadvertently, given credit to a commercially driven business empire. As you probably know, Blackmores have a reputation of being ‘a bit on the cavalier side’ when it comes to rules and regulations. This is evidenced, for instance, by the number of complaints that have been upheld against them by the Australian authorities.
For these reasons, the creation of the new chair is not just a step towards generating research, it could (and almost inevitably will) be seen as a boost for quackery. It is foremost this aspect which might endanger the reputation of your university, I am afraid.
My own experience over the last two decades has taught me to be cautious and sceptical regarding the motives of many involved in the multi-billion alternative medicine business. I have recently published my memoir entitled ‘A SCIENTIST IN WONDERLAND. SEARCHING FOR TRUTH AND FINDING TROUBLE’; it might be a helpful read for you and the new professor.
I hope you take my remarks as they were meant: constructive advice from someone who had to learn it all the hard way. If I can be of further assistance, please do not hesitate to ask me.