One of the questions that I hear regularly is: ‘What happened to your research unit at Exeter?’ Therefore it might be a good idea to put the full, shameful story on this blog.
After the complaint by Prince Charles’ secretary to my Vice Chancellor alleging that I had breached confidentiality over the Smallwood report, my University conducted a 13 months investigation into my actions. At the end of it, I was declared innocent as charged (it should have been clear from a 10 minute discussion that I had done nothing wrong: I had not disclosed any information from the report, and even if I had, it would have been a matter of public interest and medical ethics to blow the whistle. However, the Vice Chancellor never once bothered to talk to me.). Subsequently, all support that I had once enjoyed broke down, my staff’s contracts were terminated, and I eventually had to take early retirement (full details of this part of the story can be found in ‘A SCIENTIST IN WONDERLAND’).
A few months later, a new dean was appointed at my medical school. The new man seemed to have a lot more understanding for my situation than his predecessor. Provided that I accept to go into early retirement, he offered to re-employ me for one year (half time) to help him find a successor for my position.
I did accept because, above everything, I wanted to prevent the closure of my unit. We then developed criteria for advertising the post and conducted two rounds of advertisements. Several candidates applied but none them seemed suited in our view. Eventually we did find several experts who were promising; one even came to Exeter from abroad and had detailed talks with the dean and several other people.
However, Exeter was unwilling to equip my potential successor with any funds to speak of. The suggestion was to appoint the new chair with the onus to raise all the necessary funds himself. This is a proposition that no well-qualified academic at the professorial level can possibly find attractive. Consequently, the candidates all declined.
Meanwhile, there had been an initiative by several altruistic UK public figures and friends to raise funds for the new chair and thus save my unit from closure. Sadly, however, these activities did not generate in the necessary cash. When my year of half-time re-employment had expired, I left Exeter and my unit disappeared for good.
To the present day, I am not at all sure what the true intentions of Exeter had been during this final stage.
- Was I offered re-employment simply to keep me sweet?
- Did they fear that I would otherwise sue them or cause a public scandal?
- Did they truly believe they could find a suitable successor?
- If so, why did they not put up the money?
I do not expect to ever find conclusive answers for any of these questions. However, I do know what, in an ideal world, should have become of my unit. If it had been for me to decide, I would have equipped the chair with the necessary core funds and appointed an ethicist with a documented interest in alternative medicine as the new professor. I see two main reasons for this perhaps less than obvious choice:
- In my experience, Exeter would greatly benefit from an ethicist to give them guidance on a range of matters.
- After two decades of being involved in alternative medicine research, I have become convinced that this field foremost needs the input of a critical ethicist.
In case either of these last two statements puzzles you, I recommend you read ‘A SCIENTIST IN WONDERLAND’.
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.
All this recent attention to Charles’ amazing letters and unconstitutional meddling made me think quite a lot about STUPIDITY. Thus I came across the writings of Carlo Maria Cipolla who seemed to have thought deeply about human stupidity. He described “The Basic Laws of Human Stupidity” and viewed stupid people as a group of individuals who are more powerful by far than even major organizations. I liked his approach; it made me think of Prince Charles, strangely enough.
It might be interesting, I concluded, to analyse Charles’ actions against Cipolla’s 5 laws.
Here are Cipolla’s 5 basic laws of stupidity:
- Always and inevitably each of us underestimates the number of stupid individuals in circulation.
- The probability that a given person is stupid is independent of any other characteristic possessed by that person.
- A person is stupid if they cause damage to another person or group of people without experiencing personal gain, or even worse causing damage to themselves in the process.
- Non-stupid people always underestimate the harmful potential of stupid people; they constantly forget that at any time anywhere, and in any circumstance, dealing with or associating themselves with stupid individuals invariably constitutes a costly error.
- A stupid person is the most dangerous type of person there is.
How does Charles measure up against these criteria, I ask myself? Let’s go through the 5 ‘laws’ one by one.
Charles is just a ‘study of one’, so this point is irrelevant as far as he is concerned. However, he surrounds himself with yes-men of the Dixon-type (I have blogged about him here and here and here), and this evidence seems to confirm this point at least to a certain degree.
Charles had a good education, he is rich, he has influence (just read my previous post on how he made his influence felt in Exeter), and he has many other characteristics which make him unlikely to appear stupid. So, this point seems to be spot on.
Read my previous post and you will agree that this ‘law’ applies to Charles quite perfectly.
Yes, I did underestimate Charles influence. In particular, I did not appreciate the importance and impact of the KNIGHTHOOD STARVATION SYNDROME.
I think that this is a valid point. His ‘black spider memos’ reveal that he is obsessed with integrating bogus treatments into the NHS to the inevitable detriment of public health. And what could be more dangerous than that?
CONCLUSION: FROM THIS BRIEF ANALYSIS, IT SEEMS AS THOUGH THE ‘FIVE BASIC LAWS OF STUPIDITY’ ARE CONFIRMED BY THE ACTIONS OF PRINCE CHARLES
Prince Charles’ meddling beyond his constitutional role is yet again in the press today. I was sent the 2nd batch of ‘spider memos’ yesterday, studied them and commented as follows:
The letters demonstrate yet again that Prince Charles relentlessly meddles in UK health politics and thus disrespects his constitutional role. His arguments in favour of CAM, and in particular homeopathy, show a devastating lack of knowledge and understanding; they are ill-informed, invalid and embarrassingly naïve – but at the same time they are remarkably persistent. Charles tries to give the impression that he is motivated by passion and compassion, but in health care such drivers need solid evidence and expertise. Charles has neither which is not just regrettable, it is arrogant on his part and potentially harmful for public health.
If you get the feeling that I have little patience with Charles’ meddling, you may be right. I have little doubt that it was his interfering that led to the closure of my research unit at Exeter. In my book, A SCIENTIST IN WONDERLAND, I provide the full details of what happened. Here I would just like to reproduce the incredible ‘spider memo’ in question.
It was not actually authored by Charles but by Sir Michael Peat, his 1st private secretary. On 22 September 2005, Peat wrote on Clarence House note-paper to the Vice Chancellor of Exeter University wrongly accusing me of a serious breach of confidentiality:
I am writing both as The Prince of Wales’ Private Secretary and as Acting Chairman of His Royal Highness’ Foundation for Integrated Health.
There has been a breach of confidence by Professor Edzard Ernst in respect of a draft report on the efficacy of certain complementary therapies sent to him by Mr. Christopher Smallwood. The report was commissioned by The Prince of Wales.
Mr. Smallwood sent Professor Ernst an early and, at that stage, incomplete draft of the report for comment. The accompanying e-mail requested and stressed the need for confidentiality. Professor Ernst implicitly agreed to comment on the report on this basis but then, as you probably saw, gave his views about the report to the national press. I attach a copy of a letter from the Editor of the Lancet published by The Times which summarises the issues well. I also attach a copy of the e-mail sent to Professor Ernst by Mr. Smallwood.
I apologise for troubling you, but I felt that you should have this matter drawn to your attention.
What followed was embarrassing and shameful: my uni started a 13 month investigation, eventually I was pronounced innocent but my unit was closed down. Unbelievably, Clarence house denied that Charles even knew about this amazing attempt to meddle in academic affairs. As I say, you need to read my memoir to understand this story fully.
The Telegraph today reports that, despite relentless lobbying from the Prince of Wales, UK herbalists will not, after all, be regulated by statute. Here are the most important statements from this article:
Prof David Walker, deputy chief medical officer, said he had taken the decision because there was insufficient evidence that the alternative therapy works, making it impossible to set standards of good practice. Three years ago ministers had pledged to bring in an official register of practitioners of herbal and Chinese medicines, which would see therapists regulated alongside other health workers, such as physiotherapists and speech therapists…But ministers blocked the proposals, instead setting up a new committee, led by the NHS deputy chief medical officer – which has now ruled against statutory regulation. The decision came despite lobbying from Prince Charles, a keen advocate of complementary medicines, and a supporter of regulation, who held a meeting with Jeremy Hunt in 2013 in which his concerns were raised…Prof Walker said that although most herbal practitioners were in favour of regulation, those opposed to it feared it would “confer an inappropriate level of legitimacy on herbal practice which was poorly supported by scientific evidence.” He said the decision to rule against regulation was “undoubtedly the most contentious area” addressed by the working party, which also looked at the safety of herbal medicine products. Instead, the report calls for a review of all ingredients sold in such medicines, to check their safety, with a “voluntary register” for practitioners who use them. It says there is too little evidence to show that herbal medicines improve health outcomes, making it “difficult to establish the boundaries of good practice” in regulating practitioners. It also says there is very little understanding of the risks posed to patients from current practices in herbal medicine…Prof Walker’s recommendation has triggered an immediate rift among the 26 members of his working party. Twelve members of the working party have written to Dr Dan Poulter, health minister, alleging that the decision will put the safety of the public at risk, because anyone will be able to promote themselves as an expert in herbal medicine, without any training. Research suggests around three million Britons a year consult herbal practitioners, operating in shops, online and in private clinics, with up to one in 12 of all adults using a herbal medicine at some stage. Michael McIntyre, chairman of the European Herbal and Traditional Medicine Practitioners Association, said the decision not to regulate practitioners could put the public at risk from rogue operators, with no training. The herbal practitioner, who was a member of the DoH working party, said: “We are deeply disappointed by this. We feared this issue was going to be kicked into the long grass, by quietly putting something out just before the election – and that is exactly what has happened.” He said the public needed the reassurance of statutory regulation, to know that any herbal doctor who is practising had received some training. The association disputed claims there was insufficient evidence to show that herbal medicines worked, saying that several trials had shown its impact for a number of conditions, but that the sector had less money than the pharmaceutical industry had to undertake mass research. The report says that although ministers promised “some form of regulation of herbal practitioners” this only committed the working party to consider the options, and that the introduction of regulation would require the sector to be “more science and evidence-based”.
Perhaps I should first state that I was not involved in any way in this process. Furthermore, I must say that I do think it is the right decision. To understand it better, I need to refer to several previous posts: yes, some herbal medicines are demonstrably effective. But the regulation in question is NOT about herbal medicines; it is about herbal practitioners, and the two are not necessarily related. UK herbal practitioners practice within a range of traditions including traditional European herbalism, TCM, or other schools of thought. They differ vastly but have one characteristic in common: they individualise their prescriptions according to the specific characteristics of the patient. Thus they would rarely prescribe the evidence-based herbal medicines but mix up prescriptions composed of several herbal ingredients. The problems with this approach are numerous:
- there is no good evidence that this approach of individualised herbalism is effective;
- the safety of the herbs used by traditional herbalists is often unknown;
- traditional herbalists tend to use obsolete diagnostic techniques, false-positive and false-negative diagnoses are thus inevitable;
- some of the herbal mixtures have been shown to be contaminated with toxic ingredients;
- some mixtures are adulterated with powerful prescription drugs;
- the herbal ingredients could interact with each other in an unpredictable manner;
- the herbal mixtures might interact with prescribed drugs.
The long and short of it is that nobody knows whether the treatments of traditional herbalists generate more good than harm. Regulating these professions by statute would merely give them a level of credibility that they do not deserve. As with the regulation of chiropractors or osteopaths in the UK, the regulation of herbalists would simply misled the public about the value of traditional herbalism, and it most likely would have prompted the herbalists to happily rest on their assumed merits claiming that their effectiveness and safety has been officially acknowledged and is therefore no longer in doubt.
In a nutshell: THE ‘PROPER’ REGULATION OF NONSENSE GENERATES PROPER NONSENSE
The following episode gives just one of many examples of attempts by my Exeter peers to sabotage my scientific, moral and ethical standards. The players in this scene are:
- Prof John Tooke, at the time dean of my medical school,
- Dr Michael Dixon, GP in Devon,
- Nelson’s homeopathic pharmacy, known from my previous post,
- Mr Simon Mills, former director of the Centre for Complementary Health Studies, University of Exeter,
- Prince Charles, future king of England.
By the year 2000, I began to experience unnecessary unpleasantness at Exeter on a more and more regular basis. This passage from my book describes the key moment when it became clear to me that something profoundly wrong was going on:
The watershed came in 2003, when I saw an announcement published in the newsletter of the Prince of Wales’ Foundation for Integrated Health:
“The Peninsula Medical School aims to become the UK’s first medical school to include integrated medicine at postgraduate level. The school also plans to extend the current range and depth of programmes offered by including healthcare ethics and legislation. Professor John Tooke, dean of the Peninsula Medical School, said: “The inclusion of integrated medicine is a patient driven development. Increasingly the public is turning to the medical profession for information about complementary medicines. This programme will play an important role in developing critical understanding of a wide range of therapies”.
When I stumbled on this announcement, I was truly puzzled. Tooke is obviously planning a new course for me, I thought, but why has he not told me about it? When I enquired, Tooke informed me that the medical school was indeed preparing to offer a postgraduate “Pathway in Integrated Health”; this exciting new innovation had been initiated by Dr Michael Dixon, a general practitioner who, after working in collabora-tion with my unit for several years, had become one of the UK’s most outspoken proponents of spiritual healing and other similarly dubious forms of alternative medicine. For this reason, Dixon was apparently very well regarded by Prince Charles.
A few days after I had received this amazing news, Dixon arrived at my office and explained, with visible embarrassment, that Prince Charles had expressed his desire to him personally to establish such a course at Exeter. His Royal Highness had already facilitated its funding which, in fact, came from “Nelsons”, one of the UK’s largest manufacturers of homeopathic remedies. The day-to-day running of the course was to be put into the hands of the ex-director of the Centre for Complementary Health Studies (CCHS), the very unit that, almost a decade earlier, I had struggled—and eventually even paid—to be separated from because of its overtly anti-scientific agenda. The whole thing had been in the planning for many months. I was, it seemed, the last to know—but now that I had learnt about it, Dixon and Tooke leaned on me with all their might to persuade me to contribute to this course by giving a few lectures.
I could no more comply with this request than fly. Apart from anything else, anyone who had read my papers would have known that I was opposed in principle to the concept of “Integrated Health”. As I saw it, “integrating” quackery with genuine, science-based medicine was nothing less than a profound betrayal of the ethical basis of medical practice. By putting its imprimatur on this course, and by offering it under the auspices of a mainstream medical school, my institution would be encouraging the dangerously erroneous idea of equivalence—i.e. the notion that alternative and mainstream medicine were merely two parallel but equally valid and effective methods of treating illness.
To add insult to injury, the course was to be run by someone who I had good reason to reject and sponsored by a major manufacturer of homeopathic remedies. In all conscience, the latter circumstance seemed to me to be the last straw. Study after study carried out by my unit had found homeopathy to be not only conceptually absurd but also therapeutically worthless. To all intents and purposes, the discussion about the value of homeopathy was closed. Even a former director of the Royal London Homeopathic Hospital had concluded in his book that “homeopathy has not been proved to work… the great majority… of the improvement that patients experience is due to non-specific causes”. If we did not take a stand on this issue, we might as well give up and go home. Consequently, I politely but firmly declined the offer of participating in this course.
By now numerous other incidents of a similar nature had poisoned the atmosphere at my own medical school and university so much that both my work and my health were suffering. How had it come to this? Why was even the most obvious and demonstrable truth being turned upside down so that it could be used against me? Why were my peers seemingly bent on constraining me and making life increasingly difficult for me?
Chapter 5 of my memoir is entitled ‘OFF WITH HIS HEAD’. It describes the role that Prince Charles played in promoting what he now likes to call ‘integrated medicine’. The weird thing is that he was instrumental in creating my Exeter chair…and eventually in getting it shut down. Here is a short sample to whet your appetite:
With the wisdom of hindsight, it is clear to me now that my hope of bringing the scientific method to bear on alternative medicine was doomed from the start. Reason cannot negotiate with unreason any more than fire and water can commingle peacefully. In either case, a great deal of spitting and hissing is bound to ensue—and precious little else.
Soon after arriving in Exeter, in 1993, I learnt of the long-standing interest Prince Charles had in alternative medicine: he had asked via my Vice Chancellor for a copy of my inaugural lecture, and I remember being delighted at this request. As I never give lectures or speeches from a script, I even composed a summary specifically for him. In return, I received a polite note of thanks from one of his secretaries. This is great, I thought.
I was thrilled that someone as influential as Prince Charles would be interested in my work. What could be better than having support in such high places? Surely, there would come the time when I could meet the Prince and have an open exchange of views. I had no doubt that he would be keenly aware of the obvious necessity for rigorous research—in fact, he often enough had publicly stressed it—and would thus support my research endeavours.
How wrong can one be? Prince Charles turned out to be no supporter of my work. To the contrary: he seemed to be a staunch advocate of unreason and a formidable opponent of any attempt to bring science or critical thinking to bear on alter-native medicine. What is more, subsequent events suggested to me that his intervention played a part in the closure of my unit.
Guest post by Louise Lubetkin
(A SCIENTIST IN WONDERLAND: A MEMOIRE OF SEARCHING FOR TRUTH AND FINDING TROUBLE has now been published. An apt opportunity perhaps to post a letter and comment from the person who helped me GREATLY in finishing it.)
People write memoirs for a variety of reasons but perhaps one of the strongest impelling forces is the need to make sense of one’s own experiences. It is not surprising that you, who spent your entire professional career searching for explanations, identifying associations and parsing correlations, found yourself looking at your own life with the same analytical curiosity. Memoir is in many respects a natural choice in this regard.
That you chose to undertake a profoundly personal inventory at this juncture is also understandable in human terms. Retirement, whether anticipated and planned for, or (as in your case) thrust rudely upon you, reorders one’s sense of identity in ways that cannot fail to prompt reflection. It would have been surprising had you not felt an urge to look back and take stock, to trace the narrative arc of your life from its beginnings in post-war Germany all the way to the quiet house in rural Suffolk where you now sit, surrounded by the comfort of books and the accumulated paraphernalia of a life spent digging and delving in search of the building blocks of truth.
Given the contentious circumstances surrounding your departure from academic life, it is quite likely that you will be asked whether your decision to write a memoir was driven, at least in part, by a desire to settle scores. I think you can dismiss such a question unhesitatingly. You have no scores to settle: you came to England after a steady and unbroken ascent to the apex of your professional career, voluntarily leaving behind a position that most people would regard with envy and deference. You were never a supplicant at Exeter’s door; far from it. The fact that things went inexorably downhill over the course of your 20 years’ tenure there, and ended so deplorably, is not a reflection on you, your department, or the quality or quantity of work you turned out. Rather, it is a reflection on the very nature of the work you went there to do – and if there is any message in your memoir, it is this:
Alternative medicine is not, at its heart, a logical enterprise, and its adherents are not committed to – nor even interested in – a rational evaluation of their methods. Rather, alternative medicine is primarily an ideological position, a political credo, a reaction against mainstream medicine. To many of its adherents and impassioned advocates, its appeal lies not in any demonstrable therapeutic efficacy but in its perceived outsider status as the countercultural medicine, the medicine for Everyman, the David to the bullying medical-pharmaceutical Goliath. That your research work would elicit howls of protest was perhaps inevitable, given the threat it posed to the profitable and powerful alternative medicine industry. But it didn’t stop there: astonishingly, your work drew the ire of none less than the meddlesome heir apparent to the British throne. Prince Charles’ attempts to stymie your work call to mind the twelfth century martyr Thomas à Becket, of whom Henry II reputedly cried: “Oh, who will rid me of this turbulent priest?” (Henry’s sycophantic henchmen were quick to oblige, dispatching the hapless cleric on the steps of Canterbury cathedral.)
It’s clear that you were acutely aware, as a young man growing up in Germany, that science was not immune to the corrupting influence of political ideology, and that the German medical profession had entered – enthusiastically – into a Faustian compact with the Nazi regime. You have exhibited a courageous insistence on confronting and examining a national past that has at times felt like an intensely personal burden to you. It is ironic that in going to sleepy Exeter in an earnest, conscious attempt to shake off the constricting, intrigue-ridden atmosphere of academic Vienna, you ultimately found yourself once again mired in a struggle against the influence of ideology and the manipulation of science for political ends.
You went to Exeter strictly as a scientist, a skilled inquirer, a methodical investigator, expecting to be able to bring the rigors of logic and the scientific method to bear on an area of medical practice that had until then not been subjected to any kind of systematic evaluation. Instead, you were caught in a maelstrom of intrigue far worse than that which you had gratefully left behind in Vienna, buffeted and bruised by forces against which a lesser man would surely not have had the fortitude to push back so long and so hard.
I know, it’s not really original to come up with the 10000th article on “10 things…” – but you will have to forgive me, I read so many of these articles over the holiday period that I can’t help but jump on the already over-crowded bandwagon and compose yet another one.
So, here are 10 things which could, if implemented, bring considerable improvement in 2015 to my field of inquiry, alternative medicine.
- Consumers need to get better at acting as bull shit (BS) detectors. Let’s face it, much of what we read or hear about this subject is utter BS. Yet consumers frequently lap up even the worst drivel like it were some source of deep wisdom. They could save themselves so much money, if they learnt to be just a little bit more critical.
- Dr Oz should focus on being a heart surgeon. His TV show has been demonstrated far too often to be promoting dangerous quackery. Yet as a heart surgeon, he actually might do some good.
- Journalists ought to remember that they have a job that extends well beyond their ambition to sell copy. They have a responsibility to inform the public truthfully and responsibly.
- Book publishers should abstain from churning out book after book that does little else but mislead the public about alternative medicine in a way that all to often is dangerous to the readers’ health. The world does not need the 1000th book repeating nonsense on detox, wellness etc.!
- Alternative practitioners must realise that claiming that therapy x cures condition y is not just slightly over-optimistic (or based on ‘years of experience’); if the claim is not based on sound evidence, it is what most people would call an outright lie.
- Proponents of alternative medicine should learn that it is neither fair nor productive to fiercely attack everyone personally who disagrees with their enthusiasm for this or that form of alternative medicine. In fact, it merely highlights the acute lack of rational arguments.
- Researchers of alternative medicine have to remember how important it is to think critically – an uncritical scientist is at best a contradiction in terms and at worst a pseudo-scientist who is likely to cause harm.
- Authorities should amass the courage, the political power and the financial means of going after those charlatans who ruthlessly exploit the public by making a fast and easy buck on the gullibility of consumers. Only if there is the likelihood of hefty fines will we see a meaningful decrease in the current epidemic of alternative health fraud.
- Politicians should realise that alternative medicine is not just a trivial subject with which one might win votes, if one issues platitudes to please the majority; alternative medicine is used by so many people that it has become an important public health issue.
- Prince Charles need to learn how to control himself and abstain from meddling in health politics by using every conceivable occasion to promote what he thinks is ‘integrated medicine’ but which, in fact, can easily be disclosed to be quackery.
As you see, my list almost instantly turned into a wish-list, and the big questions that follow from it are:
- How could we increase the likelihood of these wishes to come true?
- And would there be anything left of alternative medicine, if all of these wishes miraculously became true in 2015?
I do not pretend to have the answers, but I do feel strongly that a healthy dose of critical thinking in all levels of education – from kindergartens to schools, from colleges to universities etc. – would be a good and necessary starting point.
I know, my list is not just a wish list, it also is a wishful thinking list. It would be hopelessly naïve to assume that major advances will be made in 2015. I am realistic, sometimes even quite pessimistic, about progress in alternative medicine. But this does not mean that I or anyone else should just give up. 2015 will be a year where at least one thing is certain: you will see me continuing me my fight for reason, critical analysis, rational debate and good evidence – and that’s a promise!
THIS POST IS DEDICATED TO HRH, THE PRINCE OF WALES WHO CELEBRATES HIS 66TH BIRTHDAY TODAY AND HAS SUPPORTED HOMEOPATHY ALL HIS LIFE
Like Charles, many people are fond of homeopathy; it is particularly popular in India, Germany, France and parts of South America. With all types of health care, it is important to make therapeutic decisions in the knowledge of the crucial facts. In order to aid evidence-based decision-making, I will summarise a few things you might want to consider before you try homeopathy – either by buying homeopathic remedies over the counter, or by consulting a homeopath.
- Homeopathy was invented by Samuel Hahnemann, a charismatic German doctor, about 200 years ago. At the time, our understanding of the laws of nature was woefully incomplete, and therefore Hahnemann’s ideas seemed far less implausible than they actually are. Moreover, the conventional treatments of this period were often more dangerous than the disease they were supposed to cure; consequently homeopathy was repeatedly shown to be better than ‘allopathy’ (a term coined by Hahnemann to insult conventional medicine). Thus Hahnemann’s treatments were an almost instant worldwide success. When, about 100 years later, more and more effective conventional therapies were discovered, homeopathy all but disappeared, only to be re-discovered in developed countries as the baby-boomers started their recent love-affair with alternative medicine.
- Many consumers confuse homeopathy with herbal medicine; yet the two are fundamentally different. Herbal medicines are plant extracts with potentially active ingredients. Homeopathic remedies may be based on plants (or any other material as well) but are typically so dilute that they contain absolutely nothing. The most frequently used dilution (homeopaths call them ‘potencies’) is a ‘C30’; a C30-potency has been diluted 30 times at a ratio of 1:100. This means that one drop of the staring material is dissolved in 1 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 drops of diluent – and that equates to one molecule of the original substance per all the molecules of many thousand universes.
- Homeopaths know all of this, of course, and they thus claim that their remedies do not work via pharmacological effects but via some ‘energy’ or ‘vital force’. They are convinced that the process of preparing the homeopathic dilutions (they shake the mixtures at each dilution step) transfers some ‘vital energy’ from one to the next dilution. They cite all sorts of fancy theories to explain how this ‘energy transfer’ might come about, however, none of them has ever been accepted by mainstream scientists.
- Homeopathic remedies are usually prescribed according to the ‘like cures like’ principle. For instance, if you suffer from runny eyes, a homeopath might prescribe a remedy made of onion, because onion make our eyes water. This and all other basic assumptions of homeopathy contradict the known laws of nature. In other words, we do not just fail to understand how homeopathy works, but we understand that it cannot work unless the known laws of nature are wrong.
- The clinical trials of homeopathy are broadly in agreement with these insights from basic science. Today, more than 200 such studies have been published; if we look at the totality of this evidence, we have to conclude that it fails to show that homeopathic remedies are anything other than placebos.
- This is, of course, in stark contrast to what many enthusiasts of homeopathy insist upon; they swear by homeopathy and claim that it has helped them (or their pet, aunt, child etc.) repeatedly. Nobody doubts their accounts; in fact, it is indisputable that many patients do get better after taking homeopathic remedies. The best evidence available today clearly shows, however, that this improvement is unrelated to the homeopathic remedy per se. It is the result of an empathetic, compassionate encounter with a homeopath, a placebo-response or other factors which experts often call ‘context effects’.
- The wide-spread notion that homeopathy is completely free of risks is not correct. The remedy itself might be harmless (except, of course, for the damage it creates to your finances, and the fact that irrational nonsense about ‘vital energy’ etc. undermines rationality in general) but this does not necessarily apply to the homeopath. Whenever homeopaths advise their patients, as they often do, to forgo effective conventional treatments for a serious condition, they endanger lives. This phenomenon is documented, for instance, in relation to the advice of many homeopaths against immunisations. Any treatment that has no proven benefit, while carrying a finite risk, cannot generate more good than harm.