Guest post by Frank Van der Kooy
Some serious flaws in the scientific reporting of two acupuncture clinical trials, for the treatment of infertility and allergic rhinitis, were recently published on this blog. The overly positive way in which the researchers made their mostly negative results public, was also of concern. Both these studies were published by the researcher of the year, Prof Caroline Smith, of the National Institute of Complementary Medicine (NICM), Australia. The stream of comments and discussions that followed made me think of another commonly overlooked aspect when it comes to acupuncture clinical trials. Conflict of interest! In both these studies the authors declared to have no conflicts of interest and in other studies by this author this also seems to be the case. The question can be asked: If you are a practicing acupuncturist who runs a clinical trial of acupuncture, isn’t that, by default, a serious conflict of interest? The intention of this article is not an in-depth discussion of what a conflict of interest is, but rather to compare medical doctors with acupuncturists turned researchers. Let me explain.
Some medical doctors (GPs, surgeons etc.) decide to leave their practice after practicing 10-20 years to become full time researchers (and visa versa). Universities accept these people with open arms because they bring with them a wealth of knowledge regarding the practical side of medicine and healthcare in general. They are thus seen as an asset to any medical research project including clinical trials. Can the same be said about an acupuncturist? They also bring with them years of experience and thus they should also be a major asset to any acupuncture clinical trial. But I am afraid not!
Why? Medical doctors have a multitude of tools (drugs, surgical procedures, diagnostic tools etc.) at their disposal to treat all types of medical conditions. When will their background constitute a conflict of interest? When they publish a positive clinical trial of a specific medical intervention in which they have a vested interest. e.g owning shares in the company producing the medical intervention (financial interest) or if they have been staunch supporters of this intervention during their years of practice (emotional interest). Just imagine that you have prescribed a specific intervention to hundreds of patients over a long period of time, and you swore by it, and now you have to face them with a negative clinical trial result – that will be difficult. The former is easy to declare whilst the latter might be slightly more difficult.
Doctors also tend to focus on a specific disease e.g. cancer and will perform research with the existing tools at their disposal but also try to find new tools in order to improve the risk-benefit profile of the disease treatment. Thus, for a doctor there is the possibility that they might run into a conflict of interest, but due to the multitude of medical interventions out there this is by no means a given.
What about acupuncture practitioners turned researchers? An acupuncturist only has one tool at their disposal to treat all medical conditions. I can hear them say; but we stick needles in different places and depths etc. depending on the medical condition! Yes, but the fact remains that they can only stick needles into people – and that is a single intervention. So is this by default a conflict of interest? I would argue, yes, it is like having only one drug to treat all medical conditions. If you have treated hundreds of patients for various medical conditions with acupuncture and now suddenly you publish a negative clinical trial, you will not only be red faced when you run into your former patients – who paid for your evidence based acupuncture treatment – they might even sue you for misleading them. As an acupuncturist, you cannot allow the single tool that you have to be ineffective, otherwise people might start to question acupuncture. The fact that they have to protect acupuncture means that an acupuncturist will by default have a conflict of interest – no matter what medical condition they aim to treat.
If you have been emotionally and financially invested in acupuncture as a cure-all for 10-20 years, it will be very difficult, if not impossible, to publish a negative result as an acupuncture researcher.
Another aspect is that the acupuncture fraternity is a very tight knit community, where negative results are frowned upon because of everyone’s financial and emotional interests. Surely they will expel you from this community, if you publish negative results?
So how do acupuncture researchers go about running clinical trials? An example: Professors Smith and Bensoussan, both at the NICM, are currently registered as practicing acupuncturists. This means that they can legally practice acupuncture and, because they have been active for decades, they are also well known in the acupuncture fraternity. It is unknown, whether they are still actively practicing in their own practice or part-time in someone else’s practice, or if they have a financial stake in their former or someone else’s practice. Based on the fact that they are still registered as active acupuncturists, I can conclude that they do have an emotional and/or financial interest in the positive outcome of their acupuncture clinical trials.
Because of this inherent conflict of interest, and due to current strict clinical trial regulations, which makes it quite difficult (although not impossible) to fabricate or falsify data, they go for the next best thing – which is the design of their clinical trial e.g. the A+B versus A design. But it doesn’t stop there. As soon as a clinical trial fails to give a positive result, the results will be inflated to make it sound positive.
Why? Because they must prevent themselves from cognitive dissonance, they need to protect the single tool that they have, they must keep the acupuncture fraternity happy and they have to protect themselves against potential lawsuits from former (current) patients or a decrease in patient numbers (and thus financial income). On top of that – how would the media and the public react to an acupuncture clinical trial if the lead researcher declare that they have their own acupuncture clinic? Surely these factors together amount to a conflict of interest and should be declared as such?
So what, in this context, is the main difference between a doctor and an acupuncturist? A doctor has a multitude of medical interventions. He or she might have a conflict of interest, if they work on a specific intervention in which they have a vested interest. An acupuncturist only has one intervention and therefore they have a vested interest by default – which they never seem to declare!
The Swiss interior ministry has yesterday announced its intention to elevate quackery to the same level as conventional medicine.
The 5 therapies were named as
- holistic medicine,
- herbal medicine,
- traditional Chinese medicine
No, this is not an early April fools joke! It might merely a sign that this country is in dire need of some critical thinking.
The 5 therapies will acquire the same status as conventional medicine by May 2017. After being rejected in 2005 by the authorities for lack of scientific proof of their efficacy, complementary and alternative medicines made a comeback in 2009 when two-thirds of Swiss backed their inclusion on the constitutional list of paid health services. As a result of the vote, these treatments are covered by basic compulsory insurance as part of six-year trial period from 2012-2017, during which their efficacy would be examined. The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. It has therefore opted to accept them on par with other medical disciplines. It plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical professionals. However, as is the practice for conventional medicine, certain controversial practices under these complementary therapies will be subjected to further scrutiny. The ministry has initiated a consultation process – open until June 30, 2016 – on the proposed modification of the regulations.
There are a few interesting things here:
- What on earth is ‘holistic medicine’? It seems to be an umbrella term under which any type of quackery can be included.
- The lack of proof of efficacy – which since 20015 has only increased – is over-ruled by a popular vote.
- The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. What does that mean? From a scientific point of view, it means science cannot show that these treatment work, BECAUSE THEY DON’T! But I suspect they did not want to say that. What did they want to say then?
- holidays for citizens who feel ‘under the weather’,
- distance healing,
- botox therapy for wrinkled faces,
- hair transplants,
- pet ownership,
- free champagne for low blood pressure,
Sorry, I just realized that all of the above are already included in the category of HOLISTIC MEDICINE.
Whenever I write something critical about an alternative therapy, chances are that I get hate mail, sometimes lots of it (and much of it is hilarious). It usually centres around themes such as:
- Ernst is bought by ‘Big Pharma’.
- Ernst is incompetent.
- Ernst is a lousy scientist.
- Ernst is a liar.
- Ernst has an axe to grind.
However, one theme that comes up more often than any other is, I think, the allegation of my ‘lack of qualifications’. Here is an example posted as a comment to my recent article on acupuncture in THE SPECTATOR:
“Ernst’s appointment as a professor at the University of the Penisula, his apparent ‘qualifications’ in Complementary Medicine (including homeopathy as well as what he says here about acupuncture) are controversial to say the least and he lacks qualifications in evidence-based medicine too.”[This particular quote is quite funny; the author not only was wrong about my qualifications but also re-named the University of Exeter ‘The University of the Penisula’ – begging the penetrating questions, who is Ula? And what has his penis to do with my professorship?]
If I have the time and the patience, I do like to respond even to the weirdest of attacks.
Because my attackers often claim that a non-response amounts to an ‘admission of guilt’ on my part. Yet, all too often, this strategy turns out to be a mistake, and the whole thing quickly degrades even further.
In the above-mentioned instance, I replied: “I never said that I had formal qualifications in acupuncture or homeopathy. I learnt these things as doctors learn most other techniques: initially by studying them and subsequently applying them, first with supervision and later independently. I once wrote as a footnote to a critical article on homeopathy: ‘CONFLICTS OF INTEREST: I AM A TRAINED HOMEOPATH’. Only a moron could miss that this was tongue in cheek. Moreover, it was correct: I was trained during several months working in a homeopathic hospital. It seems that this is the origin of all these false allegations against me. To accuse me of having no qualifications in these areas is, I think, akin to me accusing you of having no degree in particle physics.”
Rather than carefully considering what I had written, my attacker answered by bringing up a new lie: “You are not and were not a registered medical doctor in the UK at the time but were a professor of Complementary Medicine. (fact or ad hominem attack?) If this is so you deserve to be congratulated on a superb interview to get the job with your only ‘qualification’ being picking up a bit of knowledge here and there on CAM as a doctor.”[One has to excuse the confusing language of the commentator who seems far too overwhelmed with emotion and excitement to express things clearly. What was meant, I think (mostly from previous, similar attacks), was the allegation that I was not even a GMC-registered physician when I took up the Exeter job.]
I have only little hope that it will deter future attacks of this nature but, for the sake of honesty, integrity and transparency, I will (yet again) try to clarify the situation regarding my ‘lack of qualifications’.
- There is nothing controversial about my qualifications.
- I have never claimed to hold qualifications that I did not earn.
- I have no formal ones in alternative medicine, and I have never said otherwise.
- I am not even sure that such qualifications existed when I was in my ‘qualifying years’ (late 1970s).
- As for any degrees in EBM, they certainly all came in after that time (even the term ‘EBM’ was invented only later).
- If you are qualified as a doctor, you do not need to have any extra qualifications to practice alternative medicine.
- Neither does one need them to research alternative medicine.
- As I stated many times before, I have received training in several forms of alternative medicine.
- I consider myself competent to research most areas of alternative medicine.
- I have been registered with the GMC since the late 1970s.
- When it became clear that this registration was no longer needed to conduct the research I did at Exeter, I cancelled it to save the considerable annual expense.
- I have also published a full memoir entitled ‘A SCIENTIST IN WONDERLAND’ where the background to many of these issues is discussed in more detail.
All that I need to say now to future ad hominem attackers: PLEASE FIND A DIFFERENT LINE OF ATTACK; THIS ONE IS GETTING BORING AND MERELY DISPLAYS YOUR IGNORANCE.
At this time of the year, journalists like to review what has happened during the previous year. I am not a journalist, just an alt med researcher, and I don’t want to review the 10 most important events but the non-events, that is 10 relevant things that should have happened in the realm of alt med but unfortunately didn’t happen. Needless to say: my choice is subjective, personal and highly biased.
Here we go, in no particular order:
In 2014, the WHO published the WHO TRADITIONAL MEDICINE STRATEGY 2014 – 2023. Amazingly, it has all the hallmarks of a promotional document that lacks critical input: “The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role TM plays in keeping populations healthy.” In my view, those officials within the WHO who are capable of critical assessment should have spotted the danger of this strategy and, by 2015, have managed to withdraw this shameful paper, as it can only discredit this otherwise reputable organisation.
After suing my friend Simon Singh and losing the case, lots of money and even more reputation, the BCA and the chiropractic profession at large should have not only apologised to Simon but also taken more decisive actions to ensure that chiropractors around the world stop misleading the public about what they can contribute to human health. Sadly this blog has shown more than once that bogus claims still abound and chiropractors are still unable to criticise even the most extreme excesses of quackery in their ranks.
The International Council for Homeopathy (ICH) “is the international professional platform representing professional homeopaths and the practice of homeopathy around the world. ICH presently consists of 31 professional associations of homeopaths from 28 countries in four continents, and aims eventually to have member associations in all continents. Through networking and dialogue, members of ICH engage in the promotion and evaluation of the status of homeopathy in every part of the world; with emphasis on the development of international guidelines promoting freedom of access to the highest possible standard of homeopathic care.” With such high, self-declared aims, the ICH would have been in the ideal position to inform its members that the most transparent and thorough investigation of homeopathy concluded that “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.” Sadly, homeopaths all over the world prefer to go into a state of denial and carry on as before – to the detriment of public health worldwide.
Peter Fisher, the homeopath of the Queen, has been shown to have published an important lie about me. In the interest of honesty, of his reputation and that of homeopathy, he should have retracted it and apologised. The fact that he has chosen to remain silent is, I think, a telling tale about the standards of truth in homeopathy.
Prince Charles is one of the most prominent promoters of INTEGRATED MEDICINE. He may not have the wit to understand the issues involved but he certainly has access to the best advisors money can buy. By now, he should have realised that the yes-men he has been using are not up to the job of providing reasonable advice on alt med. Therefore he should have recruited proper experts who would have told him that adding unproven treatments to evidence-based medicine is not going to be an improvement. Sadly, Charles’ promotion of quackery continues unabated.
Christian Boiron, the General Manager of the world’s largest manufacturer of homeopathic remedies, ‘BOIRON’, recently stated that the critics of homeopathy are like the Ku Klux Klan. This embarrassing statement reflects a level of stupidity and arrogance that can only be harmful to his firm and homeopathy in general. The fact that it was not withdrawn does not bode well for either of them.
Dan Ullman is one of the tireless [and tiresome] entrepreneurs in US homeopathy. I recently dedicated a blog-post to him where he commented copiously and was subsequently shown to be wrong on many issues. This would have been the right moment for him to give up selling bogus drugs and misleading literature. Unfortunately, the comments did not offer any hope that fanatics like him can be brought to their senses. This sad course of events suggests, I fear, that homeopathic delusions of this nature are too severe to cure.
During these discussions, one commentator provided disturbing suspicions that one of the recent ‘flag-ship’ evidence for homeopathy might be fraudulent. The author of the paper in question, who had been a keen participant of the discussions, should have responded and argued his case. Instead his comments on this blog abruptly stopped, a fact that most experts might interpret as an admission of guilt.
My Vice Chancellor at Exeter, Steve Smith, should have read 2015 my memoire, which suggests that he behaved less than honourably, and he should then have responded to it. Instead, Exeter opted to ignore not only my book but also the award of the John Maddox Prize 2015. It is up to the reader to decide how this non-action ought to be interpreted.
The ‘INTERNATIONAL PHARMACEUTICAL FEDERATION’ has the slogan ‘advancing pharmacy worldwide’ in their logo. Therefore it seems to be the right organisation to remind pharmacists across the globe that they are not shopkeepers but a healthcare profession with ethical codes and moral responsibilities. Therefore they should have reminded community pharmacists, pharmacy chains and other interested parties that selling disproven remedies like homeopathy, Bach Flower Remedies, ineffective cough syrups etc. is a violation of pharmacists’ codes of ethics.
Any post about non-events and missed opportunities is a somewhat frustrating affaire. At the same time, it also offers hope: perhaps 2016 will see (some of) them happening?
I had thought that I know most alternative therapies. However, Shujing massage was new to me. It seems to be a massage technique from Traditional Chinese Medicine (TCM) along the Yin/Yang concept; a bit like Shiatsu perhaps.
Does it work?
This study might easily be the first to address this question. It was aimed at comparing the efficacy on insomnia between shujing massage therapy and medication with estazolam.
Eighty patients with insomnia were randomized into a shujing massage therapy group and a medication group. The massage was applied along the gallbladder meridian on the temporal area. Pressing and kneading manipulations were performed at Yangbai (GB 14), Benshen (GB 13), Toulinqi (GB 15), Zhengying (GB 17), Chengling (GB 18), Shuaigu (GB 8), and Fengchi (GB 20), etc. one minute at each acupoint. In the medication group, 1 mg estazolam was administered orally half an hour before sleep. The treatments were given once every day in both groups. After one month, the sub-scores and the total score of the Pittsburgh sleep quality index scale (PSQI) and the clinical efficacy were compared between the two groups.
After the intervention, the each sub-score of PSQI was improved as compared with that before treatment in the patients of the two groups. The differences in sleep time and the time for falling into sleep were not significant between the two groups. In the shujing massage group, the scores of sleep quality, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score were all lower than those in the medication group. The response rate was 92.1% (35/38) in the shujing massage group and 84. 2% (32/38) in the medication group.
The Chinese authors concluded that Shujing massage therapy achieves the superior efficacy on insomnia compared with the oral administration of estazolam.
Sadly, this study is less conclusive as TCM-enthusiasts may think:
- the study was not blind; therefore placebo-effects might have produced a false-positive result;
- any massage is relaxing; therefore the effect could be entirely unrelated to TCM-philosophy;
- it is likely that the regular ritual of a massage has a beneficial effect on sleep;
- before we agree with these findings, we should insist on an independent confirmation via a more rigorous study.
I think that, before we accept the ‘efficacy’ of this TCM-treatment, we should see much more convincing evidence.
This is a true gem which I found on Medline. The article was published 91 years ago by Holburt Jacob Waring (1866 – 1953) in the BMJ. I hope you enjoy it.
This article does not need a comment, I think. Its author was one of the most prominent surgeons of his time. Apparently he was known and feared for his outspokenness. I think I understand why.
First it was the Australians who made life more difficult for homeopaths; then the FDA announced that they plan to have a critical look at homeopathy. Now the Canadians have joined in with the other regulators getting concerned about the most overt abuses of medical evidence and ethics by manufacturers of homeopathic products. Here is a statement that was just published on the labelling of some Canadian homeopathic remedies:
Health Canada is advising consumers that it is introducing label changes for certain homeopathic products that fall under the Natural Health Product Regulations (NHPR). Current labelling on some homeopathic products may not provide Canadians with the information they need to make informed choices. The changes apply to the labelling of some homeopathic products, specifically nosode products as well as homeopathic cough, cold and flu products for children 12 and under.
The Department is introducing these changes to ensure that Canadians who choose to use homeopathic products have the information they need to improve their safe use, especially parents trying to make the best choices for their children.
Health Canada is requesting the addition of statements on homeopathic nosode products to make it clear that they are not vaccines or alternatives to vaccines to improve the safe use of these products.
Companies of nosode products have been asked to comply with these changes by January 2016. The new statement for nosode products is: “This product is neither a vaccine nor an alternative to vaccination. This product has not been proven to prevent infection. Health Canada does not recommend its use in children and advises that your child receive all routine vaccinations.”
In addition, Health Canada is no longer allowing companies to make specific health claims on homeopathic products for cough, cold, and flu for children 12 and under, unless those claims are supported by scientific evidence.
Companies have been asked to comply with this new labelling change by July 2016.
For more information about the labelling requirements for homeopathic products, consult the Health Canada Web site.
Health Canada reminds Canadians of the importance of vaccinations, to protect themselves, their families, and communities by ensuring their vaccinations are up to date. Immunization saves lives. The World Health Organization estimates immunization prevents between 2-3 million deaths every year.
Not nearly enough, some will say. But even they will have to admit that this is yet another (small) step in the right direction. I wonder when the UK authorities will do something similar (perhaps when Prince Charles is on summer vacation?).
One of my last posts prompted a comment informing us that Dr Dixon has just put himself forward as a candidate for the presidency of ‘THE ROYAL COLLEGE OF GENERAL PRACTITIONERS’ (RCGP) of the UK. This must be big news in the small world of alternative medicine and deserves further discussion.
Dr Dixon works in Cullompton Devon, where, according to one website, he has introduced over 20 complementary therapists alongside the normal GP services that would be expected anywhere. Patients have to pay for therapies such as healing, massage, acupuncture, or herbal medicine but at a reduced fee. The practice has its own organic and herb gardens and is next to a Boots store that stocks many of the remedies.
The RCGP’s announcement describes him with the following words:
Dr Dixon is NHS Alliance chairman, and has been a GP since 1984 at the College Surgery in Cullompton, Devon. He is acting president of NHS Clinical Commissioners, set up to represent CCGs after their creation in 2012, and has held a number of NHS advisory posts.
THE TELEGRAPH once listed Dr Dixon amongst the top ‘health gurus’ of Britain and commented: A trustee of the Prince’s Foundation for Integrated Medicine, the soothingly avuncular Dixon is one of the most persuasive advocates of complementary medicine, as well as one of its most dynamic practitioners. His new venture is an integrated health centre in Cullompton, Devon (opening in January), where practitioners of massage, homeopathy, acupuncture and so on will have rooms alongside his conventional GP’s surgery. If he’s good enough for Prince Charles…
Flattering as they may be for Dr Dixon, I don’t think that these descriptions do him justice. They fail to stress that he has, since over 20 years, been fighting tirelessly for integrating unproven alternative therapies into the NHS. He even presided over Prince Charles’ FOUNDATION FOR INTEGRATED MEDICINE when it had to be closed down amidst allegations of fraud and money laundering. He now heads the successor organisation, THE COLLEGE OF MEDICINE, and is involved in uncounted similar initiatives promoting outright quackery. Examples include:
Dixon is a medical advisor to ‘YES TO LIFE’, an organisation advocating unproven treatments for cancer.
Dixon is a practitioner of spiritual healing.
Dixon is an advocate of homeopathy.
Dixon created the Culm Valley Integrated Centre for Health which offers unproven treatments such as homeopathy, neurolinguistic programming, Bowen technique, aromatherapy and, of course, healing.
Dixon is a patron of ‘THE QUIET MIND CENTRE’ which offers unproven treatments such as healing, reflexology, kinesiology, shiatsu, Indian head massage, zero balancing, and craniosacral therapy.
Dixon advocates the statutory regulation of Chinese herbalists.
Dixon is a ‘key lecturer’ at the BRITISH COLLEGE OF INTEGRATIVE MEDICINE.
Today I would like to share with you an interesting little exchange that I had a few days ago on TWITTER. Someone who I perhaps should but did not know sent me the following tweet apparently ‘out of the blue’:
“…remember that asthma trial whose results you faked?”
It was clear that the study he referred to was our trial published in THORAX 12 years ago. I found this allegation so absurd that I re-tweeted his tweet, and a third party responded to him by asking: “any evidence for this?”
His answer: ” Yes, I was involved with the study which severely breached its protocols. It should have been abandoned not published”
My reply to this: “Involved as what? I do not recall any breach of protocol”
His next tweet: “Pity, I do. Maybe it’s because you only added your name to the paper”
My response: “Stop telling lies and find a good libel lawyer”
Over the years, I got used to all sorts of attacks, but I feel that this one is quite special. It accuses me first of faking research, then of breaching research protocols, and finally of false authorship of a research paper. To someone whose entire reputation relies on his credibility as a scientist, such very public and entirely false claims are, of course, hugely damaging. I asked myself: Is this libel? Is it defamation? Is it actionable?
Looking for answers, I found an interesting website which explains the relevant English law in some detail:
“A defamatory statement is one which is false and causes damage to a person’s reputation or otherwise does them harm. Libel is the term given to defamation in a permanent form such as in print…
For a person to bring a claim of defamation, the following must apply:
- The statement has to have been made to somebody other than the claimant. It is not defamation if the statement is not heard by anyone but the claimant.
- The statement has to be in words
- The statement may damage the person’s reputation by making people who hear or read the statement think worse of them.
- The statement may expose the claimant to contempt, disliking, hatred or ridicule.
- The statement may cause the claimant to be shunned by society or avoided by people
- The statement must be clearly applicable to the claimant, although they do not necessarily have to be named (e.g. “the head of London Metropolitan Police Force” would be sufficient without explicitly naming the claimant).
- If someone claims that a person has made defamatory statements about them, the onus is on the person who made the statements to prove that the statements are true.”
Subsequently, I tried to find out the identity of my attacker. He is Tony Pinkus who turns out to be the director of Ainsworth Homeopathic Pharmacy, 36 New Cavendish St London W1G 8UF. This fact makes my little exchange much more interesting and exciting. In my view, it begs the following questions:
- Should I ask Ainsworth for an apology?
- Or Pinkus?
- Or perhaps I should sue Ainsworth for libel?
- Or Pinkus?
- Or should I sue both?
Not being a lawyer, I wonder whether any of my readers might advise me. In addition, I will send this post to Ainsworth and will keep you posted about their reply.
Here is a third excerpt from my new book A SCIENTIST IN WONDERLAND. It describes the thinking behind the research strategy my team and I adopted and the main arguments for and against it.
After roughly one year of preparatory work, everything seemed to be in place for our research to start in earnest. Around this time, I was asked to write a “mission statement” for my new research unit, which had by then been given the official title of the Department of Complementary Medicine. “A very British thing”, a friend explained when I enquired what a mission statement might be. “Just put on paper what your unit stands for.” I gave it some thought and formulated our mission as clearly and concisely as I could:
- To conduct rigorous, inter-disciplinary and international collaborative research into the efficacy, safety and cost of complementary medicine.
- To further analytical thinking in this area.
People reading my mission statement tended to be slightly puzzled by the inclusion of “analytical thinking” as a specific, separate item, but even after two decades, I am still pleased that I added it. The fostering of critical analysis is vital to any scientific endeavour, and perhaps particularly so in a field that, until now, has been so accustomed to special pleading and so sheltered from objective evaluation.
While studying medicine, I had not been well instructed in critical thinking. It was only later that I had realized how vulnerable health care can be without it. In Vienna, we had managed to smuggle the subject onto the medical curriculum. In Exeter, I soon discovered how woefully uncritical the attitude towards alternative medicine frequently was. This phenomenon was noticeable not just when reading the popular press or when talking to lay people but also, and perhaps even more worryingly, it was equally obvious in discussions with health care professionals. This lack of critical thinking, I felt, had the potential to hinder progress or even to cause significant harm. Particularly during the later years of my time in Exeter, the theme of critical analysis would dominate my work.
My peers were happy with the mission statement, and most rational thinkers who saw it thought it was ambitious but sound. However, in many alternative medicine enthusiasts it aroused suspicion; they seemed dismayed and felt that it was misguided. Some offered the opinion that alternative medicine should not be scientifically scrutinized at all. Others believed that my work should be directed much more at promoting alternative medicine rather than questioning it. Some argued that a professor of complementary medicine should be unabashedly sympathetic towards those working in this area, and that this attitude should be specifically articulated in any mission statement. Yet others argued that the mission statement should focus primarily on sociological or psychological issues rather than medical questions.
I listened patiently and politely to everyone who wanted to comment. I discussed, re-evaluated, re-discussed and reconsidered my position. But whichever way I looked at it, I couldn’t escape the conclusion that the arguments of my critics were at best unconvincing or irrelevant, and at worst they were down-right misleading—and I became determined to show why.
I was not a politician, nor was I a propagandist or an ideologue: I was simply a scientist, and as such my role was not to further the ambitions of interested parties but to determine the true value of alternative medicine. Patients and consumers have an absolute right to know the truth about the value of the treatments they frequently use, and the obligation of a researcher is to determine truth. That required a rigorous medical research agenda which would steer us clear of the post-modernist approach advocated by so many who tried to influence me and my growing team of investigators.
Over the years, my resolve to stay on this straight and narrow path of objective medical research has provoked endless criticism. Indeed, the potential for conflict had been there from the outset, when, at that very first lecture for alternative practitioners, I had been publicly challenged: “How did they dare to appoint a doctor to this chair?” Now that I had realized that this tension existed, I had to decide how to deal with it in my professional capacity.
Initially I made a conscious effort to avoid discord, not because I lacked the necessary courage or convincing arguments, but for a variety of other reasons, both personal and pragmatic. Firstly, I do not enjoy disagreements nearly as much as some people seem to think. If conflict becomes unavoidable, I can certainly put up a good fight, but that does not mean I enjoy the process. Secondly, I was honestly tired of having disputes. The battles I had fought in Vienna had left me drained and somewhat bruised. Over the years, I did develop a thicker skin but it certainly was not something I was born with. Thirdly, conflicts take far too much time, energy and concentration away from one’s real work: the more time I was compelled to spend locked in combat, the less time I would have to focus on the science I was so eager to generate. Fourthly, if the worst came to the worst, and if I was going to have to defend my views at every turn, I needed to be entirely sure of my ground. Solid research was the only way to ensure that; and I felt the need to do the research first and have the arguments later.