MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

When we talk about conflicts of interest, we usually think of financial concerns. But conflicts of interests also extend to non-financial matters, such as strong beliefs. These are important in alternative medicine – I would even go as far as to claim that they dominate this field.

My detractors have often claimed that this is where my problem lies. They are convinced that, in 1993, I came into the job as PROFESSOR OF COMPLEMENTARY MEDICINE with an axe to grind; I was determined or perhaps even paid to show that all alternative medicine is utter hocus-pocus, they say. The truth is that, if anything, I was on the side of alternative medicine – and I can prove it. Using the example of homeopathy, I have dedicated an entire article to demonstrate that the myth is untrue – I was not closed-minded or out to ditch homeopathy (or any other form of alternative medicine for that matter).

What then could constitute my ‘conflict of interest’? Surely, he was bribed, I hear them say. Just look at the funds he took from industry. Some of those people have even gone to the trouble of running freedom of information requests to obtain the precise figures for my research-funding. Subsequently they triumphantly publish them and say: Look he got £x from this company and £y from that firm. And they are, of course, correct: I did receive support from commercially interested parties on several occasions. But what my detractors forget is that these were all pro-alternative medicine institutions. More importantly, I always made very sure that no strings were attached with any funds we accepted.

Our core funds came from ‘The Laing Foundation’ which endowed Exeter University with £ 1.5 million. This was done with the understanding that Exeter would put the same amount again into the kitty (which they never did). Anyone who can do simple arithmetic can tell that, to sustain up to 20 staff for almost 20 years, £1.5 million is not nearly enough. There must have been other sources. Who exactly gave money?

Despite utterly useless fundraising by the University, we did manage to obtain additional funds. I managed to receive support in the form of multiple research fellowships, for instance. It came from various sources; for instance, manufacturers of herbal medicines, Boots, the Pilkington Family Trust (yes, the glass manufacturers).

A hugely helpful contributor to our work was the sizable number (I estimate around 30) of visitors from abroad who came on their own money simply because they wanted to learn from and with us. They stayed between 3 months and 4 years, and importantly contributed to our research, knowledge and fun.

In addition, we soon devised ways to generate our own money. For instance, we started an annual conference for researchers in our field which ran for 14 successful years. As we managed everything on a shoestring and did all the organisation ourselves, we made a tidy profit each year which, of course, went straight back into our research. We also published several books which generated some revenue for the same purpose.

And then we received research funding for specific projects, for instance, from THE PRINCE OF WALES’ FOUNDATION FOR INTEGRATED HEALTH, a Japanese organisation supporting Jorhei Healing, THE WELCOME TRUST, the NHS, and even a homeopathic company.

So, do I have a conflict of interest? Did I take money from anyone who might have wanted to ditch alternative medicine? I don’t think so! And if I tell you that, when I came to Exeter in 1993, I donated ~£120 000 of my own funds towards the research of my unit, even my detractors might, for once, be embarrassed to have thought otherwise.

46 Responses to TIME TO OWN UP: my personal ‘conflicts of interest’

  • Interesting programme on placebo last night. It seems placebo can increase performance, lower GDA at altitude, produce dopaminein in Parkinsons and I quote ” it has a real neurological and biological affect” whats it like Prof realising you have been barking up the wrong tree for most of your professional career and that most of the work you have done was actually pointless?
    Homeopathy cannot work???? placebo isn’t some inert nothing it produces real measurable changes, so all CAM crap? or all CAM is placebo that now seems to be quite a powerful treatment. Placebo creates a measurable change in the body even when the person knows its a placebo. I know what your argument will be, but ANY treatment, placebo or not that creates a measurable change is just that. A valuable treatment. Good bye Prof Ernst your research and views are now extinct.

    • Fedup: Was that a program or an “infomercial” you were listening to? It makes a difference. We have all heard the breathless magical claims of supplement and homeopathic potion cures and the ravings of traveling medicine men.

      • It was Horizon. And if you ask prof Ernst , as I have, if he has any issues with the research and conclusions. No was his answer.

        • could you please start commenting on the topic of this post?

          • i thought CAM includes Acupuncture. If acupuncture were brought up to date with ‘smart needles’
            Ancient Chinese manuals showing lines of ‘chi’ seem models of clarity compared with the circular
            logic behind so much neoropharmacology and psychopharmacology whereby so many transmitters
            comms. channels and receivers have a circular nomenclature. There may be a certain amount
            of $$$ getting modern medical minds to look at this material, and for that matter the training
            methodologies recommended for this practice. Many established surgeons may hate this, but
            others will see this as an opportunity to treat some seriously ill patients with a short office
            procedure.TCM (Traditional Chinese Medicine) TCM is something that was based on the best
            ideas of the time but of course does not fall under ‘evidence based medicine’ but many careers
            have been built on observing small numbers of patients from the well-to-do classes.

          • try to make some sense next time, please.

          • Commentator “antony goddard” is eligible for an Ig Nobel Prize nomination for having managed to write so many words that have the lowest level of autocorrelation imaginable. In other words: his comment, had he not published it, would serve as the most uncrackable encryption key yet devised!

  • what about this one

  • Fedup you are silly and ill-mannered. You are silly to contrast one TV programme with many years research by a distinguished academic. You are silly to suppose that the content would be any surprise top Dr Ernst. You are silly to suppose his research has not allowed for the placebo effect. Since it has it is not made obsolete by research on that effect.

    Ernst’s work has shown that CAM has no more effect than placebo and, therefore, that CAM theories, eg that “dilution potentiates”, are false. Since CAM practitioners believe those theories and use them to persuade people to pay them money that’s important.

  • Thanks David, that one TV programme included 4 or 5 professors doing research around the world in such places as Harvard. saying “that CAM has no more effect than placebo” is fine as placebo has now been shown to be a very safe and powerful treatment for many problems, ” it has a real neurological and biological affect” to quote a harvard prof. I agree maybe the theories are false, but Prof Ernst has not done any research to test potency, he merely tried to show the “therapy” has no value. If you compare any therapy to placebo now you cannot conclude it has no value. Theories are not always easily proved, most physics is theory, but proving they are useless is very different to trying to find out how/why they work. I believe Prof Ernst has done nothing but the former. Would you pay money for something that actually creates a physical change in your body that you benefit from? If you watch the doc, lots of people on the IBS study have been trying to buy the placebo pills even though they knew they were placebo. Wow how stupid are they?

    • That’s a nice strawman, sorry to burn it. Prof. Ernst never claimed that “placebo does nothing”, and that would indeed be a foolish thing to say (why, for example, would one need a placebo control if it did nothing?). He has, however, come to the conclusion that most CAM treatments don’t do more than placebo. The question then is: why would you want use the CAM treatment instead of giving the patient a placebo? Why should you, for example, give homeopathic “remedies” to a patient if plain sugar pellets have the same effect? If all the diluting and “succussing” doesn’t produce something that is better than placebo, it’s time to stop this unneccessary hocus pocus and use the blank pellets instead.
      Also, patients have the right to know that the treatment they receive is a placebo treatment.

  • David, are all academics right? If they are scientist they will question their own beliefs and when new research comes along they alter their opinion. Thats science, apparently. Sticking to your guns and saying I’m right no matter, what is not a good characteristic of an academic. Please point me to the journal where Prof Ernst has published something on the placebo response. Not as an inert contrast to a therapy but a piece that has actually tested placebo. I’d like to read it.

  • fedup: in your obvious personal resentment of Prof. Ernst you are missing the point by a massive margin. It is not new information that placebo treatments have real, measurable effects. The problem is that placebos tend to produce useful therapeutic effects only in a minority of patients (read a random selection of the many well designed double-blind trials of real medicines), and it is far from easy to distinguish which patients might respond to placebo treatment.

    Even if we switched medical approaches to patients to include placebo treatments, does it really make sense for doctors to tell patients “these crystals emit energy that stimulates your chi”, or “this substance has been diluted beyond the point where it’s indistinguishable from water, but — thanks to the dilutions being banged on a leather-bound book — the water has a memory that makes it more potent than the original substance”, or “by massaging your feet I can stimulate and correct diseases in distant organs”? Do you not think such an approach is at the very least patronising, or at its worst playing disgracefully on the ignorance and gullibility of the patient? Are you happy to live in a world in which authority figures spout horse manure as a means of manipulating people to respond to worthless therapies (because some of them will respond). And for those who don’t respond you have other forms of horse manure with which to prey on their lack of comprehension? Do you really want a world that plays up people’s lack of knowledge and credulity?

    Here’s the real bottom line for you, fedup. Find a patient with bacterial sepsis, or meningitis, or AIDS, or any serious infectious disease; find a patient with a dissecting aortic aneurysm or an acute appendix or late-stage colon cancer; find a patient with motor neurone disease, or Parkinson’s, or Altzheimer’s; and treat them with your placebos. When you have discovered the hard way that seriously diseased individuals seldom if ever respond to sham therapies, you might start to get a little respect for genuine therapeutic advances (and the lack of them in the last three examples).

    Please ask yourself which you prefer if you collapse in the street. Paramedics who understand medicine, or some pillock with an armoury of camomile tea, acupuncture needles and ear candles.

    • Frank. Iam not missing the point. The research on the programme proved placebo creates a (can’t believe I’m having to say this AGAIN) biological effect which can be measured. It’s not just a perceived change but an actual change. It did cause an effect in patients with Parkinson’s. Proved with MRI scans. It did alter certain blood levels at altitude. All done with placebo. It has a real and measurable affect on many levels. Prof Ernst has concluded that many cam therapies are placebo. See the connection? If these therapies create a measurable and physical response in a person are they useless? And please stop with your straw man argument of “let’s see u ask for a placebo when u need an ambulance”. Placebo was shown to help even after surgical procedures when they injected cement into the wrong vertebral fracture!!!

    • Here’s the real bottom line for you, fedup. Find a patient with bacterial sepsis, or meningitis, or AIDS, or any serious infectious disease; find a patient with a dissecting aortic aneurysm or an acute appendix or late-stage colon cancer; find a patient with motor neurone disease, or Parkinson’s, or Altzheimer’s; and treat them with your placebos.

      You telling me you can cure all of the above? Everybody with the above survives because they wernt given placebo but real treatment?

      • Yes, definitely! While some patients inevitably fail treatment if their disease has progressed too far or they have acquired a multi-resistant bug, sepsis, meningits and AIDS all respond well to the appropriate antimicrobials, and the next three conditions respond to appropriate surgery. Certainly not 100% but a helluva lot more than people treated with placebos. (Treat any of those infections with a placebo and you’d be reightly hauled into court for malpractice.) I listed the last three diseases as examples where we don’t yet have any effective treatments. The point being that placebos do nothing in any of these either (your measurable placebo effects in Parkinsons are minimal, you don’t know which patients will show them and they’re certainly nothing like a cure). For goodness’ sake read some proper literature: don’t base your information on TV programmes!

        But this whole discussion is hijacking the thread from its more interesting OP. Edzard Ernst has set out very clearly all his major and many minor sources of funding. Remarkably, most of them are from organizations that try to PROMTE “complementary and alternative” treatments; not the dreaded “big pharma” that is assumed to be anti. He has lucidly explained how he moved from believing there was something credible in CAM to realizing it doesn’t stand up to sensible scrutiny. People doing medical research these days are (rightly) expected to state possible conflicts of interest in their work and that’s what this thread is for.

        • “The placebo effect is real, quantifiable and in fact you’re doing quite well with an active therapy if you can get as good a response as the placebo response,” said Professor Jon Stoessl, director of the Pacific Parkinson’s Research Centre at the University of British Columbia.

  • I don’t understand why you can’t just say that you are on payroll of pharmacy industry. What is wrong with that?

    It’s just common knowledge that pharmacy industry is funding most of research anyway so why need to very rare exception?

    This selfmade conflicts of interest writing is not very objective. You need to admit this. Why not let third party check you sources of income and let we know? Then we can have objective look how truthful blog writer you really are.

    • But he’s clearly NOT funded from the pharma industry, unless he’s a complete liar. Is that what you’re trying to imply? Compare the OP with the non-declaration of relevant funding by somebody like Andrew Wakefield. Ask Prof Ernst to send you his CV. I bet he lists all his grants there, and the list won’t differ much from the OP; you’ll see just a few smaller grants detailed. Why does someone like Ernst, who has seriously investigated the clinical efficacy of various alternative therapies draw so much disrespect? Why are fans of CAM so deeply afflicted with confirmation bias that they can’t accept the mountain of negative evidence?!

    • @Jorma Kärtsy:

      Did you bother to read the post you’re commenting on?

  • Fedup: The placebo reaction (not the placebo effect per se) can indeed be useful in health care. The equally (and often much more) powerful nocebo reaction is the real problem that you are continually failing to take into account. Allow me to illustrate your failure to contrast these reactions…

    Suppose that 30% of patients improve their quality of life after receiving placebo treatment (for some disorders, this figure is reasonably backed by evidence). It seems entirely obvious that the treatment would be much better than receiving no treatment — great news, it would seem. However, out of the 70% of patients who did not benefit from the treatment you seem to often imply (directly or indirectly) that they simply received no benefit. But what about the patients who became worse due to their nocebo reaction to the treatment and/or practitioner? And, very sadly, the patients who died after the treatment? We don’t have statistics on these very unfortunate patients because CAM practitioners are largely exempt from leaving an audit trail that would meet the minimum standard for proper medical health care.

    The nocebo reaction, at its best, results in misery and suffering; at its worst, it results in death: the suicide outcomes being particularly gruesome for each deceased patient’s friends and family.

    Your inability to accurately assess patient risk-benefit ratios is, in my opinion, your biggest stumbling block. Perhaps you are so fond of the possible placebo benefits of CAM treatment(s) that you have become totally blind to the orders of magnitude worse outcomes that CAM far too frequently produces.

    I’m fully capable of providing you with URLs to insightful articles on placebo and nocebo reactions, but I have refrained because your comments strongly indicate that you resent academics and that you have no wish to learn anything from them.

  • Pete. Again straw man. Did I mention nocebo? Did prof Ernst conclude that some therapies are nocebo? My inability to assess patient risk? You know me? I know many acedemics. I resent the blinkered approach taken by some.

  • And, very sadly, the patients who died after the treatment? We don’t have statistics on these very unfortunate patients because CAM practitioners are largely exempt from leaving an audit trail that would meet the minimum standard for proper medical health care.!!!!!!!!

    You have absolutely no evidence to back this up. This is pure conjecture and based solely on your own misconceptions. Biased and blinkered. That’s what I have a problem with.

    • Fedup: Many thanks for clearly demonstrating that you really don’t care about those who suffer tragic outcomes from sCAM.

      It is not me, it is you who is not in possession of solid evidence for the tragic outcomes. Your blinkers appear to be 100% efficient in preventing all the tragedies from engaging your cognition, empathy, and compassion.

      If you had bothered to carefully read through the articles on this website, and read the supporting solid evidence in the references, then you would’ve avoided making the hideously insulting accusation that my writings are based on nothing but misconceptions and conjecture.

      My writings are not simply based on what I’ve read, they are heavily based on profoundly moving life experiences that I truly wish were just anecdotally-formed conjecture rather than my reality, which is backed by independently verifiable evidence including such things as death certificates and medical records.

      My declaration of conflicts of interest: I try my very best to help prevent my friends, acquaintances, and the general public from being further injured (physically and/or psychologically) by quackery.

  • The idea that a treatment is acceptable and good because it elicits a placebo response in “some” people “some” of the time is ridiculous. What we want is a treatment that goes beyond just a placebo effect to actually have a reliable, consistent active pharmacologic effect (whether herb, drug, nutrient, whatever) as well! It’s not hard to understand….

  • I love how alternative medicine discussions always seem to be focused on one very small part of alternative medicine, and probably the part with the least success. Alternative therapies exist, that have far better success than any conventional therapies – and get this, they don’t cause cancer. Studies have been done by conventional medicine that prove their success. Ozone therapy is one of them. Let’s not throw out blanket statements that alternative medicine is bogus, and then back it up by covering one very small part of the entire picture. Alternative medicine is a very large focus – let’s talk about the part of it that is successful. Does Dr. Ernst have any studies or research on the other parts of alternative medicine, and I’m not talking about Chiropractic, homeopathy, or acupuncture.

    • yes he does!
      just go on PUBMED and search ‘ERNST E’

    • “Someone” said:

      Alternative therapies exist, that have far better success than any conventional therapies – and get this, they don’t cause cancer. Studies have been done by conventional medicine that prove their success. Ozone therapy is one of them.

      You seem to know something no one else does. Last time I checked (some months ago), ozone therapy was still useless. Please inform us of the research you are referring to. We physicians are very eager to add ozone therapy and other alternative methods to the arsenal of conventional medicine if someone has found a credible use for it.
      Until then it remains one of many useless snakeoil therapies, the sale of which constitutes fraud.

  • “One thing The Effect touched on that Horizon didn’t was that the ultimate wonder drug may be no drug at all. Obviously this is not good news for big pharma, or indeed pharma of any proportion, and yet Horizon chose not to go there. Probably this was because without all of the big pharmaceutical companies footing the bill, none of this research would be happening in the first place.”

    I would love to know your thought Prof.

  • First of all – the placebo effect can only be quantifiable in a comparison with another treatment in the same experimental setting. To give a treatment without evidence of effect and no control of confounders is just guesswork. Can patients be cured by guesswork? Of course – but is it really a path of choice? The effect in these cases is surely due to autosuggestion, an effect that can be quite measurable and positive – just compare with stigmata in the religious – but as has been pointed out again and again it is rather unpredictable. And when it fails the blame always seem to fall on the patients instead of the therapist…

  • Oh dear, a hijacked thread indeed! But interesting all the same.

    I did enjoy the post but since I never had any suspicions about your funding, I have to say I found the hijacking more fun.

    Very amusing how fedup puts all his eggs into the basket of a single telly program and does no followup. Many views might be aired on such a program and Harvard certainly has it’s cranks. It’s rather like thinking you’re a biologist because you watched a Nature episode on PBS for fedup to cite this program as any kind of body of scientific work–let alone attempt to allude that it offers any insight into the motivations or practices of EE.

    • I have a feeling that “fedup” has realised the futility of believing in the unbelievable and inexplainable and is trying to psyche him/herself into remarking his/her services as a wonderful placebo therapy. 😀

  • I don’t agree, placebo was shown to alter blood levels at altitude, the study used no oxygen and placebo oxygen (no oxygen) the effect was created by suggestion and that suggestion produced a real and measurable effect in the people taking part in the trial. It produced effects as if the person was using real oxygen. It’s not guess work in the slightest. Have you seen the Programme?Irene, If you are commenting on a science programme that involved real scientists and real research that you haven’t even seen, well speaks for itself really. This TV program offered good evidence, it involved real research, please AGAIN ask Prof Ernst if he can fault the evidence provided on the show.
    And Irene so you can’t really have an opinion on something unless you have been to uni to study it? thats funny.

    • you are not still going on about a telly programme which you think was a scientific study?!?

      • Nice try Prof. It was a telly prog that included scientific study. It included real research done by real professors. It wasn’t some disney animation. If tv programmes are not reliable ways of getting science ideas to the public you had better call prof Brian Cox.

        • As has been demonstrated and discussed ad nauseam, anyone can produce the research results they wish for. Even real professors. And anyone can have them published in some obscure magazine or non-peer reviewed popular television program.

          And the placebo effect can be as strong and convincing as you want to make it. But it does not cure real diseases, only alleviates selected (mostly stress dependent) conditions temporarily.

          Here’s a good lesson in the application of the placebo effect for you:

          http://www.youtube.com/watch?v=MzjoKhBklYg

          I hope that if “fedup” gets a serious, life threatening but curable disease, he/she forgets about the wonders of alternative and placebo for a while and seeks prompt medical attention. And says thank you afterwards.

          • Fedup will contend that your last point is a straw man. In reality it addresses the whole issue about CAM (as has been pointed out countless times before). If it works, it’s medicine. If it doesn’t it’s fodder for the “worried well”.

  • Fedup; you’re probably a troll, but your posts suggest you’re just incapable of comprehending. Let me try one last time. In every prospective, double-blind, randomized, placebo controlled study you will see therapeutic effects in the placebo arm. You will also usually see side-effects. Is this evidence that placebo therapy is worth considering as medicine? ‘Fraid not, because you can’t predict which patients will respond. When it’s less easy to define exactly what causes any particular disease, it’s less easy it is to predict who will respond to what. That’s true of real medicines, but it’s a serious handicap for placebos.

    Positive placebo responses certainly are evidence for a few things. Regression to the mean (look it up). The tendency for most illnesses to recover spontaneously. Following from the last, the difficult issue of psychosomatic responses. Our bodies are complex systems, with unknown numbers of positive and negative feedback loops. If I’m deeply saddened, I cry. If I’m sexually aroused… If I’m very cold, I pop out in goosebumps. If I’m frightened, I sweat. Quite clearly our nervous systems play a part in how we feel and to what we respond. At present we have imperfect uderstanding of the fine detail of mind-body interaction. The question is whether we seriously gain meanwhile from gullibly accepting whatever nonsense the alternative medicine folks fire at us. Personally I find it condescending and demeaning to imagine being treated with any placebo by a qualified doctor. I’m happy to accept we don’t understand all medical cause and effect; and to recognize that some or a lot of “illness” stems from delusion rather than physical causes. Belief in scientific fairies ultimately contributes nothing to our wellbeing or our self-respect.

  • I don’t believe that you were biased ( overtly anyway) but your framework was biased. In other words your vision of ‘alternative medicine’ was refracted through the prism of the current paradigm of understanding. You are a product of your education and never really broke free. Alternative medicine itself is a meaningless term and, personally, I would have refused to ever use that phrase. Is giving paracetamol for fever in children ‘alternative medicine’… there’s no evidence of benefit yet evidence of harm. Simply by using such a ‘loaded’ meaningless, inherently biased phrase you expose a (?subconscious) bias… Ps welcome trust is Big Pharma to its core

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