Monthly Archives: November 2015
A friend alerted me to this website: Hungarian Academy of Sciences statement proposing the same scientific standards for homeopathic drug registration as for normal drugs
Members of the Section of Medical Sciences of the Hungarian Academy of Sciences (HAS) voted unanimously on 9 November 2015 for supporting the earlier proposal of the Royal Swedish Academy of Sciences. The Swedish statement requested that the homeopathic remedies should go through the same efficacy trials as normal drugs should.
The Hungarian statement refers to various recent scientific statements for example to the study of the Australian Government’s National Health and Medical Research Council that analysed 175 publications and concluded that there was no reasonable scientific proof for the efficacy of homeopathy for any health conditions. The HAS also refers to the European Academies Science Advisory Council that is allegedly considering an investigation among the academies of the UN countries about this topic. The statement points out that another Hungarian scientific body (Health Science Committee – Egészségügyi Tudományos Tanács) had made a similar statement already in 1991 and opposed using and registering those drugs for that efficacy had not been proved and that had not gone through adequate research procedures.
József Mandl – biochemist, member of HAS, president of Health Science Committee said: “The Australian and Swedish statements had raised the interest of the Hungarian scientific community and now members of the Medical Sciences Section of the Hungarian Academy of Sciences voted unanimously to join the Swedish initiation… Science has well defined, rigorous methods and systems. Homeopathy can’t be fitted to these. Homeopathic remedies don’t meet the criteria of evidence based medicine. There might be various hypotheses, theories, but everything should be proved. This is what science means and this is what we would like to highlight now.”
Well said, indeed!
It is high time that the authorities concede that there can be only one standard in medicine regulation. The ‘free ride’ homeopathy has had for 200 years must now come to an end.
This notion also seems to be increasingly supported by the legal profession. An Australian lawyer just published this abstract:
The 2010 report of the United Kingdom Science and Technology Committee of the House of Commons and the 2015 report of the Australian National Health and Medical Research Council have overtaken in significance the uncritical Swiss report of 2012 and have gone a long way to changing the environment of tolerance toward proselytising claims of efficacy in respect of homeopathy. The inquiry being undertaken in the United States by the Food and Drug Administration during 2015 may accelerate this trend. An outcome of the reports and inquiries has been a series of decisions from advertising regulators and by courts rejecting medically unjustifiable claims in respect of the efficacy of homeopathy. Class actions have also been initiated in North America against manufacturers of homeopathic products. The changing legal and regulatory environment is generating an increasingly scientifically marginalised existence for homeopathy. That new environment is starting to provide effective inhibition of assertions on behalf of homeopathy and other health modalities whose claims to therapeutic efficacy cannot be justified by reference to the principles of evidence-based health care. This has the potential to reduce the financial support that is provided by insurers and governments toward homeopathy and to result in serious liability exposure for practitioners, manufacturers and those who purvey homeopathic products, potentially including pharmacists. In addition, it may give a fillip to a form of regulation of homeopaths if law reform to regulate unregistered health practitioners gathers momentum, as is taking place in Australia.
As though this is not enough, today it was reported that the UK NHS is considering to blacklist homeopathic remedies:
The Good Thinking Society has been campaigning for homeopathy to be added to the NHS blacklist – known formally as Schedule 1 – of drugs that cannot be prescribed by GPs. Drugs can be blacklisted if there are cheaper alternatives or if the medicine is not effective. After the Good Thinking Society threatened to take their case to the courts, Department of Health legal advisers replied in emails that ministers had “decided to conduct a consultation”. Officials have now confirmed this will take place in 2016.
It seems to me that the position of homeopathy as a form of health care is less and less tenable. Its place is in the history books. To satisfy the need for consumer/patient choice, the remedies should be moved to the confectionary shelves of the supermarkets.
Having just finished reading an ‘satirical esothriller’ entitled ‘VIER FRAUEN UND EIN SCHARLATAN’ (it’s a good book but it’s in German, I’m afraid), I have been thinking more than usual about charlatans. A charlatan is defined as a person who falsely pretends to know or be something in order to deceive people. In the book, the charlatan character is deliberately exaggerated as a dishonest, immoral crook. I have met such people; in fact, I have met plenty of such people in alternative medicine. But I have to admit that, in my experience, there are other charlatans too; in particular, I am talking of ‘honest’ quacks who pretend to know while also being utterly convinced to know.
Come to think of the categories of charlatans, I think the matter is really quite simple: as far as I can see, in alternative medicine, there are essentially just two types.
THE CROOK
This type of charlatan is the one we think of first when we mention the term. He (usually it’s a male) has a range of remarkable features:
- he is dishonest;
- he is entirely rational;
- he knows about evidence and has prepared all the necessary pseudo-arguments to belittle science vis a vis his followers;
- he is only interested in himself;
- he is immoral;
- he wants to make money;
- he employs all the means available to achieve his aims, including PR, advertising, branding, merchandising etc.
- he does not believe in his ‘message’;
- he systematically studies and exploits his target group;
- he does not live by his own rules;
- when he is implicated in harming a patient, he consults his lawyers;
- he is cynical;
- his ‘charisma’, if he has any, is well-studied and extensively rehearsed;
- when challenged, he sues.
THE FANATCIST
This type is very different from the crook and would be deeply shocked by the crook’s behaviour and attitude. She (often it is a female) can be described as follows:
- she is convinced to be profoundly honest;
- she is deluded, often to the point of madness;
- she ignores the evidence totally and argues that science is just one of several ways of knowing;
- she feels altruistic;
- she thinks she is on the moral high ground;
- she is not primarily out to make money and might even offer her services for free;
- she does not seek fame;
- she is religiously convinced of the correctness of her message and wants to save mankind through it;
- her message is for everyone;
- she strictly adheres to her own gospel and thinks that those who don’t are traitors;
- when she is implicated in causing harm, she consults her ueber-guru;
- she abhors cynicism;
- her charisma, if she has any, is real and a powerful tool for convincing followers;
- when challenged, she feels hurt and misunderstood.
As I indicated already, this is a SIMPLE classification. Between the two extremes, there are all shades of grey. In fact, it is a continuous spectrum.
Why should any of this be important?
Charlatans of both types cause immeasurable harm, and it is impossible to decide which type is more dangerous. Our aim must be to prevent or minimise the harm they do. I think, this aim can best be pursued, if we know who we are dealing with. Identifying where precisely on the above scale a particular charlatan or quack is situated, might help in the prevention of harm.
The aim of this study was to evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.
Patients with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology were randomised to receive 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. The NPQ score at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes) served as outcome measures. 517 patients were recruited. Their median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention.
The authors drew the following conclusions: acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
Where to begin? There is much to be criticised about this study!
For starters, the conclusions are factually wrong. They should read “acupuncture sessions plus usual care and Alexander Technique lessons plus usual care both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
On this blog, we have repeatedly discussed the ‘A+B versus B’ study design and the fact that it cannot provide information about cause and effect because it fails to control for placebo effects and the extra attention, time and empathy (for instance here and here). I suspect that this is the reason why it is so very popular in alternative medicine. It can make ineffective therapies appear to be effective.
Another point is a more clinical concern. Neck pain is not a disease, it is a symptom. In medicine we should, whenever possible, try to treat the cause of the underlying condition and not the symptom. Acupuncture is at best a symptomatic treatment. Usual care is often not very effective because we normally fail to see the cause of neck pain. In my view, alternative treatments should either be tested against placebo or sham interventions or against optimal care.
What is optimal care for nonspecific neck pain? As its causes are often unclear and usually multifactorial, the optimal treatment needs to be multifactorial (one could also call it holistic) as well. The causes often range from poor ergometric conditions at work to muscular tension, stress, psychological problems etc. Thus optimal care would be a team work tailor-made for each patient possibly including physiotherapists, pain specialists, clinical psychologists, orthopaedic surgeons etc.
My points here are:
- neither acupuncture nor Alexander technique take account of this complexity,
- they claim to be holistic but, in fact, this turns out to be merely a good sales-slogan,
- usual care is usually no good,
- if pragmatic trials using the ‘A+B versus B’ design make any sense at all, they should employ not usual care but optimal care for the control group.
In the end, we are left with a study that looks fairly rigorous at first sight, but that really tells us next to nothing (except that dedicating 600 minutes to patients in pain is not without effect). I am truly surprised that a top journal like the Annals of Internal Medicine decided to publish it.
Whenever I or anyone else conducts a debate about problems in alternative medicine with advocates of this type of health care, the following argument is bound to pop up in one form or another: NO NEED TO POINT OUT MINOR FLAWS WITH MY FAVOURITE THERAPY; LOOK AT THE ENORMOUS PROBLEMS IN CONVENTIONAL MEDICINE!
This type of ‘alternative logic’ has emerged after nearly every single post I published on this blog, and it comes up almost inevitably after lectures I give to general audiences. Recently I was even heckled in that way by one of my hosts in a German ‘Volkshochschule’. She interrupted me twice during my lecture after I had pointed out that homeopathy was both costly and not free of risks. Her arguments were so typical that I will repeat them here:
- Much more money is spent on conventional drugs than on homeopathics.
- Conventional medicines have much more serious side-effects than homeopathics.
As this sort of logic is so amazingly popular in alternative medicine, and as it seems so very convincing to most lay people, it is time, I think, that I address it in some detail.
IT IS FALLACIOUS
The seemingly logic argument is essentially nothing but a classical fallacy; it is often called the ‘tu quoque’ fallacy and can easily be shown to be illogical, for instance, by quoting examples pointing out that
- the large number of death on the road cannot justify unsafe trains,
- poor aeroplane design is no support for the concept of flying carpets,
- you neighbour beating up his wife does not entitle you to be nasty to your spouse,
- just because you claim that everyone is cheating, you are not allowed to be dishonest,
- the high fatality rate of one hospital is not a justification for negligence in another, etc. etc.
In the context of alternative medicine: a poor track record of mainstream medicine is no reason to tolerate problems with alternative medicine.
IT IS DANGEROUSLY WRONG
The argument that, compared with conventional medicine, the problems of alternative medicine are unimportant, is not just fallacious, it is factually wrong. The comparison of the costs or the risks of homeopathy with those of conventional medicines, for instance, is an entirely false approach.
When it comes to risks of therapeutic interventions, we always need to consider the benefits; as homeopathics have none of the latter, a risk/benefit comparison between homeopathy and the best evidence-based conventional therapy will hardly ever favour homeopathy. And when it comes to costs, we equally need to consider the benefits; as homeopathics have no benefits beyond placebo, a cost/benefit analysis comparison cannot favour homeopathy.
Why is it dangerous to claim otherwise? The answer is fairly obvious, I think: the argument that the problems with alternative medicine are negligible because those of conventional medicine are far, far bigger is fallacious and thus leads to wrong decisions in health care. And who would deny that wrong decisions in this area are dangerous? In fact, they can cost lives!
SO, PLEASE DO ME A FAVOUR AND DO NOT USE SUCH UNREFLECTED PSEUDO-ARGUMENTS ON THIS BLOG ANY MORE!!!
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.
Alternative medicine encompasses many bizarre treatments, but one of the weirdest must be craniosacral therapy (CST). The assumptions underlying CTS are:
- light manual touch of the head moves the joints of the cranium;
- this movement stimulates the flow of the cerebrospinal fluid;
- the enhanced flow has profound and positive effects on human health.
None of these assumptions are supported by evidence. In fact, they are as implausible as assumptions in alternative medicine get.
CST was developed by the osteopath John Upledger, D.O. in the 1970s, as an offshoot osteopathy in the cranial field, or cranial osteopathy, which was developed in the 1930s by William Garner Sutherland. Apart from this confusing terminology, we are also confronted with a confusing array of therapeutic claims; CST seems to be recommended for most conditions.
And the evidence? As good as none!
This is why any new trial is worth a mention. A recent study tested CST in comparison to sham treatment in chronic non-specific neck pain patients. 54 blinded patients were randomized to either 8 weekly units of CST or light touch sham treatment. Outcomes were assessed before and after treatment (week 8) and a further 3 months later (week 20). The primary outcome was pain intensity on a visual analogue scale; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement and safety.
In comparison to sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 as well as at week 20. Minimal clinically important differences in pain intensity at week 20 were reported by 78% of the CST patients, while 48% even had substantial clinical benefit. Significant differences at week 8 and 20 were also found for pain on movement, functional disability, physical quality of life and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8; anxiety only at week 20. No serious adverse events were reported.
The authors from the Department of Internal and Integrative Medicine, University of Duisburg-Essen and the Institute of Integrative Medicine, University of Witten/Herdecke, Germany, concluded that CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and quality of life up to 3 months post intervention.
Oddly, this is not even close to the conclusion I am going to draw: inadequate control for placebo and other non-specific effects generated a false-positive result.
Who is correct?
I suggest we wait for an independent replication to decide.
Yes, I got an award – and a very prestigious one at that!
Thanks to everyone who supported me in often difficult times and made this possible.
Here are some details from the website of Nature:
Edzard Ernst, Emeritus Professor at Peninsula Medical School, and Susan Jebb, Professor of Diet and Population Health at the University of Oxford, have been awarded the international 2015 John Maddox Prize for courage in promoting science and evidence on a matter of public interest, despite facing difficulty and hostility in doing so.
Edzard Ernst is recognised for his long commitment to applying scientific methodologies in research into complementary and alternative medicines and to communicating this need. Prof Ernst continued in his work despite personal attacks and attempts to undermine his research unit and end his employment. As a result, he has addressed a significant gap in the research base in this field and has brought insights into discussions with the public, policy makers, commentators, practitioners and other researchers.
Susan Jebb is recognised for her promotion of public understanding of nutrition on a diverse range of issues of public concern, from food supplements to dieting. Prof Jebb tackled misconceptions about sugar in the media and among the public, and endured personal attacks and accusations that industry funding compromised her integrity and advisory capabilities. Despite this experience, she continued to engage with the media and the public on issues of dietary advice, talking about the need for sound science and high quality research, and advocating for high standards of research governance.
The John Maddox Prize is a joint initiative of the science journal Nature, the Kohn Foundation, and the charity Sense About Science, and it is awarded to one or two people a year. The late Sir John Maddox FRS, was editor of Nature for 22 years and a founding trustee of Sense About Science. A passionate and tireless communicator and defender of science, he engaged with difficult debates, inspiring others to do the same.
For full award details see http://www.senseaboutscience.org/pages/maddox-prize-2015.html.
END OF QUOTE
On the day, I was quite nervous – so much so that I forgot the little text which I had prepared for the occasion. Therefore I had to memorize it and got a bit muddled up in my excitement. For all who were not present, here is the very short (they asked me for 3 minutes only!) ‘thank-you-address’ I had wanted to give:
I am delighted to receive this prestigious award and to have the research of my team recognised in this way. But, as a true sceptic, I have to ask whether I really deserve this prize.
What is remarkable about what I have done?
For the last 20 years, I have tried to find out the truth about alternative treatments. The results were often not what enthusiasts of alt med had hoped for. But my job was to test and not to promote alternative medicine. So I published our findings and, if necessary, I defended them – nothing truly remarkable about that; it is exactly what scientists should be doing. To me, it seems almost as obvious as explaining that 2 + 2 = 4.
The remarkable thing is not standing up for well-documented facts; the remarkable thing surely is that there are others who claim that reductionist science is not applicable to such a problem, and that it has to be solved holistically: 2 and 2 must be integrated not added, and anyway, the whole is greater than its parts. Therefore 2 + 2 is not for 4, it is whatever you want to make of it.
The even more remarkable thing is that, about 10 years ago, my peers in Exeter all of a sudden seemed to defend such lunacy and joined the charlatans who promoted this nonsense in attacking me, my work and my integrity.
I thank you for the prize and I thank you for the cheque that comes with it. I have decided to donate the money to THE GOOD THINKING SOCIETY founded by my friend Simon Singh. This charity stands up for science by correcting some of the many false claims that are currently being made for bogus treatments. I think this is in the spirit of John Maddox and the prize in his honour. I hope the prize will inspire other scientists to stand up for science – because our science can only be as good as the integrity of our scientists.
For me, the most touching thing of the entire evening was a man who came up to me afterwards, shook my hand with enthusiasm and said: “If we all had courage like you, the world would be a better place”. Then he disappeared into the crowd and left me fighting back my tears.
The INDEPENDENT carried a nice article about the prize, Prof Jebb and myself the next day. It attracted a comment by someone calling himself ‘ZimJay’ which typifies the level of debate in the field of alternative medicine quite well, in my view:
Who knew there’s a science award for thumbsucking? is there is a bigger white male whiner than Edzard Ernst acting out like a 4 year old while living in the UK? Name them.
The University of Exeter has, as far as I know, not put out a comment. Odd, as it is not every day that a professor from this institution wins an international prize of this standing. Or perhaps not odd at all? But it is early days, of course – I wait and see.
Today, the INDEPENDENT published a short editorial with this conclusion:
During two decades patrolling the boundary between magic and medicine, he has protected our dignity, our pockets and our health. For that, we salute him.
I WOULD NOT HOLD MY BREATH FOR FURTHER VILE COMMENTS BY ALTERNATIVISTS – AND, IN THIS PARTICULAR INSTANCE, I OUGHT TO THANK THEM: WITHOUT THEIR INCESSANT DIRTY WORK, I WOULD PROBABLY NOT HAVE BEEN AWARDED THE JOHN MADDOX PRIZE 2015.
Anyone who has read ‘A SCIENTIST IN WONDERLAND’ will know that I stood up for science more than once in my life. In fact, I strongly believe that this is what scientists ought to do, and I frequently get irritated to see that some of my colleagues seem to disagree [if not even we scientists can stick our necks out for science, how can we expect others to do it?]. Being thus convinced, I surprised myself recently when I was invited to do my bid for science – and declined to comply. Here is the story:
On 16 October, I received the following invitation by email out of the blue:
Hi Dr. Ernst,
My name is John Jackson. I am Executive Director of the Adolph Coors Foundation in Denver, the charitable arm of the Coors family (not the brewery).
I would like to invite your participation in a debate on integrative medicine which will be held Sunday evening, March 20, 2016, at the Hyatt Regency in Denver. The debate will be the keynote event of our Pioneers in Health conference. Your debate partner will be Dr. Andrew Weil. As our conference precedes Dr. Weil’s annual Nutrition and Health Conference, we expect excellent attendance of 700-800, possibly more.
The debate topic: “Fad or the Future: Will Integrative Medicine Play a Growing Role in the Future of Health Care?”
If you are willing to join us, we plan the following debate format: Opening statements with responses by each of you, questions put to each other, and responses by each of you to pre-submitted questions from the audience and, finally, closing statements. (Audience participation will be limited to questions submitted via an app, not by microphone.) We intend to invite a prominent journalist/business leader to moderate. Dr. Weil has recommended CNN’s health reporter but this has not been confirmed.
I have read numerous articles you have authored on this website and feel you would offer an excellent counterpoint to Dr. Weil. Indeed, Dr. Weil also feels you would be an ideal debate partner. I have also read your ground rules for debate (on this website). Dr. Weil and our foundation share your insistence on respect and politeness, whether it’s a blog post or a public debate.
In the interest of full disclosure, our foundation funds several institutions which are studying various “alternative” practices, including the recent study of the use of electro-acupuncture for hypertension on which you and others have commented. We have also funded a project involving Dr. Weil and the University of Arizona. You can read more about our interest in integrative medicine and who we fund at www.coorsfoundation.org.
Of course, if you agree to participate, we would cover your travel, meals and lodging expenses and are willing to negotiate a reasonable honoraria.
If you would like to discuss this further by phone, please feel free to give me a call. I can be reached in Denver at 303-388-1636.
Thank you, Dr. Ernst. I look forward to your response.
John Jackson
Adolph Coors Foundation
Denver
I have to admit, I was flattered and tempted in equal measure. This could be a great occasion to reach a large US audience and get a few important points across. But, at the same time, I had my doubts, and these doubts grew faster by the minute. There were several hints in this seemingly innocent email to suggest that there was more to this story than a straight forward invitation. Was this a set-up to give integrative medicine more credibility than it deserves?
Being uncertain, I asked several American friends for advice. They all seemed horrified and very strongly advised me not to accept the invitation. But I was still not entirely convinced – even if these people are a bit strange, even if it is a set-up, even if I do not ‘win’ the debate, it might be an interesting experience and I might learn (and earn!) something.
I clearly needed to find out more. I know Andrew Weil, of course, and I had seen him twice before in similar public debates. So I had no illusions that his charisma and slick rhetoric, combined with an audience full of admirers, would win the day. But I did not necessarily mind all that much; it could still be an occasion to make my arguments known and it might turn out to be a fascinating experience.
However, I certainly did not want to lend, through my presence, undue credibility to people or organisations who don’t deserve it. So, what about the organisers? What do the Adolph Coors Foundation stand for, and who are they?
One of my US friends alerted me to an eye-opening website. Other websites were even less complimentary and mentioned homophobic, racist, and anti-labor practices in relation to the funders. This made up my mind, and I wrote the following response to Jackson’s invitation:
Dear Mr Jackson,
as you may know, I do like a challenge. Therefore I was very tempted to accept your offer to debate with Andrew.
On second thought, however, I developed doubts that the event outlined in your email can be a fair debate of the issues around integrative medicine. The audience gathered for Andrew’s conference would be entirely on the side of their ‘guru’, and even the moderator would be Andrew’s choice. It is notoriously problematic to discuss scientific evidence with quasi-religious believers pretending facts were a matter of opinion.
I fear that a life debate in Denver would be akin to a discussion between an evolutionary scientist and a crowd of rampant creationists.
Since you know my blog, I suggest we conduct such a debate in writing there. This would have the advantage of a much wider, more diverse audience and provide the opportunity to check the evidence for any claims made by the discussants.
Meanwhile, I thank you for this invitation but, unless you can convince me that my fears are unfounded, I have to decline.
Regards
E Ernst
I was not at all sure whether to expect a response. Therefore I was pleasantly surprised that, on 25 October, the following email reached me:
Dr. Ernst,
Thank you for your response to our invitation. I apologize for the tardy reply. I have been travelling and generally avoid using my iPhone to respond to important emails. I have been burned once-too-often by the iPhone’s embarrassing auto-INcorrections.
Your hesitation about participating in the debate is totally understandable and, frankly, I would have been surprised if you had NOT asked for more detail.
Dr. Weil certainly does have a substantial following of loyal and passionate followers. And there will be a healthy contingent of them in the audience. Dr. Weil’s team estimates that 200-300 of those attending his Nutrition and Health Conference will also attend our conference, including the debate. That means the remaining attendees (400-500) will be those who sign up through our public portal which will be launched in a few weeks. Our marketing is targeting Colorado’s health community, including medical providers. We also expect our conference cosponsor, Americans for Prosperity Foundation (AFPF), to attract attendees through their outreach efforts. AFPF is a grassroots organization that has virtually nothing to do with any kind of medicine, conventional or integrative. AFPF’s interest is promoting innovations in the delivery of health care (more health care choice) which will be the focus of a panel earlier in the day. For what it is worth, you are more than welcome to encourage your readers to attend. We plan to keep the conference fee very low (somewhere between $25 and $50), a figure that does not even cover the food and beverage costs. So, while I cannot guarantee applause for your debate points, I believe you will find our audience open to a wide range of perspectives on the future of integrative medicine.
With regard to the debate format and moderator, we believe the format is conducive to a healthy exchange of ideas. You both make opening statements, you both respond to each other’s opening statements, you ask each other questions, you both answer questions from the moderator and the audience and you both will be given equal time to offer closing statements. Our foundation — not Dr. Weil — will select the moderator. He recommended a health writer at CNN although he has not provided a specific name. If you want to suggest a name, please feel free. We may or may not choose a moderator that either of you recommend.
Long story short, the Coors Foundation shares your interest in having a robust debate on this topic. That is exactly why we tendered the invitation to you. We hope that you will reconsider your initial declination. Since we are nearing the date at which we will launch our registration portal and agenda, we respectfully request a response at your earliest possible convenience. If we have not heard from you by Wednesday, October 28, we will assume your initial decision stands and will extend the invitation to our second choice.
Thank you Dr. Ernst. We look forward to your reply.
John Jackson
Adolph Coors Foundation
Denver
I found it impossible to be convinced by Jackson’s arguments; on the contrary, some of my suspicions were confirmed, and I did a little further research – this time on the ‘Americans for Prosperity Foundation’. I found numerous websites about them and even a Wikipedia page. What I learnt in the course of my inquiries made my alarm bells ring loud and clear. I decided to sleep over it and then sent this email as my final response:
Dear Mr Jackson,
I am afraid your second email did not manage to change my mind.
It was important for me to learn about the co-sponsor of the event. I did some research on both your and the co-sponsoring organisations and found that I share virtually none of their views. I am reluctant to give credibility through my presence in Denver to two prominent right wing lobby groups.
Furthermore I am not at all convinced that the event is designed to generate a balanced debate. On the contrary, by your description of it, I might even fear for my personal safety after presenting facts which contradict or deride the opinions of large parts of the audience, the organisers and Dr Weil.
Lastly I am still convinced that factual issues around integrative medicine cannot be debated fruitfully by pretending they are merely matters of opinion. A debate in writing, where all the arguments can be checked for their evidential basis, would surely be much preferable. I find it regrettable that you do not even comment on my offer to conduct such a debate on my blog. The offer, however, still stands.
I thank you again for inviting me. I do like to stand up for science but, in this particular instance, I fear the costs would be too high.
Regards
E Ernst
So far, I have not had a reply, and I do not expect to receive one soon.
The whole affair is little more than a triviality, of course. Yet it raises at least two important questions, I think:
- Should we stand up for science wherever we can, or is the price occasionally simply too high?
- What are these mysterious links between alternative medicine in the US and the far right?
I would be most interested to hear your views.
