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

Ernst’s law

Michael Dixon LVOOBEMAFRCGP has been a regular feature of this blog (and elsewhere). He used to be a friend and colleague until … well, that’s a long story. Recently, I came across his (rather impressive) Wikipedia page. To my surprise, it mentions that Dixon

See the source image“has been criticised by professor of complementary medicine and alternative medicine campaigner Edzard Ernst for advocating the use of complementary medicine. Ernst said that the stance of the NHS Alliance on complementary medicine was “misleading to the degree of being irresponsible.”[31] Ernst had previously been sympathetic to building a bridge between complementary and mainstream medicine, co-writing an article with Michael Dixon in 1997 on the benefits of such an approach.[32] Ernst and Dixon write “missed diagnoses by complementary therapists giving patients long term treatments are often cited but in the experience of one of the authors (MD) are extremely rare. It can also cut both ways. A patient was recently referred back to her general practitioner by an osteopath, who was questioning, as it turned out quite correctly, whether her pain was caused by metastates. Good communication between general practitioner and complementary therapist can reduce conflicts and contradictions, which otherwise have the potential to put orthodox medicine and complementary therapy in an either/or situation.”

REFERENCES

31) February 2009, 24. “Academics and NHS Alliance clash over complementary medicine”. Pulse Today.

32) ^ Update – the journal of continuing education for General Practitioners, 7th May 1997

I have little recollection of the paper that I seem to have published with my then friend Michael, and it is not listed in Medline, nor can I find it in my (usually well-kept) files; the journal ‘Update’ does not exist anymore and was obviously not a journal good enough for keeping a copy. But I do not doubt that Wiki is correct.

In fact, it is true that, in 1997, I was still hopeful that bridges could be built between conventional medicine and so-called alternative medicine (SCAM). But I had always insisted that they must be bridges built on solid ground and with robust materials.

Put simply, my strategy was to test SCAM as rigorously as I could and to review the totality of the evidence for and against it. Subsequently, one could consider introducing those SCAMs into routine care that had passed the tests of science.

Dixon’s strategy differed significantly from mine. He had no real interest in science and wanted to use SCAM regardless of the evidence. Since the publication of our paper in 1997, he has pursued this aim tirelessly. On this blog, we find several examples of his activity.

And what happened to the bridges?

I’m glad you ask!

As it turns out, very few SCAMs have so far passed the test of science and hardly any SCAM has been demonstrated to generate more good than harm. The material to build bridges is therefore quite scarce, hardly enough for solid constructions. Dixon does still not seem to be worried about this indisputable fact. He thinks that INTEGRATED MEDICINE is sound enough for providing a way to the future. I disagree and still think it is ‘misleading to the degree of being irresponsible’.

Who is right?

Dixon or Ernst?

Opinions about this differ hugely.

Time will tell, I suppose.

This was essentially the question raised in a correspondence with a sceptic friend. His suspicion was that statistical methods might produce false-positive overall findings, if the research is done by enthusiasts of the so-called alternative medicine (SCAM) in question (or other areas of inquiry which I will omit because they are outside my area of expertise). Consciously or inadvertently, such researchers might introduce a pro-SCAM bias into their work. As the research is done mostly by such enthusiasts; the totality of the evidence would turn out to be heavily skewed in favour of the SCAM under investigation. The end-result would then be a false-positive overall impression about the SCAM which is less based on reality than on the wishful thinking of the investigators.

How can one deal with this problem?

How to minimise the risk of being overwhelmed by false-positive research?

Today, we have several mechanisms and initiatives that are at least partly aimed at achieving just this. For instance, there are guidelines on how to conduct the primary research so that bias is minimised. The CONSORT statements are an example. As many studies pre-date CONSORT, we need a different approach for reviews of clinical trials. The PRISMA guideline or the COCHRANE handbook are attempts to make sure systematic reviews are transparent and rigorous. These methods can work quite well in finding the truth, but one needs to be aware, of course, that some researchers do their very best to obscure it. I have also tried to go one step further and shown that the direction of the conclusion correlates with the rigour of the study (btw: this was the paper that prompted Prof Hahn’s criticism and slander of my work and person).

So, problem sorted?

Not quite!

The trouble is that over-enthusiastic researchers may not always adhere to these guidelines, they may pretend to adhere but cut corners, or they may be dishonest and cheat. And what makes this even more tricky is the possibility that they do all this inadvertently; their enthusiasm could get the better of them, and they are doing research not to TEST WHETHER a treatment works but to PROVE THAT it works.

In the realm of SCAM we have a lot of this – trust me, I have seen it often with my own eyes, regrettably sometimes even within my own team of co-workers. The reason for this is that SCAM is loaded with emotion and quasi-religious beliefs; and these provide a much stronger conflict of interest than money could ever do, in my experience.

And how might we tackle this thorny issue?

After thinking long and hard about it, I came up in 2012 with my TRUSTWORTHYNESS INDEX:

If we calculated the percentage of a researcher’s papers arriving at positive conclusions and divided this by the percentage of his papers drawing negative conclusions, we might have a useful measure. A realistic example might be the case of a clinical researcher who has published a total of 100 original articles. If 50% had positive and 50% negative conclusions about the efficacy of the therapy tested, his TI would be 1.

Depending on what area of clinical medicine this person is working in, 1 might be a figure that is just about acceptable in terms of the trustworthiness of the author. If the TI goes beyond 1, we might get concerned; if it reaches 4 or more, we should get worried.

An example would be a researcher who has published 100 papers of which 80 are positive and 20 arrive at negative conclusions. His TI would consequently amount to 4. Most of us equipped with a healthy scepticism would consider this figure highly suspect.

Of course, this is all a bit simplistic, and, like all other citation metrics, my TI provides us not with any level of proof; it merely is a vague indicator that something might be amiss. And, as stressed already, the cut-off point for any scientist’s TI very much depends on the area of clinical research we are dealing with. The lower the plausibility and the higher the uncertainty associated with the efficacy of the experimental treatments, the lower the point where the TI might suggest  something  to be fishy.

Based on this concept, I later created the ALTERNATIVE MEDICINE HALL OF FAME. This is a list of researchers who manage to go through life researching their particular SCAM without ever publishing a negative conclusion about it. In terms of TI, these people have astronomically high values. The current list is not yet long, but it is growing:

John Weeks (editor of JCAM)

Deepak Chopra (US entrepreneur)

Cheryl Hawk (US chiropractor)

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

The logical consequence of a high TI would be that researchers of that nature are banned from obtaining research funds and publishing papers, because their contribution is merely to confuse us and make science less reliable.

I am sure there are other ways of addressing the problem of being mislead by false-positive research. If you can think of one, I’d be pleased to hear about it.

 

Yesterday, it was announced that UK universities are not doing well according to international league tables. Of the UK’s 84 ranked universities, 66 saw their staff to student ratio decline while 59 had a drop in research citations. International student numbers at 51 universities also fell.

No reason to despair; help is on the way!

The University of Exeter reported that “as International Education Champion, Sir Steve will have a leading role in a 10-year strategy to both increase the number of international students choosing to study in the UK higher education system to 600,000 and increase the value of education exports to £35 billion per year by 2030. The University of Exeter is delighted and proud with this appointment…

The role of International Education Champion will be to work with organisations across the breadth of the education sector, including universities, schools, the EdTech industry, vocational training, and early years schooling providers. Steve will also help target priority regions worldwide to build networks and promote the UK as the international education partner of choice. The role will additionally help to boost the numbers of international students in the UK.

The appointment of Sir Steve Smith fulfils a priority action from the International Education Strategy, published by the Department for Education and the Department for International Trade. Sir Steve will spearhead overseas activity and address a number of market access barriers on behalf of the whole education sector, including concerns over the global recognition of UK degrees and other qualifications. Sir Steve’s experience, knowledge and global connections will help to develop long-term relationships with international governments and overseas stakeholders…”

Shortly after becoming VC at Exeter, Prof Smith closed two Departments: Music and Chemistry. Apparently, they were not bringing in enough cash. Several years later, he had a key role in closing my unit. It had attracted a complaint from Prince Charles’ 1st private secretary (full story here, in case you are interested).

I hope Sir Steve is more productive in boosting international education. One thing seems certain to me: post-Brexit/post-COVID academia in the UK will need a boost after what our current government has done to it.

The Foundation for Integrated Health (FIH) does no longer exist. But it is historically important, in my view. So, I decided to do some research in order to document its perplexing history. In the course of this activity, I found that someone had beaten me to it. This article that does the job very well; I therefore take the liberty of copying it here and adding a few points at the end:

The Foundation for Integrated Health (FIH) was a controversial charity run by Charles, Prince of Wales, founded in 1993. The Foundation promoted complementary and alternative medicine, preferring to use the term “integrated health”, and lobbied for its inclusion in the National Health Service. The charity closed in 2010 after allegations of fraud and money laundering led to the arrest of a former official.

History

Prince Charles established the charity in 1993 to explore “how safe, proven complementary therapies can work in conjunction with mainstream medicine”. [1]

Dr Michael Dixon was appointed the Foundation’s medical director. From 2005 to 2007, FIH received a grant from the Department of Health to help organise the self-regulation of complementary therapies. There had been concern that with a large proportion of the public turning to complementary approaches, there were few safeguards in place to ensure that non-statutorily regulated therapists were safe, trained and would act in an appropriate way. FIH worked to bring together the representative bodies of many complementary professions to talk and agree standards. [2] The result was the formation of the Complementary and Natural Healthcare Council (CNHC) which had hoped to register 10,000 practitioners of complementary medicine by the end of 2009 but which by September 2009 had succeeded in enrolling less than a tenth of that number due to lack of interest on the part of some of their professional associations. The Department of Health is currently continuing to fund the CNHC but future funding will be dependent on substantial progress being made towards the target (which has now been reduced to 2,000). Alternative medicine campaigners argued that the move toward regulation conferred undue respectability on unproven and possibly unsafe complementary & alternative medicine (CAM) approaches.

FIH also worked with medical schools to increase the understanding of complementary approaches amongst new doctors and ran an annual awards ceremony for integrated health schemes both within the medical world and in the community.

The papers of the Foundation for Integrated Health are held at the Wellcome Library, Archives and Manuscripts, and are available for consultation by appointment. Further details about the collection can be found on the Wellcome online catalogue. [3]

Controversy

The Prince of Wales has demonstrated an interest in alternative medicine, the promotion of which has occasionally resulted in controversy. [4] In 2004, the Foundation divided the scientific and medical community over its campaign encouraging general practitioners to offer herbal and other alternative treatments to National Health Service patients, [5] [6] and in May 2006, The Prince made a speech to an audience of health ministers from various countries at the World Health Assembly in Geneva, urging them to develop a plan for integrating conventional and alternative medicine. [7]

In April 2008, The Times published a letter from Professor Edzard Ernst that asked the Prince’s Foundation to recall two guides promoting “alternative medicine”, saying: “the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous.” A speaker for the foundation countered the criticism by stating: “We entirely reject the accusation that our online publication Complementary Healthcare: A Guide contains any misleading or inaccurate claims about the benefits of complementary therapies. On the contrary, it treats people as adults and takes a responsible approach by encouraging people to look at reliable sources of information… so that they can make informed decisions. The foundation does not promote complementary therapies.” [8] Ernst has recently published a book with science writer Simon Singh condemning alternative medicine called Trick or Treatment: Alternative Medicine on Trial . The book is ironically dedicated to “HRH the Prince of Wales” and the last chapter is very critical of his advocacy of “complementary” and “alternative” treatments. [9]

The Prince’s Duchy Originals have produced a variety of CAM products including a “Detox Tincture” that Ernst has denounced as “financially exploiting the vulnerable” and “outright quackery“. [10] In May 2009, the Advertising Standards Authority criticised an email that Duchy Originals had sent out to advertise its Echina-Relief, Hyperi-Lift and Detox Tinctures products saying it was misleading. [11]

In Ernst’s book More Good Than Harm? The Moral Maze of Complementary and Alternative Medicine he and ethicist Kevin Smith call Charles “foolish and immoral” and “conclude that it is not possible to practice alternative medicine ethically”. Ernst further claims that the private secretary of the Prince contacted the vice chancellor of Exeter University to investigate Ernst’s complaints against the “Smallwood Report” which the Prince had commissioned in 2005. While Ernst was “found not to be guilty of any wrong-doing, all local support at Exeter stopped, which eventually led to my early retirement.” [12]

Between 2005 and 2007 the charity’s annual turnover was about £1.2 million. [13] In 2007 it received significant funding from The Prince’s Charities Foundation, and a £300,000 grant from the Department of Health for the regulation of complementary medicine. [14]

Lobbying allegations

The Prince personally wrote at least seven letters [15] to the Medicines and Healthcare products Regulatory Agency (MHRA) shortly before they relaxed the rules governing labelling of herbal products such as the ones sold by his duchy, a move that has been widely condemned by scientists and medical bodies. [16]

On 31 October 2009 it was reported that Prince Charles had personally lobbied Health Secretary Andy Burnham regarding greater provision of alternative treatments on the NHS. [10]

Charity Commission complaint

In March 2010, the political organisation Republic, which campaigns for an elected head of state, registered a complaint with the Charity Commission for England and Wales over a possible breach of charity regulations, suggesting that the foundation’s staff had pursued a public vendetta against Ernst. [17]

Fraud allegations and closure

In 2010, following accounting irregularities noted by the foundation’s auditor, it was reported that the Metropolitan Police Economic and Specialist Crime Command had begun an inquiry into alleged fraud. [18] Within weeks, two former officials at the Prince’s Foundation were arrested for fraud believed to total £300,000. [1] [19] Four days later, on 30 April 2010, the foundation announced [20] that it would close. The foundation stated that its closure was the result of the fraud allegations. [21]

The charity’s finance director, accountant George Gray, was convicted of theft totalling £253,000 and sentenced to three years in prison. [22] [23]

Rebranding as “The College of Medicine”

Following the disbanding of the Prince’s Foundation, many of the individuals and organisations involved launched a new organisation in late 2010 called The College of Medicine, with which the Prince of Wales was not overtly involved. Several commentators writing in The Guardian and The British Medical Journal, have expressed the opinion that the new organisation is simply a re-branding of the Prince’s Foundation, [22] [24] [25] [26] [27] describing it as “Hamlet without the Prince”. [28]

In support of this connection with Prince Charles, alternative medicine critic and pharmacologist David Colquhoun has argued that the College (originally called “The College of Integrated Health”) is extremely well-funded [29] and seemed from the beginning to be very confident of the Prince’s support; explicitly describing its mission as “to take forward the vision of HRH the Prince of Wales”. [30]

These claims have been contested by the College. [31]

  1. Robert Booth (26 April 2010). “Prince Charles’s aide at homeopathy charity arrested on suspicion of fraud”. London: guardian.co.uk.
  2. ↑ Regulating complementary therapies – Prince’s Foundation for Integrated Health
  3. ↑ “Wellcome Library Western Manuscripts and Archives catalogue”. Archives.wellcomelibrary.org. Retrieved 2015-09-07.
  4. ↑ Barnaby J. Feder, Special To The New York Times (9 January 1985). “More Britons Trying Holistic Medicine — New York Times”. Query.nytimes.com. Retrieved 2008-10-12.
  5. ↑ Carr-Brown, Jonathon (14 August 2005). “Prince Charles’ alternative GP campaign stirs anger”The Times. London. Retrieved 11 March 2009.
  6. ↑ Revill, Jo (2004-06-27). “Now Charles backs coffee cure for cancer”. London: The Observer. Retrieved 2007-06-19.
  7. ↑ Cowell, Alan (2006-05-24). “Lying in wait for Prince Charles”The New York Times. Retrieved 2009-10-15.
  8. ↑ Henderson, Mark (17 April 2008). “Prince of Wales’s guide to alternative medicine ‘inaccurate. London: Times Online. Retrieved 2008-08-30.
  9. ↑ Singh, S. & Ernst, E. (2008). Trick or Treatment: Alternative Medicine on Trial. Corgi.
  10. Tim Walker (31 Oct 2009). “Prince Charles lobbies Andy Burnham on complementary medicine for NHS”. London: Daily Telegraph. Retrieved 2010-04-01.
  11. ↑ “Duchy Originals Pork Pies”The Quackometer Blog. 11 March 2009.
  12. ↑ Ernst, Edzard (2018). “Why Did We Call Prince Charles Foolish and Immoral?”. Skeptical Inquirer. Committee for Skeptical Inquiry. 42 (3): 8–9.
  13. ↑ Charity CommissionThe Prince’s Foundation for Integrated Health, registered charity no. 1026800.
  14. ↑ The Prince’s Foundation for Integrated Health – 2007 accounts (PDF), Charity Commission, retrieved 2010-04-30
  15. ↑ “HRH “meddling in politics. DC’s Improbable Science. March 12, 2007.
  16. ↑ Nigel Hawkes & Mark Henderson (September 1, 2006). “Doctors attack natural remedy claims”The Times. London.
  17. ↑ Booth, Robert (19 March 2010). “Prince Charles health charity accused of vendetta against critic”. London: The Guardian.
  18. ↑ Delgado, Martin; Young, Andrew (4 April 2010). “Police probe into missing £300k at Prince Charles’ charity after bosses fail to file accounts”Daily Mail. London.
  19. ↑ “Prince Charles charity to close amid fraud inquiry”BBC News. 30 April 2010.
  20. ↑ Robert Booth (30 April 2010). “Prince of Wales’s health charity wound up in wake of fraud investigation”The Guardian.
  21. ↑ Laura Donnelly (15 May 2010). “Homeopathy is witchcraft, say doctors”. London: The Telegraph.
  22. Ian Sample (August 2, 2010). “College of Medicine born from ashes of Prince Charles’s holistic health charity”. London: The Guardian.
  23. ↑ Peter Dominiczak (20 August 2010). “Three years jail for accountant at Charles charity who stole £253,000”. Evening Standard. Archived from the original on 30 June 2011. Retrieved 2 February 2011.
  24. ↑ Jane Cassidy (15 June 2011). “Lobby Watch: The College of Medicine”British Medical Journal343: d3712. doi:10.1136/bmj.d3712PMID   21677014.
  25. ↑ David Colquhoun (12 July 2011). “The College of Medicine is Prince’s Foundation reincarnated”British Medical Journal343: d4368. doi:10.1136/bmj.d4368PMID   21750061.
  26. ↑ James May (12 July 2011). “College of Medicine: What is integrative health?”British Medical Journal343: d4372. doi:10.1136/bmj.d4372PMID   21750063.
  27. ↑ Edzard Ernst (12 July 2011). “College of Medicine or College of Quackery?”British Medical Journal343: d4370. doi:10.1136/bmj.d4370PMID   21750062.
  28. ↑ Nigel Hawkes (2010). “Prince’s foundation metamorphoses into new College of Medicine”341. British Medical Journal. p. 6126. doi:10.1136/bmj.c6126.
  29. ↑ David Colquhoun (July 25, 2010). “Buckinghamgate: the new “College of Medicine” arising from the ashes of the Prince’s Foundation for Integrated Health”. DC’s Improbable Science.
  30. ↑ David Colquhoun (29 October 2010). “Don’t be deceived. The new “College of Medicine” is a fraud and delusion”.
  31. ↑ Lewith, G. T.; Catto, G; Dixon, M; Glover, C; Halligan, A; Kennedy, I; Manning, C; Peters, D (12 July 011). College of Medicine replies to its critics”British Medical Journal343: d4364. :10.1136/bmj.d4364.    21750060.

_________________________________________________

This article is, as far as I can see, factually correct. I might just add some details:

  • Dixon became medical director of the FIH only a few months before it had to close.
  • The FIH was also involved in Prince Charles’ complaint about me alleging I had breached confidence in relation to the Smallwood report, even though the FHI had officially nothing to do with the report.
  • Mr Smallwood told me that, at that stage, Prince Charles considered the FIH to be ‘a waste of space’.
  • Some time ago, the College of Medicine quietly re-named itself as the ‘College of Medicine and Integrated Health’.
  • Prince Charles recently became the patron of the College of Medicine and Integrated Health.

A new appointment in the realm of so-called alternative medicine (SCAM) has just been announced:

Friends of Science in Medicine (FSM) President, Assoc Professor Ken Harvey MB BS (Melb), FRCPA, AM congratulates Professor Jon Wardle, nurse and naturopath, with postgraduate qualifications in public health, law and health economics, on being appointed to Southern Cross University’s (SCU) Maurice Blackmore Chair of Naturopathic Medicine in Lismore. Professor Wardle has also been appointed as Foundation Director of the National Centre for Naturopathic Medicine (NCNM) funded with $10 Million from the Blackmore Foundation set up to sponsor research into ‘complementary medicine’.

Vice Chancellor, Professor Adam Shoemaker BA (Hons), PhD (ANU), researcher in Indigenous literature and culture, said the benefits of basing the NCNM at Southern Cross were enormous, “Being in a region like the Northern Rivers of New South Wales means we have brilliant local networks in this field. We are also supported by a local community who, like the University, are really receptive to trying new things in order to create a healthier future”.

Professor Harvey comments, “Professor Wardle certainly has challenges ahead. The Northern Rivers region is the anti-vax capital of Australia and some naturopaths advise against vaccination. Degree courses in naturopathy such as the Torrens Bachelor of Health Science (Naturopathy) degree, include studies of homeopathy, iridology and flower essence therapy. None have scientific evidence of efficacy”.

FSM has long argued that health care should be based on scientifically sound research, published in peer-reviewed journals of accepted standing. FSM is equally concerned about medical practitioners offering unproven and often exploitative treatments as it is about complementary medicine practitioners. Professor Harvey said, “some naturopaths practicing in Lismore, associated with SCU, work at clinics that use unverified laboratory tests to make dubious diagnoses and recommend treatment programs that lack evidence of efficacy”.

Professor Harvey (and FSM) conclude that there is an urgent need for evidence-based science to be applied to naturopathy. They trust that Professor Wardle will emulate Professor Edzard Ernst, Foundation Professor of Complementary Medicine at Exeter University, by applying accepted scientific standards to the evaluation of naturopathic interventions.

The March 24 opening of the NCNM in Lismore will feature a panel discussion on the future of health care with guest speakers: Professor Kerryn Phelps AM, former President of the Australasian Integrative Medicine Association, Marcus Blackmore AM, naturopath and Executive Director of Blackmores Ltd, which markets vitamin and herbal products, and Professor Jon Wardle. FSM hopes that the panel will discuss some of the issues raised above.

Sounds exciting, but is Wardle up to the job?

Judging from his publication record, he is certainly a naturopath through and through. He has published lots of papers; as far as I can see most of them are surveys of some sort or another. Many leave me somewhat bewildered. Two examples must suffice:

No 1

Objectives: To explore the recommendations of naturopathic medicine for the management of endometriosis, dysmenorrhea, and menorrhagia, drawing on traditional and contemporary sources.

Design: Content analysis.

Setting: Australia, Canada, and the United States of America (USA).

Subjects: Contemporary sources were identified from reviewing naturopathic higher education institutions’ recommended texts, while traditional sources were identified from libraries which hold collections of naturopathic sources. Sources were included if they were published from 1800 to 2016, were in English, published in Australia, Canada, or the USA, and reported on the topic. Included sources were as follows: 37 traditional texts; 47 contemporary texts; and 83 articles from naturopathic periodicals.

Results: Across included sources, the most reported disciplines were herbal medicine, clinical nutrition, mineral medicines, homeopathy, hydrotherapy, and chemical-based medicines. Herbal medicines were extensively reported from all sources for the management of endometriosis, dysmenorrhea, and menorrhagia. Clinical nutrition was only recommended from contemporary sources for all three conditions. Mineral medicines were mentioned in both traditional and contemporary sources, but were only recommended for dysmenorrhea and menorrhagia. There were limited recommendations for homeopathy and hydrotherapy treatments in all conditions across all sources. Chemical-based medicines were only mentioned for dysmenorrhea and menorrhagia, and recommendations ceased after 1922. Recommendations for endometriosis were not present in any of the traditional sources, across all reported disciplines.

Conclusions: The findings of this article provide insights into the documented historical and contemporary treatments within naturopathic medicine for endometriosis, dysmenorrhea, and menorrhagia. While philosophical principles remain the core of naturopathic practice, the therapeutic armamentarium appears to have changed over time, and a number of the original naturopathic treatments appear to have been retained as key elements of treatment for these conditions. Such insights into naturopathic treatments will be of particular interest to clinicians providing care to women, educators designing and delivering naturopathic training, and researchers conducting clinical and health service naturopathic research.

No 2

Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

So, is Jon Wardle up to the job?

The answer obviously depends on what the job is.

If it is about publishing 100 more surveys that show nothing of much value and are essentially SCAM-promotion, then he ought to be fine. If it is about rigorously testing which SCAMs generate more good than harm, then ‘Houston, we have a problem’!

My critics regularly display a lot of imagination. For instance, some come up with the claim that I have never done any original research.

Well, I have!

How much?

A lot.

The precise answer depends on how you define original research.

Usually, my detractors then focus on clinical trials. Prof Ernst can only criticise and find fault in studies of so-called alternative medicine (SCAM) published by others, they claim, but he never did a single clinical trial in his life!

Well, I have!

The allegation came up recently in a legal case that I am involved in, and I was asked to prove that it is false. I skimmed through my files and found something that I had almost forgotten about. Until my retirement in 2012, I had kept a record entitled THE EVIDENCE, A DOCUMENTATION OF OUR CLINICALLY RELEVANT RESEARCH. The document is based on 470 of our published articles and 35 of our clinical trials (I do not know many SCAM-researchers who have done more).

For the legal case, I also did a Medline-search to get the links of clinical trials including the ones before the Exeter job. The list is quite incomplete but, for what it’s worth, here it is:

  1. Placebo-controlled, double-blind study of haemodilution in peripheral arterial disease Ernst E, et al. Lancet 1987 – Clinical Trial. PMID 2885450
  2. Regular sauna bathing and the incidence of common colds Ernst E, et al. Ann Med 1990 – Clinical Trial. PMID 2248758
  3. A single blind randomized, controlled trial of hydrotherapy for varicose veins Ernst E, et al. Vasa 1991 – Clinical Trial. PMID 1877335
  4. Effects of felodipine ER and hydrochlorothiazide on blood rheology in essential hypertension–a randomized, double-blind, crossover study Koenig W, et al. J Intern Med 1991 – Clinical Trial. Among authors: Ernst E. PMID 2045762
  5. Does pentoxifylline prolong the walking distance in exercised claudicants? A placebo-controlled double-blind trial Ernst E, et al. Angiology 1992 – Clinical Trial. PMID 1536472
  6. Exercise therapy for osteoporosis: results of a randomised controlled trial Preisinger E, et al. Br J Sports Med 1996 – Clinical Trial. Among authors: Ernst E. PMID 8889112 Free PMC article.
  7. Randomized trial of acupuncture for nicotine withdrawal symptoms White AR, et al. Arch Intern Med 1998 – Clinical Trial. Among authors: Ernst E. PMID 9818805
  8. Randomized, double-blind trial of chitosan for body weight reduction Pittler MH, et al. Eur J Clin Nutr 1999 – Clinical Trial. Among authors: Ernst E. PMID 10369493 Free article
  9. A randomized trial of distant healing for skin warts Harkness EF, et al. Am J Med 2000 – Clinical Trial. Among authors: Ernst E. PMID 10781776
  10. Can singing exercises reduce snoring? A pilot study Ojay A and Ernst E. Complement Ther Med 2000 – Clinical Trial. PMID 11068344
  11. A blinded investigation into the accuracy of reflexology charts White AR, et al. Complement Ther Med 2000 – Clinical Trial. Among authors: Ernst E. PMID 11068346
  12. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial White AR, et al. Cephalalgia 2000 – Clinical Trial. Among authors: Ernst E. PMID 11128820
  13. Spiritual healing as a therapy for chronic pain: a randomized, clinical trial Abbot NC, et al. Pain 2001 – Clinical Trial. Among authors: Ernst E. PMID 11240080
  14. Randomised controlled trial of reflexology for menopausal symptoms Williamson J, et al. BJOG 2002 – Clinical Trial. Among authors: Ernst E. PMID 12269681 Free article.
  15. Validating a new non-penetrating sham acupuncture device: two randomised controlled trials Park J, et al. Acupunct Med 2002 – Clinical Trial. Among authors: Ernst E. PMID 12512790
  16. Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery Stevinson C, et al. J R Soc Med 2003 – Clinical Trial. Among authors: Ernst E. PMID 12562974 Free PMC
  17. Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis Pittler MH, et al. Br J Dermatol 2003 – Clinical Trial. Among authors: Ernst E. PMID 12588384
  18. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial White A, et al. Thorax 2003 – Clinical Trial. Among authors: Ernst E. PMID 12668794 Free PMC article.
  19. Multiple n = 1 trials in the identification of responders and non-responders to the cognitive effects of Ginkgo biloba Canter PH and Ernst E. Int J Clin Pharmacol Ther 2003 – Clinical Trial. PMID 12940592
  20. Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial Pittler MH, et al. CMAJ 2003 – Clinical Trial. Among authors: Ernst E. PMID 14662662 Free PMC article.
  21. Autogenic training reduces anxiety after coronary angioplasty: a randomized clinical trial Kanji N, et al. Am Heart J 2004 – Clinical Trial. Among authors: Ernst E. PMID 14999212
  22. Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Wilcock A, et al. Palliat Med 2004 – Clinical Trial. Among authors: Ernst E. PMID 15198118
  23. Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee Harlow T, et al. BMJ 2004 – Clinical Trial. Among authors: Ernst E. PMID 15604181 Free PMC article.
  24. Acupuncture for subacute stroke rehabilitation: a Sham-controlled, subject- and assessor-blind, randomized trial Park J, et al. Arch Intern Med 2005 – Clinical Trial. Among authors: Ernst E. PMID 16186474
  25. Autogenic training to reduce anxiety in nursing students: randomized controlled trial Kanji N, et al. J Adv Nurs 2006 – Clinical Trial. Among authors: Ernst E. PMID 16553681
  26. Autogenic training to manage symptomology in women with chest pain and normal coronary arteries Asbury EA, et al. Menopause 2009 – Clinical Trial. Among authors: Ernst E. PMID 18978640
  27. The effects of triple therapy (acupuncture, diet and exercise) on body weight: a randomized, clinical trial Nourshahi M, et al. Int J Obes (Lond) 2009 – Clinical Trial. Among authors: Ernst E. PMID 19274056

Five things I like about the list:

  1. It is long.
  2. It displays a wide variety of subjects.
  3. It hardly depicts me as a ‘pharma shill’.
  4. Most of the trials were published in top journals (suggesting they were of decent quality).
  5. It reminds me how much fun these studies often were (I wrote a chapter about No13 in my memoir, and I could write [very amusing] short stories about No 20 and [less funny but baffling] about No 17 and 23)

So, the next time they claim ‘Prof Ernst never did any clinical trials’, I will be able to shut them up by simply showing them this post.

I am looking forward to it!

Yesterday’s blog disclosed the fact that the German ‘Natur und Medizin’, an organisation of the ‘Carstens Stiftung’, had published slanderous lies about me. Consequently, I published an ‘open letter’ urging them to correct their mistake so that they would spare us the agony and cost of using legal action.

I never doubted for a minute that they would do this (I do not assume they are stupid, just a tiny bit dishonest) – and, as it turned out, I was correct. Here is a reminder of what they had originally published:

… er ist dafür bekannt, dass er kein gutes Haar an komplementären Therapieverfahren lässt. Notfalls greift er auch zu absichtlichen Falschdarstellungen[17], erfindet Daten[18] oder behauptet einfach, klinische Studien, die nicht die Negativ-Ergebnisse erbringen, die er erwartet, seien schlicht und ergreifend Betrug.[19]…

My rough translation:

… he [Edzard Ernst] is known for not finding anything positive in SCAM. If all else fails, he uses deliberate misrepresentation [17], invents data [18], or simply claims that clinical trials which did not generate the negative findings he expected are simply falsifications [19]…

The corrected new text passage is a little longer and now reads as follows (my rough translation):

… he [Edzard Ernst] is known for not finding anything positive in SCAM. Analyses of his publications by independent scientists draw the conclusion that he represents case-reports demonstrably wrongly [17] and that he arbitrarily alters or omits data [18]. He claims occasionally that high-quality studies of SCAM which do not generate the negative findings he expected appeared to be scientifically sound, but are nevertheless not believable [19]…

… er ist dafür bekannt, dass er kein gutes Haar an komplementären Therapieverfahren lässt. Analysen seiner Publikationen durch unabhängige Wissenschaftler gelangen zu der Schlussfolgerung, dass er Fallberichte nachweislich falsch darstelle[17] und Daten willkürlich verändere oder auslasse[18]. Er selbst behauptet mitunter über methodisch hochwertige Studien zur Komplementärmedizin, die nicht die Negativ-Ergebnisse erbringen, die er erwartet, sie sähen zwar nach wissenschaftlichen Maßstäben überzeugend aus, seien aber dennoch ‚unglaubwürdig‘.[19]… 

I would like to take this occasion to sincerely thank the ‘Natur und Medizin’ and the ‘Carstens Stiftung’ for this – much obliged guys, you made my day!

  • They have shown wisdom in not wasting money on expensive lawyers (even though my brother, who is a lawyer, might have enjoyed the windfall).
  • They have shown courage to hide behind papers like the one by Robert Hahn which have been discussed on this blog and elsewhere and found to be deluded.
  • They have shown strength by not meekly apologising to me about their attempt to slander me and my work.
  • They show leadership and innovative spirit by employing Jens Behnke, the author of the above lines, who does not seem to let the truth get in the way of a good story.

Last not least, my personal thanks to dear Jens (after your generosity, I am thinking about dedicating an entire blog post to you; your employer needs to know what a genius they have in you – watch this space) for yet again having demonstrated that the phenomenon known as ERNST’ S LAW is 100% correct.

The Carstens Stiftung is a foundation that supports so-called alternative medicine (SCAM) in Germany. They own ‘Natur und Medizin’ who just published a critique of Natalie Grams‘ book WAS WIRKLICH WIRKT. In this article, they dedicate an entire paragraph to me. The text accuses me of three things:

  1. that I have deliberately misrepresented published facts in one of my reviews;
  2. that I invent data;
  3. that I claim certain published studies are fraud.

To back up these allegations, they refer to references 17, 18 and 19 (listed below).

For those who can read German, here is the original text:

Ist das ihr Ernst?

Lässt man das Wort „systematic“ weg, ist der erste Treffer ein Überblick von Cochrane-Reviews zu Akupunktur bei verschiedenen Schmerzzuständen aus 2011.[16] Diese Arbeit ist hier, obwohl noch etwas älter, von besonderem Interesse, weil sie von Edzard Ernst stammt. Dieser mittlerweile emeritierte Professor ist über die sog. „Skeptikerbewegung“ eng mit Natalie Grams verbandelt und wird von Gegnern der Naturmedizin als die wissenschaftliche Autorität schlechthin angesehen. Denn er ist dafür bekannt, dass er kein gutes Haar an komplementären Therapieverfahren lässt. Notfalls greift er auch zu absichtlichen Falschdarstellungen[17], erfindet Daten[18] oder behauptet einfach, klinische Studien, die nicht die Negativ-Ergebnisse erbringen, die er erwartet, seien schlicht und ergreifend Betrug.[19] Im Falle der Akupunktur konstatiert aber sogar Ernst: „In letzter Zeit wurden mehrere Cochrane-Reviews zur Akupunktur bei einer Vielzahl von Schmerzzuständen veröffentlicht. Alle diese Arbeiten waren von hoher Qualität. Ihre Ergebnisse legen nahe, dass Akupunktur bei einigen, aber nicht allen Arten von Schmerzen wirksam ist.“ Positive Evidenz liege bspw. zu Migräne und Spannungskopfschmerzen, Nackenschmerzen und peripherer Gelenkarthrose vor.

[17] https://www.ncbi.nlm.nih.gov/pubmed/23521332

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502141

[19] https://www.ncbi.nlm.nih.gov/pubmed/24200828

________________________________________________________________________________

According to my legal advisers, this text involves serious libellous claims. I have decided that, before considering legal action, to publish this open letter to ‘Natur und Medizin’ of the CARSTENS STIFTUNG asking them to avoid legal action by withdrawing the paragraph in question:

To ‘Natur und Medizin’ of the ‘Carstens Stiftung’, Germany

Dear Madam/Sir

you have today published on your website an article entitled ‘Was wirklich wirkt – Natalie Grams über sanfte Medizin’ and authored by Dr Jens Behnke. It contains at least three libellous and false allegations about me and my research. As they are severely damaging my professional reputation, I urge you to erase the paragraph in question as a matter of urgency. Failing this, I would have to instruct my legal team to take action.

I sincerely hope we can settle this amicably without going to court.

Best regards

Edzard Ernst

 

The ‘OFFICIAL HOMEOPATHY RESOURCE‘ is an odd publication which, until very recently, I did not know about. They inform us about homeopathy as follows:

Homeopathy is a non-corporate  200-year-old system of medicine used successfully by tens of millions worldwide, and the second most utilized complementary health discipline in the world (according to the World Health Organization 2005).  It has a laudable 200-year clinical record.  There are literally hundreds of high quality basic science, pre-clinical and clinical studies showing it works.

This is the online web site for accurate information on homeopathy, homeopaths and homeopathic organizations. Its hard to get accurate information on this popular and traditional healing modality as a result of Drug Company Sponsored Blogs, Web Sites and their sponsored “Science Writers”.

Finally, there is a positive and comprehensive resource and you have found it. We hope you enjoy this site’s information and decide on or continue homeopathic treatment to experience it’s benefits.

THIS IS AN INDEPENDENT MEDIA SOURCE

About Comments on this Web Site:

We welcome POSITIVE comments about your experience with homeopathy or positive feedback about a particular topic.

Thank you for your positive support of homeopathy and getting the word out there.

The articles and posts contained herein are educational and informational and should not be considered medical advise. We recommend that you see a licensed medical practitioner.

__________________________________________________________

So far so good; well not SO good actually: this short text opens a lot of questions. But this is not what I want to address today. The ‘OFFICIAL HOMEOPATHY RESOURCE’ appeared on my screen only for one reason; they just published a whole, albeit short article about me! It is entitled ‘Pharmaceutical Company Found Guilty of Fuelling Opioid Epidemic But Sponsored Skeptics Continue Attacks on Safe Alternatives‘. Here it is in its full and unabbreviated beauty:

Even though the pharmaceutical industry has paid billions in fines over the years for failures and deceptions that have caused serious injuries and death, the pharmaceutical sponsored skeptic organizations and skeptics like Edzard Ernst spread outright lies about the false dangers of alternatives. They try to take the heat off the failures and dangers of drugs by smearing safe alternatives like homeopathy. They even go to the point of going to government organizations and falsely claiming alternatives are dangerous. They say nothing or a minimum about their sponsors.

One such skeptic Edzard Ernst attempts to present himself as an expert which most skeptics do. As a means of puffing himself up and making it seemed like he knows something about homeopathy, he claimed he was a homeopath and switched to allopathic medicine when homeopathy did not work. This has been proven to be an outright lie. He has had no training in homeopathy.

Unfortunately skeptics, like lemmings, support only pharmaceutical company generated science as if it was the holy grail.

Homeopathy has been proven to be very effective in pain relief and is non-addictive.

_____________________________________________________________________

I am afraid they must have missed what I disclosed repeatedly about my sponsors. Let me therefore repeat it especially for them (I tried to find out who exactly ‘THEY’ are, but they are not disclosing this information, as far as I can see):

  • I am sponsored to the tune of zero £.
  • There is not a single commercial company that backs me.
  • This blog receives no funding from anywhere.
  • Its running costs are paid by me.
  • I live off my pension and savings and receive no other income.

I will not bother to correct the other falsehoods in the text above. I think, they are too obvious to bother. To those of my readers who find them not obvious, I recommend reading my memoir and my book entitled ‘Homeopathy, the Undiluted Facts‘ and considering ‘Ernst’s law‘.

This could (and perhaps should) be a very short post:

I HAVE NO QUALIFICATIONS IN HOMEOPATHY!

NONE!!!

[the end]

The reason why it is not quite as short as that lies in the the fact that homeopathy-fans regularly start foaming from the mouth when they state, and re-state, and re-state, and re-state this simple, undeniable fact.

The latest example is by our friend Barry Trestain who recently commented on this blog no less than three times about the issue:

  1. Falsified? You didn’t have any qualifications falsified or otherwise according to this. In quotes as well lol. Perhaps you could enlighten us all on this. Edzard Ernst, Professor of Complementary and Alternative Medicine (CAM) at Exeter University, is the most frequently cited „expert‟ by critics of homeopathy, but a recent interview has revealed the astounding fact that he “never completed any courses” and has no qualifications in homeopathy. What is more his principal experience in the field was when “After my state exam I worked under Dr Zimmermann at the Münchner Krankenhaus für Naturheilweisen” (Munich Hospital for Natural Healing Methods). Asked if it is true that he only worked there “for half a year”, he responded that “I am not sure … it is some time ago”!
  2. I don’t know what you got. I’m only going by your quotes above. You didn’t pass ANY exams. “Never completed any courses and has no qualifications in Homeopathy.” Those aren’t my words.
  3. LOL qualification for their cat? You didn’t even get a psuedo qualification and on top of that you practiced Homeopathy for 20 years eremember. With no qualifications. You are a fumbling and bumbling Proffessor of Cam? LOL. In fact I think I’ll make my cat a proffessor of Cam. Why not? He’ll be as qualified as you.

Often, these foaming (and in their apoplectic fury badly-spelling) defenders of homeopathy state or imply that I lied about all this. Yet, it is they who are lying, if they say so. I never claimed that I got any qualifications in homeopathy; I was trained in homeopathy by doctors of considerable standing in their field just like I was trained in many other clinical skills (what is more, I published a memoir where all this is explained in full detail).

In my bewilderment, I sometimes ask my accusers why they think I should have got a qualification in homeopathy. Sadly, so far, I  have not received a logical answer (most of the time not even an illogical one).

So, today I ask the question again: WHY SHOULD I HAVE NEEDED ANY QUALIFICATION IN HOMEOPATHY?

My answers are here:

  1. I consider such qualifications as laughable.  A proper qualification in nonsense is just nonsense!
  2. For practising homeopathy (which I did for a while), I did not need such qualifications; as a licensed physician, I was at liberty to use the treatments I felt to be adequate.
  3. For researching homeopathy (which I did too and published ~120 Medline-listed papers as a result of it), I do not need them either. Anyone can research homeopathy, and some of the most celebrated heroes of homeopathy research (e. g. Klaus Linde and Robert Mathie) do also have no such qualifications.

I am therefore truly puzzled and write this post to give everyone the chance to name the reasons why they feel I needed qualifications in homeopathy.

Please do tell me!

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories