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

King Charles

As I am currently not in the UK, I (almost) missed the news about my ex-friend Michael Dixon (can you forgive me please, Michael?). I am going to report it here as published in the Independent without any comments of my own (which would inevitably have an after-taste of sour grapes):

The King has personally honoured his top medical team amid his treatment for cancer. Dr Michael Dixon, head of the Royal Medical Household, and Charles’s GP Dr Fiona Butler – otherwise known as the Apothecary to the King – have been recognised by Charles for their personal service to the monarch and the royal family…

Dr Dixon has been made a Commander of the Royal Victorian Order (CVO) and Dr Butler is now a Lieutenant of the Royal Victorian Order (LVO), with the accolades announced on the King’s official birthday. Awards of the Royal Victorian Order are in the King’s gift and are bestowed independently of Downing Street to people who have served the monarch or the royal family in a personal way. Dr Dixon and the King have known one another for decades, and he is responsible for overseeing the eminent members of the medical profession entrusted to care for the royal family.

His appointment as head of the Royal Medical Household following Charles’s accession drew criticism due to his outspoken support for alternative therapies, such as faith healing and herbalism. In 2023, Buckingham Palace set out the doctor’s beliefs to The Sunday Times, saying: “Dr Dixon does not believe homeopathy can cure cancer. His position is that complementary therapies can sit alongside conventional treatments, provided they are safe, appropriate and evidence-based.”

As the Prince of Wales, Charles was a passionate campaigner for integrated health, raising the profile of combining evidence-based, conventional medicine with an holistic approach to healthcare. Dr Dixon’s previous roles include a practising GP, a fellow of the Royal College of GPs, a fellow of the Royal College of Physicians, former chairman of NHS Alliance and the chairman of the College of Medicine…

_____________________

In case you are not familiar with the relevant history and wonder about the “ex-friendship”, there are numerous posts on this blog about Dixon that might explain. Alternatively, you could read my memoir, A Scientist in Wonderland.

A recent post of mine seems to have galvanized concerns about my image and general attitude towards so-called alternative medicine (SCAM). Here are the comments I am referring to:

Hanjo Lehmann

…you should take care of your image: not being a man who just hates anything that smells like “alternative medicine” but rather an experienced scientist and physician who sees things with appropriate skepticism.

Eelco_G

Edzard preaches for his own parish and does not reach the people he would like to reach. A little more wisdom and ability to put things into perspective would earn him much more respect.

Mike Grant

Hanjo made some valid points Edzard. Perhaps you should suppress your ego?

Socrates

If you want to persuade people it’s not enough just to be right. There are times to be antagonistic and times to be more understanding. And sweeping generalisations can get people’s backs up unnecessarily.

Please allow me to take this opportunity to explain my attitude, motivation, image, etc. a little better.

After SCAM and SCAM-research had previously been a mere hobby of mine, I took the Exeter chair in ‘complementary medicine’ in 1993. Ever since, I spent my time studying the subject. Between 1993 and 2012, I headed the worldwide most productive department of SCAM research. My team published several books for healthcare professionals and well over 1 000 peer-reviewed papers on SCAM. I personally gave about 500 lectures on SCAM to all sorts of audiences all over the world. None of these books, papers, lectures, etc. are in any way dismissive of SCAM. They are, I hope, rigorously scientific.

What I am trying to point out is this: for 20 odd years I have done more that anyone else to persuade, to be understanding, to promote sound evidence, to abstain from opinion, to suppress my “ego”, to reach people interested in SCAM, to see things with “appropriate skepticism”, to be polite, to avoid stepping on anyone’s toes, to be politically correct – while conducting the best science that the circumstances allowed.

What did it get me?

Was my work acclaimed by the SCAM community?

No.

Did my research receive the funding I had been promised?

No.

Did I manage to persuade the SCAM-community to think more critically?

No.

Did even my own university show any appreciation?

No, more than once, my peers even tried to influence the nature and/or direction of my research.

In 2012, I retired from my Exeter post because Charles’ intervention had been allowed to completely destroy my department.

Was I disappointed?

Yes, the only department worldwide that independently and critically investigated SCAM had ceased to exist. This certainly is disappointing!

Was I bitter?

No, on the contrary, I had voluntarily taken the decision to retire and I soon felt relieved to no longer have anyone breathing down my neck. I was looking forward to carrying on my work, free of the pressures and irritating voices trying to tell me what outcomes were expected of me. I was delighted to be free of the tedious task to fund-raise. I was happy to be relieved of all the tedious amount of admin.

Now, more than 10 years later, my work gives me great fun every day and often laugh tears about certain aspects of SCAM. Those who think or hope that I am a bitter old fool I must disappoint bitterly.

After retiring, I wrote a series of books and started this blog. On the very first post, dated 14/10/2012, I explained my decision:

Why another blog offering critical analyses of the weird and wonderful stuff that is going on in the world of alternative medicine? The answer is simple: compared to the plethora of uncritical misinformation on this topic, the few blogs that do try to convey more reflected, sceptical views are much needed; and the more we have of them, the better.

I am telling you all this to explain that

  • I have little patience with people who feel compelled to tell me what to do.
  • For me a blog is something entirely different than a peer-reviewed paper – the former is written quickly and tends to be be light-hearted, ironic, sarcastic, provocative, exaggerated, journalistic, etc., while the latter usually is carefully worded, scientific and bone-dry.
  • With my blog, I try to create an entertaining counterbalance to the plethora of uncritical misinformation on SCAM.
  • Therefore, I am deliberately critical of SCAM.
  • I do not hate anyone or anything.
  • I am not in the slightest concerned about my image.
  • I know very well what I am doing and quite confident that, during the last 30 years, I have reflected on issues around SCAM more deeply than most.

So, to those who still are concerned about my image or my approach to SCAM I say THANKS for your advice – but no thanks. And of those who doubt my science I ask, please study my peer-reviewed papers.

PS

Of course, none of this means that I make no mistakes, or that am not frequently troubled by self-doubt. So, please do carry on criticising me and my work, but don’t assume that I worry about my image.

If I had a £ for each time I was asked during the last few days whether King Charles is going to treat his cancer with homeopathy, I would have my pockets full of cash. The question seems reasonable because he has been singing the praise of homeopathy for decades. But, as I have pointed out previously, he is unlikely to use homeopathy or any other unproven cancer cure; on the contrary he will certainly receive the most effective therapies available today.

In any case, the homeopathic treatment of cancer is currently a most popular topic. As if on command, an article appeared on my screen that promises to address the subject:

“Homoeopathy and Cancer – An Alternative Approach towards the path of Healing”

Here is the abstract of this remarkable paper:

Homoeopathy is a holistic system of medicine rooted on the principle of “Similia Similibus Curentur”. It has gained attention for its potential therapeutic benefits. It offers a holistic approach that addresses both the physical symptoms and emotional well-being of individuals. While this alternative approach of healing has been explored in various health contexts, a notable gap remains in understanding its application in the realm of cancer care. This review seeks to fill this void by exploring the broader landscape of homoeopathy’s principles and applications. Through a critical examination of existing research and evidence, it aims to offer valuable insights into the potential role of homoeopathy as a complementary approach in cancer care and symptomatic relief. This review underscores the need for further research and a more nuanced understanding of homoeopathy’s place in healthcare, particularly in the context of cancer patients and their well-being.

I am sure you are as impressed as I am and keen to learn more. In the article itself, the authors offer some brand-new, cutting-edge science to back up their views:

According to Samuel Hahnemann, “When a person is ill, it is originally merely the spirit-like, autonomic life force (life principle), which is always there in the organism, that is mistuned by the dynamic effect of a morbific agent inimical to life.Only the life principle, tuned incorrectly to such an anomalyis capable of causing irregular functions the body. Cancer may initially be treated as a one-sided disease because the expanded pathology weakens the Vital Force. According to Hahnemann, “Diseases that seem to have just a few symptoms are called one-sided because only one or two prominent symptoms are indicated. This makes these diseases, which primarily fall under the category of chronic diseases, harder to cure. According to Arthur Hill Grimmer, the biggest challenge in treating advanced cancer cases is getting therapeutic individualization of symptoms. Even with all the typical symptoms, it is quite difficult to create a potent homoeopathic prescription. Burnett considered both the characteristic aspects of the patient as well as the ‘action’ or‘organ affinity’ of the remedy he prescribed.

Eventually, the authors (who are affiliated with prestigeous institutions: Rajasthan Ayurved University, Jodhpur; Swasthya Kalyan Homoeopathic Medical College & Research Centre, Jaipur) arrive at the following conclusion:

In the scientific literature, homoeopathy’s use in the treatment of cancer is still largely unexplored. Pioneers have offered intriguing perspectives on disease origins and treatment challenges. The miasmatic perspective offers a distinctive approach that emphasises individualised strategies based on symptoms and characteristics. Some studies suggest an improvement in quality of life of the individuals suffering from cancer. In the dynamic landscape of cancer treatment, more studies are warranted to enhance the scope of holistic, patient-centered care through homoeopathy.

Yes, homeopathy is a joke. This paper (and the many similar publications out there) could thus be intensely funny – except for the fact that these charlatans are playing with the lives of many vulnerable and desperate patients. I sincerely hope Charles manages to stay well clear of homeopathy and its irresponsible practitioners which clearly is one precondition for making a full recovery.

Yestderday, it was announced that King Charles has cancer. He had been in hospital for surgery for his enlarged prostate. Initially, the news was positive, as it was confirmed not to be prostate cancer. However, during the investigations, a cancer was discovered that apparently is unrelated to the prostate. Since the announcement, many journalists and other people have written to me asking what I think about it and what treatment Charles is likely to receive. I therefore decided to write a short post about the matter.

As a physician and human being I am very sorry whenever I hear that anyone has fallen ill, particularly if the condition is serious and potentially life-threatening. That this includes Charles goes without saying. Equally it is self-evident that I wish that all goes well for him, that the treatment he reportedly has already started is not too arduous, that he keeps in good spirit, that he has empathetic support from all his family and recovers quickly and fully.

Charles will, I am sure, have the best treatment anyone could wish for. Will he use so-called alternative medicine (SCAM), for example, the Gerson therapy, one of the SCAMs he once promoted as a cure of cancer? Of course not! He will receive the most effective, evidence-based care that is currently available. Will he thus not try any SCAM at all? I am confident that he will use SCAM wisely, namely not as a cure but as a supportive measure. In my book on this very subject, I go through all the relevant evidence and conclude that, while SCAM is most certainly not a cancer cure, it can have a place in supportive cancer care. Depending on the symptoms that develop during and after the conventional treatments, certain SCAMs can, according to fairly sound evidence, be helpful in improving wellness and quality of life.

Going through a battle against cancer is often a most humbling experience. Therefore, I am hopeful that, as he recovers from his ordeal, Charles will see that modern medicine – he once described it as being out of balance like the leaning tower of Pisa – is not just effective, empathetic and caring but also not nearly as unbalanced and unholistic as he often proclaimed it to be. In that sense, the experience might reform our king, and – who knows? – he might, after all, turn out to be not the self-proclaimed enemy but a true friend of the Enlightenment.

If you live in the UK, it was impossible during the last week or so to escape the news that our King is going into hospital for a ‘corrective procedure’ on his benign prostate problem. Apparently, he is keen to share his diagnosis with the public to encourage other men who may be experiencing symptoms to get checked. “In common with thousands of men each year, the King has sought treatment for an enlarged prostate,” the official statement said.

According to the NHS website, the King should make lifestyle changes, such as:

  • drinking less alcohol, caffeine and fizzy drinks
  • limiting your intake of artificial sweeteners
  • exercising regularly
  • drinking less in the evening

Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate. Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.

It is said that Charles had symptoms since Christmas. So, being the most outspoken fan of so-called alternative medicine (SCAM), why has he not tried SCAM? Has he, for example, tried any of these treatments that have reported at least in one or more studies some promise?:

  • Camelia sinensis (green or black tea),
  • Solanum lycopersicum (common tomato),
  • Punica granatum (pomegranate),
  • Glycine max (common soy),
  • Linum usitatissimum (linen),
  • Ellagic acid,
  • Saw palmetto,
  • Pumpkin seed,
  • Willow herb,
  • Maritime pine bark,
  • Pygeum africanum bark,
  • Rye pollen,
  • Nettle root,
  • Dozens of Chinese herbs,
  • Acupuncture,
  • Homeopathy.

It seems not!

But why not?

Why does the world’s greatest SCAM enthusiast not go for his beloved natural cures and ancient wisdom?

Has Charles been advised that the studies are flimsy and the evidence is unconvincing (in that case, well-done Michael!)? I might have given the same advice. Yet, this begs the question, why are he and his head of the royal medical household, Dr Michael Dixon, fiercely in favor of SCAM? Is the evidence for other conditions any better?

Michael, in case you read this: it is nottrust me, I have studied the subject for >30 years.

Anyway, I would probably have consulted a surgeon too, if I had Charles’ problem. Yet, there is an important difference: I (in common with thousands of men) have to join the UK waiting list which currently stands at around 8 000 000.

Yes, I do try to understand that the King is the King and that I am far less of a priority.

The King is special!

The King deserves special, non-NHS treatment!

But scientific evidence is the scientific evidence, no matter whether it relates to SCAM or surgery. So, why does the King (and Dixon) promote SCAM when he himself does evidently not trust it?

I had the rare pleasure to give an interview for the ‘Frankfurter Allgemeine’. As it was, of course, in German, I took the liberty to translate it for my non-German speaking readers:

You have researched so-called alternative medicine over several decades, including homeopathy. What is your conclusion?

We are talking about far more than 400 methods – to draw one conclusion about all of them
is completely impossible. Except perhaps for this one: if something sounds too good to be true, it probably is.

Does this apply to homeopathy?

Highly diluted homeopathic remedies are popular because they have no side-effects. But there is also no effect. They are touted as a panacea. This is certainly not the case, on the contrary, they are
ineffective. And any therapy that is ineffective and promoted as a panacea is also dangerous.

How do you explain the fact that so many people swear by homeopathy?

There are several reasons for this. In Germany, homeopathy has an unbroken tradition, it was, for instance, promoted by the Nazis and later in the Federal Republic of Germany. It has a reputation for being gentle and effective. It might be gentle, but it is certainly not effective. It is also supported by lobby groups such as the manufacturers. And most people who use it don’t even understand what it actually is.

In any case, the placebo effect helps. What’s so bad about that??

Nothing at all, on the contrary: it is to be advocated. When we talk about placebo effects, we subsume many things under this umbrella that do not actually belong to it, such as the extensive, empathetic conversation that homeopaths often have with their patients. Besides, a common cold goes away whether you treat it or not. If you then use homeopathy, you can easily get the impression that it worked. Every good, empathetic doctor tries to maximize the placebo effect. To put it bluntly: you don’t need a placebo to generate a placebo effect. Patients also benefit from it when I give an effective remedy with empathy. In addition they benefit from the specific effect of my therapy, which should make up the lion’s share of the therapeutic response. If I withhold the most important thing I mistreat my patient.

But there are diseases for which there are no good remedies.

I often hear that argument. But there is practically always something we can do that at least
improves symptoms. Otherwise you should also say that instead of lying and recommending homeopathy – and thinking that, although there is nothing in it and it doesn’t work, but the patient, being an idiot, should take it nevertheless. It is unethical to use placebos as much as it is to use homeopathy.

Neurophysiologically, the placebo effect is becoming better and better understood.

The Italian neuroscientist Fabrizio Benedetti in particular has done very good work.  But he also warns that this does not justify the use of homeopathy, for example.

Are there any studies on whether the placebo effect of homeopathy with its esoteric superstructure is greater than that giving just a piece of sugar?

There are analyses of what makes a particularly effective placebo. From this, we can learn that effective therapies in evidence-based medicine must be applied with empathy and sufficient time in order to maximize the ever-present placebo effect. So-called alternative medicine often does this quite well, and we can learn something from it. But the reason is that it often has nothing else. Homeopaths are a serious danger because they see homeopathy as a panacea. If someone has homeopathically treated their cold “successfully” for years and then gets cancer, they might think of turning to homeopathy for their cancer. It sounds crazy, but many homeopaths do offer cancer treatments on the internet, for instance. That sends shivers down my spine.

How should doctors and pharmacists react to the demand for homeopathic remedies?

Pharmacists are not primarily salespeople, they are a medical profession – they have to adhere to ethical guidelines. In this respect, evidence-based information of their clients/patients is very important.

Thomas Benkert, President of the German Federal Chamber of Pharmacists, has stated that he would not be able to stop giving advice if he always had to explain the lack of proof of efficacy.

He should perhaps read up on what his ethical duty to patients is.

What if doctors or pharmacists themselves believe in the effect?

Belief should not play a role, but evidence should.

Are you pleased with Lauterbach’s plan to no longer reimburse homeopathy?

I think it’s a shame that he justifies it by saying it’s ineffective. That is true. But the justification should be that it’s esoteric nonsense and therefore ineffective – and dangerous.

In the end, the Bundestag will decide.

I think Lauterbach has a good chance because things have started to move. Medical associations in Germany have spoken out against the additional designation of homeopathy, for example, and overall the wind has changed considerably.

What is it like in the UK, where you live?

The UK healthcare system, NHS, said goodbye to reimbursement of homeopathy about five years ago, even before France. The pharmacists’ association has distanced itself very clearly from homeopathy. However, most pharmacists still sell the remedies and many continue to support them.

You have also had disputes with the current head of state, King Charles. How did that come about?

A few years ago, he commissioned a paper claiming that so-called alternative medicine could save the British health service a lot of money. I protested against this – Charles accused me of leaking it to The Times before it was published. My university launched an investigation, which eventually found me innocent, but it led to the demise of my department. That caused me to retire two years early.

So Charles managed to close down the only research unit in the world that conducted critical and systematic research into so-called alternative medicine. Most researchers in this field only want to confirm their own prejudices and not disprove hypotheses. This is a serious misunderstanding of how science works. If someone reports only positive results for their favorite therapy in all conditions, something is wrong.

Some people say that homeopathy should not be researched because nothing positive can come out of it anyway.

There are certainly some SCAMs that are so nonsensical that they should not be researched, as is currently the case with homeopathy. I put it this way because I have researched homeopathy myself and, from my point of view, the situation was not so crystal clear 30 years ago.

Would you say that you have approached the matter with a sufficiently open mind?

No one can be completely unbiased. That’s why it’s important to do science properly, then you minimize bias as much as possible. When I took up my position at Exeter in 1993, I was perhaps somewhat biased towards homeopathy in a positive sense, because I had learned and used it myself, as well as other alternative medicine methods. The fact that the results then turned out to be negative in the vast majority of cases initially depressed me. But I have to live with that.

Every researcher prefers positive results, also because they are easier to publish. It was clear to me that, if I had succeeded in proving homeopathy right, I wouldn’t get one Nobel Prize, but two. Who wouldn’t want that?

(The interview was conducted by Hinnerk Feldwisch-Drentrup.)

On this blog, I have often been highly critical of integrative (or integrated) medicine (IM) – see, for instance:

Recently, I began to realize that my previously critical stance has been largely due to the fact that 1) a plethora of definitions of IM exist causing endless confusion, 2) most, if not all, of the definitions of IM are vague and insufficient. At the same time, IM is making more and more inroads which makes it imprudent to ignore it.

I therefore decided it is time to change my view on IM and think more constructively. The first step on this new journey is to define IM in such a way that all interested parties can come on board. So, please allow me to present to you a definition of IM that is constructive and in the interest of progress:

IM is defined as the form of healthcare that employs the best available research to clinical care integrating evidence on all types of interventions with clinical expertise and patient values. By best available research, I mean clinically relevant (i.e., patient oriented) research that:

  • establishes the efficacy and safety of all types of therapeutic, rehabilitative, or preventive healthcare strategies and
  • seeks to understand the patient experience.

Healthcare practitioners who are dedicated to IM use their clinical skills and prior experience to identify each patient’s unique clinical situation, applying the evidence tailored to the individual’s risks versus benefits of potential interventions. Ultimately, the goal of IM is to support the patient by contextualising the evidence with their preferences, concerns, and expectations. This results in a process of shared decision making, in which the patient’s values, circumstances, and setting dictate the best care.

If applied appropriately, IM has the potential to be a great equaliser – striving for equitable care for patients in disparate parts of the world. Furthermore, IM can play a role in policy making; politicians are increasingly speaking to their use of research evidence to inform their decision making as a declaration of legitimacy. IM reflects the work of countless people who have improved the process of generating clinical evidence over several decades, and that it continues to evolve.

Developing the skills to practise IM requires access to evidence, opportunities to practise, and time. IM proponents strive to find novel ways to integrate evidence into personal holistic health in the best interest of our patients.

_________________________

I feel confident that this could create a basis for a fresh start in the dabate about the merits of IM. I for one am all for it!

In case some of my readers thought that the wording of my definition sounded somewhat familiar, I should perhaps tell you that it is my adaptation of the definition of evidence-based medicine (EBM) as published in ‘BMJ Best Practice‘.

What does that mean?

The points I am trying to make are the ones that I have tried to get across many times before:

  1. IM is a flawed, unethical, superflous and counter-productive concept.
  2. It is flawed because it is aimed at smuggling unproven or disproven treatments into routine care which can only render healthcare less safe and less effective.
  3. It is unethical because it cannot provide the best possible healthcare and thus is not in the best interest of patients.
  4. It is superflous because the aspects of IM that might seem valuable to proponents of so-called alternative medicine (SCAM) are already part of EBM.
  5. It is counter-productive because it distracts from the laudable efforts of EBM.

 

It has been reported that King Charles’ charity, formerly the Prince’s Foundation, is compelled to return £110,000 to the Indian government. The funds were earmarked for an NHS alternative medicine clinic championed by Charles, which never materialised. The proposed clinic was aimed at integrating Indian traditional medicine into the UK’s healthcare system.

But why did the plan fail?

The answer is simple: the National Health Service (NHS) did not approve it.

The history of the UK ‘Ayurvedic Centre of Excellence’ goes back several years. Here is an excerpt of my book ‘CHARLES, THE ALTERNATIVE KING‘ where I discuss it as one of Charles’ many pipe dreams in the realm of so-called alternative medicine (SCAM):

In 2018, India’s prime minister Narendra Modi paid a visit to the Science Museum in London where he inspected the ‘5000 Years of Science and Innovation’ exhibition. The event was hosted by Charles and included the announcement of new ‘Ayurvedic Centres of Excellence’, allegedly a ‘first-of-its-kind’ global network for evidence-based research on yoga and Ayurveda. The first centre was said to open in 2018 in London. Funding was to come partly from the Indian government and partly from private donors. The central remit of the new initiative was reported to be researching the effects of Ayurvedic medicine.

Dr Michael Dixon (yes, you may have met him several times before, e.g. here, here, or here) commented: “This is going to be the first Ayurvedic centre of excellence in the UK. We will be providing, on the NHS, patients with yoga, with demonstrations and education on healthy eating, Ayurvedic diets, and massage including reflexology and Indian head massage. And all this will be subject to a research project led by Westminster University, to find out whether the English population will take to yoga and these sorts of treatments. Whether they will be helped by it and finally whether it will reduce the call on NHS resources leading to less GP consultations, hospital admissions and operations.”

 On its website, the College of Medicine and Integrated Health announced that a memorandum of understanding with India’s Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) had been signed “to create centres of excellence in the UK … Dr Michael Dixon agreed the joint venture to provide the UK centres, which will offer and research traditional Indian medicine… The Indian government will match private UK donations to fund the AYUSH centres in the UK”. In November 2019, the following press release by the president of India offered more details:

The Prince of Wales called on the President of India, Shri Ram Nath Kovind, at Rashtrapati Bhavan today (November 13, 2019).

Welcoming the Prince to India, the President congratulated him on his election as the head of the Commonwealth. He said that India considers the Commonwealth as an important grouping that voices the concerns of a large number of countries, including the Small Island Developing States.

The President said that India and the United Kingdom are natural partners bound by historical ties and shared values of democracy, rule of law and respect for multi-cultural society. As the world’s pre-eminent democracies, our two countries have much to contribute together to effectively address the many challenges faced by the world today.

The Prince planted a Champa sapling – plant native to the subcontinent which has several uses in Ayurveda – in the Herbal Garden of Rashtrapati Bhavan. He was taken around the garden and shown different plants that have medicinal properties. The Prince showed a keen interest in India’s alternative model of healthcare.

The President thanked the Prince of Wales for his support for Ayurveda research. The Prince of Wales Charitable Foundation and the All India Institute of Ayurveda signed an MOU during the visit of Prime Minister Narendra Modi to the UK in April 2018. Under the MOU, the All India Institute of Ayurveda and the College of Medicine, UK will be conducting clinical research on Depression, Anxiety and Fibromyalgia. They will also be undertaking training programme for the development of Standard Operating Protocol on “AYURYOGA” for UK Health professionals.

_________________________

END OF EXCERPT

Charles’ initiative, encompassing Ayurveda, yoga, naturopathy, and homeopathy, was intended to be a landmark project, with the Indian government contributing £110,000 to the King’s Foundation for its implementation. However, the NHS, responsible for St Charles Hospital, never endorsed the project. Despite initial talks, the proposed collaboration did not progress, and the clinic failed to materialise. According to the west London clinical commissioning group (CCG), which oversaw the hospital at the time, there was no official involvement, and discussions ceased in 2020.

Under charity law, funds designated for a specific project cannot be diverted without donor permission and regulatory approval. The King’s Foundation has acknowledged the need to return the remaining budget to the Indian government but has not disclosed when this decision was made or why the funds were not promptly returned.

The initiative faced opposition from the NHS, as a year before the clinic’s launch, NHS England’s CEO Simon Stevens had issued guidance discouraging the prescription of homeopathy and herbal remedies, citing their limited efficacy and misuse of NHS funds.

Despite the failed project, connections between key figures persist. Dr Michael Dixon played a significant role in finalising agreements with the Indian government. The King’s Foundation defended its actions, stating that due to the Covid-19 pandemic, the project shifted online, resulting in reduced costs. They claim to have contacted the Indian government for the return of unused funds, emphasising that the money remains in a restricted account.

As the controversy unfolds, questions arise about the intersections between alternative medicine advocacy, royal endorsements, and international collaborations within the context of public healthcare.

An article in the Daily Mail reported that the original plan proposed that Ayush treatments would be provided to patients, who would be referred by local GPs, at St Charles Hospital in Kensington. Isaac Mathai, who runs Soukya, a homeopathic yoga retreat in Bangalore which Charles and Camilla have visited, was an adviser to the project at St Charles Hospital.

The Indian government made a payment from the budget of the Ayush Ministry, which Mr Modi has used as a tool of diplomacy to promote Indian medicine and culture worldwide, to the King’s Foundation. It was proposed the charity would use its expertise to help set up the clinic. But the NHS at no point agreed to the plans.

A spokesman of the west London clinical commissioning group (CCG), which administered St Charles Hospital at the time, said: ‘Provision of homeopathy and herbal treatments were not considered as part of the project by the CCG. The aim of the project was to test the use of yoga and massage to support the overall health and wellbeing of patients with long-term conditions.’ A King’s Foundation spokesman added that the initial intention had been to deliver Indian traditional medicine at St Charles Hospital.

In May this year, I reported that my ex-friend Michael Dixon had been appointed as HEAD OF THE ROYAL MEDICAL HOUSEHOLD. The story was picked up by Gabriel Pogrund, one of the top investigative journalists of THE SUNDAY TIMES, who published a long article about Dixon yesterday which I encourage you to read in full.

In it he revealed many things about Dixon including, for instance, that some of the academic titles he often carries might not be what they seem. On ‘X’. Pogrund commented that “He [Dixon] faces Qs after three unis could not confirm his academic roles”. The article prompted many other newspapers to report on the matter.

The Guardian, for instance, contacted The Good Thinking Society, which promotes scientific scepticism. Michael Marshall, project director at the society, said: “It [promoting homeopathy] isn’t appropriate. I think the role of the monarchy, if it has one in current society, isn’t to be advocating for their own personal projects and their own personal beliefs or using the power and influence they have to further causes that run directly counter to the evidence that we have. “It’s absolutely unequivocal that homeopathic remedies do not work and just because you happen to be in a position of extreme power and privilege, that doesn’t change that.” Marshall said the appointment was also worrying because it suggested the king might still be supporting complementary medicine behind the scenes. He added: “Before Charles became king, he was the patron of homeopathic organisations, he was an outspoken advocate in favour of homeopathy and pushing back the bounds of science towards pseudoscience. And the argument was that he would stop doing that once he became king. This appears to be a sign that he isn’t going to do that, that he isn’t going to stop. What’s worrying is, as we’ve seen from the black spider memos, Charles is someone who also wields his power and influence quietly behind the scenes as well as publicly, so if this is the kind of step he’s willing to make in public, it raises questions about whether he’s willing to make even more steps in private.”

The Guardian also asked me three questions and I provided my answers in writing:

Q: Do you think it’s appropriate that the king has appointed Dr Michael Dixon to such a prestigious role? If not, why?
A; Surely, the King can appoint who he wants. In the realm of health care, he often seemed to favour people wo promote dubious therapies [Charles, The Alternative King: An… by Ernst, Edzard (amazon.co.uk)
Q: Do you think the king’s public position on homeopathy is problematic? and if so, why?
A: Anyone who promotes homeopathy is undermining evidence based medicine and rational thinking. The former weakens the NHS, the latter will cause harm to society.
Q: Do you think homeopathy has a place in medicine and if not, why? What has your research shown on its efficacy?
A: We and others have shown that homeopathy is not an effective therapy, which has today become the accepted consensus. To me, this means its only legitimate place is in the history books of medicine.

Within hours, the story became an international isse. For example a short article in DER SPIEGEL informed Germany as follows (my translation):

He works with Christian healers and prescribes goat weed for impotence: Dr Michael Dixon looks after the health of the British royal family. Scientists are appalled.

King Charles has appointed a homeopathy advocate as head of the royal medical household and has been heavily criticised by scientists. They call the decision worrying and inappropriate, as reported by the Guardian, among others. Dr Michael Dixon, who promotes faith healing and herbalism in his work as a general practitioner, has quietly held the senior position for a year, writes the Sunday Times. Although 71-year-old Dixon is head of the royal medical household, this is the first time that this role has not been combined with that of a doctor to the monarch. His duties include taking overall responsibility for the health of the King and the entire royal family – and also representing them in discussions with the government. He once invited a Christian healer into his practice to treat chronically ill patients. He also experimented with prescribing devil’s claw for shoulder pain and goat’s weed for impotence, reports the Sunday Times.

Will all this have consequences? Will the King reflect and reconsider his affiliations with those who promote quackery? Will Dixon change?

Personally, I will not hold my breath.

On the occasion of a talk that I recently gave in Italy, I was interviewed by VANITY FAIR ITALY. I gave it in English and it was published in Italian. As I don’t expect many readers to be fluent in Italian and since it was a good interview, in my view, I thought I give you here the English original:

 

1.How can we exactly define «alternative medicine»?

There is much confusion and a plethora of definitions, none of which is fully satisfactory. In fact, the term “alternative medicine” itself is nonsensical: if a therapy works, it belongs to evidence-based medicine; and if it doesn’t work, it cannot possibly be an alternative. I therefore have long been calling it “so-called alternative medicine” (SCAM). The definition I use for SCAM with lay audiences is simple: SCAM is an umbrella term for a diverse range of therapeutic and diagnostic methods that have little in common, other than being excluded from mainstream medicine.

2.Who uses it and why?

Predominantly women! Statistics say about 30-70% of the general population use SCAM. And with patient populations, the percentage can be close to 100%. They use it because they are told over and over again that SCAM is natural and thus safe, as well as effective for all sorts of conditions.

3.Focusing on terminology, is there a difference between «complementary» and «alternative» medicine?

Theoretically, there is a big difference between «complementary» and «alternative» medicine. The former is supposed to be used as an add-on to, while the latter is a replacement of mainstream medicine. In practice, this dividing line is very blurred; most SCAMs are used in both ways, depending on the actual situation and circumstance.

4.Are users different from non-users?

Yes, there has been much research on this and my reading of it is that SCAM users tend to be less intelligent, more religious, more superstitious, less trusting in science, and more prone to conspiracy theories, for instance.

5.Which forms of alternative medicine are the most popular?

There are certain national differences, but in most European countries herbal medicine, acupuncture, chiropractic, osteopathy, homeopathy, aromatherapy, and reflexology are amongst the most popular SCAMs.

6.Does it work?

With such a wide range – someone once counted over 400 modalities and my last book evaluated 202 of them (Alternative Medicine: A Critical Assessment of 202 Modalities (Copernicus Books): Amazon.co.uk: Ernst, Edzard: 9783031107092: Books) – it is impossible to answer with yes or no. In addition we need to consider the conditions that are being treated. Acupuncture, for example, is touted as a panacea, but might just work for pain. If you take all this into account, I estimate that less than 3% of the therapeutic claims that are being made for SCAM are supported by sound evidence.

Is it safe?

Again, impossible to say. Some treatments are outright dangerous; for instance, chiropractic neck manipulations can injure an artery and the patient suffers a stroke of which she can even die. Other treatments are assumed to be entirely harmless; for example homeopathy. But even that is untrue: if a cancer patient relies exclusively on homeopathy for a cure, she might easily hasten her death. Sadly, such things happen not even rarely.

Do its benefits outweigh its risks?

That depends very much on the treatment, the disease, and the precise situation. Generally speaking, there are very few SCAMs that fulfill this condition.

You said that these were the research questions that occupied all your life in Exeter. Did you find the answers?

We published more on SCAM than any other research group, and we found mostly disappointing answers. But still, I am proud of having found at least some of the most pressing answers. Even negative answers can make an important contribution to our knowledge.

7.What is the problem with the placebo effect?

All therapies can prompt a placebo effect. Thus an ineffective treatment can easily appear to be effective through generating a placebo effect. This is why we need to rely on properly conducted, if possible placebo-controlled trials, if we want to know what works and what not.

8.Is it true that some alternative medicines can cause significant harm?

see above

9.What about herbal remedies? What do studies show about them?

Many of our modern drugs originate from plants, Therefore, it is not surprising that we find herbal remedies that are effective. But careful! This also means that plants can kill you – think of hemlock, for instance. In addition herbal medicine can interact powerfully with synthetic drugs. So, it is wise to be cautious and get responsible advice.

10.Which alternative therapies are overrated and why?

In my view, almost all SCAMs are over-rated. If you go on the Internet, you find ~5 000 000 websites on SCAM. 99% of them try to sell you something and are unreliable or even dangerous. We need to be aware of the fact that SCAM has grown into a huge business and many entrepreneurs are out to get your money based on bogus claims.

11.On the contrary, which therapies could be seen as an integration in routine care?

The best evidence can be found in the realm of herbal medicine, for instance St John’s Wort. Some mind-body interventions can be helpful; also a few massage techniques might be worth a try. Not a lot, I’m afraid.

12.Would you tell us what happened in 2005 with Prince Charles?

He complained about my actions via his private secretary to my University. A 13 month investigation followed. At the end, I was found not guilty but my funding, my team, my infrastructure had been dismantled. So, in effect, Charles managed to close down what was the only research group that looked critically and systematically into SCAM. A sad story – not so much for me but for progress and science, I think.

3.Why is alternative medicine still a controversial subject?

Mainly because the gap between the claims and the evidence is so very wide – and getting wider all the time.

14.Would you suggest the «right way» to approach it?

I often recommend this: if it sounds too good to be true, it probably is! I might add that, if you want reliable advice, don’t listen to those who profit from giving it.

Subscribe via email

Enter your email address to receive notifications of new blog posts by email.

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