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A bitter pill for alternative medicine
Edzard Ernst is quietly spoken. However, whenever the UK's only professor of complementary medicine opens his mouth, he knows it will set off an almighty storm.
It's not hard to see why. Alternative therapy has become big business. In the UK alone more than 150,000 practitioners treat one in five of us and collectively we spend 450m a year on everything from acupuncture to homeopathy and Prof Ernst has not exactly been the supporting voice many hoped he would be.
During the past 16 years he has published more than 1,000 research papers and the overwhelming majority have concluded the evidence from clinical trials shows many alternative therapies have little or no beneficial effect.
"Initially, the opposition came from within traditional medicine," says Prof Ernst, who, prior to moving to England, was a respected doctor in Austria. "It was an area many of my colleagues had absolutely no interest in. They didn't think there was a need for a professor of complementary medicine. They thought my appointment was pointless; a waste of talent and money."
Ignoring his detractors,
Prof Ernst put his head
down and began subjecting various therapies to rigorous scientific trials.
"I am a scientist, I have no personal interest in reporting or rubbishing complementary medicine, I simply report
what I find," he says, ahead
of delivering the first in the
new Straight Talking public lecture series at the University
of Bradford.
"Many practitioners began to grumble. They insisted the benefits they brought to people defied research. It was, they said, a holistic approach which couldn't be squeezed into the confines of clinical trials.
"Even now I still face the same arguments, but they are quite simply wrong. As for being too negative, that depends on your point of view. If by telling people essential oils cannot cure a particular health problem I
stop them spending lots of money on treatments which won't work, then surely that's positive. My allegiance is always to the patient."
The post at Exeter University was established with a 1.5m donation from the Maurice Laing Foundation, but while Prof Ernst's work has received international attention, he still struggles to secure large-scale funding for his research.
He insists that he has no hidden agenda and having studied alternative therapy in Munich as part of his medical degree, he has no particular axe to grind.
"They think I'm too critical and that my conclusions are too negative," he says. "I say, 'Show me a scientist who isn't critical'. Part of our job is to conduct critical analysis. After graduating, my first job was in the only homeopathic hospital in Germany. As a young doctor when you see people getting better using only natural treatments, it's very impressive.
"However, after a while I went to work in a laboratory and
if you study medicine and pharmacology, you know homeopathy can't work. The so- called active substances are so diluted that they cannot possibly have an effect. If something is scientifically implausible, but anecdotally it is said to relieve particular symptoms, that
in itself is a fascinating area
of research."
Prof Ernst is talking about the placebo effect. He dreams one day of having an entire centre devoted to research into the psychological phenomenon.
"When something looks like a placebo and behaves like a placebo, there comes a point when you have to admit that it's
a placebo," he says.
"It's not a criticism per se. There's nothing wrong with people thinking themselves better. When someone has a headache and they take an aspirin, there is a psychological element which helps the pain to go away. However, the aspirin also has proven medical effects. What I am against is treatments which rely wholly on the placebo effect. To me it's deception."
While Prof Ernst may have become a thorn in the side of complementary therapy, he isn't alone. With alternative therapy having entered the mainstream, leading doctors have previously called on NHS trusts to only use treatments whose benefits are based on solid evidence and aside from his studies, numerous other groups have cast doubt on their effectiveness.
A study by the Chesterfield-based Arthritis Research Campaign, published earlier this year, found two-thirds of alternative therapies for rheumatoid arthritis and a fifth of treatments for osteoarthritis were ineffective. Only fish oil was highly effective in reducing joint pain and stiffness.
There have also been concerns raised about the number of bogus therapists, with little or no training. The Complementary and Natural Healthcare Council is now in the process of setting up a proper register of practitioners in a bid to drive out the cowboys.
"There definitely needs to be more rigour in terms of regulation, but I do have concerns that this regulatory body does not have mandatory powers and is not looking at the efficacy of these therapies.
"Certainly mainstream medicine is not always transparent, but complementary medicine is even more murky. You may not have the big financial interest, but those who are involved in the world are convinced that alternative therapies are somehow a panacea and if trial data doesn't support it, there must be something wrong with the trial."
Prof Ernst, who co-wrote the controversial book Trick or Treatment: Alternative Therapy On Trial with colleague Simon Singh, is currently focused on acupuncture and chiropracy. Many are already braced for his conclusions, but every so often, he does deliver some positive news for the world of alternative therapy. "It's simply not possible to test everything. We have limited time and money, so we have to concentrate on those things that have the best chance of producing a positive result.
"St John's Wort, for example, does seem to be effective in treating depression and acupuncture can help with nausea and vomiting.
"Overall, I would say about five per cent of alternative therapies are backed by scientific fact.
"When I was a young boy, our family doctor was a homeopath. He used alternative and conventional methods in parallel. When I had a very painful kidney colic, he gave me conventional painkillers without fumbling around.
"Sadly, many people are so evangelical about complementary medicine, they become blind to everything else."
It was Prof Ernst's inability to turn away from uncomfortable facts that in part prompted the move to Britain. As head of
the physical medicine and rehabilitation department at the Vienna Medical School, he began looking into the history of the school. He discovered the official records stopped in 1938 and when he began to ask questions, a horrific picture emerged.
Before the Second World War, the school had been staffed by a large number of Jewish doctors. All were sacked and, under the newly appointed Nazi dean, the school was implicated in experiments on prisoners at the Dachau concentration camp.
"I wrote about what I found out and in some quarters that made me quite unpopular," he says. "When this post came up, it was the right time to get out. There was a little part of me that thought I might be bored, but it has been one of the most interesting periods of my career.
"We currently have another two years of funding guaranteed. I don't know what will happen after that, but if it does all come to an end, I will certainly have
no regrets."
n Edzard Ernst will launch the Straight Talking series of lectures at Bradford University on October 8. The lectures are free but must be booked in advance. Call 01274 234009 or email inmyview@bradford.ac.uk
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