A Scientist in Wonderland
It’s good to see that Edzard Ernst’s latest book is already selling so well but if you haven’t yet got a copy, I hope a few reflections of my own will encourage you to buy it — especially if you are a devotee of any kind of ‘alternative’ or complementary medicine and especially if you think you already know all you need to know about Edzard Ernst.
A Scientist in Wonderland is more than an autobiography and I’m not sure I can do justice to the riches to be found in its pages. Sometimes it’s reminiscent of a black comedy, other times it’s almost too painful to read. If you already understand what is meant by scientific rigour and how medical ethics depends on it, there are parts of Edzard’s story that will probably make you despair.
But what if you don’t understand? What if you are one of those who accuses the man of being a liar, a fraud, a pharma shill — not because you’ve ever seen an iota of evidence that he is any of these things but because you are so deeply invested in what he famously opposes that this kind of vilification sounds intuitively right to you? Are you open-minded enough to read and learn from this book? I doubt it but I would love you to prove me wrong.
At the heart of his story is his passion for science, for research, for accuracy and truthfulness and — let’s face it — none of these are known for being major preoccupations of those who make a living from any form of CAM. As Edzard points out:
There are thousands of books on alternative medicine but hardly more than a handful cover the subject of medical ethics in any depth. It is perhaps not surprising, therefore, that the principles of medical ethics are routinely ignored and frequently violated by promoters of alternative medicine.
Ignored and violated? You’re not kidding! I don’t think I’ve ever engaged with a practitioner or promoter who’s demonstrated a modicum of comprehension of what the words mean. Why, a handful of them who obviously haven’t read the book still apparently think it’s OK to post hateful comments in the review section of Amazon. How do they live with themselves?
The word ‘evidence’ is another tricky one in any dialogue with altmed devotees, again because so often they don’t seem to understand the meaning of the word. All the more reason this book should be read by every promoter, supporter, sympathiser and user of any complementary or alternative therapy who believes that these therapies work for them — especially if they refuse to believe they can be tested by randomised controlled trials. This would seem to be most of them and it contributes to my impression of them as being the most closed-minded people alive.
Chapter 5 contains the best, the most patient, the most thorough, accessible and user-friendly explanation of the need for RCTs I’ve ever read, using the real-life example of…ahem…”spiritual healing” and a trial conducted in consultation with a group of spiritual healers of “good reputation within their profession”.
Want to know what happened? The outcome of the four-limbed trial demonstrated how very impressive the placebo effect could be:
The findings demonstrated considerable pain-reductions in all four groups but no significant difference between them. If anything, the placebo-groups had experienced a little more pain-relief than the patients receiving real spiritual healing.
And just when I was thinking that maybe he’d found an unusually ethical group of alternative therapists to work with, I read that some or all of them had urged Edzard not to publish the results. Don’t let the public know the truth! To no avail, thankfully, he published them anyway but — Hahnemann preserve us — how in keeping with everything I’ve come to expect from such people.
Of course, even more important than evaluating the effectiveness of alternative treatments, Edzard has striven to find out if they are safe — and with a naivety shared by many of us, he initially assumed that practitioners would welcome this aspect of his work. Strangely, however, a research project getting acupuncturists to report adverse effects during acupuncture sessions was “greeted with fierce resistance by the UK acupuncture establishment, and we had a major struggle keeping enough acupuncturists on board to see this project through to its end”.
I’ll leave you to read for yourselves how desperately hard the likes of homeopaths and chiropractors tried to get him disciplined for the apparently heinous crime of exposing their anti-vax views (in a project described here) and how spinelessly some of his colleagues at Exeter behaved while ultimately coming down on his side.
Anyway, as a biography it is no less compelling. From the vividly-spun image of a teenage Edzard waking at the crack of dawn and having to prance barefoot outdoors on the cold, wet grass during his mother’s Kneipp phase to the mind-blowing tales of corruption and bureaucratic incompetence encountered during his years in Vienna; from the hilarious “discovery of real spiritual healing powers” in a group of hapless actors recruited for the above-mentioned trial at Exeter University to the shameful kowtowing of academic colleagues to the Woomeister General at Clarence House, the old cliché that you couldn’t make this up applies in spades.
It was all the more poignant to be reading this book while recovering — thanks to modern, science-based, free treatment on the NHS — from a significant injury involving multiple fractures after an accident some months ago. The early chapters take us back to another time and another place but one not so long ago or far away. The author’s description of his mother’s struggle with poverty and hunger in Germany in the aftermath of the war was reminiscent of my own mother’s stories of life in Greece after the years of Nazi occupation and savage civil war. But whereas my mother and, so it seemed to me, that entire generation of Greeks, would spend the next few decades regaling us, their offspring, with tales of their suffering and their heroism, Edzard recalls the discomfort of his elders at any mention of their country’s recent history.
With time, the growing realization that so many of our peers — teachers, uncles, aunts; perhaps even our own parents — had lent their assent, or worse, their enthusiastic assistance to the Nazi regime robbed their generation of its moral authority and left us, their children, unmoored and adrift.
Does that lack of moral guidance explain the determination to bury the past Edzard encountered decades later, when he accepted a post as Head of Physical Medicine & Rehabilitation at the University of Vienna? It was there that he happened on the first sign of the sinister history that was to consume his interest in years to come. I can imagine how compelled he must have felt to want to uncover the whole story of what went on in his faculty during the dark years but why weren’t there more like Edzard, champing at the bit to bring it into the open? Quite the contrary, he was warned time and again to leave it alone, thereby strengthening his determination to research and expose, which he did at no small personal cost.
What I found would depress me and make my life in Vienna more difficult than it was already gradually becoming. Eventually it would significantly contribute to my decision to leave.
Before his departure from Vienna, he completed what he now considers to be the most important paper he ever published. The paper, entitled A Leading Medical School Seriously Damaged: Vienna 1938 appeared in the Annals of Internal Medicine in May 1995. We are treated to a harrowing extract describing what happened in the faculty almost immediately after the annexation of Austria, starting with the appointment of a Nazi called Professor Pernkopf as faculty head and ending with the ‘ethnic cleansing’ i.e. murdering of children in the University’s paediatric hospital and the experimentation on prisoners at Dachau. We learn that Pernkopf used his time there to work on an anatomy textbook, which contained “material from children killed in a Viennese hospital. His Institute of Anatomy also used the corpses of executed persons for teaching purposes”.
As a result of the impassioned debate that ensued upon publication of Edzard’s paper, the book was banned from most libraries around the world. Worth highlighting because I am aware that there are some who are in denial about Edzard’s valuable work in this area. Shame on them.
There is possibly nothing that better illustrates the rank stupidity of so many practitioners of altmed than the opposition, repeatedly and vociferously expressed, to the appointment of Edzard to the Laing Chair of Complementary Medicine at Exeter University and the torrent of hatred and abuse he has been subjected to ever since. For the benefit of any such reading, understand this:
Edzard was raised by a mother who was an enthusiastic devotee of alternative therapies, in a country where use of them was routine. Their family doctor treated them with homeopathic as well as mainstream medicine and his first job after graduating from medical school was in Germany’s only homeopathic hospital, in Munich, where he blithely dished out homeopathic ‘remedies’ and used other CAM therapies when deemed appropriate. His training was hands-on.
When he applied for the job at Exeter, he was well-disposed towards altmed in general.
As a clinician, I had seen positive results from alternative therapies. If at all, I came to Exeter with any preconceived ideas, they were of a generally favourable kind. I was sure that, if we applied the rules of science to the study of alternative medicine, we would find plenty of encouraging evidence.
And, just to round off the case for the defence, I have in my possession a book about back pain published back in the late 1990s and giving “practical ways to restore health using complementary medicine”. Its author is one Professor Edzard Ernst but, even if it had been published anonymously, any reader would have guessed it was written by a medical doctor who looked favourably on alternative therapies but was anxious not to mislead. Thus we read that,
“Many people find that their back pain is significantly improved through acupuncture.”
“Many back pain patients experience significant relief from chiropractic and osteopathy.”
“Little harm can be done by homeopathy, provided that you remain under the ultimate control of your physician. If you are inclined, give it a try,” etc, etc, etc.
So Edzard was more than qualified for the position of the world’s first Professor of Complementary Medicine; the Queen’s homeopath himself was on the interviewing panel, which unanimously supported his appointment. By golly, there’s even a comment on Edzard’s blog by John Morgan, Founder and Managing Director of Helios Homeopathic Pharmacy, crediting Edzard with inspiring Morgan “to go further in homeopathy” when the two first met at Exeter in the 1990s. ‘Nuff said?
So, as John Morgan asks at the end of the same comment on Edzard’s blog, what went wrong? Edzard gives a short reply on his blog and a lengthier one in the book, which is worth quoting in full:
Nothing went wrong, but the evidence demonstrated more and more indisputably that most alternative therapies are not nearly as effective as enthusiasts tried to make us believe. As my research progressed and as I acquired deeper knowledge of the field, I began to view alternative medicine in a more critical light. The more data we amassed, the more we had to realize how unsubstantiated were many of the claims in support of many of these treatments. As the scientific evidence mounted, I could not help seeing what was right before my eyes. In truth, the more time I spent immersed in the world of alternative medicine, the more disillusioned I became realizing how very few of these approaches had any real therapeutic potential.
Sadly, it was Edzard’s determination to be truthful that was to be his undoing.
Wikipedia gives a brief summary of Prince Charles’ attempt to change UK health policy via a backdoor route by commissioning the Smallwood Report but omits to mention the actual reason Edzard was subjected to an internal investigation at Exeter University lasting 13 months. This was that he was accused of a breach of confidentiality by leaking the contents of the Report to the press, as if this were some dreadful crime. In fact he’d simply told a journalist from the Times who already had a copy of the Report in front of him, what he thought of it. (If, like me, you don’t subscribe to the Times, you can read his full quote here.)
I’m aware that some of his detractors are still saying Edzard was guilty as charged but he wasn’t and he was in fact exonerated by the University, though in his compelling description of events in Wonderland, he mentions he was treated as if he was guilty until proven innocent. Certainly, Prince Charles, the prince’s private secretary, the report’s author — economist Christopher Smallwood —and the University’s Vice-Chancellor all come out of the affair smelling like sewage and I came close to throwing the book at the wall in frustration at the many instances of HRH’s misuse of his privilege.
Charles continued to make public statements concerning matters which he evidently did not truly comprehend, delivering opinions on things that he had not studied in sufficient depth and expounding on issues seemingly without paying heed to the opinions of those who had worked in the field and had a lifetime of experience behind them… the dissemination of wrong information is not stimulating; wrong information is just wrong, and it is arguably even more wrong when delivered by someone to whom the public affords an exaggerated degree of deference based not on his superior knowledge, but solely on his class.
Amen to that and long live the Queen.
These are just a few highlights of an illuminating, provocative and mostly very enjoyable read. Did I mention how funny it was in places? Likely to make you laugh out loud even in public on a wet weekend. But don’t take my word for it — just buy the damn book!