The end of an era
Professor Edzard Ernst recently announced his retirement as Director of the Complementary Medicine Research Group. What does this mean for him and for the future of critical research into the evidence for alternative therapies?
I interviewed Prof Ernst to find out.
Professor Edzard Ernst is critical of many sorts of complementary therapies. But his views of what works — and what doesn’t — are informed by critical examination of the evidence.
Many of his detractors would have us believe otherwise and see any critical examination of their pet therapy as a biased attack. Nothing could be further from the truth as anyone who understands the scientific process would understand.
The whole field of science progresses because those who conduct research are self-critical and critical of the research and conclusions of others. It is that criticism that improves our understanding of how the world works. They build on previous knowledge by trying to break it and break it down, piecing it back together again, making sure all the parts fit together better than before. In the words most famously uttered by Sir Isaac Newton, “If I have seen a little further it is by standing on the shoulders of Giants.” By building on knowledge gained by others, we understand more and understand better.
If that wasn’t how scientists worked, if scientists weren’t critical and simply accepted what others said without thinking for themselves, it wouldn’t be science at all and our knowledge of the world would stagnate.
Doubt is not an agreeable condition, but certainty is absurd.
Science allows us to make progress in this understanding, sometimes painfully slowly; sometimes in leaps and bounds; sometimes overturning age-old, but erroneous, beliefs of how and why things work. Sometimes we appear to take a backwards or sideways step rather than heading in the direction of a better understanding. But the overall direction is unrelentingly forward because mistakes and misunderstandings are closely examined and flaws found and exposed.
Similarly, any bias — accidental, through human failings or otherwise — should eventually be uncovered and we can head back to the correct path. Absolute objectivity is rarely achieved, but its relentless pursuit is paramount.
We can never be absolutely certain of anything; but that should not and does not stop us asking yet more questions in pursuit of the very human trait of wanting to better understand. It is a common tactic of those who oppose science to go for this apparent jugular: science keeps changing its mind; scientists sometimes get it wrong; we don’t trust science or scientists. In their world, certainty reigns supreme; certainty that what they have been told or what they have seen with their own eyes is THE TRUTH and no one is ever allowed to disturb that dogmatic belief.
That is the antithesis of science. As Voltaire put it: “Le doute n’est pas une condition agréable, mais la certitude est absurde.” Doubt is not an agreeable condition, but certainty is absurd. Science thrives and grows on doubt; alternative therapies rot in unshakable certainties.
It was science and the scientific method that showed us the need for proper sanitation as well as giving us life-saving antibiotics and vaccines. It is science and the scientific method that allowed us to create the computer you are reading this on and allows many believers in alternative therapies to peddle their wares to the unsuspecting. Time and time again, science and the scientific method has demonstrated that it is an extremely effective and consistent method for understanding our world. It clears the fog of delusion, bias and dogma and allows us to see more clearly.
And when all else fails, it’s not uncommon for utterly irrelevant personal insults to be hurled in the direction of anyone daring to question strongly held, yet erroneous, beliefs.
We are the only group who is doing full-time CM research not for proving that this or that therapy is effective and safe but for testing whether that is the case.
Rarely is there any critical appraisal of the evidence for many of these therapies. Critical appraisal of the evidence is helpful in all sorts of areas of life, but it is most important in healthcare. Here we may just be looking for a therapy that will reduce the average duration of a head cold from seven days to six, but we also need effective treatments for serious and life-threatening conditions, like cancers and AIDS.
What is the evidence for homeopathy? For acupuncture? For chiropractic? What’s the best way to find out whether these are the future medicine their proponents would have us believe? Is it to uncritically accept what their supporters tell us? Is it to accept the word of someone who recovered after taking that treatment? How do we know what appeared to work for one person actually was the reason for an apparent recovery and how do we know it will work for others? Will it work for everyone?
What should we base answers to these questions on? Guesswork? Intuition? Gut reaction? Assumptions? Anecdotes? No. We have to base important health questions on something far more rigorous, far more transparent and far more reliable.
The answer to these questions is blatantly obvious to anyone who has even a basic understanding of science and the scientific method. But this isn’t an answer that is restricted to some cabal of scientists — it is something that we all need to realise. The best way to understand if, how and why something works is to examine it with critical eyes and a critical brain. That means not accepting the prevailing dogma, but honestly, fairly and openly examining the evidence.
This critical appraisal is particularly necessary when considering complementary and alternative therapies. Time and time again, proponents of these therapies have shown that they are incapable of applying the necessary critical thinking skills to their cherished therapy. But if we are to find out what does and what doesn’t work, someone has to perform that vital role.
All too often, ‘critical appraisal of the evidence’ is presumed by alternative therapy supporters to mean ‘negative appraisal of the evidence’. It doesn’t. It means examining the evidence and following where that evidence leads, whether positive, negative or inconclusive. Doing anything other than this is what Ernst called “treating the evidence with contempt“.
Sir Maurice Lang
In 1993, Sir Maurice Laing, a supporter of complementary therapies, realised this and founded the Complementary Medicine Research Group, now at the Peninsula Medical School at the Universities of Exeter and Plymouth.
Sir Maurice Laing was a good and clever man. He wanted foremost rigorous research.
Laing appointed Edzard Ernst, then chair of physical and rehabilitation medicine at the Medical Faculty of Vienna, to set it up and Ernst became the first occupant of the Laing chair in Complementary Medicine. In 2002 Ernst became its Director.
It is to the defining attributes of science and the scientific method that Laing wanted — and needed — Ernst to adhere.
In 2008, Ernst explained his attitude to alternative therapies:
For us [Ernst and Dr Simon Singh], there is no such thing as alternative medicine.
There is either medicine that is effective or not, medicine that is safe or not. So-called alternative therapies need to be assessed and then classified as good medicines or bogus medicines.
Hopefully, in the future, the good medicines will be embraced within conventional medicine and the bogus medicines will be abandoned.
This was shortly after Enrst had been critical of misleading claims being made by Prince Charles’ beloved, but now defunct, Foundation for Integrated Health. It was this that heralded the end of Ernst’s career.
A few days ago, Prof Ernst announced his retirement as Director of the Complementary Medicine Research Group.
To better understand the situation and future plans, I asked Prof Ernst some questions and he was kind enough to answer:
What does the Complementary Medicine Research Group at the Peninsula Medical School do and why?
From the early beginnings in 1993 we had defined our aims as follows.
- To conduct rigorous, interdisciplinary and international collaborative research into the efficacy, safety and costs of complementary medicine (CM)
- To be neither promotional nor derogatory but struggle for objectivity.
- To promote analytical thinking in this area
- The overreaching aim of all of our research is to maximise the benefit and minimise the risk of CM for the patient.
I believe that, vis-à-vis the high levels of usage and the abundance of misinformation bombarding consumers on a daily basis, these aims are important.
What was the original vision of Sir Maurice Laing?
Sir Maurice Laing was a good and clever man. He wanted foremost rigorous research. I’m sure he would have wished our results to have been more often positive, but he told me repeatedly that it was more important to conduct good research to a standard that would be acceptable even to sceptics, than to bend over backwards in an attempt to generate positive findings.
What have been the Group’s greatest achievements?
This is hard for me to say. There have been many. We published more than 1,000 papers in the peer-reviewed medicinal literature. Several independent reviews thus identified us as the most productive CM research group in the world. We also did a few books as a group; the most important two are The Desktop Guide to Complementary and Alternative Medicine. 2nd edition. Edinburgh: Elsevier Mosby. 2006 and Oxford Handbook of Complementary Medicine. Oxford: Oxford University Press; 2008.
We also created a journal, Focus on Alternative and Complementary Therapies. But these achievements are trivial compared to the fact that, I think, we changed the climate of CM research worldwide. When we started, there was hardly any critical thinking within CM at all. We have worked very hard to introduce this into CM through our articles, books, lectures, annual conferences, etc. I’m not saying that the field is known for its self-criticism. In fact, we are still the only centre that consistently does critical evaluations. But the principle has been established and will grow, I hope.
Why are you choosing to retire now as Director of the Group?
I am still two years before the official retirement age. Yet I am retiring because the £2 million donated by the Laing Foundation is running out. My University had signed a contract to match this sum, but fund raising was never successful. After Prince Charles complained to the Vice Chancellor about me five years ago, it stopped altogether. Instead of fulfilling their promise, the University told us that they will close us down in May 2011. It was only because I could persuade the new dean who started in September 2010 to reconsider that complete and final closure was averted. The ‘deal’ we struck was that I officially retire, then get re-hired half-time for a year to help find a successor and provide the continuity. Personally, I am over the moon with this solution. I have fought so many battles that the scars are beginning to show and I feel exhausted with all of this.
Why is it important that your Group continues its work?
We are the only group who is doing full-time CM research not for proving that this or that therapy is effective and safe but for testing whether that is the case. This is such an important difference! It is the difference between a scientist and a promoter. The latter we don’t need in academia, promoters; they already populate every other strand of society.
I understand you’ll be working part time for the next year to help find a successor. What qualities will you be looking for in your replacement?
I am looking for a person who is a good scientist with energy and enough courage to stand up against the often quite overpowering forces of quackery. The university wants someone who can bring in money — and that is, of course, equally important.
There has been a lot of speculation about the Group being closed down because of a lack of funding. How secure is its future?
Without money, it clearly will not work. The trouble is that it is relatively easy to get research funds if you have the reputation of being “sympathetic” to CM. If you are critical, it is much harder. But if you’re not critical, you are not a scientist — and, in that case, it is better not to do the research in the first place.
There have been a lot of very personal attacks on your integrity, impartiality and your qualifications to comment on complementary medicine. Has this affected you personally or the work you are doing?
Yes, of course! Over the years I have become rather thick-skinned. But it affects me nevertheless. The best strategy, I find, is to see the funny side of it. Homeopaths attack me for not having qualifications in homeopathy. Think of it! If that’s not really hilarious, I don’t know what is.
What will you do when you fully retire?
Become really outspoken about quackery and charlatans. I look forward to that. Hopefully, UK libel law has changed by then.