An Interview with Professor Edzard Ernst
by Caleb W. Lack
In the world of complementary and alternative medicine (CAM), there is usually a large gap between research and practice. The vast majority of those practicing various forms of CAM (such as chiropractic, homeopathy, or acupuncture) tend to have little to no training in conducting or evaluating research. Indeed, many of them balk at the very fact that research needs to be undertaken to see if what they are doing actually has any more than a placebo-level effect. But, over the past 20 years, one person has done the research, looked over the studies, written them up, and earned the respect of skeptics worldwide.
Edzard Ernst has one of the most impressive collections of letters behind his name that I’ve ever seen: MD, PhD, FMedSci, FSB, FRCP, FRCPEd. Originally from Germany, Ernst began his career as a physician there and, in addition to more standard medical training, also received training in a number of CAM modalities, including acupuncture, herbalism, homoeopathy, and spinal manipulation. He rose through the ranks to become Professor in Physical Medicine and Rehabilitation (PMR) at the Hannover Medical School and Head of the PMR Department at the University of Vienna. At this point in his career, Professor Ernst took a decidedly different direction in life. He applied for and was hired as the first ever Laing Chair of Complementary Medicine at the University of Exeter (named for Sir Maurice Laing, who endowed the position) and so moved to the United Kingdom in 1993. He ascended to the position of Director of the Complementary Medicine Research Group in 2002.
Ernst was tasked by Laing to examine the evidence for and against various non-mainstream treatment modalities. In effect, this meant that his job was to look at the CAM world through a scientific lens. Professor Ernst, the scientist and researcher, could no longer be sympathetic towards CAM just because he has been trained in using it, or because he was being funded by someone who was quite supportive of it. As such, he applied a rigorous scientific eye towards CAM, rather than becoming the “yes man” that many in the industry undoubtedly hoped he would be. This resulted in well over 1,000 papers, three dozen books, and a huge number of book chapters published over the next 20 years, examining everything from acupuncture to artichoke leaf to aroma therapy (and on dozens of treatments and topics that don’t even start with “a”). The more that Ernst and his group conducted research, the more he came to the conclusion that almost all of what is lumped under the umbrella term CAM is bunk and nonsense, useless from a therapeutic point of view, with perhaps 5% or so being useful. These conclusions led to Ernst being called “the scourge of alternative medicine,” being held up as a paragon of how a scientist should conduct research from a non-biased view, but at the same time these conclusions (and Ernst having no problems being outspoken about them) helped make him some powerful enemies.
In what is (in my opinion), the most lay-friendly book yet published on alt-med, Trick or Treatment: The Undeniable Facts about Alternative Medicine, Ernst and his co-author Simon Singh dedicated the book to Charles, Prince of Wales and heir to the throne of England. This wasn’t because of their admiration for Charles, but instead he is a huge supporter of various CAM modalities, going so far as to sponsor a foundation to promote CAM. In fact, most (including Ernst himself) credit his early retirement from Exeter to his criticism about the Prince and his foundation.The below video has Ernst discussing some of this.
Since his retirement, Ernst has become a prolific and public critic of alt-med, writing across numerous outlets and taking to social media with a vengeance, as well as still continuing to collaborate on scientific articles and edit the journal he helped found, Focus on Alternative and Complementary Therapies. He is also a very frequent blogger at his own site, and has graciously agreed to allow Healthy Skepticism to reprint some of his more popular and informative posts.
As an introduction to the republishing of some of his work here on Healthy Skepticism, Professor Ernst was kind enough to agree to be interviewed via email. My questions are in bold below, followed by his answers. Any links present were added by myself, to help lead the reader to further information.
Can you tell us what it was like being a physician trained in a number of what we today call CAM (homeopathy, acupuncture, and such) as well as more conventional medicine?
I grew up in Germany where this sort of thing was not as unusual as it now looks from a US perspective. My aim was to become a clinician, and we were told that any method that helps the patient is acceptable. Critical thinking was not our forte, I am afraid.
How do you think your early training and experiences contributed to you becoming (according to the Independent) “the scourge of alternative medicine” and one of the most well-known critics of CAM?
I left Germany and my career as a clinician and became a scientist working in a lab for several years. This taught me to think more critically. Eventually, it became my job to apply the rules of science to CAM. For me, there was no question of abusing my position to promote the treatments which I had been fond of – an uncritical scientist is a contradiction in terms, in my view, and thus I had to question the ‘CAM-wisdom’. The ‘alternativists’ took this for being anti-CAM, but that just shows how little they understand of how science works.
Speaking of CAM, it’s my understanding that you don’t think that it is a particularly useful term. Can you tell me why, and what you would propose as an alternative (no pun intended)?
Take herbal medicine or massage therapy, for instance, as examples. They are entirely conventional in Germany where I had trained, while they are CAM in the UK and the US. These umbrella terms are confusing and sometimes even counter-productive. Today I think it is best to call a spade a spade; I believe it is best to name the specific modalities we have in mind (acupuncture, chiropractic, homeopathy, etc.) which, incidentally, have virtually nothing in common with each other.
Why do you think that use of alt-med practices and purveyors continues to grow across the globe, despite the lack of evidence supporting the use of the vast majority of it?
There is not one but dozens of reasons for this phenomenon. Some patients are desperate and want to leave no stone unturned, others are disappointed by conventional medicine because of side-effects, lack of time and compassion, others are just ‘worried well’ and can afford to spend some extra money, others are lured in by the incessant hype journalists produce or are impressed by the BS that is available on millions of websites.
In your opinion, what should the role of the modern physician be when it comes to CAM and their patients? In other words, how should they be interacting with the public, in regards to the use of CAM?
Physicians have the duty to inform their patients objectively based on the best evidence available to date. This goes for any subject and certainly includes CAM as well. This would require that they know the essential facts about CAM. Unfortunately, many don’t. and that drives many patients into the hands of charlatans.
What, in your view, is the most well-supported treatment or type of therapy that is typically considered a part of CAM?
Without doubt, herbal medicine. Willow bark brought us aspirin and, of course, once we have an isolated plant-ingredient, it stops being herbal medicine. But sometimes the isolation of a single active ingredient is not possible. St John’s Wort is a good example of an effective herbal medicine where this is the case.
What, in your view, is the most dangerous treatment or type of therapy that is typically considered a part of CAM?
Difficult to say, as the risks of CAM are woefully under-researched and there are no monitoring system for adverse effects. Because it is quite popular, I might name chiropractic: it causes mild to moderate adverse effects in ~50% of all patients – imagine a drug that does that without good evidence for efficacy!!! – and, in addition there are hundreds of severe complications on record, including stroke and death.
As the editor-in-chief of Focus on Alternative and Complementary Therapies, a traditionally published journal, what’s your opinion on the rise of open access journals such as PLOS One? Do you see them as a viable alternative to the traditional publishing model, a threat to it, or something else?
I think they may well be the future of science publishing.
As a physician and an activist, what advice do you have for people like our readers when they are confronted with family members or friends who are using unsupported (or actively discredited) therapies and treatments? How should they respond, or should they? What resources would you encourage them to share with CAM believers?
Obviously, I would recommend my blog and our book Trick or Treatment. Sadly, in my experience, we are often confronted with people who have a quasi-religious belief in this or that treatment. in such cases it might be best to agree to disagree.
It was a real pleasure to talk to Professor Ernst, and you will definitely want to be on the lookout for his upcoming contributions to Healthy Skepticism!
Caleb W. Lack, Ph.D. is a clinical psychologist and professor at the University of Central Oklahoma. The author of more than three dozen scientific publications relating to the assessment and treatment of psychological problems, as well as a frequent speaker at international conferences and workshops, Dr. Lack is committed to spreading the practice of evidence-based psychology. Skeptically, he blogs for the Skeptic Ink Network at Great Plains Skeptic, where he covers topics such as critical thinking, pseudoscience in psychology and other fields, and the occasional Satanic Panic. Follow his updates on Facebook, Twitter, and YouTube.