BAAT in the media

Interview: The complementary medicine detective - with response by Malcolm Learmonth, BAAT

• 26 April 2008

Edzard Ernst
(Image: Paul Stuart)

When Edzard Ernst became the UK's first professor of complementary medicine, he was attacked by both alternative therapists and conventional doctors. The doctors have come round, but he is now alternative medicine's public enemy number one after sticking the needle into everything from acupuncture to homeopathy. He insists he is just being a good scientist, but it has been a long journey for someone whose family doctor was a homeopath. Michael Bond hears him out

You have published about 1000 articles on the safety and efficacy of alternative medicine. What have you found that is positive?

What we've found is that about 5 per cent of alternative therapies are backed up by evidence. There is good evidence for the effectiveness of some herbal remedies, such as St John's wort in treating mild to moderate depression, and devil's claw for musculoskeletal pain or hawthorn for heart failure. Acupuncture works for certain things. Traditional acupuncturists will say you can use it for everything, but the evidence suggests it works only for some pain conditions and for nausea and vomiting. Other evidence-based treatments include hypnosis for pain, music therapy for anxiety, and relaxation for insomnia.

You're not saying that 95 per cent is ineffective - rather that much of it hasn't been properly tested. So don't we need more tests?

You could say everything that is claimed needs to be tested. But we only have a limited amount of time and money, so we have to concentrate on those things that have the best chance of producing something positive. I wouldn't say studying crystal therapy or doing more studies on spiritual healing was worthwhile, because they are utterly implausible. But there are little pockets of light in this darkness and these encouraging data need firming up. It might turn out that my hope is erroneous, but at least you have provided a valuable service. Negative findings can be very useful. For example, if we have data that show for certain that homeopathy doesn't work - and I think we do - we can persuade people to use something that might help them and persuade the National Health Service not to invest in disproven treatments.

Why do so many people claim to have benefited from complementary and alternative medicine?

The discrepancy between experience and evidence is easy to explain. People may benefit from the encounter with the practitioner and not from the remedy; they might as well be given a placebo. That's very upsetting for a homeopath but it is nevertheless true. Many alternative practitioners develop an excellent relationship with their patients, and this helps to maximise the placebo effect of an otherwise useless treatment. Having said that, I believe the routine use of placebos is unacceptable for several reasons. Doctors should never lie to their patients, for instance; it would lead to a widespread culture of deception in medicine.

How do you explain the huge popularity of alternative medicine?

The obvious reason is that people are cheesed off with mainstream medicine. They may feel disappointed that decades of scientific research haven't defeated certain illnesses, or that their doctor has too little time or sympathy for them. It could also be the side effects that some drugs have. They don't want that, so they look to alternative medicine.

But the real reason, I have come to conclude, is that people are being lied to. Practitioners of complementary and alternative medicine (CAM) often fail to explain what the evidence shows and does not show. It is a triumph of advertising over rationality: many of the 40 million or so websites on alternative medicine promote outrageous lies. People seem quite gullible, and the situation is not helped by high-profile supporters of CAM

 

From Malcolm Learmonth, British Association of Art Therapists

In his inaugural lecture as professor of complementary medicine at the University of Exeter in 1993, Edzard Ernst quoted the writer H. L. Mencken: "To every complex problem there is a simple solution, and it's wrong." Yet he now claims that "the discrepancy between experience and evidence" concerning complementary therapies "is easy to explain": benefit comes from "the encounter with the practitioner".

This explanation is an oversimplification. Human encounters are complex. Their results cannot be tested by the randomised controlled trials that will yield the kind of evidence demanded by the UK-based Cochrane Collaboration, or the National Institute for Health and Clinical Excellence, or Ernst himself, because they do not lend themselves to the "isolate a single variable" approach that such studies require.

Psychological treatments based on encounter and relationship are not the same as placebo, for all that Ernst confounds the two. Meanwhile, orthodox medicine continues to roll out mechanistic drug and cognitive treatments whose evidence base is every bit as suspect as that of complementary therapies - as your report that antidepressants are barely better than placebos clearly shows (23 July 2005, p 4).

London, UK

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