糖心Vlog

A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble, by Edzard Ernst

Helen Bynum admires a physician鈥檚 quest to distinguish alternative medicine from quackery

Published on
January 29, 2015
Last updated
June 10, 2015

In Central London, on the corner of Queen Square and Great Ormond Street, stands the Royal London Hospital for Integrated Medicine, formerly the Royal London Homoeopathic Hospital. Queen Square houses the National Hospital for Neurology and Neurosurgery, and Great Ormond Street the eponymous Hospital for Children. Neurological disorders are among some of the most frustrating and intractable conditions; often chronic in their course, their debilitating effects chip away at patients鈥 life quality, morale and dignity. The plight of sick children, of course, needs little embellishment. Anything that can be done to help these people (and everyone else who is suffering) should be done. In a decent society, treatment should be part of a universal healthcare system available free at the point of use, as is currently the case in the UK under the NHS. So where does the building on the corner fit in? What does the medicine offered by the RLHIM offer to those in need?

In 1993, academic physician Edzard Ernst arrived at the University of Exeter to take up a new endowed chair in complementary medicine, and his job, as he saw it, was to answer just that sort of question. But by 2011, he had retired from his post. The position would remain unfilled, and what remained of a highly successful research unit that Ernst had run for 18 years was subsequently shut down. It is a chastening story for anyone who cares about academic medicine.

Maybe they liked to give sugar pills because they struggled with introducing an intravenous needle or taking a liver biopsy sample

Prior to 2011, Ernst was already a curiously controversial public figure, renowned for his measured stance against untested complementary or alternative medicine (CAM). For, as Ernst writes in this forthright memoir, 鈥渢here is no such thing as alternative medicine; there are just treatments that work, and those that don鈥檛. Those that work will find their way into the standard armamentarium of medicine, while those that don鈥檛 are destined to remain in the realm of quackery.鈥 These views would bring him into conflict with CAM practitioners and advocates, including members of the British Establishment, notably the Prince of Wales, and the second half of this book is about this ultimately unsatisfactory period in his life.

糖心Vlog

ADVERTISEMENT

But, like the King in Alice鈥檚 Adventures in Wonderland, let us begin at the beginning of Ernst鈥檚 painstaking account. In its opening pages, he thoughtfully explains how he gained the skills and tools that qualified him to make credible judgements about medicine and science. He also shares his attitudes to those he came across in various situations who abused their positions of power.

Born in 1948 in Germany, he was a child of the fraught immediate post-war period, and here he describes the general and personal baggage that this accident of birth brought to his life. Although more jazz musician than doctor by inclination, he followed his mother鈥檚 advice and studied hard enough to qualify in medicine in case a musical career didn鈥檛 work out.

糖心Vlog

ADVERTISEMENT

Ernst鈥檚 first job after qualification was in a homeopathic hospital in Munich. Germany is much more open to homeopathy than the UK 鈥 its founder Samuel Hahnemann was German, after all 鈥 and its homeopathy practitioners tend to be medically qualified too. During his six-month stay at the hospital, Ernst says, he learned the 鈥渋ncredible power of the placebo鈥. He also learned the basics of some other therapeutic schemes, and from watching his colleagues drew some harsh conclusions about their clinical abilities. Perhaps they preferred the obfuscation of alternative medicine because they couldn鈥檛 deal with the rigour of conventional medicine. Maybe they liked to give sugar pills because they struggled with techniques such as introducing an intravenous needle or taking a liver biopsy sample.

Jazz would bring Ernst to London as a visiting musician, and the love he found with his future wife Danielle made a move inevitable. He found a permanent job at St George鈥檚 Hospital in a research laboratory investigating the factors that impeded blood flow. Ernst writes with real joy about the pleasure he found in scientific research and in developing his ability as an analytical and critical thinker. He would take these skills back to Germany, where he became a specialist in rehabilitation medicine. From Hanover, he moved to Vienna to head up a vast department in the same field, his final stop before Exeter.

There is a decidedly different feel to the second half of this excellent book, which deals with Ernst鈥檚 Exeter years. (A brief coda explains that friends who read early drafts of A Scientist in Wonderland urged him to preface this account with details of his earlier life.) It is, in essence, a perfectly pitched meditation on the fallacies of CAM and what Ernst rightly argues are his reasonable attempts, in an age of evidence-based medicine, to subject its practices to rigorous scientific study in the same way orthodox treatments are trialled. Why, he asks repeatedly, should CAM鈥檚 advocates and practitioners not wish to see their ideas tested in randomised, placebo-controlled, double blind trials?

In Ernst鈥檚 view, the original aim of the 拢1.5 million endowment for the chair at Exeter was not to facilitate the design and execution of such thorough trials, but instead to bolster the reputation of CAM in other ways 鈥 so it is perhaps hardly surprising that his research would run counter to some expectations. Moreover, Ernst鈥檚 account of his elegant study of the effects of spiritual healing on chronic pain, which showed no benefit over placebo, attests to his concern not just with efficacy but also with patient safety. If a treatment works via placebo it may still not be the best option, he argues, because a better-than-placebo orthodox treatment may be available. He is rightly horrified by the prevalence of what he characterises as an artificial middle ground, the 鈥zeitgeist of cultural relativism鈥, where scientific data must be 鈥渂alanced鈥 by less rigorous and merely qualitative personal experience or belief.

糖心Vlog

ADVERTISEMENT

But for all its trenchant arguments about evidence-based science, the second half of A Scientist in Wonderland remains a very human memoir, and Ernst鈥檚 account of the increasingly personal nature of the attacks he faced when speaking to CAM practitioners and advocacy groups is disturbing. He also offers his side of a public disagreement with Sir Michael Peat, the Prince of Wales鈥 private secretary, over the Smallwood report, , in 2005. An accusation that Ernst had broken a confidentiality agreement led to a lengthy investigation at Exeter, as he outlines, and although he was cleared of wrongdoing, he was scarred by the experience. Significantly, as he reports, funds for his Exeter research unit dried up, and led to its eventual closure.

We are in no doubt, reading this account, that Ernst believes his university let him down and that what was at stake was more than simply a professorial chair. While the NHS grapples with rising costs and growing patient expectations, it is also charged with delivering evidence-based quality care. If it is to offer CAM, these practices must be subject to the same criteria as orthodox medicine. For Ernst, it is more than a matter of economics; it is an ethical principle. Ben Goldacre鈥檚 2012 book Bad Pharma created a storm via its exposure of the pharmaceutical industry鈥檚 unhealthy links with mainstream medicine. Ernst鈥檚 book deserves to do the same for the quackery trading under the name of complementary and alternative medicine.

A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble

By Edzard Ernst
Imprint Academic, 200pp, 拢14.95
ISBN 9781845407773
Published 20 January 2015

The author

Edzard Ernst 鈥 jazz musician, Beethoven fan (鈥渘ot very original, I know, but I don鈥檛 care鈥) and emeritus professor of complementary medicine at the University of Exeter 鈥 was born and raised in Germany. His French-born wife Danielle, he says, 鈥渟ometimes reminds me that it still shows 鈥 German efficiency, German bluntness and all that!鈥 The couple currently divide their time between 鈥渞ural Suffolk, which is our official retirement location, and Brittany, where we have plenty of family鈥.

Of his early years, Ernst recalls that he 鈥渘ever managed to take school or my teachers seriously. This deplorable attitude changed only in medical school. My childhood inspirations were more musical than medical, and it was only when I worked in a research lab in St George鈥檚 Hospital in London that I caught the science bug.鈥

He elaborates: 鈥淎s a boy, I started on the clarinet, then saxophone, and finally drums, which I took rather seriously for many years. Am I good? Not any more. But before medicine finally took over, I probably was.鈥

Thus as an undergraduate, he recalls, 鈥淢y hobby was (and indeed still is) making music, which involved long nights spent jazzing in clubs, etc. So I was a student who was struggling to cope with the tons of facts they threw at me in medical school. That is not to say I was a bad student - I just often found it quite hard to digest all this knowledge.鈥

He qualified as a medical doctor in 1978, and by 1990 was head of the department of medicine at the University of Vienna. He says that after a while in that post, 鈥淚 had essentially become an administrator, longing to do something more meaningful with his life. This and other circumstances made the decision to move to the UK (in the course of which halving my salary) quite easy. It was a country where we had lived before, and to come back to England had been our dream for some time. It turned out to be a decision that, despite all the problems I later had, I never regretted.鈥

In 1993, Ernst was appointed to a professorship in complementary medicine at the University of Exeter 鈥撀爐he first such chair in the world.

His time at Exeter was marked by highs as well as lows. 鈥淭he first 10 years or so were great: my unit quickly built up an international reputation for rigorous research in alternative medicine. We published plenty of decent research, and we were appreciated by our peers. My greatest disappointment, therefore, is that all this changed quite abruptly when we became a proper medical school. To put it in the words of my line manager at the time: 鈥業 know, we are treating you like shit.鈥

鈥淎fter much reflection, my interpretation of this development is that after Prince Charles鈥 First Private Secretary filed an official complaint with my vice-chancellor, some of my peers saw their knighthood in jeopardy and behaved accordingly. All the support I once enjoyed collapsed, my staff鈥檚 contracts were not prolonged and, most crucially, the university never fulfilled its commitment to raise 拢1.5 million for my research.鈥

Ernst adds: 鈥淏ut my greatest satisfaction is that, despite all this, the 鈥榝orces of endarkenment鈥 have so far not managed to silence me.鈥

Has he any family, friends or colleagues who are disappointed by his critical view of alternative medicine?

鈥淵es, of course. Some people are quite literally religious believers in homeopathy or some other therapy. In such cases, it is best to talk about the weather or the abominable train service we often endure.

鈥淚f it is unavoidable, I do talk about my job and tell them that it consists of applying the rules of science to alternative medicine. I also often point out that an uncritical scientist is a contradiction in terms; that a professor of toxicology cannot be expected to advocate taking poison; that it is odd to 鈥榖elieve鈥 in a therapy (I ask 鈥榙o you believe in aspirin?鈥). Sometimes this does the trick 鈥撀燼nd sometimes it leads to losing friends.鈥

Asked about whether he has found different levels of credence in alternative medicine in different countries, Ernst observes, 鈥淓very country and every culture is different. The French (and possibly Quebeckers) are mad about homeopathy. Americans are keen on supplements and chiropractic. The Germans love massage therapy and herbal remedies. The Brits are fond of aromatherapy and herbs. The explanations for these phenomena are usually very complex; there is never just a single factor that determines the popularity of alternative medicine.鈥

Are there any countries that remain relatively immune to the lure of alternative medicine? 鈥淎ctually, the UK is not too bad in this respect. Most other developed countries have considerably higher usages of alternative medicine than we have. Why? Perhaps because we have the NHS. This is one reason why I hope the Tories will not manage to destroy it completely.鈥

What gives Ernst hope? 鈥淭hat Prince Charles, who once said he was proud to be 鈥榯he enemy of the Enlightenment鈥 might be unsuccessful in his quest to usher in an era of endarkenment.鈥

Karen Shook

糖心Vlog

ADVERTISEMENT

Register to continue

Why register?

  • Registration is free and only takes a moment
  • Once registered, you can read 3 articles a month
  • Sign up for our newsletter
Please
or
to read this article.

Sponsored

Featured jobs

See all jobs
ADVERTISEMENT