杏吧原创

When Edzard Ernst became the UK鈥檚 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鈥檚 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鈥檝e 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鈥檚 wort in treating mild to moderate depression, and devil鈥檚 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鈥檙e not saying that 95 per cent is ineffective 鈥� rather that much of it hasn鈥檛 been properly tested. So don鈥檛 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鈥檛 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鈥檛 work 鈥� and I think we do 鈥� 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鈥檚 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鈥檛 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鈥檛 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.

Your new book is dedicated to Prince Charles, with whom you have had several public disagreements. Isn鈥檛 that unnecessarily provocative, given your precarious relationship with the CAM lobby?

There鈥檚 a danger of that, of course. It was partly tongue-in-cheek. He is such a public promoter of CAM that it would be almost negligent to ignore his views. He said the field needed more scientific research and I like to take people at their word. Anyway, this won鈥檛 be the main thing about my book that upsets the CAM lobby.

Your job is to focus on alternative therapies, yet conventional medicine is also full of misinformation and obscurities.

Mainstream medicine is not always transparent, but complementary medicine is several degrees more murky. You don鈥檛 have the big financial interests, it鈥檚 not big drug firms that are hiding data. Instead, it鈥檚 the many people who are obsessed with their conviction that the acupuncture needle is a panacea or that homeopathy has to be good for you, and if the trial data doesn鈥檛 support it there must be something wrong with the trial. Plenty of negative studies of alternative treatments don鈥檛 see the light of day.

What was your family鈥檚 view of alternative medicine when you were growing up?

Very favourable. I come from a medical family: my father, grandfather and great-grandfather were all doctors. But our family doctor was a homeopath. He was a good physician and he used alternative and conventional methods in parallel. He was not an evangelical believer in homeopathy. Once when I had a kidney colic as a young boy, which I remember as being immensely painful, he gave me conventional painkillers without hesitation; there was no fumbling around with homeopathic alternatives.

When I took the job as chair of complementary medicine at the University of Exeter in 1993, the idea of alternative medicine was not exotic to me at all. I learned acupuncture and several other alternative treatments when I was studying medicine in Munich, so I had hands-on experience. My first job after completing my exams was in the only homeopathic hospital in Germany. I was exposed to all these weird and wonderful treatments and I have to admit I was very impressed by them.

鈥淚 was impressed by all the weird and wonderful treatments鈥�

At what stage did you become disillusioned with alternative medicine or start to doubt it?

It鈥檚 difficult to say. At one stage I left medical practice to train as a scientist and work in a lab, and when I went back into clinical medicine my view had changed. I was a much more questioning doctor than I had been previously. What science taught me foremost is to apply critical thinking to everything I do.

You left a high-profile job as chair of physical and rehabilitation medicine at the Medical Faculty of Vienna in Austria to come to Exeter. Why?

In Vienna I felt like I was in a golden cage. I had 120 people working for me in my department, which was the biggest of its kind in Europe. I had a pension and double the salary that Exeter was offering. But there was too much intrigue and back-stabbing.

I also found myself becoming an academic administrator, while my real interest has always been clinical research. I was the first to leave a post like that in Austria since they threw out all the Jewish doctors during the Third Reich.

Did this infighting have anything to do with the investigation you had done of medical atrocities carried out by the Austrian medical establishment during Nazi rule?

Yes. We had just moved into this brand-new hospital and I thought it would be a good time to research my department鈥檚 history. I discovered the records stopped very abruptly in 1938. I tried to find out why and was advised not to. When someone says that to me, you can be sure that I鈥檒l do it despite the advice. The made me persona non grata.

Throughout your career you seem to have been driven to search for the truth, whether you鈥檙e dealing with the wartime practices of the Austrian medical establishment or the workings of complementary medicine.

Yes. My wife tells me I鈥檓 driven in that way and she must be right. It is probably my personality. I cannot easily do things halfway; I have to go all the way. It does get me into trouble. I am stubborn 鈥� either that or I鈥檓 just being a good scientist. I鈥檒l let you decide.