July 21, 2011

Dr. Edzard Ernst has spent the better part of the last two decades doing what few physicians have been inclined to do: establishing an evidence base for alternative therapies.

In that time, he and his team in the department of complementary medicine at Peninsula Medical School in Exeter, England, have turned out more than 1,000 papers on the subject, written some 40 books—including the recent Trick or Treatment?, which Dr. Ernst describes as “a passionate plea for good evidence”—and founded the journal Focus on Alternative and Complementary Therapies. On the eve of his retirement from his post as the world’s first professor of complementary medicine, he answered questions about his research and the relationship between conventional and alternative medicines.

Q: You’re an MD. How did you find yourself dedicating your career to the study of alternative medicine?

Alternative medicine had become a hobbyhorse of mine since I had worked as a junior doctor in a German homeopathic hospital. In 1993, I had become director of a large department of rehabilitation medicine in Vienna. For a number of reasons, I felt like a change, and when I saw the first chair in complementary medicine advertised at Peninsula Medical School, I applied and was offered the post.

Q: How has the business and study of alternative medicine changed over your 18 years in the field? Does this relate in any way to changes in conventional medicine?

From the beginning, I wanted to apply the rules of science to test alternative medicine, particularly in terms of determining efficacy and safety. At the time, this was an almost revolutionary concept. Now it has been widely accepted that this is the way forward. But compared to conventional medicine, there’s a lot of catching up to do. Even the most elementary questions remain unanswered.

Q: Such as?

The most important issue, I am convinced, is safety. Most people assume that alternative medicine is natural and therefore risk-free. This is not necessarily true. For instance, we know of hundreds of cases where chiropractic manipulations were followed by very severe complications like arterial dissections, strokes and deaths.
Since there is no effective monitoring system of such events, we may suspect that under-reporting is huge. So we are merely looking at the tip of an iceberg. Accurate incidence figures do not exist and it is high time that these issues are addressed by systematic research.

Q: Only 5% of the therapies you have studied have shown a benefit above and beyond a placebo or hint that further research might be warranted. What has the reception—by both the medical establishment and those practising alternative medicine—been like in response to these findings?

 It has been very mixed. Some quack-busters find it hard to believe that any alternative medicine is useful. And some believers in alternative medicine think the (5%) figure is too low because alternative medicine should not be measured with the same yardstick used in the study of conventional medicine.

 Q: So what challenges did you face when it came to getting those who sell alternative therapies involved in your studies?
Proponents of alternative medicine often think that science is a tool for proving their ideas correct. When they realize that good scientists do not aim at proving but at testing hypotheses, they usually stop co-operating. This can make research in this area quite difficult.

Q: What obstacles have you faced when it comes to getting conventional doctors engaged in your work?
Many doctors are all in favour of good science but they fail to see why alternative medicine should be a priority. This can be a problem, especially when trying to obtain funding for research in this area.

At present there are some 52 million websites on alternative medicine and the vast majority are dangerously misleading patients to make poor therapeutic choices.

Q: You have said that your work addresses a public health problem. Can you explain the problem and what you think needs to happen to solve it?
Alternative medicine is a public health issue simply because so many patients are using it. We may love or hate alternative medicine, but vis-a-vis its prevalence, we have a moral duty to find out what is effective, what is not and what is safe and what is dangerous.

The problem gets more serious if we consider the huge amount of misinformation that is out there, especially on the Internet. At present there are some 52 million websites on alternative medicine and the vast majority are dangerously misleading patients to make poor therapeutic choices.

Q: What do you think physicians can learn from practitioners of alternative medicine? And vice versa?
We know from many studies that patients go to alternative medicine practitioners not least because they like to be listened to with time and empathy. This is something we are in danger of forgetting in conventional medicine. This area of medicine must not be delegated to others; it is a core element of any good medicine.

Alternative practitioners must get their act together and come into the 21st century. This means they must practise according to best evidence and adhere to medical ethics or not practise at all. Anyone who works in healthcare and does not subscribe to evidence-based medicine and the elementary rules of medical ethics is in the wrong business, it seems to me.

Q: Where do you see the future of alternative medicine, and how do you think conventional and alternative medicine will complement each other going forward?
The future lies in demonstrating the value of alternative medicine in the same way any medicine has to show it: through proper science. Double standards in medicine are not sustainable and a hindrance to progress. If we follow this concept through, there will be no two camps. There will only be medicine that demonstrably generates more good than harm and medicine which does not fulfill this criterion—and the latter category should be important only in terms of the history of medicine.

Q: You’re now retiring from your post as the world’s first chair in complementary medicine. What do you hope is your legacy?
We have established that the scientific investigation of alternative medicine is possible and leads to progress