Edzard Ernst | |
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![]() Edzard Ernst | |
Born | Wiesbaden, Germany | 30 January 1948
Alma mater | Ludwig Maximilian University of Munich |
Known for | Scientific study of alternative medicine |
Awards | John Maddox Prize 2015 |
Scientific career | |
Institutions | University of Exeter |
Website | edzardernst |
Edzard Ernst (born 30 January 1948) is a retired British-German academic physician and researcher specializing in the study of complementary and alternative medicine. He was Professor of Complementary Medicine at the University of Exeter, the world's first such academic position in complementary and alternative medicine.
Ernst served as chairman of Physical Medicine and Rehabilitation (PMR) at the University of Vienna, [1] but left this position in 1993 to set up the department of Complementary Medicine at the University of Exeter in England. He became director of complementary medicine of the Peninsula Medical School (PMS) in 2002. Ernst was the first occupant of the Laing chair in Complementary Medicine, retiring in 2011. He was born and trained in Germany, where he began his medical career at a homeopathic hospital in Munich, [2] and since 1999 has been a British citizen.
Ernst is the founder of two medical journals: Focus on Alternative and Complementary Therapies (of which he was editor-in-chief until it was discontinued in 2016) and Perfusion . [3] Ernst's writing appeared in a regular column in The Guardian , where he reviewed news stories about complementary medicine from an evidence-based medicine perspective. [4] Since his research began on alternative modalities, Ernst has been seen as "the scourge of alternative medicine" for publishing critical research that exposes methods that lack documentation of efficacy. [5] In 2015 he was awarded the John Maddox Prize, sponsored jointly by Sense about Science and Nature , for courage in standing up for science. [6]
Ernst was born in Wiesbaden, Germany, in 1948. As a child, his family doctor was a homeopath, and at the time he saw it as part of medicine. [7] His father and grandfather were both doctors, and his mother was a laboratory assistant. Ernst originally wanted to be a musician, but his mother persuaded him that medicine might be a good "sideline" career for him to pursue. [1]
Ernst qualified as a doctor in Germany in 1978 where he also completed his M.D. and Ph.D. theses. He has received training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation. [8] He learned homeopathy, acupuncture and other modalities [9] whilst at a homeopathic hospital in Munich, when he began his medical career. [2] In 1988, he became Professor in Physical Medicine and Rehabilitation (PMR) at Hannover Medical School and in 1990 Head of the PMR Department at the University of Vienna. [1]
The world's first professor of complementary medicine, [5] Ernst researches complementary medicine with an emphasis on efficacy and safety. His research mainly surveys systematic reviews and meta-analyses of clinical trials; the institute has not performed a clinical trial for some time due to budget constraints. [5] He has over 700 papers published in scientific journals. [2] He has said that about five percent of alternative medicine is backed by evidence, [10] with the remainder being either insufficiently studied or backed by evidence showing lack of efficacy.
Ernst's department at Exeter defined complementary medicine as "diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." [11]
Ernst asserts that, in Germany and Austria, complementary techniques are mostly practiced by qualified physicians, whereas in the UK they are mainly practiced by others. He also argues that the term "Complementary and Alternative Medicine" ("CAM") is an almost nonsensical umbrella term, and that distinctions between its modalities must be made. [12]
Since his research began on alternative modalities, Ernst has been seen as "the scourge of alternative medicine" for publishing critical research. [5] In a 2008 publication in the British Journal of General Practice , his listed treatments that "demonstrably generate more good than harm" was limited to acupuncture for nausea and osteoarthritis; aromatherapy as a palliative treatment for cancer; hypnosis for labour pain; massage, music therapy, relaxation therapy for anxiety and insomnia; and some plant extracts such as St John's wort for depression; hawthorn for congestive heart failure; guar gum for diabetes. [5]
In our book More Good Than Harm? ... ethicist Kevin Smith and I discuss the many ethical issues around alternative medicine and essentially conclude that it is not possible to practice alternative medicine ethically. [13]
Ernst presented at the first Global Congress on Scientific Thinking and Action, which took place on 17-20 March 2021. He spoke about the risk and dangers of alternative medicine, pointing to homeopathy and chiropractic as the most problematic areas within alternative medicine at the time. [14]
In 2005, a report by economist Christopher Smallwood, personally commissioned by Prince Charles, claimed that CAM was cost-effective and should be available in the National Health Service (NHS). Ernst was initially enlisted as a collaborator on the report, but asked for his name to be removed after a sight of the draft report convinced him that Smallwood had "written the conclusions before looking at the evidence". [15] The report did not address whether CAM treatments were actually effective and Ernst described it as "complete misleading rubbish". [15]
Ernst was, in turn, criticised by The Lancet editor Richard Horton for disclosing contents of the report while it was still in draft form. In a 29 August 2005 letter to The Times Horton wrote: "Professor Ernst seems to have broken every professional code of scientific behaviour by disclosing correspondence referring to a document that is in the process of being reviewed and revised prior to publication. This breach of confidence is to be deplored." [16]
Prince Charles' private secretary, Sir Michael Peat, also filed a complaint regarding breached confidentiality with Exeter University. Although he was "cleared of wrongdoing", [17] Ernst has said that circumstances surrounding the ensuing university investigation led to his retirement. [15]
In the 1 January 2006 edition of the British Journal of General Practice , Ernst gave a detailed criticism of the report. [18]
In 2008, Ernst and Simon Singh published Trick or Treatment? Alternative Medicine on Trial . The authors challenged the Prince of Wales, to whom the book is (ironically) dedicated, and The Prince's Foundation for Integrated Health on alleged misrepresentation of "scientific evidence about therapies such as homeopathy, acupuncture and reflexology". [19] They asserted that Britons spent £500 million each year on unproven or disproven alternative therapies. [20] In a review of Trick or Treatment in the New England Journal of Medicine , Donald Marcus described Ernst as "one of the best qualified people to summarize the evidence on this topic." [21]
In 2008, Ernst sent an open letter urging the Royal Pharmaceutical Society of Great Britain to crack down on high street chemists that sell homeopathic remedies without warning that the remedies lack evidence for claimed biological effects. [22] According to him, this disinformation would be a violation of their ethical code:
My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous. [22]
In a 2008 interview with Media Life Magazine , when he and Simon Singh were asked this question—"What do you think the future is for alternative medicine?"—they replied:
For us, there is no such thing as alternative medicine. There is either medicine that is effective or not, medicine that is safe or not. So-called alternative therapies need to be assessed and then classified as good medicines or bogus medicines. Hopefully, in the future, the good medicines will be embraced within conventional medicine and the bogus medicines will be abandoned. [23]
In a 2009 article entitled "Should We Maintain an Open Mind about Homeopathy?" [24] published in the American Journal of Medicine , Ernst and Michael Baum—writing to other physicians—offered strong criticism of homeopathy:
Homeopathy is among the worst examples of faith-based medicine. ... These axioms [of homeopathy] are not only out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics, chemistry, and pharmacology must be incorrect.... To have an open mind about homeopathy or similarly implausible forms of alternative medicine (e.g., Bach flower remedies, spiritual healing, crystal therapy) is therefore not an option. [24]
In 2018, Ernst and co-author Kevin Smith, a medical ethicist, published the book More Harm Than Good? The Moral Maze of Complementary and Alternative Medicine.
In a review of the book for Skeptical Inquirer , Harriet Hall called Ernst the "world's foremost expert on the claims and the evidence (or lack thereof) for Complementary and Alternative Medicine (CAM)." [25] Hall said that Ernst and Smith direct their attention to the ethicists and the scientific community for this book with the goal "to inform, not to entertain. It is not a easy or 'fun' read, but it is an important one". [25]
Dougal Jeffries, writing for the British Journal of General Practice , said the book was "replete with both theoretical and real-life examples and is thoroughly referenced, but is a rather turgid read. It clearly demonstrates the extraordinary capacity of intelligent beings, including both practitioners and patients, to hold to irrational beliefs in the face of contrary evidence, but the authors show little sympathy for this very human tendency." [26]
Ernst was accused by Prince Charles' private secretary of having breached a confidentiality agreement regarding the 2005 Smallwood report. After being subjected to a "very unpleasant" investigation by the University of Exeter, the university "accepted his innocence but continued, in his view, to treat him as 'persona non grata'. All fundraising for his unit ceased, forcing him to use up its core funding and allow its 15 staff to drift away." [15]
Writing in 2022, after Charles' accession to the throne, Ernst said, "There never was a formal confidentiality agreement with signature etc. But I did feel bound to keep the contents of the Smallwood report confidential. The investigation by my University was not just 'very unpleasant', it was also far too long. It lasted 13 months! I had to take lawyers against my own University! In addition, it was unnecessary, not least because a University should simply establish the facts and, if reasonable, defend its professor from outside attacks. The facts could have been established over a cup of tea with the Vice Chancellor in less than half an hour. When my department had been destroyed in the process, I retired voluntarily and was subsequently re-employed for half a year to help find a successor. In retrospect, I see this move as a smart ploy by the University to keep me sweet and prevent me from going to the press. A successor was never hired; one good candidate was found but he was told that he had to find 100% of the funds to do the job. Nobody of high repute would have found this acceptable, and thus the only good candidate was not even tempted to accept the position." [27]
He retired in 2011, two years ahead of his official retirement. [9] [28] In July 2011, a Reuters article described his "long-running dispute with the Prince about the merits of alternative therapies" and stated that he "accused Britain's heir-to-the-throne Prince Charles and other backers of alternative therapies on Monday of being 'snake-oil salesmen' who promote products with no scientific basis", and that the dispute "had cost him his job – a claim Prince Charles's office denied". [13] [29] According to Ernst, "The snake oil salesman story is an entirely separate issue", which "happened years later." He added, "It is true that Charles's office denied that Charles knew about his 1st private secretary writing to my Vice Chancellor asking him to investigate my alleged breach of confidence." Ernst claims that as Sir Michael Peat wrote his letter in his capacity as the Prince's private secretary, Ernst finds that "exceedingly hard to believe." [27]
Ernst's book, Charles, the Alternative Prince: An Unauthorised Biography, was published in February 2022. It focuses on Charles's interest in alternative medicine, with a critical assessment of his views. [30] In 2009, Ernst's name appeared on a list of supporters of Republic – an organisation which campaigns for the abolition of the British monarchy. [31] However, writing on his website in 2022, Ernst clarified his position: "Even though Charles did a sterling job in trying, I did not become a republican. I do have considerable doubts that Charles will be a good King (his reign might even be the end of the monarchy), and I did help the republican cause on several occasions but I never formally joined any such group (in general, I am not a joiner of parties, clubs or interest groups)." [27]
In a May 1995 Annals of Internal Medicine publication, Ernst detailed the Nazi "cleansing" of the University of Vienna medical faculty that allowed the "medical atrocities" of Nazi human experimentation. [32]
In 2001, Ernst sat on the Scientific Committee on Herbal Medicinal Products of the Irish Medicines Board. [33] In 2005, he was a member of the Medicines Commission of the British Medicines Control Agency (now part of the Medicines and Healthcare products Regulatory Agency) which determines which substances may be introduced and promoted as medicine. [34] In 2008, he was an external examiner for several university medical schools in several countries. [35] He is a Founding Member and on the Board of the Institute for Science in Medicine, formed in 2009. [3]
In February 2011, Ernst was elected as a Fellow of the Committee for Skeptical Inquiry. [36] He was editor-in-chief of the journal Focus on Alternative and Complementary Therapies which he founded in 1995 and which was discontinued in 2016. [37]
In 2015, Ernst was one of two recipients of the John Maddox Prize, sponsored jointly by Sense about Science and Nature , for courage in standing up for science. [38] [6]
Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability or evidence of effectiveness. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.
Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths or homeopathic physicians, believe that a substance that causes symptoms of a disease in healthy people can cure similar symptoms in sick people; this doctrine is called similia similibus curentur, or "like cures like". Homeopathic preparations are termed remedies and are made using homeopathic dilution. In this process, the selected substance is repeatedly diluted until the final product is chemically indistinguishable from the diluent. Often not even a single molecule of the original substance can be expected to remain in the product. Between each dilution homeopaths may hit and/or shake the product, claiming this makes the diluent "remember" the original substance after its removal. Practitioners claim that such preparations, upon oral intake, can treat or cure disease.
Magnetic therapy is a pseudoscientific alternative medicine practice involving the weak static magnetic field produced by a permanent magnet which is placed on the body. It is similar to the alternative medicine practice of electromagnetic therapy, which uses a magnetic field generated by an electrically powered device. Magnet therapy products may include wristbands, jewelry, blankets, and wraps that have magnets incorporated into them.
Reiki is a pseudoscientific form of energy healing, a type of alternative medicine originating in Japan. Reiki practitioners use a technique called palm healing or hands-on healing through which, according to practitioners, a "universal energy" is transferred through the palms of the practitioner to the patient, to encourage emotional or physical healing.
Allopathic medicine, or allopathy, is an archaic and derogatory label originally used by 19th-century homeopaths to describe heroic medicine, the precursor of modern evidence-based medicine. There are regional variations in usage of the term. In the United States, the term is sometimes used to contrast with osteopathic medicine, especially in the field of medical education. In India, the term is used to distinguish conventional modern medicine from Siddha medicine, Ayurveda, homeopathy, Unani and other alternative and traditional medicine traditions, especially when comparing treatments and drugs.
Reflexology, also known as zone therapy, is an alternative medical practice involving the application of pressure to specific points on the feet, ears, and hands. This is done using thumb, finger, and hand massage techniques without the use of oil or lotion. It is based on a pseudoscientific system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work on the feet and hands causes a physical change to the supposedly related areas of the body.
Craniosacral therapy (CST) or cranial osteopathy is a form of alternative medicine that uses gentle touch to feel non-existent rhythmic movements of the skull's bones and supposedly adjust the immovable joints of the skull to achieve a therapeutic result. CST is a pseudoscience and its practice has been characterized as quackery. It is based on fundamental misconceptions about the anatomy and physiology of the human skull and is promoted as a cure-all for a variety of health conditions.
Quackwatch is a United States-based website, self-described as a "network of people" founded by Stephen Barrett, which aims to "combat health-related frauds, myths, fads, fallacies, and misconduct" and to focus on "quackery-related information that is difficult or impossible to get elsewhere". Since 1996 it has operated the alternative medicine watchdog website quackwatch.org, which advises the public on unproven or ineffective alternative medical remedies. The site contains articles and other information criticizing many forms of alternative medicine.
Anthroposophic medicine is a form of alternative medicine based on pseudoscientific and occult notions. Devised in the 1920s by Rudolf Steiner (1861–1925) in conjunction with Ita Wegman (1876–1943), anthroposophical medicine draws on Steiner's spiritual philosophy, which he called anthroposophy. Practitioners employ a variety of treatment techniques based upon anthroposophic precepts, including massage, exercise, counselling, and administration of substances.
Energy medicine is a branch of alternative medicine based on a pseudo-scientific belief that healers can channel "healing energy" into a patient and effect positive results. The field is defined by shared beliefs and practices relating to mysticism and esotericism in the wider alternative medicine sphere rather than any sort of unified terminology, leading to terms such as energy healing or vibrational medicine being used as synonymous or alternative names. In most cases there is no empirically measurable energy involved: the term refers instead to so-called subtle energy. Practitioners may classify the practice as hands-on, hands-off, and distant where the patient and healer are in different locations. Many schools of energy healing exist using many names: for example, biofield energy healing, spiritual healing, contact healing, distant healing, therapeutic touch, Reiki or Qigong.
Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities in University College London (UCL), is a British surgical oncologist who specialises in breast cancer treatment. He is also known for his contributions to the evaluation and support of patient quality of life. He has been Professor of Surgery in King's College London, the Royal Marsden Hospital and UCL. He is a notable critic of alternative medicine.
The Prince's Foundation for Integrated Health (FIH) was a charity run by King Charles III founded in 1993. The foundation promoted complementary and alternative medicine, preferring to use the term "integrated health", and lobbied for its inclusion in the National Health Service. The charity closed in 2010 after allegations of fraud and money laundering led to the arrest of a former official.
Trick or Treatment? Alternative Medicine on Trial is a 2008 book by Simon Singh and Edzard Ernst. The book evaluates the scientific evidence for alternative medicines such as acupuncture, homeopathy, herbal medicine, and chiropractic, and briefly covers 36 other treatments. It finds that the scientific evidence for these alternative treatments is generally lacking. The authors concluded that homeopathy is merely a placebo.
The College of Medicine (CoM) is a United Kingdom-based organisation founded in October 2010 that grew out of The Prince's Foundation for Integrated Health after it was shut down due to accounting fraud. It is chaired by Michael Dixon, a former director of the Foundation. It promotes alternative medicine.
George Lewith was a professor at the University of Southampton researching alternative medicine and a practitioner of complementary medicine. He was a prominent and sometimes controversial advocate of complementary medicine in the UK.
Harmony: A New Way of Looking at Our World is a 2010 book written by Charles III, with Tony Juniper and Ian Skelly. The book focuses on the world's environment which includes climate change, architecture and agriculture. The book has been translated into many different languages. There is also a children's edition of Harmony.
The Friends of Science In Medicine (FSM) is an Australian association which supports evidence-based medicine and strongly opposes the promotion and practice of unsubstantiated therapies that lack a scientifically plausible rationale. They accomplish this by publicly raising their concerns either through direct correspondence or through media outlets. FSM was established in December 2011 by Loretta Marron, John Dwyer, Alastair MacLennan, Rob Morrison and Marcello Costa, a group of Australian biomedical scientists and clinical academics.
The Smallwood Report, officially entitled The Role of Complementary and Alternative Medicine in the NHS: An Investigation into the Potential Contribution of Mainstream Alternative Therapies to Healthcare in the UK, was a 2005 report promoting the use of so-called "alternative medicine" in Britain's taxpayer funded National Health Service, as a cost-effective and efficacious alternative to evidence-based medicine. The report was written by economist Christopher Smallwood, commissioned by Charles, Prince of Wales, and funded by disgraced Tory politician Dame Shirley Porter. The report recommended that a number of treatments be made available on the NHS, including acupuncture, homoeopathy, manipulation therapies and herbal remedies. Graeme Catto wrote the introduction. Smallwood is an economist with no background in healthcare.
Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon.
The infinitesimally low concentration of homeopathic preparations, which often lack even a single molecule of the diluted substance, has been the basis of questions about the effects of the preparations since the 19th century. Modern advocates of homeopathy have proposed a concept of "water memory", according to which water "remembers" the substances mixed in it, and transmits the effect of those substances when consumed. This concept is inconsistent with the current understanding of matter, and water memory has never been demonstrated to exist, in terms of any detectable effect, biological or otherwise.
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