Critical evaluation of complementary and alternative medicine
Due to a reverence for scientific truth in an area of healthcare that is hazardously left uncontrolled, Professor Edzard Ernst left his position as chair of physical and rehabilitation medicine at the Medical Faculty of Vienna to become the world’s first chair in complementary and alternative medicine (CAM). That was in 1993; for 25 years he has been refuting pseudoscience and violation of medical ethics, raising awareness and encouraging action from the authorities, journalists, physicians and schools. He speaks to HealthManagement.org about his findings and the changes he believes are urgently needed.
Moving over to CAM research
You left your post as chair of physical and rehabilitation medicine at the Medical Faculty of the University of Vienna. Why were you convinced that there was enough medicinal value in complementary and alternative therapies to dedicate your working life to it?
You became the first and only professor of CAM in the UK. How did doctors and medical researchers respond to this? Are there many such professors of complementary medicine around the world?
How did CAM practitioners take it?
Performance of CAM therapies
Your research spans acupuncture to herbs to reflexology. In which area are you finding most evidence of positive performance?
In your reports on the efficacy of CAM treatments and therapies, you express that most of the findings are negative or inconclusive. What do you consider to be your most important findings since you moved your focus to CAM research?
Some herbal treatments are illegal in the UK, despite evidence of positive medicinal value. Kava kava proved effective in relieving anxiety, yet it was banned following some studies that linked it to liver damage (although mixed research data exists about its liver toxicity). Do you believe that authorities commonly address risks in isolation and neglect the efficacy side of some treatments?
Do you think that more research into CAM treatments could lead to healthcare system savings throughout the world?
You express that homeopathy as a treatment is scientifically implausible, yet in centres you’ve worked at, people have got better. What do you put this down to?
Do any randomised controlled trials (RCTs) for homeopathy treatment indicate its efficacy?
Do you think visiting a chiropractor is dangerous?
Do you believe recent literature has raised awareness of the dangers of chiropractic and that it can contribute more problems?
Research methods, analysis and clinical competence
Do you believe that your rigorous scrutiny of the
CAM field has reduced the amount of unethical research and unethical assertions taking place?
Are CAM researchers conducting more RCTs
and sticking to better protocol and ethical
Sorry, but I do not believe that there is rigorous scrutiny of the CAM field. Practitioners continue to do more or less what they want and violate medical ethics on a daily basis. Their collective research output is close to zero, and the few studies that do emerge tend to be of deplorable quality.
Do you think your publications, articles and interviews will encourage people to be more sceptical, educate them on how to choose a therapy, and make the most dangerous therapies commonly known in the mainstream?
On a good day, yes, I do hope my work has an effect. There is now a growing group of active sceptics in the UK. But when I see the amount of nonsense that is still out there, I sometimes despair.
Is there increasing literature on malpractice in alternative medicine?
No, by and large CAM practitioners continue to have a free ride. The UK Government seems to not care very much, and it is up to a relatively small group of highly motivated sceptics to try and prevent the worst.
What more could be done to educate the
About a million things! For starters, we urgently need better science education in schools. And then we require many more politicians to have a minimum understanding of science. Their ignorance is often frightening, in my view. The same sadly applies to many journalists.
What controls are in place to regulate clinical
competence in conducting CAM therapies?
Regulation is still very lax. Regulation should foremost protect consumers. However, in CAM it is mostly seen as giving practitioners a veneer of credibility.
What do you believe to be the gravest area of
malpractice in CAM?
Where to start? Perhaps the lack of proper informed consent is one of the gravest problems. It is almost completely missing in CAM which basically means that the current practice of CAM is unethical.