William T. Jarvis, who served as president of the National Council Against Health Fraud from its founding in 1984 through 1999 described Germany as “a mothering ground of quackery.” The herbalism of Paracelsus, magnetic healing, phrenology, homeopathy, aromatherapy, naturopathy, orgonomy, fresh cell therapy, electroacupuncture (“essentially transdermal electrical nerve stimulation masquerading as acupuncture”), anthroposophy, the Gerson cancer treatment protocol, and other ideologically-driven nonsense originated there. But Germany was also the mothering ground of one of the most influential opponents of quackery—and the most prominent opponent of the quackery-promoting efforts of Charles, Prince of Wales—during the last twenty years: Edzard Ernst.
As he described in his new book A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble (ISBN 978-1-84540-777-3), Ernst grew up in Bavaria, where healing cults such as hydrotherapy, homeopathy, and naturopathy were “as accepted and unremarkable…as lederhosen.” [p. 1] His mother was an enthusiast of such superstition as Sebastian Kneipp’s naturopathic preaching about the salubrious value of ice cold baths and walking through dewy grass or snow. Such an upbringing could predispose many people to be future allies of Prince Charles, but Ernst was inclined to rebel against dogmatic authority.
I have imagined that Ernst’s astonishingly productive record of scholarly and popular publications could be attributable to him having the luxury of a carefully charted career path that positioned him in consistently optimal work environments. But early on he was headed for a career as a jazz musician rather than as a medical researcher and, throughout most of his research career, he encountered—and often overcame— numerous obstacles to conducting scientific research.
His experience as a psychology student at University of Munich disappointed him. Instead of a curriculum emphasizing scientific discovery, he recalls exposure to postmodern concepts of truth, “a steady diet of speculation,” “Freud, graphology, and a weird type of physiology,” and classmates focused on “sorting out their own personal problems.” [p. 17.]
He describes his medical school experience as offering an overwhelming amount of knowledge to absorb for the benefit of future patients, but with little opportunity for critically analyzing the facts he was expected to learn and little opportunity to develop as a researcher. However, by completing an M.D. thesis on blood clotting abnormalities in women experiencing septic abortion, he gained research skills that he would apply later in his career.
On his first job following medical school, as junior doctor at Germany’s only homeopathic hospital, he practiced a range of so-called alternative therapies for which he would later provide evidence-based assessments. At the time, he recognized the implausibility of homeopathic preparations as therapy, but he observed that patients often got better with homeopathic treatment instead of nonsensical drugs they had been taking. This apparent paradox left him with questions he would try to answer in his future scientific investigations using proper controls for sources of bias.
After a distressing six-month stint working at a psychiatric hospital in the UK, he was hired to join a research team on blood rheology (the study of blood fluidity) at St. Georges Hospital in London. He writes that his roughly two years at St. Georges developing himself as a basic and applied research scientist with critical and analytic thinking skills was the happiest time of his life.
At his next position, a hospital near Munich, he expected that he would be able to continue his blood rheology research while also providing clinical services to patients with severe circulatory conditions. It turned out that the hospital was only interested in the image of being active in research and did not support his interest in conducting research in order to make important advancements in scientific knowledge.
He moved on to a university-based position in Munich emphasizing research with some clinical and teaching responsibilities. He completed his PhD, started the journal Perfusion, won an award for his research on naturopathic treatments on blood rheology, became a certified specialist in rehabilitation medicine, and began to investigate the egregious involvement of doctors and a medical journal he wrote for in experiments on concentration camp prisoners during the Third Reich.
As Professor of Rehabilitation Medicine at the Medical School of Hannover, his clinical responsibilities left little opportunity to continue his research. He moved on to the Vienna Medical School as the chair of Rehabilitation Medicine to lead the development of the largest department of its kind in Europe. He encountered corruption and enormous bureaucratic obstacles to moving his department into what was to be the largest hospital in Europe. Nevertheless, he managed to coordinate a large clinical service, conduct research on blood rheology, carry out clinical trials on some so-called alternative therapies, and found The European Journal of Physical Medicine. Most notably, he uncovered details of the shameful Nazi past of the Vienna Medical School. He considers his report of his findings published in the Annals of Internal Medicine to be the most important paper of his career.
After four years of enduring petty and sometimes vicious bureaucratic infighting among his colleagues in Vienna, he moved on to the University of Exeter as Laing Chair in Complementary Medicine, a position he held from 1993 to 2011. Ernst comes off as naïve in the book in his expressions of surprise about the intense resistance from so-called complementary and alternative medicine practitioners to his research agenda.
I say “so-called” because the buzzwords ‘complementary’ and ‘alternative’ are euphemisms used to misrepresent: (1) non-validated and invalidated health enhancement methods as worthwhile and (2) superstition-oriented practitioners as health experts. Not all quackery is promoted using the marketing doublespeak of ‘complementary’ and ‘alternative.’ (For example, the quackery of “John of God” and Ernest Angley is promoted without such language.) But when practitioners label themselves or their practices as ‘complementary,’ ‘alternative,’ ‘holistic,’ ‘integrative,’ ‘natural,’ etc., they engage in the popular semantics of quackery.
Just because a treatment is labeled complementary medicine does not mean it complements some other type of medicine to enhance health outcomes. (If all it is supposed to do is comfort patients rather than alter the course of illness and there is a plausible rationale for its use, it does not need to be labeled as if it is a special kind of palliative medicine.) And just because a treatment is labeled alternative medicine does not mean it is a viable alternative to a validated method for producing beneficial health outcomes.
Professor Ernst didn’t create the language for his title at Exeter so he can’t be blamed for taking a title that makes ‘complementary medicine’ seem like a bonafide field of medical specialty. The mission statement Professor Ernst wrote for his Department of Complementary Medicine should not have been controversial if ‘complementary and alternative medicine (CAM)’ practitioners are really concerned with accountability to consumers:
While I quibble with the term ‘complementary medicine’ and question the wisdom of carrying out efficacy research on supposed alternatives such as homeopathy of decidedly implausible value, Ernst’s mission was laudable for its focus on scientific advancement. But practitioners who position themselves in the Neverland of ‘CAM’ and their admirers tend not to welcome scrutiny of their activities. Professor Ernst realized only in hindsight that he was asking for trouble—even when he tried to be accommodating.
For example, he worked with ‘spiritual healers’ in planning a study to test their abilities to reduce chronic pain. Although they approved of the design of the study, they objected when Ernst published results showing no significant difference in pain levels following ‘spiritual healing’ versus sham healing rituals performed by actors.
‘CAM’ practitioners would have preferred if his research simply served to document patient satisfaction with ‘CAM.’ However, over the years his research team published well over a thousand papers including around 40 clinical trials, more than 300 systematic reviews. Findings were predominantly negative. He found far less of value than he had initially expected.
Ernst’s research team also investigated consumers’ motivations to use ‘alternative medicine,’ practitioners’ attitudes toward and knowledge of ‘alternative medicine,’ and advice given by ‘alternative’ practitioners regarding vaccination. As founder and editor-in-chief of the journal Focus on Alternative and Complementary Therapies, he became well acquainted with the work of other researchers and found little else in the literature indicating therapeutic value in the world of ‘CAM.’
I’m glad that A Scientist in Wonderland includes clear, concise refutations of common arguments and tactics used by Ernst’s hostile critics to defend ‘CAM’ methods despite the lack of validating evidence for them. ‘CAM’ proponents commonly: (1) fail to consider risks relative to benefits, (2) overrate their own expertise and denigrate the expertise of their critics, (3) question the integrity of those who disagree with them, (4) disregard rare, but serious risks [such as chiropractic neck twisting], (5) mistakenly equate “natural” with “safe,” (6) design studies to make positive outcomes unavoidable, (7) claim ‘CAM’ methods cannot be tested scientifically, (8) claim ‘CAM’ is especially compassionate, (9) claim to be victims of conspiracies, and (10) make fallacious appeals to popularity, post hoc reasoning [after this, therefore because of this], ignorance, and tradition.
Many readers will be most interested in A Scientist in Wonderland for its extensive discussions of quackery passionately promoted by Prince Charles. Ernst makes a persuasive case that he behaved ethically in calling “Complementary Healthcare: A Guide for Patients” published by the Prince’s Foundation for Integrated Medicine “frankly inaccurate and over-optimistically misleading” and in objecting to unfounded claims made in The Role of Complementary and Alternative Medicine in the NHS a report by retired economist Christopher Smallwood commissioned by the Prince.
Sir Michael Peat, the first private secretary of Prince Charles complained to the University of Exeter that Ernst broke a confidentiality agreement with Smallwood. Although an investigation cleared Ernst of wrongdoing, fundraising efforts to support Ernst’s Department of Complementary Medicine ceased, leading to the closure of the department and to Ernst’s retirement. However, Ernst has continued to write and speak out against quackery and for the need for promoters of health products and/or services to meet their moral obligation to be truthful, competent, and accountable.
The writing in A Scientist in Wonderland is clear and engaging. It combines good storytelling with important insights about medicine, science, and analytic thinking. Despite all the troubles Ernst encountered, I found his story to be inspirational. I enthusiastically recommend the book to scientists, health professionals, and laypersons who like to see nonsense and mendacity exposed to the light of reason.