A scientist in the alternative camp

Geoff Watts talks to Edzard Ernst, holder of the only chair of complementary medicine in the United Kingdom, about his career

Edzard Ernst, who recently celebrated his first 10 years as occupant of Britain's only chair of complementary medicine, at Exeter University, lives with contradictions. A firm believer that his branch of medicine should be treated like any other, and scrutinised accordingly, he concedes that he may be robbing it of the sense of "otherness" that is one source of its appeal. He says he understands that but believes that scientific honesty is a higher imperative.

If medical techniques are to be classified simply on the basis of their efficacy--they work or they don't--why separate out one small batch under the heading "complementary"? Ernst points out that he didn't create the distinction. But he concedes that the very existence of his chair is reinforcing it. "This is true--to my regret. But I don't see any other way to make progress."

And progress he has made. According to his department's own summary of its past 10 years' work (Complementary Medicine: the Evidence So Far) his department has published some 800 peer reviewed papers, making it the field's most productive research unit. German born, Ernst had an orthodox medical training in Munich and worked in London for some time. Why the interest in complementary medicine? "Our family doctor in the little village outside Munich where I grew up was a homoeopath. My mother swore by it. As a kid I was treated homoeopathically. So this kind of medicine just came naturally. Even during my studies I pursued other things like massage therapy and acupuncture."

The history of non-orthodox medicine in continental Europe is unlike that in the United Kingdom, where the creation of the NHS excluded most of its techniques. In countries like Germany it seems to face much less conflict with science. "As a young doctor I had an appointment in a homoeopathic hospital, and I was very impressed with its success rate. My boss told me that much of this success came from discontinuing mainstream medication. This made a big impression on me."

Appointed to the chair of rehabilitation medicine in Vienna, he headed a department that included doctors practising massage, relaxation techniques, and spinal manipulation.

The chair he now occupies in Exeter was initially financed by a grant from the Maurice Laing Foundation, a charity created by the current head of the Laing building dynasty.

"He [Maurice Laing] offered to donate £1.5m to any university that would create a chair," Ernst explains. "Apparently the foundation had some trouble finding one willing to take up the offer." He laughs. "They didn't mind cigarette money, but complementary medicine was too hot!"

Exeter University eventually agreed; a chair was set up, and Ernst saw the advert. "I rushed to my atlas to find out where Exeter was," he recalls. He got the job.

At the core of his approach is rigorous science. This caused dismay to many practitioners. Ernst was puzzled. "It sounded to me so inoffensive that it was a huge surprise that people were up in arms. Some claimed that their individualised and holistic methods defy testing by randomised clinical trial. When I'm being polite I say this is based on a misunderstanding of what science is about. When I'm being less polite I say these people are mad."

The charity Health Watch exists to support the case for properly assessing medical techniques, conventional or otherwise. Its chairman, John Garrow, views Ernst's efforts with some sympathy. "The various studies were done, and a handful of alternative therapies seemed to be useful. But the thing that really put him in bad odour with the alternative therapists was that he reviewed the evidence on safety."

Complementary medicine has always made much of the claim that because its therapies are "natural" they're necessarily safe. This is not the case, and to Ernst, safety was a key issue. "Assumption is not good enough when we talk about safety. We need to demonstrate it. When I decided early on that safety would be a research issue for us, it created a lot of opposition."

The academic world's initial wariness about a chair in complementary medicine has largely evaporated. "Some doctors are condescending," says Ernst. "They give me a smile and say it's a waste of a good talent or it's not really worth investigating." But, with a few exceptions, he claims to have achieved acceptance from the orthodox medical establishment.

By contrast his relations with the complementary community remain troubled. "Virtually from the word go I've had problems with the complementary camp. Sometimes it subsides. But then as soon as we publish a negative result it flares up. We are champions so long as we produce positive results, but enemies when we produce negative ones." And many of the department's findings have, it must be said, proved negative.

His critics argue that he is too inflexible in his application of orthodox research methods; that most of his comments on complementary medicine seem unduly pessimistic; and that he should be using more subtle methods of assessing its effects. Above all he's charged with not recognising its uniqueness. But that is precisely his point.

When his chair was created, the complementary medicine community thought it was getting an advocate. Instead it got a detached analyst. It was disappointed. "Seriously disappointed," says Ernst. "At my first public meeting someone was even up in arms that a medic had got the job. But whatever complementary medicine is, and there's a lot of debate about definitions, it is medicine."

The complementary community's disappointment has had a predictable consequence: less than 10% of Ernst's research funds come from within it. "Proponents of complementary medicine see me as too critical," says Ernst. "There's also a lot of propaganda against me. There are ridiculous stories that we are funded by the pharmaceutical industry to ditch complementary medicine." Although he has not received grants from any mainstream drug company, he would do so if they came without strings. "Of course it would confirm the belief of some that I am on the other side of the fence, so to speak. But for me it wouldn't be a problem."

Geoff Watts freelance journalist


studentBMJ 2004;12:1-44 February ISSN 0966-6494