KEY POINTS

1. The Economist wrote a high-profile article on natural healthcare, attributing virtually all positive results to the placebo effect
2. It relied on a single source for its data: Professor Edzard Ernst
3. Professor Ernst’s objectivity and reliability are highly questionable
4. His views on herbal medicine are shown to be similarly biased

Take statistics from a single, highly biased and unreliable source, mix it in with some baseless assumptions about alternative healthcare and top it all off with the ultimate bastion of neoliberal capitalism and what have you got? The Economist’s recent piece on natural medicine, later picked up by CNN.

The premise of the article is that, “Alternative medicine is big business”, worth around $60 billion, but that there is barely a shred of evidence to back any of it up. A highly industrious group of workers has examined the evidence in over 160 meta-analyses, which have shown conclusively that around 95% of treatments are no better than placebo.  The key sentence in the whole thing is this one: “Unlike their conventional counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect”. By this point, the intention of the article is clear: to create the impression that alternative medicine only works because of the poorly understood placebo effect. All natural or alternative medicine, with the possible exception of one or two herbs such as St John’s wort for depression, is kidology, of no use in and of itself beyond the ritual of the consultation.

The power of placebo

We have no quibble with the power of the placebo effect, and neither do we deny that it is poorly understood. Research into using the placebo effect in clinical practice, such as a recent study published in PLoS One into the use of placebo for irritable bowel syndrome, is fascinating and should be heeded by all practitioners, alternative or otherwise. What we do object to is the extremely shoddy journalism on display!

The Economist should be embarrassed

Pretty much the first rule of good journalism is, “Don’t rely on a single source”. Even disregarding journalistic do’s and don’ts, common sense dictates that, occasionally, sources can get their facts wrong, whether deliberately or not. But here, in the widely respected business community magazine, The Economist, read by many thousands of movers and shakers worldwide, we find that all of the statistics on alternative medicine used in the piece come from a single source. And who is this august sage, this font of all knowledge as regards natural healthcare? Why, it’s our old friend, Professor Edzard Ernst!

Ernst recently announced his retirement as Director of the Complementary Medicine Research Group at the Peninsula School of Medicine and Dentistry, part of the Universities of Exeter and Plymouth, after the university pulled his funding. His fans shouldn’t worry, though, because when he does retire after finding a successor, he will become, “Outspoken about quackery and charlatans.  I look forward to that.  Hopefully, UK libel law has [sic] changed by then." How can a man who eagerly anticipates the day when he can legally defame people to a level currently considered libellous be taken seriously as an unbiased source of information?

Make your mind up, Professor!

On a scientific level, as well, Ernst is hardly as objective about natural medicine as he likes to pretend. As the Economist article makes clear, his group specialises in meta-analyses of original studies of natural modalities. One of the most famous came to the conclusion that there is no evidence that individualised herbal medicine is effective in any indication (Guo R et al. Postgrad Med J 2007;83:633–637) – but only after rejecting all but 3 studies for his analysis, out of a total of 1345 originally identified! Is this science? Or is it reductionist dogma being used to create a false body of pseudo-academic work, which can then be drawn upon by skeptics and other enemies of natural healthcare as the need arises?

Oddly enough, Ernst is on record as saying that 53% of the alternative modalities he has studied gave positive results! A bit different from the 95% negative figure he uses in the Economist piece. So which is it, Edzard?

It’s always worth pointing out in these debates that most of orthodox medicine would also be rendered invalid if subjected to Ernst’s beloved methods. Remember, only 11% of around 3000 treatments are considered ‘beneficial’ according to the British Medical Journal’s Clinical Evidence project – and while these 3000 do include some alternative therapies, the majority are undoubtedly of the orthodox variety.

Ernst on herbal medicine

Ernst popped up again earlier in the year, writing a piece entitled The difference between herbal medicines, and herbalists for the general practitioners’ magazine, Pulse. In this case, the appropriate emotion would be anger on the part of doctors at being so blatantly deceived and patronised, rather than the magazine’s embarrassment. “The totality of the published evidence fails to show that [individualised herbal medicine] is effective or safe”, he proclaims, referencing his statement with the ridiculous study discussed above. Again, the only herbal treatment quoted as worthwhile by Ernst is St John‘s wort for depression. Thousands of years of practice of and experience with herbal medicine are dismissed as, “Obsolete notions straight from the dark age…[using] tailor-made mixture[s] of several herbs based on pre-scientific assumptions of health and disease”. All herbalists using the ancient and traditionally proven energetic and holistic systems, such as the Ayurvedic doshas or Chinese elements, to prescribe are wasting their time, and all traditional uses of herbs are fictions of the imagination! Only Ernst’s narrow interpretation of evidence-based medicine means anything.

To top off a truly terrible piece, written as though for ignorant 10-year-olds rather than highly trained professionals, he slanders all UK herbalists as, “Spend[ing] their funds on lobbying and spinning the evidence” instead of setting up clinical trials of their treatments. That’s on top of the 1342 trials jettisoned by Ernst from his meta-analysis, presumably. Interestingly, Ernst used exactly this language right at the start of 2011 in his piece accompanying the UK Independent newspaper’s front-page story about the THMPD, which we criticised at the time. As they say, particularly in the world of propaganda, repetition sells!

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