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The tragic death of Steve Jobs may have added new urgency to Edzard Ernst’s work. In October 2003, when Jobs was diagnosed with pancreatic cancer, he turned not to conventional medicine but to acupuncture, macrobiotic diets and visits to a spiritualist, delaying surgery that he said some doctors, could have saved his life. About ten years before this diagnosis, Ernst, an award-winning doctor based in the United Kingdom, had begun building an evidence base for alternative therapies. Since then, Ernst has become the world’s first professor of complementary medicine at the Peninsula Medical School in Exeter, England, and founded two academic journals on the subject (Infusion And Focus on alternative and complementary therapies), and published more than 1,000 articles and more than 40 books (including the recent Trick or treat? Alternative medicine on trial).
So far, only five percent of Ernst’s alternative therapies have shown curative powers greater than those of a placebo. The death of Apple’s founder therefore seems like a good opportunity to reflect on the powerful appeal that alternative medicine has, even for the geniuses among us. “My first thought was: ‘How tragic’ and my second: ‘When are we going to learn our lesson?’ “, Ernst said. “People, even if they are intelligent, are too easily misled into doing the stupidest things, especially when the promotion of alternative medicine is as viciously effective as it is.” Indeed, Jobs was not the first VIP to use alternative medicine: Bob Marley, Peter Sellers and Steve McQueen were all enthusiastic supporters. And in this country, recent estimates estimate our out-of-pocket spending on alternative care providers at $5.6 billion.
So, according to Ernst, what do we need to know about this type of care? I caught up with him at Proof2011 to discuss the evidence base for alternative therapies.
Question : You said you were tired of being known as a charlatan. For what?
A: Charlatans, like alternative medicine enthusiasts, do their job to confirm their previous beliefs. They don’t even try to be objective. Scientists first test their hypotheses with an open mind and strive to be objective.
Question : So, what areas of alternative medicine are helpful or effective, according to your research?
A: By far the best evidence comes from herbal medicine. Some herbs, like St. John’s Wort, are both effective and safe if used correctly.
Question : If you had to choose, are there any particular claims that alternative medicine practitioners make that irritate you the most?
A: That their pet therapy somehow defies scientific scrutiny. A close second would be: “My ideas haven’t turned out to be wrong, so they might be correct.” »
Question : What are the direct risks associated with alternative medicine that people should consider?
A: Chiropractic manipulations of the neck can injure an artery that supplies blood to the brain. This can cause strokes or death.
Question : Can you give me an idea of the absolute or relative risks associated with complementary medicine?
A: The risks of alternative medicine are understudied and underestimated. There are approximately 700 serious complications after chiropractic treatment. We also know that underreporting is such that this figure could be an order of magnitude or two higher.
Question : Do you think regulating this industry would be helpful? If so, what type of regulation would you like to see?
A: Yes, regulation is essential. But it must be regulation consistent with accepted standards. Otherwise, regulation will only be a means of giving credit to people or products that do not deserve it.
Question : Have you checked if alternative medicines can lead patients to postpone their consultation conventional health professionals? If so, what are the dangers here?
A: Even homeopathic remedies, or other treatments that are pure placebos, can kill someone if used as an alternative to effective therapies. The most recent tragic example is that of Steve Jobs.
Question : Are there reliable, reliable references for patients who want to learn more about the risks or benefits of alternative therapies?
A: Because there is so much misinformation and so much unreliable information, we decided to write Trick or treat. I recommend it as an honest attempt to summarize the evidence.
Question : Many people use acupuncture, but high-profile studies show that sham acupuncture is just as effective as “real” acupuncture. What does this tell us?
A: This shows how important the placebo effect can be, especially if expectations are high. But we don’t need fake treatments to benefit from a placebo response. Any effective therapy also comes with a gratuitous placebo effect in addition to its specific therapeutic effects, as long as it is administered with compassion and empathy.
Question : Overall, your research shows that only five percent of the therapies you studied provided greater benefit than a placebo or suggests that further research may be warranted. How do evangelical users or practitioners of alternative medicine react to this discovery?
A: The 5 percent figure is based on the evidence we evaluated for our book Office Guide. To do this, we have pre-selected the most promising areas. The five percent figure is therefore a gross overestimate. Overall, the actual percentage is probably one dimension lower. Believers react with disbelief to such data. You cannot easily disprove a religion.
Question : What do you say to those who claim that conventional medicine kills more people than alternative medicine and that the latter is even more dangerous, and that we must therefore focus on this threat to public health?
A: I say it’s true but I’m missing the point. Treatments must be judged according to their benefit-risk balance. If a therapy causes harm but at the same time saves thousands of lives, it may be worth considering. Very few alternative medicines generate many benefits. This means that even small risks can significantly affect the risk-benefit balance.
Question : Any final message for consumers considering alternative medicine?
A: If it sounds too good to be true, it probably is.
