Edzard Ernst and Herbal Remedies

In today’s Independent there is an opinion piece by Edzard Ernst, on the need for less opinion, at least as far as herbal remedies are concerned, specifically “Edzard Ernst: We need less opinion and more scientific research” on Thursday, 30 December 2010 (http://www.independent.co.uk/opinion/commentators/edzard-ernst-we-need-less-opinion-and-more-scientific-research-2171782.html).

Having read a great deal of Ernst’s work and writings, I came to the conclusion, some time ago, that in much of his field of supposed expertise, he is, more or less, completely clueless.

The comment I contributed to the discussion in the Independent is as follows:

Edzard Ernst is, regularly, ready to give his opinion, sometimes based on “science” from his point of view, even though much of that science is seriously flawed.

The description of my own Healing modality in “Trick or Treatment?”, the book he wrote with Simon Singh, contains double figures of errors on a single page. When I questioned Edzard Ernst about such matters on his own Blog on the “Pulse” website, he, essentially, ran away. As a so-called Professor of Complementary Medicine who professes to know about my modality, has supposedly researched it and pontificates on it, he turns and runs when asked questions by someone who knows the subject, has years of experience of it, plus half a century of involvement with science; a combination that is clearly too much for him.

I do not claim to know other parts of the CAM field in depth, unlike Edzard Ernst and the semi-instant expertise of Simon Singh who went from zero to an “expert” in about two years. In practice Singh has not a clue what he is talking about and Ernst is little better.

Unlike Ernst, Singh and many others, I do at least have an appreciation of the history, principles and thinking behind many CAM modalities as well as a strong science background. Applying science to them would be advantages in several ways. Unfortunately the science usually applied is often rubbish. Because he understands so little that even my non-scientific Healer colleagues could, immediately, see the flaws in his research. The supposed mechanism of placebo is related to the self healing abilities which are natural too us. Many non-mainstream methodologies, including spiritual healing, specifically encourage, apply, “set in motion” an individual’s self healing abilities. Hence, Edzard Ernst essentially proved that Spiritual Healing did not work because Spiritual Healing was not better than Spiritual Healing, or placebo did not work because placebo was not better than placebo. Ernst made the basic error of assuming that the procedure he chose to act as a placebo really was a placebo.

From what I have read of Ernst’s work, which is fairly extensive, I doubt that his expertise is much better in other areas, including that of herbal medicine.

How many other professors are utterly clueless about a significant subject in the field they claim to profess, particularly one on which they have pontificated and given strong opinions?

There are many fields of endeavour that depend heavily on experience, both on a personal basis and the “handed down” variety. That is certainly true of my own profession of engineering, which is less than 20% science in content. If we applied the evidence based approach in purely the science sense, as opposed to the generality of evidence, the world as we know it would not exist. There many are areas of engineering where “evidence based” in either the straight scientific sense, or “randomly controlled trial” sense is impractical, ridiculously expensive, or simply not there, not available, unattainable. That is the difference between living in the real world and inhabiting the amateurish theoretical scientific world of Edzard Ernst and his acolytes.

Similarly, there are many other matters in which handed down experience, group and/or society experience is valuable, including herbal traditions.

Besides, how come that from a health point of view, herbal remedies are to be considered not safe unless proven to be safe, whereas mobile ‘phones and similar are to be considered safe unless proven unsafe? Such inversions of the proof of safety are very common in our society and seem to have a strong correlation with vested interests.

Mainstream Science and Medicine, Complementary and Alternative Medicine, Legal Action and Double Standards from the Mainstream

In the 16th May Issue of New Scientist David Allen Green, otherwise known as Blogger Jack of Kent, wrote a piece entitled “Don't criticise or we'll sue” New Scientist 6th May 2009, page 24. Until the the British Chiropractors Association legal action against Simon Singh, I had not heard of much by way of legal action by Complementary and Alternative therapy practitioners, against any mainstream scientists, or anyone else, or vice versa. Even in the situation between the chiropractors and Simon Singh, the chiropractors gave an opportunity for the offending comments to be withdrawn, though that was declined, even though it would have made little difference to the thrust of the argument.

Everyone I know in the CAM field is somewhat bemused and, to some degree, amused by the general attitude of the mainstream people, both scientists and their “hangers on”. Their arrogance is, admittedly, an irritation, though the immaturity of their absolute certainty in themselves and their ways, as well as their juvenile language is, usually, met by indulgent smiles, gently shaking heads and wondering how long it will take them to grow up.

In the current issue of New Scientist (6th June 2009, page 26) there is a letter from Dr George Lewith, who also writes that, until the chiropractors' action against Simon Singh, he was unaware of any CAM people taking legal action against critics. On the other hand he has been on the receiving end of legal action from anti-CAM people. The was of no great surprise to me as the ant-CAM brigade, as George Lewith refers to them, as well as a vast swathes of mainstream scientists and their supporters are consistent in very few ways, though one of those ways is inconsistency. Another way is the obvious juvenility; I deliberately hold back from using the word “childish” for the simple reason that to so characterise the behaviour and attitudes of very many of the anti-CAM brigade and many other of the mainstream types, would be an insult to children. There is a similarity with children in the “running to mummy” syndrome that rapidly develops. While they are deriding and “bad mouthing” others everything is fine; as soon as someone hits back, “Wah!, That's not fair.” I think we have a long wait before they grow up.

I have reproduced George Lewith's letter below:

George Lewith,
Complementary and Integrative Medicine Research Unit
University of Southampton, U.K.

David Allen Green suggests that there is an increasing trend towards complementary and alternative medicine (CAM) practitioners threatening libel action against those who criticise them (16 May, p 24). I am unaware of anybody prior to the chiropractors he describes taking this course of action in the U.K.

Furthermore, as a medically qualified researcher of CAM, I have experienced two prominent members of the “anti-CAM brigade” attempting to take legal action against me, which I had to defend. It should be noted that the article you published on this matter is from a prominent member of the anti-CAM brigade.

Science, Knowledge and Noblesse Oblige

The matter of Simon Singh and the British Chiropractic Association rumbles on.

For some strange reason there are many who still try to characterise the situation as a freedom of speech issue. If there was absolute freedom anyone would be able to say what they wished to anyone else, do what they wished to anyone else, a complete free for all. It would also deny people freedom from unnecessary and undue harassment and harm. Usually, there is a balance with everyone being able to say and do as they wish, up to a point.

Simon Singh could easily have made his points on chiropractic procedures without using the word “bogus”. You do not have to be more than an average “word smith” to achieve that.

However, there is also a problem which many have overlooked. Just because someone is a scientist that does not make them sufficiently knowledgeable, generally able, or qualified to move into areas outside their own.

The first sentences of the Preface of “What is Life” by Erwin Schrödinger (Cambridge University Press Edition, page 1) reads as follows:

“A scientist is supposed to have a complete and thorough knowledge, at first hand, of some subjects and, therefore, is usually expected not to write on any topic of which he is not a master. This is regarded as a matter of noblesse oblige.”

Noblesse Oblige:
Literally “the obligation of honourable, generous, and responsible behaviour associated with high rank or birth “
Merriam Webster Dictionary

In practice the implication is that those who have inherited, or attained, a position with which comes wealth, power and prestige, also comes social responsibilities including a moral obligation to act with honour, kindliness and generosity.”

In this context and similar, a scientist should keep to the subject, or subjects, that he has mastered, tread very carefully if he ventures outside them and moderate his behaviour towards others.

A physicists going well outside his area or making strident assertions without proving those assertions hardly fits with those requirements on any count; not just the chiropractic matter but the repeated use of the word “lies” in the book “Trick or Treatment”, co-authored with Edzard Ernst.

Admittedly with Edzard Ernst it could be argued that he is not outside his area of expertise, or at least supposed expertise. However, his ways of delivering judgements tends to wards the strident, seeming to have become more unpleasant, and he is co-responsible for the repeated use of “lies” in the book. However, since he, along with Simon Singh does not know the definition of Spiritual Healing, or any idea of the “mechanism” and he carried out experiments on the subject that failed to rule out an obvious variable, one wonders how competent he is. To spend fifteen years as a Professor of Complementary Medicine and not know the definition of a major topic in the field, let alone make such basic errors in experiments, is a major achievement, albeit a perverse one.

Admittedly, Schrödinger goes on to write:

“For the present purpose I beg to renounce the noblesse, if any, and to be freed of the ensuing obligation. My excuse is as follows:”

… which I will leave any interested reader to follow up.

However, the point is that Schrödinger was well aware of his limitations and the dangers of stepping outside his field of knowledge and expertise. Not only that, when he did so Schrödinger progressed with extreme care, a tightly argued and carefully structured approach, and always conscious of his limitations.

Contrast that with the approach of Simon Singh and, is his own particular way, Edzard Ernst; neither of them are remotely in the same league as Schrödinger. Their approach to science and evidence, let alone analysis is nowhere near that level.

Simon Singh, the British Chiropractic Association and the High Court Ruling by Sir David Eady

Over the last day or two, reports have appeared on the Internet about the High Court Ruling on the legal action taken against Simon Singh by the British Chiropractic Association by the Judge, Sir David Eady.

As usual, one of the most comprehensive descriptions and assessments in on Jack of Kent's Blog.

The passage in Singh's original article which caused most difficulty is:

“The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”

The judgement revolved around ruling whether the passage was a “comment” or “statement of fact”, Singh's lawyers arguing the former and the BCA's lawyers arguing the latter.

The Judge ruled that, although the passage in Singh's article was a comment piece and published on a comment page, it was a statement of fact.

Jack of Kent writes that this ruling did not even refer to the fact that Singh's use of the word bogus is actually set out in the following paragraph in the original article:

“I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world's first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects he examined the evidence of 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.”

That is fair enough, if it is fully substantiated, though would still be better couched in less emotional terms, science is supposed to be objective after all. However, not finding evidence that chiropractors could treat such conditions is not proof of anything other than that inability to find evidence; it might suggest something else, it may be possible to tentatively infer something else, but it is not proof of anything else. It is certainly not proof of the treatments being bogus; they may be, they may not be but no evidence was brought to bear to prove that they were bogus.

In any case, I have read and wrote a review of Singh and Ernst's book, “Trick or Treatment” and it is certainly not a good science book; a populist book but not science book, certainly not in the textbook sense. Although, of course, many of Singh and Ernst's supporters laud it as science as it confirms their prejudices. “Trick or Treatment” contains no references and an extremely limited bibliography, while I would expect a book of science to have at least references, preferably references and bibliography; science is about providing evidence, after all, or at least it is supposed to be. “Trick or Treatment” is peppered with the word “lies”, in the “untruths”, “falsehoods” sense of the word, though I did not come across any proof that anyone was telling lies. The book has only one page on the knowledge, area, of “Spiritual Healing” and makes numerous errors in just a few hundred words, displaying a complete lack of understanding of the subject, wrongly describing the procedures involved and failing to give an accurate definitions of Spiritual Healing, quite an achievement for supposedly competent sceintists, let alone Ernst who has specialised as a Professor in a field that includes Spiritual Healing for fifteen years. I reviewed the Spiritual Healing section of “Trick or Treatment” separately as I practice it and, clearly, know more about it that either Ernst or Singh.

Then there is the matter of definitions. Although, as Jack of Kent wrote, the ruling did not refer to Singh's use of the word bogus being set out in another paragraph of his article, there seems no pressing reason that it should need to do so. Surely an intelligent man and experienced writer like Simon Singh is aware of language and tat it is wise to check definitions. There seems little point in having a language and dictionaries if anyone who wishes to can simply come up with their own definition. I am probably too pedantic but I tend to write on my word processor with dictionaries to hand, both usual and technical, with several browser windows open to check definitions, references, etc. No-one is perfect but it does reduce errors somewhat.

Bogus: counterfeit, not genuine, spurious
Merriam Webster Online Dictionary

Bogus:
1. An apparatus for counterfeit coining
2. adj. Counterfeit, spurious, sham 1852
The Shorter Oxford English Dictionary

The statement made by Simon Singh seemed fairly definitive and the way I was brought up to learn and practice science, along with engineering, which uses science at times, as well as life in general, if you make a definitive statement you provide the evidence to back it up, or have the evidence to hand if asked for it. If there is not enough evidence to make a definitive statement, you make a qualified statement commensurate with the strength, weight and reliability of the evidence.

It is a matter of thoroughness, completeness and precision which seems to have gone out of science in recent years, decades, even to be replaced by a juvenile howling down and name calling. Never mind the quality of the evidence, if any at all for their positions, feel the juvenile bile and weight of numbers.

“Trick or Treatment” comes over as very much in that vein. So, recent utterings and writings by both Simon Singh and Edzard Ernst being even stronger in that sense have come as no great surprise.

It is not just the language that is juvenile, much, most, of the so-called science brought to bear is of a similar level.