When Dr Ben Goldacre recently voiced concerns in the British Medical Journal about drug companies ‘engineering’ drug trials, resulting in what he called “bad evidence, which distorts medical decision-making, and harms patients”, we only have to look at the Champix fiasco to see how true that is. But that is not the only type of ‘trial engineering’ that has been going on in the last couple of decades… is it, Professor Ernst?

Folks, if you bought the official cover story, The University of Exeter’s Professor of Complementary Medicine has been toiling away for the last seventeen years to discover ‘the truth’ about CAM therapies. This work was allegedly paid for by a £1.5 million grant from The Maurice Laing Foundation, established from the wealth of the Laing building firm.

Now, here’s a funny thing. Well, to be more accurate, here are a number of distinctly funny things:

Funny Thing No.1

There is no obvious connection between the Laing Foundation, a.k.a. the Rufford Maurice Laing Foundation, and complementary medicine, except what has been told to the newspapers that covered the story at various intervals. Where did they get that information - investigative journalism? No, press releases from the Ernst camp, where else would it come from. A grant of £1,500,000 is a very large amount of money, an extremely generous donation from a charitable foundation which would suggest a seriously deep commitment to health matters of a complementary nature. Yet if you visit the website of The Rufford Maurice Laing Foundation, you will find no mention of it anywhere. Have a look!

Funny Thing No.2

Not only that, but the whole Maurice Laing Foundation website is evidently about nature conservation projects, mainly overseas. If you want to apply for a grant for something like that, there is a facility for doing so, but no other contact details. No email address. No general ‘Contact Us’ facility. No postal address. So why the anonymity? What if you just wanted to ask them about something - what are you supposed to do?

Potential applicants are told to expect that funding for new projects would be “normally of up to £5000″. The difference between that modest sum and the vast amount of money that we are told was initially pledged to establish the Laing Chair occupied by Ernst is striking, to say the least! Also, this is an astonishingly basic website for an organisation which we are told could afford to give away two million quid to a single project. It reminds me of the old TV testcard, or a sign on a door that says “Back Later”. Hastily thrown together or what? Hope they didn’t pay much for that job! Obviously it’s not just some kind of front, because when people do that they usually take the trouble to make it look convincing. So I think it’s genuine, I really do…

Funny Thing No.3

Although the reference to Maurice Laing is made over and over again, his is the only name that has ever been linked to this project when it comes to funding. Clearly some other money has been involved during the last seventeen years, so why have we not been kept informed about that? There is brief mention in Sarah Boseley’s article of the unit submitting lots of other grant applications - more than 200 - but according to the article, only “roughly 1 in 20 is funded” and Boseley reports that Ernst’s “biggest frustration is over the lack of funding for the research he wants to do.”

There is a pretty obvious gap between this tale of woe, and the fact that Ernst has been able to not only keep going but expand and take on more researchers…. who is paying for all this really? Who is paying for it NOW, now that they can no longer claim it is an incredibly philanthropic CAM supporter?

Funny Thing No.4

During the course of the first ten years to 2003, Ernst published 700 or so papers, all of which suggested that complementary medicine was of no use, or only very limited use. The suggestion made over and over again was that any positive results were really down to the placebo effect - in other words, belief and expectation, little more than that.

The constant repetition of these published ‘findings’ has encouraged the use of the term “faith-based medicines” as distinct from “evidence-based medicines” - conveniently ignoring the problems to which Dr Goldacre refers - and the project seems to be to drill that simplistic message into the minds of an unsuspecting public over a long period.

Naturally, since a quarter of the population use CAM therapies it would be plain stupid to just claim that they “don’t work”, so what better approach than to damn them with very faint praise in a drip, drip series of literally hundreds of publications whilst whispering “placebo, placebo” - a mantra picked up by every well-meaning ‘armchair scientist’ who knows nothing at all about CAM therapies in practice and has no idea he/she is being cynically manipulated, as is the media.

Why should I suspect that? Well, for a kick off there is Funny Thing No.5: We are actually expected to believe that after funding ten years of this ‘research’, which certainly didn’t find anything in Complementary Medicine to get excited about, The Maurice Laing Foundation mysteriously decided that £1,500,000 wasn’t enough, and they ought to pay for another three years of this exercise, during which hundreds more publications would add to the weight of the ‘evidence’ that they weren’t going to find out anything very exciting! Ernst has suggested in the media that this indicated a particularly admirable quality in Maurice Laing, when in reality it is simply hard to believe, because a charitable foundation which now warns applicants to expect no more than £5000 for any project would surely have concluded that another half a million after ten years of disappointing findings - if indeed that’s what Laing and Ernst thought the publications were - would surely seem to any sane person like throwing good money after bad! And really, how gullible do Ernst supporters have to be to simply accept that without raising an eyebrow? This leads us straight on to:

Funny Thing No.6

On the strength of these ‘findings’, Edzard Ernst was one of those notorious 13 ‘eminent’ professors who signed the open letter by Professor Michael Baum in 2006 calling for NHS funding for Complementary Medicines to be withdrawn. So at the same time that Ernst was suggesting that public money shouldn’t be ‘wasted’ on these therapies, based on his publications over a decade, the Maurice Laing Foundation apparently decided exactly the opposite, based on the same findings! Funny how Ernst didn’t object to that!

Yeah, strange, that is. He might have been considerate enough to say to them: “Look, guys - I know you mean well, but as we’ve just been explaining to the public and the NHS you really are flogging a dead horse! Fact is, you’ve pretty much wasted £1,500,000 and it turns out sugar pills are just as good, so seeing as how you’ve got all these other nature conservation applications coming in, I really should give you the same advice we gave the government: spend your resources more wisely!

No, he took the cash.

Funny Thing No.7

Still, that extended funding would have run out in 2006, wouldn’t it? And Ernst is still going strong. Seventeen years. According to Wikipedia’s summary of his work:

“He has said that about 5 percent of alternative medicine is backed by evidence,[5] with the remainder being either insufficiently studied or backed by evidence showing lack of efficacy.”

So either the Laing Foundation have coughed up another few million to perpetuate this pointless exercise indefinitely (seriously doubtful - why would they? And anyway, we’d have been told for sure, right?), or some other major players have been helping all this along right from the start - but we aren’t being told who any of them are.

Question: Who applied to the Maurice Laing Foundation for the original funding? Was it Ernst? If it wasn’t, then who was it? How was Ernst selected? Were there any other candidates? He states in the Boseley article that after ten years in the post: “I know what I’m talking about, whereas 10 years ago, to be frank, it was more of a hobby-horse”.

WHAT? You accepted responsibility for private funding of £1,500,000 and it was just a “hobby-horse”? What numbskull selected HIM for that post? It’s not as if he was familiar with ANY of those disciplines except homeopathy, and no great expert in that. Part of the original cover story that sought to make him sound impartial (HA!) was that he uses homeopathy on his wife, the explanation being; “We were brought up on it”! Ernst, I was brought up going to Sunday School… I don’t still go. The truth is this man had no real qualifications for this post at all, and the only reason he has so many supporters is because he is publishing exactly what all those people want to hear. But that doesn’t make it true.

Trial by Engineering

Which brings us back to Dr Ben Goldacre, who has been very vocal in dismissing CAM therapies in the media, probably influenced in no small degree by the last seventeen years of publications from Ernst, who is now not only the U.K.’s first Professor AGAINST Complementary Medicine at the University of Exeter but also director of complementary medicine of the Peninsula Medical School (PMS) since 2002. We are not told who funds that post.

Dr Goldacre must have been irritated to have his legitimate concerns simply dismissed in the BMJ by one Vincent Lawton, “a healthcare consultant and non-executive director at the Medicines and Healthcare Products Regulatory Agency (MHRA) in London”, who suggested that his concerns really related to past issues, and everything was all right now. Since Goldacre’s description of the current system was that it is “dangerous and absurd”, clearly they cannot both be right.

What Dr Goldacre may not realise is that the practice of engineering trials to produce the ‘results’ you want to arrive at is not limited to the shady practice of drug companies themselves. How many of Ernst’s ‘findings’ have been produced by the sharp practice of ’selective systematic reviews’? This is not new research - which Ernst has suggested was impossible due to “lack of funding”, Ha Ha! Nice one, Ernst! - but the cynical practice of sifting through old research to filter out all studies that show exciting (or just good) results, and selecting all the ones that didn’t, which you then publish. To the uninitiated, this looks for all the world like ’scientific proof’ that CAM therapies are pretty useless overall, but as I said before, to make this seem broadly credible you have to include some minor examples of success here or there - a price worth paying in the overall project of hoodwinking the media and the public at large.

So when Ernst suggested that hypnotherapy was of some limited use as a treatment for anxiety, and also pain relief, but no good for smoking cessation - that’s when I realised that Ernst certainly does not know what he’s talking about, because I’ve spent most of the last ten years helping thousands of smokers quit with hypnotherapy, usually in one session. And HE’S supposed to be the expert?

No surprise, then, to note that Ernst is also a member of the Healthcare Products Regulatory Agency (MHRA), just like the bloke who blithely dismissed Dr Goldacre’s very real concerns.

Wonder how Ben feels about that? Maybe he thought for a moment that if you raise fair points about unscientific practices which risk harm to the public he would get a fair hearing? No, he got slapped down and he seems to have dropped it now, which makes us wonder if someone has had a quiet word, because they don’t like troublemakers and whistleblowers in the medical profession. They don’t give a shit if you’re right.

And as for Ernst - drop the bogus Tales Told in the Media about how you came to find yourself in the Laing Chair, and tell us who is REALLY paying for this enormously expensive, apparently endless operation to manufacture and spread misinformation about complementary medicine?

Let’s set Ben and Ernst a little test, see how they respond. Ernst demanded that Boots the Chemist stop selling homoeopathy remedies because his publications suggested it doesn’t work any better than placebo. Now that we know from the University of Iowa study and others that the success rate for willpower alone is about 6%, and from the Borland report that the NHS Services long term (1 year) results are also about 6% will Ernst and Ben Goldacre now join the Truth Will Out Campaign in calling for Boots the Chemist to stop selling that as well, unless they label it clearly as being no more effective than a placebo? If so, my faith in their integrity will be restored - which would genuinely please me, actually - but if they find some way to wriggle out of that simple test of their real motives, their position will be revealed as exclusive CAM-bashing, NOT having the best interests of the public at heart at all. And before some dim spark suggests it is not Ernst’s job to do that…. actually it IS, because he is also a member of the Medicines and Healthcare Products Regulatory Agency (MHRA) - a fact strangely omitted from the original cover story - funny how he never called for Prozac to be withdrawn, or Champix the Suicide Pill - no, the dangers all lie in the evil world of acupuncture and chiropractic.

Now that the Laing money has run out, should it still be the Laing Chair? One of the comments I thought was interesting was when Ernst suggested in the media that “no-one wanted to touch that funding” until the University of Exeter accepted it, supposedly because the subject of study was CAM therapies. He said: “It was hotter than cigarette money”. Was it? Actually Ernst, the reason people got edgy about tobacco money was because it came from tobacco companies, which was latterly regarded as ‘dirty money’. But you said the money came from a charitable organisation set up by a family who made their money in building. Why on earth would that be regarded as “hotter than cigarette money”?

Unless of course it really came from somewhere else, and Ernst made a little Freudian slip there…

Thanks to my new friends at Bad Science blog for helping me to edit this post and make it more accurate. We’ll get to the truth in the end.

Filed under: Champix/Chantix, Drugs on Trial, Publicity, The Campaign by Chris