The Trials of Edzard Ernst
Show me a hundred different scientific studies into the efficacy (or lack thereof) of any kind of therapy. Will they all produce more or less the same findings? No. But why not? If the RCT is the gold standard of assessment, surely it will just come up with truth, will it not? Isn’t this the reason that Ernst says “Don’t shoot the messenger!” as if he didn’t play any personal role in producing those finding whatsoever, and his followers will point to his publications and say: “The science says…”
Almost as if “the science” just does itself, and Ernst’s role is rather like that of the sorcerer’s apprentice: once he has set it in motion he has no influence over the process or the outcomes…
And indeed this would be the case with all scientists, would it not? It’s just pure science, and it simply reveals pure truth. That’s the idea, that’s the suggestion whenever we have one study or another shoved under our noses by the cynics. So if the cynics were right about CAM therapists - that we’re all just quacks - then all the scientific studies that have already been done (not just Ernst’s activities) would have demonstrated this beyond all doubt, would they not? What would there be left to say? Why bother paying him any longer?
Back in the Real World
Of course the cynics are not suggesting that ALL scientific studies are just revealing pure truth! How could they be, when some of them produce ‘findings’ that seem to confirm their prejudices, and some do not! Clearly they cannot ALL be right! So it becomes necessary to find crucial errors in the way some of those studies were designed or conducted, or the interpretation of the results…
“Really? That can happen in Science?”
“Oh yes, but don’t worry! Don’t lose your faith in the RCT and the Scientific Way! If the results aren’t what we want them to be, clearly we need to do the Science differently until we get the results right!”
For how likely is it, really, that the cynic’s PREJUDICES might be wrong in the first place? Exactly, that couldn’t happen, because a cynic knows everything already and most especially knows for sure that anyone who doesn’t agree with them is wrong. So there is never any need to question The Science That Says The Right Thing (bless the messenger), only the Bad Science That Says The Wrong Thing (denounce the author, attack the methodology, the interpretation… call people nasty names…) yeah that’s way more scientific. In fact the entire history of Science is full of that sort of abusive slanging match… and that’s just how scientists talk to each other, they have even less regard for people who are prepared to think outside of scientific paradigms. Those are just Voodoo People, and should probably be burned or something.
Science says Nothing
“The Science” says nothing, mainly because there is no such thing as “The Science”. This doesn’t make science useless, of course it doesn’t. But it does mean that with any kind of study you read about in The Daily Rag, if you don’t know who funded it, what they are trying to achieve and whether this is part of a wider programme which hasn’t been mentioned deliberately in the press release or whether there were other trials which the authors of the press release decided not to tell The Daily Rag about because they contradict the trials that Say The Right Thing… then you only know what the press release says.
All the questions I raised about Ernst, and how on Earth he ever came to occupy that position are perfectly valid, but I know we’ll never get answers that haven’t just come from a fawning interview with an adoring hack or some dodgy press release that came from the Ernst camp anyway. And I really can’t be bothered to exchange another pointless word with the cynics who don’t even understand the difference between skepticism and cynicism. It is impossible to communicate in any useful way with any person who has convinced themselves before the conversation even starts that you must be a fraud, a fantasist or an idiot because you don’t already agree with them.
So I thought I’d do one last post about the boring old duffer but every time I considered it, it just seemed like a chore. Somewhere along the line I realised that although I found it very annoying at first that he said things about hypnotherapy that were totally wrong, he’s really just another dull academic who knows nothing about it. The fact that someone decided he could have a title that makes it sound like he’s knowledgable is irrelevant, he remains a nobody in the field of complementary therapy, his own university don’t even seem to like him, just about everything he says is negative and no ordinary member of the public I’ve ever mentioned him to has heard of him at all, so although he’s beloved by a few hacks and a small platoon of cynics, the rest of the world could not give a toss.
Therefore: neither do I.
Filed under: Drugs on Trial, The Campaign by Chris
The placebo effect forms the foundation of EBM. Yet the concept of a placebo effect when studied objectlvely is of dubious value. When will Ernst et al. turn the microscope around and examine EBM?
1. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003974.
Placebo interventions for all clinical conditions.
Hróbjartsson A, Gøtzsche PC.
The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen,
Denmark, 2100.
BACKGROUND: Placebo interventions are often claimed to substantially improve patient-reported and observer-reported outcomes in many clinical conditions, but most reports on effects of placebos are based on studies that have not randomised
patients to placebo or no treatment. Two previous versions of this review from 2001 and 2004 found that placebo interventions in general did not have clinically
important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials
have been published. OBJECTIVES: Our primary aims were to assess the effect of placebo interventions in general across all clinical conditions, and to
investigate the effects of placebo interventions on specific clinical conditions. Our secondary aims were to assess whether the effect of placebo treatments
differed for patient-reported and observer-reported outcomes, and to explore other reasons for variations in effect. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4,
2007), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), PsycINFO (1887
to March 2008) and Biological Abstracts (1986 to March 2008). We contacted experts on placebo research, and read references in the included trials.
SELECTION CRITERIA: We included randomised placebo trials with a no-treatment control group investigating any health problem. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted
study authors for additional information. Trials with binary data were summarised using relative risk (a value of less than 1 indicates a beneficial effect of
placebo), and trials with continuous outcomes were summarised using standardised mean difference (a negative value indicates a beneficial effect of placebo). MAIN RESULTS: Outcome data were available in 202 out of 234 included trials, investigating 60 clinical conditions. We regarded the risk of bias as low in only
16 trials (8%), five of which had binary outcomes.In 44 studies with binary outcomes (6041 patients), there was moderate heterogeneity (P < 0.001; I(2) 45%)
but no clear difference in effects between small and large trials (symmetrical funnel plot). The overall pooled effect of placebo was a relative risk of 0.93
(95% confidence interval (CI) 0.88 to 0.99). The pooled relative risk for patient-reported outcomes was 0.93 (95% CI 0.86 to 1.00) and for observer-reported outcomes 0.93 (95% CI 0.85 to 1.02). We found no statistically significant effect of placebo interventions in four clinical conditions that had been investigated in three trials or more: pain, nausea, smoking, and depression, but confidence intervals were wide. The effect on pain varied considerably, even among trials with low risk of bias.In 158 trials with continuous outcomes (10,525 patients), there was moderate heterogeneity (P >>CONCLUSIONS: We did not find that placebo interventions have important clinical effects in general.
However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea,
>>>though it is difficult to distinguish patient-reported effects of placebo from biased reporting.
The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
Welcome George, and thanks for that!
In fact, this is a useful example of what I’m talking about: the problem of people who know nothing much about the Subconscious mind - such as Edzard Ernst and the Cochrane Group - investigating matters entirely pertaining to the operations of the Subconscious mind.
All experts in the field of hypnotherapy (that doesn’t include Ernst, who certainly isn’t) will know that the pain system is controlled by the Subconscious and that pain can be reduced, relocated or switched off through standard hypnotic procedures that were already being used in surgery in the modern world as early as 1820. Nausea can have various causes but is in fact a reaction that I have personal experience of removing through hypnotherapy as an effective preparation for chemotherapy AND in the case detailed on my practice website of the ‘travel sickness’ caused by tilting trains (see second post down, “What might be holding YOU back?”). The elimination of these reactions proves that they are not simply a direct result of the chemotherapy or the tilting trains themselves, but the Subconscious mind’s REACTIONS to those experiences caused by the uncertainty of the Subconscious as to whether those things pose a threat. Appropriate reassurances to the conscious mind alone make no difference (same with phobic reactions) but appropriate reassurances presented to the Subconscious mind eliminate the reactions at once. Would a scientist with no hypnotherapy experience know how best to present such appropriate reassurances to a person’s Subconscious mind? Would Edzard Ernst? Would he know how to spot a scientific trial where that was being done inappropriately and therefore very unlikely to change anything? I would. You see? This is why training and experience matter so much.
Smoking is a compulsive habit entirely controlled by the Subconscious mind… and I have shut down thousands of those habits over the last decade with hypnotherapy… and depression is an emotional state, so that too falls within the Subconscious domain, as do all emotions and emotional reactions.
Question: what is a placebo effect? Answer: a positive reaction to a treatment modality that doesn’t involve an independently active agent (such as a drug). What are we left with? The reaction of the patient themselves. Since all those ‘clinical’ conditions (what does ‘clinical’ really mean in that context, anyway? Why is a smoking habit a ‘clinical condition’?) …are controlled by the mind, any number of different reactions or non-reactions are possible, both in hypnotherapy and as a placebo effect.
This does NOT mean that the results of hypnotherapy are nothing more than the kind of placebo effect normally to be expected in scientific investigations, because the placebo effect is really a very mild form of hypnotherapy ie. a positive reaction to suggestion. I call this “a very mild form of hypnotherapy” because in generalised situations like the scientific trial designed to measure the effectiveness of something else against the background of random individual ‘placebo’ reactions, it is vague, unfocussed, misunderstood and totally lacking in any kind of real verve or ambition, so we should not be at all surprised to see placebo effects (reactions) that range from amazing but inconsistent… to mild but not much out of the ordinary - which would pretty much sum up the expectations scientists have regarding the placebo ‘phenomenon’.
Get together a handful of really top hypnotherapists in private practice who specialise in treating those ‘clinical’ conditions and the results will be nothing short of spectacular, except perhaps with regard to the depression cases.
Any of you scientists know why there should be a difference with depression? And would you know exactly how to GET spectacular results with smoking, pain and nausea, if not necessarily depression? Perhaps Edzard Ernst would like to tell us, that well-known “worldwide expert” in Complementary Medicine.
I commented to Ernst not so long ago, on Septic Cat’s blog (aka ‘Skepticat’, should be ‘Cynicat’ really but I prefer Septic Cat), that I bet he couldn’t even answer three basic questions on the subject of hypnotherapy! Did he immediately say: “Try me! After all, I am the World’s only Professor of Complementary Medicine you know!”?
No he didn’t. He said nowt. Then when I asked him directly what his qualifications in Complementary and Alternative Medicine actually were, first he said:
“i have no reason to justify anything vis a vis nitwits who clearly don’t understand much.”
Then he copped out of the question by saying:
“for me ,this is the end of the debate.as i said,i don’t need to justify anything.my qualifications were seen by my uni and they employed me presumably because they were more convincing than the ones of the other candidates.they were keen to hire someone with a good track record of publishing research and they got that person.
THE END”
Ah! As usual with academia, it’s all about publishing. Well, Ernst is certainly keen on publishing stuff. The fact that he has no formal qualifications in the subjects he is studying and no practical expertise either might account for the mistakes, such as his silly finding that hypnotherapy is no use for smoking cessation.
Might also account for his obvious touchiness on the subject, eh?