The Quacks, the Hacks and the Therapists

by Chris Holmes

Edzard Ernst, if we are to believe what certain hacks tell us, is in danger of losing his position at Exeter University – but it has nothing to do with his own behaviour, of course!  This is a link to a particularly lame piece from the Guardian’s Sarah Boseley which tries to suggest that the reason nobody seems to want to fund “the scourge of complementary medicine” is because The Prince of Wales has somehow made it so! Since when did he have the power to forbid the funding of University research, Sarah? Don’t be silly.

After 17 years of CAM-bashing, with hardly anything positive to say about Complementary Medicine at all, it could just be that everyone’s sick to death of the guy, except of course for all the pathological cynics like Sarah Boseley, Simon Singh, Ben Goldacre etc etc who seem to have the simplistic, collective notion that all CAM therapists are “quacks”.  The repeated suggestion they make in the media is that private therapists make vast fortunes by hoodwinking people who, because they are ‘deluded’ or ‘vulnerable’ pay willingly for therapies that they often seem quite happy with – only their opinion doesn’t count, because they’re ‘deluded’. How patronising is that?

The only thing that does count – according to these few self-appointed “quackbusters” – is the relentlessly negative outpourings of Ernst’s unit which can be summed up thus: whatever therapy he’s looking at, after a selective review of previous studies the verdict is that there’s no evidence that it works and it could even be dangerous! Yes, that’s right: it’s more or less the same verdict for everything he looks into!

This is exactly why most open-minded people have stopped taking him seriously. After all, if he were finding the very reverse with the same consistency – that ALL complementary therapies worked – how long would it be before everyone suspected his methods, eh? So he’s left with only the rabid hard-core of New Simple Scientism, which can equally be named Prejudice.

Has it not occurred to any of these people that for many, many years millions of people have been using these therapies and returning to them because they find them effective?  Not only that, but all those people have families and friends who will also have been aware of that, so although it is often said that only 25% of the population use CAM therapies, a hell of a lot more will have heard about the results.  The only people who dismiss those first-hand opinions are pathological cynics, and although those people are often noisy, opinionated and usually rude to anyone who tries to explain that they’ve got it wrong, they are actually in a very small minority.  They are the only people with an axe to grind about all this, and they aren’t doing that for the sake of the people who use CAM therapies at all!  They have nothing but contempt for people who use CAM therapies… but no-one else does.

So Ernst has had an exciting time, drawing attention to himself as the “scourge of Complementary Medicine” as Boseley rather tellingly put it – which is why she approves – forgetting that officially he is supposed to be objective.  But no-one normal who is aware of Ernst at all would ever regard him as impartial, he is quite clearly the champion of the pathological cynics and was from the start, although many people didn’t realise that straight away.

Some of these Ernst Groupies call themselves skeptics, but they are quite wrong to do so.  I work with skeptics all the time, and I don’t find their skepticism a problem at all.  Hypnotherapists are used to the fact that most new clients are skeptical, which is another reason I object to the term “faith-based therapies” which is repeatedly used to denigrate CAM therapies in general. Most of my new clients don’t have any particular faith in hypnotherapy, in fact they are usually very surprised by the results.  Of course we partly have the likes of Ernst to thank for that low level of expectation, but it is also partly caused by the fact that many of my clients will have tried to fix the problem through their own efforts previously with no lasting success, so their conscious expectations are fairly low because of that.

The “faith-based” suggestion is a snidey way of making out that the results don’t go beyond a placebo effect caused by their own delusions, which is extremely patronising and (in the case of hypnotherapy, for sure) utterly inaccurate.  Although the majority of people are fairly skeptical of all unfamiliar things, they are not cynics. Most people who try CAM therapies are simply being practical: if you want to get rid of a problem, you just try one thing after another until you find the thing that works for you.  If the cynics had their way, you wouldn’t have the choice: you would have to take what the doctor recommended even if it kills you (See ‘Trust Me, I’m a Doctor’ on this site, and also the blogpost ‘Daily Mail Article’ in the blog category Drugs On Trial.

When I was growing up, if someone said they were “off to see the quack” they meant the doctor, their General Practitioner.  Lately the word has been used by the cynics and a few opinionated hacks to attack the entire field of Complementary Medicine, and what these people are forgetting is that the only people who will agree with those mocking, patronising and extremely negative and ignorant opinions are the cynics of the world.  Edzard Ernst’s publications haven’t made those people the way they are, they were like that already.  He just gave them – briefly – more credibility because of his bogus title and his academic position, but his “don’t shoot the messenger” suggestion that he uses to deflect criticism is a pathetic attempt to erase himself from “the science”, and nobody with any intelligence will fall for that one!  So, all published studies are simply “the truth” are they, Edzard?  Never mind the intent, never mind the funding, never mind the methodologies… the studies just selected themselves, did they?  The science just happened all by itself, as if by magic, and Ernst is just the guy who told us all what it said, like Moses coming down from the mountain with The Word of God. Yeah, right!

No, Ernst was never a simple messenger, he is an author and an instigator, a collaborator with other anti-CAM extremists and a campaigner against CAM – as Boseley says: “unusually outspoken” and “the scourge of Complementary Medicine”.  Not really what we expected from the first ever Professor of Complementary Medicine, because it is so clearly at odds with the everyday experiences of CAM users.  When those people try to explain that, their views and their attempts to report successes are instantly dismissed just because they did not occur under laboratory conditions.  By contrast, Ernst’s activities are given blanket approval despite the fact that the studies he is looking at never involved any professional CAM therapists and he has never been one himself.

So perhaps the only people who think what he has done is admirable, objective or reliable in any way are the pathological cynics who dismiss ALL complementary therapists as “quacks”.  And those people are in such a small minority that I seriously doubt they could fund his work for very long if they all pitched in together with every penny they have.

No-one else is taking him seriously any more, it seems.  The fact is, we do not need this endlessly negative anti-CAM voice at all, because even if he never published another word on the subject we all know, already, what Edzard Ernst would tell us: “There’s no evidence that it works…” apart from all the millions of people who happily use it, but they don’t count… “…and it could even be dangerous…” although it hardly ever is.  Why would anyone waste their valuable resources generating yet more of that kind of unconvincing drivel after being subjected to seventeen years of it already?  And no-one needs Boseley whining on about it either. “We need this voice” to tell us what to think!  You might, Sarah, but no-one else does, evidently, or people would be willing to fund it without a special appeal from you! (Is there a brain in there anywhere?)

If Ernst and Boseley do find themselves out of work sometime though, I reckon they could get together and reinvent themselves as a Keith Harris and Orville tribute act.  “I wish I could have an original thought, but I can’t!”  “You can!”  “I CAN’T!”

To explain the reference for non-UK dwellers: Ernst could be Keith Harris, a ventriloquist whose dummy is a large and generally clueless baby duck, so of course Edzard provides the voice for both.  And if Boseley doesn’t like the idea of being Orville the duck, maybe she shouldn’t play the role of Ernst’s special media mouthpiece and keep mindlessly repeating the word “quack”.  What goes around comes around Sarah.

Central Hypnotherapy

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 findings 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.

Ageism and the Chemical Cosh

When I first commented on this a year or so ago, I was horrified by the estimate that in the previous five years, these medications were reckoned to have killed about seven hundred people – mainly through causing strokes and pneumonia. Now the estimates are between 1000 and 2000 elderly people being killed in this way every year yet the N.I.C.E. guidelines are that unless the patient is psychotic, these drugs should not be used to sedate them. They are so powerful that they are now being spoken of as a kind of “chemical cosh”, and the accusation is that this dangerous practice is simply to make these people less troublesome and easier to handle.

by Chris Holmes

Twice before I have mentioned the scandal of people of a certain age who are more frail and confused than they used to be being knocked senseless by GPs with the use of powerful anti-psychotic drugs, and now this scandal is back in the news again.

Deliberate Mis-Prescribing

No-one is suggesting that the job of a GP is easy.  A great number of the decisions a GP will make when considering whether to prescribe a certain medication or whether not to, will be a judgement call, and it is possible to get that wrong.  That’s why they have advisory bodies like N.I.C.E. to give them guidelines.

The trouble is, quite a lot of GPs are ignoring the guidelines.  These drugs are designed for people who are psychotic, but of the 180,000 people currently being prescribed these drugs in care homes, it is reckoned that about two-thirds of them aren’t psychotic – they are confused, suffering from some form of dementia or are just agitated about the transition of going into care.

The Telegraph’s Health Correspondent Beezy Marsh wrote:

The findings emerged in Keep Taking the Medicine, a report by Paul Burstow, the Liberal Democrat spokesman for older people, who obtained information through parliamentary questions.

Last night he said: “The chemical management of older people is a continuing scandal.

“It denies older people dignity and robs them of a better quality of life. Pressures on care providers are not an excuse for inappropriate medication.

When I first commented on this a year or so ago, I was horrified by the estimate that in the previous five years, these medications were reckoned to have killed about seven hundred people – mainly through causing strokes and pneumonia.  Now the estimates are between 1000 and 2000 elderly people being killed in this way every year yet the N.I.C.E. guidelines are that unless the patient is psychotic, these drugs should not be used to sedate them.  They are so powerful that they are now being spoken of as a kind of “chemical cosh”, and the accusation is that this dangerous practice is simply to make these people less troublesome and easier to handle.

The Telegraph again:

Frank Ursell, chief executive of the Registered Nursing Home Association, said accused Mr Burstow of “pointing the finger of blame”. He said: “We want to disassociate this idea of these drugs being used as a chemical cosh, because it is just not true.

“If you are running a home, you do not want people wandering around in a sleepy state. They can be useful to help people settle in, because it can be very traumatic for elderly people when they first arrive, to bridge that gap.

“It is the GP who prescribes the drug and to suggest that there is inappropriate prescribing is a scurrilous attack on GPs.”

“Help people settle in”?  Settle in to what, a shroud?  And this is not just a “suggestion” that the drugs are being mis-prescribed – clearly the guidelines are being ignored which is causing the deaths of over a thousand people a year!

Look, if someone is upset or agitated, or having trouble adjusting to a new way of life, you could just give ’em a Valium or something like that.  You don’t have to put them on a tablet designed for something completely different that also has the slight drawback of killing a thousand people a year, thus deliberately ignoring the official guidelines that tell you not to do that.  Forgive me, but that is not “a scurrilous attack on GP’s”.  And yes, it is “pointing the finger of blame” because GP’s ARE to blame for that one!  There are times, Mr Ursell, when pointing the finger of blame is entirely appropriate, and when GPs cause unnecessary deaths by choosing to ignore the official guidelines – not just once or twice but in thousands of cases annually, then clearly the blame lies WITH THEM… not with N.I.C.E., not with the care homes, not even in this case with the drug companies who manufacture the damn stuff, but the individuals that sign those prescriptions.

I did call it, last time, a Licence to Kill.  GPs know that if any of these old folk die as a result, no-one is going to sue them personally.  How is this different from Shipman’s arrogant assumption that he should remain untouchable if he killed people off with the inappropriate use of medication?  And it is clearly ageism: would they even dream of deliberately knocking out any other section of the population en masse with these drugs?  It isn’t really to help them settle in, otherwise it would be used on children during their first few weeks at boarding school.  It isn’t really to manage difficult behaviour, otherwise the same drugs would be used on half the prison population, but no – these nasty, deadly drugs are only being mis-prescribed to the elderly.  So Paul Burstow is right when he states that the chemical management of older people is a scandal.

I make no apologies for once more making the point that people like Edzard Ernst, who spend so much time atacking complementary medicine or trying to damn it with faint praise say nothing – NOTHING – about things like this, even though Ernst used to be actively involved in the work of the Medicines and Healthcare Regulatory Agency!  No, conventional medicine and general practitioners can kill as many people as they like, that’s fine by Ernst.  But he’ll be very quick to warn you about things like acupuncture or homoeopathy… as if that is where the danger lies!

This is just one of many examples that prove that the overall drive is to medicate, medicate, medicate.  Not all doctors are pill happy but too many clearly are, and it is now killing people in vast numbers but for some really scary reason, the trend is to prescribe even more despite that, and the guidelines, well… they might as well be in the bin.

Central Hypnotherapy