Why debates with alternative health gurus so often turn ugly

‘They would say that, wouldn’t they?’ This bon mot has been attributed, not entirely correctly, to Mandy Rice-Davies giving witness in the Profumo affair. During the trial of Stephen Ward, the defence counsel pointed out that Lord Astor denied having had an affair with Mandy, and she laughed it off by replying: ‘Well, he would, wouldn’t he?’ In a way, her rhetorical question aptly highlights some of the issues related to conflicts of interest that abound in medical research.

When a researcher publishes a paper in a medical journal, (s)he must disclose all conflicts of interest that he might have. The aim of this exercise is to be as transparent as possible; if someone has received support from a commercial company, for example, it does not necessarily mean that his/her paper is biased. Yet it is nevertheless important to be transparent so that we can make up our own minds.

The questionnaires that authors are being asked to complete prior to publication of their article focus almost exclusively on financial issues. For instance, one must disclose any sponsorship, fees, travel support or ownership of shares. In conventional medicine, these matters are deemed to be the most important sources for potential conflicts of interest.

In my field, alternative medicine, financial issues are usually thought to be far less critical; it is generally seen as an area where there is so little money that it is hardly worth bothering. Perhaps this is the reason why many journals of alternative medicine do not even insist on declarations of conflicts of interests and few authors disclose them.

After having been a full-time researcher of alternative medicine for more than two decades, I agree that, in this field, financial interests are often negligible. Yet I have become convinced that conflicts of a different nature are at least as prevalent and potentially more powerful. Sure, there is less money at stake, but this fact is more than compensated by non-financial issues. Quasi-evangelical convictions abound in alternative medicine, and it is, I think, obvious that they can amount to significant conflicts of interest.

During their training, alternative practitioners learn many things which are unproven, have no basis in fact or are just plainly wrong. Eventually this education — or is it brain-washing? — creates a belief system to which practitioners adhere, regardless of the scientific evidence, and which they tend to defend at all cost.

Moreover, this belief is indivisibly linked to more existential issues. In alternative medicine, there may not be huge amounts of money at stake, but any criticism or challenge nevertheless has the potential to endanger an alternative practitioner’s livelihood. And this creates a situation which is fundamentally different from conventional medicine. If someone published evidence to show that a new drug is ineffective, most GPs would simply use another one. If, however, someone demonstrates that acupuncture is a placebo, acupuncturists would automatically fear for their cash flow.

In other words, in alternative medicine, such conflicts of interest tend to be very acute, powerful and personal. Consequently, enthusiasts of alternative medicine are often incapable or unwilling to look upon criticism as anything other than an attack on their income, their beliefs, their status, or their person.

When chiropractors deny that neck manipulations carry a risk, when herbalists insist that traditional herbalism is based on good evidence, when homeopaths claim that their remedies are more than placebos, when acupuncturists tell us that meridians, yin and yang are real and evidence-based, we should ask who, in these often fiery and emotional debates, might have a conflict of interest. Who might have an interest that might directly benefit his or her income? Who is more likely to be objective, the person whose belief is being challenged and whose livelihood is endangered, or the independent expert who studied the subject in depth but has no axe to grind? If you ask such questions, you might end up concluding: ‘They would say that, wouldn’t they?’

Edzard Ernst, emeritus professor at the University of Exeter, is the author of Homeopathy: The Undiluted Facts and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.

  • Alternative medical practices are basically religious belief systems. When a homeopath, say, hears you state that there is no reason to suppose homeopathy should work, no way it can work, and no proof it does work, this is like a Christian hearing that there is no good evidence that Jesus existed.

    When facts conflict with Revealed Truth, fact loses out. Hence 2016….

    I strongly believe that the cult-like level of belief is more important than mere financial motivation. Some alt-medders are cynical charlatans, but most seem to me to be delusional first and foremost.

    Trying to get these people to accept evidence is alike trying to get young Earth creationists to accept reality-based concepts of cosmology, geology, evolutionary biology and the like.

    • Dirk Thrust

      As ever, it is impossible to defeat with logic a belief which is fundamentally illogical.

  • ReallyGoodMedicine

    Just the usual attempt to influence the public against safe, effective, inexpensive medicine through pure, unadulterated disinformation. I recommend that anyone who wants to know what homeopathy can do for them and their families google “homeopathy cured cases”.

    • Dirk Thrust

      “Safe” What? Like Hyland’s Teething tablets which have been linked to the deaths of ten babies?

      “Effective” What? Despite what weight of scientific evidence shows us?

      “Inexpensive” What? At £100 for a consultation, not including cost of nostrums? http://www.homeopathyhelpline.com/consultations/in-person-consultation

      Edzard’s not the one sharing disinformation.

      But anyway, as I said above, it is impossible to defeat with logic a position which is fundamentally illogical. Carry on believing RGM. And we’ll keep laughing.

    • Mountainwilliam

      I can google “flat earth” or “reptillians run our government” and get somebody to tell me that’s true too. Doesn’t make it true.

      • Callipygian

        Also why one should never be persuaded to buy ‘because it got good reviews!’. You can always find people with lower standards than yours to leave a ‘good’ review of anything.

    • edzard ernst

      she would say that, wouldn’t she?

    • I did google “homeopathy cured cases” as you suggested. There were 75 results returned. The top result was for a seminar, many were for sites selling homeopathy but by far the majority were newspaper websites where someone in the comments was suggesting people google “homeopathy cured cases”.

    • Mc

      I feel your pain (btw, could you point me to a homeopathic cure for chest pain caused by arguing with Big Pharma shills?). Google is an incredible resource for uncovering truths: US involvement in 9/11, alien control of the British Royal Family, alchemy formulas, perpetual motion machines, etc. Don’t you just hate it when deniers in the pay of Big Oil claim that perpetual motion machines are impossible because they defy basic laws of physics?

    • Tetenterre

      Isn’t it interesting how words sometimes reverse their meanings? These must be strange new usages of the words “safe, effective, & inexpensive” of which I was previously unaware.

  • UK Homeopathy Regs

    The Great Healer likes to surround themselves with acolytes.

  • Callipygian

    learn many things which are unproven: should be: learn many things that are unproven

    creates a situation which is fundamentally different: should be ‘that’, again.

    Restrictive relation pronoun. Still alive and justified in 2017!