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Edzard Ernst

Edzard Ernst: The “natural” equals “safe” fallacy

15 Aug, 12 | by BMJ

Things that are natural must be safe—this fallacy is deeply ingrained in our minds; it almost seems that, as human beings, we are hard-wired to believe this myth. An entire industry has developed around this claim: from toothpaste to wine, from dog-food to hand-cream, products are deemed to be better if they carry the label “natural.” One sector which clearly thrives on this fallacy is alternative medicine (AM). more…

Edzard Ernst: Research into implausible assumptions is likely to result in implausible conclusions

31 Jul, 12 | by BMJ

Evidence-based medicine is rarely concerned with the biological plausibility of medical interventions. This, I argue, may be a weakness, particularly when assessing the value of alternative medicine (AM). Many basic assumptions of AM fly in the face of our knowledge about nature, physics, physiology, pathophysiology or even common sense. A few examples to back up this seemingly bold statement may suffice: Iridologists believe that certain sections of the iris somehow correspond to inner organs, reflexologists assume that the same is true for the soles of our feet, traditional acupuncturists are convinced that some form of “life-energy” flows in meridians through our body, spiritual healers claim to channel “healing-energy” into a patient’s body, homeopaths think that endlessly diluting a substance renders it not less but more potent, chiropractors postulate that “subluxations” of the vertebrae are the cause of most human illness, etc, etc. more…

Edzard Ernst: The “middle ground” fallacy

11 Jul, 12 | by BMJ

When we are confronted with two opposing views, we tend to look for the comfort of the middle ground hoping the truth might lie somewhere between the two extremes. For instance, if someone describes a play, a book, or a restaurant as brilliant and another person thinks it is awful, we might feel that, in fact, it probably is of moderate quality.

But, in many areas, this simplistic logic does not apply. If someone says the earth is flat and another person insists that it is a sphere, we cannot very well conclude the truth lies somewhere in the middle. Facts are facts and disagreements about facts cannot be settled by half-truths or semi-facts. more…

Edzard Ernst: The “integrated medicine” straw-man

28 Jun, 12 | by BMJ

Proponents of integrated medicine want us to believe that they are offering “the best of both worlds” to their patients and claim that using a combination of alternative plus conventional medicine is preferable to conventional medicine alone. This approach allegedly extends our therapeutic options, respects patient choice, and provides compassion in healthcare.

Alternative practitioners, they say, have the ability and time to listen, offer understanding, empathy, sympathy, and compassion. They postulate that these qualities, once called “the art of medicine,” have been lost in modern healthcare which tragically has become de-humanised, technical, heartless, and uncaring. Modern medicine is in a deep crisis, they insist, and integrative medicine offers a way out of the predicament. more…

Edzard Ernst: My evidence is better than yours

12 Jun, 12 | by BMJ

Humans tend to remember their pleasant and positive experiences and forget those events which were disagreeable or negative. We are not natural talents at coping with cognitive dissonance, and therefore our minds select the memories and evidence that we are most comfortable with. This trait can seriously impede our objectivity. In extreme cases, it can even obscure the truth. This is one reason why we often cannot trust our own experience but need scientific tools to establish the facts.

Whenever there is a sizable set of scientific data, it is likely that not all of them yield entirely the same result. In situations where the evidence is mixed, it is usually best to first define what type of evidence is most likely to be reliable and subsequently consider the totality of such data. This usually means evaluating all randomised clinical trials of a given therapy for a given condition, an approach best realised in systematic reviews or meta-analyses. more…

Edzard Ernst: Thousands of patients cannot be wrong or can they?

21 May, 12 | by BMJ

The subject of alternative medicine (AM) is littered with surveys, and it almost seems as though a new one crops up every other day. Typically these surveys assess how many patients use AM. The resulting prevalence figures show an extremely wide range. One reason for this huge variability is that most of these surveys are so flimsy that their findings are therefore unreliable.

Nevertheless, collectively they give us a vague inkling that the prevalence of AM-use is considerable. In UK general populations, the one-year prevalence of AM-use seems to be around 20%, according to the most reliable data we have at present. In other words, thousands of UK consumers and patients employ AM, and most pay for it out of their own pocket. more…

Edzard Ernst: Pascal’s Wager and alternative medicine

26 Apr, 12 | by BMJ

Blaise Pascal (1623-1662) argued that, because it is impossible to either prove or disprove the existence of God, it would be best to wager in favour of his existence. In case one got it wrong, little would be lost; in case one was correct, everything was gained.

The same logic seems to be employed by many consumers/patients who apply it to alternative medicine (AM). Here the argument often is as follows: Because we cannot be sure whether AM is effective, it is best to try it anyway. In case it does not work, little is lost; in case it does work much is gained. more…

Edzard Ernst: I don’t care how treatment works, as long as it helps my patients.

2 Apr, 12 | by BMJ

During the last two decades, many doctor’s attitudes towards alternative medicine have become more liberal. The general attitude seems to be: “I don’t care how it works, as long as it helps my patients.” At first glance, this argument seems correct—after all, clinicians have a duty to do all they can to alleviate the suffering of their patients. Once we dissect the argument carefully, it turns out to be ill conceived when debating the value of ineffective interventions. more…

Edzard Ernst: Absence of evidence is not evidence of absence

19 Mar, 12 | by BMJ

“Absence of evidence is not evidence of absence.”

Amongst the many misleading arguments, which are frequently used to promote useless treatments, this one occupies a prominent place. When I first heard it, I was impressed: it is succinct and elegant. In fact, it is also entirely logical: the absence of evidence for extra-terrestrial life represents no evidence that such life does not exist; just because you have not seen someone being struck by lightning does not mean that lightening does not hit people; you may never have seen the Northern Lights, yet they do exist. more…

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