The Importance of Skepticism in the Modern World with Evan Bernstein

Abhijit: Hey, everyone. Welcome to Rationable Conversations. Today, we are going to be continuing on our journey through the world of alternative medicine with one of the stalwarts of the field, actually, not of alternative medicine, but of actually being a skeptic.

and promoting investigation and testing of alternative medicine. Today, we're going to be discussing a few of them. Acupuncture homeopathy, and other natural remedies. So stick around. This is going to be one fantastic trip.

Abhijit: Hey, welcome back. Today, I have with me Dr. Edzard Ernst.

Edzard Ernst: Just call me Edzard. Yeah, that's fine.

Abhijit: All right. Edzard Ernst has also been a homeopathic doctor. He started out that way.

He found his way out of it and has been promoting skepticism towards alternative medicine and has also written a fantastic book with Simon Singh called... Trick or treatment. Very clever name and very informative. I've read most of it and then I dip into it every now and then for reference,

but Edzard, how are you doing today? Welcome

Edzard Ernst: Hi. Nice to be with you.

Abhijit: It's a pleasure to meet you finally. I've been seeing your conversations on Twitter and of course with your book you definitely are very well known in the field of skepticism in alternative medicine.

Tell us your story How did you get into homeopathy in the first place?

Edzard Ernst: How did I get into medicine in the first place? I wanted to become a musician when I was a young chap. I was very enthusiastic and thought this would be a nice career. But I had a wise mother who said, why don't you do both and study medicine and music and then you'll see how it goes.

And that's what I did. she knew very well that medicine one day would take me over because it's not a part time job. I did study medicine, I also studied psychology and when I was finished with medicine that was in Germany in the late 70s.

And there was a surplus of doctors, would you believe it? So I couldn't find a hospital job which I needed to go anywhere really. I applied for various posts and eventually got the job in Germany's only homeopathic hospital.

 I wasn't deterred by that because for me homeopathy was just medicine. I was brought up on homeopathy. Our family doctor was a homeopath, not just any homeopath, but a very prominent homeopath in Germany. until I studied medicine, homeopathy was just a branch of medicine.

During my studies in medicine, I quickly comprehended that homeopathy was different it enraged our pharmacology professor who told us it was nonsense, and then I started the job in the homeopathic hospital, and I was really amazed because patients did get better with basically the placebos as our pharmacology professor used to call them. So I was puzzled, to say the least but that was a relatively short period about half a year and then I changed into various other jobs as one does as a young physician, and, Never forgot homeopathy.

How could I forget it? I was treated as a boy with homeopathy. It was my first exposure to patients. I was quite impressed. By that I think every young doctor is impressed when he sees his first patients. Absolutely. And I never forgot homeopathy then I had a complete career change yet again. I went to London from Munich. And first worked in psychiatry for several months, didn't like that at all, and then I accepted a research post, I did. Research into what is called hemorrheology, for those who don't know what it is, I don't blame you.

It's the study of the fluidity of blood. that totally fascinated me for a very long time. Oh, very interesting. For about 10 years. I became a scientist. I was trained properly as a scientist. as a student you are not trained as a scientist.

the study of medicine is so crammed full with facts that you haven't the time to think critically and maybe that's why I ended up in homeopathy for a little while.

Abhijit: Ah, it's something that I've heard about engineers as well, which for some reason it's all applied science, but that sense of criticism and skepticism is not really taught as a part of the course because obviously they're very extensive. so you were studying medicine and homeopathy at the same time. Is that what I understood?

Edzard Ernst: No. I finished my conventional studies of medicine in 1978. my first job was in a hospital of homeopathy. It was led by a homeopath. It was the only hospital in Germany which was completely homeopathic and I learned. Homeopathy never during courses during exams and such things, I'm not even sure that they existed in Germany at the time. Homeopaths are very angry when I say I'm a trained homeopath and they point out that I haven't got the slightest background in homeopathy. Which in a way is true, but I learned it on the bedside as medics do learn stuff after their final exams on the bedside. You, there's no special study of any therapeutic modality. You learn it while you do it.

Abhijit: Ah. So were you were you learning this? So how did you pick up things? was there a doctor that kind of told you the ropes or or Yeah, exactly.

Edzard Ernst: You go into any medical field, whether gynecology or neurology or rheumatology. You enter the field And you need somebody who tells you how it's done. You need to obviously study quite a bit and learn as you do it. That's how it is not just with homeopathy, but with any other speciality. This is how I was taught several other modalities as well, acupuncture, herbal medicine, etc.

It's not by going to university courses. It's by doing it and having a teacher who shows you how to do it. Then having become a scientist changed my outlook almost completely. I began to learn how to think critically, and I questioned a lot of things that I had been doing. And after about 10 years of basic research, I went back into clinical medicine.

I went back to Munich, and became... As a specialist in physical medicine and rehabilitation I became professor of special, of physical medicine and rehabilitation first in Hannover Germany. Then I got a chair in Vienna, Austria Germany. In physical medicine and rehabilitation took over a very large de department, lots of responsibility, et cetera, et cetera.

And all these years, in the back of my mind there was the, this, these questions about homeopathy. . At that stage I had reached the point where I could decide what my department was doing. I decided to do a study of homeopathy and other alternative treatments and published things.

And one day I saw an advertisement in the New Scientist that Exeter was looking to establish a chair in complementary medicine. I applied. And at first I couldn't believe that a full professor from Vienna was applying to a backwater like Exeter to a chair, which wasn't even a life position.

I had a position in Vienna. I was willing to halve my salary by going to Exeter why did I do that? Vienna did get on my nerves quite a lot, and that is a different story and would need to need another hour to explain really but I applied for that new chair and got the post and established a team of a multidisciplinary team to do research, which wasn't quite clear at the beginning because in Exeter I originally was meant to do a lot of teaching. And and I com completely redirected that in, into just research.

So we didn't see patients. I did some teaching at the medical school but very little and we were almost 99% research based and that's why we were. hugely productive. We published in the 20 years that I was in Exeter, over a thousand papers in peer reviewed journals, books, etc.

And that's what we did. And having been trained as a scientist It was clear to me that I wasn't going to promote homeopathy or any other treatment. I wasn't going to advance the business of homeopathy. All I had to do on the academic level was to answer questions, and for me The main two questions were, does it work?

And is it safe? That latter question upset a lot of people because they said, of course, alternative medicine is safe. Don't be stupid and I spent quite some time showing that this assumption is not true. Homeopathy may be safe. But the homeopath isn't safe and that's quite an important differentiation.

So we were hugely productive. I can honestly say the most productive research unit worldwide in alternative medicine.

Abhijit: So what are the kind of studies that you did? What are the topics that you did the studies on? Was it across all natural medicine or alternative medicine?

Edzard Ernst: Across, basically across everything.

But As you probably know, there are so many alternative treatments.

Abhijit: They're popping up all the time.

Edzard Ernst: Yeah, they're popping up all the time, so we couldn't do everything. Our focus was on homeopathy, herbal medicine, chiropractic, osteopathy, and acupuncture. But we did other things too, like spiritual healing dietary issues, et cetera, et cetera.

Quite opportunistic in the sense that when we saw the opportunity for funding a trial we just went for it. collaboration with alternative practitioners became more and more difficult because after about five to ten years, we had a reputation of being very much anti Ayurvedic.

alternative medicine, which is nonsense, because I'm in favor of evidence. I'm totally subscribed to the principles of evidence based medicine and for that you need to establish the evidence, and for that you need to do clinical trials. the collaboration became more difficult, and that was one of the reasons why we also did a lot of Reviews, systematic reviews, meta analysis, where we just collect all the evidence that there is out there for a certain subject, then condense it, if possibly statistically in a meta analysis, and create a new bottom line, like acupuncture for back pain, for instance, In total we did about... 40 clinical trials, which is already pretty much, because you can't, in any one year, you can't possibly do more than two clinical trials as a research unit. We were just 20 odd people. But we did around 300 systematic reviews. That became our real expertise and probably we are better known for our systematic use and our clinical trials.

In fact, there are some idiots who say professor Ernst has never done a clinical trial so he should shut up, but I've done around 40, which is more than any of these idiots have.

Abhijit: But the first thing about homeopathy, I spoke to Dr. Arif Hussain, based in Kerala India, he's doing important work testing alternative medicines and working with Dr. Abby Phillips. Interviews of theirs are links in the description. They've been doing a lot of work because Dr. Abbey Phillips found that there are people coming in, especially after COVID, there were a lot of people coming in to him, he's a biliary specialist, so people were coming in with non alcoholic liver failure, the only cause of that was because they were wasting food.

consuming copious amounts of things like Giloy and Ashwagandha and other Ayurvedic preparations, which everybody thinks doesn't have any side effects, but they definitely do. And especially when your liver is trying to filter out all the toxins from these compounds, your liver has a tough time doing it.

they have been doing a lot of excellent work and they're following in your footsteps. But I wanted to ask you a couple of things about homeopathy. with Dr. Theruvath, we got quite a bit of insight into how homeopathy came into being and that it was a German creation, which is something, oddly enough, a lot of Indians have a thing that, if it's a German creation, it must be amazing.

Look at the BMW, which I have to give them that BMW is fantastic, but this was of course, pre scientific. it was better than the other alternatives, which was bloodletting inducing vomiting and diarrhea But these days it has become extremely popular, especially in India, where it has been since very soon after it came out of Germany.

So how is homeopathy prevailing in Germany and in Europe in general right now? What do you think?

Edzard Ernst: I think England or the UK was the first European country where things changed dramatically in relation to homeopathy. Homeopathy was declared to be part of the NHS, which by the way is.

Today celebrating a birthday. The NHS today is 75 years old, so Oh, wonderful. When it was created people de defined certain things, and one of the things they defined that homeopathy belongs to the NHS. when I arrived in the uk, we had five homeopathic hospitals.

Today we have zero. I think that my work has contributed to that decline.

Abhijit: if your work had actually contributed to that.

Edzard Ernst: You should also at this point, we have to mention the royal family, Almost since the creation of homeopathy 200 years ago, the royal family has been advocating homeopathy and using homeopathy this royal protection people say, is the reason why it was the only alternative treatment declared to be inside the fence of the NHS 75 years ago. what changed? Basically the evidence changed and I certainly contributed to that people in the NHS were Forced to realize that homeopathy is just an expensive placebo and they maybe shouldn't be paying for it. Nobody wants people to not have access.

I don't want to forbid homeopathy. I don't want to forbid anything. I want people to be well informed and make up their own choices. And that's precisely what we did. And eventually, the message was received at the level of the NHS, and they said, okay, we better stop that. And as I said, today we don't have a single homeopathic hospital. The London Homeopathic Hospital still exists but it has renamed itself and it's called the Royal London hospital for integrated medicine or something like that. The late queen was the patron and now King Charles is the patron. So still royal support, but despite the royal support homeopathy went into decline.

The NHS pays No longer for it. And in, in a sense, that created an example for the rest of Europe. France followed. France has a long tradition in homeopathy. Hahnemann spent his last years in Paris and therefore the French are traditionally very fond of homeopathy, and the healthcare system in France paid for it and now has stopped paying for it. The Germans are still struggling with that, but since about five years or so, there's a vocal opposition opposed to homeopathy, and it's a question of time that the insurance system in Germany will consider its position on homeopathy.

Abhijit: you mentioned integrative medicine from my perspective, integrative medicine is just taking regular medicine and adding aspects of alternative medicine into it. Is that correct? is it just something in medicine in disguise or what exactly is that?

Edzard Ernst: there's a history in all this terminology. We used to call it Fringe medicine, that was perhaps unacceptably hostile, then we called it alternative medicine. Then people realized that it can't possibly be an alternative if it doesn't work. Then people called it Complementary Medicine.

That was my chair in Exeter, emphasizing the fact that it's used in addition To be even more politically correct, people began to call it integrative medicine, which means an integration on the same level. It's not just an add on, but it's considered an integrative part of it.

As somebody once said, if you integrate cow pie into apple pie, You don't make the apple pie more tasty. that's precisely what it is. It is a clever ploy to make people think that integrative medicine is very open to new ideas, Politically correct. But actually it is just, admitting quackery by the backdoor.

Abhijit: Backdoor also comes with the cow poi part.

Edzard Ernst: If something did really work, then it would be submitted to the scrutiny of evidence based medicine. And then there's nothing against integrating it. What I'm trying to say is that the principle of integration is already...

It does already exist in, in, in evidence based medicine. Evidence based medicine isn't closed and says it has to come from science and from a pharmaceutical factory, otherwise we don't consider it. Evidence based medicine considers everything that is supported by good evidence and therefore the principle of Integrated medicine is just idiotic.

Abhijit: Yeah, I totally agree. I was having a conversation with my father a couple of days back actually and we're talking about the, and you also saw A lot of patients recover when you give them homeopathic medicine there are several books and many real life accounts and of course people swear that once they took homeopathic medicine It cured them or it improved their condition Now, this could be a combination of things, the placebo effect and confirmation bias etc. But how does this happen when it comes to infants? What do you think that happens? Because they don't have... A confirmation bias set in and the same goes with pets. A lot of people give their pets homeopathic medicines and they seem to get much better after that.

So how does one explain that sort of thing?

Edzard Ernst: Exactly like you explained it with adults, the placebo effect is operative in animals and in children. In fact, if you remember good old Pavlov he discovered the placebo effect in animals, not in humans.

the placebo effect exists, it's a little bit more complicated, I'm trying to keep it simple. And in... It, it exists also as the placebo effect by proxy, if the mother is convinced that the baby cries less and sleeps better, then perhaps the baby cries less and sleeps better through the reduced anxiety of the mother.

But that's just one of the factors. The other factors of importance are regression to the mean, natural history of the disease, things do get better by themselves. in a single case, whether it's your father or the mother of the child or a keeper of an animal, These people can never say that it was the treatment that worked.

This is the logic of 300 years ago. And look where we were 300 years ago in terms of curing disease. Medicine advanced to its present stage as soon as we realize that we cannot go by experience. Experience can be completely, misleading. We need clinical trials and the invention of the clinical trials is probably the biggest breakthrough in medicine of all the big breakthroughs that we had.

Only in a properly conducted clinical trial can we sort out all these. confounding factors and biases and say, yes, it probably was truly the treatment that caused the effect that we are observing.

Abhijit: And of course with pets as well, they are given all sorts of medicines at different times and a lot of people give them both alternative medicines as well as mainstream medicines to treat them.

Edzard Ernst: If you look at the trials in children and animals using homeopathy, you find exactly the same thing as with adult human beings, namely it doesn't work people who say it has worked in my child and therefore that is enough proof, these people then ought to explain that If I do a proper clinical trial why doesn't it happen then? The answer is obviously because a proper clinical trial cuts out all the biases and confounding factors and this is just Proof that the experience these people report is wrong.

It is wrongly interpreted. Of course, they do get better. It would be foolish to say your child or your dog or your grandpa didn't get better. That would imply they're lying or dishonest. The child got better. But the interpretation of the fact that the child got better is wrong.

The child got better not because of the homeopathic remedy, but the child would have got better even without the homeopathic remedy.

Abhijit: That is an important factor. you also wrote a lot about acupuncture have you studied acupressure at all?

Edzard Ernst: Yeah the thing is acupuncture usually is sticking a needle into the skin of a patient.

the aim of doing that is to stimulate an acupuncture point. Now you can stimulate an acupuncture point with all sorts of other things. You can put ultrasound pressure light electricity etc. there are dozens of different forms of acupuncture.

we try to cover them all. in clinical trials you can't do everything, of course, but in, in the system reviews that we did, we usually included any form of acupuncture if we do a, Systematic review of acupuncture for back pain, which I mentioned earlier, we would also consider forms like acupressure, electro acupuncture etc.

And one form of acupuncture isn't very much different from another in the sense that the evidence is very dodgy and Quite unconvincing. Whether you apply a needle, electricity or pressure doesn't matter.

Abhijit: Yeah, I tried it a couple of times. When I was a kid, living in India, you get all sorts of homeopathy and other things including Ayurveda and stuff.

Even my mother has been a believer, if you start coughing or you're choking on something, then you should hold the base of your thumb very tightly. And for a long time, even I did that.

There was one where you press the bridge of your nose to quell a headache, which I have tried and it did not work. My headaches are very persistent when they happen only recently I had a conversation where I said that you will stop coughing eventually. That will take just a couple of minutes as whatever you're choking on comes out and your airway clears.

So whether you press it or not, probably not going to do much, but it's a very good excuse to slap someone on the back, especially if it's your husband.

Edzard Ernst: the best trick of any type of alternative medicine is to treat conditions that are self limiting. coughing is excellent. Common cold is also excellent. it'll take 10 days if you treat it and one and a half weeks if you don't treat it.

Abhijit: So have you done any research on Ayurveda or any Ayurvedic compounds or preparations of that sort?

Edzard Ernst: We once had a visiting scholar from Sri Lanka, I think, and he started doing some interesting work in terms of systematic review, but then left and never finished it, so we had to pick up The leftovers, and we published that, that was the only time we ever looked into Ayurveda, except for looking at the dangers of alternative medicine, there I've published, three or four reviews of the dangers of Ayurvedic medicine. As you know they are adulterated, contaminated, And often have very dubious ingredients which damage your liver and other organs. So if they, yeah. My advice to anybody around here, of course in India, that's a much more problematic advice, but my advice is stay well clear of Ayurveda.

Abhijit: Ah, that's very good advice. Of course, most people are not. going to take it. As in the advice, unfortunately They're going to still keep taking Ayurveda. It's so deeply ingrained in our culture that it's really hard to tear away from. As a kid, I used to have something called Chavanprash, which is like a massive conglomeration of 50 different ingredients. Everybody makes it in a different way, and it comes out in this black gooey paste. It doesn't look appetizing at all, but people swear by it that it's supposed to give your immunity a boost, give all sorts of things like it's supposed to make you superhuman.

But as is evident Indians are not yet superhumans as much as we wish we were, but there is a Western equivalent to Ayurveda and that's naturopathy. Now what exactly is it? I've had a very hard time trying to put naturopathy together.

It just seems like a vague collection of ideas. There's no central dogma or ideology behind it. What have you learned about it?

Edzard Ernst: Yeah, I don't blame you for being confused about it. Basically, if you just analyze What the terminology means, it means using the means nature provides for treating and diagnosing people.

Nature provides Heat, cold, pressure all of these things are used in naturopathy. Naturopathy gets particularly well known for its herbal supplements. But that's just one element one of the fathers of naturopathy was a Bavarian priest. he was famous for the water cures. He cured everything in including himself. Oh, so often meant by a confidence. You go back to the history so often these inventors of modalities famous for curing themselves or started by curing themselves and then became enthusiast. So he was called Sebastian Kneipp cured his own tuberculosis with cold water treatments. Cold water treatments are supposed to boost your immunity. We did a trial of this a long time ago. And it seemed to show that if you take Intermittent hot and cold showers every day, you suffer less from the common cold than people who don't do it.

It wasn't a brilliant trial I have to say. But It was interesting. Sadly we never followed this up, nor did anybody else, but the notion that water treatments are good for protecting you via the immune system is very widespread Naturopathy is such a diffuse area because people add vitamins to it. Some say detox is an important element. Some even say homeopathy is part of naturopathy, which is nonsense. Most American colleges of naturopathy teach homeopathy. So it is confused, the area, and I don't blame you for not understanding it.

I'm not sure I understand it.

Abhijit: But I've heard some horrific things, like especially there's a lady called Britt Marie Hermes. Who is settled in Germany at this point of time, I think she was American. She is American. And used to be a naturopath. And so I've managed to, learn whatever I could from her, from at least from her the talks that I've seen of hers and she has, she mentioned some really horrific practices like giving people with cancer certain banned substances, which I think her boss was importing from some, from from a different country, but giving them potentially poisonous things. There have been people have been killed by naturopathy there have been cases where somebody tried to give a vitamin C direct infusion, a high concentration of it, and the person went into shock and died.

Right there and there. So it's, really horrible things that people do in the name of naturopathy. And it's, hey, we've got a ministry supporting that as well. Even though the N is not mentioned in the ministry of Ayush, apparently it's in there somewhere. It's a silent N, but we've got colleges and things about that stuff.

Edzard Ernst: That's a very interesting story because we had just published a systematic review of this herbal anti cancer drug you mentioned it's called Ukraine because The inventor came from Ukraine went to Vienna and then marketed this very strange anti cancer drug and got imprisoned for all sorts of fraudulent activity.

And Bridget Hermes had to use it in her. College of naturopathy in America. . And this is how came into contact. And I think I'm partly guilty of turning her off naturopathy

Abhijit: That's something you should be guilty of.

Edzard Ernst: And I met her several times.

She's a Charming lady. She now lives in Germany and has done a PhD in a proper science. So she's thoroughly converted and is now one of us.

Abhijit: Wonderful. this gives me a great idea. I really need to get her on the show.

Edzard Ernst: She's brilliant.

Abhijit: Yeah, so I've seen and so I've heard. So time to, get to know that in person. what are some of the strangest things that you have found in your studies about alternative medicine? Let's say about naturopathy or acupuncture. Has some really surprising things popped out at you?

Edzard Ernst: our very first study was perhaps also the most surprising. One day, somebody rang the doorbell on my private home in Exeter. this was a middle aged lady and she said I heard that you are going to study faith healing.

I said, I have no intention to do that. She said you said in a radio interview that you will study those treatments which are most commonly used in the UK, I did say that in order to emphasize that, as coming from Germany, I wasn't going to bring in all sorts of weird stuff from Germany that is of no relevance to the UK.

I looked it up and lo and behold faith healing was one of the commonest alternative treatments in the UK. I was taken by my word and we found some funding for a study. the funding was quite generous in the sense that we were allowed to design the trial after receiving the okay for the funding.

So we didn't have to submit a full protocol, but could develop that protocol after receiving the financial support. we assembled five faith healers of good reputation, and I told them we want to do a clinical trial testing faith healing, my research question... is whether it's any better than a placebo, because I have no doubt that your patients benefit from it, but I have much doubt that they benefit from the face healing per se.

It would be a placebo effect or whatever else. We had long discussions, and we came up with the idea, all together, it was a consensus, that we would find five actors, which were almost look alike, the same age group, etc., who would be trained to pretend to be faith healers, Everybody liked that idea, and we went ahead. They trained their counterparts, the actors. Then we had another meeting, and they came to me and said, We can't do this study, because while training our actors, we discovered that they all have healing power as well.

Abhijit: anybody can be a faith healer.

Edzard Ernst: So basically, they were predicting that the study we had designed would not show a result. this would be due to both the actors and the face healers having healing energy. We had a few more conferences and I came up with the idea that we do the original trial, but two more groups Included, the additional group would receive the face healing by the face healer sitting in a cubicle which was obscured to the patient, in a distance of two meters away from the patient, but the patient wouldn't see the face healer.

And in the control group for that arm, there would be nobody in the cubicle. we refined the method and played a tape recording of human sounds like moving on the chair in the empty cubicle. We had four groups. Faith healing like normal, Faith healing... Administered by the actor.

Faith healing like normal except from a cubicle at a two meter distance and nothing at all delivered by the empty cubicle. The trial happened and the condition we were treating was severe chronic pain. We cooperated with our local pain clinic and there were plenty of people so badly affected that they were in wheelchairs.

And one day I remarked that some of the patients that I had seen arriving in wheelchairs were walking. I wasn't involved in the trial anymore, but I could talk to these patients, I said, haven't I seen you in a wheelchair a few weeks ago? And the patient said, yes whatever is happening in the laboratory is marvelous. I I've been in the wheelchair since five years and now I'm walking. So I thought we are doing miracles here. Wonderful. the trial eventually finished. we analyzed the results, and opened the random code, the results... were truly amazing.

 the two control groups had better results than the Faith healing groups. the differences were not significant, but if you wanted to exaggerate that, then doing nothing is better than Faith healing, right? In any case, what we did show was that there was no difference no statistical difference in pain reduction.

remarkable cases of people giving up wheelchairs happened in all the groups distributed evenly throughout all the groups. This, for me, It was the most remarkable lesson to demonstrate how much, not just the placebo effect, but all the other effects regression towards the mean, very important natural history of the condition, et cetera, can achieve.

Earlier we talked about how utterly misleading experience can be. This, for me, showed it clearer than anything else, because if I had... Selectively told just those patients who had abandoned wheelchairs that they had healing,

They would have been convinced for the rest of their lives that the healing power is actually curative and in fact it is nothing, if anything it's worse than doing nothing.

Abhijit: Oh my goodness, I've just had an interview with Holy Kool Aid or Thomas Westbrook from the YouTube channel called Holy Kool Aid, where he's compiling an entire series of videos on faith healing. This is going to go very well with that. Again, link in the description for everybody who's watching. this is fascinating.

Edzard Ernst: by the way, I should mention this. This was published in the journal Pain. If you go on Medline and put my name... into spiritual healing, You'll find the actual publication and you can see that I'm not fantasizing. I'm telling the truth.

Abhijit: I'm curious, though, the patient you spoke to, who had been walking around, which group were they in?

Edzard Ernst: They were distributed evenly throughout all four groups.

Abhijit: At that point of time, you had no idea which group they were in.

Edzard Ernst: No I was head of department. I helped design the study, but as soon as the study started, I wasn't involved anymore. I had people doing that, I was too busy otherwise.

Abhijit: ingenious. That is completely genius study design. Having an empty box. That's fantastic. there's a Darren Brown, who is that who the British mentalist, he trained an actor to be a faith healer as well. there was an entire TV show about it.

he taught that person how to do faith healing, all the motions, how to, behave, how to speak and how to interact with all the people in the congregation. even when he came out and admitted that he was a fraud.

Everybody still believed that he had healing powers. This goes to show how powerful faith healing is. But speaking of the placebo effect, nowadays there's a lot of people who are giving the placebo effect a lot of credence. There are people who have put comments in my videos and there are others who have basically said that, I want to go ahead with this just for the placebo effect.

Now, there are certain effects that placebos have, there are even placebo surgeries which seem to have a lot of effect in certain situations. But could you give us the experienced, professional description of what a placebo is and why it has the effect it has and what that effect really is?

Edzard Ernst: Now, you need somebody more clever than I am.

Abhijit: It's seriously done. Give it a shot,

Edzard Ernst: To put it simply, Placebo stands on two feet. One is classic Pavlov conditioning. Pavlov conditioned, he rang a bell. Yeah. And fed his at the same time. He did that many times repetition. And he, me, he measured gastric secretion because the dog starts with gastric secretion as soon as they know they get some food as we do.

 Then he stopped giving food, just rang the bell, and gas execution, and the gas execution started, just by ringing the bell. That phenomenon is called... Conditioning and the human example would be, I go to the dentist because I have dental pain, but I'm very afraid of dentists I sit in the waiting room getting more and more anxious and all of a sudden I notice my dental pain is gone.

That or you go to the doctor and you think you're gonna tell him about this and that problem, and as soon as you're with the doctor, you notice that the problem has gone, and you feel a fool because you have nothing to report to your doctor.

You're conditioned to get better as soon as you see the doctor, basically. That's putting things rather simple. the conditioning is an unconscious phenomenon. You cannot control it. The second foot that the placebo stands on, is expectation. That is a conscious problem. I expect to get better when I take a pill.

I have a headache. I take an aspirin and two minutes later my pain has gone. And that is a pure placebo effect. Why? Because the aspirin takes longer to work pharmacologically. So if it's gone after two minutes, it's the placebo effect. You can be sure of that. Now the question is, why is the placebo effect not a proper justification for using Things like homeopathy. The simple answer to that is because I don't need homeopathy in order to create a placebo effect. If you have a health problem, you come to me and I treat it properly. For instance, with a pharmaceutical drug that is known to be effective and I emphasize with you and I listen to you and I...

And give you enough time to explain your problem, I generate a placebo effect. You will benefit from the placebo effect, plus the pharmaceutical effect of the drug that I prescribe. if I only give you a homeopathic remedy, you don't have the benefit of the pharmaceutical drug, you have the benefit of the placebo, but I cheat you out of the main component of you getting better, namely, the specific effect of the drug. in most instances, giving a placebo in clinical practice is dishonest, and being dishonest is unethical. if you have a treatable condition, then it's better to treat it rather than to give a placebo, because the placebo effect is short lived.

We don't understand exactly why some people respond to placebo effect and others not and why it is mostly short lived, sometimes very short lived, sometimes a bit longer, but on average it is short lived you certainly can't cure disease with a placebo effect. You can alleviate the symptoms, but you don't cure it.

Abhijit: Yeah, absolutely. And you know what, a lot of people claim that homeopathy, Ayurveda, a lot of these alternative medicines treat a disease from the root cause, whereas modern medicine only treats the symptoms. which I find is exactly the opposite.

Because in modern medicine, we understand germ theory, what cancers are, what causes diabetes, where the central problems are, and we try to manage those using evidence based treatments from as close to the root as we can get. If you want to get rid of a cancer, there is radiation therapy to target exactly that cancer, or we have specially designed chemotherapy regimes.

They're not pleasant, but they work. Now whereas in things like homeopathy, the medicines, the preparations are made from substances that are thought to cause the symptoms of the disease you have. And then dilute it to the extent where they are supposed to cure the disease, but they don't know the root cause of it.

They don't even understand germ theory, and yet they're here trying to treat it. How can that be a root treatment? It doesn't make any sense whatsoever.

Edzard Ernst: The notion of treating the root cause is hugely attractive to consumers. Because they often feel that modern medicine is just putting a sticking plaster on a deeper problem, whereas the long history taking in homeopathy goes much deeper, and therefore it makes sense.

From the perspective of the... Practitioner. It also makes sense. the practitioner is being taught that the root cause of the disease is the imbalance of life energies. If you think of acupuncture, you fall ill, according to acupuncturists, because your yin and yang are out of balance. to put it back into balance, you need to stick needles into acupuncture points and you need to have studied acupuncture.

This is a misunderstanding about the pathogenesis of disease. they have their own totally invented theories which have no... Foundation, in fact, they claim and are being taught in the schools and in every single book about alternative medicine, treating the deeper cause of the disease they believe it.

They are absolutely adamant because they believe that the stuff about yin and yang and life energy and so forth and they think that modern medicine studying molecular mechanisms is missing the target it's a fundamental misunderstanding i can understand how it happened but i can tell you it is complete bullshit

Abhijit: It's surprising how people, even with the least bit of critical thinking about that claim, can understand the deep problems that lie within it. And when it comes to this life energy, even chiropractic, basically says that all diseases stem from the spine, so straightening the spine will straighten your life and your health But a lot of people like on TikTok, and of course TikTok is banned in India, but on Instagram, on YouTube, there are a lot of people, having these images of chiropractors yanking their necks and twisting their heads and hips I've had a little bit of such adjustments. And yes, it did help when it come to when it comes to things like, neck pain or, what do you call it? Spondylitis. most chiropractors have now started using whatever they know in ways that actually work.

Are there applications where chiropractic actually helps, where it works, where it can be supported by evidence?

Edzard Ernst: Chiropractic is a big subject. There are two different types of chiropractors, the ones that are more modern and up to date are called the mixes because they mixed the mixed methods into the original principles of chiropractic. And the other ones are called the straights because they are straightforward perpetuating the gospel of D. D. Palmer, who invented chiropractic 120 years ago, and who said that virtually all human illness originates from subluxations of the spine and if the spine is subluxated then life energy cannot circulate therefore The spine needs adjusting and then everything is fine again. Palmer did not advocate primarily chiropractic manipulations for back pain or neck pain. his first patient was a deaf man. who he cured from his deafness by manipulating his upper spine. The second patient he allegedly cured had coronary heart disease and angina, and he cured his coronary heart disease by manipulating his spine. The fact That this is nonsense is pretty obvious to everybody.

What is not so clear is whether chiropractic and spinal manipulation is nonsense for back pain. There the evidence is very mixed. I am not convinced that it works even for back pain, and I'm convinced that it is quite dangerous for neck pain, because if you manipulate the neck, you can break an artery that supplies the brain, and then you have a stroke, there are hundreds of cases reported in the medical literature where this has happened. And there's no reporting system. Therefore, a few hundred cases being reported are very significant. Probably the true figure is in the tens of thousands.

 Nobody will ever manipulate my neck. I advise anybody who's listening to this not to let anybody, whether it's a physiotherapist, whether it's an osteopath or chiropractor, manipulate your neck or indeed, whether it's a doctor, because some doctors do it too.

Abhijit: So this is a lot more troublesome than I thought. I didn't know that there were tens of thousands. Yes, it has to be reported properly. does that happen almost immediately? Does that stroke take place almost immediately while they're on that funky little bed?

Edzard Ernst: Sometimes it happens immediately, sometimes what happens the artery is injured and blood clot forms in order to repair that and then the blood clot grows and eventually dislodges into the brain and then you have a stroke maybe three days later. so many cases are happening where the connection isn't made.

Imagine your grandmother having neck pain, getting her neck manipulated, and three days later your father finds her dead in her bed. Who's making the connection to the chiropractor? Nobody. The unknown might be absolutely overwhelmingly big. there's no monitoring system.

We know it's dangerous, but for one reason or another, chiropractors have not established a monitoring system.

Abhijit: Oh my goodness. Guys, if you're watching this, and if you're going to the chiropractor or if you're planning to go to the chiropractor, please don't I guess the mixers might treat you a little bit better, but why take a chance with that sort of thing when you get your neck broken over, something that can be easily fixed with a normal massage or just a trip to an orthopedist, which is cool.

Edzard Ernst: The mixers are called mixers because basically they have stolen modalities from physiotherapy. So if you want a mixer, why don't you go to the professional and go to a physiotherapist?

Abhijit: Or they can go to the bar and have a cocktail.

That's a nice mixer as well.

 Anyway, if it comes back to you, do let me know. But I think we've taken up quite a bit of your time. Thank you so much for that. we've packed in a lot of information into a relatively short period of time, I have to say. I will definitely get back to you. I think we have a lot more that we can unpack.

First of all, thank you so much for your work. your work has been absolutely phenomenal. It's been very inspiring for me as well. I think we need more people exactly like you to do the kind of work that you've done to research. alternative medicine and bring it to the light of evidence so that we can figure out what's going on I honestly think Ayurveda might have a lot of potential but the studies are just not being done they're not being done right like even Patanjali as you had critiqued their paper for corona kit There were a lot of holes in that paper.

There are a lot of holes in a lot of the Ayurvedic studies that are being done right now. So more power to you and to everybody you have inspired and all the work that you've done. Edzard, thank you so much for joining us.

Edzard Ernst: Thank you. I should maybe mention that if you're interested in, in, in following up new publications and my criticism of lots of them, then you should go on my blog, which is just edzardernst in oneword.

com. I post a new article virtually every day, mostly on. Criticism of what has just been published in Alternative Medicine. there you will see all the latest studies If you ever feel the urge to insult me, You can happily join in and I'll see you there.

Abhijit: Absolutely. Thank you so much. I'll put the link in the description and you can follow Edzard on Twitter as well. What is your Twitter handle again?

Edzard Ernst: I have no idea.

Abhijit: I'll put that down in the description.

Edzard Ernst: thanks for inviting me. See you soon.

Abhijit: See you soon.

Thank you so much. And guys, thank you so much for watching. This has been Rationable Conversations with Edzard Ernst, and that has been very illuminating indeed. Please subscribe to the channel and ring that bell so that you get notified next time the next video comes out.

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