‘Nobody knows what utter hell it is to be Prince of Wales,’ Charles said in November 2004. He had just spoken at the memorial service for the poet Kathleen Raine, who had died at the age of ninety-five. Her mystic philosophy had encouraged him throughout his adult life to proclaim his intolerance towards the materialism of the modern world and to ‘fight the battle’ to advance ancient insights. ‘Wisdom,’ he said in his address, ‘is born not of reductionist analysis but of contemplation and ultimately revelation.’ Spiritualism, encouraged by Raine, was guiding his life. ‘May God rest her dear departed soul,’ he ended, ‘and may flights of angels sing her to her rest.’ He did not seem concerned that his reference to himself, an outcast prince unsuccessfully rebelling against the state of the world, was at that moment, amid all the scandals, singularly inappropriate. Regardless, he carried on with his causes.
Those same mystic sentiments encouraged his faith in complementary medicine, although he no longer had confidence in the management of his Foundation of Integrated Health, fearing it had not made a significant impression – not least because Michael Fox, its chief executive, had failed to raise sufficient money, and had employed some unimpressive people. To solve what he described as a crisis, Michael Peat arranged to be appointed the foundation’s chairman to oversee Fox. ‘His standards of attire,’ Peat complained, ‘leave much to be desired. He forgets that he represents HRH.’ Like Peat, the majority of board members were dissatisfied with Fox, not because of his appearance, but following an unfortunate controversy.
Largely due to Charles’s aggressive campaign, complementary medicine’s status had markedly improved. In May 2003 his foundation hosted a relaunch addressed by Nigel Crisp, the permanent secretary at the Department of Health. The antagonism towards alternative medicine within some NHS circles was diminishing slightly. Charles wrote an article in the Guardian to assert with some confidence that the NHS should provide such treatments to prevent and cure allergies. He urged the government to research coffee enemas and carrot juice for the treatment of cancer, but at the same time cast doubt on nanotechnology, a method to manipulate materials one-millionth the size of a pinhead. Scientists, he added, did not know everything, and should be challenged. His disapproval of orthodox medicine provoked Michael Baum, a cancer specialist, to advise that the ignorant should remain silent. ‘My twenty-five years in cancer research,’ wrote Baum, ‘are just as valuable as the prince’s power and authority, which rest on an accident of birth. If homeopathy is correct, much of physics, chemistry and pharmacology must be incorrect.’
The criticism bounced off the prince. Boldly, he urged the government to oppose EU directives that banned the sale of untested herbs produced in China and sold as homeopathic remedies in Europe. The shrubs, according to the EU’s experts, could cause serious harm. Initially, Charles’s private protest to John Reid, the health secretary, was rebuffed. Reid sent him an advance copy of a paper that endorsed the EU rules for the statutory regulation of herbal medicine and acupuncture. Undeterred, Charles met Tony Blair, and after their meeting wrote that the Brussels directive requiring medicines to be licensed would have ‘a deleterious effect on the complementary medicine sector … I think we both agreed that was using a sledgehammer to crack a nut.’ Blair replied sympathetically, ‘The implementation as it currently stands is crazy … We can do quite a lot here: we will delay implementation for all existing products.’ He weakened the rules so as to delay the new laws until March 2011, and praised the prince for his contribution.
Charles tempered his successful lobbying with self-deprecation: ‘I think you will know by now to your cost!’ he wrote to Blair, ‘that there are matters about which I care deeply. But perhaps now I am too dangerous to associate with …’ Such humorous sign-offs were the nearest he got to self-criticism.
The following year, 2005, Charles individually encouraged both Michael Fox and Michael Dixon to approach Alan Johnson, the new secretary of state for health, to provide government finance for the foundation. Johnson, a supporter of complementary medicine, agreed on the eve of the general election to give £900,000 over three years to two universities to study the benefits of such therapies, and to organise the self-regulation of ten thousand practitioners of complementary medicine. The foundation also received funds from the Prince’s Charities Foundation, giving it an annual turnover of about £1.2 million.
A further £90,000 was donated by Robert Wilson, chairman of Nelsons, a manufacturer of complementary medicines. At the time, Wilson was financing a campaign to promote his company’s products intended for use during childbirth – ‘The use of Bach Flower remedies is another way of helping to reduce maternal anxiety in pregnancy,’ ran one ad. Although there was no scientific proof to support that assertion, Charles approved the advertisement and, to show his appreciation for Wilson’s donation, invited him to dinner at Clarence House.
Emboldened by government support, he also stepped up his promotion of complementary medicine as a cure for cancer. His favourite remedy was called the Gerson Therapy, advertised as ‘a natural treatment that activates the body’s extraordinary ability to heal itself through an organic, plant-based diet, raw juices, coffee enemas and natural supplements’. At a healthcare conference he told two hundred professionals, ‘I know of one patient who turned to Gerson Therapy having been told she was suffering from terminal cancer and would not survive another course of chemotherapy. Happily, seven years later, she is alive and well. So it is vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments.’
Prodding doctors to reconsider their use of chemotherapy as a treatment for cancer, and instead to offer their patients thirteen glasses of fruit juice and five coffee enemas per day, and weekly injections of vitamins, raised inevitable criticism. Charles made no distinction between leading a healthy lifestyle in order to prevent cancer, and the use of nutrition to cure the disease. Most doctors believed the Gerson diet probably hastened death. His embrace of the ‘blood flow’ theories advanced by Andrew Taylor Still, the inventor of osteopathy, raised yet more doubts. ‘Charles is a master of quackery,’ maintained Edzard Ernst, who classed Still’s opinions as pseudo-science. Fox was asked by Charles to neutralise Ernst’s defiance, so in 2005 the foundation published Complementary Healthcare: A Guide for Patients, which recommended the use of acupuncture to cure addictions and osteopathy to cure asthma, as well as listing homeopathic solutions for other complaints.
The publication sparked a further riposte from Ernst. He had just completed a study for the World Health Organization analysing the cost-effectiveness of natural cures. On the basis of twenty-seven economic evaluations, he concluded that there was no proof that the therapies provided any value. In a bitter exchange with Fox, he criticised the foundation’s new brochure as ‘misleading’ and failing to provide any information about the effectiveness of the treatments. ‘I knew I was declaring war against Charles,’ admitted Ernst. His battle isolated him throughout Exeter University.
Stung by his own appointee’s opposition, Charles encouraged Peat to mount a challenge. Peat commissioned the company Fresh Minds to produce a series of interviews promoting non-chemical therapies. Fox opposed the idea. ‘It isn’t the right approach,’ he told Peat. He feared a damaging debate.
Peat simply ignored the chief executive of the prince’s own foundation, and two young researchers began interviews with experts, including Ernst. But their work was abruptly halted by Charles. Rather than producing more advertisements, he said, the foundation should gather research to persuade government ministers of the value of alternative treatments, and directly challenge Ernst’s negative reports. This new directive, Peat and Tom Shebbeare agreed, could threaten the foundation’s charitable status, but neither chose to question the prince. Instead, Peat recommended that Charles appoint Christopher Smallwood, the former chief economic adviser for Buckingham Palace and Barclays Bank, to report on the cost-effectiveness of natural cures for the NHS. The report, Charles directed, would be presented to the government to support his argument that the NHS’s use of complementary medicine would save taxpayers billions of pounds.
Once again, Fox opposed the appointment: ‘Peat was talking about “Marketing the Foundation”, and I didn’t understand where he wanted to go. It was more important to secure more money for research to produce the scientific evidence in favour of complementary medicine.’ Fearful that the foundation was heading in the wrong direction, he continued, ‘Peat didn’t understand healthcare delivery, how to get change in the NHS or the complicated, fragmented world of complementary medicine.’ Nor, he believed, did the accountant understand Fox’s own efforts to introduce better regulation of practitioners of alternative cures.
Peat ignored Fox’s criticisms. Their relationship finally came apart over the private secretary’s aim to make the charity financially self-sufficient, regardless of where the money came from. He accepted a further donation from Robert Wilson, which Fox opposed as a conflict of interest. They agreed that Fox should resign. ‘I’m surprised you’re leaving,’ Charles said. After seven years, Fox knew it was pointless to explain why. He was followed by the charity’s accountant, who, in what proved to be a fateful decision, Peat replaced with George Gray as the foundation’s finance director.
Naturally, Charles did not consider offering any payment to Christopher Smallwood for his work, and, delighted by the commission, Smallwood did not ask for a fee. The Fresh Minds research, partly funded by Dame Shirley Porter, the controversial former Conservative leader of Westminster council, was limited to a survey of the published literature and interviews with six experts. ‘That was the best we could do,’ Smallwood would later concede. There was no other data he could use.
Homeopathy was an easy target for the critics, and Smallwood played to the enemy’s strength. Endorsing the placebo effect, he had recommended in his draft the value of the watery mixtures because some people felt better even if water produced no medicinal benefits. As a newcomer, he emailed Ernst the drafts of the relevant chapters, asking him to read them in confidence. Ernst assured him that the contents would not be disclosed to anyone.
In his draft, Smallwood suggested that about £480 million could be cut from the NHS’s prescription drugs bill if 10 per cent of GPs offered homeopathy rather than standard drugs, even for asthma; a further £38 million could be saved by prescribing the herbal remedy St John’s wort to 10 per cent of depression patients; and that milk thistle could treat liver problems. Smallwood did not cite any medical tests as proof. A pilot study, he wrote, showed that the use of complementary medicine had cut the number of consultations with GPs by 30 per cent, and the prescription drugs bill by 50 per cent. He concluded that the national use of homeopathy would save £4 billion from the NHS’s drugs bill. After reading that, Charles would feel vindicated.
Smallwood and Ernst met before Ernst had read the material, and his mood changed during their conversation. He disagreed with Smallwood’s conclusions that complementary medicine was effective in three areas, including acupuncture, and was appalled by Smallwood’s endorsement of homeopathic mixtures. ‘The bottles,’ he complained, ‘are mostly filled with water.’ Smallwood, a reasonable man, departed acknowledging that he and the fiery German would never agree.
Ernst, however, was indignant. In an increasingly acrimonious email exchange following their meeting, he told Smallwood that his draft was strewn with errors. By focusing purely on value for money and ignoring whether people’s health benefited from complementary medicine, the report was worthless. He added that his own report for the World Health Organization showed that this form of medicine was not cost-effective, and had actually added to the NHS’s bill. Moreover, a dozen scientific reviews had shown that homeopathic remedies were useless, especially in the treatment of asthma. The solution to rectify all the mistakes, he suggested, was that he should write the report for Charles.
Smallwood, with Peat’s support, rejected that offer. In response, Ernst asked for his name to be removed from the final document, adding, ‘You wrote the conclusions before you looked at the data.’ The dispute should have ended on that note, but in August 2005 the outraged professor spoke to The Times. Somehow the paper had obtained a copy of the draft chapters. Despite agreeing to Smallwood’s request for confidentiality, Ernst volunteered his comments. Aiming directly at Charles, and intending to ‘destabilise’ Smallwood’s conclusions, he told the paper: ‘These are outrageous estimates without any strong evidence to support them. The report glosses over the science and its methodology is deeply flawed. It is based on such poor science, it’s hair-raising.’ He added that Smallwood had ‘selected all the positive evidence and he left out all the negative studies’. He concluded, ‘The Prince of Wales also seems to have overstepped his constitutional role.’
Smallwood was furious that his uncorrected drafts had been leaked and his reputation publicly trashed. ‘Ernst broke our confidential agreement and was absolutely outrageous,’ he fumed, before emailing the professor that he would ‘regret’ his behaviour. He wanted Ernst’s head. So did Peat, and so did Charles.
A few days later, Steve Smith, Exeter University’s vice-chancellor, received a written protest from Peat. Acting not only as Charles’s private secretary but also as a foundation trustee (and its chairman), he complained about Ernst’s ‘disreputable breach of confidence’, and enclosed a letter just published in The Times from Richard Horton, editor of the Lancet, which echoed his outrage. Horton’s anger was unexpected, since the Lancet had just published a commentary by Ernst on another draft report about complementary medicine.
Equally surprising was Peat’s reliance on Horton, who had stated in his letter that ‘complementary medicine is largely a pernicious influence on contemporary medicine, preying as it does on the fears and uncertainties of the sick’. He would subsequently write that Smallwood’s published report ‘contains dangerous nonsense’.
Smith telephoned Peat. For Clarence House to interfere in a spat between academics, he said, was unusual. He asked whether Charles really wanted an investigation into a minor breach of etiquette that was not a sacking offence. After consulting the prince, Peat replied that he did. Accordingly, Smith asked the university’s Research and Ethics Committee to investigate whether Ernst had breached Smallwood’s requirement of confidentiality. The German rejected the allegation and, in his defence, argued that Charles was both challenging academic freedom and denying that ‘a doctor had a public interest not to be silent’. Thirteen months later Ernst was found culpable, but the offence was deemed too trivial to merit even a reprimand. He would remain at Exeter until his retirement seven years later – with full permission to criticise the prince.
As usual, Charles divided rather than united. Peat’s ‘usual snakepit stuff’, according to one eyewitness, pushed Smallwood to the sidelines, and palace politics took over. To assert Charles’s primacy, Peat and Shebbeare asked the prestigious King’s Fund to host a conference to discuss Smallwood’s report. The opening speaker was Peter Hain, the Labour secretary of state for Northern Ireland. To Charles’s satisfaction, Hain had announced his intention to introduce complementary medicine in Northern Ireland through the NHS. In turn, the King’s Fund endorsed some alternative therapies and urged the government to finance more research and to promote cooperation with NHS doctors. The Department of Health agreed to study whether Hain’s initiative in Northern Ireland should be copied in England.
The foundation appeared rejuvenated. Part of the credit, Charles acknowledged, was owed to Kim Lavely, the new chief executive appointed by Peat. Lavely, a former director of consumer organisations including Which, was, like Peat, unfamiliar with the NHS. She was also not a professional fundraiser. Nevertheless, she was told to find donors and to follow Peat’s mantra to ‘get a more balanced look at alternative medicines’. Peat’s new direction presented Lavely with a divided board. The diehards wanted the foundation to focus entirely on promoting complementary cures to the public, while others offered their support of Charles’s ambition to integrate natural remedies into the NHS.
After successfully reasserting Charles’s cause in Whitehall and in some universities, Lavely encountered another problem. During her quarterly meetings with Charles, the prince would support both strategies, but would then veer off to talk about some particular passion. ‘We must push Gerson,’ he said over cups of tea. Lavely was not surprised. At meetings with health ministers, Charles would ignore the agreed agenda and switch to preaching about the importance of Gerson’s Therapy. Usually in these sermons he referred to some personal experience of the previous twenty-four hours. Lavely’s scepticism about Gerson, she could see, did not please her employer. Without any scientific evidence that coffee enemas would cure cancer, she told Charles, the foundation’s credibility would suffer. ‘Well, get the evidence,’ Charles spluttered. Patiently, Lavely explained that only controlled trials could produce scientific proof, and that finding cancer sufferers prepared to risk their lives to justify Gerson would be difficult. Charles’s anger mounted. Hovering over every discussion was Professor Ernst’s public rebukes about homeopathy. The German’s criticism, Lavely discovered, ‘drove Charles crazy’.
‘There are different types of evidence,’ retorted Charles, ‘and the evidence of experience is just as important as scientific evidence.’ To calm his irritation, he regularly lapsed into reflections about the ‘harmony’ of the projects and places he knew, before ending the meeting. Clearly, he was reluctant to discuss the charity’s administration with Lavely. For him, the natural world was much more relevant than the practical one.
As the standoff continued, Charles was unwilling to approve the additional money Lavely repeatedly requested to keep the foundation from insolvency. Any hope that Peat might support the practical agenda evaporated. At board meetings, he closed down any discussion that contradicted Charles’s convictions. A look of iron resolve would cross his face as he protected his employer. At her meetings with the prince, Lavely encountered the same resistance.
‘How do you get to their offices?’ Charles had asked Peat, seemingly unaware where the foundation had relocated after leaving Holloway, a seedy north London area disliked by Peat.
‘By bike, of course, sir,’ replied Peat.
‘Oh,’ said Charles, wincing. ‘I would so like to do that.’
His hands were clutched tightly, hiding his chewed fingernails, as he drifted into a description of his visit to the Physic Garden in Chelsea. With sudden animation, he described the plants growing there for use in complementary medicine. ‘You see, it’s not just me who believes in this,’ he sighed. Lavely departed without any agreement about finding money. Sensing the direction of the tide, Peat lost interest and resigned as chairman, to be replaced by Tom Lynch, an Irish businessman who promised cash. Like so many donors, Lynch had been enticed to ‘keep an eye’ on the charity, but Clarence House transferred his donations to other trusts and not to the foundation.
Charles’s campaign had reached a crossroad. His support for treating the ‘mind, body and soul’ was undermined when, addressing an audience in May 2006, he referred to the origins of diabetes and heart disease as a disturbed flow of blood. The ‘sacred geometry’ of the body, he continued, composed by a ‘spiral’ of numbers called the ‘Fibonacci sequence’, was his diagnosis for the cause of those illnesses. Complementary medicine, he said, including Gerson’s Therapy, provided the proper cure. ‘Harmony’ was the answer.
His suggestions were ridiculed by doctors and scientists alike. ‘Homeopathy,’ admitted Michael Dixon, ‘was Charles’s Achilles heel. There was so much more that was credible.’ The herbal practitioner Simon Mills had become disillusioned. The complementary medicine team, he lamented, had ‘failed to get their act together’. Instead, they had engaged in pointless territorial and professional disputes. ‘There is an absence of leadership,’ said Mills. ‘There’s no Mr Complementary Medicine.’ Charles could not fight the battle alone, but his frustration that his wishes were not being obeyed paralysed the foundation. ‘In the vacuum,’ recalled Mills, ‘we didn’t deliver a fully argued opinion against Ernst, and so there was no lobby to bridge the division between complementary and orthodox medicine.’ He abandoned the foundation and the campaign.
By 2007, the beginning of worldwide financial turbulence coincided with the crisis at the foundation, just as David Brownlow, a self-made entrepreneur and publicist known in Clarence House as a ‘king of donors’, was appointed as president of the Prince’s Foundation for Integrated Health. To Kim Lavely, Brownlow showed little interest in his new fiefdom.
The absence of leadership had weakened virtually all of Charles’s charities, by then heading towards twenty-five separate organisations. Each chief executive was still chasing the same sources for funds, and the duplication included needlessly rented offices and other overheads. To reduce costs, Shebbeare was once again told that merging was the answer, but as before the chief executives and their boards refused to sacrifice their independence. Charles, they knew, enjoyed saying ‘all my charities I’ve created’. Numbers were important to him. Unable to overcome these objections, Shebbeare struggled to achieve a single economy.
Among those who supported a merger to solve their own charity’s financial crisis was Lavely. Charles begrudgingly met her plea for money, persuading Robert Wilson to pledge a further £150,000, making a total £194,000 for the year 2007, while the government contributed an extra £110,000, bringing the taxpayers’ stake to £1.1 million. In Lavely’s opinion that was still insufficient, yet no one offered more. Mark Leishman, Charles’s deputy private secretary newly responsible for the medical charity, focused entirely on implementing Charles’s wishes to promote Gerson and other therapies. Lavely was bewildered. ‘It’s driving me crazy,’ she told Leishman. ‘Close the foundation down. You aren’t providing the money to make it work.’
Leishman too was powerless. He could only refer it ‘up’. Proper management was impossible. Lavely resigned. Automatically, she was removed from Charles’s Christmas card list. She was not replaced. Instead, George Gray, the finance director, was made temporary chief executive.
Disaster struck the following year. The audit of the 2008 accounts revealed that the financial director, George Gray, had stolen nearly £253,000 from the foundation. He would be convicted of theft and jailed. The foundation, Charles and Michael Dixon agreed, could no longer continue with the prince as sole standard-bearer. The £1.1 million donated by the Department of Health had been spent. The collateral damage to Charles’s reputation was a warning about the result of mismanagement.
‘The fraud was a shock,’ admitted Dixon. ‘The brand was sullied.’ He and the other trustees resigned from the board, and the bankrupt foundation closed. Not only was Charles embarrassed, but the ‘Pathway in Integrated Health’ course at Exeter University was wound up. Edzard Ernst was, as usual, available to comment, particularly about the prince. ‘Under the banner of holistic and integrated healthcare,’ he told the Guardian, ‘he promotes a quick fix and outright quackery.’
Charles found the renewed criticism ‘very difficult’, said Dixon. The prince ‘was surprised by the vindictiveness making him out to be a monster. There was a feeling of hurt about the way he was being attacked, like an academic jihad against him and complementary medicine. He found it strange that just a few people could so loudly denounce his ideas to promote the importance of lifestyle, social relationships, daily exercise and healthy living.’ But, Dixon concluded, ‘the attacks made him more determined to make his case. He had courage to stick to his guns.’