Chapter 4: Mission Impossible

On 17 September 1993, we arrived in Exeter with two huge lorries full of our furniture and other belongings. We had bought a slightly dilapidated yet rather splendid old house in the centre of Exeter. The builders had promised that the much-needed renovations would be finished before our arrival but, as happens with builders everywhere, that had unfortunately been an over-optimistic prediction. For the first three or four weeks we lived in total chaos, yet despite the thick clouds of plaster dust, mountains of rubble and treacherous voids left by pried-up floorboards, we were utterly euphoric. Nothing could possibly spoil our excitement: we had arrived amongst people we liked and felt instantly comfortable with. As soon as the head of the postgraduate medical school, Prof. Perreira-Gray, learned that we had arrived, he called with a bottle of champagne to celebrate the occasion with us: what kindness and what style! This, we felt, was the way to live and the place to be.

The first few months in Exeter were dominated by an overwhelming sense of relief and profound happiness: we had finally managed to make our home in the country of our dreams; we felt like two refugees who had found their way to freedom.

People seemed both fascinated and puzzled by us. What had brought us here? How could we possibly have chosen the staid, unassuming country town of Exeter in preference to the sophistication and the bright lights of Vienna? How could anyone in his right mind exchange the medical school of Vienna with a mere postgraduate medical centre in Exeter? My short, and truthful, answer usually was: “We truly love England and are more than happy to be here.” Most people were very pleased, even flattered with this explanation but, of course, it was more complicated than that. Yes, we had long dreamt of living in England, and yes, I desperately wanted to escape the politely suffocating, intrigue-ridden world of Viennese academic medicine. But I also wanted to turn my full attention back to research, and the Exeter appointment offered a wonderful opportunity to do just that. I had never forgotten my years in the earnest collegial atmosphere of St George’s, which was in many ways so singularly British and so unlike the research environments that I had subsequently experienced. And then there was the nature of the research itself: I would have been content researching almost any area that I knew well enough to investigate competently, but the fact that this appointment was focused on research into alternative medicine seemed particularly intriguing to me. I was going to investigate uncharted territory - and what could be more exciting than that?

Alternative medicine had by then begun to attract a considerable amount of public attention - and not a little controversy. To me, raised as I had been in Germany, where alternative medicine had been considered unremarkable, just another ancillary means of supporting general health, the passions that could be so quickly aroused by this subject in other countries such as the UK and the US were philosophically and culturally intriguing. It seemed that now was an ideal time to shine the cool, dispassionate light of reason onto the whole topic of alternative medicine, to evaluate scientifically what its contribution had been to date, and to establish what role it might conceivably play in the age of evidence-based medicine.

I had no idea just how deeply emotional and worryingly politicized the debates in and around alternative medicine had already become, but I was about to find out.

As my new position was the first chair of its kind, the university administrators had decided to organize a press conference. Universities tend to like such events: they create publicity - and publicity would create prestige which might in turn generate funds. I was not unfamiliar with the task of facing the press and knew that these occasions could easily turn awkward: one can never predict what questions journalists might come up with. In this particular instance, not only I but also Sir Maurice Laing (who had endowed the chair) as well as the Vice Chancellor of the University were to make brief statements, after which the journalists would have the opportunity to quiz us. As alternative medicine was a controversial topic, we tried to play it safe: the Vice Chancellor praised the generosity of Sir Maurice and spoke of the unique opportunity his endowment would offer for both the University and the field of complementary medicine, as well as of the University’s good fortune in finding an experienced professor to tackle this difficult and important task. For his part, Sir Maurice told the audience of his deep conviction that rigorous research and proper science were the best ways to reveal the true value of the treatments that he and his wife had repeatedly found helpful.

Then it was my turn. I briefly outlined my professional background, explained what rigorous research in alternative medicine would entail and where it might take us. When I had finished, one journalist in the front row raised his hand: “What will you do, Prof Ernst, when your medical colleagues turn out to be sceptical about alternative medicine?” Shooting from the hip, I answered: “I am not worried about that, because I intend to be more sceptical than they are.” As soon as these words had crossed my lips, I wondered how the benefactor would take this somewhat provocative and unexpected comment. My concern turned out to be unfounded: everybody smiled approvingly, including Sir Maurice, probably thinking that I had not meant it entirely seriously - but indeed I had.

A considerably more aggressive and curious public challenge occurred a few weeks later during a conference hosted by the Research Council for Complementary Medicine in London. This organization had been established a few years earlier with the aim of conducting and facilitating research in all areas of alternative medicine. My impression of this institution, and indeed of the various other groups operating in this area, was that they were far too uncritical, and often proved to be hopelessly biased in favour of alternative medicine. This, I thought, was an extraordinary phenomenon: should research councils and similar bodies not have a duty to be critical and be primarily concerned about the quality of the research rather than the overall tenor of the results? Should research not be critical by nature? In this regard, alternative medicine appeared to be starkly different from any other type of health care I had encountered previously.

On short notice, I had accepted an invitation to address this meeting packed with about 100 proponents of alternative medicine. I felt that their enthusiasm and passion were charming but, no matter whom I talked to, there seemed to be little or no understanding of the role of science in all this. A strange naïvety pervaded this audience: alternative practitioners and their supporters seemed a bit like children playing “doctor and patient”. The language, the rituals and the façade were all more or less in place, but somehow they seemed strangely detached from reality. It felt a bit as though I had landed on a different planet. The delegates passionately wanted to promote alternative medicine, while I, with equal passion and conviction, wanted to conduct good science. The two aims were profoundly different. Nevertheless, I managed to convince myself that they were not irreconcilable, and that we would manage to combine our passions and create something worthwhile, perhaps even groundbreaking.

Everyone was excited about the new chair in Exeter; high hopes and expectations filled the room. The British alternative medicine scene had long felt discriminated against because they had no academic representation to speak of. I certainly did sympathize with this particular aspect and felt assured that, essentially, I was amongst friends who realized that my expertise and their enthusiasm could add up to bring about progress for the benefit of many patients.

During my short speech, I summarized my own history as a physician and a scientist and outlined what I intended to do in my new post - nothing concrete yet, merely the general gist. I stressed that my plan was to apply science to this field in order to find out what works and what doesn’t; what is safe and what isn’t. Science, I pointed out, generates progress through asking critical questions and through testing hypotheses. Alternative medicine would either be shown by good science to be of value, or it would turn out to be little more than a passing fad. The endowment of the Laing chair represented an important milestone on the way towards the impartial evaluation of alternative medicine, and surely this would be in the best interest of all parties concerned.

To me, all this seemed an entirely reasonable approach, particularly as it merely reiterated what I had just published in an editorial for The Lancet entitled “Scrutinizing the Alternatives”.

My audience, however, was not impressed. When I had finished, there was a stunned, embarrassed silence. Finally someone shouted angrily from the back row: “How did they dare to appoint a doctor to this chair?” I was startled by this question and did not quite understand. What had prompted this reaction? What did this audience expect? Did they think my qualifications were not good enough? Why were they upset by the appointment of a doctor? Who else, in their view, might be better equipped to conduct medical research?

It wasn’t until weeks later that it dawned on me: they had been waiting for someone with a strong commitment to the promotion of alternative medicine. Such a commitment could only come from an alternative practitioner. A doctor personified the establishment, and “alternative” foremost symbolized “anti-establishment”. My little speech had upset them because it confirmed their worst fears of being annexed by “the establishment”. These enthusiasts had hoped for a believer from their own ranks and certainly not for a doctor-scientist to be appointed to the world’s first chair of complementary medicine. They had expected that Exeter University would lend its support to their commercial and ideological interests; they had little understanding of the concept that universities should not be in the business of promoting anything other than high standards.

Even today, after having given well over 600 lectures on the topic of alternative medicine, and after coming on the receiving end of ever more hostile attacks, aggressive questions and personal insults, this particular episode is still etched deeply into my memory. In a very real way, it set the scene for the two decades to come: the endless conflicts between my agenda of testing alternative medicine scientifically and the fervent aspirations of enthusiasts to promote alternative medicine uncritically. That our positions would prove mutually incompatible had been predictable from the very start. The writing had been on the wall - but it took me a while to be able to fully understand the message.

* * *

In contrast to Germany or Austria, alternative medicine in the UK is not normally in the hands of doctors. Instead, it is practised by a disparate array of independent workers - acupuncturists, chiropractors, homeopaths, herbalists, reflexologists, aromatherapists, naturopaths, healers, iridologists, massage therapists, osteopaths, etc. These alternative practitioners have not studied medicine; in fact, many have little training and no medical or academic education to speak of.

What is worse, most alternative practitioners exhibit a deep resentment towards science. By its very definition, “alternative” signifies “anti-establishment” and, in turn, this is understood as “anti-science”. Being both a doctor and a scientist, I was the perfect symbol of the establishment: in the eyes of a fundamentalist I embodied “THE ENEMY”, someone who must be resisted, fought and eventually defeated - or at the very least silenced.

But, of course, it is in the British national character to abide by the rules of fair play: it would be very poor form to deny the new professor his chance. Thus open hostilities were postponed and, for two or three years, the world of alternative medicine seemed to hold its breath, giving me the benefit of the doubt. Meanwhile, both my work and I were watched with great suspicion; my aims, methods and research concepts were questioned, and aspersions were none too subtly cast on my motives and integrity.

Being constantly challenged in this way was not at all a problem for me; on the contrary, after the stuffily devote atmosphere in Vienna, I found it quite stimulating and continued to harbour the hope that it might be possible to harness the criticism in a constructive way. After all, my team and I were about to venture into uncharted territory, and it was therefore necessary and potentially helpful to make sure that each step was carefully considered.

I was keenly aware of the concerns and worries of alternative practitioners and ready to accommodate them as much as I possibly could. Consequently, I accepted every invitation to give lectures and regularly spent long hours in discussions and debates trying to make sure that all reasonable views were taken on board. However, what did eventually tire, and at times really exasperated me, was the insistence of many in the alternative medicine camp that their favoured therapy should somehow be exempt from scientific testing.

Actually, it was often even more extreme than that. Many players in the UK alternative medicine scene also rejected the concepts and the tools of mainstream medicine. Most alternative practitioners felt no need to question, let alone test, their traditions, ideas, notions or claims. Those few who would consider science at all would advocate it as a means of proving that their concepts were correct, usually with a view to improving their status, advancing their trade or increasing their income. The field of alternative medicine seemed rife with fundamentalists; people who had an evangelical conviction; crackpots who could not think straight; garrulous pseudo-researchers who had never conducted real research or even tried to understand science; pseudoscientists who found it not unusual to research an entirely implausible treatment and produce one false-positive result after the other; and overt anti-scientists who believed that science was a serious threat to everything they believed in. Unfortunately, such attitudes turned out to be right at my doorstep, and I had to address them sooner and more directly than I had ever imagined.

* * *

The University of Exeter had received the initial Laing endowment of £1.5 million not least because, a few years earlier, the University had opened the Centre for Complementary Health Studies (CCHS). Negotiations between the Laing representatives and other (arguably more prestigious) institutions to accept the endowment had failed, apparently because these other universities feared that a chair in complementary medicine might tarnish their academic reputation. From today’s perspective this seems hard to imagine but, in the early 1990s, things were very different: alternative medicine was still seen as a subject too dubious to be allowed into the “ivory tower of academia”.

Without wanting or even realizing it, I had become the director of the CCHS. I had not appreciated that this role would automatically fall into my lap: the job description had merely stated that I would be “based” at the centre. Taking charge of it meant that I had unknowingly ousted the centre’s two former co-directors - and not only that: I had become their new boss. The two ex-directors, the herbalist Simon Mills and the acupuncturist Roger Hill, seemed distinctly miffed at this turn of events and appeared to feel uneasy at the prospect of someone breathing down their neck.

It occurred to me that I had landed myself in a rather awkward situation. For the time being, I thought it would be prudent to interfere as little as possible with any of the activities at the CCHS. I decided to lie low for a few months and simply observe what this unit was all about.

What I learnt in the course of this period worried - no, it horrified - me. I had become the head of a small group responsible for teaching a Bachelor of Science (BSc) course tailor-made for alternative practitioners. In order to judge the quality of the course and the thoroughness of student supervision, I studied a dozen theses that had been written by the centre’s former graduates and had earned them the desired BSc degree. My hope was to see whether any of this material might be publishable. This would have been a good way to put the CCHS on the map of medical research and, at the same time, it might reward the students for their hard work. As it turned out, none of these documents would have, in my view, passed the process of peer-review in a reputable medical journal. I had read lots of poor research in my life, but when it came to pseudoscience and inadequate research these documents seemed in a class of their own. The typical thesis would be based on a small survey of the student’s own patients who had elected to use a particular therapy and were evidently happy with their choice - otherwise they would hardly have continued paying for it. The student would pose a few questions to the patients about the perceived value of the intervention. Predictably, the answers were extremely positive. Thus the conclusion of this “research” might be that this particular treatment modality - aromatherapy, for example - was clearly effective and should be used more widely. Perhaps I am exaggerating a bit, but the point is clear: this type of enquiry would tell us nothing more instructive about the worth of a treatment than the observation that, if people choose to pay for something, they tend to claim that they have spent their money well.

Things quickly got worse when someone told me about the “Feasibility Study” which Exeter University had submitted to Sir Maurice Laing in order to compete for the endowment. The day I managed to obtain a copy of this document, I needed a very stiff drink to relax. To my shock and horror, the study described the role of the new chair essentially as designing and running more educational courses to bachelor and masters level using various means, including distance learning. This had certainly not been my intention, and neither was it the remit I had signed up to.

In truth, while all my previous jobs had entailed some teaching commitments, teaching was not an aspect of my work that I truly enjoyed. I had always been acutely aware of my own shortcomings as a teacher: the memory of the uninspiring teachers of my childhood, whose only reason for remaining in that profession seemed to be the malign pleasure they derived from exercising power over their reluctant pupils, had left an indelible impression on me. But, most of all, I was eager now to spend the majority of my time doing research. In other words, teaching alternative practitioners was neither my calling nor my skill; on the contrary, it seemed a bit like the subject of a nightmare. So I went straight to the Vice Chancellor, David Harrison, to discuss this issue with him directly.

During my two decades in Exeter, I had the opportunity to work under three different Vice Chancellors. David Harrison, the first one, was a true gentleman, a compliment that, unfortunately, I would hesitate to pay to his two successors. He smiled and assured me not to worry: of course, he knew about my plans to concentrate on rigorous research and he fully supported it. Not only that, but he was very clear about the fact that the University had appointed me precisely because of my research ability and track record in science. The “Feasibility Study” should be ignored, he said. What a relief!

But what was I to do with the CCHS and its two ex-directors? The more I learnt about their BSc course, the more concerned I became. In addition to some solid and well-taught subjects such as statistics and law, which were in the hands of respectable professionals recruited from other university departments, students were exposed to what I felt was a steady stream of pseudoscience about energy healing, vitalism, traditional Chinese medicine, homeopathy, etc., all taught by naïvely uncritical believers in the respective subjects. How on earth could I take responsibility for such an irrational curriculum?

What was I to do? My alarm-bells were ringing loud and clear, even keeping me awake at night. A BSc course in claptrap and my agenda of rigorous scientific enquiry were as incompatible as fire and water. With the best will in the world, this story could not possibly have a happy ending. I had started my contract in October 1993, and by the end of that year I had realized that the CCHS was a disaster waiting to happen. It had the potential to impede my research agenda and even to seriously tarnish my academic career, as well as the reputation of Exeter University.

On arrival in Exeter, I had been elated. Only two months later, my enthusiasm had been replaced by grinding worry. There were moments when I started to doubt that leaving Vienna had been the right decision. This sentiment of having made a wrong professional move was entirely new to me. Of course, I had felt a strong need to escape the stultifying environment of Vienna with its “golden cage” but even there I never had experienced deep regrets. In Vienna, I had been in charge of about 120 staff, in a well-funded department that was housed in very large and brand new premises. In Exeter, by contrast, I found myself with less than a handful of recalcitrant co-workers, no rooms to speak of and tightly limited funds. I had given up a professorship for life and accepted one with an uncertain long-term future. I had halved my salary and had swapped a luxury office for one that looked more like a broom cupboard. I had exchanged a whole armada of secretaries for one singularly ungifted temp. Worst of all, I had come here to conduct research in conjunction with alternative practitioners who, on closer inspection, seemed to feel threatened by science in general and me in particular.

Why did you take this job? I asked myself. How on earth can you sort out this mess? All I had wanted was to lead a peaceful and quiet life in England, to get away from the academic in-fighting in Vienna, to be out of the limelight and do some meaningful research. I hadn’t specifically sought out alternative medicine research. Yes, it was an interesting subject, but there were many other topics that were at least as fascinating.

Ruefully I remembered how most of my friends had warned me that a move into alternative medicine might turn out to be a perfect way to ruin a promising academic career. I had ignored them, not least because I did not want a “career” in the first place. I had happily decided to retire from my Viennese life as an academic high-flyer, and I certainly did not wish to fight against anyone anymore. The last months in Vienna had been a long, unpleasant battle with an increasing number of adversaries; not being a born fighter, this struggle had worn me out. Now I was looking for a calm environment in which to research productively. Had I gone from the frying pan into the fire?

What on earth could I do? It seemed to me that there was no other solution than to roll up my sleeves and get on with the job at hand. The only way I could accomplish anything, I decided, was to completely detach myself from the CCHS and its oddballs, and if at all possible to do so in a way that did not create too much fuss or ill feeling. I quickly negotiated this option with the appropriate university officials who proved surprisingly sympathetic to my suggestion. It felt a bit like forcing doors that had already been open: everyone I talked to saw my point and promised to support my plans.

My next task was to consult the two external advisors to my chair concerning the need for separation from the CCHS. The Laing Foundation had appointed Dr William Davey, the Queen’s homeopath, to guide my actions, and the University had asked Sir James Watt, retired Surgeon General of the British Navy, to act as their advisor. I was not at all sure where these two individuals might stand regarding the CCHS. Davey in particular seemed to identify with the idea of promoting homeopathy to a degree that worried me. It therefore took some careful preparatory work followed by gentle persuasion. But eventually both advisors agreed that, in order to build up a high quality research team and an international reputation for first class research, I needed be freed of the shackles of the CCHS.

Then I had to convince the two former co-directors of the CCHS that it would be in their best interest to consent to the separation. This last step in my plan turned out to be a piece of cake: when I offered them £50,000 of the Laing endowment (as had been agreed with my peers) together with the prospect of regaining their independence from me, they could barely hide their excitement. They were clearly delighted with the thought of once again being in charge and able to continue their forays into quackery. They accepted my proposition without any hesitation whatsoever.

This was perhaps less surprising than it looked: by that time, our relations had become fairly tense. In my frustration concerning the academic standards of the CCHS I had gone as far as to declare that “this is a university, not a knitting class”. They did not consider my comment to be funny at all and made sure it became widely known around the campus and misunderstood as a sexist remark. Luckily I was able to point out that knitting is not necessarily an exclusively female occupation and that assuming otherwise was arguably sexist in itself. This and many other disagreements had created an atmosphere of overt animosity between us. Consequently, they seemed as happy to get rid of me as I was delighted to move on. About two years later, the CCHS was closed down - although not because of its promotion of anti-science, pseudoscience and outright quackery, nor because of its undistinguished academic standards, but for the more prosaic reason that its directors had failed to render it financially viable.

Roughly a decade later, a lively debate emerged about what had by then had become sardonically known as “quackademia” - first on a national, and eventually also international, level. At that stage, numerous university courses in alternative medicine had sprung up, as far as I could see, all of them dominated by pseudoscientists. Eventually, alarm at the teaching of quackery at university level began to grow. An increasing number of experts felt that it was wrong, even dangerous, to brainwash youngsters with mystical nonsense, potentially undermining rationality and critical thinking in the larger society. As a consequence, most of these alternative medicine courses were closed down again. I pride myself on being among the very first to achieve such a victory of reason, without undue fuss, controversy or publicity.

The first major obstacle on the road to some proper science had been overcome. Now I needed to organize the logistical infrastructure for successful research: a team of bright and dedicated co-workers, adequate premises - and, of course, money to pay for all this.

Dr Karl-Ludwig Resch had been my co-worker ever since he had graduated from medical school in Munich and started working as my research assistant in the field of blood rheology. Later, he had followed me from Germany to Austria and, in 1993, he volunteered to come to Exeter. He had done a splendid job in helping my Viennese team get organized, and had been particularly useful in encouraging critical thinking among our co-workers. We had even managed to establish a course on this important topic in the Viennese medical curriculum.

Now, once again, Dr Resch proved to be an invaluable help in setting up a research team. We became close friends and our work continued to be successful - so successful, in fact, that after only one and a half years in Exeter he was offered a professorship back in Germany which he accepted and holds to the present day. Other researchers followed, most notably Dr Adrian White, an experienced and nationally known acupuncturist. Within a year of our arrival in Exeter, my team had grown into a group of a handful of co-workers with expertise in a range of relevant areas and, most importantly, with lots of enthusiasm for giving “mission impossible” a good try.

My next step was to find adequate premises for my growing unit. This unfortunately proved more of an obstacle than anticipated. For several months, we were shunted from one provisional location to the next. At one time, the university administration even tried to squeeze us into a Portakabin. This was where I drew the line and protested forcefully. Eventually suitable rooms were rented close to the Postgraduate Medical School (PGMS), which, a few years later, developed into the Peninsula Medical School (PMS). Even though my contract was with the University rather than the medical school per se, I had always been keen to be affiliated as closely as possible with my medical colleagues. The director of the PGMS, Prof Pereira-Gray, was most supportive of this aim, yet despite his influence, I was unable to get rooms on the hospital grounds. It seemed that some colleagues wanted nothing to do with anyone related to alternative medicine: the idea of a “witch doctor” amongst their ranks made them feel uneasy, it was rumoured. This attitude only changed once the separation between the CCHS and my research unit had become general knowledge and after the generally sceptical hospital consultants had read some of my early articles, finally convincing them that my aim was not to promote but to scientifically investigate alternative treatments.

The final item on my “to do” list was money. The initial Laing endowment of £1.5 million was certainly generous but it was not nearly enough to support a sufficiently sizable research team for any length of time. Essentially, the financial plan was for my unit to live off the income that the invested capital would generate. In order to build up a strong team I therefore had to find more money. The university fundraiser was charged with spearheading this effort; after all, the University had signed a contract with Sir Maurice Laing to match his funding.

We decided to hold regular discussion meetings about how to raise the necessary funds. Even though our attempts to procure funding met with little success, I was repeatedly assured that, if all else failed, we would be underwritten from the University’s substantial core endowment. University officials made it very clear that they viewed this issue to be a priority.

From the start, it was obvious to me that money was the Achilles heel of the whole undertaking, but as far as I could see there was no choice but to trust the many assurances my peers were giving me: funding would be found by hook or by crook. This trust would prove misplaced.

* * *

Over the years I had acquired considerable expertise in the design and conducting of clinical trials. I had run and published about two dozen such investigations and I was certain that this type of research would be the most productive way to evaluate alternative medicine. The original advertisement for my post had described the task of the new professor as “encouraging the assimilation of appropriate treatments into conventional medicine”. As I saw it, the best possible way to test the effectiveness of any treatment, new or old, standard or unconventional, mainstream or alternative, was by conducting clinical trials, and everybody with whom I discussed this question - including Davey and Watt, the two external advisers - agreed with this view.

I was equally convinced that thorough investigation of the safety of alternative treatments was urgently required; in fact, the more I thought about it, the more I felt that this issue should be at the top of our priority list.

People tend to assume that so-called “natural” treatments are risk-free, yet one needs to look no further than deadly nightshade, botulism or poisonous mushrooms to illustrate that such notions about the harmlessness of nature are ill founded. Patient safety is far too important to allow it to be based on mere assumptions. What we needed were facts, not opinions. Alternativists usually disagreed with this view, pointing out that conventional medicine, and pharmaceuticals in particular, were burdened with much greater risks than alternative treatments. I argued that, while this may well be so, the worth of any intervention must be seen in the context of a balance between its risks and its demonstrable benefits. If the benefits are uncertain, then even relatively small risks will weigh heavily and tilt the risk–benefit balance into the negative.

As a nation, we spend huge amounts of money on alternative medicine. Globally the annual sum is now about US $100 billion, and one estimate we arrived at in cooperation with the BBC implied that, in the UK, we spent £1.6 billion each year on alternative medicine. It would therefore seem entirely prudent to investigate whether this money is well spent. Are alternative treatments cost effective? Particularly on the political level, this question seems highly relevant, especially if increasingly scarce public money and resources are to be diverted in order to pay for the use of such treatments alongside standard care. In my view this was, and remains, an important research topic and a question that still has the potential to determine the future of this field.

Our three main research questions had thus been determined:

After roughly one year of preparatory work, everything seemed to be in place for our research to start in earnest. Around this time, I was asked to write a “mission statement” for my new research unit, which had by then been given the official title of the Department of Complementary Medicine. “A very British thing”, a friend explained when I enquired what a mission statement might be. “Just put on paper what your unit stands for.” I gave it some thought and formulated our mission as clearly and concisely as I could:

People reading my mission statement tended to be slightly puzzled by the inclusion of “analytical thinking” as a specific, separate item, but even after two decades, I am still pleased that I added it. The fostering of critical analysis is vital to any scientific endeavour, and perhaps particularly so in a field that, until now, has been so accustomed to special pleading and so sheltered from objective evaluation.

While studying medicine, I had not been well instructed in critical thinking. It was only later that I had realized how vulnerable health care can be without it. In Vienna, we had managed to smuggle the subject onto the medical curriculum. In Exeter, I soon discovered how woefully uncritical the attitude towards alternative medicine frequently was. This phenomenon was noticeable not just when reading the popular press or when talking to lay people but also, and perhaps even more worryingly, it was equally obvious in discussions with health care professionals. This lack of critical thinking, I felt, had the potential to hinder progress or even to cause significant harm. Particularly during the later years of my time in Exeter, the theme of critical analysis would dominate my work.

My peers were happy with the mission statement, and most rational thinkers who saw it thought it was ambitious but sound. However, in many alternative medicine enthusiasts it aroused suspicion; they seemed dismayed and felt that it was misguided. Some offered the opinion that alternative medicine should not be scientifically scrutinized at all. Others believed that my work should be directed much more at promoting alternative medicine rather than questioning it. Some argued that a professor of complementary medicine should be unabashedly sympathetic towards those working in this area, and that this attitude should be specifically articulated in any mission statement. Yet others argued that the mission statement should focus primarily on sociological or psychological issues rather than medical questions.

I listened patiently and politely to everyone who wanted to comment. I discussed, re-evaluated, re-discussed and reconsidered my position. But whichever way I looked at it, I couldn’t escape the conclusion that the arguments of my critics were at best unconvincing or irrelevant, and at worst they were downright misleading - and I became determined to show why.

I was not a politician, nor was I a propagandist or an ideologue: I was simply a scientist, and as such my role was not to further the ambitions of interested parties but to determine the true value of alternative medicine. Patients and consumers have an absolute right to know the truth about the value of the treatments they frequently use, and the obligation of a researcher is to determine truth. That required a rigorous medical research agenda which would steer us clear of the post-modernist approach advocated by so many who tried to influence me and my growing team of investigators.

Over the years, my resolve to stay on this straight and narrow path of objective medical research has provoked endless criticism. Indeed, the potential for conflict had been there from the outset, when, at that very first lecture for alternative practitioners, I had been publicly challenged: “How did they dare to appoint a doctor to this chair?” Now that I had realized that this tension existed, I had to decide how to deal with it in my professional capacity.

Initially I made a conscious effort to avoid discord, not because I lacked the necessary courage or convincing arguments, but for a variety of other reasons, both personal and pragmatic. Firstly, I do not enjoy disagreements nearly as much as some people seem to think. If conflict becomes unavoidable, I can certainly put up a good fight, but that does not mean I enjoy the process. Secondly, I was honestly tired of having disputes. The battles I had fought in Vienna had left me drained and somewhat bruised. Over the years, I did develop a thicker skin but it certainly was not something I was born with. Thirdly, conflicts take far too much time, energy and concentration away from one’s real work: the more time I was compelled to spend locked in combat, the less time I would have to focus on the science I was so eager to generate. Fourthly, if the worst came to the worst, and if I was going to have to defend my views at every turn, I needed to be entirely sure of my ground. Solid research was the only way to ensure that; and I felt the need to do the research first and have the arguments later.