Chapter 8: The End of the Road

During my professional career I have been on the faculty of five different universities and have been appointed to full professorships in Germany, Austria and Britain as well as visiting professorships in the US and Canada. If this experience has taught me anything, it is that the world of academia is not always the comfortably sheltered environment that it is so often made out to be.

After my time in Vienna, where I experienced more than my fair share of intrigue and machination, I had sincerely hoped that Exeter would be a little more peaceful. And, initially at least, it turned out very much that way. At the medical school in Vienna there had been about four hundred professors, and we were all expected to sit on countless committees. By contrast, at the time I joined the faculty in Exeter, its postgraduate medical school could boast a grand total of three professors. Consequently, life there was agreeably quiet. But in 2000, when the Peninsula Medical School was established, this situation began to change.

When John Tooke became the new Dean of the Peninsula Medical School we had been friends for some years, and I was confident that, in his new position, he would become a useful ally and staunch supporter of my research. From previous encounters, I had gained the impression that, although he did not perceive alternative medicine as a subject worthy of serious consideration, he was nevertheless impressed by our publication record, and by the national profile and international reputation my team was beginning to enjoy. These things do count for a lot in academia and are important for any medical school, especially so for a brand-new one.

At four-yearly intervals, all UK academic institutions must undergo what is known as the Research Assessment Exercise, a review process designed to evaluate the quality of research being done at those institutions with the aim of deciding on the apportionment of public funds to support research during the next four years. While some researchers at Exeter had a hard time marshalling enough high quality research articles for submission, the problem faced by my unit consisted more in deciding which of our numerous publications we should submit: our publication rate in top medical journals was second to none.

Any medical school depends to a very large extent on funding from government, charities and private donors, so the public image of our school, and in particular the way it is depicted in the national press, is of considerable importance. It was therefore predictable, perhaps, that this would be the subject on which Tooke and I had our first real differences of opinion.

Aware that my unit attracted much more press interest than any other department of “his” new medical school, and feeling somewhat nervous about the unvarnished frankness with which I often talked to journalists, the Dean notified me that my contacts with the press would henceforth have to be limited, and that he wanted to “be informed about PR activities”, as he put it in an email.

What followed was a somewhat unsettling correspondence between us in which he expressed views that seemed to me to be inconsistent with the principles of academic freedom and free speech. Essentially, he wanted to control what I said to journalists. For my part, I felt that it was up to me to decide how I responded to enquiries from the press regarding my research (I never approached journalists on my own initiative). Eventually, he put an end to the discussion by declaring that his decision was non-negotiable: henceforth I was to obtain permission for what he termed “every major” exchange involving the press. This seemed the academic equivalent of a D notice: either I cut myself off voluntarily from all contacts with the press, or Tooke would step in and act as gatekeeper, allowing me to speak to journalists only on those topics that he considered appropriate and not politically sensitive.

Faced with this ultimatum I had little choice. I managed to continue responding to enquiries from the press for a while longer by interpreting his definition of “major” as broadly as possible. Inevitably, though, this led to further disagreements: press coverage of a positive story (e.g. “professor finds that acupuncture is safe”) would usually pass without comment, while negative news (e.g. “professor finds that homeopathy does not work”) would promptly elicit a reprimand.

Of course, this atmosphere, tense and heavy with implicit - and increasingly explicit - hostility, could not continue indefinitely. The watershed came in 2003, when I saw an announcement published in the newsletter of the Prince of Wales’ Foundation for Integrated Health:

The Peninsula Medical School aims to become the UK’s first medical school to include integrated medicine at postgraduate level. The school also plans to extend the current range and depth of programmes offered by including healthcare ethics and legislation. Professor John Tooke, dean of the Peninsula Medical School, said: “The inclusion of integrated medicine is a patient driven development. Increasingly the public is turning to the medical profession for information about complementary medicines. This programme will play an important role in developing critical understanding of a wide range of therapies”.

When I stumbled on this announcement, I was truly puzzled. Tooke is obviously planning a new course for me, I thought, but why has he not told me about it? When I enquired, Tooke informed me that the medical school was indeed preparing to offer a postgraduate “Pathway in Integrated Health”; this exciting new innovation had been initiated by Dr Michael Dixon, a general practitioner who, after working in collaboration with my unit for several years, had become one of the UK’s most outspoken proponents of spiritual healing and other similarly dubious forms of alternative medicine. For this reason, Dixon was apparently very well regarded by Prince Charles.

A few days after I had received this amazing news, Dixon arrived at my office and explained, with visible embarrassment, that Prince Charles had expressed his desire to him personally to establish such a course at Exeter. His Royal Highness had already facilitated its funding which, in fact, came from “Nelsons”, one of the UK’s largest manufacturers of homeopathic remedies. The day-to-day running of the course was to be put into the hands of the ex-director of the Centre for Complementary Health Studies (CCHS), the very unit that, almost a decade earlier, I had struggled - and eventually even paid - to be separated from because of its overtly anti-scientific agenda. The whole thing had been in the planning for many months. I was, it seemed, the last to know - but now that I had learnt about it, Dixon and Tooke leaned on me with all their might to persuade me to contribute to this course by giving a few lectures.

I could no more comply with this request than fly. Apart from anything else, anyone who had read my papers would have known that I was opposed in principle to the concept of “Integrated Health”. As I saw it, “integrating” quackery with genuine, science-based medicine was nothing less than a profound betrayal of the ethical basis of medical practice. By putting its imprimatur on this course, and by offering it under the auspices of a mainstream medical school, my institution would be encouraging the dangerously erroneous idea of equivalence - i.e. the notion that alternative and mainstream medicine were merely two parallel but equally valid and effective methods of treating illness.

To add insult to injury, the course was to be run by someone who I had good reason to reject and sponsored by a major manufacturer of homeopathic remedies. In all conscience, the latter circumstance seemed to me to be the last straw. Study after study carried out by my unit had found homeopathy to be not only conceptually absurd but also therapeutically worthless. To all intents and purposes, the discussion about the value of homeopathy was closed. Even a former director of the Royal London Homeopathic Hospital had concluded in his book that “homeopathy has not been proved to work... the great majority... of the improvement that patients experience is due to non-specific causes”. If we did not take a stand on this issue, we might as well give up and go home. Consequently, I politely but firmly declined the offer of participating in this course.

By now numerous other incidents of a similar nature had poisoned the atmosphere at my own medical school and university so much that both my work and my health were suffering. How had it come to this? Why was even the most obvious and demonstrable truth being turned upside down so that it could be used against me? Why were my peers seemingly bent on constraining me and making life increasingly difficult for me?

This was by no means a trivial question and, on reflection, the most plausible answer, in my view, was that the results of my research were a thorn in the flesh of powerful interests operating in the background. Our critical analyses of alternative medicine, once acclaimed locally, nationally and internationally, seemed no longer wanted.

It was time to take a step back, talk things over with Danielle and assess the situation as objectively as I could. For more than a decade, I had done precisely the job that the University had hired me to do. I had worked extremely hard to establish an outstanding international reputation for our unit, with obvious benefits to the medical school and the University. On several occasions I had been told “you have put Exeter on the academic map”. This might just have been flattery, but surely nobody could dispute that we had done amazingly well. For the first years that the new medical school had been in existence, my team had published more papers in the peer-reviewed medical literature than the rest of that institution put together. Even today, there is not a single academic in the whole of Exeter University who has published more in the last two decades than I have. My “H-Index”, a widely used measure to quantify an academic’s standing, was around 80, more than twice that of any other faculty member of the medical school. These facts alone should have earned me the appreciation of my institution.

Was I being unreasonable? Were the obstacles and problems I was increasingly encountering just the normal “rough and tumble” any academic researcher might come across? I considered this possibility seriously but it simply couldn’t account for the way things had so clearly and dramatically changed. Virtually all the financial, administrative and moral support I once had enjoyed had disappeared; my team and I were systematically isolated; the importance of our work was constantly belittled; and I was made to feel that my hard work was not an asset but a burden to the University. Anyone visiting the medical school could have been forgiven for thinking that my unit did not even exist. A glossy brochure describing the research activities of the Peninsula Medical School, for instance, altogether failed to mention us - and that was at a time when we were authoring more papers than the rest of the school put together.

There seemed to be very little I could do to improve the situation. Of course, if I had been prepared to change the direction or attitude of my research and become more “politically correct”, I might have ingratiated myself with the Dean, the Vice Chancellor and all the others who were so visibly irritated by me. Virtually all research groups in alternative medicine were conducting an entirely different kind of science, so why couldn’t we?

The easiest way to study alternative medicine in the “politically correct” way would have been to investigate how many patients use it, to monitor how satisfied users of alternative medicine were, to evaluate why some people preferred alternative to conventional therapies, and so on. Invariably, the results would then show that this sector of health care is surprisingly popular, and from that one could then comfortably and non-controversially conclude that, “if people use it, are satisfied with it, and even pay for it, alternative medicine must be good.” This line of enquiry would not rock anyone’s boat and would make everyone - including Prince Charles - happy. But, as I see it, this type of research is irrelevant, inconsequential and intrinsically misleading. Certainly it is not what I ever considered to be rigorous, high-quality science and most definitely it would not have been in line with our mission statement. To change direction in this way was not a reasonable option, at least not for me. I was not prepared to sacrifice my integrity as a scientist for the sake of avoiding being given a rough ride by those who opposed me and were disquieted by my research findings.

But what should I do? The future of my entire team depended on the answer to this question. After many sleepless nights and several anxious meetings with the team, together we decided to batten down the hatches, try to be as self-sufficient as possible, and simply get on with our job as before. Aggrieved though we felt, we did not look for praise; we did not need a red carpet to be rolled out for us; we merely wished to be treated fairly and be left in peace to conduct our research.

Try as we might, though, the worsening tension and the frigid to hostile collegial atmosphere inevitably had a significant impact. The team slowly began to disintegrate: our morale, work ethic and enthusiasm seemed to be ebbing away. I had been so very proud of the group that I assembled and held together, a team of highly motivated, skilled, loyal and industrious researchers with whom I had worked closely for almost 15 years. Now it was becoming impossible to sustain these high standards when, at almost every one of our weekly staff meetings, we were forced to discuss the glaring lack of support and the overtly obstructive behaviour we had to contend with.

Inevitably, these problems also took a personal toll. For the first time in my life I became a regular visitor to my GP. To my dismay, within the space of just a few months, I had developed three different stress-related illnesses. The situation was not only making my work more and more difficult, it was progressively robbing me of my health.

Amidst these professional and personal difficulties, I decided to explore one last, desperate attempt to save my unit, and with it the important work of continuing a critical evaluation of alternative medicine.

As my own salary was the largest of my team, I considered cutting my working hours and taking half pay so that that Sir Maurice’s endowment could be made to last longer. I enquired whether this was an option and asked my administration to calculate the impact and outline the feasibility of prolonging the life of my unit in this way. My hope was that my right hand man and deputy, Dr Max Pittler, could ease into my shoes and eventually take over from me entirely, allowing me to retire early. Perhaps a new leadership could open the door to a fresh start, new prospects and even a renewed source of funding.

Unfortunately the administration was unable - or unwilling? - to discuss with me what financial consequences my semi-retirement would have. This, along with many other indicators, strongly suggested that neither the University nor the medical school were at all interested in securing the long-term future of our research unit.

In this situation, it was everyone for him- or herself. My co-workers obviously had first and foremost to look after their own employment and career prospects. Dr Pittler decided to take up the post of research director at the German equivalent of the National Institute for Clinical Excellence (NICE). On the one hand, this was a strong testament to our achievements in research: after all, Pittler had joined us straight after medical school, and everything he had achieved was due to our collective efforts. On the other hand, his decision to leave seemed in a potent but unspoken way to seal the fate of our unit.

Although the University had long ago signed a legally binding contract committing to raising £1.5 million towards our research, there was no sign of any effort to follow through on that obligation. Indeed, it seemed to me that my peers had quietly agreed amongst themselves to switch off my unit’s life support and were now simply biding their time, waiting for me to take the hint and cooperate by exiting. When I failed to oblige, Tooke declared that, due to lack of funds, it had been decided that my unit would be closed down, all my staff would be dismissed or relocated, and I would have to take early retirement.

So there it was at last: my research team had been disbanded.[1]

For almost two decades my professional life and my whole identity had been inextricably bound up with the work of my unit. I had gone to Exeter with high hopes, confident that I was entering an institution wholeheartedly dedicated to the pursuit of high quality scientific enquiry. Instead I had to realize that, under certain circumstances, science could be perceived as an unwelcome intrusion.

Lawyer friends urged me earnestly to take the university to court; they were convinced that I would win. However, I had reached the end of the road. After so many years of feuding, I was bone weary and had no wish to become embroiled in protracted legal proceedings.

It was time to go.

1 After John Tooke had left Exeter, the new dean seemed to have a more open and sympathetic attitude towards my position. He and I agreed that I would volunteer to take early retirement and, in return, he would try to save my unit from closing. He even offered to re-employ me on a half-time basis after my official retirement in order to help him find a successor. Unfortunately, though, a suitable successor was never identified, nor were any funds made available for that post.