Just over a decade ago, Edzard Ernst's name would have been whispered with deference in the corridors of one of the most prestigious medical schools in the world. He held the chair of physical and rehabilitation medicine at the Medical Faculty of Vienna, a city where medicine has huge status and practitioners such as Sigmund Freud waltzed into legend. Ernst presided over the biggest department of its kind in Europe, with 120 people under him.
But then Ernst did something quite unexpected: he chose to turn his back on all that and head down the path of what some of his peers consider superstition and folklore. "It was a very big job," he says of Vienna, smiling. "A life job. It had all the security and pension and boredom that goes with it." He quotes a proverb from his native Germany: "They say when a donkey gets bored, he goes on the ice."
Ernst launched himself at the thinnest ice one could imagine. This world-class scientist became the first and only professor of complementary medicine in the UK, based in what looks like a large detached house in Exeter. "I had 3,000 sq metres and 10 secretaries. When I came here I had nothing but havoc," he says.
Not just havoc but suspicion and downright hostility. Complementary and alternative medicine (CAM) practitioners had been delighted when the building magnate Maurice Laing decided to plough £1.5m into establishing the chair. They were appalled when the post was given to a conventional scientist who declared his intention was to put therapies and treatments from acupuncture to herbs to reflexology under rigorous scrutiny, to find out what worked and what did not. Most CAM practitioners insist that centuries of use are sufficient demonstration that therapies work. Others blame science for most of the world's evils.
Ernst admits his one big mistake was not to have understood quite what he was walking into: "Ten years ago I didn't fully comprehend the situation. On the continent, CAM practitioners would normally be doctors. I didn't realise that there are between 20,000 and 40,000 CAM practitioners in the UK and that most of them would be opposed to what I was planning to do."
He was caught between a rock and a hard place, because the medical establishment was not keen either and several universities had turned Laing's offer down ("it was hotter than cigarette money").
"At the beginning I had more opposition from mainstream medicine locally. At the hospital and the Trust [in Exeter], they felt they did not need a witch doctor in the first place and certainly not a German witch doctor. A lot of people thought once they had seen what I was up to that it was a waste of talent and money."
He won most of the mainstream critics over, but failed so regularly with the CAM lobby that after a few years of assiduously attending meetings, giving lectures and trying to convince them of the value of rigorous randomised controlled trials, he gave up: "They say you can't squeeze a holistic, individualised approach like homeopathy or spiritual healing into the straitjacket of RCTs - not that it is the only research tool, but it is a good one. The argument surfaces on a daily basis. It is as frequent as it is wrong."
For the past few years, he says, he has kept his head down. "That was successful - anybody can successfully ignore anybody else," he says ruefully. "It was also successful in that we produced an awful lot of work and got this unit on the map and we are proud of our achievement. Maybe it is time to re-engage in the dialogue from the powerful position of being the leading centre in the world."
Ernst has 700 papers published in reputable scientific journals now and a worldwide reputation. "I know what I'm talking about, whereas 10 years ago, to be frank, it was more of a hobby-horse."
It is hard to imagine a member of the UK's medical elite devoting their life to complementary medicine. Ernst, however, comes from a culture where alternative therapies have long blended with the mainstream. He is from four generations of conventional doctors but, he says, "Even as a young boy I was treated with complementary therapies - mostly homeopathy."
His first post was in a homeopathic hospital in Munich, where he was greatly impressed. "If you study medicine and pharmacology, you know [homeopathy] can't work," he says. The active substances in homeopathic medicines are so diluted that pharmacology says they cannot have an effect. "Then you start working in a homeopathic hospital and people get better. Is that a miracle? It certainly is very impressive for a young doctor.
"Looking back, I wonder if a lot was a placebo effect." Placebo to him, however, is not a negative. He would never assume people who get better on placebos were not ill in the first place. "I would like to have an institute of placebo research, but the funding would be even worse. You would get placebo money! But it's absolutely fascinating what's happening there. It is what gels mainstream and complementary medicine together. As doctors, we don't want to realise it. We pride ourselves that therapy does the trick."
This is a scientist willing to explore the unthinkable and unwilling to be told what to think. Scientific logic says homeopathy cannot work, but Ernst continues to study its therapies not to shoot it down, but in the hope of discovering what it is that does work. He treats his French wife with homeopathy, he says. "We were both brought up with it."
But he adds: "People mistakenly think I must be a promoter of complementary medicine - that I should have an allegiance to the camp. I don't. My allegiance is firstly to the patient - I feel that very strongly as an ex-clinician - and secondly to science. If in the course of that I have to hurt the feelings of homeopaths I regret that, but I can't help it."
He left Vienna, he says, because medicine there was about power and money and status. "The Viennese got on my nerves ... The time they spent intriguing against each other in the faculty could have been spent more fruitfully." Secondly, he didn't like being an academic administrator when his real love was research. Thirdly, "I had been in England before as a young doctor in St George's, Tooting and I always felt this had been my happiest time." It was there he met his wife, a librarian working in London. "I thought the English had their priorities right. They studied medicine for the right reasons. Within the national health service, there is a much more ethical and moral approach to medicine."
His departure was not, he says, to do with the shocking discoveries he made when he decided to look into the history of the Vienna medical school for a special occasion. He found the official records stopped in 1938. He was told he had better not delve further, but in a paper that he describes as among the most important he has ever published, in the Annals of Internal Medicine of May 1995, Ernst exposed the terrible truth of what took place during the Nazi years in the name of medicine in Vienna.
Jewish doctors who dominated the profession there were sacked - 153 of the 197 faculty members - and the dean was replaced by the Nazi professor Eduard Pernkopf. Appalling atrocities took place. Many children were killed at the paediatric hospital. Pernkopf worked on an anatomical atlas, which is still in use, drawn from the bodies of those children, and his institute of anatomy used the corpses of the executed for teaching. Viennese professors led experiments on prisoners at Dachau. After the war the Jewish doctors who had been sacked but survived were not invited back, and the Nazi physicians stayed on, mostly escaping retribution.
In a letter in a later edition of the journal, Ernst wrote: "It is important to realise that, by and large, the German and Austrian medical professions were not victimised by the Nazis but actively guided the developments leading to the monstrous disasters and unspeakable violations of ethical behaviour." His family was not Jewish and his father had a clean record in the war, but Ernst finds it hard to deal with the legacy of medicine under the Nazis. He has no wish to return to Germany and he has taken British nationality, "because it became clear to me that this is where I will spend my days. It is just an honest way of approaching it".
There have been several tempting offers from the US, where he has quite a following. "For a long time, I loved going over to America because they would fall over with admiration there. I felt so flattered."
He admits to "several sleepless nights" but finally turned them down. After all, at least a third of the reason for taking the job was to come to England, he says.
Looking through a summary of the mountain of papers his unit has published in 10 years, a lesser mortal might feel discouraged. Most of the findings on the efficacy of therapies and treatments are either negative or inconclusive because too little research has been done for anyone to be sure. But not Ernst.
"They are not always negative results. In meta analyses [pooling the results of all available good quality studies], we generate quite a lot of positive results," he says.
Herbs such as St John's wort, which has proved effective in treating depression, have shown much promise. Kava kava also proved effective in relieving anxiety. But then evidence surfaced linking it to liver damage.
"I fought very hard not to have it banned," says Ernst, who has been on the Medicines Commission in the UK since his Vienna days. "I thought that the argument of the authorities neglected the efficacy side of it totally. I felt that the risk was being addressed in isolation. There was a risk and it needed addressing. To forget about it would have been totally wrong, but an outright ban on it was harsh.
"I have often said that if you banned kava today, you should have banned Valium ten years ago." (Kava kava has been voluntarily withdrawn from sale in the UK, pending a formal legal ban.)
Among his successes, he numbers the study of the safety of acupuncture, which he carried out against the mass opposition of acupuncturists, who clearly thought he was out to get them. They needed 30,000 patients, he calculated, to make it definitive. He managed to get the doctors practising acupuncture on board, and the rest did their own study on a similar model. They found a very small percentage of very mild adverse events.
"All of a sudden we became the heroes of the acupuncture world," he says. "The lesson is that studying safety is not to the detriment necessarily of complementary medicine.
"We are likely to show that it is safer than whatever else is used for that condition, but safety is too important an issue to leave to assumption or public opinion."
His biggest frustration is over the lack of funding for the research he wants to do. It matters. A quarter of the population and close to 100% of cancer patients use complementary medicine, and yet 0.5% of charitable funds and 0.8% of NHS grants go to CAM studies. "That to me is pretty outrageous."
They have submitted more than 200 grant applications and roughly one in 20 is funded. "I'm a pretty tough guy and highly motivated, but when the young researchers have been turned down three or four times I find it hard to motivate anybody."
He is scathing about the grant review panels who reject applications because his researchers cannot use standardised doses of their therapies. "They are demonstrating that they are reviewing applications they should not be reviewing in the first place," he says.
Maurice Laing's 10-year funding runs out in October. Laing has agreed to pay for three more years. The unit is a world leader and has recently become part of the Peninsula medical school in Exeter - enormous achievements, but Ernst still has a precarious future, and at 55, no Viennese pension to look forward to. Does he regret taking the job on?
"Not for one minute," he says. "There were milliseconds at the very beginning when I thought, what have I done, particularly coming from a pompous, big institution. But a lot of money that they were throwing at me in Vienna doesn't necessarily make for good doctoring or good science."
Further reading
The Desktop Guide to Complementary and Alternative Medicine
E Ernst, MH Pittler, C Stevinson, AR White (Mosby 2001) ISBN 0723432074
Focus on Alternative and Complementary Therapies
A review journal; www.ex.ac.uk/FACT
The Evidence So Far
A report on research from 1993 to 2003; contact: nicola.watson@pms.ac.uk
American Cancer Society's Guide to Complementary and Alternative Cancer Methods
(American Cancer Society) ISBN 0944235247
