„Man hat das Thema Gentechnik bereits geschickt tabuisiert.“ Ein Interview mit Prof. Beda Stadler

Prof. Dr. Beda M. Stadler arbeitet und forscht am Universitätsinstitut für Immunologie in Bern. Er ist der Öffentlichkeit aus vielen Diskussionsrunden im TV und Kolumnen in der Presse bekannt. Er war so nett, uns ein Interview zu geben.

How much medicine is evidence-based?

A few weeks ago we noticed a claim in GEO, a German magazine, stating that only 40% of medicine were evidence-based. Since the article contained lots of errors (we blogged about its flaws) and no real source was given (apart from the allegation this was a quote from a former president of State Chambers of Physicians), we were inclined to dismiss the contention without further consideration.

But then we pondered the question and started digging. We found an official document on Evidence-Based Medicine and we discovered a website of the British Medical Journal dedicated to evidence based medicine supporting the claim.

Clinical Evidence

Clinical evidence for medicine

The BMJ Site displays a nice diagram showing that 51% of medicine were of unknown effectiveness! 51%. And another 15 percent were harmful/likely ineffective. We were flabbergasted. According to these figures, medicine(about 40% proven efficiacy) was not much better than alternative medicine(about 0% proven efficiacy).



A rate of unknown effectiveness of as much as 51% for medicine? Wow. We were stunned and decided to ask Professor Edzard Ernst about the BMJ page.

You probably know the following page: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp
This overview isn’t exactly much to write home about. What is your opinion on this?
Isn’t it unfair to look down upon alternative methods when there is still so much unknown in medicine?

  • Firstly, the low percentage of proven treatments is partly due to the fact that this figure includes alternative medicine.
  • Secondly, the figure relates to all treatments even those that are very rarely used. If you look at the percentage of effective treatments that are actually in daily use, you arrive at figures around 80%.
  • Thirdly the process of applying science to medicine is relatively young – so we are looking at work in progress.
  • Fourthly, if one area is not optimal, this is no reason to allow another one to be even worse.

Alternative medicine is included in those figures? Well, ok, that explains a lot.

“By definition”, I begin
“Alternative Medicine”, I continue
“Has either not been proved to work,
Or been proved not to work.
You know what they call “alternative medicine”
That’s been proved to work?

(Storm by Tim Minchin)

Wieviel Medizin ist evidenzbasiert?

Vor einigen Wochen stolperten wir im GEO-Magazin über die Behauptung, dass nur 40 % der medizinischen Behandlungen evidenzbasiert seien. Da der Artikel viele Fehler enthielt (wir haben über die Mängel gebloggt) und keine echte Quelle angegeben war (abgesehen von der Behauptung, dass es sich um ein Zitat eines früheren Präsidenten der Bundesärztekammer handle), waren wir geneigt, die Aussage ohne weitere Betrachtung zu verwerfen.

Aber dann dachten wir über die Frage nach und begannen zu suchen. Wir fanden ein offizielles Dokument zu Evidenzbasierter Medizin und eine der Evidenzbasierten Medizin gewidmete Webseite des British Medical Journal, die beide diese Behauptung stützen.

Clinical Evidence

Klinische Evidenz für Medizin

Die BMJ-Seite enthält ein nettes Diagramm, das zeigt, dass die Wirksamkeit von 51 % der medizinischen Behandlungen unbekannt ist. 51 %. Weitere 15 % sind schädlich oder zumindest wahrscheinlich ineffektiv. Wir waren verblüfft. Nach diesen Zahlen wäre Medizin (etwa 40 % erwiesene Wirksamkeit) gar nicht soviel besser als Alternativmedizin (etwa 0 % erwiesene Wirksamkeit).



Ein Anteil von 51 % bei medizinischen Behandlungen mit unbekannter Wirksamkeit? Wow. Perplex fragten wir Professor Edzard Ernst:

Sie kennen vermutlich die folgende Seite:

Die Übersicht ist ja nicht gerade berauschend. Was ist Ihre Meinung dazu?
Ist es nicht unfair auf alternative Methoden herunter zu blicken, wenn es noch solche Lücken in der Medizin gibt?

  • Erstens: Zum Teil beruht die niedrige Prozentzahl der Behandlungen mit bewiesener Wirksamkeit darauf, dass in dieser Übersicht auch die Alternativmedizin enthalten ist.
  • Zweitens enthält die Einschätzung alle medizinischen Behandlungen, auch solche, die nur selten angewendet werden. Betrachtet man die Prozente für effektive Behandlungen, die täglich angewendet werden, kommt man auf einen Wert von etwa 80 %.
  • Drittens ist der Prozess Wissenschaft auf Medizin anzuwenden noch relativ jung – wir betrachten da einen Vorgang, der noch lange nicht abgeschlossen ist.
  • Viertens, wenn ein Bereich nicht optimal ist, so ist das keine Rechtfertigung für einen anderen, noch schlechter zu sein.

Alternativmedizin ist in den Zahlen inkludiert? Na dann, das erklärt einiges.

“By definition”, I begin
“Alternative Medicine”, I continue
“Has either not been proved to work,
Or been proved not to work.
You know what they call “alternative medicine”
That’s been proved to work?

(Storm von Tim Minchin)

Edzard Ernst and the Half-Quack Prince

When we contacted Edzard Ernst about the disgraceful interview in the Telegraph, we were presented with the opportunity to do a full interview. It was very interesting and a bit alarming…

As you may know, Edzard Ernst is the first Professor of Complementary Medicine, and more or less retired, two years prior to the official age of retirement. To understand the reasons for his early retirement and some of our questions, we need to look back a few years:

Edzard Ernst became professor for Complementary Medicine in 1993 and has built quite a reputation as a man of science and as a researcher. But in 2005, things took a rather strange turn. Economist Christopher Smallwood, personally commissioned by Prince Charles, claimed a lot of money could be saved applying CAM treatments. Unfortunately, this position was not supported by evidence. Not in the least! Edzard Ernst called it “complete, misleading rubbish.”. To cut a long story short, Prince Charles’ private secretary complained about Edzard Ernst who became “persona non grata” at his university.

Mr Ernst had been promised further funding, but all fundraising died down at that time. (This is actually quite an obvious development, since most CAM institutions apparently do not want real science to have a look at their methods) He had been promised the university would match initial funding of his unit, but this did not materialize. The unit was not able to keep all employees. He was informed the unit would be entirely dismantled after his retirement.

And so he negotiated. The deal: Immediate retirement and getting re-hired part-time for a year to help find a successor. The unit was not to be shut down.

Professor Edzard Ernst officially retired in May. We did not like that kind of horse-trade, but if Professor Ernst is fine with it, it is fine with us, too. The world is complicated, and so be it. The only part of the bargain we truly liked was that Professor Ernst may choose his successor. Well, at least this is what we assumed when we started asking…

But let’s get started with the interview:
Professor Ernst, when you started examining these methods scientifically, did you expect to meet such massive opposition or did that come as a surprise?
Lots of things were very surprising to me: that alternative medicine practitioners in the UK are often anti-scientific untrained non-medics, that so many of our results turned out to be negative, that there was so much public interest in my work, that alternative medicine enjoys royal protection in Britain etc, etc. The fact that I soon came under increasingly bitter criticism from the enthusiasts was, of course, a result of all this.

Most “alternative professors” practice Cargo-Cult-Science. Why does critical approach seem to be so unusual?
Yes, most if not all of my colleagues use science as a drunken man uses a lamppost – for support and not for illumination. I have come to the conclusion that this is due to them being primarily advocates of alternative medicine and true scientific scrutiny comes at a far remote second or third place.

In which way could this be improved?
One would need to make sure that critical scientists are appointed, for instance, by looking closely what any candidate has previously published. If it is mostly poor science or promotional pseudo-science, the person should be disqualified.

Do you agree with the way your results are being communicated?
I am often misquoted from both sides of the divide. The Telegraph article, for instance, claimed that I am against all alternative medicine. This is not true; I am against all ineffective or unsafe treatments, and that is very different.

You are compelled to a state of “retirement” now, as a result of the éclat with “Prince Charles”. (Smallwood report)
Was there any reaction by the Prince (or someone from his environment) after you called him a ‘snake-oil salesman’?

I offered to go in order to save the unit. My med school is now looking for a successor. Previously I was told that they will close the unit on my retirement. When I called Charles “snake oil salesman” there was no reaction from him or his entourage at all. I did not expect a reaction.

So, you are looking for a successor; do you believe he will have an easier life? Or do you think Prince Charles and his ilk will also try to throw a spanner in his works?
It depends what he/she will do. It would be easy to have it easy in that position; either one does very little or one does only stuff that upsets no one [such as surveys] or one does some basic research that is not so relevant to the public or one avoids all publicity – there are many ways.

The reaction of Charles and other enthusiasts of bogus medicine will depend on the work of my successor and the public image it receives.

Are there promising candidates for the position yet?
I have not yet heard of any.

How much freedom do you have in choosing a candidate? Can you choose/decide freely?
Sadly, I was only involved in drafting the job description. Everything else is out of my hands. I offered my further assistance but the offer was so far not accepted.

ERRM. Half a second. Wait.
What the …??? We understood the deal Professor Ernst made to save his unit, but so far we were under the impression that he will choose his successor!

We winced and mourned the loss when Professor Ernst retired (even when, in an interview, he said he was over the moon with that solution; that he feels exhausted, feels the scars from the many battles). We felt the loss. And now once more, we feel very strongly about the issue at hand!

Dear University of Exeter, to whomever it may concern, do not forget you (probably) have the only real chair of alternative medicine in the entire world (the entire world!), the only position respected by the scientific community and not just by quacks and royal half-quacks. Please, pretty please, do not gamble with your reputation.

Professor Ernst, can the public assist you in any way? Is it possible for us ordinary citizens to help your unit in any way to continue work same as before the éclat?
Public support will be a crucial element whenever controversies arise. I had lots of it – despite all the flack.

This answer is too diplomatic for our liking!

We know there are lots of supporters of Mr Ernst and his fantastic work out there, fighting an eternal battle against the overwhelming degree of lunacy in the world; therefore we would like to encourage all of you to join this fight, too. You may think it is premature, the university of Exeter should be given a chance. Certainly, but once they have taken a decision, it will be too late. We have to take a stance now and proactively defend this chair.

Let’s tell the university that we, the public, will not accept a quack or mediocre scientist in that position. While he/she will not be able to fill the gap, he/she has to be a true scientist! We will accept nothing less!