A bitter pill to swallow

The sketchy evidence for the effectiveness of homoeopathic medicine has no scientific basis, and pos

There was an outcry in September when we learned that children in Scotland were being given a homoeopathic "MMR vaccine", a product that offered no protection against the serious dangers posed by measles, mumps and, for pregnant women, rubella. This had echoes of the discovery a few years ago by Sense About Science, Simon Singh and Newsnight that some pharmacists were offering homoeopathic pills for protection against malaria to people travelling to Central Africa. Such practices may be disturbing, but they occur because we tend to think there is no harm in indulging the clamour to maintain the alternative health market.

Reading the 11 October issue of the New Statesman, I was shocked by an advertisement in the accompanying supplement, "Social Care: Who Pays?", referring to me and my work. Rarely had I seen an advert so inaccurate and borderline libellous in a respected publi­cation. The advert, which appeared to breach the British Code of Advertising, was by a lobby group called Homeopathy: Medicine for the 21st Century (H:MC21). It contained unjustified attacks on myself and colleagues, including statements that gave a dangerously false impression of homoeopathy's therapeutic value.

As the advert questioned my own competence, I should address this first. I started my medical career in a homoeopathic hospital, where I was trained in homoeopathy for several months. Many years later, it became my job to apply science to this field and I felt I had a duty to keep an open mind - open but not uncritical.

A critical mind would notice that the two basic principles of homoeopathy fly in the face of science, logic and common sense. The first assumption is that "like cures like". For instance, if onions make my eyes and nose water, homoeopathic remedies derived from onions can be used to treat my patients' hay fever, which sometimes causes runny eyes and noses. The second assumption proposes that diluting remedies homoeopathically makes them not less but more potent, even if the final preparation no longer contains a single molecule of any active substance. These theories are not based on anything that remotely resembles fact. Like does not cure like, and endlessly diluting remedies certainly does not render them stronger, but weaker. But is there some entirely new energy to be discovered that we do not yet comprehend? Not understanding homoeopathy does not necessarily mean that it is useless.

The best way to find out is to determine whether homoeopathic remedies behave differently from placebos when patients use them. In other words, we need clinical trials.

Data gap

About 150 such studies (mostly conducted by homoeopaths) and well over a dozen syntheses of this research are available. Their results are sobering: the totality of the most reliable evidence fails to show that homoeopathic remedies work better than placebos. So, after about 200 years of research, there is no good data to convince non-homoeopaths that homoeopa­thic remedies are any different from pure sugar pills. Pro-homoeopathic lobby groups such as the one that placed the advertisement therefore have to employ propaganda to try to convince consumers who may not know better. This is perhaps understandable, but surely not right.

What of patients' experience, some might ask. Thousands of people across the world swear by homoeopathy. Are they all deluded? Clearly not. People undoubtedly do get better after seeing a homoeopath. There are many observational studies to show that this is true. Homoeopaths therefore keep telling us that their treatments work, regardless of the implausibility of homoeopathy's principles and the largely negative trial evidence.

When we rationally analyse this apparent contradiction of evidence versus experience, it quickly dissolves into thin air. The empathic encounter with a homoeopath is just one of many factors that provide ample explanation for the observation that patients can improve even when they receive placebos. A case in point is Bristol Homoeopathic Hospital's 2005 study, cited in the offending advert. The 6,500 chronically ill patients might have im­proved because of the concomitant use of conventional treatments, or because of the attention they experienced, or because of their own expectation to improve, or because the disease process had come to an end. In fact, they might have improved not because of, but despite, the homoeopathic remedies they were given.

Still, some people ask what is wrong with using placebos as long as they help patients feel better. The answer is that it prevents clinicians telling the truth to patients. Being honest would defeat any placebo effect: if I tell my patient, "Take this remedy; it contains nothing and the trial data shows nothing," she is unlikely to experience a placebo response. Hence, homoeopaths, knowingly or unknowingly, deprive patients of informed consent. This paternalistic approach is recognised as unethical. Also, placebo effects are unreliable and normally short-lived; they happen occasionally but often do not. Even if placebo responses are generated, they are usually small - certainly too small to compete with effective therapies.

Twin-track effect

Endorsing homoeopathic placebos would mean that people might use them for serious, treatable conditions. In such circumstances, homoeopathy can even cause (and has caused) the death of patients. Furthermore, if we allow the homoeopathic industry to sell placebos, we must do the same for "Big Pharma". Imagine a world where pharmaceutical companies could sell us placebos for all sorts of conditions just because some patients experience benefits through a placebo response.

Crucially, and paradoxically, we don't need placebos to generate placebo effects. If I, for instance, prescribe an antihistamine for a patient suffering from hay fever, with empathy, time and understanding, that patient benefits from a placebo effect as well as the pharmacological action of the antihistamine. If, by contrast, I prescribe a homoeopathic remedy, I deprive her of the latter, crucial benefit. It is difficult to argue, as most homoeopaths try to, that this approach would be in the interest of my patient.

What follows is straightforward: there is no good evidence that homoeopathy does more good than harm. This is not just my conclusion after 17 years of researching the subject, but a fact based on the best available evidence, which is supported by virtually all experts who are not homoeopaths. The recent decision by the coalition government to continue homoeopathy on the NHS is thus puzzling, to say the least.
The advertisement that prompted this article is misleading about the work of experts which has conclusively shown that homoeopathy can have no place in evidence-based medicine. It is an insult to our intelligence.

Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter, and co-author, with Simon Singh, of "Trick or Treatment? Alternative Medicine on Trial" (Corgi, £8.99)

Here comes the non-science

Homoeopathy was developed in 1796 by the German physician Samuel Hahnemann. He based his treatments on the twin ideas that "like cures like" and "less is more". The latter notion was implemented by taking a substance and diluting it over and over again, so that the final product generally contains not a single molecule of the original active ingredient.

Homoeopaths accept that most of their remedies are devoid of pharmacologically active principles, but they argue that the pills contain a "memory" of the original ingredient. The memory is supposedly imprinted in the diluting agent, which is used to moisten sugar pills.

Although homoeopathy defies the laws of physics, chemistry, biology and therapeutics, there have been numerous attempts to test its impact on patients through clinical trials. In 2005, Aijing Shang and seven colleagues from the University of Berne published an analysis of the best trials in the Lancet.

Their findings confirmed many other such published assessments. Commenting on the paper, they wrote: "This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects." An accompanying editorial entitled "The end of homoeopathy" said: "Doctors need to be bold and honest with their patients about homoeopathy's lack of benefit."

This article first appeared in the 08 November 2010 issue of the New Statesman, Israel divided

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First they came for Pepe: How “ironic” Nazism is taking over the internet

Over the last year, various internet subcultures have embraced Nazi iconography while simultaneously claiming to hold no Nazi beliefs. Why?

There is a scene in Roman Polanski’s critically-acclaimed World War Two film The Pianist in which the Jewish protagonist, played by Adrien Brody, puts on a German soldier’s coat to keep warm.

“Don’t shoot!” he tells the Polish troops who have come to liberate Warsaw. “I’m Polish!” A soldier, realising his mistake, lowers his gun. With disdain on his face, he asks: “Why the fucking coat?”

The chilly hero might not have been acting unreasonably, but neither was the soldier. It's safe to say that in normal circumstances, "Nazi coat" can be used as shorthand for "Nazi person". I found myself asking a similar question last month when I interviewed a “Nazi furry”. The furry (ie. person who dresses as an animal, often for sexual reasons) likes to wear a red armband reminiscent of those worn by the Nazi party. “It’s just a piece of cloth,” he said at the time, insisting he held no far-right views. Then why not choose another piece of cloth? I wondered to myself.

This furry is just one of hundreds of people online who flaunt the iconography of National Socialism whilst denying they hold any Nazi views. If that doesn’t make sense, it shouldn’t. “Ironic” Nazism, “satirical” Nazism, and “just joking” Nazism have taken over the internet. Who is behind it, what are they doing, and how did it begin?

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Unfortunately, it is probably Hillary Clinton’s fault. In September 2016, the presidential hopeful’s website declared popular internet meme Pepe the Frog to be a white supremacist symbol. If we ignore that this has now become a self-fulfilling prophecy (racists embraced Pepe after the Anti-Defamation League chimed in and officially declared the meme a hate symbol), this was a frankly ridiculous assertion.

“We've won folks... My God ...We've won,” read a post on r/TheDonald – the Reddit hub for Donald Trump supporters – after the news. They didn't hold back with their disdain. “This makes her look absolutely retarded to anyone young enough to be on the internet,” read the top comment. Why? White supremacists were undoubtedly already using the meme – many on the notoriously politically incorrect 4Chan board /pol/ had emblazoned the frog with swastikas. So why wasn’t it, in turn, a white supremacist symbol?

The answer to this is irony. Layers and layers of it slathered with thick, glutinous nonsense that form a Bruce Bogtrotter’s cake that is impossible to digest. You and I are what 4Chan would pejoratively call “normies”, i.e. normal people. We can’t possibly hope to understand the difference between someone on 4Chan who holds sincere Nazi beliefs and someone who is shouting “Death to all Jews” for the keks (see glossary), like a toddler who has just learnt the word “poo”.

This doesn’t normally matter – we can just ignore them – but Clinton’s post gave them the legitimacy and media attention that they craved.

It also, I would argue, set off a new internet trend. Angry at liberals labelling everything (most notably, the alt-right) “Nazis”, fringe internet communities decided to fight back. The logic – if it can be called that – went like this:

“Let’s dress like Nazis and act like Nazis so that liberals call us Nazis when we’re not! That will show just how stupid these liberals are!”

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“The press, the media, does not deserve to have a consistent picture of reality presented to them.”

These are the words of Qu Qu, a man in his late twenties who considers himself the leader of the “alt furry” movement, who is speaking to me over Twitter. Alt furries are furries who have embraced far-right messages and Nazi iconography on the social network. Some wear armbands, others write erotic Nazi literature, some tweet anti-Semitic jokes. When I spoke to some last month, I was shocked when only one of them actually admitted to holding Nazi views. Many claimed they were being “ironic” or fighting back at what they consider to be left-wing intolerance.

“If the press becomes obsessed with a moral panic, such as the one about the resurgence of National Socialism, it is the duty of every subculture to feed that paranoia until its absurdity becomes plain for all to see.”

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Earlier this week, the king of this logic died.

PewDiePie – the most subscribed content creator on YouTube – was dropped by Disney after the Wall Street Journal exposed an array of anti-Semitic comments in his videos. In the past, he has spoken out against the media for misrepresenting his “jokes”, but this time he wrote a blog post in which he admitted: “I understand that these jokes were ultimately offensive.” What changed?

What changed is that PewDiePie was confronted with a reality that anti-hate campaigners have long since known to be true. After his anti-Semitic videos, PewDiePie was embraced by the neo-Nazi website The Daily Stormer, which is now calling itself “The world’s #1 PewDiePie Fansite.” PewDiePie has learnt a truth that many of the “just joking” brigade frequently try to deny – that satire, irony, and jokes can validate and legitimise hate speech in a way that helps it to spread.

“Pushing out anti-Semitic tropes has consequences in the real world,” says a spokesperson for anti-racism organisation Hope Not Hate. “PewDiePie may or may not believe this stuff himself, but he does need to understand that he has an effect on the world, and that racists and haters can sometimes act on the words and memes that are shared so readily on social channels, and – with soaring hate crime rates – already have.”

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Then they came for Trash Dove.

The head-banging purple pigeon is a Facebook sticker (a picture users can post in the social network’s comment sections) that went viral this week. In response, 4Chan started “Operation Nazi Bird”, a satirical campaign to turn the meme into a Nazi symbol. The aim was to trick the left.

This started to work when a self-described philosopher known as Quincy Frey wrote a satirical Medium post (which has since been removed after a copyright claim) declaring Trash Dove to be an “alt-right” symbol. When people began to fall for this, 4Chan won. Yet so too – as Hope Not Hate argue – did actual white supremacists.

“What started as irony will now actually spread and this will become a ‘Nazi hate’ symbol whether we like it or not,” Quincy Frey tells me. “The alt-righters from 4Chan work in a funny way; it always starts ironic but they seem to take irony to the next level and then these idiots become brainwashed… eventually their sickness will spread.”

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Which leaves us with a question that regrettably summarises today’s state of affairs: are ironic Nazis as dangerous as real Nazis?

Simon Johnson, the chief executive of the Jewish Leadership Council, seems to think so. “It is difficult to understand how people can use Holocaust language, imagery or comments and think that it is a joke,” he says. “The French comedian Dieudonne uses the Quenelle gesture and other supposedly humorous Holocaust imagery, as well as dressing cast members in concentration camp uniforms, as part of his act." The Quenelle gesture was an originally jokey gesture which has grown to be considered anti-Semitic after individuals posed in front of Jewish institutions holding the stance. In December 2013, French President François Hollande reacted to the gesture, saying: "We will fight against the sarcasm of those who purport to be humorists but are actually professional anti-Semites.”

Johnson agrees it is important to tackle this alleged comedy. "For many this demeans the Holocaust and would be considered anti-Semitism. Allowing these acts to continue perpetuates myths and often leads prejudice against the Jewish community.”

It is also important to note that many who claim to be “satirical” Nazis are simply hiding behind a thin veil of plausible deniability. The word “irony” – however incorrectly it’s being used – allows them to spread Nazi messages and iconography whilst denying culpability. It also leaves many on the left unsure where they stand. What’s more important: combatting hate speech or protecting free speech?

Kassie is a 31-year-old graduate student who reached out to me after being mocked for taking Trash Dove seriously as an alt-right symbol - proving that online trends can have real-world consequences. “My friend is liberal but thinks I'm overreacting and don't understand satire,” she tells me. “But I don't get why I have to call Nazi jokes satire.

“The most frustrating part is that my concern is immediately written off as stupid because I don't belong to the community. If we get past that part, then I'm overreacting or dumb because I don't get that it's ironic or I don't understand that it's a joke. But I get that on some level people are saying that it's a joke, and some are ‘just joking’ and I still think that a joke can be racist and misogynist and alt-right or whatever.

“I'm just left with feeling like I've fallen down a hole of ironic devils advocates who use that as an excuse to say ‘funny’ racist and misogynistic things.”

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When Prince Harry donned a Nazi uniform for a fancy dress party in 2005, no one thought he was actually a fan of Hitler. If ironic Nazis had emerged twelve years ago, they might have been given the same benefit of the doubt by being considered poor taste but not ultimately racist. Yet context is key. In an era when the President of the United States wants a registry of Muslim citizens, and fascism appears to be on the rise across Europe, no one who is “just joking” – not furries, YouTubers, or 4Channers – can be annoyed if the media labels them Nazis.

I do agree that fundamentally it is important to combat the left’s tendency to label everything right-wing “Nazi” or “racist”. Internet subcultures are not wrong to attempt to challenge this and other examples of left-wing extremes. Yet if this is what they really want, then one - very pressing - question remains. Why the fucking coat? 

Amelia Tait is a technology and digital culture writer at the New Statesman.