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

Jean-Luc Mélenchon. Photo; Getty
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How Jean-Luc Mélenchon built a resistance

Like Jeremy Corbyn, France's leftist candidate for the presidency has been caricatured by the media. Nonetheless, he has succeeded in building a movement. 

After months of indifference, the rise of Jean-Luc Mélenchon in the French presidential race has finally caught the attention of the British media. Still, it is frequently misrepresented and reduced to familiar categories: populism, Euroscepticism and spendthriftedness, with commentators quick to draw parallels with Jeremy Corbyn. However, to boil down the Mélenchon phenomenon to such clichés is to fundamentally misunderstand it. 

The authors of this article propose taking a closer look at a highly innovative manifesto and campaign. Cambridge University lecturer Olivier Tonneau is involved with La France Insoumise (France Defiant) and co-authored the cartoon version of Mélenchon’s programme. He runs a blog dedicated to exposing its policies and addressing the many rumours and falsehoods floated about the candidate. Nick Jones is a student who was in Paris at the time of Nuit Debout, and experienced first-hand the energy and thirst for radical change in France.

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Given the deep wound that Brexit has inflicted upon British society, perhaps the most urgent clarification is that Mélenchon does not wish to leave the EU, although he does have a radical strategy to reform it. France and Britain have different relations to the EU. Whilst Britain’s austerity policies were self-inflicted, the same is not true of France. The French people voted “no” to the European constitution in 2005 only to see its vote overturned in Parliament by a coalition of the center-left and center-right parties. This event marked a tectonic shift in French politics, and incidentally determined Mélenchon’s break from the Socialist Party. In 2012, François Hollande was elected on the promise of renegotiating the Lisbon treaty, a promise he failed to hold, and proceeded to impose austerity measures in France (cutting down public spending and corporate taxes, flexibilising the labour market), constantly justifying these measures by the necessity to abide by European norms. He has thus fuelled a deep resentment against both the center-left and the EU. Meanwhile, Mélenchon has campaigned for a showdown with the EU: reform it or leave it (“plan A, plan B”).

His strategy, designed by his chief economist Jacques Généreux, consists of unilaterally disobeying European Treatises: disregarding budgetary norms to implement a Keynesian stimulus package, creating a public investment bank, and ending privatisation policies. His prognosis is that the EU will not dare exclude France because such an exclusion would signal the end of the European project altogether. The EU will thus have to inscribe French exceptions to the treatises (just as it had done for UK). Such exceptions could prove highly desirable to other austerity-stricken countries such as the infamous PIIGS (Portugal, Ireland, Italy, Greece and Spain), with enormous pressure placed on the most intransigent promoters of austerity, the chief of which is Germany.

Far from being anti-European, this strategy is aimed to save the European project which, according to Généreux, is doomed to implode if unreformed. Généreux had reached this conclusion as early as 2012: Brexit and the European-wide rise of the far-right has confirmed his diagnosis. Unencumbered by a reluctant party, Mélenchon has been able to forcefully defend a position that Corbyn was unable to hold, thus shattering the “in/out, good/bad” dichotomy of the Remain and Leave campaigns in the UK.

Already, by 2012, Mélenchon’s Parti de Gauche (co-founded with the Green MP Martine Billard) had published an eco-socialist manifesto which advanced on the Left’s historical bend towards productivism. This time round, Mélenchon’s program is an environmentally focused Keynesian plan. Its aim is to turn France into using 100 per cent renewable energy by 2050 – ending the country’s heavy dependence on nuclear power – by implementing the “negawatt scenario” elaborated by a collective of scientists and engineers.

Mélenchon is especially determined to make the most of France’s maritime territory – the second largest in the world. His program also addresses in detail matters of public health: for instance, schools should serve organically sourced products exclusively, securing a market for organic producers. The turn to organic production, for instance, is expected to create 300,000 jobs. Mélenchon’s environmental plans tie in neatly with forensic budgeting and a clear plan for job-growth, in line with the “One Million Climate Jobs Now” campaign in the UK.

Another aspect of Mélenchon’s Keynesian plan is its redistributive policies. Low and middle wages are spent within the economy on essential goods such as food and clothing, whereas high wages are lost in the speculative bubble: by raising the minimum wage, pensions, and social benefits, Mélenchon intends to boost demand and help small and medium businesses prosper. He also acknowledges the need to reduce working time, without necessarily cutting the length of the working week. Instead, he wishes to return the retirement age to 60 – a measure that is acutely urgent given the high unemployment rate among senior citizens – and impose a strict adherence to the current, 35-hour week.

Impossible to fund? Not at all. More than hundred economists from 17 countries – including Ha-Joon Chang – published a column supporting Mélenchon’s program. His policies were presented in details by economists and high-ranking public servants in a 5-hour budget program broadcasted on YouTube, whose last hour was a discussion with economic journalists from liberal news outlets. Ghilaine Ottenheimer from Challenge praised the broadcast as “modern” and “bold”; Hedwige Chevrillon (BFM Business) compared the approach to that of the ‘slow food movement’ and deemed it a rare opportunity to think things through; Marc Landré (Le Figaro) was impressed by the openness with which La France Insoumise was laying itself open to criticism.

The broadcast has already been viewed more than half a million times. On every aspect of its program, from the environment to counter-terrorism via culture and international relations, La France Insoumise has taken the same care to involve experts. Who, then, are the ‘Insoumis’? How did such an extraordinary campaign get off the ground? This question takes us back to 2012.

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After Mélenchon’s remarkable 2012 campaign, the Front de Gauche fell apart because of strategic disagreements: the Communist Party wanted to maintain alliances with the Socialist Party whereas Mélenchon was convinced that any association with the now hugely-unpopular party of Hollande could only drag them with its fall. When Mélenchon claimed in 2015 that he did not aim to ‘unite the left’ but to ‘federate the people’, it was widely perceived as the desperate gambit of an isolated figure. And yet the gambit paid off: there was indeed a people to answer his call. With the massive demonstrations against Macron’s labour laws and the grassroots movement Nuit Debout, the writing was on the wall. Mélenchon was careful not to lay claims to these movements which were profoundly suspicious of established politicians and parties, but he has nevertheless been able to tap into their energy by creating La France Insoumise, a loose structure within which everybody contributes freely.

The Insoumis have shown ebullient creativity: some created a board game, others a computer game (Fiscal Kombat), and one of the authors of the present article wrote a comic book adaptation of the manifesto. Alongside quirky stunts such as appearing at meetings via hologram, the Insoumis have brought a vitally seductive and energetic edge to Mélenchon’s campaign. Crucially, they have brought to fruition another aspect of Mélenchon’s strategy: his struggle against the press.

In 2012, Mélenchon often claimed that the media was the “second skin of the system”. The only way to break the neoliberal hegemony was to subvert its own logic: that of audience and profit. Thus was created the colourful figure who claimed to incarnate “the sound and the fury of his time”. Yet, having become a celebrity, Mélenchon had to avoid being pigeon-holed into a caricature. The media, he claims, are “not a mirror but an arena”, so he adopted a confrontational strategy aimed at exposing the biases of journalists and interviewers.

Yet there is only so much one can say in the constraining format of TV and radio interviews; all one could achieve was to fire “bullet words” that would open cracks in the listeners’ preconceptions. In response, listeners had to be provided with alternative sources of information. In 2012, Mélenchon’s blog was the most read of any French politician; in 2013, a galaxy of “6th Republic blogs” was created; in 2016 Mélenchon’s extremely successful YouTube channel was launched; it has so far has over 22 million views. The book detailing his manifesto, L’Avenir en commun (A Shared Future) has found its way into bestseller lists, shifting well over 250,000 copies. If such independently-made material is inaccessible to non-French speakers, international viewers should not be tricked into seeing it as Trump-style, anti-system fake news. For example, a host of global NGOs including Oxfam and ActionAid have backed key aspects of Mélenchon’s campaign, with Amnesty and Greenpeace ranking him highest overall in their breakdown of all the candidate’s policies. Leading economists have also signed a pledge backing his candidacy will be published this week.

The communication machine of Defiant France is firing on all cylinders. It is remarkable that the fear-mongering of the mainstream media has failed to halt Mélenchon’s surge in the polls – remarkable, but not surprising given that his latest meeting, in Toulouse, was attended by 70,000 people, and had attracted 320,000 views on YouTube in under 24 hours. 

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Do not be mistaken: something astonishing is happening. This is about much more than meeting attendance. To be sure, Mélenchon is not simply preaching to the choir: bucking all recent trends, recent polls have shown that he is denting Marine Le Pen’s share of the working-class vote, and has overtaken her as the most favoured candidate of the youth. People are flocking from all across the political spectrum: recently, an entrepreneur from the Silicon Valley published a piece titled If Mélenchon is elected, I return to France.

He is not an isolated case, and a petition of the entrepreneurs with Mélenchon has just been launched. Even the ‘Gaullists’, disillusioned with the Fillon scandals, are now seduced by Mélenchon’s cultural style, his integrity, and his vision of France’s place in the world which is in line with the tradition of the General himself. What seemed like a fanciful vision is thus coming true: the French people is being transformed. One of the most striking signs of the campaign’s success is the change in people’s priorities: whilst employment had always ranked first, it has now been displaced by institutional reform. This, of course, is intrinsically tied to the centrepiece of Mélenchon’s program, which aims to accomplish no less than a Révolution citoyenne: creating the 6th Republic by means of a Constituent Assembly.

Under the Nazi Occupation of France, resistance networks sought not only to liberate the country, but also to bring about a better world. At great peril, they formed the National Resistance Council and drafted a program which was circulated under the cover of a novel titled Les Jours Heureux. It is no coincidence that the crowds at Mélenchon’s meetings do not chant his name but the word “resistance”, and that Melenchon himself synthetizes his aim with the phrase “let us bring forth the happy days”. The perils are undoubtedly lesser but with a deeply dysfunctional economic system preventing us from addressing climate change and fuelling the rise of the far-right, the stakes may be even higher.

Olivier Tonneau is lecturer in Modern and Medieval Languages at Homerton College, Cambridge. He participates in La France Insoumise, the movement supporting Jean-Luc mélenchon's presidential campaign. He writes a blog on French politics. Nick Jones is in the final year of his undergraduate degree studying French at Homerton. During his year abroad in Paris, he was a participant in, and keen observer of, the grassroots movement Nuit Debout. 

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