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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It's time for the government to think again about Hinkley Point

The government's new nuclear power station is a white elephant that we simply don't need.

Today I will welcome Denis Baupin, Vice President of the French Assembly, to Hinkley.

His own choice to come and visit the site of the proposed new nuclear power station reflects his strong desire to prevent the UK disappearing up a dangerous dark alley in terms of energy policy. It also takes place as France takes a totally different path, with the French government recently adopting a law which will reduce nuclear energy in the country.

Greens have opposed Hinkley ever since the government announced its nuclear strategy. Hinkley, with its state aid and an agreed strike price of £92.50 per megawatt, has always been financially and legally suspect but it is now reaching the level of farce. So much so that George Osborne is required to be economical with the truth in front of a House of Lords committee because he cannot find anything honest to say about why this is a good deal for the British people.

Mr Baupin and I will join hundreds of protestors – and a white elephant – to stand in solidarity against this terrible project. The demonstration is taking place under a banner of the triple risks of Hinkley. 

First, there are the safety and technological risks. It is clear that the Pressurised Water nuclear reactor (EPR) – the design proposed for Hinkley C – simply does not work. France’s nuclear safety watchdog has found multiple malfunctioning valves that could cause meltdown, in a similar scenario to the 1979 Three Mile Island nuclear accident in the US.  The steel reactor vessel, which houses the plant’s nuclear fuel and confines its radioactivity, was also found to have serious anomalies that increase the risk of it cracking. Apart from the obvious safety risks, the problems experienced by the EPR reactors being built at Flammanvile in France and Olkiluoto in Finland have pushed the projects years behind schedule.

Secondly, Hinkley poses risks to our energy security. Hinkley is supposed to produce 7% of the UK's energy. But we now know there will be no electricity from the new nuclear plant until at least 2023. This makes power blackouts over the next decade increasingly likely and the only way to avoid them is to rapidly invest in renewable energy, particularly onshore wind. Earlier this week Bloomberg produced a report showing that onshore wind is now the cheapest way to generate electricity in both the UK and Germany. But instead of supporting onshore wind this government is undermining it by attacking subsidies to renewables and destroying jobs in the sector. 

Thirdly, there is the risk of Chinese finance. In a globalised world we are expected to consider the option of allowing foreign companies and governments to control our essential infrastructure. But it is clear that in bequeathing our infrastructure we lose the political control that strengthens our security. The Chinese companies who will be part of the deal are part owned by the Chinese government and therefore controlled by the Chinese Communist Party. What a toppy-turvy world globalisation has created, where our Conservative British government is inviting the Chinese Communist party to control our energy infrastructure. It also seems that China National Nuclear Company is responsible for the manufacture of Chinese nuclear weapons.

Of course it is the Chinese people who suffer most, being at the hands of an oppressive government and uncontrolled companies which show little respect for employment rights or environmental standards. By offering money to such companies from British consumers through their energy bills our government is forcing us to collude in the low human rights and environmental standards seen in China.  

Research I commissioned earlier this year concluded we can transform the South West, not with nuclear, but with renewables. We can generate 100 per cent of our energy needs from renewables within the next 20-30 years and create 122,000 new quality jobs and boost the regional economy by over £4bn a year.

The white elephant of Hinkley looks increasingly shaky on its feet. Only the government’s deeply risky ideological crusade against renewables and in favour of nuclear keeps it standing. It’s time for it to fall and for communities in the South West to create in its place a renewable energy revolution, which will lead to our own Western Powerhouse. 

Molly Scott Cato is Green MEP for the southwest of England, elected in May 2014. She has published widely, particularly on issues related to green economics. Molly was formerly Professor of Strategy and Sustainability at the University of Roehampton.

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Matteo Renzi, the scrapper in the swamp

 Italy’s prime minister – “Europe’s last Blairite” – vowed to take on vested interests and smash open the economy. Can he still succeed?


In the summer of 2009, Daniele Caponi graduated from Sapienza University in Rome. His CV looked impressive. He had a degree in languages, and was fluent in four: Spanish, German, English and Italian. But the timing of his entry into the job market was terrible.

The global financial crash the previous year had badly affected Italy’s already weak economy. Prospects for graduates were so bleak that the best work Caponi could find was as a taxi driver. Six years later, the situation remains so precarious – youth unemployment is running above 40 per cent – that Caponi says he is “proud and honoured” to have a job at all.

Intelligent, confident and articulate, Caponi would appear to be precisely the type of person that Prime Minister Matteo Renzi has in mind as a beneficiary when he says he wants to jumpstart Italy’s economy by breaking it open to competition – with a war on entrenched interests and an influx of foreign capital leading the way to more jobs. Yet Caponi also embodies forces conspiring to defeat him. As a taxi driver, he belongs to one of Italy’s “closed-shop trades” (which also include chemists and lawyers) that hold back the economy, clinging to privileges and blocking outsiders from entry. For members of these trades, the benefits of the status quo are clear: Caponi makes enough money to wear smart clothes, eat at good restaurants and go trekking in south-east Asia or Latin America every year.

He is not willing Renzi, who has been called “Italy’s Tony Blair”, to fail, but thinks it is inevitable that he will. For the man at the helm of the centre-left Democratic Party, who a year and a half ago – at the age of just 39 – became his country’s youngest-ever prime minister has the task of changing not only Italy’s legislation, but its way of life. It is a struggle of allegiances versus globalisation; gerontocracy versus meritocracy; made-in-Italy quality versus stark economic efficiency – and the rule of law versus the tendency to bend it.

On the day I meet Caponi, he is illegally cramming extra passengers into his car because a transport strike has affected his takings. “You see, Italian politics mirrors Italian people,” he says. “Even me, you find me criticising politics. But look at what happened today. I pulled two rides into one – I did something I was not supposed to do.”


When Renzi took over as Italy’s leader in February 2014, many in the country felt it as a gale of fresh air after two decades of political tragicomedy and economic stagnation dominated by Silvio Berlusconi, whose main interest in power, his many disparagers say, was to protect his media empire and keep himself out of prison. That protracted era of zero growth, from 1994 to this year, left Renzi with enormous problems: more than one in every ten people out of work, chronic dips into recession, and a national debt that is 135 per cent of GDP, against 95 per cent for France, 90 per cent for Britain and 75 per cent for Germany. Add to that one of the rich world’s lowest fertility rates, at 1.39 births per woman – a demographic crisis that prompted the health minister to call this a “dying country”– and it may seem surprising that anybody would want the job of extracting Italy from the bureaucratic and parliamentary mess that Italians call il pantano, “the swamp”.

Renzi, however, seems to relish challenges that are the proper measure of his ambition, which was apparent from an early age. The son of a centre-right municipal councillor, he grew up in Rignano sull’Arno, a quiet Tuscan town outside Florence, where he became a keen Boy Scout. (His official website uses a quotation from Robert Baden-Powell,
the founder of the Scout movement, as its epigraph: “Leave this world a little better than you found it.”) The modest scope of this idealism provides clues to Renzi’s combination of pragmatism and engagement.

His passion for politics began in high school, and as a law student at the University of Florence he co-founded a committee to help Romano Prodi, a Democratic Party stalwart, become prime minister. Around that time, the 19-year-old Renzi appeared on the Italian version of Wheel of Fortune, raking in £20,000. It was a precocious sign of his penchant for games of risk.

His first break in politics came at the age of 24 when he became provincial secretary of the centrist People’s Party. From there, his rise was fast: president of the province of Florence at 29; mayor of Florence, a much bigger job, five years later. As mayor, Renzi shook up the city by cutting back sharply on the number of councillors, increasing the efficiency of public services and boosting welfare spending. As Italy began to take notice, the young mayor already had his eyes on a bigger stage: national politics.

In early 2013, he sensed the moment had arrived. In parliamentary elections, one in four Italians had voted for a comedian, Beppe Grillo, whose populist Five Star Movement proudly stood for little other than revulsion with the ruling elite. It was a turning point in Italian politics. After the Berlusconi era – and a brief technocratic government led by Mario Monti, who imposed austerity to pull the country back from a financial abyss – Italians were fed up with the political class and hungry for change.

Renzi, then still mayor of Florence, blitzed TV and social media with a vision of himself as the saviour of Italy, while his Democratic Party colleague Enrico Letta plodded along at the head of an unwieldy coalition government. Renzi promised to rottamare – “wreck” – the system (from this he acquired the nickname “The Scrapper”). He was bold and passionate and, like Berlusconi, he projected sunny optimism. Best of all, as mayor of Florence from 2009, he was an outsider, untainted by the machinations and scandals of national politics. Many Italians dared to hope again, as Renzi promised a bold reform programme that would generate jobs and revive the economy.

Late in 2013 he won the Democratic Party leadership, and quickly showed his ruthlessness by orchestrating what the Italian press called a “palace coup”, toppling Letta the following February. (A popular cartoon from the time shows Renzi in a relay race, handing his predecessor a stick of dynamite.) Days later, without ever having been even a member of parliament, Renzi was appointed prime minister.


While many Italians began to place their hopes in Renzi, there was also an undercurrent of suspicion about him that still prevails. One reason for this is his opportunism. On a stroll through Rome’s best food market, in the rough-and-tumble Testaccio district, I heard a story about him that went like this.

“A municipal councillor of Florence from the time that Renzi was mayor was once asked by a journalist: ‘Renzi – according to you, is he a capable man?’

“The councillor responded: ‘Yes, he is capable of anything.’”

Indeed, while Renzi purports to be a man of the left he often doesn’t sound like one. Besides smashing open protected sectors and taming the trade unions, he wants to overhaul the bloated and coddled public sector and attract overseas capital, which would inevitably entail foreign corporate takeovers. In the context of the rise of far-left parties in Europe, such as Syriza in Greece and Podemos in Spain, and given Jeremy Corbyn’s ascent to the Labour leadership in Britain, Renzi is increasingly looking like Europe’s last Blairite. (He got to know Blair when he was serving as mayor and Blair holidayed in Tuscany, and they became friends. Last year, Blair told the newspaper Corriere della Sera that Renzi was “the only way forward for Italy’s left”.) Indeed, on 21 September, Renzi appeared to be channelling Blair when he said that Corbyn’s victory was evidence that Labour “delights in losing”.

Yet there are signs that Renzi may not be winning his own battle. Another reason for Italians’ growing scepticism about him is that six months into his premiership the country slipped back into recession. This year, according to the European Commission, Italy is projected to eke out 0.6 per cent growth. By contrast, Spain and Portugal, which also have suffered severe debt and austerity crises, are forecast to grow at 3.1 and 1.6 per cent, respectively.

Meanwhile, unemployment remains stubbornly high despite the passage in the spring of Renzi’s signature “Jobs Act” – a package of laws that aims to generate employment by scaling back job protections and offering tax incentives to companies that hire long-term workers (as opposed to the surging number of people on precarious short-term contracts). And reform means nothing unless people believe it will work. Foreign investment has increased but Italian businesses are clinging to their capital. After rising early this year on the back of the imminent labour reforms, business confidence slumped again over the summer.

Critics say that whatever growth Italy does achieve this year may be due less to him than to another Italian: the European Central Bank chief, Mario Draghi, who has sought to invigorate the eurozone economies with a flood of easy credit. Some economists say that without a cheaper euro to boost its exports, Italy would still be in recession.

Meanwhile, in times of uncertainty, Italy’s business cliques hunker down to their old ways – hostile to hiring young people and preventing newcomers from encroaching on their turf. Renzi is fighting hard to tame these entrenched interests. The problem is that he may be running out of time. His approval ratings have nearly halved, down from more than 60 per cent after he became premier to around 32 per cent today.

“If nothing happens, especially in terms of kick-starting the economy, then people will start saying you’re just hot air,” said Vincenzo Scarpetta, an expert on Italy based at the Open Europe think tank.

One might imagine that students here would be among Renzi’s biggest fans, given that he is promoting policies that would help them find work. But on the Sapienza campus, Caponi the taxi driver’s alma mater, I cannot find a single student who believes that Renzi could improve their prospects by the time they enter the workforce. The overwhelming message: once I graduate, I’m out of here.

Beatrice Parsi di Landrone, studying chemistry, shakes her head at the thought of change being possible in Italy. The economy, she says, is built on patronage and favours that keep talent out of the best jobs. She wants to move to England and apply her skills in cosmetics, working for Max Factor.

“You can’t work here unless you have an inside track,” she explains. “For 20 years now, the government has been ruining Italy, even if we’re the best in the world in so many things. Overseas, it’s our brains that make a difference.”

The message on the sweatshirt worn by Mirko Mandarino, a medical student, speaks for his generation: “F**KIN’ PROBLEMS”. He is from Calabria, in the deep south, where people are poorer on average than in other parts of Italy. That makes it even harder for him to succeed in this country, where
many northerners hold southerners in contempt. Under Renzi, the gap between north and south has widened: national GDP fell 0.4 per cent last year but the south suffered a 1.3 per cent decline. “Renzi?” Mandarino says with a chuckle. “He’s an opportunist. A social climber. That’s how he’s gotten to where he is. My future? Outside of Italy. There are no other alternatives.”

Like Parsi di Landrone, Mandarino laments a culture of vested interests that blocks young people from achieving their dreams. “Nobody wants to give up anything,” he says. “They’re clans. The mentality is mafioso.”

Still, he feels sympathy for older Italians who cling to jobs and power. “In Italy, an old person can’t give way to the young, because at his age he wouldn’t find anything else. I have an uncle in Canada. He got fired at age 48. The next month he found a new job. That kind of thing doesn’t exist in Italy.”

Christian Abete, a classics student, sums things up: “We export wine and graduates.”


Franco Pavoncello, a political scientist and president of John Cabot University in Rome, meets me on the terrace of Vanni, a café in the genteel Prati district. Of the dozens of Romans I speak to, Pavoncello is the only one who believes that Renzi will succeed. “I am bullish about Italy,” he says.

The professor presents a heroic narrative of the prime minister, calling him a “revolutionary figure” – and only time will tell whether he is right. But he does make a basic point that it is hard to argue with: “He’s the only game in town. The right is dead. Completely melted. The left continues to be the usual communist left. It’s a disaster.”

It is the disarray among Renzi’s opponents not only on the right, where Berlusconi’s Forza Italia is fighting to regain relevance, but also in the crumbling old guard of the Democratic Party, that may allow him to press forward. “Nobody can stop this avalanche,” Pavoncello says.

That is an exaggeration, as the reform process is moving slowly. The big question is whether the Italian people will have the patience to endure a drawn-out and complicated overhaul – which promises pain to millions who benefit under the status quo – as the economy continues to stagnate. A stumble for Renzi’s party in regional elections in late May signalled threats hovering over his future. Voters are growing hostile to his pro-business ethos, alien to Italian tradition, and his own camp is beginning to bridle under a leadership style often described as dictatorial. Adding to his problems, the xenophobic, anti-euro Northern League’s vote share jumped across the nation, extraordinary for a party that long advocated a divorce between the affluent Italian north and the poorer south.

Pavoncello insists that Renzi has the political smarts and determination to be a transformative figure. But won’t he hit the brick wall of Italians’ cherished way of life?

“What way of life?” he fumes. “People staying at home? Fifty per cent youth unemployment? Taxi drivers who think they’re middle-class? In New York taxi drivers are not middle-class. Here taxi drivers make three, four, five thousand dollars a month. They feel they are shopkeepers. Taxi drivers are not middle-class. They are the bottom of the class! Can you remain middle-class when you have Uber? You can fight. You can try. But the world is going against you.”

Roberto Fabiani, the spokesman for Rome’s main cabbies’ association, who is a taxi driver, too, does indeed come across as middle-class. He wears Ray-Ban aviators, designer stubble and a crisp white shirt as he meets me at the Romana Tassisti headquarters on the outskirts of the city. Like Caponi, he is university-educated and asks why he shouldn’t have a pleasant family life after working a hard shift behind the wheel. He sees Renzi’s argument about reviving the economy by making it easier for firms to fire as being fundamentally at odds with Italy’s communitarian sensibilities.

“This is a philosophy that is molto liberal,” Fabiani says of the Jobs Act programme. “In Italy we have a vision that is very much to the left. Article 1 of our constitution says that Italy is a country founded on work. Translated, that means that every citizen should have the right to a dignified job, not extravagantly paid, but one that allows him to live in a dignified manner. ‘Dignified’ for me means not only to have an income that allows me to live, but also the security to know that I can live my life. If I’m hired, and in three months somebody says ‘you’re no longer needed’, that’s a problem.”

Italy’s commitment to social welfare, with its roots in age-old ideas about community and family, has provided cushions that allow people to live with dignity even in the midst of a sharp downturn. Yet millions of young Italians are living with precisely the indignity of uncertainty that Fabiani finds unacceptable. He is prepared to fight to protect his own. “If this happened,” he says of Renzi’s plan to break open closed sectors, “it would be the end. We’d take a hard position. Until the bitter end.”


There is no country in the world where cliques do not fight hard to keep their privileges. In Italy, however, the instinct is particularly strong; and this may present the greatest challenge of all to Matteo Renzi’s desire for reform. Italy’s historical experience as a jumble of city states and patches of empire has left a structure of allegiances and patronage that poses daunting obstacles to change.

Campanilismo, loyalty to the village bell tower, is central to Italian life. This signifies loyalty not only to your village, but to your trade association, your social circle, uncles and cousins, and, at the highest echelons, your political faction or business cabal.

“I’m not Italian, I’m a Roman,” says Caponi the taxi driver. “This is another thing that we are missing. We aren’t like the French or the Germans or the English, who are French and German and English.”

It’s a spirit captured in a song by the singer Luca Carboni called “Inno Nazionale” – “National Anthem”. You might expect a patriotic paean, but it goes like this:

“I’m too much of a Bologna man,

And you’re much too Neapolitan.

Him? Too much from Turin,

And you guys too stuck in Bari.

And if we’re all too proud,

They’re all too Venetian.”

The song continues in this vein, a hard rap with a techno beat. In its simplicity, this national anthem conveys how the Italian identity is precisely the lack of one. The paradox hits home in the song’s conclusion:

“We were once too fascist, and then

Too don’t-give-a-fuckists . . .

And then became too communist,

As well as too Christian-Democratic.

And even as time passes,

We’re still too ITALIAN!”

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide