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

© LEWIS MORLEY/NATIONAL MEDIA MUSEUM SCIENCE & SOCIETY PICTURE LIBRARY. COURTESY OF VICTORIA AND ALBERT MUSEUM, LONDON
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Nostalgia without memory

We had a terrific time in the Sixties – but at what cost to the millennial generation?

There is a flurry of Sixties-worship at present, with an exhibition at the ­Victoria and Albert Museum in London and a cinema documentary about the Beatles’ ­touring years directed by Ron Howard. Next month, two more books on the ­subject will join the pile to which I have admittedly contributed more than my share. Steve Turner’s Beatles ’66: the Revolutionary Year reconstructs the band’s exploits in that eventful season (also recently chronicled in Jon Savage’s weighty 1966: the Year the Decade Exploded). And Paul Howard’s I Read the News Today, Oh Boy tells the story of Tara Browne, the gilded young Guinness heir whose death at the wheel of a Lotus Elan inspired John Lennon’s greatest song, “A Day in the Life”.

Truly, this is the decade that never dies. At frequent intervals since the mid-­Eighties, glossy magazines have announced that “the Sixties are back”, with fashion spreads of Paisley fabrics, Mary Quant-ish bobs, ­shorter-than-ever miniskirts and elastic-sided Chelsea boots. Sixties pop music eternally dominates radio playlists, while the Rolling Stones, the decade’s most notorious band, though now withered old-age pensioners, are still widely reckoned the coolest, most dangerous dudes on the planet.

For that, we largely have to thank the “Sixties children”, who lived through the most magical time for youth there ever was, survived its surfeits of alcohol, sex and mind-shredding drugs, and now seek to perpetuate their glorious heyday even unto senility. But the greatest celebrants of the era are often people who never experienced it first-hand yet still yearn for it in a syndrome that psychologists call “nostalgia without memory”. Tony Blair’s “Cool Britannia” shtick in the Nineties, for instance, pastiched the Swinging London of three decades earlier, right down to the Union Jack carrier bags. In folk memory the Sixties are as a rosy blur of psychedelic colour, free love and Beatles music, their complexity and manifold horrors either unrealised or disregarded.

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The mythic decade, as opposed to the real one, was no straight ten-year stretch. It didn’t get into gear until 1962 with the satire boom that produced BBC TV’s That Was The Week That Was, David Frost’s first starring vehicle, and Private Eye magazine, and didn’t absorb pop music until the Beatles’ historic first visit to America in 1964. Its closing year, marked by a series of vast open-air festivals – Woodstock, Bob Dylan on the Isle of Wight, the Stones’ free concert in Hyde Park – felt almost like a decade on its own. When 1970 dawned, so much resembling a grey morning-after, many Sixties children simply refused to believe the party was over and clung to their caftans and joss sticks far into the harsh new eras of glam rock and punk.

Its prime time is generally agreed to have been 1965, when London gave vent to a concerted burst of youthful creativity in music, art, fashion, photography, cinema and graphics, and a shabby, sleepy metropolis, bombed to ruins not long previously, received the unlikely sobriquet of “swinging”. At this stage, the swinging was confined to a small circle of musicians, models, actors and photographers, congregating in the same few, unpublicised bistros and clubs: the most emblematic pop single, among so many, was Dobie Gray’s “The ‘In’ Crowd”.

It is seen above all as an era of burgeoning freedom and tolerance when Britannia seemed to be loosening her Victorian stays one by one. The contraceptive pill became widely available, ending centuries of shotgun marriages and perilous backstreet abortions, and theatre censorship by an archaic royal flunky called the Lord Chamberlain came to an end. Male homosexuality was decriminalised, though not yet destigmatised, and the first feminist voices spoke out. The word “fuck” appeared in the Times (during the farcically unsuccessful obscenity prosecution of Penguin, publisher of D H Lawrence’s Lady Chatterley’s Lover) and was heard on BBC Television, albeit only in quotation marks, from the National Theatre’s literary manager, Kenneth Tynan.

Yet alongside the pop-cultural harlequinade, Britain faced many of the same problems as we do today – some, indeed, significantly worse. Industrial strife was so common that the rest of Europe came to know strikes as “the English disease”. Harold Wilson’s Labour government, continuously in power after 1964, imposed a strict wages freeze, then known as a “pay pause”, and failed so utterly to solve its own financial deficit that in 1967 Wilson was forced to devalue the pound by 14 per cent. The World Cup-winning 1966, that supposed annus mirabilis, also brought two events whose horrors still resonate: the Moors murders trial and the Aberfan disaster, in which a south Wales primary school was engulfed by a giant slag heap, killing 116 children and 28 adults.

Meanwhile, the outside world was taking its first steps backwards into hell. America’s inspirational young president John F Kennedy was assassinated, as, in horrifically quick succession, were his brother Robert and the great civil rights leader Dr Martin Luther King. The United States was shamed at home by racism and police violence (not much change there, then) and abroad by its war in Vietnam, which nightly filled British TV screens with images of bombed civilian enclaves and maimed children (little change there, either – except today barrel bombs replace napalm). A democratic movement in communist-controlled Czechoslovakia was crushed; there was incalculable murder and terror in China’s Cultural Revolution, genocide in Indonesia and Biafra, apartheid in South Africa and endemic famine in India. June 1967 brought not only Sgt Pepper’s Lonely Hearts Club Band and the “Summer of Love” but the Arab-Israeli Six Day War, whose cumulative effects remain seemingly impossible to resolve.

Throughout the Sixties, Britain, along with the rest of western Europe, faced the threat of nuclear war with Soviet Russia and more-than-possible total obliteration. And yet, paradoxically, this was a time of enviable domestic peace and stability. There was full employment, with almost nobody ever getting sacked except at the very top. Inflation was marginal; the NHS and other public services functioned without any hint of crisis; the nationalised railways, shorn of unprofitable branch lines by Lord Beeching, were dirty but dependable; the postal service, even after the introduction of an avowedly “second-class” tier, remained the envy of the world.

Pending that terminal flash in the sky, people felt safe. The only communicable disease left to be feared was smallpox. ­Terrorism was something that happened only in the distant Middle East: it could not conceivably take root among Britain’s hard working and law-abiding Indian and Pakistani immigrants despite the unfettered racism constantly hurled at them. One walked on to aircraft or into official buildings or the BBC without security checks. The first shadow of Northern Ireland’s Troubles, which were to bloody the Seventies and be described by American commentators as “Britain’s Vietnam”, did not appear until 1968.

Two world wars in the space of 30 years had trained ordinary Britons to feel guilty about any conspicuous consumption. In the Sixties, the advertising industry set about remedying this. The new Sunday newspaper colour supplements bulged with adverts for Scandinavian furniture, stereo systems and white Kosset carpets, and bombarded their readers with recipes for exotic dishes such as chicken Kiev and beef stroganoff, using quantities of butter and cream that once would have seemed downright immoral. When Rowntree launched a new wafer-thin chocolate mint, the company made a last-minute name change from Minty Thins to After Eight, suggesting elegant high-society dinner parties to a demographic only recently weaned from high teas. So older generations, too, could join an “in” crowd and share the feeling of life becoming measurably better every day.

The attention paid to youth was an extraordinary volte-face from that ancient British maxim “Children should be seen and not heard”. Young people now not only wielded huge economic power through pop music and fashion, but kicked aside class distinctions and social barriers. Following the Beatles template, almost all of the decade’s brightest new celebrities were in their twenties and from humble backgrounds: the photographer David Bailey, the model Twiggy, the painter David Hockney, the comedian Jimmy Tarbuck, the film stars David Hemmings, Rita Tushingham, Tom Courtenay and Terence Stamp. A northern or a cockney accent was almost a prerequisite of success. In Britain in the past, the working class had always tried to talk “up”; now the upper and middle classes strove to talk “down”. It still goes on.

Without any form of social media other than underground newspapers and ­flyers, Sixties youth culture managed to be remarkably united. It assumed that every figure of authority – indeed, anyone over 30 – was a pitiable lunatic. Unlike its counterparts in America and across Europe, it raised up no demagogues: its figureheads were lead singers in bands and radio disc jockeys whose dimness in no way reduced their potency. The hippies, who arrived post-1966, are now viewed as hopelessly naive and deluded, with their mantra of “Love and Peace”. Yet their pop festivals, love-ins and “happenings” were occasions that brought hundreds of thousands together without the slightest violence. There were ­moments when even their fiercest detractors wondered if they might really be a force for changing the world for the better.

***

The V&A exhibition “You Say You Want a Revolution?” focuses on the decade’s final phase, when Britain’s initially playful underground hardened into a many-headed protest movement containing every kind of extreme-leftish ideology; churning out insurrectionary literature amid the comforts of the consumer society; holding marches, demos and sit-ins of increasing militancy despite having nothing to protest about nearer than the Vietnam War (in which the Wilson government played no part whatsoever). It was always more serious in other European countries and the US, where former hippies made an easy transition to urban guerrillas and to Charles Manson’s serial-killing “Family”.

Simultaneously, the British police declared war on leading musicians whose songs seemed to encourage their fans to take drugs, whether the pot known to jazz players for generations or the new, man-made, “mind-expanding” lysergic acid diethylamide (LSD), which leaked from the very pores of the Beatles’ Sgt Pepper album. The fear was legitimate – in fact, nowhere near proportionate to the long-term problem in the making – but the reaction was hysterical scapegoating. In early 1967, with the collusion of MI5 and possibly the CIA, 18 police officers raided the Rolling Stone Keith Richards’s cottage in Sussex and Richards and Mick Jagger were charged with drug possession. After a grotesque show trial – yet another strike against that supposed Summer of Love – both Stones received prison terms for offences that normally would have rated a small fine or merely probation.

The recent death of Richard Neville, the founder of Oz magazine, awoke further memories of that moment when the Sixties’ indulgence of youth was suddenly turned off. The 1971 trial of Neville and his two co-editors for conspiracy to corrupt youthful morals (specifically by depicting Rupert Bear with an erection) was just as self-defeatingly comical as the Lady Chatterley prosecution almost a decade earlier.

For millennials who grew up around the year 2000, the Sixties are an object not so much of nostalgia without memory as envy without memory. My 25-year-old daughter often remarks what a terrific time my generation had and what a messed-up world we created for hers. I can’t argue with that.

Philip Norman’s “Paul McCartney: the Biography” is published by Weidenfeld & Nicolson. He tweets at: @PNormanWriter

This article first appeared in the 15 September 2016 issue of the New Statesman, The fall of the golden generation