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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Conservative disunity is not all good news for Labour

The Tory leadership election could squeeze Labour out of the conversation, just like Blair and Brown did to the Tories.

The first test of opposition politics is relevance. Other key yardsticks - political plausibility, economic credibility, setting the agenda and developing a governing vision - all matter greatly. But making yourself a central part of the relentless cycle of daily politics, the terms of which are generally set by the governing party, is the first hurdle. It matters not whether you sign up to new politics or old: be relevant or wither. 

The issue of relevance is becoming a pressing issue for Labour. Take George Osborne’s favoured issue of the so-called national living wage.  Leave to one side the rights, wrongs and nuances of the policy and just consider the basic political dynamic it creates.  Osborne has, quite deliberately, set up a rolling five year argument over a steadily rising wage floor. On one side, is the Chancellor arguing that his policy is the right thing for Britain’s ranks of low paid workers. Pitted against him are ranks of chief executives of low-paying big business. With each impending hike they will holler at Osborne to go no further and the media will happily amplify the row. In response the Chancellor will quietly smile.

Sure, on occasions this will be uncomfortable stance for Mr Osborne (and if the economy takes a downward turn then his pledge will become incredible; there are always big risks with bold strokes).  Yet the dominant argument between the Conservatives and big business leaves Labour largely voiceless on an issue which for generations it has viewed as its own.

We may well see a similar dynamic in relation to the new national infrastructure commission – another idea that Osborne has plundered form Labour’s 2015 manifesto. It’s far too early to say what will come of its work looking at proposals for major new transport and energy projects (though those asserting it will just be a talking shop would do well not to under-estimate Andrew Adonis, its first Chair). But there is one thing we can already be confident about: the waves of argument it will generate between Osborne’s activist commissioners and various voices of conservatism. Every big infrastructure proposal will have noisy opponents, many residing on the right of British politics. On the issue of the future of the nation’s infrastructure – another touchstone theme for Labour – the opposition may struggle to get heard amid the din.

Or take the different and, for the government, highly exposing issue of cuts to tax credits. Here the emerging shape of the debate is between Osborne on one side and the Sun, Boris Johnson, various independent minded Conservative voices and economic think-tanks on the other. Labour will, of course, repeatedly and passionately condemn these cuts. But so have plenty of others and, for now at least, they are more colourful or credible (or both).  

The risk for the opposition is that a new rhythm of politics is established. Where the ideological undercurrent of the government steers it too far right, other voices not least those within the Conservative family - moderates and free-spirits emboldened by Labour’s current weakness; those with an eye on the forthcoming Tory leadership contest – get reported.  Where Osborne consciously decides to tack to the centre, the resulting rows will be between him and the generally Conservative supporting interests he upsets. Meanwhile, Labour is left struggling for air.

None of which is to say there are no paths back to relevance. There are all sorts of charges against the current government that, on the right issues, could be deployed - incompetence, complacency, inequity – by an effective opposition.  Nor is the elixir of relevance for a new opposition hard to divine: a distinct but plausible critique, forensic and timely research, and a credible and clear voice to deliver the message. But as yet we haven’t heard much of it.

Even in the best of times being in opposition is an enervating existence. Those out of power rarely get to set the terms of trade, even if they often like to tell themselves they can. Under Ed Miliband Labour had to strain – sometimes taking big risks - to establish its relevance in a novel era defined by the shifting dynamics of coalition politics. This time around Jeremy Corbyn’s Labour is up against a Chancellor willing to take risks and pick big fights: often with traditional Tory foes such as welfare claimants; but sometimes with people on his own side.  It’s also a new and challenging context. And one which Labour urgently needs to come to terms with.   

Gavin Kelly is chief executive of the Resolution Foundation 

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In the valley of death

Labour and the disintegration of social democracy.

When Fenner Brockway, the Labour MP, lifelong anti-imperialist and peace activist, recalled his early involvement in the Independent Labour Party, he wrote, “On Sunday nights a meeting was conducted rather on the lines of the Labour Church Movement – we had a small voluntary orchestra, sang Labour songs and the speeches were mostly Socialist evangelism, emotion in denunciation of injustice, visionary in their anticipation of a new society.”

Fast-forward a century or so, and Brockway could be describing a Jeremy Corbyn leadership rally: the same joyfulness, fervour of conviction and ecstasy of expression, only this time clothed in the self-belief of the Labourist left, rather than Nonconformist millenarianism, and playing to a larger crowd. Corbyn’s campaign reinvented the party political rally, a form of British politicking long since presumed dead. He created a space in which the lost tribes of the British left could reunite, and new followers join the throng. Suddenly a “surge” was under way, a democratic explosion within the mainstream body politic, not safely contained outside it.

Corbyn’s election as leader of the Labour Party is undoubtedly a seismic event. But it does not herald a wider political transformation. For although the left of the Labour Party is not a sect, it is sectarian. It inhabits a world-view, culture and practice of politics that is largely self-referential and enclosed. Save for brief moments of popular experimentalism – such as the two occasions when Ken Livingstone governed London – its reach has been minimal. Corbyn’s policy platform is an unreconstructed Bennite one, defined by nationalisation and reinstatement of the postwar settlement, given a fresh lease of life by revulsion at foreign wars and the social consequences of austerity. While his campaign tapped into discontent with the decrepit state of mainstream Labour politics, it did not give birth to a new social movement, rooted in popular struggle, like those that have sprung up in southern Europe. His improbable leadership of the Labour Party is another symptom of the crisis of social democracy, not the incubator of its future.

That social democracy is in crisis across Europe is indisputable. Few parties of the democratic left now register more than 30 per cent in national elections. In its northern European heartlands, social democracy is either besieged by populist anti-immigrant parties or marginalised by a dominant centre right. Even in Germany, where a recognisably social-democratic culture still exists, the SPD is reduced to junior-party status, topping out at 25 per cent of the electorate. Elsewhere, austerity has either destroyed the mainstream left, as in Greece, or cut it back to its core, as in Spain and France. Only in Italy, where the right has been discredited by years of corruption and abject economic performance, does the centre left have any energy.

Britain’s first-past-the-post system has protected the Labour Party from the full force of these currents, but the pull of their logic is at work here, too: political loyalties have fractured, immigration has split the core working-class vote, and the financial crisis has ushered in a politics of economic security, not reform.

The last time the death notices of social democracy were written in the early 1990s, a wave of Third Way revisionism brought it back to life. Then, social-democratic parties expanded out of their working-class electoral heartlands and public-sector redoubts, forging new coalitions of support. The freshly modernised centre left won power across Europe and in the United States. But the breadth of its appeal was not matched by depth. Over time, centrist voters proved fickle and the core vote started to abstain or desert to the anti-immigrant right. Centre-left parties began to shed votes and lose power. The financial crisis provided the coup de grâce, punishing incumbents and passing the baton of energetic opposition to new parties of the left such as Syriza and Podemos.

Today, it is clear that Third Way modernisation relied on historical circumstances that cannot be repeated now: principally a long wave of growth, in which a build-up of household debt and government transfers maintained living standards, despite rising asset inequality and the sundering of the link between productivity increases and wages. “Globalisation plus good schools” is no longer a plausible formula for winning back working-class voters, and the fiscal headroom for binding the middle classes into an electoral coalition built on investment in public services has shrunk. Nor can the rise of identity politics, whether of the civic nationalist or the anti-immigrant kind, be properly understood, let alone contested, within a political strategy that gives pride of place to individual social mobility. Even the crowning achievement of the New Labour era – the rescue and revitalisation of public services – would now require a very different set of tools from the centralism of the turn-of-the-century delivery state.


In the early 1990s, New Labour thinkers looked across the Atlantic for inspiration and renewal. Bill Clinton’s insatiable curiosity for policy ideas rubbed off on Blair and his advisers, but the most important lessons were strategic: how to win back voters in the mainstream of politics and push the right off the centre ground. Today, the transatlantic cable is broken. Latino migration to the US has replenished the Democrats’ vote base and refreshed its politics, while immigration has done the reverse to European social democrats. The White House cannot be won with older white voters, but, in Europe, ageing societies have become more conservative, making it harder for the reformist left to win. At the last general election, Labour won every age group up to those aged 55 and over, but haemorrhaged support among pensioners. The party’s Russell Brand moment never arrived. Inequalities of turnout between young and old, prosperous and poor, are such that it likely never will.

The conservatism of ageing societies, the cultural and political fracturing of the working class, and the structural dysfunctions of debt-laden western economies all pose grave challenges to social-democratic parties. The task is magnified for Labour by the break-up of the political unity of the British state, and the collapse of its support in its Scottish heartlands. Unlike in the 1980s, it cannot fall back on the ballast of a centrist trade union movement and cross-national solidarities of class.

More serious still, its intellectual resources are depleted, left and right. Those who have sought to renew Labour at critical moments in its history have always had to battle against a deep strain of anti-intellectualism in the party. Because it famously owes more to Methodism than Marx, it has never possessed a theoretical tradition. In the 20th century, it borrowed heavily from Liberal giants such as Keynes and Beveridge, and turned to the Fabians and the London School of Economics for technocratic expertise when economic planning and the construction of the welfare state demanded it. But it only ever produced a few big thinkers of its own, such as Tawney, G D H Cole and Crosland, and even their influence on the course of Labour politics was limited. When it last faced the prospect of terminal decline, in the 1980s, it had almost no intellectual resources to fall back on. Instead, it was the Gramscian thinkers grouped around Marxism Today who furnished it with an analysis of Thatcherism and a route map towards re-election.

New Labour’s openness to wider currents of ideas – at least in its early, formative phase – allowed it to draw on fresh thinking from academia, think tanks and elsewhere. But the Labour Party’s intellectual revival in the late 1980s and 1990s owed much to a cadre of soft-left MPs, epitomised by Robin Cook and Gordon Brown, who could act as receptors into the labour movement of the thinking that was taking place outside it. No such cadre exists today. The soft-left tradition was weakened by defection, desertion and (tragically, in Cook’s case) death, and what remained of it in the parliamentary party at the turn of this century had become a Brownite patronage network. Ed Miliband failed to revive it, despite being suited to the task. The reductio ad absurdum of this decline was reached in the desperate political gymnastics of Andy Burnham’s leadership campaign.

Labour’s anti-intellectualism would be less of a problem if the party were well attuned to public sentiment and capable of intuiting the sources of change in British society. But it is not. Like other mainstream political parties, it has become hollowed out, professionalised and state-centred in recent decades. As the class structures that gave birth to Labour politics declined in the second half of the 20th century so, too, did the party’s roots in civil society begin to shrink. Its forms of popular culture, its institutions and its membership base all withered, leaving it with leaders drawn from a professional caste, possessed with all the skills and networks necessary to navigate Westminster and Whitehall, but with not much underneath or around them in the wider society.

This decline has been apparent since the late 1970s – certainly since Eric Hobsbawm wrote his celebrated essay “The Forward March of Labour Halted?” (1978). And yet, despite significantly broadening its electoral appeal in the New Labour era, Labour has not created social and economic bases to replace those lost with the passing of industrial society. It has become caught in what the political scientist Peter Mair diagnosed as the trap facing all centrist parties: the one between responsibility and responsiveness. Parties aiming for elected office seek the patina of responsibility, fiscal and political. They set out credible, carefully crafted programmes for government, mindful of its constraints and compromises. Instead of representing the people to the state, they increasingly represent the state to the people. This leaves the field open for populists, who eschew responsibility in favour of responsiveness, unmediated authenticity and the articulation of an anti-politics. In recent years, only the SNP has sprung this trap, combining broad appeal with seriousness of governing purpose.


Corbyn’s surge did not reverse this decline. The number of trade unionists voting in the 2015 leadership election was lower than that in 2010, and even the addition of registered supporters did not push the selectorate back up to where it was in the mid-1990s (he is also now learning that leadership itself can’t be dissolved into networks, and that the task of leading demands considerable skills). Yet Corbyn’s campaign held up a mirror to the Labour Party, showing it how shrunken, uninspiring and detached from society it had become. Over the course of a few months, he mobilised 16,000 volunteers, pulled in thousands of new activists, and showed the Labour high command how to do digital politics. Some of his supporters are day trippers who won’t stick around. But many more are for real, with decent intentions; and they have changed the party irrevocably. Corbyn used Labour’s new internal democracy to open the party up, and in so doing placed the cadaver in full view. There is no going back.

Is social democracy finished, a relic of 20th-century class society, as John Gray and others predicted three decades or so ago? Its twin historic tasks – to tame and humanise capitalism, while harnessing its dynamism – remain as valid and pressing as ever. But in this post-crash era, it needs to equip itself with new economic reform agendas. Croslandite and Third Way revisionism were both creatures of eras of economic moderation, and shared a conviction that capitalism had overcome its contradictions. The great financial crisis of 2007-2008 destroyed those assumptions, and threw into sharp relief the challenge of stabilising highly financialised economies while reducing the inequalities and imbalances to which they are subject. Despite his political failure, Ed Miliband was undoubtedly right to see this as the most important challenge facing contemporary social democrats. Without being able to offer more widely shared prosperity, generated from within market economies, and not just by redistribution, social democracy is purposeless.

The intellectual resources for this renewal are readily to hand, in both new Keynesian and heterodox economic thinking, as well as a welter of empirical analyses of central policy challenges, such as productivity and wage growth, household indebtedness, and so on. Indeed, far more original new economic thinking has come from the centre left since the financial crisis than from the right of politics, where think tanks and commentators rehash comfortable Thatcherite nostrums. Politically, however, the story is reversed. Labour’s economic credibility has been shot to pieces since the recession and the party shows no signs of knowing how to restore it. Simply opposing austerity will not do the trick, and arguments about the deficit – let alone quantitative easing – will be otiose by 2020, unless the global economy tips back into recession (and relying on that eventuality would be unwise, if not reckless).

More fundamental still, Labour and its sister parties in Europe have yet to work out how to build broad coalitions for economic reform, in the absence of the strong trade unions and organised workers’ movements that they had at their back in the postwar period. The growth of self-employment, the spread of automation, and the decline of public-sector jobs are all making labour itself more disorganised and therefore harder to mobilise politically. Meanwhile, older voters turn a deaf ear to labour-market concerns. If they are on zero-hours contracts, they are likely to be content with them. If not, they are concerned about savings, asset prices and stable inflation. Even in countries with strong trade unions and large manufacturing sectors, there has been a substantial growth in flexible service-sector employment, and a concomitant decline in the political muscle generated in the workplace.

If nothing else, Corbyn’s victory is a dramatic forcing mechanism for the mainstream of the Labour Party to confront these challenges. A generation of Labour MPs and activists grew up in the shadow of Blair and Brown, and now must shoulder the burden of rebuilding the party without the intellectual and political leadership they once took for granted. They are now freed from the narcissistic feuds and rivalries of that era, but this liberty comes with the heavy responsibility of toiling hard to haul the party back. The scale of their defeat is such that cosmetic change will be wholly inadequate. Corbyn’s campaign showed up the profound individual organisational and intellectual weaknesses of the old-right, New Labour and soft-left wings of the party. The soft left vacillated hopelessly and the old right, deprived of the unions and the power of its MPs, had little, if anything to offer. Blairite standard-bearers were blunt and unforgiving in their analysis of Labour’s 2015 election defeat, but they had no answer to the mobilisation taking place in front of their eyes, nor did they have the magic ingredient that had once made them so successful, of what Hobsbawm in 1988 called “having the future in your bones”. They cannot now retread their old path to power.


The character of the Labour Party that emerges from this tumult will tell us whether it has a future as a serious political party. Corbyn’s paradox is that he harnessed democratic energy to a familiar statist and dirigiste project. Labour can only hope to renew if it embraces the democracy and ditches the dirigisme: if any part of 20th-century social democracy needs consigning to history, it is the preference for centralist standardisation and bureaucratic public administration. There are strong currents of both liberalism and conservatism in contemporary Britain, but each shares a hostility to remote, dominant power, whether in the state or in the market. Many of the most liberating contemporary social and economic trends, not least the diffusion of digital technologies, point in the direction of individual empowerment and political decentralisation. Labour has been too slow to grasp this.

Importantly, political and economic dynamism in capitalist economies today is increasingly concentrated in our cities, and this is where progressive politics is strongest. Although national elections cannot be won with cosmopolitan voters alone, city leadership is a vital source of energy, and many of Labour’s best politicians are now found in the town halls and civic offices of Britain. These leaders will be a critical building block in Labour’s renewal, whenever it comes. But that will require the party to understand and embrace the devolution of power, rather than tolerate or, worse still, reject it.

Class reductionism on the Corbynite left gives it a tin ear to the claims of territory and patriotic identity, as well as the demands for power currently swelling across the UK, not just in Scotland, but in England, too. Unchallenged, this will place Labour on the wrong side of one of the most important vectors of British politics: the reconfiguration of the UK as a federal (or quasi-federal) entity. The rise of the SNP cannot be accounted for as an expression of anti-austerity
politics, any more than the demands for greater recognition of English identity can be reduced to anti-immigrant sentiment. Both are expressions of deeper underlying historical changes in the Union, as well as the importance of culture and identity in politics. Without sensitivity to these claims, and an awareness of their democratic potential, Labour will become marginal or irrelevant, when it should be transformative.

There are grounds for optimism on the centre left. Economic reform, meeting the challenges of climate change and ageing, and the promise of digital technologies – all of these hold progressive potential. Social democracy could be just as well placed as any other tradition to capitalise on what the 2020s will bring; it doesn’t need to remain trapped between hollowed-out centrist technocracy and revanchist state socialism. But the depth of the crisis it faces demands deep and sustained rethinking, as well as political reorganisation. The rupture that Corbyn’s election has forced must be a catalyst for that change, or it will never come.

Nick Pearce is the newly appointed Professor of Public Policy at the University of Bath and the outgoing director of the Institute for Public Policy Research. He writes here in a personal capacity.

Nick Pearce is the director of the Institute for Public Policy Research.

This article first appeared in the 24 September 2015 issue of the New Statesman, Revenge of the Left