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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Speaking the unspeakable

Thirty years ago, Ronald Reagan and Mikhail Gorbachev tried and failed to abolish nuclear weapons. Yet out of that failure they built a new order.

Their body language said it all: two men, dejected, drained, unable to look each other in the eye. Cameras flashed as Ronald Reagan and Mikhail Gorbachev left Höfði House in northern Reykjavík on the evening of 12 October 1986. These were the images that the media beamed around the world. Time magazine headlined its cover story “NO DEAL: Star Wars sinks the summit”.

That is also how it went down in history. An enormous missed opportunity. The chance to abolish nuclear weapons thrown away because the two leaders wouldn’t budge on the small print of Reagan’s “Strategic Defence Initiative” (SDI). And a spectacular instance of the roller coaster of summitry at the highest level, where high hopes collide with harsh realities.

Thirty years on, the time is ripe to review this negative verdict on the Reykjavík summit. With the transcripts of the meetings now available, as well as other documents from both the Russian and the American archives, we can explore what happened behind closed doors and also reflect on the summit’s historical significance. It is a chance to evoke the drama of those 36 hours, when human beings were stretched to their physical and mental limits – and, in the light of history, to show how the “no deal” proved to be a springboard for one of the most important nuclear arms agreements of the Cold War in Washington just a year later, when Reagan and Gorbachev signed away their cruise, Pershing II and SS-20 missiles. As Britain faces years of Brexit haggling, Reykjavík also offers possible lessons in how to engage in what Winston Churchill called “parleys at the summit”.




Such parleys had been rare during the “New Cold War” of the early 1980s, after the Soviet invasion of Afghanistan at Christmas 1979 prompted President Jimmy Carter’s boycott of the 1980 Moscow Olympics. All superpower arms control negotiations were consigned into a deep freeze. In March 1983 Carter’s immediate successor, Ronald Reagan, damned the USSR as an “evil empire” and outlined his vision for SDI, which the Soviets (and much of western Europe) saw as a threat to put the arms race in a new technological spiral and spin it into outer space.

In the USSR, these years were the “era of stagnation”, in which a cohort of old men in Moscow had run out of steam and ideas. Leonid Brezhnev, who for years had been in very bad health, died in November 1982; his successor, Yuri Andropov, died in February 1984. After attending his second Soviet state funeral in 15 months, Vice-President George H W Bush bade a jocular farewell to US embassy staff: “See you again, same time next year!” Bush was wrong – but only by a month. Konstantin Chernenko, aged 73, wheezed his last on 10 March 1985.

At this point, the Kremlin gerontocracy got the message and jumped a generation, appointing as Soviet general secretary an energetic, university-educated reformer in his early fifties. Mikhail Gorbachev had ­already caught Western eyes as a new breed of Soviet apparatchik – lively and articulate, keen to argue freely rather than read from prompt cards. Margaret Thatcher had declared as early as December 1984 that they could “do business together”. But Gorbachev was unquestionably a product of the system. He advocated economic and social reform in order to make the USSR more competitive in the East-West global contest. His first slogan was uskorenie (“acceleration”), soon followed by perestroika (“restructuring”).

Gorbachev’s willingness to talk to Reagan was initially utilitarian in motive. He wanted to curb the arms race to reduce the burden of the military-industrial complex on the Soviet economy, thereby allowing him to concentrate on domestic reform. Against all the odds, however, the two men found at their first summit in Geneva in late 1985 that they really clicked. After several frank but often stormy sessions on 19 November, they parted company in the car park that evening with a handshake that Gorbachev called “a spark of electric mutual trust”. Afterwards Reagan muttered to his chief of staff, “You could almost get to like the guy.”

Despite the barriers of language and ­ideology, the two men got on very well, particularly during an informal “fireside chat” at a pool house by the lake. They also discovered that they were kindred spirits on nuclear politics. Each was convinced that the doctrine of mutual assured destruction – often abbreviated to “Mad” – was ­literally mad and that nuclear weapons should be abolished. In short, they were Cold War heretics.

By January 1986, Gorbachev was calling for 50 per cent cuts in superpower nuclear arsenals, and his nuclear-phobia became all-consuming after the Chernobyl disaster that April. The meltdown at the Ukrainian power plant was the worst civilian nuclear accident of the Cold War era, releasing over 400 times more radioactive material than the bomb dropped on Hiroshima in 1945, with fallout spreading across much of eastern Europe, from the Baltic to the Mediterranean. “Just a puff,” Gorbachev told a sombre politburo, “and we can all feel what nuclear war would be like.”

By September 1986 Gorbachev feared that the “spark” of Geneva had been extinguished. He told Reagan, “I have come to the conclusion that the negotiations need a major impetus . . . They will lead nowhere unless you and I intervene personally.”

The Soviet leader proposed “a quick one-on-one” in Iceland or London to “demonstrate political will” and to galvanise their respective bureaucracies to prepare agreements for them to sign during his planned visit to the United States in 1987.

Reagan agreed, but there was a fundamental mismatch in expectations on each side. We know from Soviet documents that Gorbachev instructed his staff to prepare a position with “breakthrough potential”, based on his earlier proposal for 50 per cent cuts. Yet, on the American side, a senior staffer on the National Security Council claimed that the president would have to “smoke out” a “coy” Gorbachev to find out what exactly he wanted. The then secretary of state, George Shultz, told Reagan that they should avoid “permitting the impression that Reykjavík itself was a summit”, rather than just a useful preparation for what he called “Summit II” in the US. The Americans were not prepared for the gale that would hit them in Iceland.

What was supposed to be the “base camp” for the US summit took place at Höfði – an elegant, wooden government guest house on the coast. Although the ­location seemed suitably remote (it was also roughly equidistant from Moscow and Washington), the building was inadequate. The two leaders held their tête-à-têtes in a small room downstairs. Each delegation had working quarters upstairs – the Americans in two holding rooms and a bathroom on one side of the house and the Soviets similarly accommodated on the other side, with a large common room in between. For one presidential briefing, American staffers had to use their tiny bathroom, with three senior aides standing in the bath. When Reagan walked in, he said, “I’ll take the throne,” and perched on top of the toilet.

The two leaders had rejected London as a venue because, as the US president remarked, “It is too large a city, with too many distractions.” Reagan hoped that they could “discuss everything calmly” in Reykjavík, away from the limelight. Yet, in the event, the media circus was frantic: thousands of journalists descended on the small city of 90,000 people (roughly the same size as present-day Bath), desperate for new angles and local colour, however fanciful. Some papers peddled stories about Höfði being a haunted house; even the Washington Post resorted to headlines such as “A supernatural summit”. Amid such hype, the encounter at Reykjavík was not going to be the low-key “non-summit” that Shultz had envisaged.





Nor was there any need to smoke out a coy Soviet leader when the first session opened on Saturday 11 October at 10.40am. Reagan began in a slow and formal manner, talking from his briefing book, but Gorbachev – pumped up for the occasion and much more expansive – soon unveiled a comprehensive three-point disarmament plan. First, he suggested a 50 per cent reduction in strategic nuclear weapons: in other words, those of intercontinental range. Second, the elimination of all intermediate-range nuclear forces (INFs) in Europe, excluding the British and French “independent” nuclear deterrents – in what he called “a great concession”. His third proposal was to extend the Anti-Ballistic Missile (ABM) Treaty of 1972 for another ten years and to confine any testing of space weapons to what he called “laboratories”. All three proposals, he insisted, had to be taken as a single integrated package.

The ABM Treaty was the most sensitive issue. It served to reinforce the doctrine of mutual assured destruction by limiting the right of either superpower to build defensive systems against enemy missiles. Reagan’s SDI project threatened to upset this “balance of terror” by creating a missile defence shield in space – hence the Soviet desire to prevent US testing of such hardware. Reagan’s approach was diametrically opposite. The president claimed that once defensive systems had been tested, he would share this technology with the Soviets as a protection against “some maniac like Hitler”. He likened this to abolishing poison gas after the First World War but keeping gas masks “in case of unforeseen situations”.

At 12.30pm they took a break for lunch, so that the US could absorb what Gorbachev kept emphasising were his “entirely new” proposals.

When they reconvened at 3.30pm, the rhythm was similar, with Reagan ­plodding and Gorbachev impatient, at times explosive. “You went into Europe with your missiles, and you don’t want to leave it,” he barked at one point. Although anxious not to have his “package” unpicked, lest the Americans gain an advantage in “space weapons” if the USSR reduced its missile stockpiles, Gorbachev agreed that, in the evening, groups of experts from each side should try to thrash out disputed issues in the two critical areas of arms control and human rights.

Just before the meeting ended at 5.40pm, Reagan put aside his notes to deliver an ­impassioned speech about how “we are two civilised countries, two civilised peoples”, whereas the strategy of mutual “mass extermination” was “an uncivilised situation”. He declared: “I think that the world will become much more civilised if we, the two great powers, demonstrate this example, create defensive systems and eliminate terrible modern armaments.” Once again, he offered to share SDI with the Soviets. This time Gorbachev blew his top. “Excuse me, Mr President, but I do not take your idea of sharing SDI seriously. You don’t want to share even petroleum equipment, automatic machine tools, or milking machines . . . Let’s be realistic.”

While the two leaders went to bed, their delegations went to work. The human rights group got through their agenda relatively quickly, finishing at 2am. Yet the group on arms control laboured through the night from 8pm to 6.30am, even waking the two foreign ministers at 2.30am for urgent consultations. After such a nocturnal marathon, everybody must have been exhausted by the time day two began.

The third session commenced at 10am on 12 October. This was supposed to wrap up the conference. Reviewing the conclusions of the working groups, the leaders agreed fairly quickly on moving towards a 50 per cent cut in strategic nuclear arsenals and discussed a “zero-level option” for ­intermediate-range nuclear forces in Europe. After a further concession by Gorbachev, they accepted the idea of a ceiling of 100 Soviet INFs in Asia and 100 American missiles on US territory. So far, so good.

But then the discussions went around in circles over the balance between deterrence and defence. Gorbachev’s aim was to abolish offensive nuclear weapons within ten years, while retaining the ABM Treaty during that period as a protection for the Soviet Union against new “space ­weapons”. Reagan, however, kept hammering on about the right to develop a defensive “shield” in space, claiming that this would provide long-term protection against rogue states for all of humanity. The Soviet leader’s obsession with the ABM Treaty was now infuriating the president. “Damn it,” he shouted, “what kind of agreement are you defending? . . . Our defence today is the threat of retaliation against the other. That is not defence in the right sense of the word.”

Gorbachev was equally angry about Reagan’s fixation with SDI. “We said that President Reagan is a man who does not like to make concessions. I am now convinced of this. But, as the American saying goes, ‘It takes two to tango.’ And it takes two to control arms, to reduce and eliminate nuclear weapons . . . Therefore I invite you to a male tango, Mr President.”

But Reagan wasn’t ready to dance with a partner on whom he felt he couldn’t rely. Citing historical examples of occasions when, he claimed, the Soviets had broken promises about nuclear arms control, he reminded Gorbachev of another American saying: “Once burned, twice shy.” Trust was the basic issue. “I understand that you do not trust us,” Reagan exclaimed, “just as we do not trust you.”

With tension mounting, Gorbachev raised the president’s “evil empire” rhetoric and his calls for a crusade to drive socialism on to the scrapheap of history. What did that mean, he asked: “War?” “No,” Reagan replied hotly. Then the president launched into a diatribe about the Soviet Communist Party having “a monopoly of power”.




The two men could easily have carried on point-scoring for the rest of the day, but then Gorbachev paused and said: “I am convinced that if you and I have different ideological ideas, that is not a reason for us to shoot at one another. On the contrary, I am convinced that, in addition to political relations, purely human relations between us are possible also.” He looked hard at Reagan: “Let us return to the wording.”

The two foreign ministers, Shultz and his Soviet counterpart, Eduard Shevardnadze – desperate to reach a compromise – tried to disentangle the three big issues. Even if SDI remained unresolved, they wanted at least to walk away with agreement on halving strategic arsenals and abolishing most of their INFs. But Gorbachev would have none of it. “I proposed a definite package and would ask you to consider it as such,” he said. They had reached an impasse. Reagan exclaimed: “How can we go away from here with nothing?” Gorbachev coolly countered: “Unfortunately, we in fact can.”

Pulling back from the brink, the two sides took time out to go over the findings of the working group on humanitarian issues. After a quick trot around topics such as the opening of consulates in Kiev and New York and trade union visits between the two countries, Gorbachev pressed Reagan once more: “Well, Mr President, ‘X-hour’ is approaching. What are you going to do?”

Shultz, who had been frantically working up an anodyne communiqué, now read it out. “That is not acceptable to us,” Gorbachev said. He proposed that they take a break of an hour or two to draw up something better: “After all, we do not want everything to end with a façade.” He reminded the Americans of his bottom line: “It is exceptionally important to reaffirm the ABM Treaty. Then we can substantiate the risk that we are taking in questions of strategic weapons and intermediate-range missiles.”

They broke for lunch at 1.35pm and resumed at 3.25pm, only to stop again an hour later so that the Americans could try to come up with a compromise formulation on Star Wars research and development. But when they reconvened at 5.30pm, Gorbachev remained stuck on one word.
He insisted that all testing had to be confined to “laboratories”.

“I cannot go along with restrictions on the plan as you demand,” Reagan replied.

“Is that your final position? If so, we can end our meeting at this point.”

“Yes, it is.”

Gorbachev took a deep breath: “You must understand me. To us, the laboratory issue is not a matter of stubbornness or hard-headedness. It is not casuistry. It is all too serious. We are agreeing to deep reductions and, ultimately, the destruction of nuclear weapons. And at the same time, the American side is pushing us to agree to give them the right to create space weapons. That is unacceptable to us.”

He tried to play on Reagan’s desire for a place in history – the chance to go down as “a great president”.

Reagan in turn appealed to Gorbachev as a fellow politician. “Let me say frankly that if I give you what you ask, it will definitely hurt me badly at home.” He asked: “Are you really going to turn down a historic opportunity for agreement for the sake of one word in the text?”

Gorbachev was now in full flight: “But it’s not a matter of a word, it’s a matter of principle . . . If I go back to Moscow and say that despite our agreement on the ten-year period, we have given the United States the right to test SDI in space so that the US is ready to deploy it by the end of that period, they will call me a fool and an irresponsible leader.”

Reagan then implored Gorbachev to do this as “a personal favour”, based on the relations they had established at Geneva.

Yet Gorbachev would not budge: “We cannot go along with what you propose. If you will agree to banning tests in space, we will sign the document in two minutes. We cannot go along with something else. We have already agreed to what we could; we are not to blame. Even though our meeting is ending in this way, I have a clear conscience before my people and before you. I have done everything I could.”

“It’s too bad we have to part this way,” Reagan said. “We were so close to an agreement. I think you didn’t want to achieve an agreement anyway. I’m very sorry.”

“I am also very sorry it’s happened this way. I wanted an agreement and did everything I could, if not more.”

“I don’t know when we’ll ever have another chance like this and whether we will meet soon.”

“I don’t, either.”

The two men, angry and exhausted, trudged down the steps of Höfði House, their grim faces captured by the press and the TV cameramen. There was clearly “no deal” – and not even a date for Summit II in America. To the watching world, Reykjavík was a total failure.




But was it? Immediately after the summit, Jack Matlock, one of Reagan’s leading Sovietologists, went over the interpreter’s notes and realised that the extent of agreement on key points was “unprecedented”. Indeed, he said, “Reagan and Gorbachev had solved more problems than any of us had expected of the Reykjavík meeting.”

On the plane back to Moscow, Gorbachev took a similar view of the summit. The ­issue, he said, was never “who won over whom”. Rather, it was to move beyond the post-Geneva “deadlock” and press towards “a major breakthrough”. That hadn’t been achieved, but significant progress had been made. It proved, he said, “quite easy to reach an understanding” on strategic weapons and intermediate-range missiles.

On SDI, he noted, “Perhaps we will need one more try to step over [the boundary] which still divides us.” Far from deeming it a failure, Gorbachev judged the Reykjavík summit to have been “a step in a complicated and difficult dialogue, in a search for solutions”.

On his return to Washington, Reagan said the same thing publicly in his address to the American people. Despite some point-scoring about Gorbachev’s intransigence over SDI, the president’s tone was upbeat. He insisted, “We are closer than ever before to agreements that could lead to a safer world without nuclear weapons.”

But how to move from words to deeds? Someone had to shift ground. Gorbachev did so first. In late October, he and the Politburo secretly agreed that they would accept SDI tests not just in “laboratories” but anywhere except in space. He needed to make progress towards arms reduction because of the scale of Soviet military spending and the growing national budget crisis.

Reagan’s position also changed. On 3 November, news broke about a secret US government operation to sell arms to Ayatollah Khomeini’s regime in Iran and use the proceeds to finance anti-communist guerrillas in Nicaragua. Within weeks, “Irangate” had sapped the administration and tarnished even the “Teflon president”. Equally damaging, on 4 November the Democrats won the midterm elections: they would now control both houses of Congress. So Reagan had no chance on Capitol Hill of getting the funding he needed to sustain SDI during his remaining two years in the White House. Politically weakened and also fretful about his legacy as a “peace president”, he – no less than Gorbachev – needed to compromise.

Aware of the new political dynamics in Washington, Gorbachev decided to “untie” the disarmament package on which he had been so insistent at Reykjavík. His aide Alexander Yakovlev advised that, although its individual elements still made sense, both as policy and as propaganda, “the ‘package’ in its present form only ties our hands”. Gorbachev had no illusions. Superpower “competition” would continue but he wanted to “remove the confrontation”. He lamented: “As difficult as it is to conduct business with the United States, we are doomed to it. We have no choice.”

So both sides decided to focus on one of the mattes about which they had more or less agreed at Reykjavík: INFs. Despite resistance from the Pentagon and the Soviet military, over the course of 1987 Shultz and Shevardnadze hammered out a worldwide “double-zero” deal to eliminate all Soviet and American INFs in Europe and in Asia. Equally importantly, they established an unprecedented regime of mutual on-site inspections that would give substance to Reagan’s mantra “Trust, but verify”.

Furthermore, they agreed that Gorbachev would travel to Washington in December to sign the INF Treaty. Despite all the media gloom on that bleak evening outside Höfði House, the base camp had prepared the way for Summit II.

During that frenetic weekend in October, Reagan and Gorbachev had not merely thought the unthinkable but dared to speak the unspeakable. Face to face, each had catalysed the anti-nuclear radicalism in the other. This was positive summitry, generating synergy between two leaders.





To move from base camp to summit also required a willingness to compromise. Leaders had to be ready, as Gorbachev put it, to “tango”: looking together for ­outcomes that were mutually beneficial. Creative diplomacy was not – and is not – a “zero-sum” game, in which I win only if you lose. That one-sided approach to summitry is nonetheless tempting to political leaders who are playing to the gallery at home. In Britain, for instance, Tory leaders from Margaret Thatcher to David Cameron have obsessed over the perceived need always to come back from Brussels with a deal in which “we” beat “Europe”. Indeed, that was how they and the British media couched the business of negotiation – in a zero-sum conception of summitry, of a kind that Gorbachev deplored.

Theresa May, who operated cannily as a sotto voce Remainer during the referendum campaign, will find it hard to avoid the temptation to play to the gallery now that the spotlight is on her in working out Brexit Britain’s new relationship with the EU. The need to claim victory at every turn is at odds with achieving durable compromises. These depend on creating a co-operative spirit.

Summitry across international divides has little chance of success if it is treated as a series of confrontations in which one side wins and the other loses. As Reagan and Gorbachev showed in their journey from Geneva via Reykjavík to Washington, each summit is ideally part of a process of dialogue. Angela Merkel recently reiterated this point, emphasising the need to keep open lines of communication with Vladimir ­Putin’s Russia at a time of renewed East-West tension. Equally, she has insisted on the need to maintain strong defence.

Merkel is surely right. There is always a delicate balance to be struck between the politics of deterrence and the diplomacy of dialogue – making up your mind when to stand firm and when to reach out. That remains the perennial challenge for those who have the vision, skill and nerve to parley at the summit.

“Transcending the Cold War”, edited by Kristina Spohr and David Reynolds, is published by Oxford University Press

This article first appeared in the 06 October 2016 issue of the New Statesman, Trump's triumph