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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One man and his whale: how an iconic Natural History Museum exhibit fought class divides and transformed science

As a blue whale skeleton replaces the entrance hall’s historic dinosaur cast, curator Richard Sabin reveals the secrets of the giant mammal’s much-loved replica.

On 25 March 1891, a female blue whale was harpooned by a whaling vessel and fatally injured. She was in the Irish sea, and ended up beached on a sandbank at the entrance of Wexford Harbour, on the south-east Irish coast.

Local fishermen discovered her floundering and thrashing around, four-and-a-half times the size of their boat, significantly taller, and more than 25 metres long. They had never seen a creature this size. A fisherman called Ned Wickham eventually put her out of her misery with a blade, and, according to contemporary reports, “succeeded in dispatching the big fish”.


The blue whale skeleton, c.1950-74. Photo: © Trustees of the NHM, London​

Over 126 years later, and that same creature that caught a handful of fishermen’s attention will be seen by millions. Her 4.5 tonne skeleton is going on display in London’s Natural History Museum entrance hall, replacing the traditional Diplodocus cast in the grand Hintze Hall. It’s a controversial move. Dippy ­– who received his nickname from an adoring public – is an iconic part of the Natural History Museum’s history, wowing visitors since 1905.

A special panel of collection managers, curators and scientists was put together to choose Dippy’s replacement. Specialists across the museum were invited to make a case for their preferred exhibits.

“Will our blue whale skeleton become iconic like Dippy?”

Richard Sabin, the resident whale expert, won them over. “What makes a specimen iconic? Will our blue whale skeleton become iconic?” he frets, when I meet him before the skeleton is unveiled. “I think so. It can’t fail to be, because of its very nature, but also because of where it is in the museum’s history and what we’re actively doing, in the field, with our researching.”

“It’s an interesting one because Dippy is of course part of people’s memories, childhood, and bringing their own children and so on,” he adds. He admits that his specimen of choice doesn’t even have a name – it’s been “lost over the years” – but says it’s “inevitable that she’ll get a nickname” now.


What the skeleton will look like in Hintze Hall. Photo: ® 2015 Casson Mann 

Sabin, 51, is a marine mammal curator, and has been working at the Natural History Museum for 25 years, where he’s the collections manager for the vertebrates division. But wandering among the Victorian grandeur in his camouflage hoodie, blue jeans and battered trainers, you wouldn’t tell that he is one of the museum’s senior figures.

We enter a dimly lit hall closed off to the public, where the exhibition for the Natural History Museum’s special whale season – which opens this week, along with Hintze Hall’s new resident – is being prepared. With its high brick arched ceiling and stained glass windows, it has the hushed atmosphere of a church. It is here that exhibitions are prepared before going on show.

Specimens, lit up and attended to by blue lab-coated conservators, loom out of the gloom like stalagmites. The corkscrew-shaped jaw of a deformed sperm whale; the rib cage of a bottle-nosed dolphin; giant toothed whale skulls gazing up at the ceiling – some with bandages, others being cleaned with cotton buds.


A whale conservator working on a flipper. Photo: © Trustees of the NHM, London​

“When they [visitors] leave the exhibition, we want them to have connected with whales and dolphins in an emotional way, but a way that hopefully makes them want to take some kind of an action,” Sabin says, referring to marine exploitation and mankind’s gruesome whale-hunting past.

The Wexford whale was discovered just before the rise of commercial whaling, and a decade ahead of the industry dominating the Irish coast. She was on one of the last migrations of blue whales unthreatened by an industry that would come to endanger the species by turning them into oil, soap, perfume, candles, margarine, corsets and even umbrellas.

 “Welcome to the blue whale, the biggest mammal in the world!”

Although Sabin has been working on this exhibition for years, he looks wide-eyed at the assorted bones and skulls with boyish delight. Aside from his white hair and grey speckled stubble, he probably had the same expression when he first visited the Natural History Museum on a school trip at ten years old.

It was then that he first saw the Wexford whale skeleton. Until last year, it was suspended above the museum’s world famous blue whale replica.

“My first and overwhelming memory of the museum was the whale hall,” Sabin grins, as we walk towards it through the echoing corridors. The blue whale replica is especially sign-posted. “You walk in at ground level as a tiny child and you’re just presented with a wall of blue. And then you look up above the blue whale model and you see all the other skeletons. That was really the memory that I took away from the museum back then.”



The blue whale replica with the skeleton above. Photo: © Trustees of the NHM, London​

Sabin remembers asking a gallery attendant if the blue whale, suspended like a big blue zeppelin from the ceiling, was real. She said no. And so he asked about the Wexford skeleton above it, where it had been until last year. She told him it was genuine, and that these animals were still out there in the ocean. “My imagination just went off on one,” he recalls.

As a child, Sabin was fascinated by bones. He used to collect roadkill from a main road near where he grew up in north Birmingham, and bring it home. His “very understanding parents” let him have a little patch of ground at the bottom of the garden to bury the carcasses, “so I could rot away the flesh and look at the bones”, he explains.

“I wanted to know what was inside these animals. I wanted to know how they moved and how they supported themselves.”

“It's not always the case that people are able to afford visiting London”

When he returned to the museum in 1981, having just finished school, he says he was “absolutely sold”. He applied for an archaeology degree, specialising in osteology, at Sheffield University, and then ended up working with marine mammals.

We gaze at the blue whale replica from a viewing gallery. Its ridged jaw slopes up at such an angle that it appears to be half smiling, its tiny eyes creased. It has been here since 1938. It is the first lifesize scale model of a blue whale ever built, at 29 metres long (later, the Smithsonian in Washington DC would build theirs a few inches longer to make it the biggest in the world). We now know that it’s inaccurately rotund, but that doesn’t stop it stunning first-time visitors.



The whale hall. Photo: © Trustees of the NHM, London​

Most children who see it for the first time share the schoolboy Sabin’s reaction – we can hear them gasping and shrieking below as we speak. I remember being flabbergasted by its size when I visited on a school trip; I’d never realised – and can still hardly comprehend – that such large creatures exist. A model like this brings it to life more than any documentary I’ve seen.

“It was borderline whether I went on that school trip in 1976, because money was tight”

Although our ancestors’ thirst for replication has fallen out of fashion, we have them to thank for these reactions. Models such as this one make scientific research part of our cultural memory, as well as a key part of the museum’s body of research. This makes the study of science more accessible, Sabin believes. From the meticulous collecting and cataloguing of the Victorian era to the modern push for digitising the museum’s vast data records, it’s about bringing information to everyone, whatever their background. “I am a great proponent of that, because as a child, visiting London for the first time on a school trip from Birmingham, we didn’t really have a lot of resources at my school.”

Sabin was brought up in a working-class household; his father was a lorry driver and his mother worked in a factory. “It was a good life, but not a family with a huge amount of cash; we had holidays to Wales every other year in a caravan,” he says. “It was borderline for me whether I went on that school trip in 1976, because money was a bit tight.”

But it was his last year of primary school, and “it was the big trip,” he recalls. “So my parents were like he’s got to go to London to see these things, but it's not always the case that people are able to do that.” For this reason, Dippy will be taken on a tour around the country, hoping to attract five million new viewers.

Hundreds of people affected by their first impressions of the blue whale replica have told Sabin their stories. A woman whose mother ran a nearby coffee shop in the 1950s used to visit it every morning as a child. She told him about a security guard walking in at 10am on the dot each day and shouting, “Welcome to the blue whale, the biggest mammal in the world!” and then turning around and walking out. “It’s a pity we don’t do that anymore,” smiles Sabin.



The blue whale replica being built in the Thirties. Photo: © Trustees of the NHM, London​

He shows me a big leather-bound volume of photos of the model being built in the Thirties, by a father-and-son team of the zoology department, Percy and Stuart Stammwitz. Men in aprons and flatcaps climb all over its wooden skeleton, like the hull of a ship. Some, like regular painter-decorators, apply individual plaster strips to its throat, to make a pleat effect. A man on a step ladder cleans the whale’s back with a long broom.

As they built it, some of the workers suffered motion sickness, as the suspended model used to sway. Nevertheless, they would occasionally take cigarette and lunch breaks inside the whale.

“It’s about making people realise that science really is for everyone”

Myths swirl around the museum about the whale’s hollow belly, which is said to have housed everything from a secret gambling den to romantic liaisons to a makeshift distiller. These aren’t true, but the team did put a 1937 telephone directory and change from their pockets inside before sealing it. “Like a time capsule,” Sabin says.

Although the blue whale model is so adored, it was important to Sabin for a real-life specimen to replace Dippy. “Moving away from using casts, putting the actual specimens into the space, puts it into a context,” he tells me, as we walk back through the museum’s halls. “It breaks down the barriers between the behind-the-scenes work of the scientists and what goes on in the gallery . . . . It’s about making people realise that science really is for everyone.”

Hintze Hall reopens with the blue whale skeleton, along with the exhibition “Whales: Beneath the Surface”, on Friday 14 July 2017.

Anoosh Chakelian is senior writer at the New Statesman.

This article first appeared in the 08 November 2010 issue of the New Statesman, Israel divided

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