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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Labour's populism for the middle classes

Jeremy Corbyn has consolidated a bourgeois capture of the party begun by Tony Blair.

With the rise of Jeremy Corbyn a mutant strain of populism has become an integral part of British politics. Commentary on the general election and its dramatic upshot has focused on Theresa May’s disastrous campaign and the hubris of her now departed senior advisers. But what finally defeated the Conservatives was that, along with practically everyone else, they underestimated the power of Corbyn’s message. As the advance of the far right has stalled in Europe and with Donald Trump adrift in Washington, the peaking of populism has been announced almost daily, especially by the Financial Times. The rise of a far-left version in Britain went largely unappreciated.

Corbyn’s campaign had more than a little in common with Trump’s experiment in engineering popular emotions and perceptions. The ecstatic mass rallies, the indifference to fact shown in the Labour leader’s repeated denials of his meetings with terrorists and of the reflexive anti-Semitism that pervades much of the movement he has created, the belief of his supporters that the media are conspiring against him and the poisonous Twitter abuse of his critics are clear parallels. But this is not a protest from despairing communities left to moulder in abandoned zones of economic desolation. It is populism for the middle classes, serving the material and psychological needs of the relatively affluent and the well-heeled.

Labour’s success in taking Kensington in west London will be remembered as a defining event. That Corbyn could seize a safe Tory seat in one of the richest constitu­encies in the country is testimony to an extraordinary shift. It is also the culmination of a transformation in Labour that has been under way for many years. Corbyn has solidified a bourgeois capture of the party begun by Tony Blair. Public-school Stalinists and Debrett’s-pedigreed Trotskyites have long been familiar figures in the upper reaches of the left, just as they are today. What is new is Corbyn’s marriage of radical leftist ideology with a systematic appeal to middle-class interests. Nowhere is this better expressed than in Labour’s manifesto promise to abolish student tuition fees (which would cost the country as much as £12bn) and reintroduce maintenance grants, while declining to unfreeze welfare benefits on the grounds that reversing Tory cuts would be (as Emily Thornberry put it in May) “unaffordable”. Rather than addressing the desperate lack of opportunities for working-class children, who may never make it to university, Labour has successfully courted the middle-class youth vote.

Labour’s embourgeoisement is an important reason for Corbyn’s success. For Blairites, this can only be bitterly ironical. Peter Mandelson’s stupefaction at the election result showed him struggling to grasp how the modernisation of Labour he masterminded could have such paradoxical consequences. Extending Labour’s reach beyond its working-class base was one of the keys to Blair’s electoral successes.

The goal was to return Labour to power by aligning the party with neoliberal economic policies and the large numbers of those who for a time were benefiting from them. The project was continued by Gordon Brown, and until the financial crisis it worked fairly well. At that point a shiver of doubt went through the body politic. Movements such as Occupy became more prominent. Inequality was back on the political agenda. Another Great Depression had been avoided, but the effect of near-zero interest rates was an inflation of asset prices that left the rich even richer. At the same time, many people found their incomes stagnant or falling in real terms, but their discontent failed to find effective political expression. Because of his inability to communicate to a mass audience and failure to target the beneficiaries of his policies, Ed Miliband’s move to the left came to nothing.

Corbyn’s opportunity to mobilise the anti-capitalist mood came by accident, as an unintended consequence of Miliband’s decision (supported by Blairites) to include the party’s mass membership as voters in leadership contests. The upshot was an organised takeover of the party by hard-left forces, the paralysed impotence of its parliamentary wing and Corbyn’s unchallengeable dominance today. Labour has been modernised, but not in the way Mandelson intended. Whether by serendipity or by design, Corbyn has brought together some of the most vital forces on the contemporary scene: the anti-capitalist radicalism of young people who are innocent of history, a bourgeois cult of personal authenticity and naked self-interest expressed as self-admiring virtue. Nothing could be more exotically modern than Corbyn’s hybrid populism.

Media obsession with the performance of the two main party leaders has obscured this larger picture. It is true that Corbyn acquired a charismatic fluency in the course of the campaign, whereas Theresa May appeared inflexible and lacking in empathy. The result was close enough for this dif­ference to matter – especially as so much had been made of May’s leadership qualities. But the strategic positioning of the two parties has more enduring significance. May and her advisers aimed to create a working-class conservatism by harvesting former Ukip voters and exploiting the alienation of Labour’s old base from a metropolitan, liberal consensus. By offering more stringent control of immigration, and shelter from globalisation through an active industrial strategy, she believed that Labour’s old fortresses could be stormed. If there was such a thing as a May project, this was it.

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Reconciling the anarchic productivity of the market with social cohesion is the political dilemma of the age, and there is no reason to think that it is, even in principle, properly soluble. May’s manifesto had the merit of at least acknowledging the problem. But the electoral arithmetic on which her strategy depended was over-simple. The Labour vote was stickier than expected, and in some constituencies the party may have benefited from Ukip’s collapse. Much criticised for his equivocations on Brexit, Corbyn turned out to have read the public mood astutely. Support for Remain had shrunk substantially, but few voters were chiefly exercised by Brexit. When he refused to put it at the heart of his campaign, Corbyn outsmarted May’s advisers and strategists. In turn, he helped bring about a move back towards something like a two-party system.

That Ukip lost its reason for existing once Brexit got under way was the theme of countless op-eds before the election. But the same logic applied, in lesser degree, to Tim Farron’s Liberal Democrats. Even before the election, it was apparent that a large new grouping of “Re-Leavers” had appeared, while support for reversing Brexit had slumped. Zac Goldsmith retaking Richmond Park and Kate Hoey increasing her majority despite a determined effort to oust her in Vauxhall showed Brexiteers prevailing in what had been strongly Remain constituencies. In contrast, the Lib Dems were damaged by Farron’s decision to shape their campaign around the demand for a second referendum. Though the party made a modest gain in seats (even as its vote share fell), Farron held on by a much-reduced majority and Nick Clegg lost the constituency he had held for 12 years. Because of their fixation on Brexit the Lib Dems remain where they have been for so many years, a bit player in national politics.

More than anything else, it is the spectacular setback suffered by the Scottish National Party that has produced the shift back to two-party politics. Nicola Sturgeon fought the election by trying to link Scottish independence with resistance to Brexit. Ignoring cautionary voices in her party, she displayed a hubris starker than any Theresa May showed. Roughly a third of SNP supporters voted Leave in the referendum, and many others have been disillusioned by the SNP’s record on domestic issues. By making a second independence referendum the central issue in the SNP’s campaign, Sturgeon has shortened her political career and posed a question about the need for the continued existence of her party. With her credibility damaged, Alex Salmond and Angus Robertson casualties of the election, and the push to independence indefinitely postponed, a new generation will have to redefine what the SNP means today.

The compelling leadership of Ruth Davidson was a decisive factor in the revival of Scottish Conservatism. Not only has she revived the party north of the border and buried any prospect of Indyref2 for the foreseeable future, she has, by adding 12 Conservative seats in the Commons, saved the Conservatives in Westminster from outright defeat and delivered the UK from any risk of Scottish secession. The new Scottish MPs could be as important in shaping the government’s approach to the EU as the ten Democratic Unionists to whom May has turned in cobbling together a minority government. Davidson favours what she calls an “open Brexit”, which might mean a version of a Norwegian-style model in which Britain joins the European Free Trade Association and the European Economic Area, ensuring access to the single market. The Democratic Unionist Party leader, Arlene Foster, pointed in a similar direction when she spoke of the need to keep the border with the south open and avoid a hard Brexit.

There have been suggestions that May could end up negotiating with Brussels to secure some such deal: the opposite of the stance on which she fought the election. But given her weakened position the advantage would lie with EU negotiators, who might be tempted to make punitive demands. At that point negotiations could break down, as May cannot risk losing the support of the Brexiteers who are keeping her in power.

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Of course, there may be a challenge to her leadership. Inevitably, Boris Johnson is being touted as someone with the human touch that May is seen to lack. But Johnson has dismissed all such talk as “tripe” – at least for the time being. A leadership contest in the current circumstances would be savage and rancorous, leaving the Conservatives dangerously weakened in another general election that would soon follow. Are they ready to risk another gamble in the near future with even higher stakes than before? They lost their majority for the same reason Labour moderates lost control of their party: they failed to take Corbyn seriously. To make the same mistake again would look like carelessness.

There must be many who still cannot imagine Jeremy Corbyn as prime minister. After all, Labour failed to win the election. May lost her wager, but in numbers of votes she matched Margaret Thatcher’s 1983 landslide (the electorate is now larger, of course). Corbyn edged closer to power, but many Labour MPs continue to think him unfit to be leader of his party, let alone the country. Yet it would be foolish to conclude that Corbyn will not enter Downing Street.

So far, his march towards power has been greeted with remarkable complacency. Believing it will enable a less disruptive Brexit, the markets have welcomed the humiliation he has inflicted on the May government. The smirking Cameroons have not been able to conceal their vengeful satisfaction. The property tycoons of Chelsea must be congratulating themselves on having seen off a threat to their children’s inheritances. And Remainers will be thrilled as the prospect of an all-out Brexit seems to have faded from view.

These could be brief and costly pleasures. Markets will start to panic if another election is called, and if Corbyn wins they will go into a tailspin. Capital flight will surely leave his government unable to finance its cornucopian schemes, which include expensive commitments to renationalise rail, mail and water companies. Though students will be cheering at the prospect of their burden of debt being lifted from them, the largesse they have been promised is ­unlikely to materialise. Labour would face the same pressure on public services that led the Conservatives to revise their policies on care homes, but in much-worsened fiscal conditions.

It is unclear that Labour, once in government, would opt for a soft Brexit. Corbyn has repeated the mantra about preserving access to the single market and putting jobs first. But the shadow chancellor, John McDonnell, has said that Labour accepts Britain must honour the EU referendum and may have to leave the single market. There is a hard-left tradition that dreams of a socialist Britain outside the EU, and while Labour may have won by attracting youthful Remainers, the millions of Labour supporters that voted Leave have not gone away.

A Corbyn government would be more divided on Brexit than that of Theresa May. The upshot could be that no deal is reached – a scenario not unlike that favoured by hard Brexiteers, but without any of the preparatory work that could make it viable. As house prices in London crumbled, the nabobs of Chelsea would find their cleverness had backfired. Hopeful Remainers and spiteful Cameroons would have the smile rudely wiped off their face.

At present, Corbyn is walking on water. Like Chauncey Gardiner at the end of Hal Ashby’s magical film Being There, who after leaving his walled garden enchanted the world with his unexpected wisdom and Zen-like calm, the Labour leader seems to defy the laws of gravity. Yet politics is not magic, and the mutant strain of populism he embodies cannot conjure away painful realities. If he finds himself facing the ordeals of power, Corbyn will quickly fall to Earth, along with much else in Britain.

John Gray is the New Statesman’s lead book reviewer. His latest book is The Soul of the Marionette: A Short Enquiry into Human Freedom.

This article first appeared in the 15 June 2017 issue of the New Statesman, Corbyn: revenge of the rebel

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