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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The learning machine: Angela Merkel

Her mentor Helmut Kohl called her his assassin. She is ruthless with those who betray her. She is also now being described as the leader of the free world. So, who is the German chancellor and what’s next for her?

World news these days is dominated by posturing tough guys – Vladimir ­Putin, Donald Trump, Recep Tayyip Erdogan. Amid all the pose and swagger, one politician stands out. Quiet and understated, she is now the West’s longest-serving leader. No tweets, no gossip, no hissy fits or saucy photos: this is Angela Merkel, chancellor of Germany since 2005, who will be seeking a fourth term in the elections this September. With the German economy strong and the refugee crisis abating, she is favourite to win once again.

Merkel’s unshowy style has made it easy to overlook her international prominence. But now, in the summer of 2017, with Trump’s United States turning in on itself, the transatlantic alliance in the balance, the European project in doubt, British politics upended and Russia at loggerheads with the West, Merkel has become the fulcrum of the international system. Not everyone likes her, but niemand kann um sie herum: nobody can get around her. Not Theresa May, not Trump – not even Putin.

This week, on 7 and 8 July, she hosts the G20 summit in Hamburg, where Trump will encounter Putin for the first time in a tête-à-tête stage-managed by Merkel. Yet Germany’s quiet strongwoman remains an enigma. Where did she come from? What motivates her? What does she want? And where is she going?

The eldest of three children, Angela Merkel was born in Hamburg, in the Federal Republic of Germany, in 1954. Her mother, Herlind, was an English teacher and her father, Horst Kasner, an official of the Lutheran Church. Soon after Merkel’s birth, her father responded to a call for more clergymen in the Soviet-controlled German Democratic Republic (GDR). He moved his family first to Quitzow in Brandenburg and then, three years later, to Templin, north of Berlin, where he took up a post at the local theological seminary. He joined the GDR’s state-controlled Federation of Evangelical Pastors, earning himself the nickname “Red Kasner” among his Western colleagues.

In East Germany the Kasners were both servants of their flock and members of an elite. They enjoyed the privileges of the state Church (which included access to Western newspapers and clothes) as well as parcels from relatives in the West. But they also lived under the persistent suspicion of the communist regime. Religious orga­nisations represented an alternative value system and were seen as potential vehicles of Western intelligence.

Merkel later recalled the GDR as a grey and confined place; she remains haunted by the first images she saw of the Berlin Wall. But she also says she enjoyed her childhood, and as a teenager she chose to adapt to the logic of the political situation. Her aim was to get on without being noticed. In this vein, despite being a vicar’s daughter and getting confirmed in the Church, she also chose to join the communist youth movement.

According to her teachers, Merkel was a ferociously motivated student, brilliant, tenacious and ambitious. She took no interest in clothes, fashion or school romances. Instead, there were three successive top performances in East Germany’s Russian language Olympiad. By the age of 15, she was the national champion in the language of the occupiers.

After moving to Leipzig University to study physics, she met and married a fellow scientist, Ulrich Merkel, but they were divorced in 1982. Subsequently she earned a doctorate in quantum chemistry in Berlin. During the 1980s she worked as a researcher at the Academy of Sciences in East Germany: the only woman in her field, a pattern that would be repeated throughout her life. It is worth stressing that Merkel was a theoretical scientist, not an experimentalist. She tackles problems methodically, running various scenarios, weighing up risks, trying to anticipate reactions and then making an informed choice. It’s an approach she has translated into politics, and calls Dinge vom Ende her denken: to think about things from the end result.

The young Merkel was self-conscious and reticent, though this was balanced by flashes of irony and self-deprecation. Seeking to rise in a man’s world, she turned these traits into her trademark style. Her attire reflects this. She is a woman who wears the same blazer, in more than 50 colours, always buttoned up, with flat, simple shoes. She never appears with a handbag. No showiness, no emotional display – no Thatcherite tantrums or cover stories for US Vogue.

This may seem an unpromising perfor­mative strategy for someone who aspires to make her way in public life, but it aligns Merkel with a deeply rooted trait of postwar West German political culture: a cult of sobriety in reaction to the disastrous seductions of Hitler’s charismatic leadership. She projects an untheatrical sincerity that millions find believable and reassuring. She often stands in the background – observing, learning and biding her time. She plays a long game, sitting out disputes until she is ready to make a decisive intervention.

***

Merkel entered politics as East Germany was collapsing; her rise was driven more by external forces than by her own actions. As street protests grew in late 1989, she did not join in. Instead, she gravitated to the liberal-conservative group Democratic Awakening, which was soon absorbed into the Allianz für Deutschland – an electoral coalition of centre-right parties led by the GDR wing of the Christian Democratic Union (CDU), West Germany’s governing party. In spring 1990, after the Allianz won the first free East German elections, Merkel was unexpectedly chosen to be the new government’s deputy spokeswoman. And so she found herself looking west, towards Chancellor Helmut Kohl, who by now was brokering the reunification of the two states.

In unified Germany’s first national elections in December 1990, Merkel gained a seat in the Bundestag as a CDU MP. Kohl immediately saw her as an asset in his first all-German cabinet – a clever 36-year-old woman, an Ossi (easterner) from a church family background with no Stasi ties. He appointed her minister for women and youth, the first female East German to hold any post in cabinet.

Within two years, Merkel had gone from being an obscure GDR research scientist in East Berlin to front-line government politics in Bonn. She used her ministerial opportunity quietly and effectively. She was no feminist – indeed, not particularly interested in her portfolio – but she had an instinct and appetite for power.

Though Kohl belittled Merkel by ­calling her mein Mädchen (“my girl”) from the East, he helped her ascend the ranks. In 1994 he made her the minister for the environment, nature conservation and nuclear safety, a role that gave her a higher international profile. Merkel convened the first UN Climate Change Conference in Berlin in 1995 and two years later led the negotiation of the Kyoto Protocol, the first and only binding global climate protection treaty to date. (She remains passionate about climate change, which is why she was unable to conceal her fury when last month Trump sabotaged a common G7 line on global warming.)

In government Merkel always seemed in a hurry, never made small talk, and ­often looked down on the “boys in the playground” – as she privately referred to her beer-drinking, ever-politicking male colleagues. She was feared for her directness and notorious for sacking those who opposed her or betrayed her trust. But she was also respected for her ability to distil a mass of information and admired for her self-­discipline and work ethic.

In the 1998 federal elections, Kohl was defeated by the young and dynamic Social Democrat (SPD) leader, Gerhard Schröder. Fourteen months later, still reeling from its defeat, the CDU was engulfed in a campaign finance scandal. Kohl was implicated but few in the party dared challenge him. Merkel, however, did, writing a cutting opinion piece in the Frankfurter Allgemeine Zeitung that urged the CDU to break with its old “war horse” Kohl. It did just that: and on 10 April 2000 the CDU elected her as the first female party leader in Germany. “I brought my killer close to me,” a bitter Kohl remarked later. “I put the snake on my arm.”

In the 2005 election the CDU secured a narrow victory, and Merkel formed her own government in coalition with the Social Democrats. The steely woman from East Germany was inaugurated as the Federal Republic’s first female chancellor.

***

Ever since the Second World War, “Europe” has been central to Germany’s identity and foreign policy. But unlike Kohl or West Germany’s first chancellor, Konrad Adenauer – men of the Rhineland, dedicated to reconciliation between Germany and its old enemy France – Merkel’s approach to the European project has not been particularly idealistic or historical. She came into the EU as an East German outsider who could not feel any special emotional bond either to the idea or to the institution.

From her pragmatic perspective, “Europe” secures peace and allows an integrated Germany to flourish economically. For this reason, the EU as a political and an economic entity must be repaired and held together. “If the euro fails, Europe fails,” she declared in 2011, at the peak of the Greek financial crisis. She went about ensuring the euro’s survival her own way. Sensitive to German public opinion, she had no desire to bail out Athens. Eventually, after long silences and many zigzags, she gave in to fellow EU leaders and Barack Obama, who warned that, without a financial rescue package, Greece would default on its debts and be forced out of the euro – pulling down the currency union and perhaps the EU, too. But Merkel insisted that in return for credits, Greece (and other weak southern European economies, such as Italy, Spain and Portugal) must accept German fiscal standards: thrift in public and private life and strict budgetary discipline, overseen by the EU.

The euro had been saved but at a cost to both sides. The austerity imposed on the debtors, especially Athens, created politically intolerable levels of unemployment. Germany was perceived as the bully of the continent. Cartoons in Greece showed Merkel’s face wearing Hitler’s moustache.

Despite early criticism at home, saving the euro ultimately earned Merkel strong public backing, because she had brought the crisis under control without too much damage to German living standards. In the process, a somewhat derogatory yet oddly affectionate new verb had been born – merkeln: to sit tight and say little. It rhymes with werkeln: to tinker. But in the end tinkering may not be such a bad thing.

The crucial role Merkel played in the Greece/euro saga made her acutely aware of her responsibilities as a German who was now, in effect, the leader of Europe. And it was in this dual position that she faced the refugee crisis in the autumn of 2015.

Confronted by a sudden mass migration into Europe after the collapse of the Arab spring and the Syria catastrophe, the EU failed to agree a unified response. Front-line states in the south-east, especially Greece and Hungary, were overwhelmed; big, rich states in the north-west, notably Britain, believed they were insulated against the human tide, and chose to stand aloof.

Motivated at first by compassion, Merkel pursued a different strategy. Dismissing demands from conservatives to close Germany’s borders, she announced in September 2015 that “Germany’s basic right to asylum has no upper limits”. She appealed to her fellow citizens, who had benefited hugely from international help after the Second World War, and urged them to welcome the needy of the 21st century, shunned by other Europeans. “If we now have to start apologising for the fact that we are showing a friendly face in an emergency situation, then this is not my country,” she said.

The “no upper limit” was swiftly interpreted as a “refugees welcome” message. Germany ended up with over 800,000 newcomers from the Middle East in 2015 – this in a country of 80 million which already had three million residents of Turkish origin. (It has been estimated that hundreds of thousands more from the Middle East, Africa and the Balkans entered the country illegally.) Many Germans responded positively by helping the refugees at reception centres. Yet conservatives in her party often saw Merkel as weak and reactive. Such criticism in turn bolstered the growth of right-wing populism.

During 2016, as reports of crime, rape and child marriages filled the tabloid newspapers, thousands of people gathered at anti-immigrant rallies. After the Berlin terrorist attack of December 2016 – when a failed Tunisian asylum-seeker crashed a hijacked lorry into a Christmas market, killing 12 people – Merkel’s approval rating dropped to 57 per cent, almost 20 points lower than before Europe’s migrant crisis erupted. Looking towards her re-election year, CNN predicted: “Angela Merkel may be the biggest loser of 2017.”

Her risk-taking over the refugees was more calculated than it appeared. Merkel had acted out of conviction, given her “Christian empathy”, as she put it, and her sensitivity to Germany’s Nazi guilt. There was also a distinctively East German element: when Hungary used razor wire to fence out migrants from the south, it brought back her darkest memories of the walled-in GDR.

More pragmatically, she felt confident that the German economy was robust enough to absorb the cost of hundreds of thousands of refugees and believed that there would be long-term benefits from an influx of young, skilled workers for a country whose population was projected to fall. Above all, she feared, as with the euro crisis of 2011, that the controversy over refugees could tear Europe apart unless Berlin showed strong leadership.

Merkel has a capacity to recognise mistakes and discreetly learn from them; some German commentators have nicknamed her “the learning machine”. There was no overt apology for her refugee gamble but a subtle shift of direction with one eye on the ballot box. Seeking to build a new consensus within her party, she told the CDU’s annual conference in December 2016, to loud applause: “A situation like the one in the late summer of 2015 cannot, should not, and must not, be repeated.”

She promised speedier asylum decisions, so that those who failed to qualify would be sent back more promptly. She also stressed that those migrants who stayed would not be permitted to develop a “parallel society” but be pushed towards full integration: “Our law takes precedence before tribal rules, codes of honour and sharia.”

Today, six months on, continental Europe is more stable after the far right’s defeat in the Netherlands and Emmanuel Macron’s presidential and parliamentary triumphs in France. And following significant CDU victories this spring in three regional elections, Merkel is strongly favoured to win another term as chancellor.

What’s more, with Britain exiting the EU, Merkel is keen to “relaunch” Europe. Calling for a “historic reconstruction of Europe”, she and Macron agreed in Berlin on 15 May to draw up a joint roadmap of how to deepen EU integration and make the eurozone more resilient. After her fraught relationship with the president’s lame-duck predecessor François Hollande, the Franco-German “couple” are back in business.

***

Dominant in Europe, resurgent at home, Merkel has also been operating on the global stage with growing confidence. Her greatest challenge here is the re-emergence of Russia as a would-be world power.

Merkel and Vladimir Putin (the de facto lord of the Kremlin for the past 17 years) share a long history in power – and go further back than that: he helped run the “dictatorship” under which she had grown up. In the back of Merkel’s mind Putin is still the KGB officer who spent five years in Dresden as a functionary of the occupying power.

These two leaders have held dozens of meetings and talked for hundreds of hours over the phone, conversing easily in German and Russian. Merkel has always sought to push Russia and Putin towards a relationship rooted in rules, principles and common interests – not one based on emotion or personal chemistry. Putin, in turn, has looked for a partner who would strike good economic and political deals and help keep his country at the international top table.

Putin had found such a partner in Merkel’s predecessor Gerhard Schröder. In 2005 they struck a deal for a gas pipeline from Russia to Germany through the Baltic Sea; as soon as Schröder left office, Putin installed him as chairman of the board of Gazprom, the Russian energy giant. In 2014 Schröder celebrated his 70th birthday with Putin in the Russian leader’s home town of St Petersburg, just weeks after the Russia-Ukraine crisis had erupted.

Merkel is repelled by alpha-male bonding (Kohl and Boris Yeltsin sweating it out in the sauna), not merely because she is a woman but as a matter of principle. And modish sympathy for Putin (Putinverstehertum) on the extremes of left and right in German politics is anathema to someone who has never underestimated Russian power. Indeed, Merkel has always seen through Putin. There was a telling moment soon after the 9/11 attacks when Putin addressed the Bundestag, pledging solidarity with the Americans and presenting his vision of Russia’s European destiny. German MPs were enthralled by his delivery – in fluent German – and by his apparently pro-Western message, and gave him a standing ovation. Merkel, too, stood up but she whispered to her neighbour that Putin’s German was that good “thanks to the Stasi”.

For his part, Putin introduced an element of mind games into their relationship. In 2006, when Merkel made her first official visit to Moscow, he gave her a stuffed toy dog. The Kremlin was aware through its intelligence channels that Merkel was nervous around dogs, having been bitten by one a decade earlier. The following year, during talks in the Black Sea resort of Sochi, Putin had his large black Labrador, Koni, run into the room while he and Merkel were sitting across from each other. Though she did not flinch, photos of the meeting show her looking awkward as the dog buried its head in her lap. Merkel soon got her own back, telling the media: “I understand why he has to do this – to prove he’s a man . . . He’s afraid of his own weakness. Russia has nothing, no successful politics or economy. All they have is this.”

Their personal edginess became central to world politics in 2014 after Russia annexed Crimea. For Merkel, Putin had now crossed a red line. Crimea had been part of Ukraine since 1954. Yet Putin claimed, after a referendum rubber-stamped the annexation, that the Russian inhabitants of the region were invoking the right to “self-determination” – just as the Germans did during reunification in 1990. This analogy did not go down well in Berlin. And relations with the West grew even worse after Putin presented the subsequent Russian intervention in eastern Ukraine as an assertion of his country’s rights as “an independent, active participant in international affairs”.

Merkel considered Russia’s actions a flagrant breach of international law. She rallied the EU, together with Barack Obama’s America, to impose sanctions on Russia, precipitating a financial crisis in Moscow. With the rouble losing almost half its value within two years and a collapse in the price of oil – on which Russia’s economy depends – the country slid into a recession.

The Ukraine situation remains deadlocked but Merkel’s position has evolved over the past couple of years. Initially, with Obama and David Cameron happy for her to take the lead, she tried, with French support, to broker a peace deal between Russia and Ukraine. This effort became harder to sustain after Russia extended military support to Bashar al-Assad in Syria. In response, Merkel began to toughen her stance. She reprimanded Putin for siding with Assad, stating: “I think we’re very close to war crimes.” Yet she also invited him to Berlin in October 2016 to resume dialogue and find a way out of the Ukraine quagmire.

After no progress was made in the Berlin talks, she insisted that dialogue had to be balanced by deterrence and committed German troops to Lithuania under Nato’s build-up in the Baltic states. Her position towards Russia hardened further after Donald Trump’s election win. The US president’s inability to provide steady global leadership and his unwillingness to reaffirm Washington’s unqualified commitment to Nato collective defence has forced her to fill the vacuum. This was clear when she met Putin at his summer residence in Sochi on 2 May – her first visit to Russia in two years.

By accepting the Russian leader’s invitation, Merkel risked seeming weak, but in the talks she refused to soften her positions. Putin did the same, of course, and so the summit yielded nothing on Ukraine or Syria – or, indeed, on anything at all.

However, Merkel unexpectedly blasted Putin in the press conference. Deliberately eschewing diplomatic comfort words such as “good” or “constructive”, she referred merely to their “extensive talks”, from which, she added sarcastically, “if nothing else, at least one learns something new”. As she spoke, Putin looked ­uncomfortable, staring at the ceiling or scrutinising the floor. She ended the press conference with a barbed but clear warning. When Putin was asked to comment on accusations of Russian meddling in recent Western elections, notably in the US and France, he replied indignantly: “We never interfere in the political life and the political processes of other countries.” Merkel said drily that she was well aware that “hybrid warfare plays a role in Russia’s military doctrine” and warned that her government “would act decisively if such moves were detected” when Germany went to the polls.

***

In Merkel’s valedictory address at the funeral of Helmut Schmidt in Nov­ember 2015, she described the former West German chancellor in words that mirrored her own approach to leadership. Schmidt, she said, was “convinced that a decision was only ripe once it had been thought through and infused with reason”. Perhaps mindful of her gamble over the refugees, she added that he had been willing “to pay the highest price, because he always factored the risk of failure into his actions – including even the risk of losing his chancellorship”.

She also praised Schmidt as an international statesman who in the 1970s already understood that the world was becoming “more open” and that this therefore demanded “greater global co-operation” on matters such as finance, security and climate in such forums as the G7 and G20.

Unlike Schmidt, however, Merkel has to operate as a woman in a man’s world. Her German nickname, Mutti der Nation, initially sounded somewhat deprecatory: Kohl’s little “girl” had grown up into Germany’s “mummy”. Sexist alpha-male politicians from Silvio Berlusconi to Donald Trump have found it hard to assimilate her into their patriarchal universe. And CDU traditionalists have long worried about whether the party’s Catholic, conservative, middle-class values were being undermined by a pinko, Protestant, Ossi woman.

Yet over time the more positive connotations of Mutti have filled the headlines: calm, good-hearted and dependable. Her courage in standing up for international ideals in an increasingly nationalistic era is widely acknowledged. Few dispute that she is now the most powerful defender of Western liberal values. Or, as the ­Washington Post put it, the “leader of the free world”. 

Kristina Spohr’s most recent books are “The Global Chancellor: Helmut Schmidt and the Reshaping of the International Order”; and, as co-editor, “Transcending the Cold War” (both Oxford University Press)

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