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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Who benefits, and who loses out, from David Cameron’s housing plan?

The prime minister’s plan to scrap the affordable rental homes requirement, explained.

What has Cameron actually announced about housing today?

In David Cameron’s closing speech to the Conservative Party conference in Manchester today, he announced plans to change the requirements to build affordable rented homes in new developments so developers can build "starter homes" instead of homes to be leased at affordable or social rents. 

The policy is geared toward ensuring that his party meets its campaign pledge of building 200,000 new homes by the close of this parliament, by taking the emphasis off renting (affordable housing requirements usually refer to rented, not owned houses) and onto owning. It should, claims Cameron, take us from “Generation Rent” to “Generation Buy".

What sort of houses will they build instead?

"Starter homes" are homes sold at 80 per cent of market rates to those under 40. These an be sold for a maximum of £450,000 in London, and £250,000 everywhere else. 

That sounds quite good!  

There is a chance that Cameron is right – that removing these obstacles will make developers move through the planning process more quickly, and will help boost the number or houses built. 

But (and this is a big but): most predictions so far are that this won’t happen, and if it does, it’ll only help a very specific demographic. As my colleague Stephen Bush has already pointed out, the announcement is good politics, but bad policy. It makes it look like Cameron is doing something about the housing crisis, while scoring points with big property developers along the way.

My colleague Jonn Elledge, meanwhile, notes that this system could actually slow down housebuilding, as the houses will take longer to sell than they would to let. Moreover, if housebuilding is more profitable in the long run, this will push up land – and therefore house – prices. 

Who'll benefit?

Tory voters and their children, in a nutshell. The starter homes will mostly be one or two bedrooms, and will be aimed at working couples.

Shelter calculated earlier this year that a couple would need a combined income of £76,957 in London and £50,266 in the rest of the UK to afford one of these homes, which makes it clear that they're aimed at well-off professionals. If you're in a stable relationship, earn £40,000 or £26,000 a year each and are looking to get on the housing ladder, you're in luck. 

Who won't it help? 

Everyone else. Under this policy, the Conservatives are effectively redefining “affordable”, just as they co-opted the phrase “living wage” earlier this year. By most peoples' definitions, a housing option only available to those with access to £80,000 in earnings a year is not affordable. The situation outside London is a little better. 

That’s not to say the affordable housing requirements were perfect before – these, too, were defined by some councils as 80 per cent of market rents, which in many places equates to anything but affordable. Yet removing the requirement for affordable rentals leaves nothing for those unable to afford to buy, leaving the squeezed lower-middle (and most young people) increasingly in the lurch.

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.

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The men saving Syria’s treasures from Isis

A remarkable group of archaeologists are battling to save the country’s ancient artifacts.

On 19 May this year, the ancient city of Palmyra was about to fall. Jihadist fighters were advancing in pick-up trucks mounted with heavy machine-guns. They were from the group that calls itself Islamic State, also known as Da’esh and Isis.

Khalil Hariri, an archaeology expert who worked at the Syrian city’s museum, could hear the sounds of the fighting getting closer. Grunting and sweating, he and four friends kept on manhandling wooden crates out of the door of the museum and down to three trucks that were parked outside.

Bullets hit the outside of the museum, sounding like enraged insects as they hissed over their heads. Mortars exploded nearby, sending hot pieces of shrapnel fizzing through the air, blowing shards of wood off the trees and turning them into daggers. The men bundled the last crate into the nearest truck. As they jumped in after it, with the vehicles careering out of Museum Square, a bullet hit Khalil. Shrapnel wounded two of the others.

They drove fast down the road to Homs, away from Da’esh, as they call Isis, not even stopping to treat the wounded until they were well clear of Palmyra.

Against all odds and under heavy fire, five middle-aged men had managed to thwart the new barbarians of Islamic State. In scenes reminiscent of the George Clooney film The Monuments Men, about an army unit that tries to save art treasures hidden by the Nazis, Hariri and his friends had rescued Palmyra Museum’s priceless collection of artefacts, the legacy of one of the world’s earliest civilisations. Ten minutes after the men left, Isis fighters entered the museum. The display cases were empty. Nothing was left inside, except big statues that were too heavy to lift without a crane.

Who were the men who saved the treasures of Palmyra? The first, Khalil Hariri, was the museum’s director. When he left in May, his wife stayed behind in the city with his young son. So rapid was the Isis advance that he had to leave them behind and it took nearly a month to get them to safety. When they were reunited, she told him that the jihadists stormed out of the museum and into their house 30 metres away, looking for him and demanding to know what he had done with the collection.

When I met him this month in Damascus, Khalil inhaled his cigarette smoke to the base of his lungs. “I’m going to get a harsh sentence, if they get hold of me,” he said. He knows this because after the jihadists escaped with the few remaining contents of the museum, Isis men took away his brother and two cousins and killed them. It was, he says, a reprisal.

He was helped in his daring plan by his brothers-in-law Mohammed, Walid and Tarik al-Asaad. Their father was Khaled al-Asaad, the 83-year-old keeper of Palmyra’s antiquities, who was publicly murdered by the jihadists last month.

Khaled al-Asaad was born in the city and served as head of the museum and director of antiquities for 40 years, until 2003. Even in retirement, he was still the man whose opinion and judgement about Palmyra and its treasures mattered most. He so admired Zenobia, the 3rd-century warrior queen of Palmyra who rebelled against the Roman empire, that he named his daughter after her. She married Khalil Hariri.

Mohammed al-Asaad was not scared when the bullets began flying as they were struggling with crates of antiquities. “We believed that what we were doing was important,” he told me. The whole family had been brought up by their father to venerate Palmyra, its buildings and its treasures.

In Iraq over the past year, Islamic State has destroyed ancient sites and reduced statues in museums to rubble. Mohammed’s father knew what might be coming when they reached Palmyra.

So, in May, Khaled al-Asaad refused to leave with his sons. They never saw him again. He was beheaded by Isis fighters in a public square; his body was left hanging on a traffic light.

“My father was 83 years old,” Mohammed told me, “and a true believer in the importance of Palmyra. He was deeply attached to it and refused to flee. He believed that it should be protected against any harm from militants or anyone else.”

I sat with Khalil and Mohammed in the garden of the Damascus museum and talked about how and why Isis had killed Khaled. Mohammed had a picture of his father in better times, downloaded from the internet, on his phone. All the family’s physical mementoes were left behind in Palmyra.

Mohammed was Khaled’s right-hand man at the museum for 25 years; he is proud of his father’s bravery, the way he brought them up, and the love he instilled in them all for Palmyra. “The main reason Da’esh executed my father was he refused to swear allegiance to them. They labelled him an apostate – a non-believer. There were stories that they killed him because he knew the secrets of Palmyra and locations of a hidden store of gold. But that’s false . . . they killed him because he was honest and loved Palmyra and was devoted to it and refused to leave it till his last breath.”

Mohammed added: “We were punished by getting chased out of Palmyra. All our possessions were confiscated. All that’s left for us in Palmyra are the ruins.”



The nihilists of Isis revile all the relics of religious life in the Middle East before the Prophet Muhammad, which they regard as a time of heresy. Palmyra was always a prime target for them because it has Syria’s greatest single concentration of buildings and artefacts from that era. The Prophet died in 632AD; by then Palmyra was already an ancient city, with a remarkable body of architecture. It has survived earthquakes and wars, but is now in greater danger than ever.

It was not an accident that Syria’s monuments men were able to empty Palmyra’s museum. It was part of a plan hatched by Syria’s director of antiquities, an engaging, francophone, energetic man in his early fifties called Professor Maamoun Abdulkarim. He had watched with alarm what was happening in Iraq, and realised as Isis advanced that it was a matter of time before it tried to take its drills and sledgehammers to some of Syria’s heritage, too. Until March the plan had been to bring some objects to Damascus and to hide others locally. But after the fall of a strategic provincial capital, Idlib, to Islamist extremists in March, he gave orders to crate up as much as possible and bring it to “safe places” (he won’t say where they are) in and around Damascus.

When wars are going on, while the killing seems endless, and the fear and the desire to run away and not to stop is overwhelming, it can be hard to think about a time when it will all be over. Looking back and thinking about all the wars that went before – in Syria’s case, over roughly 5,000 years or more of history – and knowing
that all wars end eventually is no comfort for the refugees struggling to escape the battle zone, or to get to Europe. But now history is on the front line of the war in Syria. Perhaps history shouldn’t matter any more. I asked Professor Abdulkarim whether it was right to be concerned about ancient relics when so many human beings were being slaughtered.

“I think it’s two different things; we cannot compare them,” he said. “I understand lives are very important because we are people, too, we are living in this crisis, we know we can be killed in this crisis, too. We understand this question. But our job as archaeologists is saving this heritage. And finally
what we are doing to save cultural heritage in Syria. It’s the memory of the Syrian people, it’s the identity of these people. I’m sure the crisis will finish. Life will be better in the future. But all the damage to the cultural heritage will stay for all the generations. That’s why we are thinking about how we can reduce the damage, how we can save all the collections in all the museums in Syria.”

The National Museum of Damascus is opposite the hotel where the UN is based. Journalists stay there as well. Since the war started, I’ve looked down on the museum many times from a balcony, as the thunder of artillery has broken over the city, and flashes and explosions have come from the Yarmouk Palestinian refugee camp and all the other urban battlefields. All that time, the museum has been there, battened down, closed for the duration of the war.

Abdulkarim ordered that the most precious tombs and sculptures in the garden should be encased in concrete to protect them. On my visit this month, we walked past the strange concrete cubes to see how he has improved security. We waited while a four-tonne steel door at the main entrance rumbled slowly upwards. The old steel grille lay on the floor, dusty and fragile-looking. Armoured glass has been put into the windows. The display cases here have been emptied, too, and their contents put into safe storage.

In the basement is a stunningly preserved tomb from Palmyra which was moved to the museum in the 1930s. It shows the man who commissioned it at a feast, surrounded by his family and possessions. He reclines like a Roman, propping himself up on his elbow as he eats, but the carving is in the distinct style of Palmyra. The generations that followed his body into the tomb for two centuries are immortalised in lines of sculpted heads.



Isis smashes up statues and ancient sites on video to scare its enemies and excite its supporters. But the archaeologists say it also makes a lot of money selling off attractive, portable pieces to dealers. To pre-empt them, Abdulkarim’s team has rescued 16,000 cuneiform tablets and 15,000 coins, ceramics and other objects from Deir az-Zour, a city where Isis has been fighting the Syrian army and local tribes. The tablets are relics of a writing system developed by the Sumerians in Mesopotamia around 3,500BC. Their makers used reeds to mark clay tablets, creating one of the earliest records of politics, war and trade. Many of the objects are small, easy to hide and to smuggle, and worth a lot of money to collectors.

Syria has monuments women, too. A 25-year-old archaeologist, who does not wish to named, so that she can carry on with her work, led the team that rescued 24,000 ancient objects from Aleppo. The road from the regime-held side of Aleppo to Damascus is dangerous, and in places lonely and almost empty. The Syrian army secured it only last year, and its hold on parts of the road is tenuous. The convoys moved quickly and discreetly in unmarked vehicles because of the risk that they might be robbed. They were high-value targets.

Another young female archaeologist, Mayassa Deeb, is in charge of classifying and repacking all the objects that have been saved so they can be put safely into storage. Each one is photographed, its details uploaded on to a database, then it is wrapped in layers of cotton wool and tissue paper. They are packed into sandwich boxes – the staff have had to improvise – and slotted into packing cases lined with protective foam.

Mayassa is an expert on chariots. She showed me her favourite object: a 5,000-year-old clay model of a chariot that was rescued from Deir az-Zour. If Isis had found it, she said, they would have either smashed it or sold it.

The archaeologists work in an open courtyard in the museum, and sometimes they can hear shells, mostly fired out from Syrian army positions, sometimes coming back in from the rebel-held suburbs. May­assa loves coming to work, because it helps her forget what is happening outside. “It’s hard because every minute we have a noise and we have an explosion, and some die, it’s hard . . . but we work, and sometimes we don’t remember we have a war. We feel safe here, we don’t think about the war. Some people lose their houses, somebody loses his family, somebody goes abroad. Everybody has problems.”

She looked at the clay chariot, about the size of a couple of matchboxes, decorated with tiny marks that were made five millennia ago. “It’s important for everybody because this isn’t just about the history of Syria – this chariot speaks to us about the history of all the human world. For this reason we must keep it.”

I expected the museum to be full of despair because of the attacks on Palmyra by Isis and the desolation elsewhere in the country. Some of the worst destruction is in Aleppo’s Old City. It was a gem, a tight mass of alleys and khans, as full of entrepreneurs as it must have been a thousand and more years ago. Now it is in ruins.

But Professor Abdulkarim and his team are remarkably positive, horrified by the destruction of the most significant relic in Palmyra, the Baalshamin temple, but delighted about what has been rescued. They are even hopeful, if the stones are not too badly damaged, that they can put the buildings back together after the war. Now they want help from abroad. Foreign governments, the professor said, need to crack down much harder to stop the illegal trade in stolen antiquities.

He also talked about rebuilding the great minaret of the Umayyad Mosque in the Old City of Aleppo, which was flattened earlier in the war. “We’ve told them not to touch the stones,” he told me enthusiastically. “If they’re all there, we can fix it.”

Abdulkarim has 2,500 people working to save Syria’s past, on both sides of the lines. Fourteen of them have been killed so far. “We saved 99 per cent of the collection in the [country’s] museums. It’s good. It’s not just for the good of the government. It’s for the opposition, for the humanity, for all Syria. It is our common identity, our common heritage.”

The National Museum and the remarkable people who work there have created an unexpected oasis, transcending politics and trying to save a vital part of their country for better times. In a country full of despair, it was the most hopeful place I have been in Syria since the war began.

Jeremy Bowen is the BBC’s Middle East editor and the author of “The Arab Uprisings” (Simon & Schuster)

This article first appeared in the 17 September 2015 issue of the New Statesman, Corbyn's Civil War