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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A to Z of the 2017 general election

Our strong and stable guide – for the many, not the few.

A is for the Andrews

Although Theresa May spent the election campaign dodging debates (and, consequently, an unhappy junior reporter from the Mirror in a chicken costume) there were a few live interviews for masochistic audiences. The BBC’s Andrews – Neil and Marr – both had a go.

On 30 April, Marr made it harder for the Prime Minister by telling her before they started that she wasn’t allowed to use the phrase “strong and stable” or other soundbites. (She lasted 30 seconds before cracking.) “People can listen to that sort of thing and think it’s a bit robotic,” he told her, foreshadowing later criticism. By the time of Andrew Neil’s BBC1 interview on 22 May the conversation had moved on. “You started this campaign with a huge double-digit lead in the polls. It’s now down to single digits in some polls. What’s gone wrong?” Mrs May’s answer? “Well, Andrew, there’s only one poll that counts . . .”

B is for Brenda

Brenda, a resident of Bristol, spoke for the nation on 18 April when she heard the news that an election had been called. “You’re joking. Not another one?!” she said, her face a cross between overheated aunt at village fete and Edvard Munch’s Scream. “Oh for God’s sake, I can’t, honestly – I can’t stand this,” she told a BBC reporter. “There’s too much politics going on at the moment. Why does she need to do it?” Judging by Brenda’s subsequent internet fame, much of the country was asking the same thing.

C is for clinky

Boris Johnson was mostly kept on the bench during the campaign but he did surface from time to time. He began the campaign by insulting Jeremy Corbyn (see M), and on another occasion he put in an awkward appearance at a Sikh temple. “I hope I’m not embarrassing anybody here by saying that when we go to India, we have to bring ‘clinky’ in our luggage,” he told the audience. “We have to bring Johnnie Walker.”

The Foreign Secretary added that, after Brexit, we could reduce the stiff import tax on alcohol. The audience told him that Sikh teachings forbid drinking alcohol. “How dare you talk about alcohol in a Sikh temple?” said one. Johnson’s plan to visit a mosque to talk about the pork trade was presumably cancelled.

D is for dementia tax

David Cameron, George Osborne, Theresa May – all came a cropper because of a tax that isn’t really a tax. While Cameron and Osborne opted for taxes on spare bedrooms and hot pasties, the 2017 Conservative Party manifesto announced a raid on your ailing granny. The principle of the so-called dementia tax was that those with assets of more than £100,000 would have to pay for their social care. (Those with assets of less than £100,000 would escape paying anything.)

The world quickly turned on its head: the left-wing Momentum group defended the right of the middle classes to large inheritances, and the once-obdurate PM was forced into a hasty U-turn (lamely stating that “nothing has changed”).

E is for Emmanuel Macron

Be still, notre beating coeurs. On 7 May, the pragmatic centrist Emmanuel Macron beat the far-right Marine Le Pen in the run-off of the French presidential election. After Brexit and the success of Donald Trump, it felt like a ray of sunshine to Europe’s weary liberals – proof that Euroscepticism, isolationism and anti-immigrant rhetoric are not the only ways to win.

Since taking office, Macron, 39, has consolidated France’s commitment to the EU and eurozone, naming a minister for “European and foreign affairs”. He has condemned Russian state news outlets as “organs of influence” while standing next to Vladimir Putin, and he shook Trump’s hand (above) for a really, really long time. “My handshake with him – it wasn’t innocent,” Macron said. “It was a moment of truth.”

F is for Fallon

Michael Fallon has many roles: Defence Secretary, “Minister for the Today Programme” and Smearer-in-Chief. An otherwise unremarkable cabinet member, he was happy to be drafted in by CCHQ as an attack dog – unleashed to make personal gibes about the opposition whenever it looked as if the Tory campaign was wobbling.

In 2015, he warned that Ed Miliband had “stabbed his own brother in the back” to become Labour leader and would be “willing to stab the UK in the back” by doing a deal with the SNP to cancel Trident. This time around, Fallon branded Jeremy Corbyn a “security risk” because of his stance on the nuclear weapons. A bit rich, when you consider that the pompous Fallon presided over a failed Trident missile test.

G is for go-karting

“Labour is in pole position to beat the SNP”, proclaimed Scottish Labour’s Twitter account on the day of the party’s manifesto launch. Accompanying this optimistic statement were three pictures showing the regional party’s leader, Kezia Dugdale, as she won a go-kart race against a black-helmeted racer wearing an SNP rosette. If only it were that easy to defeat First Minister Nicola Sturgeon.

H is for hairstyles

The Andrew Marr Show is best known for its interviews (and end music) rather than its style tips. Yet during this campaign, two politicians used it to share their grooming tips with a grateful nation. First up, Labour’s Diane Abbott told us that in the 1980s she used to have an afro (and strong opinions about the need for armed struggle in Ireland) but has since “moved on”.

The Home Secretary, Amber Rudd, then responded by saying that she had “changed her hairstyle a few times in 34 years, too” but her opinions on public safety had not shifted. Let us know if you move away from 2017’s shoulder-grazing blonde bob, Amber. We’re waiting for your update.

I is for ivory sales ban

It isn’t every day that Britain’s “powerful antiques industry lobby” – presumably made up of those interchangeable men in tweed jackets on Antiques Roadshow – makes headlines. However, after the Conservative manifesto launched without a pledge to ban the ivory trade in Britain, Theresa May was accused by animal rights campaigners of U-turning on David Cameron’s previous commitment.

Given that Prince William is one of the ban’s most vocal advocates, you would have thought Theresa the Traditionalist might have happily ditched the antiques dealers in favour of the royal seal of approval.

J is for java

Dark, bitter and scalding: coffee has become the latest accessory of class war. While out in his constituency, the Tory candidate for Wakefield, Antony Calvert, caused outrage by tweeting about a mere proletarian’s audacity in entering a branch of that renowned aristocratic haunt, Costa: “Man recognises me at #Wakefield Westgate. ‘These f*ckin Tories, always looking 2 trample on t’working class, like me’. Man walks into Costa.” Working-class people can’t drink competitively priced caffeine products in popular high-street chains, so the guy must have been a faker, right?

And it’s not just Tories who think an espresso is la-di-da. The Mayor of Manchester, Andy Burnham, suggested that only rich people buy coffee from shops when he condemned the government’s proposed “barista visa” as a Tory plan for avoiding “waiting longer in the morning for their posh coffee”. Workers of the world, percolate!

K is for Katie Hopkins

For the past few years, it seems, no news event has escaped the attention of the former LBC shock jock and Mail Online columnist Katie Hopkins, formerly a candidate on The Apprentice. After expressing her hatred of tattoos, the obese, mobility scooters, maternity leave, the McCanns and redheads, and her admiration for ebola (“Malthusian”), she finally lost her LBC gig after tweeting, then deleting, a call for a “final solution” to Muslim terrorism in Britain after the Manchester bomb.

L is for Lynton Crosby

Nicknamed the Wizard (or Lizard) of Oz by unimaginative Westminster insiders, Lynton Crosby is the Australian election campaign guru who delivered David Cameron’s surprise general election victory in 2015. He is known for his colourful metaphors: the need to “get the barnacles off the boat” (ditch any baggage that might impede a campaign); “you can’t fatten a pig on market day” (voters’ preconceptions are hard to overturn); and, of course, the “dead cat”, which is irrelevant to the argument but nonetheless changes the conversation (often thrown by Michael Fallon; see F).

M is for mugwump

On 27 April, an attention-starved Boris Johnson momentarily forgot that everyone stopped finding his sub-Wodehouse shtick amusing some time ago. Writing in the Sun, he claimed that Labour voters didn’t realise what a grave danger Jeremy Corbyn posed to Britain. “They say to themselves: he may be a mutton-headed old mugwump, but he is probably harmless.” Cue a day of people googling “mugwump”, which turns out to mean: a) someone who left the US Republicans in the 19th century because they found the Democrat Grover Cleveland more appealing; b) the supreme wizard in Harry Potter; c) a predatory species from William Burroughs’s Naked Lunch that “have no liver and nourish themselves exclusively on sweets”.

In its response, Labour went both high (“It is the sort of look-at-me name-calling that you would expect in an Eton playground,” said the shadow housing secretary, John Healey) and low: “Boris Johnson is a caggie-handed cheese-headed fopdoodle with a talent for slummocking about,” said the deputy leader, Tom Watson.

N is for Natalie

“I’m not Natalie,” said Plaid Cymru’s Leanne Wood, after Ukip’s Paul Nuttall twice got her name wrong in the second-tier leaders’ debate on 18 May. Later, Natalie (Bennett of the Greens) tweeted: “The only time I can recall being in the same room as Paul Nuttall was #BBCAQ in 2014. He clearly hasn’t recovered.” No wonder Ukip wants to ban face coverings (see V). Nuttall already has difficulty telling women apart.

O is for The One Show

After the rigours of the set-piece political interview, Theresa May (with her husband, Philip, above) and, later, a solo Jeremy Corbyn had a chance to show their softer side on BBC’s teatime chatfest The One Show. Revelations from the Mays included that their household has “boy jobs and girl jobs” (ie, Philip puts the bins out), that it was “love at first sight” and that “the Red Box has never made an appearance in the bedroom”.

Poignantly, May recounted how when she was a young Conservative candidate she received a phone call from her shocked mother-in-law, after a local newspaper mistakenly printed that she had a new baby. For his appearance, Corbyn was in full-on affable uncle mode, talking about his allotment and his love of decorative drain covers and presenting the show’s hosts with a jar of his home-made jam.

P is for polling

In the final days of the 2015 campaign, the pollsters were accused of “herding”: massaging their raw figures with turnout filters and other wizardry to produce what they thought was the most plausible election result, and therefore missing the possibility of a Tory majority. No such problem this time: there were double-digit differences between pollsters’ estimations of the Conservative lead over Labour, indicating that they were prepared to go out on a limb and take some risks.

Q is for the Queen

“I had a very nice chat with the Queen,” said Jeremy to Jeremy on 29 May. Paxman had been trying to press Corbyn on why his republican leanings hadn’t led to Labour calling for the abolition of the monarchy. “You don’t like her, though – you don’t like what she represents,” Paxman said. But Monsieur Zen was untroubled. “We got along absolutely fine.” Are you thinking what we were thinking? What a pair of replacements they would make for Paul and Mary on Channel 4’s Great British Bake Off . . .

R is for regressive alliance

In the early stages of the campaign, left-wing idealists and disillusioned tribal politicians alike turned to the prospect of a “progressive alliance” as the only hope of challenging the Tories. (And Theresa May invoked it herself with her line about a “coalition of chaos” propping up Labour.) However, commentators largely ignored the emergence of the Regressive Alliance: that is, a Conservative Party boosted by Ukip’s decision not to run in nearly half of the 650 seats. Forget a progressive realignment – this is the big shift in British politics.

S is for strong and stable

It was Lynton Crosby’s New Coke moment: out with the lame old Conservative brand, in with unfussy Theresa May and her “strong and stable leadership”. The campaign began with May and the cabinet – fresh from unlearning the phrase “long-term economic plan” – dutifully parroting their new line. Destination: landslide? Not quite. “Strong and stable” lost much of its rhetorical power when it turned out that the equivocating May was, in the words of Channel 4’s Michael Crick, more “weak and wobbly”. Soon afterwards, Jeremy Corbyn’s performance in the polls began to improve.

T is for terror

The horrifying terror attacks on Manchester and London led to temporary suspensions of the national election campaign. Theresa May and her Home Secretary, Amber Rudd, faced questions about cuts to police numbers and the ability of the security services to monitor known extremists.

The Manchester bomb prompted an outpouring of solidarity and fellow feeling, with thousands of people gathering in the city’s Albert Square for a vigil on 23 May. There they listened to Tony Walsh’s moving performance of his poem “This Is the Place”: “And there’s hard times again in these streets of our city/But we won’t take defeat and we don’t want your pity/Because this is a place where we stand strong together/With a smile on our face, Mancunians for ever.”

U is for Ulster

“Can we ever have too much democracy?” ask the people of Northern Ireland. Having stoically endured decades of tumult and violence, this was their fourth national election in 13 months (after two assembly elections and the EU referendum).

V is for Vitamin D

Ukip’s election manifestos have often been very odd (anyone remember their 2010 pledge to reintroduce “proper dress for major hotels, restaurants and theatres”?) but their 2017 offering surpassed all expectations. Under its “show your face in a public place” policy, Paul Nuttall’s party suggested that the UK should implement a ban on the burqa and niqab: partly because they are a “barrier to integration”, but also because these face coverings “prevent intake of essential Vitamin D from sunlight”. Unsurprisingly, the science was a bit whiffy. Sunlight causes the body to make Vitamin D; we don’t “intake” it from sunrays.

W is for worker bees

The Manchester attack led to a quirky fundraising attempt for the victims’ families as tattooists donated their time to create a permanent symbol of Manchester’s resilience and unity. Among those who got a worker bee tattoo – taken from the city’s coat of arms – was Labour’s Jonathan Reynolds, who was first elected the MP for Stalybridge and Hyde in 2010.

His only worry, he wrote on Facebook, was how his mum would react. Less than quarter of an hour later, we found out. Luckily, although Judith Reynolds expressed shock, she thought her son’s action was for a good cause. “OMG this is your mother!!! I hate tattoos but under the circumstances totally support you.” By early June, the appeal had raised more than £300,000.

X is for xeroxed

As the Labour Party was preparing to launch its general election manifesto, the entire draft was leaked in the Daily Mirror and the Telegraph. This allowed the Daily Mail and other right wing newspapers the opportunity to run pearl-clutching “Back to the 1970s” headlines a few days earlier than they would otherwise have done.

Although the usual accusations of incompetence were levelled at Jeremy Corbyn’s office, the leak might have been deliberate – it gave Labour two days of coverage rather than one for its policies, most of which polled well with the public.

Y is for Yotam Ottolenghi 

When the celebrated restaurateur appeared on the Today programme to discuss the Conservatives’ plan to scrap free school lunches, it was hard to tell what shocked Middle England more: that Theresa May’s favourite chef strongly disagreed with her proposals, or the revelation that he sometimes sends his children to school with ham-and-cheese sandwiches for lunch, rather than a fancy fattoush salad topped with pomegranate and baba ganoush.

Yotam Ottolenghi argued that a hot school lunch was an important social, as well as nutritional, experience for children. Friends and relatives of the Prime Minister should be on high alert for regifted copies of his cookbook Jerusalem this Christmas.

Z is for Zac Goldsmith

It’s just traditional now, innit? Yes, Z for Zac is standing again, mere months after he lost his Richmond Park seat to the Liberal Democrats’ Sarah Olney in a by-election he had called over the proposed expansion of Heathrow Airport. No, he didn’t get the concession he wanted from the Conservatives. Yes, people still remember his dog-whistle campaign for the London mayoralty, which was run by the “strategic mastermind” Lynton Crosby (see L).

We are caught between admiring Goldsmith’s commitment to public service and wondering whether he should just find a hobby. 

This article first appeared in the 08 June 2017 issue of the New Statesman, Election special

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