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 new puritans: What Theresa May and Jeremy Corbyn have in common

In different ways, Jeremy Corbyn and Theresa May are “puritans”. Each has a strict view of what public life should be – and their manners are a rebuke to the low hucksterism that has disfigured our politics.

A puritan revival is under way. It explains the success of Jeremy Corbyn and, in a subtler way, the rise of Theresa May. It also underpins the hatred of figures such as Tony Blair and Boris Johnson, and the disgust one feels as one gazes at a Mediterranean view, spoiled by the superyachts of plutocrats who wish to proclaim their unbounded wealth and utter lack of taste.

Take Corbyn first. The puritan distrust of theatre is plainly what inhibits him from even attempting, most of the time, to make anything in the way of a witty, let alone flamboyant, retort to the Prime Minister. Corbyn’s supporters admire this, for they, too, are puritans. As the shadow chancellor, John McDonnell, recently said, they think he is more upright and honest because he disdains the politics of display. In their eyes, to act a part is to be untruthful and, therefore, sinful: a point confirmed by the pleasure it might give.

Theatre can, of course, be done in many different ways, and whenever one style has prevailed for too long it creates a hunger for something new. Kitchen-sink drama is, at its best, a delightful change from the well-made play or, in Labour’s case, the well-made spin at which Peter Mandelson and Alastair Campbell excelled. Every politician’s mannerisms become wearisome in the end: Stanley Baldwin’s pious bromides, Harold Macmillan’s Edwardian ­affectations, Harold Wilson’s cheeky chappie act.

But to imagine one can get by, in politics, without putting on a performance of some kind is madness. How else is the audience’s interest to be engaged? I mean the wider audience, which for most of the time ignores politics. When Claud Cockburn arrived in Washington as a young man to work for the Times, he was advised by Willmott Lewis, the celebrated correspondent for whom he would be standing in: “I think it well to remember that, when writing for the newspapers, we are writing for an elderly lady in Hastings who has two cats of which she is passionately fond. Unless our stuff can successfully compete for her interest with those cats, it is no good.”

The same is true of political leaders. But whenever one makes the elementary point to a Corbyn supporter that the Labour leader is not only bad at engaging the interest of people who are more interested in their cats, but does not even conceive that it would be a good idea to do so, the supporter takes this as a compliment to Corbyn. He, at least, is pure enough not to engage in the low hucksterism that has disfigured our politics. He may be wilfully understated, Pooterish and dull, but he can congratulate himself on being unspotted by Blair’s worldliness, greed and pro-Americanism.

The Labour Party has not yet split, but is already divided by a gulf of incomprehension. On one side stand the puritans, whose self-righteousness is fortified by criticism, which to them is proof of their virtue. On the other side stand the careerists, who think it pointless to be in politics unless you are at some stage going to win power, but who cannot tell us the point of doing so. Nobody since Tony Crosland has managed to give a persuasive account of the future of socialism (his book was published in 1956), but Corbyn at least enables his followers to believe that puritanism, understood as a return to the original verities of their faith, has a future, even though the policies needed to achieve this remain elusive.

The new spirit of puritanism can be found in the Conservative Party, too. A ruthless purge of the plutocrats has taken place. By holding the EU referendum, David Cameron, an Old Etonian descended from a long line of stockbrokers, took a gamble that did not pay off. He knew he had to go, and Theresa May has since sacked most of his coterie. One of the few to make the transition from the old regime to the new is Gavin Williamson, who served for three years as Cameron’s parliamentary private secretary. He joined May’s campaign as soon as Cameron resigned as prime minister, became her parliamentary campaign manager a day later, and so impressed her with his ability to marshal Tory MPs that she appointed him Chief Whip in July.

Williamson was educated at state schools in Scarborough, read social sciences at the University of Bradford, worked in the pottery industry in Stoke-on-Trent, fought Blackpool North and Fleetwood in 2005, was elected for South Staffordshire in 2010, and in his maiden speech to parliament ­asserted that manufacturers “often have a lot more common sense than bankers”. Under May’s leadership, this sort of proudly provincial background is more in favour than it was under Cameron.

May’s closest adviser, Nick Timothy, is from Birmingham. Both of his parents left school at the age of 14, but he went to King Edward VI in Aston, the grammar school for boys, which he describes as a “transformational” experience with “extraordinarily brilliant teachers”, after which he became the first member of his family to go to university, studying politics at Sheffield. Many people are puzzled that the Prime Minister has taken the risk of deciding to create new grammar schools, and wonder why she has done this. A large part of the answer is surely that she and Timothy think it is the right thing to do. They are true believers who feel themselves called on to show courage in defence of what they know to be right.

Unlike Cameron and George Osborne, they are confident that they are in touch with people of modest means, who cannot dream of paying school fees. It does not occur to them that, with their own fond memories of grammar schools, they may be out of touch with state education as it has evolved over the past 20 years. Towards the end of May’s time there, Holton Girls’ Grammar School in Oxfordshire was turned into the comprehensive Wheatley Park School, and the transition was not, at first, a success.

Timothy drafted May’s first statement as Prime Minister, in which she said: “If you’re from an ordinary working-class family, life is much harder than many people in Westminster realise . . . The government I lead will be driven not by the interests of the privileged few, but by yours.”

This rhetoric does not exactly make May a puritan. She is an Anglican, which is an altogether more complicated thing. Her father trained for the priesthood in the Community of the Resurrection at Mirfield, in West Yorkshire, which promulgates an austere and deeply felt Anglo-Catholicism, with roots in Christian socialism. The Prime Minister’s dress sense cannot be described as austere, but her attitudes usually are. At Mirfield, a monastic foundation, one gets up awfully early, in order to attend the first services before breakfast.


Boris Johnson is the least puritanical figure in British politics. He nevertheless helps to illustrate the rise of puritanism: respectable people often say how entertaining he is and even start laughing as they relate his exploits, but then remember how serious they themselves are and add that his amusement value is, naturally, a disqualification for high office. Johnson is a star performer in the theatre of politics, capable (as he showed during the 2012 London Olympics) of eclipsing his rivals, and this summer he helped swing the referendum result for Brexit. A senior figure in the Leave campaign said that when Johnson attacked President Barack Obama for coming to Britain and telling us how to vote, the polls moved in Leave’s favour, even though (or perhaps in part because) the attack was condemned by high-minded commentators.

Johnson was given the job of Foreign Secretary in order to help reunite the Conservatives, because he might be good at it and also because he had the wit, as soon as Michael Gove deserted his campaign, to recognise that May was going to win the leadership election. But the losing side in the referendum had immediately blamed Johnson for its defeat. It accused him of not only populism, but opportunism: telling lies, stirring up racism and wrecking the economy in order to seize power for himself. For the first time in his life, Johnson’s enemies didn’t just scorn him, they hated him.

Long ago, when he went to Brussels as a correspondent, his rivals accused him of embroidering his news stories for the Daily Telegraph in a way that was not strictly true. This was intensely annoying for them, especially when they were hauled out of bed to follow up reports that turned out to be inaccurate. They were not prepared to accept the defence that Johnson had made these imaginative embellishments in order to dramatise a deeper truth – namely, that Jacques Delors, the then president of the European Commission, was grabbing power at the expense of the nation states.

Puritans cannot accept that it is permissible, or even praiseworthy, to draw a caricature in order to show what a person is really like. They possess a painful literal-mindedness. Their aim is to purify religion by stripping away the corruption of later centuries and getting back to the simple, honest faith of the first believers.

In the United States, a country founded by puritans, each president arrives promising to return the republic to a state of pristine perfection by cleansing Washington of crooked lobbyists. The new president’s mission is to protect the people from the politicians. After a while, it becomes apparent that the president is, after all, a politician, too, and the process starts all over again.

In Britain, the desire to purify the system recurs at similarly frequent intervals. Before the 1970 general election, the then Conservative leader, Edward Heath (the subject of A Singular Life, an absorbing new study by Michael McManus), promised to sweep away the “trivialities and gimmicks” that had characterised Harold Wilson’s six years as Labour prime minister. Douglas Hurd, who was working for Heath, said this declaration, made in the foreword to that year’s Tory manifesto, was entirely sincere:


There runs through it a note of genuine puritan protest, which is familiar in British history, sometimes in one party, sometimes in the other. It is the note struck by Pym against the court of Charles I, by Pitt against the Fox-North coalition, by Gladstone against Disraeli, by the Conservatives in 1922 against Lloyd George. It is the outraged assertion of a strict view of what public life is about, after a period in which its rules have been perverted and its atmosphere corrupted.


To many people’s surprise, though not his own, Heath won the 1970 election. Yet his puritanism was insufficient to guide him through the difficulties that followed, and in 1974 he was out of office again. His astounding bad manners to colleagues, which the following February helped bring about his downfall from the Conservative leadership (won by Margaret Thatcher), sprang in part from his puritanical refusal to accept that courtly behaviour, with its connotations of idleness and insincerity, could ever be worth bothering about.

Andrew Gimson is the author of “Boris: the Adventures of Boris Johnson”, out now in an updated edition (Simon & Schuster)

This article first appeared in the 29 September 2016 issue of the New Statesman, May’s new Tories