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

All pictures: BBC screengrabs.
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David Cameron made a terrible sex joke in his Conservative party conference speech

And he looked really pleased with himself afterwards.

As if the general public wanted to know anything else about the Prime Minister's sex life, he's gone and forced some more unsavoury images into our minds. 64 of them, to be precise.

During a particularly grim section of his speech to Conservative party conference, David Cameron took a break from his vague security theme (essentially: "Drones, lads! Who's with me?!") to tell a miserable sex joke. He began by talking about Labour's "economics guru", Richard Murphy – classic foreplay – before deploying this awkward punchline:

"His book is actually called The Joy of Tax. I’ve got it. I took it home to show Samantha. It’s got 64 positions – and none of them work."


Here he is, building up to his sex joke. Relaxed, in control:


Here he is, telling the joke. Part anxious, part relieved:


Here he is, when laughter ensues. Gleeful little schoolboy:


And here's Samantha. Eyes betraying bitter hatred:

I'm a mole, innit.

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A letter to Rosa Luxemburg

The socialist pioneer Rosa Luxemburg was killed in Berlin in 1919. In 2015, John Berger sits down to write a letter to her.

Rosa! I’ve known you since I was a kid. And now I’m twice as old as you were when they battered you to death in January 1919, a few weeks after you and Karl ­Liebknecht had founded the German Communist Party.

You often come out of a page I’m reading – and sometimes out of a page I’m trying to write – come out to join me with a toss of your head and a smile. No single page and none of the prison cells they repeatedly put you in could ever contain you.

I want to send you something. Before it was given to me, this object was in the town of Zamosc in south-east Poland. In the town where you were born and your father was a timber merchant. But the link with you is not as simple as that.

The object belonged to a Polish friend of mine called Janine. She lived alone, not in the elegant main square as you did during the first two years of your life, but in a very small suburban house on the outskirts of the town.

Janine’s house and her tiny garden were full of potted plants. There were even potted plants on the floor of her bedroom. And she liked nothing better when she had a visitor than to point out, with her elderly working woman’s fingers, the special particularity of each one of her plants. Her plants kept her company. She gossiped and joked with them.

Although I don’t speak Polish, the European country I perhaps feel most at home in is Poland. I share with the people something like their order of priorities. Most of them are not intrigued by Power because they have lived through every conceivable kind of power-shit. They are experts at finding a way round obstacles. They continually invent ploys for getting by. They respect secrets. They have long memories. They make sorrel soup from wild sorrel. They want to be cheerful.

You say something similar in one of your angry letters from prison. Self-pity always made you angry and you were replying to a moaning letter from a friend. “To be a human being,” you say, “is the main thing above all else. And that means to be firm and clear and cheerful, yes, cheerful in spite of everything and anything, because howling is the business of the weak. To be a human being means to joyfully toss your entire life in the giant scales of fate if it must be so, and at the same time to rejoice in the brightness of every day and the beauty of every cloud.”

In Poland during recent years a new trade has developed and anyone who practises it is called a stacz, which means “taking the place”. One pays a man or a woman to join a queue and after a very long while (most queues are very long), when the stacz is near to the head of the queue, one takes his or her place. The queues may be for food, a kitchen utensil, some kind of licence, a government stamp on a document, sugar, rubber boots . . .

They invent many ploys for getting by.

Illustration: John Berger

In the early 1970s, my friend Janine decided to take a train to Moscow, as several of her neighbours had done. It was not an easy decision to take. Only a year or two before in 1970 there had been the massacre of Dzank and other seaports, where hundreds of shipbuilding workers on strike had been shot down by Polish soldiers and police under orders from Moscow.

You foresaw it, Rosa, the dangers implicit in the Bolshevik manner of arguing with all reasoning, you already foresaw it in 1918 in your commentary on the Russian Revolution. “Freedom only for the members of the government, only for the members of the Party – though they are quite numerous – is no freedom at all. Freedom is always the freedom of the one who thinks differently. Not because of any fanatical concept of justice, but because all that is instructive, wholesome and purifying in political freedom depends on this essential characteristic, and its effectiveness vanishes when ‘freedom’ becomes a special privilege.”

Janine took the train to Moscow to buy gold. Gold cost there a third of what it did in Poland. Leaving the Belorussky Station behind her, she eventually found the backstreet where the prescribed jewellers had rings to sell. There was already a long queue of other “foreign” women waiting to buy. For the sake of law and order each woman had a number chalked on the palm of her hand which indicated her place in the line. A cop was there to chalk the numbers. When Janine eventually reached the counter with her prepared roubles she bought three gold rings.

On her way back to the station she caught sight of the object I want to send to you, Rosa. It cost only 60 kopeks. She bought it on the spur of the moment. It tickled her fancy. It would chat with her potted plants.

She had to wait a long while in the station for the train back. You knew, Rosa, these Russians stations that become encampments of long-waiting passengers. Janine slipped one of her rings on to the fourth finger of her left hand, and the other two she hid in more intimate places. When the train arrived and she climbed up into it, a soldier offered her a corner seat as she sighed with relief; she would be able to sleep. At the frontier she had no problems.

In Zamosc she sold the rings for twice the sum she had paid for them, and they were still considerably cheaper than any which could be bought in a Polish shop. Janine, after deducting her rail fare, had made a little windfall.

The object I want to send you she placed on her kitchen windowsill.

The goal of an encyclopaedia is to assemble all the knowledge scattered on the surface of the earth, to demonstrate the general system to the people with whom we live, and to transmit it to the people who will come after us, so that the works of centuries past is not useless to the centuries which follow, that our descendants by becoming more learned, may become more virtuous and happier . . .

Diderot is explaining in 1750 the encyclopaedia he has just helped to create.

The object on the windowsill has something encyclopaedic about it. It’s a thin cardboard box, the size of a quarto sheet of paper. Printed on its lid is a coloured engraving of a collared flycatcher, and underneath it two words in Cyrillic Russian: SONG BIRDS.

Open the lid. Inside are three rows of matchboxes, with six boxes to each row. And each box has a label with a coloured engraving of a different songbird. Eighteen different songsters. And below each engraving in very small print the name of the bird in Russian. You who wrote furiously in Russian, Polish and German would have been able to read them. I can’t: I have to guess from my vague memories of sporadic birdwatching.

The satisfaction of identifying a live bird as it flies over, or disappears into a hedgerow, is a strange one, isn’t it? It involves a weird, momentary intimacy, as if at that moment of recognition one addresses the bird – despite the din and confusions of countless other events – one addresses it by its very own particular nickname. Wagtail! Wagtail!

Of the eighteen birds on the labels, I perhaps recognise five.

The boxes are full of matches with green striking heads. Sixty in each box. The same as seconds in a minute and minutes in an hour. Each one a potential flame.

“The modern proletarian class,” you wrote, “doesn’t carry out its struggle according to a plan set out in some book or theory; the modern worker’s struggle is a part of history, a part of social progress, and in the middle of history, in the middle of progress, in the middle of the fight, we learn how we must fight.”

On the lid of the cardboard box there is a short explanatory note addressed to matchbox-label collectors (phillumenists, as they are called) in the USSR of the 1970s.

The note gives the following information: in evolutionary terms birds preceded animals, in the world today there are an estimated 5,000 species of birds, in the Soviet Union there are 400 species of songbirds, in general it is the male birds who sing, songbirds have specially developed vocal chords at the bottom of their throats, they usually nest in bushes or trees or on the ground, they are an aid to cereal agriculture because they eat and thus eliminate hordes of insects, recently in the remotest areas of the Soviet Union three new species of singing sparrows have been identified.

Janine kept the box on her kitchen windowsill. It gave her pleasure and in the winter it reminded her of birds singing.

When you were imprisoned for vehemently opposing the First World War, you listened to a blue titmouse “who always stayed close to my window, came with the others to be fed, and diligently sang its funny little song, tsee-tsee-bay, but it sounded like the mischievous teasing of a child. It always made me laugh and I would answer with the same call. Then the bird vanished with the others at the beginning of this month, no doubt nesting elsewhere. I had seen and heard nothing of it for weeks. Yesterday its well-known notes came suddenly from the other side of the wall which separates our courtyard from another part of the prison; but it was considerably altered, for the bird called three times in brief succession, tsee-tsee-bay, tsee-tsee-bay, tsee-tsee-bay, and then all was still. It went to my heart, for there was so much conveyed by this hasty call from the distance – a whole history of bird life.”

After several weeks Janine decided to put the box in her cupboard under the stairs. She thought of this cupboard as a kind of shelter, the nearest she had to a cellar, and in it she kept what she called her reserve. The reserve consisted of a tin of salt, a tin of cooking sugar, a larger tin of flour, a little sack of kasha and matches. Most Polish housewives kept such a reserve as a means of minimal survival for the day when suddenly the shops, during some national crisis, would have nothing on their shelves.

The next such crisis would be in 1980. Again it began in Dzank, where workers went on strike in protest against the rising food prices and their action gave birth to the national movement of Solidarnosc, which brought down the government.

“The modern proletarian class,” you wrote a lifetime earlier, “doesn’t carry out its struggle according to a plan set out in some book or theory: the modern workers’ struggle is a part of history, a part of social progress, and in the middle of history, in the middle of progress, in the middle of the fight, we learn how we must fight.”

When Janine died in 2010, her son Witek found the box in the cupboard under the stairs and he brought it to Paris, where he was working as a plumber and builder. He brought it to give it to me. We are old friends. Out friendship began by playing cards together evening after evening. We played a Russian and Polish game called Imbecile. In this game the first player to lose all his or her cards is the winner. Witek guessed that the box would set me wondering.

One of the birds in the second row of matchboxes I recognise as a linnet, with his pink breast and his two white streaks on his tail. Tsooeet! Tsooeet! . . . often several of them sing in chorus from the top of a bush.

“The one who has done the most to restore me to reason is a small friend whose image I am sending enclosed. This comrade with the jauntily held beak, steeply rising forehead and eye of a know-it-all is called Hypolais hypolais, or in everyday language the arbour bird or also the garden mocker.” You are imprisoned in Poznan in 1917 and you continue your letter like this:

This bird is quite an oddball. He doesn’t sing just one song or one melody like other birds, but he is a public speaker by the grace of God, he holds forth, making his speeches to the garden, and does so with a very loud voice full of dramatic excitement, leaping transitions, and passages of heightened pathos. He brings up the most impossible questions, then hurries to answer them himself, with nonsense, making the most daring assertions, heatedly refuting views that no one has stated, charges through wide open doors, then suddenly exclaims in triumph: “Didn’t I say so? Didn’t I say so?” Immediately after that he solemnly warns everyone who’s willing or not willing to listen: “You’ll see! You’ll see!” (He has the clever habit of repeating each witty remark twice.)

The linnet’s box, Rosa, is full of matches.

“The masses,” you wrote in 1900, “are in reality their own leader, dialectically creating their own development procedure . . .”

How to send this collection of matchboxes to you? The thugs who killed you, threw your mutilated body into a Berlin
canal. It was found in the stagnant water three months later. Some doubted whether it was your corpse.

I can send it to you by writing, in this dark time, these pages.

“I was, I am, I will be,” you said. You live in your example for us, Rosa. And here it is, I’m sending it to your example.

“Portraits: John Berger on Artists” will be published by Verso on 6 October

John Berger will be in conversation with Ali Smith and Tom Overton at the British Library, London NW1, on 18 September

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