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

DAN BURN-FORTI FOR NEW STATESMAN
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Ralph Steadman: The gonzo marksman

For six decades, the Welsh artist's savage cartoons have thrilled, angered and shocked readers. He is not done yet.

IIn the summer of 1970, a 34-year-old Welsh artist with a shock of prematurely white hair and a thick, moustache-less goatee was asked by the Times to draw political cartoons during the general election campaign. Idealistic and mistrustful of authority, Ralph Steadman saw little that was likeable or even distinguishable in the Conservative Party’s Edward Heath and Labour’s Harold Wilson. But he had four children to support from a recently ended marriage and needed a steady income, so he accepted the assignment – and got on with causing offence.

Steadman’s first cartoon for the newspaper, featuring the diminutive Mr Weath and Mr Hilson, as he named them, along with the Liberal Party leader, Jeremy Thorpe, was titled Happiness Is a Small Politician. Another used the three faces to form the undulations of a landscape, which he called The Wasteland. Most memorably, he portrayed Enoch Powell as a fly sitting on a heap of shit, with the Northern Irish unionist Ian Paisley buzzing in from the side. “Go find your own heap, Paisley!” Powell says, as Mr Weath approaches from behind with a fly swatter.

The then Times editor, William Rees-Mogg, worried that the drawings were inflammatory, but others on the paper liked Steadman’s strange, savage style. After the election, he was offered a three-month trial as a staff cartoonist, which he took. As the letters of complaint from readers began to pile up at the newspaper, Steadman was receiving another stream of correspondence from the United States, which often started like this:

 

Dear Ralph . . .

You filthy twisted pervert. I’ll beat your ass like a gong for that drawing you did of me . . .

 

The author was Hunter S Thompson, a renegade journalist who had achieved renown in America for his book about living and riding with the Hell’s Angels. The two men had met earlier that year, when Scanlan’s Monthly magazine commissioned Steadman to join Thompson at the Kentucky Derby horse race and provide pen-and-ink illustrations for his article.

The collaboration started badly – Thompson greeted Steadman with the line, “They told me you were weird, but not that weird” – and got worse. Steadman showed some of the locals the grotesque portraits he had drawn of them and came close to being beaten up. Thompson, who was six foot three, drunk and ill-tempered, sprayed Steadman with Mace. Yet when the magazine published their work, under the headline “The Kentucky Derby is decadent and depraved”, it caused a sensation in literary journalism circles. Bill Cardoso, an editor at the Boston Globe Sunday magazine, wrote to Thompson praising the piece, which he called “pure gonzo”. Gonzo journalism – in which the reporter becomes the story – was born.

Now, a few months later, Thompson was eager to capitalise on the success by taking on more assignments with Steadman. In what he described as a “king-bitch dog-fucker of an idea”, he suggested that they travel around America and produce a series of articles “so weird and frightful as to stagger every mind in journalism”.

Steadman knew that he was not cut out for a long-term career in newspapers and so, that August, he took leave from the Times and flew to Newport, Rhode Island, to cover the America’s Cup yacht race for Scanlan’s. Though they lacked accreditation, Thompson had hired two berths on a boat – the other occupants were members of a rock band – so they could sail out and observe the contest. But the wind was mild and the racing boring.

With just a day of the competition left, they had no story and Steadman was seasick. He asked Thompson, who had shown no sign of discomfort on the water, for one of the little yellow pills that he had been popping. It was a bad mistake. Steadman had little experience with drugs – hallucinogens, in this case – unlike his companion.

“Hunter had no fear of the effect of drugs on his body,” he tells me, when I visit him in October. “People would come to him and say, ‘Have one of these.’ He’d eat it and then say, ‘What was that?’”

The yellow pill made Steadman feel weird and brave. That night, when Thompson produced two cans of spray paint and suggested that they row out in a dinghy to deface the racing boats – Australia’s Gretel II and America’s Intrepid – Steadman was game. As the artist, it fell on him to decide on the graffiti. He suggested spraying “FUCK THE POPE” on one of the multimillion-dollar yachts. As they approached the vessels in the darkness, Steadman shook one of the cans of paint. The clicking noise alerted a guard on the jetty, who pointed his torch and shouted at the trespassers.

“Ralph, we must flee!” Thompson said, and frantically rowed the dinghy away from the yachts. To distract the police, he fired two flares towards the harbour, one of which landed on the wooden deck of a boat. He and Steadman caught a lift on a passing fishing boat and escaped the scene.

“It was just a schoolboy prank,” Steadman says. “But if I had managed to spray the graffiti and got caught, I may never have been allowed to leave America!”

 

***

 

Nearly half a century has passed and Steadman is now 80, but the details of the escapade are still fresh in his mind. “Ralph, we must flee!” he says, chuckling as he imitates Thompson’s deep voice. It’s autumn and he is sitting on a stool in the kitchen of his large Georgian house in the village of Loose in Kent. With him is his second wife, Anna, and their daughter, Sadie, who lives with her husband and their two sons on the property. They are having a breakfast of boiled eggs, Marmite on toast and tea.

Steadman wears two fleeces over his grey-and-white-striped shirt, a necklace with several shiny pendants, navy trousers and black leather slip-on shoes. He’s still warming up after spending 15 minutes in the pool in his back garden, swimming a few lengths and then jogging through the water, as he does most mornings, even through the winter.

He dislikes sport (one of his reporting assignments with Thompson involved shouting, “Run, you bastards!” at competitors in the Honolulu Marathon in Hawaii), and being out in the elements is more important to him than the health benefits of the exercise.

“At one point in my life, I did wonder, ‘Why does the human heart keep beating?’” he tells me. “But I am over that.”

Seeing my notebook, he takes his own out of his pocket, a small, soft-cover version that he always keeps with him. He thumbs through it and shows me what he has written: “Gonzo-koala – DRAW! . . . Senet – old Egyptian game . . .”

“How did I find that out?” he wonders. “I don’t know. I’m properly ill-informed.”

He is not, of course. He may be best known for his brutal ink-blot cartoons, which have appeared in many of the world’s leading English-language newspapers and magazines, but he has also written and illustrated books about Leonardo da Vinci, Sigmund Freud, fine wine and God, among other things.

And though his most famous collaborator is gone – Thompson, depressed and struggling with chronic medical problems, committed suicide in 2005, aged 67 – Steadman has shown no sign of laying down his nib pen and paintbrush. His output in recent months includes the poster for Louis Theroux’s new film on Scientology, the artwork for the indie musician Ed Harcourt’s latest album and dozens of paintings of real and imaginary creatures for his own forthcoming book Critical Critters.

He also continues to produce for the New Statesman his political drawings that reflect his dismay at the state of the world and the role of the powerful in its decay. Sometimes it’s a commission, such as the drawing of Nicola Sturgeon with tartan horns, or Nigel Farage with a braying donkey grin. At other times, it’s something that he sends in unprompted to the NS creative editor, Gerry Brakus, who joins me on the visit to Steadman’s house: for instance, Donald Trump as a pig wearing Stars and Stripes underpants. Titled Porky Pie, it ran in the paper exactly a year ago and now seems highly prescient.

“I don’t know what else to do,” he tells me, when I ask him why he keeps working. (He does not need the money.) “It can be hard to fill the hours, so I try to make a mark every day.”

 

***

 

Ralph Steadman was born in the town of Wallasey, near Liverpool, in 1936. His mother was a Welsh coal miner’s daughter who had dreamed of being a teacher but ended up as a shopgirl at a branch of the T J Hughes department store. His father was a commercial traveller
who sold ladies’ costumes out of a van but wanted to build cars.

When war broke out and the German bombs started falling, Steadman’s mother would rush him and his sister to an Anderson air-raid shelter, where she knitted to try to stay calm. Eventually, the danger became too great. “Father drove us out in the middle of the night in his Rover car. I was four and my sister was eight. We ended up in Abergele in Wales and stayed with one of my father’s customers, Mrs Hudson. My mother did not like it, but we could not go back,” Steadman tells me.

As a child, he showed little sign of rebellion or artistic talent. He was a choirboy and a Boy Scout, neither of which especially pleased his father, “a lovely fellow” whose experiences in the First World War had left him mistrustful of God and anything militaristic. Steadman liked to build model planes and hoped to become an aircraft engineer. After leaving Abergele Grammar School at 16, he was taken on as an apprentice by de Havilland Aircraft Company in Broughton, Flintshire. He learned technical drawing – circles and straight lines would later mark his art – but hated factory life, and quit within a year.

Unsure of what he wanted to do with his life, he took a job at Woolworths in Colwyn Bay, in north Wales. One day, while sweeping outside the entrance to the shop, his old headmaster walked past. “He was a vicious bastard, who would cane boys whenever he could,” Steadman says. “He sneered and said, ‘Look at you – you could have been something if you had stayed on at de Havilland. Now you are sweeping the streets in Colwyn Bay.’

“I was mortified. I should have said, ‘At least it’s honest work.’ Authority is the mask of violence – I believe that.”

His next job was as a tea boy at a small advertising company, where he saw in a brochure an advert for Percy V Bradshaw’s Press Art School that said: “You, too, can learn to draw and earn pounds.” The correspondence course cost £12 for 12 lessons and an extra £5 to study cartooning. That second part especially appealed to Steadman, whose father had introduced him to Giles cartoons years earlier.

His parents paid for the course, which he completed while doing his two years of national service as a radar operator in the RAF. “I would sit on my bed, drawing pictures of my boots,” he says. Soon, he was proficient enough to start sending off his work to regional newspapers, such as the Manchester Evening Chronicle, which published his first cartoon – about Gamal Abdel Nasser and the Suez crisis – in 1956.

After moving to London to find work, he was hired as a cartoonist for a group of newspapers distributed in the north of England. In the evenings, he took classes at East Ham Technical College, where the art teacher Leslie Richardson became his mentor.

“I wanted to learn to draw properly,” he says. “We would go to the museums of ­science and natural history and the Victoria and Albert, and draw for hours. That’s when art evolved for me into a fixation, or a conviction, or a compulsion.”

Who did he draw inspiration from? “They are all dead now,” he says, mentioning the French cartoonist André François and his British friend Ronald Searle, as well as the German artists George Grosz and Otto Dix, who were prominent members of the New Objectivity movement in 1920s Germany. His daughter Sadie chimes in: “Dix’s portrait of the journalist [Sylvia von Harden], with the monocle . . .” and Steadman nods.

In the early 1960s, at Richardson’s urging, Steadman studied further at the London College of Printing and Graphic Arts while pursuing a freelance career, publishing in Punch and Private Eye. He also started illustrating books. He takes down a couple of them from a shelf in his living room, including his first one, Fly Away Peter (1964), about a short-necked giraffe and a bird that cannot fly, and The Yellow Flowers, from 1968, about the children of immigrants in Islington, north London, a subject that seems even more relevant today. He reads a few pages aloud and says approvingly, “Isn’t that sweet?”

The artwork is tame by his later standards – these are children’s books – but all the while, his style was developing. As he drew with his William Mitchell 0565 steel-nib dipping pen and Snowdon 300-grams-per-square-metre paper, his work became edgier, more instinctive, and his confidence grew. He seldom felt the need to sketch out a picture before inking it. “I always say a mistake is just an opportunity to do something different.”

Among his peers and those who followed him, Steadman’s work has been recognised as groundbreaking. “It was all about the ­potency of his line,” says Martin Rowson, the cartoonist and writer, who regards Steadman as one of the most brilliant illustrators of the 20th and 21st centuries. “Very early on, Ralph found the courage not to care about the niceties of the line. It was so rough – like dirty sex, not airbrushed pornography. He’s a true artist.”

We are meant to be going for an early lunch at a pub, and Steadman’s wife, Anna, and Sadie are trying to hurry him along. But he keeps brushing them off, saying, “This is part of the story.”

In an adjoining sitting room, he picks up a black box that looks like a walkie-talkie and a smaller box with a button. He presses it and the larger box emits a loud fart sound. And then another, with a different pitch. He keeps pressing the button on the Fart Machine No 2 – Boom Box Blaster, a gift from a friend in the United States. Now he is laughing uncontrollably, his eyes watering, as he dances a little jig, poking out his bum. “You have to get one, it’s the best,” he says. “There’s nothing funnier than a fart.”

I’m not sure how his mother-in-law feels about that. When she came over to the house one recent Christmas, the fart machine was hidden underneath the couch where she sat, to the delight of the great-grandchildren – and Steadman.

 

***

 

We all squeeze into ­Anna’s car for the drive to the nearby Chequers Inn, which sits beside a pretty stream. Anna and Ralph, who have been together for 46 years, have been ­coming here since they bought their house in Loose in 1980. The pub recently hosted Steadman’s 80th birthday party, at which the festivities were enlivened by magic mushrooms (“brought by some Americans”) and fistfights between some inebriated guests. Hunter S Thompson would have approved.

“I once brought Hunter here,” Steadman says, as we sit down. “I said to the barman: ‘Give him a Chivas, double.’ So he does, and Hunter looks at him and says, ‘What’s that? A sample?’”

Steadman doesn’t usually drink in the day, but he allows himself a half-pint of Rockin Robin, a local ale.

Despite the disaster of the America’s Cup story, his partnership with Thompson flourished. Their best-known collaboration is “Fear and Loathing in Las Vegas”, which was first published in Rolling Stone magazine in 1971, and then as a book. That style of reporting and writing, with its fuzzy distinctions between non-fiction and fiction and its subjective focus, became a significant part of the New Journalism movement in the US, whose other practitioners included Tom Wolfe, Norman Mailer and Joan Didion.

Steadman did not accompany Thompson on his drug-fuelled road trip to Las Vegas – he did the illustrations from London, after reading the manuscript. But they were together three years later, in 1974, when Rolling Stone sent them to Kinshasa, Zaire (now the Democratic Republic of Congo), for the “Rumble in the Jungle” boxing match between Muhammad Ali and George Foreman. After spending weeks in the city, and many thousands of dollars in expenses, Thompson decided that the fight wasn’t worth seeing and gave away his and Steadman’s tickets. On the day of the bout, he took a huge bag of marijuana from his hotel room and poured it into the swimming pool. “He put whiskey in a bucket by the pool and then dived in, swimming in the grass,” Steadman says.

It was gonzo taken to its extreme – Steadman thinks that the term means “unhinged”, after the Portuguese word for “hinge” – and beyond. Their article about one of the seminal sporting events of the 20th century was never printed. “It was the biggest fucked-up story in the history of journalism,” he says.

Even so, it did not do their careers much harm. “You could do a bit in those days, have some fun,” Steadman says. “Today, journalism has become more robotic. People don’t do things so experimentally, and news­papers have lost their idiosyncratic nature. The media is in a more controlled, restricted state – more like an assembly hall full of schoolchildren.”

In the US, he also covered the Watergate hearings, which confirmed his deep dislike for most politicians. He continued to savage them with his pen, drawing political cartoons for the New Statesman from 1976 to 1980. By the late 1980s, however,
his disillusionment with Margaret Thatcher’s Tories – and the money-obsessed British society that they had created – was so great that he resolved to stop drawing politicians altogether.

When he resumed in 1997, while covering the election campaign for this magazine, he refused to draw any politician’s face, only their legs. Today, he does the whole body, though not because his opinion of them has changed. If anything, it has sunk even lower. “Back in the Seventies, they were real politicians, even if they were crooked, like Nixon. Now it’s all fatuous,” he says.

He holds Nigel Farage in special contempt for his role in getting Britain out of the European Union, “our biggest mistake”. “He’s a bastard among them. He said he wants his life back [after the Brexit campaign]. Fine, but you’ve buggered it up for everyone else. We were part of something great. Now we are an offshore island.”

Are there any politicians he has admired? “Denis Healey. What a lovely man. A good man and a good politician,” he tells me. “A consummate human being.”

And of the current crop? “Owen Smith pissed me off. I like Hilary Benn. Chuka Umunna is interesting.”

Labour has “had it”, he says. “[Jeremy] Corbyn has a passive approach to leadership. I wish he would assert himself in a left-wing way. Do something for the workers.”

When I meet him, the US presidential election is still a few weeks away, and Steadman has faith that the American people will do the right thing. “Hillary [Clinton] will be all right. Trump is unthinkable. A thug and a molester. Who wants him?” he says.

In late November, I call him on the tele­phone and I ask what he thinks about President-Elect Trump. Steadman pauses and then says: “Where is Lee Harvey Oswald when you really need him?”

 

 

***

 

Steadman’s work may be searing, and his opinions strong, but in person he is warm-hearted, funny and generous. At the pub, he tips the staff on the way out even though I’ve already left a tip when paying the bill.

Back at the house, he insists on going into the garden to pick some apples for the New Statesman’s Gerry to take home. On a table in the living room, he keeps a Lamy fountain pen and a bottle of ink so he can write a dedication in the books that he gives away to visitors, his tongue out, flicking his wrist to send the black liquid splattering across the page.

“My mother always said, ‘I don’t want to be a bother.’ I like that. I’ve only ever been a bother to people doing my drawings,” he says. (The America’s Cup security guard and the marathon runners in Honolulu may dispute that.)

Asked if he has any regrets, he thinks for a moment and then asks for the name of a British-Scandinavian broadcaster. Sandi Toksvig? “Yes, that’s her. When I spoke to her once, I said: ‘Pity about the voice.’ She has a slightly masculine voice. That has always stayed with me. It was a very rude thing that I should never have said to her.”

The walls of his home are covered in his original art, which he resolved not to sell after being burned early in his career when his agent advised him to let Rolling Stone’s owner, Jann Wenner, buy some of the Fear and Loathing drawings for $75 apiece.

The largest artwork in his home is also the one that took him the longest: a one-third-size replica of Leonardo da Vinci’s 15th-century mural The Last Supper, which Steadman painted on to his bedroom wall using egg-white paint. “I started in 1984 and it took me 18 months,” he says.

Below the painting, next to his side of the bed, is a pile of paperbacks that is as tall as a side table. Hunter S Thompson’s novel The Rum Diary is near the top of the stack. After Thompson shot himself in the head in 2005, Steadman flew to Colorado to help instal a monument that the two of them had agreed on in the 1970s – a 47-metre-tall silver “cannon” topped with a double-thumbed fist clutching a button of peyote, a cactus with psychoactive properties. Thompson’s ashes were fired out of the top. The actor Johnny Depp, a friend of Thompson and Steadman, picked up the bill.

Among the ornaments hanging from Steadman’s necklace – which also include a silver toothpick, an animal tooth and a silver-and-turquoise Navajo piece that he bought in 1973 – is a tiny clay head that Thompson gave to him.

“He told me, ‘Wear it Ralph: it will ward off evil spirits.’” Later, looking at a photo of Thompson in the living room, he says: “I miss him.”

Besides reading, Steadman enjoys watching television: the news in the morning and some light entertainment in the evening, such as Strictly Come Dancing. “I was quite interested in Judge Rinder [Robert Rinder, a contestant on the show]. He did a somersault.”

Yet the studio is still the place he feels most content. “It’s a mess at the moment,” Sadie says, before we go there.

“Most of the mess is your tidying up!” Steadman replies.

The studio is set away from the house and looks out over a field of apple trees. On the walk there, I spot a porcelain toilet that has been repurposed as a flowerpot. “It’s a beautiful toilet! It came out of my house,” Steadman says.

The studio, which has several rooms, is more clutter than mess, though it is true that there is paint splattered everywhere – on the walls, on the photocopier and the hairdryer. His large drawing table has a fresh sheet of paper on it, numerous bottles of Winsor & Newton ink, a tin of Caran d’Ache watercolour pencils, paintbrushes, nib pens, glue and scissors.

Besides the digital camera positioned over the table, it’s all low-tech. Steadman still works in the manner he did in the 1970s. “We live in such a self-contained electronic community now. People do things on the computer. There’s no wet ink any more.”

He’s not a technophobe, though. Around the corner, in a narrow office, is a desktop computer, which he uses to answer email and send digital copies of his work to publishers. He enjoys using Skype, because he can see the person he is talking to. But he has no interest in social media, which he views as enabling malevolence, or smartphones.

“I’m worried about the world for my grandkids. People spend all their time looking at their phones with their headphones on,” he says.

He prefers to be alive to the world and its creatures. “When I am in the pool, I listen to the birds. I blow my bird whistle and you can hear the birds calling.”

In his studio, he does not have to look far for inspiration. On the wall are pictures of the American comedian W C Fields and printouts of Dylan Thomas’s poem “Fern Hill” and Oscar Wilde’s “Phrases and Philosophies for the Use of the Young”. Behind his drawing desk is a mini-shrine to Picasso, who Steadman calls a “huge influence” – he once made a triptych called Gonzo Guernica – for his artistic genius and his work ethic. Picasso made art into his nineties.

Steadman’s legacy is assured, even if he has not received all of the accolades that some feel he deserves. “Ralph is not just a cartoonist, he’s an artist, and he’s been hugely influential,” says Dave Brown, the Independent’s political cartoonist. “But satirical artists don’t get the plaudits – you won’t see them winning the Turner Prize.”

Sometimes, when he’s working, Steadman breaks off to play music; a penny whistle, pan pipes and a ukulele are part of the clutter. But mostly he listens. He has a rack full of audio cassettes, a turntable and albums stored digitally.

On his computer, he clicks on iTunes and calls up a nine-minute rock song called “Weird and Twisted Nights”, which he wrote the lyrics for and recorded in the late 1970s. The track alludes to Thompson’s frightening habit of driving along the highway with the headlights off so the police couldn’t see him:

 

Drive your stake through a darkened heart

In a red Mercedes-Benz

The blackness hides a speeding trap

The savage beast pretends . . .

 

Steadman is the lead vocalist and has a surprisingly good, clear singing voice. Thompson contributes a single line, a gruff refrain that goes “It never really happened anyway”, before a saxophone solo by a session musician who Steadman asked to play “as if the devil has just entered the church”.

As the late-afternoon light filters through the window, Steadman leans back in his chair, lost in the music. When Thompson’s voice comes in, he smiles as he sings along: “It never really happened anyway . . .” 

Xan Rice is Features Editor at the New Statesman.

This article first appeared in the 15 December 2016 issue of the New Statesman, Christmas and New Year special 2016