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

Biteback and James Wharton
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“It was the most traumatic chapter of my life”: ex-soldier James Wharton on his chemsex addiction

One of the British Army’s first openly gay soldiers reveals how he became trapped in a weekend world of drug and sex parties.

“Five days disappeared.” James Wharton, a 30-year-old former soldier, recalls returning to his flat in south London at 11pm on a Sunday night in early March. He hadn’t eaten or slept since Wednesday. In the five intervening days, he had visited numerous different apartments, checked in and out of a hotel room, partied with dozens of people, had sex, and smoked crystal meth “religiously”.

One man he met during this five-day blur had been doing the same for double the time. “He won’t have been exaggerating,” Wharton tells me now. “He looked like he’d been up for ten days.”

On Monday, Wharton went straight to his GP. He had suffered a “massive relapse” while recovering from his addiction to chemsex: group sex parties enhanced by drugs.

“Crystal meth lets you really dig in, to use an Army term”

I meet Wharton on a very different Monday morning six months after that lost long weekend. Sipping a flat white in a sleek café workspace in Holborn, he’s a stroll away from his office in the city, where he works as a PR. He left the Army in 2013 after ten years, having left school and home at 16.


Wharton left school at 16 to join the Army. Photo: Biteback

With his stubble, white t-shirt and tortoise shell glasses, he now looks like any other young media professional. But he’s surfacing from two years in the chemsex world, where he disappeared to every weekend – sometimes for 72 hours straight.

Back then, this time on a Monday would have been “like a double-decker bus smashing through” his life – and that’s if he made it into work at all. Sometimes he’d still be partying into the early hours of a Tuesday morning. The drugs allow your body to go without sleep. “Crystal meth lets you really dig in, to use an Army expression,” Wharton says, wryly.


Wharton now works as a PR in London. Photo: James Wharton

Mainly experienced by gay and bisexual men, chemsex commonly involves snorting the stimulant mephodrone, taking “shots” (the euphoric drug GBL mixed with a soft drink), and smoking the amphetamine crystal meth.

These drugs make you “HnH” (high and horny) – a shorthand on dating apps that facilitate the scene. Ironically, they also inhibit erections, so Viagra is added to the mix. No one, sighs Wharton, orgasms. He describes it as a soulless and mechanical process. “Can you imagine having sex with somebody and then catching them texting at the same time?”

“This is the real consequence of Section 28”

Approximately 3,000 men who go to Soho’s 56 Dean Street sexual health clinic each month are using “chems”, though it’s hard to quantify how many people regularly have chemsex in the UK. Chemsex environments can be fun and controlled; they can also be unsafe and highly addictive.

Participants congregate in each other’s flats, chat, chill out, have sex and top up their drugs. GBL can only be taken in tiny doses without being fatal, so revellers set timers on their phones to space out the shots.

GBL is known as “the date rape drug”; it looks like water, and a small amount can wipe your memory. Like some of his peers, Wharton was raped while passed out from the drug. He had been asleep for six or so hours, and woke up to someone having sex with him. “That was the worst point, without a doubt – rock bottom,” he tells me. “[But] it didn’t stop me from returning to those activities again.”

There is a chemsex-related death every 12 days in London from usually accidental GBL overdoses; a problem that Wharton compares to the AIDS epidemic in a book he’s written about his experiences, Something for the Weekend.


Wharton has written a book about his experiences. Photo: Biteback

Wharton’s first encounter with the drug, at a gathering he was taken to by a date a couple of years ago, had him hooked.

“I loved it and I wanted more immediately,” he recalls. From then on, he would take it every weekend, and found doctors, teachers, lawyers, parliamentary researchers, journalists and city workers all doing the same thing. He describes regular participants as the “London gay elite”.

“Chemsex was the most traumatic chapter of my life” 

Topics of conversation “bounce from things like Lady Gaga’s current single to Donald Trump”, Wharton boggles. “You’d see people talking about the general election, to why is Britney Spears the worst diva of them all?”

Eventually, he found himself addicted to the whole chemsex culture. “It’s not one single person, it’s not one single drug, it’s just all of it,” he says.



Wharton was in the Household Cavalry alongside Prince Harry. Photos: Biteback and James Wharton

Wharton feels the stigma attached to chemsex is stopping people practising it safely, or being able to stop. He’s found a support network through gay community-led advice services, drop-ins and workshops. Not everyone has that access, or feels confident coming forward.

“This is the real consequence of Section 28,” says Wharton, who left school in 2003, the year this legislation against “promoting” homosexuality was repealed. “Who teaches gay men how to have sex? Because the birds and the bees chat your mum gives you is wholly irrelevant.”


Wharton was the first openly gay soldier to appear in the military in-house magazine. Photo courtesy of Biteback

Wharton only learned that condoms are needed in gay sex when he first went to a gay bar at 18. He was brought up in Wrexham, north Wales, by working-class parents, and described himself as a “somewhat geeky gay” prior to his chemsex days.

After four years together, he and his long-term partner had a civil partnership in 2010; they lived in a little cottage in Windsor with two dogs. Their break-up in 2014 launched him into London life as a single man.

As an openly gay soldier, Wharton was also an Army poster boy; he appeared in his uniform on the cover of gay magazine Attitude. He served in the Household Cavalry with Prince Harry, who once defended him from homophobic abuse, and spent seven months in Iraq.


In 2012, Wharton appeared with his then civil partner in Attitude magazine. Photo courtesy of Biteback

A large Union Jack shield tattoo covering his left bicep pokes out from his t-shirt – a physical reminder of his time at war on his now much leaner frame. He had it done the day he returned from Iraq.

Yet even including war, Wharton calls chemsex “the most traumatic chapter” of his life. “Iraq was absolutely Ronseal, it did exactly what it said on the tin,” he says. “It was going to be a bit shit, and then I was coming home. But with chemsex, you don’t know what’s going to happen next.

“When I did my divorce, I had support around me. When I did the Army, I had a lot of support. Chemsex was like a million miles an hour for 47 hours, then on the 48th hour it was me on my own, in the back of an Uber, thinking where did it all go wrong? And that’s traumatic.”

Something for the Weekend: Life in the Chemsex Underworld by James Wharton is published by Biteback.

Anoosh Chakelian is senior writer at the New Statesman.

This article first appeared in the 08 November 2010 issue of the New Statesman, Israel divided