Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis

Photo: Getty Images
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What's to be done about racial inequality?

David Cameron's words on equal opportunities are to be welcomed - now for some action, says Sunder Katwala.

David Cameron made the strongest, clearest and most high profile statement about ethnic inequalities and the need to tackle discrimination ever yet offered by a British Prime Minister in his leader’s speech to the Conservative Party conference in Manchester.
“Picture this. You’ve graduated with a good degree. You send out your CV far and wide. But you get rejection after rejection. What’s wrong? It’s not the qualifications or the previous experience. It’s just two words at the top: first name, surname. Do you know that in our country today: even if they have exactly the same qualifications, people with white-sounding names are nearly twice as likely to get call backs for jobs than people with ethnic-sounding names? … That, in 21st century Britain, is disgraceful. We can talk all we want about opportunity, but it’s meaningless unless people are really judged equally”, said Cameron.
While the proof of the pudding will be in the eating, this was a powerfully argued Prime Ministerial intervention – and a particularly well-timed one, for three reasons.

Firstly, the Prime Minister was able to root his case in an all-but-universally accepted appeal for equal opportunities. It will always prove more difficult in practice to put political energy and resources behind efforts to remedy discrimination against a minority of the population unless a convincing fairness case is made that values cherished across our whole society are at stake. Cameron’s argument, that any party which tells itself that it is the party of the ‘fair chance’ and ‘the equal shot’ must have a response when there is such clear evidence of discrimination, should prove persuasive to a Conservative Party that has not seen race inequalities as its natural territory. Cameron argued that the same principles should animate responses to discrimination when it comes to race, gender and social class. Put like that, wanting job interviews to be fair – by eradicating conscious and unconscious patterns of bias wherever possible – would strike most Britons as offering as clear a case of the values of fair play as wanting the best baker to win the Great British Bake-Off on television.
Secondly, Cameron’s intervention comes at a potential "tipping point" moment for fair opportunities across ethnic groups. Traditionally, ethnic discrimination has been discussed primarily through the lens of its impact on the most marginalised. Certainly, persistent gaps in the criminal justice system, mental health provision and unemployment rates remain stark for some minority groups. What has been less noticed is the emergence of a much more complex pattern of opportunity and disadvantage – not least as a consequence of significant ethnic minority progress.

Most strikingly of all, in educational outcomes, historic attainment gaps between ethnic minorities and their white British peers have disappeared over the last decade. In the aggregate, ethnic minorities get better GCSE results on average. Ethnic minority Britons are more likely, not less likely, to be university graduates than their fellow citizens. 

As a result of that progress, Cameron’s intervention comes at a moment of significant potential – but significant risk too. Britain’s ethnic minorities are the youngest and fastest-growing sections of British society. If that educational progress translates into economic success, it will make a significant contribution to the "Great British Take-Off" that the Prime Minister envisions. But if that does not happen, with educational convergence combined with current ‘ethnic penalties’ in employment and income persisting, then that potential could well curdle into frustration that the British promise of equal opportunities is not being kept.  Cameron also mirrored his own language in committing himself to both a ‘fight against extremism’ and a ‘fight against discrimination’: while those are distinct challenges and causes, actively pursuing both tracks simultaneously has the potential, at least, depolarise some debates about responses to extremism  - and so to help deepen the broad social coalitions we need for a more cohesive society too.

Thirdly, Cameron’s challenge could mark an important deepening in the political competition between the major parties on race issues. Many have been struck by the increase in political attention on the centre-right to race issues over the last five to ten years. The focus has been on the politics of representation. By increasing the number of non-white Conservative MPs from two to seventeen since 2005, Cameron has sent a powerful signal that Labour’s traditional claim to be ‘the party of ethnic minorities’ would now be contested. Cameron was again able to celebrate in Manchester several ways in which his Cabinet and Parliamentary benches demonstrate many successful journeys of migrant and minority integration in British society. That might perhaps help to ease the fears, about integration being impossible in an era of higher immigration, which the Home Secretary had articulated the previous day.

So symbolism can matter. But facial diversity is not enough. The politics of ethnic minority opportunity needs to be about more than visits to gurdwaras, diversity nights at the party conference fringes and unveiling statues of Mahatma Gandhi in Parliament Square. Jeremy Corbyn’s first speech as Labour leader did include one brief celebratory reference to Britain’s ethnic diversity – “as I travelled the country during the leadership campaign it was wonderful to see the diversity of all the people in our country” – and to Labour bringing in more black, Asian and ethnic minority members - but it did not include any substantial content on discrimination. Tim Farron acknowledged during his leadership campaign that the Liberal Democrats have struggled to get to the starting-line on race and diversity at all. The opposition parties too will no doubt now be challenged to match not just the Prime Minister’s rhetorical commitment to challenging inequalities but also to propose how it could be done in practice.

Non-white Britons expect substance, not just symbolism from all of the parties on race inequalites.  Survation’s large survey of ethnic minority voters for British Future showed the Conservatives winning more ethnic minority support than ever before – but just 29 per cent of non-white respondents were confident that the Conservatives are committed to treating people of every ethnic background equally, while 54 per cent said this of Labour. Respondents were twice as likely to say that the Conservatives needto do more to reach out – and the Prime Minister would seem to be committed to showing that he has got that message.  Moreover, there is evidence that ethnic inclusion could be important in broadening a party’s appeal to other younger, urban and more liberal white voters too – which is why it made sense for this issue to form part of a broader attempt by David Cameron to colonise the broad centre of British politics in his Manchester speech.

But the case for caution is that there has been limited policy attention to ethnic inequalities under the last two governments. Restaurateur Iqbal Wahhab decided to give up his role chairing an ethnic minority taskforce for successive governments, unconvinced there was a political commitment to do much more than convene a talking shop. Lib Dem equalities minister Lynne Featherstone did push the CV discrimination issue – but many Conservatives were sceptical. Cameron’s new commitment may face similar challenges from those whose instinct is to worry that more attention to discrimination or bias in the jobs market will mean more red tape for business.

Labour had a separate race inequalities manifesto in 2015, outside of its main election manifesto, while the Conservative manifesto did not contain significant commitments to racial inequality. The mid-campaign launch in Croydon of a series of race equality pledges showed an increasing awareness of the growing importance of ethnic minority votes - though the fact that they all involved aiming for increases of 20 per cent by 2020 gave them a slightly back-of-the-envelope feel. 

Prime Ministerial commitments have an important agenda-setting function. A generation ago the Stephen Lawrence case opened the eyes of middle England to racist violence and police failures, particularly through the Daily Mail’s persistent challenging of those injustices. A Conservative Prime Minister’s words could similarly make a big difference in the mainstreaming of the issue of inequalities of opportunity. What action should follow words? Between now and next year’s party conference season, that must will now be the test for this Conservative government – and for their political opponents too. 

Sunder Katwala is director of British Future and former general secretary of the Fabian Society.

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Matteo Renzi, the scrapper in the swamp

 Italy’s prime minister – “Europe’s last Blairite” – vowed to take on vested interests and smash open the economy. Can he still succeed?


In the summer of 2009, Daniele Caponi graduated from Sapienza University in Rome. His CV looked impressive. He had a degree in languages, and was fluent in four: Spanish, German, English and Italian. But the timing of his entry into the job market was terrible.

The global financial crash the previous year had badly affected Italy’s already weak economy. Prospects for graduates were so bleak that the best work Caponi could find was as a taxi driver. Six years later, the situation remains so precarious – youth unemployment is running above 40 per cent – that Caponi says he is “proud and honoured” to have a job at all.

Intelligent, confident and articulate, Caponi would appear to be precisely the type of person that Prime Minister Matteo Renzi has in mind as a beneficiary when he says he wants to jumpstart Italy’s economy by breaking it open to competition – with a war on entrenched interests and an influx of foreign capital leading the way to more jobs. Yet Caponi also embodies forces conspiring to defeat him. As a taxi driver, he belongs to one of Italy’s “closed-shop trades” (which also include chemists and lawyers) that hold back the economy, clinging to privileges and blocking outsiders from entry. For members of these trades, the benefits of the status quo are clear: Caponi makes enough money to wear smart clothes, eat at good restaurants and go trekking in south-east Asia or Latin America every year.

He is not willing Renzi, who has been called “Italy’s Tony Blair”, to fail, but thinks it is inevitable that he will. For the man at the helm of the centre-left Democratic Party, who a year and a half ago – at the age of just 39 – became his country’s youngest-ever prime minister has the task of changing not only Italy’s legislation, but its way of life. It is a struggle of allegiances versus globalisation; gerontocracy versus meritocracy; made-in-Italy quality versus stark economic efficiency – and the rule of law versus the tendency to bend it.

On the day I meet Caponi, he is illegally cramming extra passengers into his car because a transport strike has affected his takings. “You see, Italian politics mirrors Italian people,” he says. “Even me, you find me criticising politics. But look at what happened today. I pulled two rides into one – I did something I was not supposed to do.”


When Renzi took over as Italy’s leader in February 2014, many in the country felt it as a gale of fresh air after two decades of political tragicomedy and economic stagnation dominated by Silvio Berlusconi, whose main interest in power, his many disparagers say, was to protect his media empire and keep himself out of prison. That protracted era of zero growth, from 1994 to this year, left Renzi with enormous problems: more than one in every ten people out of work, chronic dips into recession, and a national debt that is 135 per cent of GDP, against 95 per cent for France, 90 per cent for Britain and 75 per cent for Germany. Add to that one of the rich world’s lowest fertility rates, at 1.39 births per woman – a demographic crisis that prompted the health minister to call this a “dying country”– and it may seem surprising that anybody would want the job of extracting Italy from the bureaucratic and parliamentary mess that Italians call il pantano, “the swamp”.

Renzi, however, seems to relish challenges that are the proper measure of his ambition, which was apparent from an early age. The son of a centre-right municipal councillor, he grew up in Rignano sull’Arno, a quiet Tuscan town outside Florence, where he became a keen Boy Scout. (His official website uses a quotation from Robert Baden-Powell,
the founder of the Scout movement, as its epigraph: “Leave this world a little better than you found it.”) The modest scope of this idealism provides clues to Renzi’s combination of pragmatism and engagement.

His passion for politics began in high school, and as a law student at the University of Florence he co-founded a committee to help Romano Prodi, a Democratic Party stalwart, become prime minister. Around that time, the 19-year-old Renzi appeared on the Italian version of Wheel of Fortune, raking in £20,000. It was a precocious sign of his penchant for games of risk.

His first break in politics came at the age of 24 when he became provincial secretary of the centrist People’s Party. From there, his rise was fast: president of the province of Florence at 29; mayor of Florence, a much bigger job, five years later. As mayor, Renzi shook up the city by cutting back sharply on the number of councillors, increasing the efficiency of public services and boosting welfare spending. As Italy began to take notice, the young mayor already had his eyes on a bigger stage: national politics.

In early 2013, he sensed the moment had arrived. In parliamentary elections, one in four Italians had voted for a comedian, Beppe Grillo, whose populist Five Star Movement proudly stood for little other than revulsion with the ruling elite. It was a turning point in Italian politics. After the Berlusconi era – and a brief technocratic government led by Mario Monti, who imposed austerity to pull the country back from a financial abyss – Italians were fed up with the political class and hungry for change.

Renzi, then still mayor of Florence, blitzed TV and social media with a vision of himself as the saviour of Italy, while his Democratic Party colleague Enrico Letta plodded along at the head of an unwieldy coalition government. Renzi promised to rottamare – “wreck” – the system (from this he acquired the nickname “The Scrapper”). He was bold and passionate and, like Berlusconi, he projected sunny optimism. Best of all, as mayor of Florence from 2009, he was an outsider, untainted by the machinations and scandals of national politics. Many Italians dared to hope again, as Renzi promised a bold reform programme that would generate jobs and revive the economy.

Late in 2013 he won the Democratic Party leadership, and quickly showed his ruthlessness by orchestrating what the Italian press called a “palace coup”, toppling Letta the following February. (A popular cartoon from the time shows Renzi in a relay race, handing his predecessor a stick of dynamite.) Days later, without ever having been even a member of parliament, Renzi was appointed prime minister.


While many Italians began to place their hopes in Renzi, there was also an undercurrent of suspicion about him that still prevails. One reason for this is his opportunism. On a stroll through Rome’s best food market, in the rough-and-tumble Testaccio district, I heard a story about him that went like this.

“A municipal councillor of Florence from the time that Renzi was mayor was once asked by a journalist: ‘Renzi – according to you, is he a capable man?’

“The councillor responded: ‘Yes, he is capable of anything.’”

Indeed, while Renzi purports to be a man of the left he often doesn’t sound like one. Besides smashing open protected sectors and taming the trade unions, he wants to overhaul the bloated and coddled public sector and attract overseas capital, which would inevitably entail foreign corporate takeovers. In the context of the rise of far-left parties in Europe, such as Syriza in Greece and Podemos in Spain, and given Jeremy Corbyn’s ascent to the Labour leadership in Britain, Renzi is increasingly looking like Europe’s last Blairite. (He got to know Blair when he was serving as mayor and Blair holidayed in Tuscany, and they became friends. Last year, Blair told the newspaper Corriere della Sera that Renzi was “the only way forward for Italy’s left”.) Indeed, on 21 September, Renzi appeared to be channelling Blair when he said that Corbyn’s victory was evidence that Labour “delights in losing”.

Yet there are signs that Renzi may not be winning his own battle. Another reason for Italians’ growing scepticism about him is that six months into his premiership the country slipped back into recession. This year, according to the European Commission, Italy is projected to eke out 0.6 per cent growth. By contrast, Spain and Portugal, which also have suffered severe debt and austerity crises, are forecast to grow at 3.1 and 1.6 per cent, respectively.

Meanwhile, unemployment remains stubbornly high despite the passage in the spring of Renzi’s signature “Jobs Act” – a package of laws that aims to generate employment by scaling back job protections and offering tax incentives to companies that hire long-term workers (as opposed to the surging number of people on precarious short-term contracts). And reform means nothing unless people believe it will work. Foreign investment has increased but Italian businesses are clinging to their capital. After rising early this year on the back of the imminent labour reforms, business confidence slumped again over the summer.

Critics say that whatever growth Italy does achieve this year may be due less to him than to another Italian: the European Central Bank chief, Mario Draghi, who has sought to invigorate the eurozone economies with a flood of easy credit. Some economists say that without a cheaper euro to boost its exports, Italy would still be in recession.

Meanwhile, in times of uncertainty, Italy’s business cliques hunker down to their old ways – hostile to hiring young people and preventing newcomers from encroaching on their turf. Renzi is fighting hard to tame these entrenched interests. The problem is that he may be running out of time. His approval ratings have nearly halved, down from more than 60 per cent after he became premier to around 32 per cent today.

“If nothing happens, especially in terms of kick-starting the economy, then people will start saying you’re just hot air,” said Vincenzo Scarpetta, an expert on Italy based at the Open Europe think tank.

One might imagine that students here would be among Renzi’s biggest fans, given that he is promoting policies that would help them find work. But on the Sapienza campus, Caponi the taxi driver’s alma mater, I cannot find a single student who believes that Renzi could improve their prospects by the time they enter the workforce. The overwhelming message: once I graduate, I’m out of here.

Beatrice Parsi di Landrone, studying chemistry, shakes her head at the thought of change being possible in Italy. The economy, she says, is built on patronage and favours that keep talent out of the best jobs. She wants to move to England and apply her skills in cosmetics, working for Max Factor.

“You can’t work here unless you have an inside track,” she explains. “For 20 years now, the government has been ruining Italy, even if we’re the best in the world in so many things. Overseas, it’s our brains that make a difference.”

The message on the sweatshirt worn by Mirko Mandarino, a medical student, speaks for his generation: “F**KIN’ PROBLEMS”. He is from Calabria, in the deep south, where people are poorer on average than in other parts of Italy. That makes it even harder for him to succeed in this country, where
many northerners hold southerners in contempt. Under Renzi, the gap between north and south has widened: national GDP fell 0.4 per cent last year but the south suffered a 1.3 per cent decline. “Renzi?” Mandarino says with a chuckle. “He’s an opportunist. A social climber. That’s how he’s gotten to where he is. My future? Outside of Italy. There are no other alternatives.”

Like Parsi di Landrone, Mandarino laments a culture of vested interests that blocks young people from achieving their dreams. “Nobody wants to give up anything,” he says. “They’re clans. The mentality is mafioso.”

Still, he feels sympathy for older Italians who cling to jobs and power. “In Italy, an old person can’t give way to the young, because at his age he wouldn’t find anything else. I have an uncle in Canada. He got fired at age 48. The next month he found a new job. That kind of thing doesn’t exist in Italy.”

Christian Abete, a classics student, sums things up: “We export wine and graduates.”


Franco Pavoncello, a political scientist and president of John Cabot University in Rome, meets me on the terrace of Vanni, a café in the genteel Prati district. Of the dozens of Romans I speak to, Pavoncello is the only one who believes that Renzi will succeed. “I am bullish about Italy,” he says.

The professor presents a heroic narrative of the prime minister, calling him a “revolutionary figure” – and only time will tell whether he is right. But he does make a basic point that it is hard to argue with: “He’s the only game in town. The right is dead. Completely melted. The left continues to be the usual communist left. It’s a disaster.”

It is the disarray among Renzi’s opponents not only on the right, where Berlusconi’s Forza Italia is fighting to regain relevance, but also in the crumbling old guard of the Democratic Party, that may allow him to press forward. “Nobody can stop this avalanche,” Pavoncello says.

That is an exaggeration, as the reform process is moving slowly. The big question is whether the Italian people will have the patience to endure a drawn-out and complicated overhaul – which promises pain to millions who benefit under the status quo – as the economy continues to stagnate. A stumble for Renzi’s party in regional elections in late May signalled threats hovering over his future. Voters are growing hostile to his pro-business ethos, alien to Italian tradition, and his own camp is beginning to bridle under a leadership style often described as dictatorial. Adding to his problems, the xenophobic, anti-euro Northern League’s vote share jumped across the nation, extraordinary for a party that long advocated a divorce between the affluent Italian north and the poorer south.

Pavoncello insists that Renzi has the political smarts and determination to be a transformative figure. But won’t he hit the brick wall of Italians’ cherished way of life?

“What way of life?” he fumes. “People staying at home? Fifty per cent youth unemployment? Taxi drivers who think they’re middle-class? In New York taxi drivers are not middle-class. Here taxi drivers make three, four, five thousand dollars a month. They feel they are shopkeepers. Taxi drivers are not middle-class. They are the bottom of the class! Can you remain middle-class when you have Uber? You can fight. You can try. But the world is going against you.”

Roberto Fabiani, the spokesman for Rome’s main cabbies’ association, who is a taxi driver, too, does indeed come across as middle-class. He wears Ray-Ban aviators, designer stubble and a crisp white shirt as he meets me at the Romana Tassisti headquarters on the outskirts of the city. Like Caponi, he is university-educated and asks why he shouldn’t have a pleasant family life after working a hard shift behind the wheel. He sees Renzi’s argument about reviving the economy by making it easier for firms to fire as being fundamentally at odds with Italy’s communitarian sensibilities.

“This is a philosophy that is molto liberal,” Fabiani says of the Jobs Act programme. “In Italy we have a vision that is very much to the left. Article 1 of our constitution says that Italy is a country founded on work. Translated, that means that every citizen should have the right to a dignified job, not extravagantly paid, but one that allows him to live in a dignified manner. ‘Dignified’ for me means not only to have an income that allows me to live, but also the security to know that I can live my life. If I’m hired, and in three months somebody says ‘you’re no longer needed’, that’s a problem.”

Italy’s commitment to social welfare, with its roots in age-old ideas about community and family, has provided cushions that allow people to live with dignity even in the midst of a sharp downturn. Yet millions of young Italians are living with precisely the indignity of uncertainty that Fabiani finds unacceptable. He is prepared to fight to protect his own. “If this happened,” he says of Renzi’s plan to break open closed sectors, “it would be the end. We’d take a hard position. Until the bitter end.”


There is no country in the world where cliques do not fight hard to keep their privileges. In Italy, however, the instinct is particularly strong; and this may present the greatest challenge of all to Matteo Renzi’s desire for reform. Italy’s historical experience as a jumble of city states and patches of empire has left a structure of allegiances and patronage that poses daunting obstacles to change.

Campanilismo, loyalty to the village bell tower, is central to Italian life. This signifies loyalty not only to your village, but to your trade association, your social circle, uncles and cousins, and, at the highest echelons, your political faction or business cabal.

“I’m not Italian, I’m a Roman,” says Caponi the taxi driver. “This is another thing that we are missing. We aren’t like the French or the Germans or the English, who are French and German and English.”

It’s a spirit captured in a song by the singer Luca Carboni called “Inno Nazionale” – “National Anthem”. You might expect a patriotic paean, but it goes like this:

“I’m too much of a Bologna man,

And you’re much too Neapolitan.

Him? Too much from Turin,

And you guys too stuck in Bari.

And if we’re all too proud,

They’re all too Venetian.”

The song continues in this vein, a hard rap with a techno beat. In its simplicity, this national anthem conveys how the Italian identity is precisely the lack of one. The paradox hits home in the song’s conclusion:

“We were once too fascist, and then

Too don’t-give-a-fuckists . . .

And then became too communist,

As well as too Christian-Democratic.

And even as time passes,

We’re still too ITALIAN!”

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide