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

Andre Carrilho
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Putin's revenge

Twenty-five years after the demise of the Soviet Union, Russia is consumed by an insatiable desire for recognition as the equal of the USA.

President Trump meets President Putin. It’s the most eagerly awaited encounter in world politics. Will The Donald thaw the New Cold War? Or will he be trumped by “Vlad” – selling out the West, not to mention Ukraine and Syria?

The Donald v Vlad face-off comes at a sensitive moment for the Kremlin, 25 years after the demise of the USSR on Christmas Day 1991 and just before the centenary of the Russian Revolution. Were the heady hopes at the end of the Cold War about a new world order mere illusions? Was Mikhail Gorbachev an aberration? Or is Putin rowing against the tide of post-Cold War history? How did we end up in the mess we’re in today?

These are some of the questions that should be explored in Trump’s briefing book. He needs to get to grips with not only Putin, but also Russia.

 

****

Today President George H W Bush’s slogan “new world order” sounds utopian; even more so the pundit Francis Fukuyama’s catchphrase “the end of history”. But we need to remember just how remarkable that moment in world affairs was. The big issues of the Cold War had been negotiated peacefully between international leaders. First, the reduction of superpower nuclear arsenals, agreed in the Washington treaty of 1987: this defused Cold War tensions and the fears of a possible third world war. Then the 1989 revolutions across eastern Europe, which had to be managed especially when national boundaries were at stake. Here the German case was acutely sensitive because the Iron Curtain had split the nation into two rival states. By the time Germany unified in October 1990, the map of Europe had been fundamentally redrawn.

All this was accomplished in a spirit of co-operation – very different from other big shifts in European history such as 1815, 1871, 1918 and 1945, when great change had come about through great wars. Amid such excitement, it wasn’t surprising that people spoke of a new dawn. This was exemplified by the unprecedented working partnership between the US and the USSR during the First Gulf War in the winter of 1990-91 to reverse Saddam Hussein’s invasion of Kuwait. Bush and Gorbachev agreed that they shared a set of “democratic” and “universal” values, rooted in international law and in co-operation within the United Nations.

The new order of course assumed the continued existence of the Soviet Union. Despite the USSR’s growing economic and political problems, no one anticipated its free fall in the second half of 1991. First came the August coup, an attempt by a group of anti-Gorbachev communist hardliners to take control of the Union. Their failed putsch fatally undermined Gorbachev’s authority as Soviet leader and built up Boris Yeltsin as the democratic president of a Russian republic that was now bankrolling the USSR. Then followed the independence declarations of the Baltic states – Estonia, Latvia and Lithuania – and crucially Ukraine, which precipitated the complete unravelling of the Union. And so, on Christmas Day 1991, Gorbachev became history, and with him the whole Soviet era. It seemed like the final curtain on a drama that had opened in Petrograd in 1917. A grandiose project of forced modernisation and empire-building pursued at huge human and economic cost had imploded. The satellites in eastern Europe had gone their own way and so had the rimlands of historic Russia, from central Asia through Ukraine to the Baltic Sea. What remained was a rump state, the Russian Federation.

Despite all the rhetoric about a new world order, no new structures were created for Europe itself. Instead, over the next 15 years, the old Western institutions from the Cold War (the Atlantic Alliance and the European Union) were enlarged to embrace eastern Europe. By 2004, with the inclusion of Lithuania, Latvia and Estonia, Nato and the EU reached the borders of Russia, less than 100 miles from St Petersburg.

Initially the West’s eastward expansion wasn’t a big problem. The Kremlin did not feel threatened by the EU because that was seen as a political-economic project. Nato had been repackaged in 1990 as a more political organisation. Indeed, four years later, Russia joined the alliance’s “Partnership for Peace”. And in 1997, when Nato announced its first enlargement to include Poland, Hungary and the Czech Republic, Russia was invited to join the alliance’s new Permanent Joint Council. That same year, Russia became a member of the G8. In short, during the 1990s the consensual atmosphere of 1989-91 seemed to be maintained.

But Yeltsin failed to create a new Russia from the ruins of Soviet communism. Between 1989 and 1992, as the command economy disintegrated, inflation soared and national income fell by one-third – a crash as spectacular as those America and Germany had suffered in the early 1930s. The largest and fastest privatisation that the world had seen created a cohort of super-rich oligarchs. Crime and corruption became rampant, while millions of Russians were condemned to penury. “Everything was in a terrible, unbelievable mess,” Yeltsin’s adviser Yegor Gaidar later admitted. “It was like travelling in a jet and you go into the cockpit and you discover that there’s no one at the controls.”

Meanwhile, the proliferation of political parties resulted in chaos. Yeltsin managed to hang on, thanks to increasingly autocratic rule. In October 1993, after several months of wrangling over the balance of power between executive and legislature, he used army tanks to shell the parliament building in Moscow and imposed a new constitution built around a strong presidency. This and a succession of contrived referendums kept him in power for the rest of the decade. Finally, on New Year’s Eve 1999, an ill and exhausted Yeltsin orchestrated his own departure. Declaring that he would hand over to “a new generation” that “can do more and do it better” at the start of a new millennium, he said that he was conveying his powers to an acting president.

His designated successor was an apparently unassuming little man called Vladimir Vladimirovich Putin.

***

Who was Putin? Where had he come from? Most immediately he had been prime minister since August 1999 – the sixth man to serve as Yeltsin’s premier. Yet he had made his career as a discreet outsider, often underestimated by those around him. In fact, he was a long-serving KGB officer: he joined in 1975, at the age of 23, entering a culture that would define his persona and outlook.

Crucially, the Gorbachev era was almost a closed book to Putin: he never experienced the intoxicating passions of reform politics within the USSR – perestroika, glasnost and demokratizatsiya – because he spent 1985 to 1990 as a case officer in Dresden in East Germany. To him, Gorbachev’s reforms signified destruction: an empire discarded and a country ruined. During the 1990s, as Putin rose through the ranks of the city administration of his home town St Petersburg and was then moved to Moscow, he witnessed the disastrous effects of chaotic privatisation, the erosion of Russia as a great power and the collapse of the national economy.

Out of the traumatic 1990s came Putin’s passion for a strong state. He spelled this out in a 5,000-word document entitled Russia on the Threshold of the New Millennium, published on the Soviet government website on 29 December 1999. In it, he stated bluntly that the Bolshevik experiment had totally failed. “Communism and the power of the Soviets did not make Russia into a prosperous country,” he wrote. It had been “a road to a blind alley which is far away from the mainstream of civilisation”.

Putin welcomed recent “positive changes”, especially the Russian people’s embrace of “supranational universal values” such as freedom of expression and travel, as well as “fundamental human rights and political liberties”. But he also highlighted traditional “Russian values”, especially patriotism – pride in “a nation capable of great achievements” – and “social solidarity”, which, he asserted, had “always prevailed over individualism”. He did not believe that Russia would become “a second edition of, say, the US or Britain, in which liberal values have deep historic traditions”. What he presented as “the new Russian idea” would be “an alloy or organic unification of universal general values with traditional Russian values which had stood the test of the times, including the test of the turbulent 20th century”.

Woven into Putin’s manifesto was a distinctive conception of his place in politics. He envisaged himself as a “statesman” in the Russian sense – meaning a builder and servant of the state, in a country where the state has always been seen as superior to society and the individual. He considered the true leader to be above mere electoral politics, occupying a more permanent position as the guardian of state interests. He looked back admiringly to the autocratic reformers of the late tsarist era – men such as Nicholas II’s prime minister Pyotr Stolypin – and had no time for Gorbachev and Yeltsin, who had both been submerged by democracy and had undermined the state.

Above all, he believed that Russia had to resume its rightful historic place as a “great power”. He considered the vicissitudes of the 1990s an aberration that had to be overcome. Adapting one of Stolypin’s celebrated phrases, he liked to say that the people did not need “great upheavals”. They needed “a great Russia” – with a “strong state” as the “guarantor of order” and the “main driving force” of any durable change.

The “acting president” was elected in his own right in March 2000 and won re-election in 2004 for another four years. During the 2000s Putin concentrated on kick-starting the economy, bringing the oligarchs of the Yeltsin era under firm control and building monetary reserves, aided by rising prices for Russia’s oil and gas. This enabled the country to survive the financial crisis of 2008 and stood in marked contrast to a decade earlier, when the Asian crash of 1997-98 led Russia to default on its foreign debt and devalue the rouble. In rebuilding prosperity and pride, Putin earned the gratitude of millions of Russians, scarred by the poverty and humiliations of the Yeltsin era.

Showing himself off as a military strongman, he targeted Chechnya, which had claimed independence in 1991. Yeltsin had failed to tame the anarchic north Caucasus republic in the Chechen War of 1994-96; Putin imposed direct Russian rule brutally in the first year of his presidency, reducing the Chechen capital, Grozny, to rubble in 2000.

Increasingly secure at home, he began to reassert Russian power in the international arena. Initially, this did not involve confrontation with the West. He co-operated with the US in the post-9/11 “war on terror”, though he didn’t support the toppling of Saddam Hussein in Iraq, abstaining from the Bush-Blair mission of forceful regime change. In 2003-2004 he protested but ultimately accepted the Orange Revolution in Ukraine and the accession of the Baltic states into Nato and the EU – even if the Kremlin regarded them as part of Russia’s “near abroad”. In 2007, however, Washington’s plans for a Nato missile defence “shield” in eastern Europe (deploying interceptor missiles and radar tracking systems), officially justified as protection against “rogue states” such as Iran, prompted Russia to withdraw from the Conventional Forces in Europe (CFE) treaty. This was part of the fabric of co-operation woven in 1990-91. Nevertheless, foreign policy wasn’t Putin’s priority in his first stint as president.

***


In 2008, after two terms in office, Putin was obliged under the constitution to step down from the presidency. Under a notorious job swap, however, he was elected as prime minister to the new (nominal) president, Dmitry Medvedev, who within months pushed through a law extending the term for future presidents from four to six years. Then, in September 2011, Putin announced that he would run for the presidency again.

For millions of Russians, this second job swap seemed a cynical power play. Putin won the election of March 2012, naturally – the Kremlin machine ensured that. Yet he gained only 64 per cent of the vote despite having no serious opposition. Rural areas run by local clans tied to him were easily manipulated, but in many big cities, including Moscow, he polled less than 50 per cent.

The 2012 election campaign was the moment when Putin’s conception of the statesman-strongman collided with the democratic expectations of Russia’s perestroika generation, now coming of age. It marked a crunch point in the history of post-Soviet Russia – a clash between different models of the country and its future. Ranged against Putin were those whom the opposition leader Vladimir Ryzhkov, of the liberal People’s Freedom Party, called the new “mass middle class”, formed over the previous two decades. Taking to the streets in protest against the Putin-Medvedev “tandem” were managers, engineers, journalists, lawyers, IT specialists and the like. For these people, Putin had passed his sell-by date. After his announcement that he wanted another term in the Kremlin, images circulated on the internet of an aged Putin dissolving into the geriatric visage of Leonid Brezhnev – whose near-two decades in office symbolised the “era of stagnation” that Mikhail Gorbachev had swept aside.

Social media was transforming urban Russia. Between 2008 and 2012 internet penetration among the over-16s doubled from 25 per cent to 50 per cent. Russia had its own version of Facebook: VKontakte. The Kremlin’s alarm at the upsurge of virtual opposition and street protest was intensified by the Arab spring in 2011. Much international comment highlighted the role of a young “Facebook Generation” in countries such as Egypt and Tunisia, fostering a “digital democracy” that toppled long-standing autocrats – supposedly financed and supported by Washington. Putin liked to claim that the protests in Russia had also been stirred up and/or funded by the then US secretary of state, Hillary Clinton. Little wonder that one of his priority projects after winning the 2012 election was refining a sophisticated system of internet surveillance known as Sorm, run from part of the old secret-police headquarters of Lenin’s Cheka and Stalin’s KGB in Lubyanka Square, Moscow. With that in mind, the oppositionist Ryzhkov declared that even though Russian society was now very mature and “European”, the regime was “still Chekist-Soviet”. This, he said, was the “main contradiction” in contemporary Russia.

The domestic protests and the Arab spring threatened Putin’s determination to rebuild Russia’s position in the world and consolidate its sphere of influence in the “near abroad”. He focused on a “Eurasian Union”, an idea first touted in the 1990s by some central Asian states, notably Kazakhstan, but picked up in earnest by Putin after 2011. Yet, for him, the crux of a viable Eurasian bloc lay in the west, not the east: in Ukraine, with 45 million people, a strong industrial base, and its critical geopolitical position. Putin didn’t just see Ukraine as Russia’s historic “borderland”. Celebrating Kievan Rus – the original east Slavic state of the 9th to 13th centuries – he insisted that Kyiv was “the mother of Russian cities”. Keeping Ukraine within Moscow’s sphere of influence was a red-line issue for the Kremlin.

That line was crossed in February 2014. For a decade Ukraine – an ethnically fractured country (78 per cent Ukrainian; 17 per cent Russian) – had hovered between Russia and the West, depending on the latest change of leaders in this corruption-riddled state. In November 2013 the Russia-leaning Ukrainian president, Viktor Yanukovych, stalled Ukraine’s long-discussed “association” agreement with the European Union. Thousands of pro-EU protesters surged into Maidan Nezalezhnosti (Independence Square) in Kyiv.

In the face of repressive police measures, the mass demonstrations continued for three months and spread across the country, including the Crimea, where Russians were the majority, bringing Ukraine to the brink of civil war. Yanukovych fled Kyiv for Russia on 21 February 2014. The next day Putin began a campaign of retaliation, culminating in the forcible annexation of the Crimea, rubber-stamped by a referendum in which (officially) 96.77 per cent of the Crimean electorate voted to join Russia.

For the West, Putin had finally overstepped the mark, because the Crimea had been part of Ukraine since 1954. Putin claimed that the Russian inhabitants of the region were invoking the right to “self-determination”, just like the Germans during unification in 1990, or the Albanians in Kosovo in 1999 when seceding from Yugoslavia. But in the West, Russia’s military intervention in an independent state was condemned as a flagrant breach of international law. The US and the EU imposed political and economic sanctions against Russia, precipitating a financial crisis and a collapse of the stock market. By the spring of 2016 the rouble had fallen 50 per cent in two years. This was coupled with a halving of the price of oil, on which Russia’s economy depends. The country slid into recession, reversing the economic success of the president’s first stint in power.

Yet the slump does not appear to have damaged his domestic popularity severely. The state-controlled media whipped up patriotic fervour: Russia v the West. And Putin – the “History Man”, as Fiona Hill and Clifford Gaddy dub him in their book Mr Putin – has deliberately constructed his own version of the recent past to justify his actions. Playing on the trauma and humiliation of the Soviet break-up, he appealed to national pride, touching the emotions of millions of Russians.

Putin has presented his intervention in the Crimea (and subsequently eastern Ukraine) as an assertion of Russia’s right as “an independent, active participant in international affairs”. In a major policy statement on 18 March 2014, he harked back to the era of “bipolarity” as a source of “stability”, arguing that America’s arrogant attempts after 1991 to create a “unipolar” world, exacerbated by Nato’s progressive enlargement, had pushed his country into a corner.

It was not just that Kyiv’s turn towards the EU threatened to detach Ukraine from Russia and its “Eurasian” sphere; talk about actually joining Nato raised the spectre of the Western military alliance being “right in our backyard” and on “our historic territory”. Putin conjured up the prospect of Nato warships entering the Black Sea and docking in Sevastopol, that “city of Russia’s military glory” – a “real threat to the whole of southern Russia”. Enough was enough, he declared: “If you compress the spring all the way to its limit, it will snap back hard.”

***

 

To Western eyes the story looked very different. The enlargement of the EU and Nato was driven less from Brussels and Washington than by the desire of eastern European countries to escape from the clutches of “the Bear”. Putin had tolerated the loss from Russia’s “near abroad” of Warsaw Pact states from Poland to Bulgaria, but the Baltic states (former Russian imperial territory) were a very different matter. Estonia, Latvia and Lithuania had won their independence from the tsarist empire after the First World War, only to be absorbed into the Soviet Union after the Second World War. For the Balts, 1991 therefore represented the rebirth of freedom and statehood; they saw membership of the institutional West – the European Union and Nato – as an essential guarantee of national security.

Nato has become a “four-letter word” for Russia and one can argue that, ideally, the “new world order” should have been based on new institutions. But in 1989-90 the persistence of Nato was essential to allay European fears, not least in the USSR, about a unified Germany at the heart of the continent. There was no discussion at this moment about Nato’s further extension beyond Germany, let alone a firm pledge that it would not. Contrary to Putin’s assertions, an expansionary blueprint did not exist.

Whatever the arguments about ­history, however, relations between Russia and the West are deadlocked. So are we in a “New Cold War”, as touted by the Russian government since Dmitry Medvedev’s speech to the Munich Security Conference in February 2016? In fundamental ways: no. Russia and America are not engaged in an all-encompassing global power struggle, military, political, economic, cultural, ideological. The new Russia is essentially capitalist and fully integrated into the world economy, with a multitude of trade and financial links with the West.

Despite bellicose rhetoric at the top, Russian and US diplomats talk and work together behind the scenes, not least in the recent selection of a new UN secretary general, António Guterres. Above all, the language of “unipolarity” and “bipolarity” no longer reflects the reality of international affairs: a “multipolarity” of world powers, a profusion of “non-state actors” capable of terrorism and warfare, and potent transnational forces, notably mass migration – all of which are deeply destabilising. This is very different from the Cold War.

Amid this new world disorder, today’s Russian-American stand-off revolves around differing approaches to international relations. Putin’s policy is rooted in traditions of great-power politics: the control of territory and the assertion of state sovereignty, especially within what Russia regards as its historic sphere. By contrast, the United States, albeit erratically, has promoted humanitarian interventionism, pursued regime change and indulged in the rhetoric of global democracy, especially since the 9/11 attacks.

So, why the divergence? One can say that the West has failed to pay consistent attention to Russia’s sensitivities about its post-Soviet decline. Nor has it given due recognition to the reality of Russia as a great Eurasian power. On the other side, Putin has increasingly pulled his country out of the network of co-operative political forums and agreements forged with the West in the aftermath of the Cold War. He has also challenged the independence of small states on Russia’s periphery. Today, abandoning any vestiges of entente with America, Putin seems to believe that Russia can regain its great-power status only by distancing itself from the West and by overtly challenging the US in hot spots around the world. This is very different from the world imagined by Bush and Gorbachev and pursued to some degree by Bill Clinton and Boris Yeltsin. Putin is undoing what he sees as a “democratic” peace, made to Russia’s geopolitical disadvantage in 1989-91.

Take Syria: Putin knew that Barack Obama had no stomach for wholesale military intervention on such a fragmented battleground, where few direct US interests are at stake. As an appalling human tragedy has unfolded, especially in Aleppo, Putin has exploited his free hand by despatching Russia’s sole (Brezhnev-era) aircraft carrier, the Admiral Kuznetsov, to Syrian waters and building a Russian airbase near the key port of Latakia. US passivity has allowed him to establish a novel, if tenuous, military presence in the eastern Mediterranean and thereby to strengthen his position in the Middle East as a whole.

On the Baltics, Washington drew a firm line last summer: Nato’s Warsaw summit in July 2016 committed Alliance troops and aircraft to each of these states by way of a token but unequivocal act of deterrence. Putin responded by further beefing up the Russian short-range nuclear arsenal in Kaliningrad. This tit-for-tat in the Baltic Sea area is likely to spiral.

In the standoff over Ukraine – where Russia has done nothing to end the fighting – the Americans have been content to let Angela Merkel take the lead in trying to broker a peace deal. While playing tough in the Baltic, she has kept open channels of communication with Putin over Ukraine. Significantly, the president has not spurned her offer to talk. The two can converse without interpreters, in German and in Russian; Merkel seems to be one of the few foreign leaders for whom Putin entertains a certain respect, if only because she recognises Russia’s need to be taken seriously.

Nevertheless, all these various power plays reflect essentially conventional ways by which Putin seeks to unpick 1989-91. More significant is the Kremlin’s increasingly aggressive avant-garde methods of combating the Western “bloc” of liberal democracies – by manipulating transnational financial and commercial ties, spinning the global media and steering policy discourse in target states. Russia can leverage its relative weakness if it cleverly exploits its post-Cold War immersion within the global capitalist system and Western popular culture as a kind of “Trojan Horse” .This is what Putin’s personal adviser Vladislav Surkov has termed “non-linear war”.

It is no secret that, in this vein, Moscow used cyber-power in an attempt to mould American opinion during the 2016 presidential election campaign. For all the media hype about hacked computer systems and leaked emails, the Kremlin’s information warfare is not that innovative. After all, the underlying concepts and most of the techniques were developed by the USSR (and equally by the United States) to interfere in other countries’ internal affairs during the Cold War. Let’s not forget that the young Mr Putin was schooled in KGB Dresden.

So, although we may not be back in the era of bipolarity, some of the new ways are also old ways. Under Putin, Russia seems to have resumed its historic quest for position against the West and its insatiable desire for recognition as America’s equal. Will it ever be possible to forge a stable “alloy” blending “universal” and “Russian” values? That would truly be a Russian revolution. l

Kristina Spohr (London School of Economics) and David Reynolds (Cambridge) are the co-editors of “Transcending the Cold War” (Oxford University Press)

This article first appeared in the 12 January 2017 issue of the New Statesman, Putin's revenge