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

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“Yes, it was entertaining”: A twisted tale of Twitter trolls and fake terror victims

Here’s what happened when I contacted people involved in the insidious new social media trend.

When I reach out to Sam to ask why she stole the image of a 19-year-old Minnesotan man to post on her Twitter account, the first thing she says is: “Am I getting paid?” The day after the Manchester Arena bombing, Sam took the profile picture of a man named Abdulfatah and posted it alongside a 137-character tweet. “Please retweet to help find Abdul,” she wrote. “He has chemo and we're very worried. We last heard from him before Ariana's concert”. She rounded it off with a hashtag. #PrayForManchester.

Abdulfatah was not a victim of the Manchester bombing and nor was he at Ariana’s concert, as he has been living in Cairo for the last year. Sam’s tweet was a lie that generated (at the time of writing) 1,280 retweets, mostly from people simply trying to help after a tragic terrorist attack. Over the last few years, trolls have responded to terrorism and other catastrophes by opportunistically pretending that their friends and family are among the victims of attacks. After the Manchester bombing, a handful of accounts continued this trend – for varied reasons.

“I had no aim,” is Sam’s simple response to being asked why she posted her tweet.

Sam explains that she wants me to pay her so she can “feed [her] team”, who she says are called the Halal Gang. After explaining that I cannot ethically pay for her interview, she concedes to speak when I say that I will link to her twitter account (@skrrtskrtt).

Born a male, 18-year-old Sam tells me she “prefers female pronouns” and immediately gives me her full name, town of residence, and the name of the English university where she studies civil engineering. When I ask for a form of ID to prove her identity, she claims she left her wallet on campus. When I ask her to simply email from her university email address, she says – over Twitter’s direct messaging service – “unfortunately i cannot provide u with evidence at this very moment”. For this reason, I will refer to her by her first name only. Her quotes are here copied verbatim from the messages she sent me online.

“I chose that mans image because he seemed like an easy target. I was quite intrigued by the huge number of retweets because i got the attention i never got at home. And yes i did him a favour by getting him clout. He's ugly so i guess I got him some girls. People who also made fake missing people are G's and i salute them.”

Why did you do it, I ask? The reply is one word. “Entertainment”.

***

Abdulfatah was casually scrolling through Twitter when he realised his profile picture had been stolen. “Honestly, it was horrific,” he tells me – again over Twitter’s messaging service – “I hope nobody has to go through what I did. Just imagine scrolling through Twitter only to find that some random person used your photo to claim you’ve gone missing in a bombing.”

When Abdulfatah decided to confront his troll on Twitter, his tweet got 63,000 retweets and 98,000 likes. “i'm from Cairo and i don't have Chemo... who tf are you? how do you know me???” he wrote – and his response went on to be featured in articles by The Sun, Yahoo!, Mashable, and AOL.com. The tweet is part of a larger story that has spread over the last few days – of “sick Twitters trolls” targeting innocent people by pretending they are missing. 

My Twitter chat with Abdulfatah spans a few hours, and he hammers home how “vile and disgusting” he finds the act of spreading fake victims on social media. “I hope people come to their senses soon and stop this type of behaviour. It’s not funny at all.” Half an hour after we exchange goodbyes, he messages me to explain that there is something else he wants to say.

“I totally forgot to mention this,” he begins. “I couldn't have done this without this groupchat I'm in called ‘Halal Gang’.”

***

In their 2017 book, The Ambivalent Internet: Mischief, Oddity, and Antagonism Online, authors Whitney Phillips and Ryan M Milner dedicate an entire chapter to “Identity Play” on the internet.

“Online and off, identity is a series of masks,” they write. “Whether online deceptions are harmless or targeted or somewhere in between, determining why anonymous or pseudonymous actors do the things they do can be very difficult.”

So why do people use the internet to deceive? The authors’ argue it is simple: “because they’re able to: because the contours of the space allow it.”

Creating a person online is incredibly simple. Believing that someone online is who they say they are is even easier. Many newspapers now create entire stories based around a single tweet – taking what is said and who said it as fact, and covering their backs with a few “appears to have” and “allegedly”s. By taking viral tweets at face value and crafting stories around them, media companies consistently break one of the internet’s oldest rules. Do not feed the trolls. 

***

Abdulfatah sent me a copy of his provisional driver’s license to prove to me that he is who he claims. After his announcement about the Halal Gang, I became suspicious that both the victim, Abdulfatah, and the perpetrator, Sam, were in fact working together to go viral. Why else would they both independently reference the same group? Instead of a random troll picking on a random person, was this the case of two friends working together to achieve social media fame?

“I have never met this person prior to this incident,” said Abdulfatah over Twitter, promising me that I could call him for clarification (at the time of writing, he has not answered his phone). “I feel offended that someone like that would ever try to claim to be a part of our group.” Abdulfatah was added to the Halal Gang (which is a Twitter group chat) in January, and says to me: “I promise you this isn't a troll.” It is worth noting that a Twitter search shows that Abdulfatah and Sam have never previously interacted publicly on the site.

From 19:43 to 20:30 on Wednesday night, I was added to the Halal Gang chat. The group describes themselves as a place for young people to “find peace and tranquillity” through the Islamic faith. The 12 members told me Sam was a “lost person” who used to be in the chat but was kicked out for inappropriate behaviour. Abdulfatah was her replacement (he says he didn’t know this) and thus Sam targeted him in her tweet after the Manchester attack. One member of the Halal Gang said that Sam was his ex and went on to send a sexually-suggestive picture of her in the chat.

“It wasn’t our intention to go viral, just to help out Abdul but I guess it was kind of cool to go viral lol,” said one member.

Rather than trolls targeting random people, this incident therefore seemed to be a case of personal rivalry and revenge. This goes some way to explaining the psychology behind, and the motivations of, people who claim to have missing friends and family after terrorist attacks. According to the Halal Gang, Sam was simply targeting her replacement, Abdulfatah, because she likes trolling.

But then, at midnight, I received another Twitter message, from a person wishing to remain strictly anonymous.

“This is a MAJOR conspiracy,” they wrote.

***

Most of the time people make up fake victims on social media, the motives are cut and dried.

Andrea Noel is a Mexican journalist whose picture was circulated after the Manchester bombing, in a collage purporting to show 20 missing people. She has been trolled extensively in the past after speaking on social media about her sexual assault, and believes some of the same “anti-feminist” trolls may have been at work.

“I started getting Facebook messages and Twitter messages from various people that I know… getting in touch with me to make sure I wasn’t in Manchester,” she tells me over the phone.

The collage Andrea appears in also includes photographs of YouTubers, and was featured on the Daily Mail’s Twitter and Fox News as a legitimate collage of missing people. According to Buzzfeed, 4Chan trolls may have been behind the picture, choosing people they disliked as their victims.

Yet when a handful of people create a fake image, it is thousands more who are responsible for its impact. In 2013, researchers found that 86 per cent of tweets spreading fake images after Hurricane Sandy were retweets, not original tweets.

Caroline Leo is a 16-year-old from Florida who gained over 15,000 retweets on her tweet of the collage. “I felt good about it because I was helping find so many people and my phone was literally freezing and I had to turn it off for a little while,” she tells me of the initial reaction to the tweet. Yet when multiple people contacted her to say it was fake, she decided not to delete it as some of those featured in the picture were actual missing people. “I was so happy to make their faces familiar to over one million people and I wanted to keep it up because I like Ariana so much and I wanted to help other people who love her just as much as I do,” she says.

Andrea understands Caroline’s motivations, but does think people need to be more careful about what they spread online. “If you realise that half of these people are YouTubers then just delete it, you know. Make a new one,” she says. “I understand that she’s trying to be sweet but after a couple of hours everyone knew this was fake… so, really just make a new one.”

Yet a big part of the reason people create fake images – or accidentally spread them believing them to be real and then don't want to delete them – is for the likes, retweets, and comments. The buzz that we feel from social media attention doesn’t go away just because of a tragedy, and Dr Linda Kaye, an expert in the psychological impacts of technology, explains social media interactions facilitate our “need satisfaction”.

“Humans are social animals and have a basic need for social belonging,” she says. “Perhaps these individuals who [use social media] in this way to gain ‘social approval’ are not having their social needs fulfilled by their existing relationships with friends and family. Adolescents may be particularly prone to this sort of behaviour, as this is a period of great change, in which peer relationships often become more fundamental to them than parental ones.”

John, a YouTuber who was also featured in the collage and in a separate tweet claiming he was missing, urges people to think before they act on social media. “If there is one thing I would like to say about this all... I understand that during events such as this, information can develop and spread very rapidly,” he tells me, “but it doesn't hurt to try to confirm information through a second source.

“For instance, say that a story on Yahoo is claiming that I was a victim - is the BBC reporting the same story? During a crisis situation, I feel that disseminating the correct information to the general public is absolutely crucial and potentially lifesaving.”

***

The Twitter user who contacted me about the Halal Gang “conspiracy” refused to speak when I said I would not transfer $10 to his PayPal account. “$10 is a steal for the info I have not gonna lie,” they said. When I refused, they sent me this offensive meme from the adult cartoon The Boondocks.

At 3:05am, another anonymous Twitter user messaged me. They claimed that the man in the Halal Gang who claimed to be Sam’s ex and had sent me a sexual picture of her, was in fact trying to humiliate his ex. “It’s embarrassing don’t use that picture in any articles,” they wrote.

As it stands, there is potential that the Halal Gang were working together to get multiple viral tweets. There is also potential that the man who asked me for $10 was also trolling in turn by trying to tell me the Halal Gang were acting like this when they are, in fact, innocent. Yet if not Abdulfatah, some members of the group seem to be corresponding with Sam, as she changed her story after I spoke with them. “I believe they kicked me way before the incident and I’ll be completely honest with you, I wanted to get them back, yes,” she says, despite moments earlier saying that they kicked her out after her Manchester attack tweet.

It is impossible to work out Sam’s true motivations for creating a fake victim, as she is hiding behind her online persona and simply answered “nope” when I asked if there was a number I could call her on. Her comments – that she lives in a foster home and is emotionally abused by her family, that she is “not dumb enough to go to an Ariana Grande concert”, and that people critical of her actions “need to move on init” – read as though she is simply trolling me, a journalist, in turn.

There is no real way for me to know who is who they say they are, and whether the Halal Gang are telling the truth that they didn't collaborate with Sam (they refuse to send over screenshots of her being kicked out from the groupchat, as the chat has a “no SS” rule). As Phillips and Milner note, even experts have great difficulty identifying people online. Either way, there is clearly more of connection between Sam and Abdulfatah than the two initial tweets made it seem. 

The reason why this matters is because this story isn’t really about Sam, nor is it about Abdulfatah. If two friends (or people involved in the same group) seek to get revenge or go viral by attacking each other on social media, it is not their actions that have wide-reaching ramifications. It is the actions of the hundreds of thousands of people who choose to Retweet uncorroborated claims, and the journalists who take tweets as gospel. Naturally, in the painful hours proceeding a terror attack, we all make mistakes about what we share on social media. But we can fix them and we can avoid making the mistakes again.

Before claiming she wanted revenge, Sam told me she was acting on a desire to be entertained. I check with her, after this revelation, whether she succeeded in this aim. “So did you find it entertaining?” I ask.

“Yes,” she replies. “It was entertaining.” 

Amelia Tait is a technology and digital culture writer at the New Statesman.

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