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

DAVID YOUNG FOR NEW STATESMAN
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An English tragedy: how Boris, Dave and Brexit were formed by Eton college

It's said that the Battle of Waterloo was won on the playing fields of Eton. Was Britain's relationship with Europe wrecked there?

The brief window in which it was cool to be an Etonian has closed. That period was marked not just by Etonian success and visibility – in politics, on the stage, in the media, even on the balcony of Buckingham Palace – but also by a new-found unabashedness in expressing pride at having attended King Henry VI’s Thames-side ­college, founded for 70 poor scholars in 1440. David Cameron summed it up when he said he was “not embarrassed” that he had gone to “a fantastic school . . . because I had a great education and I know what a great education means”.

All this was quite strange and ­perturbing to me, as an alumnus of an older era, the 1970s, when being an Etonian seemed decidedly uncool. When asked which school we had attended, my contemporaries and I muttered that we had been to a comprehensive near Slough. It was perturbing because I always had my doubts about Etonian confidence, or arrogance.

The closing of this window can be dated precisely to the early hours of the morning of 24 June. At that moment, it became clear that David Cameron had taken an insouciant, arrogant and disastrous gamble, in the interests of maintaining Conservative Party unity, by calling an unnecessary referendum on Britain’s membership of the European Union that he believed he was sure to
win. The window closed even more tightly a week later, when Boris Johnson, having helped to lead the Leave campaign, suddenly declared that he was no longer standing for the Tory leadership – the glittering prize for which he had apparently abandoned his principles and betrayed his friends.

If the Battle of Waterloo had been won on the playing fields of Eton, it now appeared that Britain’s relationship with Europe, and even its continued integrity as a nation, had been wrecked there. It was no surprise that there should be a turning against Eton, with gleeful opinion pieces from the left-leaning commentariat mocking everything from Tom Hiddleston’s backside to the commitment to public service of one of our ablest MPs, Jesse Norman.

I find this reaction as shallow as the ­excessive pride that preceded it. Maybe that is not surprising, as I both love and feel dissatisfied, even disappointed, by the school where I spent five years of my boyhood and then two and a half years teaching English literature as a young adult. The feeling of let-down is more than personal. Eton has something to answer for, at a national level. A few years ago, I wrote these words: “I’ve often wondered whether this famous Eton confidence could be skin-deep: certainly people such as Boris Johnson and David Cameron do not lack chutzpah, but the confidence to believe you deserve the high position does not necessarily mean you possess the other talents – humility, for instance, and the ability to listen to others – needed to honour it.” Now the 11 Eton pupils who managed to secure an interview with Vladimir Putin have trumped even Cameron and Johnson
in the chutzpah department, but not necessarily added lustre to their alma mater.

I had a chance to reassess the ambivalence I feel about Eton, and to reflect on the role that this ancient and eccentric place has played in our national crisis, when I attended a reunion at my old school just three days after the dark night of 23 June.

This was not a reunion of old boys but a celebration of the 50th anniversary of the Eton English department, an institution for which I feel affection and profound gratitude. As a boy, I was inspired not only to read voraciously and widely – the novels of Thomas Hardy, Henry James, Dickens, William Faulkner; the poetry of Coleridge, Wordsworth, Emily Dickinson, T S Eliot, Charles Causley, Louis MacNeice, Henry Vaughan; Shakespeare at his most intense – but also to analyse, think and feel simultaneously. Alan Paton’s Cry, the Beloved Country and Dickens’s Hard Times opened my eyes to conditions as far from my comfortable Home Counties upbringing as you could imagine, to the realities of racial segregation and working-class ­deprivation; opened my heart, too, I hope.
I was being challenged to reflect on my privilege, even be discomfited by it – not just blindly perpetuate it.

For those reasons, I was honoured to be invited back to teach, initially for just a year, in the department that had given me so much mind-and-soul nourishment. I was not the most confident or organised of teachers, but pupils I bumped into years later said they had enjoyed and gained something from classes in which discipline was not always the tightest. A debate I set up to discuss the miners’ strike turned into a riot. Above all, I enjoyed directing motivated and talented boys in productions of Journey’s End and Death of a Salesman which moved audiences.

***

Inspiration, warmth and a streak of anarchy are, perhaps, not the qualities you associate with Eton. But they were present in the English department, which started as a sort of anti-establishment challenge to the hegemony of classics. Angus Graham-Campbell, my laconic head of department, summed up the department’s signature virtues as scholarship, exuberance and irreverence.

The English department was not exactly typical of Eton as a whole. It was, I suppose, the haven for sensitive and artistic souls, for subversives and mavericks. Eton had other, for me less attractive, sides. I particularly disliked Pop, the self-elected club of prefects who strutted their stuff and lorded it over underlings in brightly embroidered waistcoats – the club to which Boris Johnson (but not David Cameron) belonged. This was more Game of Thrones than “The Love Song of J Alfred Prufrock”.

Eton, above all, was intensely male, intensely hierarchical and intensely competitive. Like Boris, I was a King’s Scholar; successors of the original 70 poor scholars, we lived apart from other Etonians in ancient quarters close to the 15th-century chapel, wore gowns and competed more for academic honours than for social kudos. Like Boris, I won the Newcastle Scholarship in classics and divinity, a strange 19th-century leftover that involved composing verses in Greek iambics, reading the Gospel of Matthew and the Acts of the Apostles in Greek and answering a paper on the doctrine of the Atonement – all in the term before A-levels.

I was proud of my academic achievements. But having had a chance to reflect on the Etonian male culture of competition from the outside, and then seeing it from a different angle when I went back to teach there, I began to doubt how healthy it was. I realised that coming top of the form and winning prizes had mattered far too much to me. It had even affected my choice of A-levels; I was good at classics and felt fairly confident of being the biggest fish in that smallish pond, rather than swimming in the broader waters of history and modern languages. Surely what mattered was finding yourself, your passion and your vocation?

I was artistically minded and Eton provided wonderful opportunities in drama (the groundwork was being laid for the flowering of acting talent we have seen recently) and music; but “creative writing” and painting, encouraged up to the age of 14, were suddenly put away as childish things when you reached adolescence (this, mind you, is not unique to Eton). From the age of 15, I never even considered choosing to go to music, art or drama school rather than taking the well-worn path to an Oxbridge scholarship. Achieving that seemed to be the pinnacle of Etonian success, and the only thing my worldly housemaster ever cared about.

Certainly no one talked much about happiness or emotional health. Eton’s pastoral care seemed close to non-existent. I kept my unhappiness to myself, with unhelpful consequences. For four of my contemporaries in college, who committed suicide in their late teens or twenties, the consequen­ces were more dire.

This may be sounding too much like a personal lament, or a reprise of Cyril Connolly’s theory of permanent adolescence in Enemies of Promise. I found my way eventually to what I wanted to be and do (it involved a lot of psychotherapy and a wonderfully liberating year in Barcelona). But I think my criticisms of Eton have a bearing on our national tragedy.

The atmosphere at the Eton English department celebration a few weeks ago did not lack the appropriate exuberance and irreverence, and the setting in the provost’s garden, surrounded with sculptures by Rodin, Jacob Epstein and Henry Moore, was exquisitely beautiful. Yet I could not help sensing the unquiet ghosts of Dave and Boris stalking the corridors behind us. I imagined them locked in an immature male rivalry that has ended up inflicting incalculable damage on a nation. Now Dave has decided to quit the political stage, leaving rather little in the way of legacy behind him.

Perhaps Boris, the King’s Scholar, could not forgive Dave for winning the ultimate prize. However, in taking revenge, he found himself hoist with his own petard, before somehow managing to emerge with a lesser prize, which some see as a ­poisoned chalice.

It all made me think of that supremely pointless sport, the Eton wall game. I played once or twice before giving up, repelled by the sheer unpleasantness of being ground into either brick or mud, and the tedium of a game in which the last goal had been scored in 1909. As a Colleger, though, I supported our team of brainboxes, drawn from the 70 scholars to play against the brawn of the Oppidans (the rest of the school, 1,200 of them). No doubting that it was antler-to-antler stuff, or like the contests of male musk oxen that knock each other senseless.

Eton remains archaic in its attitude towards women. It is still a boys-only boarding school (though a small number of girls, mainly the daughters of teachers, have been pupils there), and the staff are overwhelmingly male. Being largely cut off from women and girls for much of your boyhood and adolescence does not seem to me an ideal recipe for emotional health, or for regarding women as equals.

The school that has educated 19 prime ministers may provide a brilliant academic education and countless other opportunities, but it can leave its pupils emotionally floundering behind a façade of polish and charm. The effects of that emotional impoverishment can be far-reaching indeed. I am encouraged that the new headmaster, Simon Henderson, has signalled a change of tone at Eton, with more stress on “emotional intelligence” and “mental health”. That change is long overdue.

Harry Eyres is the author of “Horace and Me: Life Lessons from an Ancient Poet”, published by Bloomsbury

This article first appeared in the 15 September 2016 issue of the New Statesman, The fall of the golden generation