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

CHRISTOPHER FURLONG/GETTY IMAGES
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The lost boys: how the white working class got left behind

The gap between poor and middle-class white pupils is widening. What can we do about the educational plight of underprivileged white youngsters?

One pleasant Thursday at 3.20pm, Carl Roberts, the principal of the Malling School in Kent, walks to the front gates. Along with several other members of staff, he makes the same journey every morning and afternoon, greeting pupils as they arrive and leave. “It’s all about modelling positive behaviour for young people from disadvantaged backgrounds,” he explains.

Roberts is an admirable head teacher. Energetic and ambitious, he runs a school that marries warmth with a sense of order. Just outside the gates, he gently admonishes the only boy without his shirt tucked in. The child immediately apologises.

The Malling has thrived during Roberts’s eight years as head. In 2015 it was rated “good” across all of the main areas assessed by Ofsted, the schools standards agency, and “outstanding” for its students’ personal development. In recent years, its overall progress has been in the top third of schools nationally and the attainment gap between disadvantaged and non-disadvantaged pupils is less than half the UK average.

The school is nestled in East Malling, a town that at first glance seems to conform to an idealised view of 1950s England: abundant green spaces and farmland, several busy pubs and a couple of churches. There was an uproar last year when East Malling Cricket Club, which dated back to the 19th century, closed because of a shortage of funds and players – even though there remain three other clubs within four miles of the station. Tonbridge and Malling, the constituency that encompasses the town, is among the safest Conservative seats in the country and ranks above average judging by national indicators for employment, health and well-being.

This is not an obvious place to find students struggling. Yet at the Malling School last year only 30 per cent of pupils got five good GCSEs including English and maths. Of the third of students eligible for free school meals (FSMs) – the national average is one in five – just 17 per cent get five good GCSEs, falling to 15 per cent for boys. Here, almost all of these pupils are white.

These results are indicative of a wider trend. Across England, the white working class performs badly. Overall, just 28 per cent of white children on FSMs get five good GCSEs; the figure drops to 24 per cent when girls are excluded. A white working-class boy is less than half as likely to get five good GCSEs, including the core subjects, as the average student in England, and among white boys the gap between how poor and middle-class pupils do is wider than for any other ethnic background. As Theresa May noted in her first speech as Prime Minister, “If you’re a white, working-class boy, you’re less likely than anybody else in Britain to go to university.” More recently, she signalled her intention to address this and other shortcomings in education through sweeping reforms, including allowing grammar schools to expand. Britain, May said, should be the world’s “great meritocracy”.

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A few hundred metres away from the Malling School lies the East Malling estate known to local people as Clare Park. About one-third of the school’s 700 students live in tower blocks here. Roberts says that, all too often, these pupils “will be worried about their parents, they will be worried about where their next meal is coming from. And suddenly they are no longer worried about passing exams.”

Roberts can relate to this. He grew up in the 1980s on a council estate in Tewkesbury, Gloucestershire, and his father was unemployed for many of his teenage years. Roberts attended the local comprehensive and, helped by his supportive parents, got the best GCSE grades in his year. He went on to study at the University of Bath.

“My childhood shaped my values, which is why I now work with children from disadvantaged backgrounds, with a view to ensuring they can have the future I was lucky enough to have,” he says. Maximising pupil attendance is central to doing so. On the main school noticeboard, a sign reads: “365 days a year, 190 in school, 175 not in school”. This is designed to stress to pupils how important it is to attend class, but it also serves as an unwitting reminder of the limits of what any school can achieve.

“Schools will see children for six hours a day,” Roberts says. “There’s a lot of other time when children are much more influenced. Until you sort out things like health for people from disadvantaged backgrounds, until you help them overcome the issues with crime, until you help them overcome the issues associated with poverty and lack of employment, schools are never going to be able to close that attainment gap by themselves.”

When pupils arrive at the Malling School at the age of 11, their attainment is already 20 per cent below the national average. Here, as across England, much of the damage to deprived pupils’ prospects is done even before primary school begins. In his or her first years of life, a young child with two highly educated parents will receive 40 minutes a day more parental engagement in playing and reading – 240 hours more per year – than one with two low-educated parents. By the age of five, there is an average 19-month gap in school readiness between the most and least disadvantaged children.

“This is a wider issue that’s actually nothing to do with schools,” Roberts tells me. “If you’re going to tackle [it], you need to do it between the ages of nought and two in the family home. It’s a social issue, not an education issue.” From their early years, poor white boys do particularly badly. At Key Stage 1, the exams taken when children are six or seven, white boys on FSMs already perform worse than any other ethnic group.

The challenge facing disadvantaged students is exacerbated by politicians’ neglect of primary education. Primary-school teachers in the UK are the youngest in the Organisation for Economic Co-operation and Development area. In an OECD report in 2012, the UK and Estonia were the only two out of 30 countries surveyed in which class sizes at primary were larger than at secondary level.

“There’s something fundamentally crackers about having a class size of 34 for children aged five and a class size of five for children aged 18,” says Phil Karnavas, the executive principal of the academy trust that runs Canterbury High, another school in Kent with a large proportion of underprivileged white pupils. The earlier in a child’s life money is invested, the further it goes.

Yet deprivation alone cannot explain the struggles of poor white children. Equally disadvantaged pupils from other ethnic groups perform far better. Thirty years ago, researchers divided children in Kingston, Jamaica, into three groups. One group received nutritional supplements; the parents of another group received hour-long weekly coaching sessions in parenting techniques and were encouraged to play with their children and to read and sing to them; the control group received nothing. Those whose parents were encouraged to play with them thrived both at school and in later life and now earn 25 per cent more, on average, than the other sets of children.

Parenting seems to explain some of the differences in results between white children and those of other ethnic groups on FSMs. Studies suggest that ethnic-minority parents often have higher aspirations for their children and are more involved with their education. This leads their children to engage more at school, says Simon Burgess, an economics professor at Bristol University whose speciality is education. More engaged parents can transform a child’s educational prospects. In July, a trial involving 16,000 pupils conducted in England by the Education Endowment Foundation found that children in secondary schools perform better and are absent less often when their parents receive regular text messages alerting them about forthcoming tests.

***

Demographics also work against poor white children. According to the Social Market Foundation, where a child grows up now has a greater impact on his or her results in school than in previous generations. Only about 10 per cent of England’s white population lives in London, against 45 per cent of the ethnic minorities. Schools in London have been transformed over two decades with intensive investment and focus from politicians; they are also more likely to have thriving after-school clubs, which are crucial in ensuring that children from disadvantaged areas do not fall behind. There is little selection among state schools in London but, instead, an emphasis on demanding higher standards from all students.

Disadvantaged white children perform better when they are in London but they are more often educated in small towns or rural areas where they can be “invisible”, as Michael Wilshaw, the head of Ofsted, warned in June. They can also suffer because they have longer commuting times than children in big cities, making it harder for them to take part in after-school or homework clubs, if their school offers them at all. Meanwhile, local services such as libraries are more difficult to find, especially since the cuts imposed under the government’s austerity programme. And in places such as Kent, the allure of London, which is nearby, can make it even more of a struggle for schools to attract the best teachers.

“As each year goes on, the quality of teachers gets better and better but it becomes harder to recruit teachers,” Roberts says. He is desperate to introduce a homework club after school but lacks the funding.

Throughout the Western world, boys now work less hard at school than girls and get worse results. Across 64 countries that the OECD surveyed last year, boys were less likely than girls to do homework and to read for enjoyment, but were more likely to play computer games and surf the internet, as well as have negative attitudes towards school and turn up late. Girls aged 15 were, on average, a year ahead of their male peers in reading aptitude.

Yet the gender gap is particularly high among the white working class in England. Just 9 per cent of white males on FSMs aged 18 go to university. For every two disadvantaged white boys who go to university, three disadvantaged white girls do: the highest gap between boys and girls on FSMs in any ethnic group.

White working-class boys suffer from a paucity of positive role models. The decreasing numbers of well-educated, working-class men in public life makes poor white boys less willing to work hard at school. “It’s not cool for boys to do well. They have stereotypes to live up to,” a girl at Canterbury High School tells me.

Another factor working against young boys is that most teachers in the UK are female and middle class, says Anna Wright, an educational psychologist. Less than 15 per cent of primary-school teachers in England are male (the figure rises to 37 per cent in secondary school). And poor children are more likely than advantaged children to grow up with only one parent. In nine cases out of ten, children from broken families live mostly with their mother rather than their father, and so have no male role model.

White boys suffer in particular because of the legacy of deindustrialisation and the collapse of secure jobs for life. “The culture of white, Anglo-Saxon, working-class boys is one which has historically led them from the terraces to the factory, the fields or the farm. That doesn’t exist any more,” says Karnavas, of the Canterbury Academy. “If you’re at the bottom end of generational unemployment – not just first-generation, but in some cases second- and third-generation – your assumption will be that you are not going to be employed.”

Karnavas says that when GCSEs come around, teachers are left “firefighting”, attempting to salvage a few decent results from boys facing stiff challenges from birth. This is nothing new: he argues that we could have been having a similar discussion 40 years ago. However, in a globalised world, the consequences of failure at school have become “more dramatic than they may have been in the past”, as a House of Commons education committee report warned two years ago. There is more competition for jobs than ever before. This bodes ill for white working-class boys, who now rank bottom for educational attainment in England. Their position relative both to girls and to other ethnic groups has never been lower. In the job market, poor white boys are left standing at the back of the queue.

The position of white working-class boys is falling. Ethnic minorities continue to soar: since 2005, the GCSE results of black children on FSMs have improved 50 per cent more than those of white children on FSMs. A white British boy on FSMs is now less than half as likely to get five good GCSEs as a Bangladeshi British boy on FSMs.

The gender gap, too, continues to grow. On current trends, a girl born in 2016 will be 75 per cent more likely than a boy to proceed to higher education. For the first time in history, it will become the norm for women to date and marry men with fewer educational qualifications than they have.

Back at the Malling School, Roberts is content as he lingers by the gates. “They’ve all left incredibly happy, having had a very positive day,” he says. Then he pauses, and regrets that many of the children “may not have their own bedroom or their own workspace. They may not even have books in their house.” By the time they return to school tomorrow, many boys at the Malling may have fallen even further behind. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.

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