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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An army with lead boots

Last Friday morning, within a few hours of the street massacre in Nice, I arrived in Paris.

Last Friday morning, within a few hours of the street massacre in Nice, I arrived in Paris to report on the way France was responding to the attack. Even before my report went out on that night’s BBC News at Ten, reports of the attempted coup in Turkey were coming in. By Saturday morning, I gave up asking senior French politicians for interviews because British interest in Nice was fading. By Sunday three policemen were dead in Baton Rouge. The next day an Afghan attacked railway passengers in southern Germany and was shot dead. New events crowd in on us constantly, overlaying and obliterating whatever happened yesterday, or this morning, or tonight.

But not, understandably, in France. Nicolas Sarkozy says that France is now at war. So does Le Figaro, which was calling on Saturday for a “pitiless response”. “Merah, Charlie, Bataclan, Magnanville and now Nice . . . How many savage murders and blind massacres before our leaders admit that Islamic fanaticism is engaged in a struggle to the death against our country and our civilisation?”

As Le Figaro’s editorial director whipped himself up into a frenzy of imprecision in his editorial, I was reminded of a television interview I once did with Margaret Thatcher at the height of the IRA’s terror campaign. I was never an admirer of hers but on this occasion I thought she was magnificent. “War?” she said as the camera turned over. “War? This isn’t a war. These are criminals, murdering and injuring decent people. We’ll find them and the courts will put them in prison, and there’s an end to it.”

It worked. A lot of other things had to be done, including addressing the serious grievances of the nationalist community in Northern Ireland and changing the whole basis of life and society there. Yet after its appalling early mistakes the British government stopped declaring war and demanding pitiless responses. On the contrary: life went on as close to normal as possible throughout the IRA’s bombing campaign. There’s no doubt that some shameful things happened in secret, but the basic principle – that a civilised society should remain true to its values even when it’s under attack, and perhaps especially when it’s under attack – was maintained; and the IRA was eventually beaten.

There are dangerous characters in any country and they require monitoring and infiltrating. The Bataclan attackers in Paris last November were a disciplined group with a clear plan. But some of the worst incidents in Europe have been the work of deranged loners. Le Figaro called Mohamed Lahouaiej-Bouhlel, the mass murderer of the Promenade des Anglais, “a soldier of the caliphate”. Bulls**t: he was just a sad, nasty little character with a propensity for violence against women, who had stopped taking his medication and wanted to validate his craziness. No doubt the Afghan teenager who was shot dead on the German train after going berserk with an axe was deranged, too, but that didn’t make him a soldier in anyone’s army. Attacking people in the street is a horrible, vicious fashion, just like storming on to a university campus in America and shooting people with an ­assault rifle, or stabbing children to death in Chinese schools. You have to take proper precautions and eventually, with luck, the fashion fades away.

However, the security authorities have to get their act together. This is where the French system has fallen down. According to the right-wing president of the Nice regional council, there were only 45 policemen on duty at the 14 July celebrations. No significant roadblocks had been set up, and it was pathetically easy for Lahouaiej-Bouhlel to steer his lorry round the concrete barriers and get on to the boulevard.

The previous week a government commission under a centre-right politician, Georges Fenech, reported that France simply wasn’t very good at defending itself against terrorism. The commission recommended the establishment of a single national counterterrorism agency, in place of the six competing and, by all accounts, mutually hostile intelligence organisations. Fenech said France’s inadequacy was like equipping an army with lead boots. Yet directly after his report came out, the interior minister, Bernard Cazeneuve, rejected the notion of overhauling the intelligence services.

As many as 230 people have been killed in terrorist attacks in France since the start of last year. “Something bad seems to happen every six months,” said a woman I filmed outside the Bataclan, “and we don’t know how to stop it.” France feels itself uniquely targeted. Yet the British example shows that Fenech was right and that it is possible to stop terrorism. After the 7 July 2005 bombs in London, an inquiry showed – in terms remarkably similar to Fenech’s – that intelligence about the culprits hadn’t been shared properly. Regional counterterrorist units were set up across Britain and the Security Service, MI5, opened up to the other agencies to a remarkable extent. The long rivalry between MI5 and the Secret Intelligence Service, MI6, was defused.

Now, once a week, MI5 and MI6 hold a meeting with GCHQ and the police at MI5’s headquarters, at which they share intelligence and agree what action to take on it. Extremist groups have been infiltrated with great success. As a result, Britain hasn’t suffered a mass-casualty terrorist attack since 2005, though 40 plots have been foiled in that time – including seven in the past 18 months. Sometimes, of course, we’ve just been lucky: a car bomb was planted outside a London nightclub in 2007 but it was so poorly assembled that it didn’t go off.

Mohamed Lahouaiej-Bouhlel, who despite his last-minute radicalisation would certainly have been picked up under the British system, rented his white lorry, drove it past the inadequate police check-points, and murdered 84 people who were just out to enjoy themselves. Forget about pitiless responses and declaring war on abstract nouns: what is required is proper, joined-up policing. That’s how a civilised society protects itself best.

John Simpson is the BBC’s world affairs editor. He tweets @JohnSimpsonNews

John Simpson is World Affairs Editor of BBC News, having worked for the corporation since the beginning of his career in 1970. He has reported from more than 120 countries, including 30 war zones, and interviewed many world leaders.

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt