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

RICHARD SAKER/REX
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Electric dreams

How the “hippie tycoon” Dale Vince – a pioneer of renewable energy – plans to turn football and our motorways green.

In the hills above the tiny Cotswolds town of Nailsworth, on a road named Another Way, is an unusual football stadium. As you enter the New Lawn ground, the first thing you see is a pair of Nissan Leaf electric cars plugged into charging stations; on the reception counter are flyers for the Vegan Society. This is the world’s only meat-and-dairy-free football club, where players and fans enjoy Quorn fajitas, veggie burgers, cheeseless pizza and tea with soya milk.

Look out from the main terrace at the Forest Green Rovers club and you’ll see more curious sights. An array of 170 solar panels is positioned atop the south stand. Behind a corner flag is a large tank for storing water that has been recycled from beneath the organic pitch, which is fertilised with seaweed. Even the advertising banners stand out: the most prominent bears the white skull-and-crossbones logo of Sea Shepherd, the marine conservation charity.

It might all seem quaint and worthy, the vanity project of a hippie tycoon. But Forest Green Rovers are a serious club. The team of full-time professionals sits in the playoff places near the top of the National League, the fifth tier of English football. If they keep that up, they stand a good chance of winning promotion to League Two, for the first time in the club’s 127-year history. But the longer-term goal is to make it all the way to the Championship, just a step from the
Premier League.

That is why Forest Green Rovers are moving ahead with plans for an extraordinary new stadium near Stroud, in Gloucestershire. Designed by Zaha Hadid Architects, the firm that built the London Aquatics Centre for the 2012 Olympics, it will seat 5,000 people, with a capacity to expand to twice that. And it will be constructed almost entirely of wood. “That’s never been done before, anywhere,” said Dale Vince, who rescued the club from near bankruptcy in 2010 and is now its chairman. “It will be the greenest stadium in the world.”

We met in early November at the Stroud headquarters of Ecotricity, the renewable energy firm he founded in 1995, which runs 19 windfarms and two solar parks. Vince, who is 55, is not your typical corporate boss. He was wearing brown boots, ripped jeans and a black T-shirt. His hair is shaved on the sides, with a small ponytail on top, and his sideburns are long. A silver ring hangs from the tragus of his left ear.

Vince’s office is scantily furnished with two beanbags, a standing desk, a small, round table in the middle and a large, green Union Jack on the wall. If you didn’t read the newspapers, which drew attention to his wealth last summer while covering a legal battle with his ex-wife, you would have no idea he was worth more than £100m.

It is a fortune that has allowed him to spread his green dreams into areas beyond football. Before the 2015 general election, Vince gave £250,000 to Labour, £50,000 to the Liberal Democrats and £20,000 to the campaign of the Green MP, Caroline Lucas. But he may yet make the biggest difference with transport. Ecotricity has built what it calls the Electric Highway, a network of 296 charging points at motorway service stations which has made it possible to drive from Land’s End to John o’Groats in an electric car. Vince says he is trying to accelerate the demise of the internal combustion engine. “Our government is not the most ambitious on green issues but by 2030 it wants all new cars to be electric or hybrids. We think it could happen sooner.”

 

 

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Vince grew up in Great Yarmouth, Norfolk, in a two-bedroomed ­bungalow. His father was a self-employed lorry driver who worked hard yet worried about being able to pay the bills. “That’s why I decided to drop out and live like a hippie,” Vince wrote in the Daily Telegraph in 2009. “I didn’t want a career or a mortgage.”

He left his local grammar school at 15 and four years later became a New Age traveller: his first home was an old ambulance. He toured Britain and Europe, and along the way he got married, painted, learned to bake bread – and had run-ins with the police. He was part of the Peace Convoy, a confederation of anti-authoritarian travellers, and in summer 1985 he took part in the “Battle of the Beanfield”, when police trying to prevent a free festival at Stonehenge clashed with protesters. Some travellers were beaten and vehicles were smashed.

Vince, a tinkerer, built a small windmill on top of his van to power the lights. In the early 1990s, while living on a hill in Gloucestershire in a former army truck, he had an epiphany: what if he could harness the wind on a much bigger scale and change the energy industry? He decided to “drop back in” to society to set up Ecotricity, which claims to be the world’s first green energy firm. The model was simple: the company would produce as much renewable electricity as it could, buy in any extra fossil-fuelled power it needed, and use customer revenues to construct more windfarms until the operation was fully green.

“I built my first windmill in ’96, after a five-year battle with all-comers – Nimbys, bigots, planners, big power companies, you name it – and went to Kyoto in ’97,” Vince wrote on his blog, Zero Carbonista. “The rest is just more history.”

That windmill is still turning: its blades can be seen from the top of a stand at the New Lawn. And like the football club, which has doubled its home attendance in six years, Ecotricity is thriving. It has nearly 200,000 customers. Accounts filed at Companies House show turnover for the year ending April 2016 of £126m, up from £109m; pre-tax profit was £6.7m. Vince is the sole shareholder but the company does not pay dividends and he draws a salary of less than £150,000. The converted 18th-century fort where he lives with his second wife and their son is worth more than £2m, but he says he is not motivated by money.

Despite Ecotricity’s success, the firm faces several challenges, including the implications of Brexit, which Vince opposed. “We have not left [the EU] yet, but the pound has slumped and banks are thinking of leaving,” he said. “The process of leaving will be tortuous, and the idea that we can trade better outside the EU – that’s nonsense.”

A more immediate problem for Ecotricity is regulatory. The last Labour government introduced attractive incentives for companies and homeowners to produce renewable energy, especially wind and solar power. These subsidies amounted to billions of pounds – since 2002 Ecotricity has received £36m towards building windmills costing over £100m – and have helped make Britain a world leader in green power. In 2011, 9 per cent of Britain’s electricity came from wind, sun and other renewable sources; in 2015 the figure was 25 per cent.

But since the Conservatives won a majority under David Cameron in 2015, breaking free from the restraints of their coalition partners, the eco-friendly Lib Dems, the government has made it harder for green projects to secure planning permission. It has also reduced financial support for the industry. In December 2015, days after helping seal the Paris climate-change accord, which called on all countries to reduce their dependence on fossil fuels, the government announced a series of cuts to subsidies for renewables, which are paid for through business and household energy bills.

“They [the Tories] have smashed renewable energy with a sledgehammer,” Vince said. “And they’ve done it in a deceitful way, saying it was for the good of the industry. They’ve practically shut down solar and onshore wind in the UK. Bringing forward new stuff now – I don’t see it happening.”

At the same time, the government is promoting fracking, a controversial process that involves blasting water and chemicals into rocks to release trapped gas. Fracking has been suspended or banned in France, Germany, the Netherlands, Scotland and Wales because of environmental concerns. Official surveys show that fewer than one in five Britons supports fracking, yet in October the government overruled councillors in Lancashire and approved plans to explore for shale gas there. “[Fracking] is a big risk to take for a gas that we cannot afford to burn if Britain is to hit its carbon-reduction targets,” Vince said.

His proposed alternative is to produce “green” gas from grass grown on marginal farmland. Ecotricity will build its first grass-to-gas mill in Hampshire next year, and Vince says that in theory the green fuel could be used to heat almost all homes in Britain within two decades. His vision is unlikely to get much support from Theresa May, who, after taking office in July, abolished the Department of Energy and Climate Change and transferred its functions to an enlarged department responsible for business. “It’s ideological when it comes to green stuff,” Vince said. “The left embraces it and the right does not.”

That is why, in February 2015, he donated funds to Labour, the first time he had done so. What does he think now, with Labour trailing so far behind the Tories in the polls? “Jeremy [Corbyn] is a lovely man. He believes that he can lead the party to a general election victory. But if I were him I might be inclined to stand aside. The party seems so riven, and that is a real problem. The Tories are having a free-for-all.”

He believes that Tony Blair has a role to play in restoring the fortunes of the left. “I am against Trident and nuclear energy, and for social justice. But I’m also a practical person. What Tony Blair did with Iraq was disgraceful. But there was more that was right. I think Blair did a fantastic job, and rumours of his return excite me.”

Ask Vince what he would do if he were Energy Secretary and he reels off a list: ban fracking; rip up the Hinkley Point C nuclear power contract; spend “a billion dollars” on promoting energy efficiency; tax polluting power companies; perhaps renationalise the energy industry, from producers to suppliers. He would also give green vehicles a big stimulus, as has happened in Norway with marked results. Thanks to tax breaks and incentives – exemption from VAT and public parking fees, freedom to use bus lanes – plug-in cars now account for over a quarter of new car sales in Norway. “It’s economic signals that change behaviour,” Vince says.

 

***

 

As a boy, Vince was astonished at how many cars there were on the road. Surely the fuel they were burning couldn’t last for ever, he remembers thinking. But the oil companies kept discovering reserves, so there was no incentive for manufacturers to develop green cars. In 2008, when there were fewer than 2,000 electric vehicles on the road across 40 of the world’s most developed countries – and barely any at all in the UK – Vince and his engineers decided to take the initiative.

“I’m a bit of a petrolhead and also a tree-hugger, which is a dilemma. I could not get an electric car at that time, so we bought the shell of a Lotus Exige on eBay and turned it into a supercar,” he told me.

The Nemesis, as it was called, broke the British land speed record for an electric car in 2012, clocking 151.6 miles per hour. By then, however, Vince had realised that building cars was a different proposition from generating energy. Instead, he had started rolling out the infrastructure that he hoped would hasten the take-up of electric vehicles.

“We wanted to break the chicken-and-egg scenario,” he said. Few people owned electric cars, so there were barely any motorway charging points in Britain, which in turn discouraged people from buying the vehicles. Ecotricity started with a three-pin-plug point at a service station in 2011. It took eight hours to charge a Nissan Leaf, a small, five-door family hatchback that at the time had a 73-mile range. “We knew it was not good enough, but that a massive increase in technological capacity was coming.”

Today, a Nissan Leaf, the world’s bestselling electric vehicle, can drive for 80 miles on a half-hour power-up at a service station, which isn’t a full charge. Most new electric cars can run for between 100 and 150 miles before they need to be plugged in. “Range anxiety”, which has been a deterrent for many potential buyers, is fading away. “In a few years’ time you’ll be able to drive 400 miles on a 15-minute charge,” Vince said.

The Electric Highway has encountered some bumps along the way. Early on, Ecotricity entered into an agreement with Tesla, the Californian electric car company run by the technology billionaire Elon Musk (who also plans to colonise Mars). But in 2014 Ecotricity claimed that Tesla had gone behind its back, negotiating with service stations with a view to installing its own chargers. Ecotricity sued Tesla, which then countersued; the companies reached an out-of-court settlement in June 2015. (Vince was involved in another settlement a few months later. His former wife, whom he divorced in 1992 when they had no assets, had claimed nearly £2m of his fortune, and was awarded £300,000.)

As with his early embrace of wind power, Vince’s bet on the Electric Highway looks a smart one. According to the International Energy Agency, there were 1.26 million either fully electric or plug-in hybrid vehicles on the road at the end of 2015, more than three times as many as in 2013. The IEA forecasts that by 2040 there will be 150 million plug-in cars in service. With petrol consumption accounting for nearly 20 per cent of all oil consumed, that has huge implications for the petroleum industry – and the planet’s climate. In November, Shell announced that overall demand for oil could hit its peak in as little as five years.

Ecotricity had allowed drivers free use of its motorway plug-in stations since 2011, but in July it introduced tariffs for the first time. A half-hour charge now costs £6. The move angered some motorists; but Vince, who says the Electric Highway should cover its costs this year, is unapologetic. “We don’t have to make money in everything we do,” he said, referring to the football club and the car-charging network – but however altruistic his motives might be, he is also a businessman.

Green cars remain relatively expensive in the UK – the cheapest model in the Nissan Leaf range costs more than £20,000. But prices are falling and choice is growing, with more than 40 electric or hybrid models on sale in the country.

“The stumbling block was the range of the cars and the cost. What’s happening is one is going up and the other is going down,” Vince said. “The technology is on the cusp of mass appeal. You will see the government jump in before long and claim credit for that.”

As for Vince, he doesn’t even own a car. On a beanbag at the office in Stroud are the helmet and jacket he uses when riding in to work on his KTM motorcycle. And yes, it’s electric.

Xan Rice is the features editor of the New Statesman

Xan Rice is Features Editor at the New Statesman.

This article first appeared in the 05 January 2016 issue of the New Statesman, Divided Britain