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

PETER MACDIARMAID/GETTY IMAGES
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Long shadows of old wars

A century on from the Battle of the Somme, why should we remember an utter disaster?

Thiepval didn’t make it into the TV version of Birdsong starring Eddie Redmayne. But it did feature in the original novel by Sebastian Faulks about Stephen Wraysford, a Great War soldier who survived the Battle of the Somme. To Wraysford’s granddaughter in the 1970s, it looks from a distance like a sugar beet refinery; close up, as if the Arc de Triomphe had been “dumped in a meadow”. And then, as she stands beneath it, like some modernist monstrosity designed by Albert Speer for Hitler’s Berlin.

In Another World – the novelist Pat Barker’s exploration of the haunted mind of a Somme veteran – the grandson of the old man Geordie likens Thiepval to “a warrior’s helmet with no head inside”. “No,” he adds, “worse than that: Golgotha, the place of a skull,” celebrating not “a triumph over death but the triumph of death”.

For the historian Gavin Stamp, however, Thiepval is simply “one of the finest works of British architecture of the 20th century”.

The 140-foot-high war memorial, atop a chalk ridge at the near centre of the Somme battlefield, has always aroused intense and often extreme reactions – as it did again a few weeks ago during televised commemorations of the Somme centenary. Designed by Sir Edwin Lutyens, the architect of the Cenotaph in Whitehall, Thiepval is a red-brick tower of interlocking arches faced in white Portland stone. Carved across every available facing are more than 72,000 names – as if, to quote Faulks again, “the surface of the sky had been papered in footnotes”.

These names are, indeed, footnotes to the most horrific battle in the annals of the British army. Inaugurated in 1932, Thiepval is officially the Memorial to the Missing of the Somme, commemorating soldiers whose remains were never found. Lutyens and the then Imperial War Graves Commission (IWGC) wished to ensure that at least “their name liveth for evermore”.

A century on from 1916, it is right to ponder again why we should “remember them”. The opening day of the Battle of the Somme, 1 July, was the worst in British military history, when 19,240 men were killed and another 37,000 were listed as wounded or missing in action. Yet 1 July 2016 formed the centrepiece of the government’s programme of commemorative events for the Great War centenary. So, why do we choose to remember what was, frankly, an utter disaster?

Now that we have moved on from the evocative ceremonies of last month, it is perhaps time to consider this question. It raises challenging questions about the morality of war, the responsibilities of government and, above all, about the special place of the two world wars in Britain’s Brexit-shaped national memory. To explore them let’s think first about what we are remembering; then about how has it been remembered over time; and finally about why we are still remembering it now.

***

On the “what” question the answer is not clear-cut. The Somme offensive was months in the making and remaking. Indeed, that was a central problem. It was originally intended as a joint Franco-British operation to which the French army would commit 40 divisions and the British 25, but the plan changed profoundly when the Germans commenced their all-out assault on the French front further south at Verdun on 21 February. Verdun proved to be a ten-month slugging match, the longest battle of the Great War.

Once Verdun exploded, the British became the senior partners in the Somme operation, with the French demanding that it start as soon as possible to relieve the pressure on them. Field Marshal Douglas Haig, a cavalryman by training, always hankered after a total breakthrough, hoping even to win the war. Haig’s principal subordinate, General Henry Rawlinson, commander of the British Fourth Army, was more aware of the tactical difficulties of trench warfare – especially the problem of how to shift rapidly from offence to defence in order to hold initial gains against inevitable counter­attacks. Rawlinson favoured a “bite and hold” strategy on the Somme but Haig rejected this as insufficiently ambitious. The planning for the opening of the battle was, therefore, a messy compromise between Haig and Rawlinson. To quote the Somme historian William Philpott, it was not so much “bite and hold” as “rush and hope”.

Compounding the problem was the artillery barrage beforehand – on the face of it, hugely impressive: a week-long, mind-numbing bombardment involving 2.5 million shells in total. But the reality was different. Although Haig employed 1,400 guns, more than the Germans used at the start of Verdun, the firepower was less concentrated because the front was twice as long and many of the shells were “duds” that failed to explode. The British targeted mainly barbed wire and the enemy front-line trenches, so the German guns in the rear were able to keep blasting Rawlinson’s troops. In any case, British artillerymen and their commanders were still only beginning to learn the complex science of the creeping barrage. “For British gunners,” the military historian Hew Strachan observes, “the Somme had come a year too soon.”

It was the ordinary Tommies who paid the price for the strategic snafu and the botched barrage. At 07.30 on a beautiful midsummer morning, the shelling ceased and the infantry climbed out of the forward trenches. They were supposed to walk steadily across no-man’s-land and through the fragments of the barbed wire and take possession of the German front-line trenches, before pressing on to the second line and maybe beyond. Instead, most were mown down in front of the largely intact wire as the ­Germans, alerted by the end of shelling, raced up from their fortified dugouts to man their machine guns.

What happened is vividly evoked in two very different new books: Jolyon Fenwick’s Zero Hour (Profile), which presents 14 hauntingly beautiful panoramas of the British front line today on to which are inscribed the lethal data of 1916 (“enemy front line 150 yards”, “machine-gun 240 yards”, et cetera), and Hugh Sebag-Montefiore’s richly textured account of the battlefield experience, Somme: Into the Breach (Viking). Some German machine-gunners fired off 20,000 rounds on 1 July, their hands ­often reduced to lumps of burnt flesh from the red-hot MG 08s. One British survivor never forgot those arcs of bullets, sweeping across the ground to brush away line upon line of Tommies like “a glistening fan”.

It was the same story along much of the British line. At Beaumont-Hamel, 780 men of the 1st Newfoundland Regiment – mostly fishermen and lumbermen – went into ­action at 09.15. Less than half an hour later, as Andrew Roberts writes in Elegy (Head of Zeus), another recent book about the first day of the Somme, “89 per cent of the men who went over the top had been either killed or wounded, including all of their 26 officers”. Today a huge bronze Newfoundland caribou, head thrust high in defiance, surveys the memorial park at Beaumont-Hamel, with orientation arrows identifying the battlefield sites. One points dolefully to the rear: “Newfoundland 2,500 miles”.

A few enterprising British commanders took advantage of the barrage to push their men out into no-man’s-land and closer to the barbed wire. As a result, in some cases the Tommies did win the race against the German machine-gunners. The most successful unit was the 36th (Ulster) Division – mostly Protestant loyalists from Belfast – who not only overran the German front line but also reached parts of the second. By the following day, however, virtually isolated, they were driven back to where they had started.

After the war the survivors and the bereaved built the Ulster Tower on Thiepval Ridge – a replica of Helen’s Tower on the Clandeboye Estate in County Down, near where they had trained – as a memorial to the 5,500 men, roughly one-third of the division’s strength, who ended up killed, wounded or missing on 1-2 July 1916.

Contrary to myth, the First of July was not a total disaster. The Somme front was bisected by the old Roman road from the town of Albert to Bapaume. To the north of the road, the story was grim but to the south the offensive went much better. Much of that sector was in the hands of the French Sixth Army, whose role has been airbrushed out of many centenary accounts. The Sixth Army commander was General Marie Émile Fayolle, who – tellingly – had learned painful lessons from Verdun. “We have understood that we cannot run around like madmen,” he noted in his diary. “Doctrine is taking shape.” In particular, the French ­realised the need to keep the artillery barrage short but sharp to maximise surprise and to redeploy the guns rapidly once the enemy’s forward trenches had been captured, so as to target the second line.

But Fayolle could soon see the writing on the wall. “This battle . . .” he noted grimly on 12 July 1916, “has always been a battle without an objective.” Although apologists for Douglas Haig rightly emphasise that the Somme continued for another 140 days after 1 July, there was little to show for it. Most of the assaults – some 150 in all – were small-scale and poorly co-ordinated. Occasionally, bigger and better-organised offensives did make notable progress but the price was usually high.

The fighting in July and August to secure the village of Pozières on the crest of the Albert-Bapaume road cost the Australians more casualties in six weeks than they had suffered during the whole eight months of the Gallipoli land campaign from April to December 1915. Surveying the devastation from the stump of the Pozières windmill (where a memorial to the 1st Australian ­Division now stands), their official war ­historian Charles Bean – the curator of the Anzac myth – wrote of a ridge “more densely sown with Australian sacrifice than any other place on Earth”.

“Sacrifice” was the operative word – used then and now in an attempt to give meaning to the slaughter. By the time the Battle of the Somme muddied out in mid-November the British had lost 420,000 men killed, wounded or missing, in order to advance at most six miles. The question now was how this “sacrifice” would be remembered and justified.

***

In today’s world of embedded war reporters and soldier selfies, it needs emphasising how little most British people in 1916 knew about what the Battle of the Somme really was like. The British military were far more secrecy-obsessed than the French or Germans: they kept most journalists well away from the front and had no official photographers until mid-1916. But such was the importance of the Somme (and the expectancy at home about the Big Push) that the army commissioned a special black-and-white, silent movie, with brief intertitles by way of explanation.

Although technically very crude to modern eyes, The Battle of the Somme had an immense impact when first screened in August 1916. Twenty million people watched it in the first six weeks. Again and again, reviews extolled the film’s “realism”. Frances Stevenson, David Lloyd George’s secretary and then mistress, had lost her brother on the Western Front. After seeing the film she wrote in her diary: “I have often tried to imagine myself what he went through, but now I know, and I shall never forget.”

In fact the “realism” was highly contrived: The Battle of the Somme’s only footage of combat, showing soldiers climbing out of a trench into no-man’s-land, was probably filmed later behind the lines. Yet the image of a wounded man sliding back into a trench was recalled endlessly by viewers as one of the most heart-rending moments in the film. Other scenes, such as the (silent) artillery barrage, the detonation of a huge mine, the recovery of wounded soldiers and shots of ruined villages, all conveyed destruction on a scale far beyond anything previously imagined.

The Battle of the Somme did not dent popular resolve. On the contrary; most people seem to have shared the sentiments expressed in lines from the London Evening News that were used in advertisements for the film: “In this picture the world will obtain some idea of what it costs in human suffering to put down the devil’s domination.”

There were dissenters, not only on the radical left, but also at the highest levels of government. In November, as the battle subsided into the mud, Lord Lansdowne, a former foreign secretary and now wartime minister, wrote a memo to his cabinet colleagues imploring them to consider a negotiated peace. “Generations will have to come and go before the country recovers from the loss which it has sustained in human beings, and from the financial ruin and the destruction of the means of production which are taking place.” Casualties had already topped a million and the war was costing Britain £5m a day. “All this it is no doubt our duty to bear,” Lansdowne went on, “but only if it can be shown that the sacrifice will have its reward.”

His pleas, however, were brushed aside. Despite its private doubts, the government closed ranks behind Haig and his belated spin-doctoring of the Somme as part of a carefully planned strategy of attrition. Lloyd George insisted to the press that “the fight must be to a finish – to a knock-out” because the “inhumanity and pitilessness” of the current fighting was “not comparable with the cruelty that would be involved in stopping the war while there remains the possibility of civilisation again being menaced from the same quarter”. And in September he told the Times: “‘Never again’ has become our battle cry.”

Lloyd George’s words proved prophetic. After the losses at Verdun and on the Somme, neither France nor Britain could accept a negotiated peace – if that had ever been possible. The body count seemed too high for either side to declare a draw and shake hands; the war “had” to end in a knockout. But as people in Britain knuckled down for more carnage (in 1917 Passchendaele followed the Somme), they seem also to have found solace in the mantra of “never again”. The terrible sacrifice might be justified, if the Great War proved to be “the war that will end war”.

***

Those words of H G Wells, promulgated in 1914 as propaganda, became a statement of faith, or at least hope and love, for millions in the 1920s and 1930s. Although the horrors of trench life were exposed by interwar writers – tongue-in-cheek by Robert Graves, in simple but deadly earnest by R C Sherriff – this does not seem to have undermined the widespread conviction that 1914-18 had been a necessary sacrifice in an effort to abolish war. In November 1933 the cover of the British Legion Journal depicted a statue of a mother holding the body of her dead son, with the word “Disarm” on the plinth. Peace, it seemed to millions, would be the sincerest form of remembrance. Hence the passion for appeasement in the 1930s.

That all changed in September 1939. Another conflict against Germany, almost ­exactly a quarter-century after the first, put “the war to end war” in a different perspective. The Treaty of Versailles now seemed like a mere armistice – a pause for breath before round two. And this time it was clearly a “good war” that was fought to the finish, with the knockout blow delivered in the ruins of Berlin as a genocidal dictator took his own life, having taken the lives of millions.

In 1939-45, what’s more, Britain’s war was waged very differently from that of 1914-18: largely in alliance with the United States and the British Commonwealth after France collapsed in 1940. (There was little mention during the Cold War of those once lauded as “Our Gallant Russian Allies”.)

During the two decades after 1945 this British-centred narrative was absorbed into popular culture thanks to a cavalcade of war films from British studios, featuring stars such as Jack Hawkins and Richard Todd as stereotypically English males, tough and determined, yet reserved. Recycled on television ever since, these movies have helped to define our cultural memory of the Second World War.

It was only in the mid-1960s, around the fiftieth anniversary of 1914-18, that the British rediscovered the First World War. In the writings of A J P Taylor, Alan Clark and Martin Middlebrook, in the blockbuster BBC television series The Great War, with its graphic footage and poignant interviews, and above all in Richard Attenborough’s savagely satirical 1969 big-screen version of Oh! What a Lovely War, the children and grandchildren of Tommies encountered the Great War almost for the first time.

But this was now a war in which the language of “sacrifice” had morphed into “victimhood”. Sniping at Haig and his generals, Clark popularised the tag “lions led by donkeys”. Middlebrook’s bravura oral history-cum-Greek tragedy of the first day of the Somme helped turn the spotlight on a battle previously overshadowed in British memory by the hauntingly named Passchendaele. He and others also rediscovered the battalions of “Pals” from small towns and cities, who volunteered en masse in 1914, and many of whom went over the top together on 1 July 1916. In the bleak words of the local author John Harris, in his novel about the Sheffield Pals: “Two years in the making. Ten minutes in the destroying. That was our history.” The First of July 1916, hanging at the mid-point of the middle year of the conflict, had become the crucifixed centre of Britain’s Great War.

The 1960s recast the Great War into a mould that is still ours today. Through the cult status in schools of Britain’s “War Poets” (a tiny fraction of the roughly 2,200 men and women who published poetry during the war); through the dark comedy of Blackadder and the vivid prose of Pat Barker and Sebastian Faulks; and, at a more domestic level, through the passion for family history – we have become used to seeing the Tommies of 1914-18 as victims. Viewed from this perspective, from the bottom of a trench full of mud, guts and excrement, the Great War looks mindless and meaningless: the appliance of science to the dance of death.

Since the 1990s this “Blackadder” view of the conflict has been subjected to counterattack. Revisionist military historians such as Gary Sheffield and William Philpott insist that the first day of the Somme was followed by 140 others in which the German army was irreparably ground down. For them, 1 July 1916 must be seen as the regrettable but necessary start of a “learning curve” that led slowly but inexorably to what Sheffield calls “the greatest military victory in British history”: Haig’s triumphant “Hundred Days” in the autumn of 1918.

Up to a point, I can see what the revisionists are getting at. Their “learning curve” argument reminds me of the dictum attributed to France’s Great War hero Marshal Ferdinand Foch: “It takes 15,000 casualties to train a major general.” In other words, we all learn by our mistakes but for most of us the consequences are merely embarrassing. Soldiers, however, are in the business of death. An officer kills others “efficiently” only after seeing his own men killed and then absorbing the lessons.

That task gets ever more difficult as one ascends from the circumscribed role of a platoon commander to the complex mysteries of supplying, manoeuvring and deploying thousands of men, and especially so in 1914-18, when a general had only the most rudimentary information with which to penetrate the fog of war. And so a “fight to the finish” would inevitably entail thousands of casualties for Us as well as Them.

Yet the phrase “learning curve” sounds clinical and callous. Even if one accepts that Haig and his staff had to learn the craft of generalship at the expense of their countrymen, did such a huge number of British soldiers – 750,000 – have to pay with their lives? Could one ever justify the shambles that occurred on the Somme on 1 July 1916? These questions certainly nagged at the minds of Winston Churchill and Field Marshal Montgomery; together, they managed to end up on the winning side of the second war at roughly half that number of British dead.

In our own time, a similar reluctance to accept what we might call the human cost of educating generals prompted a long campaign to rehabilitate over 300 Tommies of 1914-18 who were executed by firing squad for various capital offences, including murder, but also “desertion” or “cowardice”. The Shot at Dawn memorial at the National Arboretum in Staffordshire was unveiled in 2001. Five years later, the Labour defence secretary Des Browne, a human-rights lawyer, offered these men a posthumous group pardon, describing them all as “victims of war”. For Browne’s supporters, it was belated justice; to his critics, an anachronistic rewriting of the past to fit the different moral standards of our own age.

In his recent book Breakdown (Little, Brown) the historian and film-maker Taylor Downing re-creates the mentality of Haig’s staff in an era long before modern ideas of post-traumatic stress. He shows how the incidence of so-called shell shock soared in July 1916 with the start of the Somme, amounting to a minimum of 60,000 cases in the second half of the year. The high command saw shell shock as akin to a contagious disease, which, if not contained, might cause the breakdown of the whole army.

A striking example comes from the sad story of the 11th Borders, or “Lonsdales”, a Pals Battalion from what is now Cumbria. The unit lost two-thirds of its officers and men on 1 July. Pulled out of the line, the survivors had to sort out the kit of their dead comrades and bury the decomposing corpses, sleeping in open trenches under heavy artillery fire. Sent back to the front line on 9 July and ordered to take 200 yards of enemy trench in a night attack under even more ferocious shelling, many of the men – shaking and disoriented – baulked at going over the top and the attack had to be aborted. The Lons­dales were court-martialled and ritually humiliated. Stripped of their weapons, the 250 survivors were paraded before the rest of their regimental brigade as a “disgrace” to themselves and the army.

Today this story seems appalling. Yet, to a high command stuck at the very bottom of its “learning curve” on the Somme, the epidemic of shell shock that summer posed a crisis as grave as poison gas in 1915. Rejecting one request for clemency for a foot soldier of the Warwickshire Regiment, Haig confirmed the death sentence with almost anguished words: “How can we ever win if this plea is allowed?”

***

To recall the “deserters” and not just the “heroes” raises a larger question. Again and again today, the words of the poet Laurence Binyon from 1914 are repeated: “We will remember them.” Yet that simple word, “remember”, needs unpacking. No one now alive in 2016 has direct memories of the war of 1914-18, so this isn’t remembering in any normal usage of the word. Our act of remembrance necessarily entails reinterpretation – seeing their past through the eyes of our present. In other words, anachronism and judgement are almost ­inescapable. And the verb “will” also needs interrogating, because remembrance has become an official ritual, orchestrated at selected moments of our national history for reasons that are not always clear.

So, is the Somme a story of victimhood, to adopt the Blackadder version? Or are we recalling, as Prime Minister David Cameron declared in 2012, “the extraordinary sacrifice of a generation” and, in fact, the “sacrifice they made for us”?

British attitudes to the Great War centenary, it seems to me, quiver uneasily between the two. The language of sacrifice – poignantly meaningful for the survivors and the bereaved in the 1920s and 1930s – comes less naturally to the 21st century. On the other hand, it seems equally clear that most veterans of the Great War did not regard themselves as victims. Although appalled by what they had experienced, they continued to believe in the necessity of what they had done and in the rightness of their cause.

Yet it is also worth noting that the language of victimhood is not entirely anachronistic. It lurked in the minds of those who began the remarkable project of war cemeteries for the soldiers of Britain and the empire. Consider three of these men.

Fabian Ware: an educator and journalist, too old to fight, who volunteered to run an ambulance unit in France and was horrified to see the bodies and bones littering the fields. Almost single-handed, he persuaded the British government to establish a proper programme of graves registration and then induced the French government to donate land for the burial of Allied soldiers. The Imperial War Graves Commission received its royal charter in May 1917.

Edwin Lutyens: often dismissed today as the architect of mock-Tudor country houses or the imperial grandiloquence of New Delhi. Yet Lutyens, like several other eminent architects, spent most of the 1920s designing memorials along the Western Front. It proved to be a deeply moving experience. “I am here doing Graves in France,” he wrote to a client in 1925, “and the magnitude of that host of boys that lie fearfully still, quickens the sense of unspeakable desolation.” For Lutyens, Thiepval was a work of art, and heart.

And Rudyard Kipling: the bard of empire and the troubadour of war in 1914, who never recovered from the loss of his only son at the Battle of Loos in 1915. This was literally a “loss”, because Jack disappeared without trace. It was Kipling who added words to Ware’s vision and Lutyens’s monuments. “Their Name Liveth for Evermore” is taken from Ecclesiasticus and inscribed on the War Stone, designed by Lutyens, that reposes like a secularised altar under the Thiepval arch, and in most cemeteries. And his legend “Known Unto God” on the headstones of unidentified British soldiers, in striking contrast to the stark “Inconnu” on the graves of their anonymous French counterparts. One can see the distinction graphically at the little Franco-British cemetery that slips gently away from the Thiep­val memorial down the hill towards the old British front line of 1 July 1916.

Ware, Lutyens and Kipling: all men too old to fight, yet haunted by what their generation had inflicted on the next. We catch Kipling’s sense of grieving guilt in one of his sardonic “Epitaphs of the War”, first published in 1919:

If any question why we died,

Tell them, because our fathers lied.

For these old men, perhaps, the young Tommies were their victims.

***

The project of the war cemeteries cost over £8m – roughly the cost of two days’ shelling at the end of the war. In other words, burying was a lot cheaper for His Majesty’s Treasury than killing. Even so, the work of the Imperial War Graves Commission represented one the biggest government construction projects of the 1920s, eclipsing the building of the modern stations on the London Underground or the network of new telephone exchanges.

It was also a project for the dawning democratic age. “Tommy” in the trenches and the deserts (and “Tommy’s Sister” in the factories, on farms and in offices on the Home Front) had indeed “done the state some service”. Their reward was the Representation of the People Act 1918, which gave the vote to nearly all men over 21, propertied or not, and to women over the age of 30 who owned property. The war had in fact changed the terms of political debate. “What property would any man have in this country if it were not for the soldiers and sailors who are fighting our battles?” asked Sir Edward Carson, the Ulster Unionist leader and former diehard. “If a man is good enough to fight for you, he is good enough to vote for you.” And even good enough (though this may not have occurred to Carson) for you to vote for him. The new slogan “One Gun, One Vote” was rigorous in its logic: the 1918 act denied the franchise to conscientious objectors.

To Ware and his colleagues, the young men who had not lived to vote at least deserved democratic recognition in death. All the headstones were uniform in style: generals just like “other ranks”, the sons of colliers treated no differently from the scions of landed gentry. Rich families were not allowed to repatriate remains to a family plot in some English churchyard. Instead, officers and men would lie together, eternally equal, in “some corner of a foreign field/That is for ever England”.

Many at home fumed about the “Prussian” attitude of the IWGC but Ware and his fellow commissioners did not relent. Speaking in their defence, Winston Churchill told the House of Commons in May 1920 that “there is no reason at all why, in periods as remote from our own as we ourselves are from the Tudors, the graveyards in France of this Great War shall not remain an abiding and supreme memorial to the efforts and the glory of the British army”. He acknowledged “the mutability of human arrangements”, but predicted that “even if our language, our institutions, and our empire all have faded from the memory of man, these great stones will still preserve the memory of a common purpose pursued by a great nation in the remote past, and will undoubtedly excite the wonder and the reverence of a future age”.

Churchill’s rhetoric of 1920, casting forward four centuries, was remarkable: almost a “Their Finest Hour” oration 20 years before its time. Back in the age of the Tudors only the likes of Henricus Rex, Elisabetha Regina and a happy few aristocrats had their names preserved for posterity. But at Thiepval, the Menin Gate in Ypres and many other war cemeteries and monuments, the names of ordinary soldiers of Britain and the empire live on a century after their death. Through the names their stories live on as well.

The visitors’ centre at Thiepval displays a panel of photographs of “600 Missing” whose lives have been painstakingly rescued from oblivion by a Northumbrian couple, Ken and Pam Linge. Their moving book Missing But Not Forgotten: Men of the Thiepval Memorial, Somme (Pen & Sword), tells some of these men’s stories.

What is now called the Commonwealth War Graves Commission has carried out Ware’s mandate for nearly a century. Under its charter the CWGC’s mission is to maintain the graves “in perpetuity”: as Churchill put it, into an era “as remote from our own as we ourselves are from the Tudors”.

That is a heavy burden. Is it, perhaps, a dead weight? In Britain we are preoccupied – some would say obsessed – with our national memory of the two world wars. The headline slogans of that memory-story are clear. 1914-18: over there in Mud and Blood, sacrificing the Lost Generation to win only the Lost Peace. 1939-45: over here, Our Finest Hour, Alone in 1940. Then victory, won in tandem with the English-Speaking Peoples. Two wars enshrined in ways that serve to distance us from mainland Europe – even though both narratives are highly selective.

Across the Channel, however, the story is very different. After 1945 the French and Germans, who had been killing each other for three centuries, managed to kick the habit. Not only were they reconciled but they moved on into what the founding father of the European Economic Community, Robert Schuman, called a “European solution” to the “German Question”.

Yet European integration has not exerted much attraction in the “United Kingdom”. As a country we have been at the very most “reluctant Europeans”; after all, no other member of the EU has held two referendums in four decades on whether to get out. And no one else has actually voted to do so. Of course, both affairs were staged for narrow party-political reasons and the second was a shambolic chapter of accidents from start to . . . well, not “finish”, but shall we say to “the end of the beginning”, which is where we are now. Yet the referendums also reflect what might be called the “Channel of the Mind” between Us and Them, a great divide that was deepened by our ­nationalist narratives of 1914-18 and 1939-45. This, in turn, fed into the Brexit vote of 23 June.

***

Should we keep clinging to our “Glorious Dead”? After all, there are no veterans of the First World War still alive. We are now as distant from the men who marched away in 1914 as they were from the Redcoats who fought Napoleon at Waterloo. So maybe it’s time to let go of the dead? To allow them to vanish quietly into the past? If we did so, perhaps it might be easier to comprehend the Great War as history?

Part of me, the historian, thinks this way. I worry that when it comes to the Great War we British are still stuck in the trenches and trapped in Poets’ Corner. Rather than just evoking myriad individual tragedies on the Western Front, illuminated by a few anguished verses, I would also like us to see 1914-18 as truly a “world war”; to grasp its impact on eastern Europe, India, China and the Middle East – not to mention on politics and society at home – in ways that still affect us in 2016. In other words, not just to “remember” but also to understand.

And yet, as a citizen, I keep coming back to Lutyens and Thiepval. To those names. Carved into the stone and thereby etched into the national memory. Reminding us of their mortality – and ours. As the historian G M Trevelyan mused softly in 1927: “The Dead were, and are not. Their place knows them no more, and is ours today. Yet they were once as real as we, and we shall tomorrow be shadows like them.”

Bodiless names that can spring out of the stone shadows – suddenly alive at a glance or even a touch. I still remember ­being with my son Jim, then ten, when we found his name on the Tyne Cot Memorial, near Ypres. The almost electric shock of ­encountering a “James Reynolds” on the wall of the dead.

Or perhaps, dare one say it, of encountering a “Blair” or a “Cameron”, or even a “May”. I do not imagine for one moment that any democratic leader lightly sends men (and now women) into battle, knowing that it may be signing their death sentence. This is the moral loneliness of leadership. Power brings with it an inescapable burden of guilt because politicians, no less than generals, learn from their mistakes.

The Somme centenary reminds us of this. So does the excoriating Chilcot report into the Iraq War, published on 6 July. For all the differences of time and place, here are two essentially similar stories. Simplistic assumptions; inept planning; sloppy intelligence; duplicitous spin. It is tragically apt that, having reflected on the first day of the Somme, five days later we were pondering “Mission ­Accomplished” in Iraq.

I believe that every political leader should visit the Memorial to the Missing of the Somme. To touch the names and feel the pain. To “learning-curve” the human cost of going to war. That is why for me, ultimately, Thiepval matters. Why we should not forget 1 July 1916. Why, a century on, and however hard it now may be, we should remember them.

David Reynolds is the author of “The Long Shadow: the Great War and the Twentieth Century” (Simon & Schuster)

For details of events visit: www.1914.org

This article first appeared in the 11 August 2016 issue of the New Statesman, From the Somme to lraq