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

© LEWIS MORLEY/NATIONAL MEDIA MUSEUM SCIENCE & SOCIETY PICTURE LIBRARY. COURTESY OF VICTORIA AND ALBERT MUSEUM, LONDON
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Nostalgia without memory

We had a terrific time in the Sixties – but at what cost to the millennial generation?

There is a flurry of Sixties-worship at present, with an exhibition at the ­Victoria and Albert Museum in London and a cinema documentary about the Beatles’ ­touring years directed by Ron Howard. Next month, two more books on the ­subject will join the pile to which I have admittedly contributed more than my share. Steve Turner’s Beatles ’66: the Revolutionary Year reconstructs the band’s exploits in that eventful season (also recently chronicled in Jon Savage’s weighty 1966: the Year the Decade Exploded). And Paul Howard’s I Read the News Today, Oh Boy tells the story of Tara Browne, the gilded young Guinness heir whose death at the wheel of a Lotus Elan inspired John Lennon’s greatest song, “A Day in the Life”.

Truly, this is the decade that never dies. At frequent intervals since the mid-­Eighties, glossy magazines have announced that “the Sixties are back”, with fashion spreads of Paisley fabrics, Mary Quant-ish bobs, ­shorter-than-ever miniskirts and elastic-sided Chelsea boots. Sixties pop music eternally dominates radio playlists, while the Rolling Stones, the decade’s most notorious band, though now withered old-age pensioners, are still widely reckoned the coolest, most dangerous dudes on the planet.

For that, we largely have to thank the “Sixties children”, who lived through the most magical time for youth there ever was, survived its surfeits of alcohol, sex and mind-shredding drugs, and now seek to perpetuate their glorious heyday even unto senility. But the greatest celebrants of the era are often people who never experienced it first-hand yet still yearn for it in a syndrome that psychologists call “nostalgia without memory”. Tony Blair’s “Cool Britannia” shtick in the Nineties, for instance, pastiched the Swinging London of three decades earlier, right down to the Union Jack carrier bags. In folk memory the Sixties are as a rosy blur of psychedelic colour, free love and Beatles music, their complexity and manifold horrors either unrealised or disregarded.

***

The mythic decade, as opposed to the real one, was no straight ten-year stretch. It didn’t get into gear until 1962 with the satire boom that produced BBC TV’s That Was The Week That Was, David Frost’s first starring vehicle, and Private Eye magazine, and didn’t absorb pop music until the Beatles’ historic first visit to America in 1964. Its closing year, marked by a series of vast open-air festivals – Woodstock, Bob Dylan on the Isle of Wight, the Stones’ free concert in Hyde Park – felt almost like a decade on its own. When 1970 dawned, so much resembling a grey morning-after, many Sixties children simply refused to believe the party was over and clung to their caftans and joss sticks far into the harsh new eras of glam rock and punk.

Its prime time is generally agreed to have been 1965, when London gave vent to a concerted burst of youthful creativity in music, art, fashion, photography, cinema and graphics, and a shabby, sleepy metropolis, bombed to ruins not long previously, received the unlikely sobriquet of “swinging”. At this stage, the swinging was confined to a small circle of musicians, models, actors and photographers, congregating in the same few, unpublicised bistros and clubs: the most emblematic pop single, among so many, was Dobie Gray’s “The ‘In’ Crowd”.

It is seen above all as an era of burgeoning freedom and tolerance when Britannia seemed to be loosening her Victorian stays one by one. The contraceptive pill became widely available, ending centuries of shotgun marriages and perilous backstreet abortions, and theatre censorship by an archaic royal flunky called the Lord Chamberlain came to an end. Male homosexuality was decriminalised, though not yet destigmatised, and the first feminist voices spoke out. The word “fuck” appeared in the Times (during the farcically unsuccessful obscenity prosecution of Penguin, publisher of D H Lawrence’s Lady Chatterley’s Lover) and was heard on BBC Television, albeit only in quotation marks, from the National Theatre’s literary manager, Kenneth Tynan.

Yet alongside the pop-cultural harlequinade, Britain faced many of the same problems as we do today – some, indeed, significantly worse. Industrial strife was so common that the rest of Europe came to know strikes as “the English disease”. Harold Wilson’s Labour government, continuously in power after 1964, imposed a strict wages freeze, then known as a “pay pause”, and failed so utterly to solve its own financial deficit that in 1967 Wilson was forced to devalue the pound by 14 per cent. The World Cup-winning 1966, that supposed annus mirabilis, also brought two events whose horrors still resonate: the Moors murders trial and the Aberfan disaster, in which a south Wales primary school was engulfed by a giant slag heap, killing 116 children and 28 adults.

Meanwhile, the outside world was taking its first steps backwards into hell. America’s inspirational young president John F Kennedy was assassinated, as, in horrifically quick succession, were his brother Robert and the great civil rights leader Dr Martin Luther King. The United States was shamed at home by racism and police violence (not much change there, then) and abroad by its war in Vietnam, which nightly filled British TV screens with images of bombed civilian enclaves and maimed children (little change there, either – except today barrel bombs replace napalm). A democratic movement in communist-controlled Czechoslovakia was crushed; there was incalculable murder and terror in China’s Cultural Revolution, genocide in Indonesia and Biafra, apartheid in South Africa and endemic famine in India. June 1967 brought not only Sgt Pepper’s Lonely Hearts Club Band and the “Summer of Love” but the Arab-Israeli Six Day War, whose cumulative effects remain seemingly impossible to resolve.

Throughout the Sixties, Britain, along with the rest of western Europe, faced the threat of nuclear war with Soviet Russia and more-than-possible total obliteration. And yet, paradoxically, this was a time of enviable domestic peace and stability. There was full employment, with almost nobody ever getting sacked except at the very top. Inflation was marginal; the NHS and other public services functioned without any hint of crisis; the nationalised railways, shorn of unprofitable branch lines by Lord Beeching, were dirty but dependable; the postal service, even after the introduction of an avowedly “second-class” tier, remained the envy of the world.

Pending that terminal flash in the sky, people felt safe. The only communicable disease left to be feared was smallpox. ­Terrorism was something that happened only in the distant Middle East: it could not conceivably take root among Britain’s hard working and law-abiding Indian and Pakistani immigrants despite the unfettered racism constantly hurled at them. One walked on to aircraft or into official buildings or the BBC without security checks. The first shadow of Northern Ireland’s Troubles, which were to bloody the Seventies and be described by American commentators as “Britain’s Vietnam”, did not appear until 1968.

Two world wars in the space of 30 years had trained ordinary Britons to feel guilty about any conspicuous consumption. In the Sixties, the advertising industry set about remedying this. The new Sunday newspaper colour supplements bulged with adverts for Scandinavian furniture, stereo systems and white Kosset carpets, and bombarded their readers with recipes for exotic dishes such as chicken Kiev and beef stroganoff, using quantities of butter and cream that once would have seemed downright immoral. When Rowntree launched a new wafer-thin chocolate mint, the company made a last-minute name change from Minty Thins to After Eight, suggesting elegant high-society dinner parties to a demographic only recently weaned from high teas. So older generations, too, could join an “in” crowd and share the feeling of life becoming measurably better every day.

The attention paid to youth was an extraordinary volte-face from that ancient British maxim “Children should be seen and not heard”. Young people now not only wielded huge economic power through pop music and fashion, but kicked aside class distinctions and social barriers. Following the Beatles template, almost all of the decade’s brightest new celebrities were in their twenties and from humble backgrounds: the photographer David Bailey, the model Twiggy, the painter David Hockney, the comedian Jimmy Tarbuck, the film stars David Hemmings, Rita Tushingham, Tom Courtenay and Terence Stamp. A northern or a cockney accent was almost a prerequisite of success. In Britain in the past, the working class had always tried to talk “up”; now the upper and middle classes strove to talk “down”. It still goes on.

Without any form of social media other than underground newspapers and ­flyers, Sixties youth culture managed to be remarkably united. It assumed that every figure of authority – indeed, anyone over 30 – was a pitiable lunatic. Unlike its counterparts in America and across Europe, it raised up no demagogues: its figureheads were lead singers in bands and radio disc jockeys whose dimness in no way reduced their potency. The hippies, who arrived post-1966, are now viewed as hopelessly naive and deluded, with their mantra of “Love and Peace”. Yet their pop festivals, love-ins and “happenings” were occasions that brought hundreds of thousands together without the slightest violence. There were ­moments when even their fiercest detractors wondered if they might really be a force for changing the world for the better.

***

The V&A exhibition “You Say You Want a Revolution?” focuses on the decade’s final phase, when Britain’s initially playful underground hardened into a many-headed protest movement containing every kind of extreme-leftish ideology; churning out insurrectionary literature amid the comforts of the consumer society; holding marches, demos and sit-ins of increasing militancy despite having nothing to protest about nearer than the Vietnam War (in which the Wilson government played no part whatsoever). It was always more serious in other European countries and the US, where former hippies made an easy transition to urban guerrillas and to Charles Manson’s serial-killing “Family”.

Simultaneously, the British police declared war on leading musicians whose songs seemed to encourage their fans to take drugs, whether the pot known to jazz players for generations or the new, man-made, “mind-expanding” lysergic acid diethylamide (LSD), which leaked from the very pores of the Beatles’ Sgt Pepper album. The fear was legitimate – in fact, nowhere near proportionate to the long-term problem in the making – but the reaction was hysterical scapegoating. In early 1967, with the collusion of MI5 and possibly the CIA, 18 police officers raided the Rolling Stone Keith Richards’s cottage in Sussex and Richards and Mick Jagger were charged with drug possession. After a grotesque show trial – yet another strike against that supposed Summer of Love – both Stones received prison terms for offences that normally would have rated a small fine or merely probation.

The recent death of Richard Neville, the founder of Oz magazine, awoke further memories of that moment when the Sixties’ indulgence of youth was suddenly turned off. The 1971 trial of Neville and his two co-editors for conspiracy to corrupt youthful morals (specifically by depicting Rupert Bear with an erection) was just as self-defeatingly comical as the Lady Chatterley prosecution almost a decade earlier.

For millennials who grew up around the year 2000, the Sixties are an object not so much of nostalgia without memory as envy without memory. My 25-year-old daughter often remarks what a terrific time my generation had and what a messed-up world we created for hers. I can’t argue with that.

Philip Norman’s “Paul McCartney: the Biography” is published by Weidenfeld & Nicolson. He tweets at: @PNormanWriter

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