Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis

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When it comes to responding to Islamic State, there is no middle ground

If Britain has a declared interest in curtailing Islamic State and stabilising Syria, it is neither honourable nor viable to let others intervene on our behalf.

Even before the brutal terrorist attacks in Paris, British foreign policy was approaching a crossroads. Now it is time, in the words of Barack Obama, addressing his fellow leaders at the G20 Summit in Turkey on 16 November, “to step up with the resources that this fight demands”, or stand down.

The jihadist threat metastasises, and international order continues to unravel at an alarming rate. A Russian civilian charter plane is blown out of the sky over the Sinai Peninsula in Egypt, killing 224 people, most of them returning from holiday, and the various offshoots of Islamic State bare their teeth in a succession of brutal attacks in France, Lebanon, Tunisia, Turkey and further afield. Our enemies are emboldened and our friends want to know to what extent we stand with them. The UK can no longer afford to postpone decisions that it has evaded since the Commons vote of August 2013, in which the government was defeated over the question of joining US-led air strikes against President Bashar al-Assad’s regime following a chemical weapons attack on Syrian civilians. MPs’ continued introspection is on the verge of becoming both irresponsible and morally questionable. There is no fence left to sit on.

On Sunday night, two days after the Paris attacks, the French – with US support – launched a series of bombing raids against Islamic State targets in Raqqa. With much more to come, the choice facing this country may not be easier but it is certainly clearer. Britain must determine whether it wants to be a viable and genuine partner in the fight against Islamic State, and in the long-term efforts to bring an end to the assorted evils of the Syrian civil war; or whether we are content to sit on the sidelines and cheer on former team-mates without getting our knees dirty. We can join our two most important allies – France and the United States, at the head of a coalition involving a number of Arab and other European states – in confronting a threat that potentially is as grave to us as it is to France, and certainly more dangerous than it is to the US. Alternatively, we can gamble that others will do the work for us, keep our borders tighter than ever, double down on surveillance (because that will certainly be one of the prices to pay) and hope that the Channel and the security services keep us comparatively safe. There is no fantasy middle ground, where we can shirk our share of the burden on the security front while leading the rest of the world in some sort of diplomatic breakthrough in Syria; or win a reprieve from the jihadists for staying out of Syria (yet hit them in Iraq), through our benevolence in opening the door to tens of thousands of refugees, or by distancing ourselves from the ills of Western foreign policy.

That the international community – or what is left of it – has not got its act together on Syria over the past three years has afforded Britain some space to indulge its scruples. Nonetheless, even before the Paris attacks, the matter was coming to the boil again. A vote on the expansion of air operations against Islamic State has been mooted since the start of this year, but was put on the back burner because of the May general election. The government has treated parliament with caution since its much-discussed defeat in the House in summer 2013. The existing policy – of supporting coalition air strikes against Islamic State in Iraq but not Syria – is itself an outgrowth of an awkward compromise between David Cameron and Ed Miliband, an attempt to reverse some of the damage done by the 2013 vote in parliament.

The Conservatives have waited to see where the ground lies in a Jeremy Corbyn-led Labour Party before attempting to take the issue back before the Commons. Labour pleaded for more time when Corbyn was elected, but there is no sign that the Labour leader is willing to shift in his hostility to any form of intervention. More significantly, he has now ruled out Labour holding a free vote on the matter.

If anything, the coalition of Little Englanders, anti-interventionists and anti-Americans in the House of Commons seems to have dug its trenches deeper. This leaves the Prime Minister with few options. One is to use the Royal Prerogative to announce that an ally has been attacked, and that we will stand with her in joining attacks against Islamic State in Syria. The moment for this has probably already passed, though the prerogative might still be invoked if Isis scores a direct hit against the UK. Yet even then, there would be problems with this line. A striking aspect of the killing of 30 Britons in the June attacks in Sousse, Tunisia, is just how little domestic political impact it seems to have made.

Another option for Cameron is to try to make one final effort to win a parliamentary majority, but this is something that Tory whips are not confident of achieving. The most likely scenario is that he will be forced to accept a further loss of the UK’s leverage and its standing among allies. Co-operation will certainly come on the intelligence front but this is nothing new. Meanwhile, the government will be forced to dress up its position in as much grand diplomatic verbiage as possible, to obfuscate the reality of the UK’s diminishing influence.

Already, speaking at the G20 Summit, the Prime Minister emphasised the need to show MPs a “whole plan for the future of Syria, the future of the region, because it is perfectly right to say that a few extra bombs and missiles won’t transform the situation”. In principle, it is hard to argue with this. But no such plan will emerge in the short term. The insistence that Assad must go may be right but it is the equivalent of ordering the bill at a restaurant before you have taken your seat. In practice, it means subcontracting out British national security to allies (such as the US, France and Australia) who are growing tired of our inability to pull our weight, and false friends or enemies (such as Russia and Iran), who have their own interests in Syria which do not necessarily converge with our own.

One feature of the 2013 Syria vote was the government’s failure to do the required groundwork in building a parliamentary consensus. Whips have spent the summer scouting the ground but to no avail. “The Labour Party is a different organisation to that which we faced before the summer,” Philip Hammond, the Foreign Secretary, has said. It is ironic, then, that the Prime Minister has faced strongest criticism from the Labour benches. “Everyone wants to see nations planning for increased stability in the region beyond the military defeat of the extremists,” says John Woodcock, the chairman of the Parliamentary Labour Party defence committee, “but after two years of pussy-footing around, this just smacks of David Cameron playing for time when he should be showing leadership.”

The real story is not the distance between the two front benches but the divisions within both parties. There are as many as 30 Conservative MPs said to be willing to rebel if parliament is asked to vote for joining the coalition against Islamic State in Syria. It seems that the scale of the Paris attacks has not changed their position. A larger split in the Labour ranks also seems likely. Even before Paris, there were rumoured to be roughly 50 MPs ready to defy their leader on this question.


At first, in the wake of last week’s attacks, it seemed as if the Prime Minister might force the issue. To this end, he began the G20 in Turkey with a bilateral meeting with President Putin. His carefully chosen words before and after that discussion, in which he was much more emollient about Moscow’s role, showed the extent to which he was prepared to adapt to the changing situation. Cameron hoped that if he could show progress in building an international coalition on the diplomatic front, that might just give him enough to get over the line in a parliamentary vote.

This new approach has not had the desired effect. At the time of writing, the government believes it is too risky to call another vote in the short term. It calculates another defeat would hugely diminish Britain’s standing in the world. In truth, the government was already swimming upstream. On 29 October, the Conservative-
dominated Commons foreign affairs select committee, chaired by Crispin Blunt, released a report on the extension of British military operations into Syria, in anticipation of government bringing forward a parliamentary vote on the question. The report recommended that Britain should avoid further involvement unless a series of questions could be answered about exit strategy and long-term goals. The bar was set deliberately high, to guard against any further involvement (even the limited option of joining the existing coalition undertaking air strikes against IS in Syria).

The most flimsy of the five objections to further intervention in the report was that it will somehow diminish the UK’s leverage as an impartial arbiter and potential peacemaker. This is based on an absurd overestimation of the UK as some sort of soft-power saviour, valued by all parties for its impartiality in Middle Eastern affairs. Britain cannot hope to have any influence on policy if it is always last to sign up while others put their lives on the line. As so often in the past, what masquerades as tough-minded “realpolitik” is nothing of the sort. It is just another post-facto rationale for inaction.

Although it is sometimes said that Britain has yet to recover from the consequences of the invasion of Iraq, the committee report had a retro, 1990s feel. Many of the objections raised to burden-sharing in Syria were the same as those raised against humanitarian intervention in the Balkans two decades ago, when Blunt was working as special adviser to Michael Rifkind as defence and foreign secretary, and the UK was at the forefront of non-intervention. Likewise, two of the committee’s Labour members, Ann Clwyd and Mike Gapes, were veterans of the other side of that debate, and strong supporters of the Nato intervention in Kosovo in 1999. They expressed their dissent from the report’s conclusions but were voted down by their Conservative and SNP fellow committee members. “Non-intervention also has consequences,” said Gapes when he broke rank. “We should not be washing our hands and saying, ‘It’s too difficult.’”

Polling figures have shown majority public support for air strikes against IS since the spate of gruesome public executions that began last year, but nothing seems to change the calculus of the rump of anti-interventionist MPs.

All this promises an uncertain future for British foreign policy. On 6 November, the Defence Secretary, Michael Fallon, suggested that the UK’s existing position, of joining the coalition in Iraq but stopping at the borders of Syria, is “morally indefensible”. The killing of Mohammed Emwazi, aka “Jihadi John”, by a US predator drone on 12 November demonstrates what he meant. Emwazi was a Briton who was responsible for the beheading of British and American citizens, as well as countless Syrians. While the UK government was closely involved in that operation – and has previously used the justification of “self-defence” to “take out” targets in Syria – such are the restrictions placed upon it that we are forced to ask our allies to conduct potentially lethal operations (which are in our core national interests) on our behalf. The very act of “self-defence” is subcontracted out once again.

How long can this last when Islamic State poses a much greater threat to the UK than it does to the US? There is an issue of responsibility, too, with hundreds of British citizens fighting for and with Islamic State who clearly pose a grave danger to other states.


The very notion that Britain should play an expansive international role is under attack from a pincer movement from both the left and the right. There are two forms of “Little Englanderism” that have made a resurgence in recent years. On the left, this is apparent in the outgrowth of a world-view that sees no role for the military, and holds that the UK is more often than not on the wrong side in matters of international security, whether its opponent is Russia, Iran, the IRA or Islamic State. The second, and arguably just as influential, is the Little Englanderism of the right, which encompasses a rump of Tory backbenchers and Ukip. This is a form of neo-mercantilism, a foreign policy based on trade deals and the free movement of goods that regards multilateralism, international institutions and any foreign military intervention with great suspicion, as a costly distraction from the business of filling our pockets.

The time is ripe for long-term, hard-headed and unsentimental thinking about Britain’s global role. The country is not served well by the impression of British “decline” and “retreat” that has gained ground in recent times; and it is no safer for it, either. Given how quickly the security and foreign policy environment is changing, the publication of the Strategic Defence and Security Review in the coming week, alongside an update of the National Security Strategy, is likely to raise more questions than it answers. The officials responsible for its drafting do not have an easy brief, and news forecasting is a thankless task. Strategic vision and leadership must come from our elected politicians.

For all the talk of British decline, we are still one of the five wealthiest nations in the world. What we do matters, particularly at moments when our friends are under attack. However, until a new broad consensus emerges between the mainstream Labour and Conservative positions on foreign policy, the Little England coalition will continue to have the casting vote.

Syria continues to bleed profusely and the blood seeps deeper into different countries. There will be no political solution to the civil war there for the foreseeable future; to pretend that there is a hidden diplomatic solution is to wish to turn the clock back to 2011, when that might have been possible. Nor is the security situation any easier to deal with. A few hours before the attacks in Paris began, President Obama gave an interview in which he argued that he had successfully “contained” Islamic State. For the wider Middle East and Europe, that is simply not the case. Now, France will escalate its campaign, and the US will do more. Russia already has troops on the ground and will most likely send reinforcements.

The war in Syria is becoming more complicated and even more dangerous. The best that can be hoped for is that the Syrian ulcer can be cauterised. This will be achieved through the blunting of Islamic State, simultaneous pressure on Assad, and the creation of more safe places for Syrians. All roads are littered with difficulties and dangers. Yet, in the face of this ugly reality, is Britain to signal its intention to do less as every other major actor – friend and foe alike – does more? If we have a declared national interest in curtailing Islamic State and stabilising Syria – both because of the growing terrorist threat and because of the huge flow of refugees – then it is neither honourable nor viable to let others take care of it on our behalf.

John Bew is an NS contributing writer. His new book, “Realpolitik: a History”, is newly published by Oxford University Press

This article first appeared in the 19 November 2015 issue of the New Statesman, The age of terror