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

Photo: Miles Cole
Show Hide image

Labour's populism for the middle classes

Jeremy Corbyn has consolidated a bourgeois capture of the party begun by Tony Blair.

With the rise of Jeremy Corbyn a mutant strain of populism has become an integral part of British politics. Commentary on the general election and its dramatic upshot has focused on Theresa May’s disastrous campaign and the hubris of her now departed senior advisers. But what finally defeated the Conservatives was that, along with practically everyone else, they underestimated the power of Corbyn’s message. As the advance of the far right has stalled in Europe and with Donald Trump adrift in Washington, the peaking of populism has been announced almost daily, especially by the Financial Times. The rise of a far-left version in Britain went largely unappreciated.

Corbyn’s campaign had more than a little in common with Trump’s experiment in engineering popular emotions and perceptions. The ecstatic mass rallies, the indifference to fact shown in the Labour leader’s repeated denials of his meetings with terrorists and of the reflexive anti-Semitism that pervades much of the movement he has created, the belief of his supporters that the media are conspiring against him and the poisonous Twitter abuse of his critics are clear parallels. But this is not a protest from despairing communities left to moulder in abandoned zones of economic desolation. It is populism for the middle classes, serving the material and psychological needs of the relatively affluent and the well-heeled.

Labour’s success in taking Kensington in west London will be remembered as a defining event. That Corbyn could seize a safe Tory seat in one of the richest constitu­encies in the country is testimony to an extraordinary shift. It is also the culmination of a transformation in Labour that has been under way for many years. Corbyn has solidified a bourgeois capture of the party begun by Tony Blair. Public-school Stalinists and Debrett’s-pedigreed Trotskyites have long been familiar figures in the upper reaches of the left, just as they are today. What is new is Corbyn’s marriage of radical leftist ideology with a systematic appeal to middle-class interests. Nowhere is this better expressed than in Labour’s manifesto promise to abolish student tuition fees (which would cost the country as much as £12bn) and reintroduce maintenance grants, while declining to unfreeze welfare benefits on the grounds that reversing Tory cuts would be (as Emily Thornberry put it in May) “unaffordable”. Rather than addressing the desperate lack of opportunities for working-class children, who may never make it to university, Labour has successfully courted the middle-class youth vote.

Labour’s embourgeoisement is an important reason for Corbyn’s success. For Blairites, this can only be bitterly ironical. Peter Mandelson’s stupefaction at the election result showed him struggling to grasp how the modernisation of Labour he masterminded could have such paradoxical consequences. Extending Labour’s reach beyond its working-class base was one of the keys to Blair’s electoral successes.

The goal was to return Labour to power by aligning the party with neoliberal economic policies and the large numbers of those who for a time were benefiting from them. The project was continued by Gordon Brown, and until the financial crisis it worked fairly well. At that point a shiver of doubt went through the body politic. Movements such as Occupy became more prominent. Inequality was back on the political agenda. Another Great Depression had been avoided, but the effect of near-zero interest rates was an inflation of asset prices that left the rich even richer. At the same time, many people found their incomes stagnant or falling in real terms, but their discontent failed to find effective political expression. Because of his inability to communicate to a mass audience and failure to target the beneficiaries of his policies, Ed Miliband’s move to the left came to nothing.

Corbyn’s opportunity to mobilise the anti-capitalist mood came by accident, as an unintended consequence of Miliband’s decision (supported by Blairites) to include the party’s mass membership as voters in leadership contests. The upshot was an organised takeover of the party by hard-left forces, the paralysed impotence of its parliamentary wing and Corbyn’s unchallengeable dominance today. Labour has been modernised, but not in the way Mandelson intended. Whether by serendipity or by design, Corbyn has brought together some of the most vital forces on the contemporary scene: the anti-capitalist radicalism of young people who are innocent of history, a bourgeois cult of personal authenticity and naked self-interest expressed as self-admiring virtue. Nothing could be more exotically modern than Corbyn’s hybrid populism.

Media obsession with the performance of the two main party leaders has obscured this larger picture. It is true that Corbyn acquired a charismatic fluency in the course of the campaign, whereas Theresa May appeared inflexible and lacking in empathy. The result was close enough for this dif­ference to matter – especially as so much had been made of May’s leadership qualities. But the strategic positioning of the two parties has more enduring significance. May and her advisers aimed to create a working-class conservatism by harvesting former Ukip voters and exploiting the alienation of Labour’s old base from a metropolitan, liberal consensus. By offering more stringent control of immigration, and shelter from globalisation through an active industrial strategy, she believed that Labour’s old fortresses could be stormed. If there was such a thing as a May project, this was it.

***

Reconciling the anarchic productivity of the market with social cohesion is the political dilemma of the age, and there is no reason to think that it is, even in principle, properly soluble. May’s manifesto had the merit of at least acknowledging the problem. But the electoral arithmetic on which her strategy depended was over-simple. The Labour vote was stickier than expected, and in some constituencies the party may have benefited from Ukip’s collapse. Much criticised for his equivocations on Brexit, Corbyn turned out to have read the public mood astutely. Support for Remain had shrunk substantially, but few voters were chiefly exercised by Brexit. When he refused to put it at the heart of his campaign, Corbyn outsmarted May’s advisers and strategists. In turn, he helped bring about a move back towards something like a two-party system.

That Ukip lost its reason for existing once Brexit got under way was the theme of countless op-eds before the election. But the same logic applied, in lesser degree, to Tim Farron’s Liberal Democrats. Even before the election, it was apparent that a large new grouping of “Re-Leavers” had appeared, while support for reversing Brexit had slumped. Zac Goldsmith retaking Richmond Park and Kate Hoey increasing her majority despite a determined effort to oust her in Vauxhall showed Brexiteers prevailing in what had been strongly Remain constituencies. In contrast, the Lib Dems were damaged by Farron’s decision to shape their campaign around the demand for a second referendum. Though the party made a modest gain in seats (even as its vote share fell), Farron held on by a much-reduced majority and Nick Clegg lost the constituency he had held for 12 years. Because of their fixation on Brexit the Lib Dems remain where they have been for so many years, a bit player in national politics.

More than anything else, it is the spectacular setback suffered by the Scottish National Party that has produced the shift back to two-party politics. Nicola Sturgeon fought the election by trying to link Scottish independence with resistance to Brexit. Ignoring cautionary voices in her party, she displayed a hubris starker than any Theresa May showed. Roughly a third of SNP supporters voted Leave in the referendum, and many others have been disillusioned by the SNP’s record on domestic issues. By making a second independence referendum the central issue in the SNP’s campaign, Sturgeon has shortened her political career and posed a question about the need for the continued existence of her party. With her credibility damaged, Alex Salmond and Angus Robertson casualties of the election, and the push to independence indefinitely postponed, a new generation will have to redefine what the SNP means today.

The compelling leadership of Ruth Davidson was a decisive factor in the revival of Scottish Conservatism. Not only has she revived the party north of the border and buried any prospect of Indyref2 for the foreseeable future, she has, by adding 12 Conservative seats in the Commons, saved the Conservatives in Westminster from outright defeat and delivered the UK from any risk of Scottish secession. The new Scottish MPs could be as important in shaping the government’s approach to the EU as the ten Democratic Unionists to whom May has turned in cobbling together a minority government. Davidson favours what she calls an “open Brexit”, which might mean a version of a Norwegian-style model in which Britain joins the European Free Trade Association and the European Economic Area, ensuring access to the single market. The Democratic Unionist Party leader, Arlene Foster, pointed in a similar direction when she spoke of the need to keep the border with the south open and avoid a hard Brexit.

There have been suggestions that May could end up negotiating with Brussels to secure some such deal: the opposite of the stance on which she fought the election. But given her weakened position the advantage would lie with EU negotiators, who might be tempted to make punitive demands. At that point negotiations could break down, as May cannot risk losing the support of the Brexiteers who are keeping her in power.

***

Of course, there may be a challenge to her leadership. Inevitably, Boris Johnson is being touted as someone with the human touch that May is seen to lack. But Johnson has dismissed all such talk as “tripe” – at least for the time being. A leadership contest in the current circumstances would be savage and rancorous, leaving the Conservatives dangerously weakened in another general election that would soon follow. Are they ready to risk another gamble in the near future with even higher stakes than before? They lost their majority for the same reason Labour moderates lost control of their party: they failed to take Corbyn seriously. To make the same mistake again would look like carelessness.

There must be many who still cannot imagine Jeremy Corbyn as prime minister. After all, Labour failed to win the election. May lost her wager, but in numbers of votes she matched Margaret Thatcher’s 1983 landslide (the electorate is now larger, of course). Corbyn edged closer to power, but many Labour MPs continue to think him unfit to be leader of his party, let alone the country. Yet it would be foolish to conclude that Corbyn will not enter Downing Street.

So far, his march towards power has been greeted with remarkable complacency. Believing it will enable a less disruptive Brexit, the markets have welcomed the humiliation he has inflicted on the May government. The smirking Cameroons have not been able to conceal their vengeful satisfaction. The property tycoons of Chelsea must be congratulating themselves on having seen off a threat to their children’s inheritances. And Remainers will be thrilled as the prospect of an all-out Brexit seems to have faded from view.

These could be brief and costly pleasures. Markets will start to panic if another election is called, and if Corbyn wins they will go into a tailspin. Capital flight will surely leave his government unable to finance its cornucopian schemes, which include expensive commitments to renationalise rail, mail and water companies. Though students will be cheering at the prospect of their burden of debt being lifted from them, the largesse they have been promised is ­unlikely to materialise. Labour would face the same pressure on public services that led the Conservatives to revise their policies on care homes, but in much-worsened fiscal conditions.

It is unclear that Labour, once in government, would opt for a soft Brexit. Corbyn has repeated the mantra about preserving access to the single market and putting jobs first. But the shadow chancellor, John McDonnell, has said that Labour accepts Britain must honour the EU referendum and may have to leave the single market. There is a hard-left tradition that dreams of a socialist Britain outside the EU, and while Labour may have won by attracting youthful Remainers, the millions of Labour supporters that voted Leave have not gone away.

A Corbyn government would be more divided on Brexit than that of Theresa May. The upshot could be that no deal is reached – a scenario not unlike that favoured by hard Brexiteers, but without any of the preparatory work that could make it viable. As house prices in London crumbled, the nabobs of Chelsea would find their cleverness had backfired. Hopeful Remainers and spiteful Cameroons would have the smile rudely wiped off their face.

At present, Corbyn is walking on water. Like Chauncey Gardiner at the end of Hal Ashby’s magical film Being There, who after leaving his walled garden enchanted the world with his unexpected wisdom and Zen-like calm, the Labour leader seems to defy the laws of gravity. Yet politics is not magic, and the mutant strain of populism he embodies cannot conjure away painful realities. If he finds himself facing the ordeals of power, Corbyn will quickly fall to Earth, along with much else in Britain.

John Gray is the New Statesman’s lead book reviewer. His latest book is The Soul of the Marionette: A Short Enquiry into Human Freedom.

This article first appeared in the 15 June 2017 issue of the New Statesman, Corbyn: revenge of the rebel

0800 7318496