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: Getty
Show Hide image

Flight: an essay

A story about leaving by imprisoned writer and human rights consultant Ali Gharavi.

This is the lucky night you will try to flee your country.

You do realise you are one of the luckier ones, don’t you?

You will fly out of Tehran’s main airport. Your aunt had to hike through the snow-capped mountains of Azerbaijan Province.

You get to say goodbye, if only to your grandparents. Your aunt left on ten minutes’ notice.

She didn’t say goodbye.

Yes, you are lucky, all right.

But you don’t notice feeling lucky. You don’t really notice feeling anything. There is fear, of course. But these days fear is a constant companion, lingering like an impending migraine pestering you right under your skin.

And daily life provides the prospects of getting shot on the street, being bombed from the sky, getting attacked by street thugs, getting arrested by the morality police, being hijacked off the city bus by lecherous men, or being hunted in a local school by lecherous boys.

These days, daily life paints the fear-stretched canvas of your soul with vivid splashes of terror.

But tonight, if you successfully get on that plane, it will be the last night you will spend in your home. The revolution has taken hold, and the revolutionaries do not tolerate your kind, with your western-educated parents, your feminist aunt, your apostate uncle and your military-general grandfather. The revolution is out on a purge of your corrupt way of thinking, your decadent way of life.

So your departure has been kept a secret. They are not asking you to leave, they are not allowing you to leave. They are demanding you and the likes of you repent, become someone else. Even within the confines of your own house, you have to conform to their wishes. You must pretend to recoil at what they deem evil and rejoice at their brand of joy. Inside your home, within your country, you have become an outsider. Your leaving without ever being ordered to is validation of the sneaking sense that you no longer belong.

They have beaten your aunt on the streets, they have harassed you at school, they have spat on your mother in the market, they have threatened your grandfather in his own home, they plan to send you to win or die in a war that cannot be won, they have forced their way into your most private places to bring you their version of salvation. 

In this new social order, you are an unwanted pest, but not allowed to leave. Leaving will mean sneaking out, the quiet scurry of a cowardly rodent.

And yet you must be thankful for the opportunity to choose your life over someone else’s conviction, even though it means deserting your family and your country in their time of dire need. For your escape, you are even allotted a suitcase—a red Samsonite hard-shell—and three weeks for packing a lifetime. Lucky again, since your lifetime has been only 16 years. At first you welcome the distraction from the world outside and the uncertainty within.

But this, too, proves daunting. It is one suitcase, after all, and you can put in all you want, as long as it weighs less than 30 kilograms. What you pick, you will keep for a long time; what you leave behind, you will never see again. What books to take? How to pick from the 400-strong collection of Matchbox cars? Will you leave your father’s Zenith camera, your main inheritance, behind? Will you part with the complete collection of your Tin Tin adventure series? Maybe this will be your rendition of a Tin Tin adventure. He is always able to travel lightly to unknown places and find new friends. Speaking of friends, you will obviously not be able to pack any of those in the suitcase. None of them will be going with you, and none of them know you will be gone.

News of this monumental event affecting your lives and friendships will remain trapped in your throat: you will have to deprive the little words tickling your vocal chords of the air that would give them flight. Your friends will remain oblivious until the first day of eleventh grade. They will file in to your second-floor classroom on the first day of fall, hear your name called for attendance, see that your seat is empty, and will realise it always will be. You're leaving your home and hometown, Tehran, is a secret dressed up as a summer vacation.

***

On this moonless night at two in the morning, you stand wide-eyed atop the stairs leading  to the walled front yard of your home, next to a slightly bulging suitcase, looking down at the flower garden, the family’s Mitsubishi Gallant, and the heavy sheet-metal gate leading to the dark street. Your eyes scan past the small bush with cloudlike flowers, underneath which you helped bury grandfather’s military medals, past the spot on a stone step where you had a bonfire of your aunt’s poetry.

You look at the dirt-filled pond where you practiced long jumping and military crawling, shooting bb guns at pickle cans and building snow fortresses after wintertime roof-shovelings. You stare at the crevice between the flowerpots and the basement steps, where you snuck out with your grandmother during nighttime air raids and together rode the seesaw of panic and curiosity set to the score of anti-aircraft fireworks.

The creak of the house door behind you sets things in motion. Your mother and grandparents step onto the landing, and the procession towards the dark unknown begins.

Suddenly everything is vivid, all senses keen. Your grasp against the suitcase handle jiggles and jolts as you drag the suitcase across the slate stairs and onto the driveway. The marble steps showcase every fault line, reminding you of days you pretended they were maps of unknown places far from here. The crusted paint on the railing scratches your hand; the same paint you spent a summer applying wrongly, waiting for it to dry, stripping and sanding it, and reapplying it again, wrongly.

The brown Mitsubishi stands quiet, headlights shyly looking straight ahead; the same headlights you helped tape over with slitted-up blue carbon paper for driving during air raid blackouts. You run your fingers along the pockmarked hood, onto the windshield and the broken side-mirror. Your eyes scour the backseats for the remnants of previous trips, spilled cocoa-puffs and pistachio nuts, or the hard candies your grandfather requested with clocklike frequency en route to the Caspian Coast: Two please, one for each cheek, because you always want to go through life in balance.

You peel your glistening palm from the Samsonite handle to touch the cool of the garage doors. The foreboding, three-meter-tall metal doors that protected you as best they could from bullies and bullets; who thanked you for a proper paint job by divulging the secret to unlatching them with one hand; the doors who screeched with dismay when the revolutionary gunmen stormed into your sanctuary, unable to keep them out; the same doors who will grumble because they cannot keep you in.

The sparkle of the marble fault lines, the bumps of the slate driveway, the aroma of specks of dirt, the smoke-cloud flowers, the chipping paint, your many eyes in the broken side-view mirror, all stretch invisible arms to embrace you, to keep you home a moment longer.

But it is the real, open arms of your grandmother you find yourself lunging for. Her embrace is as always soft and safe, but for the first time it is also tenuous. She doesn’t speak or ask questions, but her staccato breath tells you a thousand times over that she is parting with the first of her children, your mother, and the first of her grandchildren, you. As you climb into the waiting taxicab, busy with leaping into an unknown and adventurous journey, she must go close the grumbling metal doors, walk past the quiet car, up the marble steps, into the house, to confront the empty rooms that her last remaining child and grandchild once called home.

***

The sleepy city does its best to go unnoticed past the taxi windows: an early bird street sweeper here, a hobbling stray dog there. The Azadi monument, the white Arc-de-Triomphe of yesteryear, flashes past your window as if ignoring a trespasser; or maybe it is too sad to look you in the eye and bid you farewell.

The airport is awake and awash in bright lights and a white-noised hustle. You and your Samsonite follow your mother and hers through the doors and onward to the departure hall. Somewhere on the other side of this labyrinth of a building stands the airplane that will lift you from here - if you reach it.

You must successfully pass with your age undetected through an obstacle course of checkpoints. At sixteen you are not officially barred from leaving. But sixteen year-olds aren’t officially dying by the busload at the war front either.

Your lack of facial hair and “girly” voice have been fodder for constant taunting by classmates and cousins. But here, prepubescence is an asset in the calculus of safe passage through the document check. Your mother’s passport, in which you are noted as a child co-traveler, sits in a cubbyhole behind a control desk. The attendant spends eternal seconds to locate it, check the picture against your mother’s face, hand the passport over unceremoniously and wave the two of you by. The first of the gauntlets is traversed.

Next, a baggage controller demands you carry your luggage and follow him to his pedestal. He is wearing a grey, sweat-stained dress-shirt with sleeves rolled up to elbows; dark, dusty slacks; and worn-out dress shoes fashioned into slippers, which he drags on the smooth mosaic of the terminal as he saunters to his perch.

The control is meant to prevent illegal exportation of goods. The caveat is that there is no indication of what constitutes an illegal good. You are at the mercy of your baggage-controller: of what he considers illegal, what he might find of interest for him to keep, and whether he finds your face appealing. You can see your mother undergoing a similar fate with a larger suitcase and a large, veiled woman. They are more animated, one woman lifting this blouse or that, saying something to the other’s flushed face, and the other taking it from her, folding and putting it back.

Things are less controversial with your controller, in the beginning. He ensures all items are sufficiently disturbed; the one Tin Tin book you couldn’t part with flipped through and scoffed at, stacks of your shirts and pants kneaded and stretched, some socks twirled in mid-air, your Rubik’s Cube scrambled some more. After your suitcase is adequately ransacked, he waves the back of his hand to motion you off his pedestal. You will be past the second gauntlet as soon as you are able to get your Samsonite’s jaw to close over your vagabond possessions.

But you take too long and will pay for it soon, because lingering near these new compatriots means drawing attention, and attention means interaction, which is almost always unpleasant. 

He suddenly looks back.

“Is that your brown bag?” he points at the brown paper bag by your feet. You are carrying this for your mother; a token homegrown souvenir for her friend in Germany.

“Yes, it is ours.”

“What is in it?”

“Cucumbers.”

He suddenly chuckles.

“Are you planning a picnic?”

“No Agha.”

“Are you taking these…(by now he has dumped the cucumbers on top of your heap of clothes, counting them)…eleven cucumbers to Germany?”

“Yes, Agha.”

He turns to another baggage-controller and chortles, “Asghar, look, he has brought us cucumbers. Hope he has bread in another bag, and some cheese in his pockets. I’m getting hungry. Say boy, you don’t have any Bulgarian cheese with you?”

“No, Agha.” You don’t know if you should smile or be annoyed, or neither.

“Wait a second. Are you hiding something in these cucumbers?”

You choose smiling, which is a bad choice.

“Is something I am telling you humorous? Are you hiding some gold or jewelry in them?” he says, this time with no dimples on his face, and a half-threatening move in your direction.

“Oh, no, Agha!”

“Don’t they have cucumbers in Germany?”

“Not Persian ones like this, Agha.”

“Well, you’ll have to eat one of them here, just to make sure they’re actually cucumbers.”

And it is so, that at 4.20am on your last day in your country, you start biting into a randomly selected cucumber off your stack of unfolded underwear. You remind yourself of an animal at a zoo, performing tricks to amuse its masters. You continue making crunchy cucumber chewing sounds as this man stares at you with folded arms. Luckily, the constant stress of being found escaping has made you mentally absent about the real contraband you are smuggling out: your life. Instead, you resign yourself to watching the man examine every cucumber-cum-smuggling-canister (which actually are all cucumbers, it turns out), then wipe his hands on your clean, knitted-by-mom blue sweater, all the while nagging for you to chew faster because this is no fruit market for hanging around eating. You catch a glimpse of a jumbo jet's tail in the corner of a distant window, beyond another passport-check, waiting.

***

Your next task is to stand in the men's line for the body search. An official walking down the line demands you produce your passport.

“I am in my mother’s passport.”

 “Well then why aren’t you with her? You can’t just run around by yourself. You can’t be separated from the person in whose passport you appear!”

“We told them this, but the baggage-controllers separated us.”

“What idiot told them to separate you?”

Panic sets in and you answer this rhetorical question, realising too late that silence would have been a better answer.

“Agha, it is because I am a boy, and because my mother had to go to women’s line for baggage-control, and they told us the rule is that only sisters can open sisters’ bags.”

“Be quiet, you chatterbox! It is bad enough you are loitering here like a lost goat.”

He grabs you by the elbow, drags you back to the fork in the line where he commands you to stand there, summons a veiled sister to go and locate your mother who can produce a passport for you.

This is when your mind has you being taken away into a jail or a dungeon or whatever other terrible place it conjures up. In the meantime, the sister is arguing with the brother. She has already checked you against the passport, she says (though you have never seen her before). Then you get shaken by the elbow and scolded for not saying this in the first place. Years of practicing lies and deceit to survive have not trained you well enough to corroborate other people’s future lies.

He drags you to the front of the queue. He grumbles that you are stupid, that he is angry for you wasting his time, that children like you should be punished, that you must be hiding something, that he is not to be trifled with, that he will find whatever it is you are concealing, that he will teach you a lesson. He pushes you through the middle door of a bank of five doors, too fast for you to read the title of the room. He tells you to strip off all your clothes except your underwear, and to do this at once, while he goes and fetches the key to lock the door.

The room is small, rectangular and white, as wide as your wingspan, and as long as seven steps between two doors. Behind a waist-high, off-white, grungy fabric partition, there is a waist-high slab of cold, smooth metal, dented here and stained there. Nothing lines the walls, and a single, bright incandescent light bulb hangs out of reach from the center of the high ceiling. You feel confined nevertheless. Voices start dueling inside, one telling you to think of this room as a vestibule (why else would there be two doors?) — while another convinces you this is a jail cell (why else would he need a key to lock the door?).

In the moments while you wait for the man to return to be alone with you and the light bulb as your witness, you can’t bring yourself to undress. Instead you stand there, frozen, biting your lips, fighting back tears, and feeling the blood drain from your clinched fists, still holding onto the suitcase and the paper bag.

To your surprise, the vestibule’s other door opens, and an older man in an old uniform steps in. He is orderly, serious and official. He is a remnant of the border patrol of years past, he explains to you.

“Wait a moment here please,” he says, and slides past you to open the other door. His torso leans out and you hear his part of a conversation:

“I am processing the young boy in Number Three.”

“No, I have it under control—

“Yes, I will make sure—

“No, you won’t. I told you—

“NO! Go ahead, tell Brother Lari the supervisor.” 

Then he mumbles something to himself about cursing the devil for being stuck with hoodlums for colleagues.

He explains to you that he is an old border officer. He tells you not to be afraid.

“Yes, Agha.” You obey in words, but not in thought, because these days, you don’t trust anyone except members of your family (and not even all of them, either).

“What did the other officer say to you?”

“Nothing, Agha. He was upset about my mother and I not being in line together.”

“Well, you should tell him that it is their own rules.”

“I tried, Agha, but he didn’t like that either.”

“Is there anything they do like?” he asks, mostly to himself, shaking his head and motioning you to step around the screen. He asks you to stand next to the slab, remove and pass him your pants. Your body complies while your mind processes only snapshot images; your hands on your belt, your kneecap out of the pant leg, the mosaic next to your shoe, the unwrinkling of your pants as you lift it, the man’s hairy hand as he reaches across, the runaway coins twirling on the ground, the man snapping the pant legs, his hands running at the seams and the hems. His voice snaps you out of the images.

“Has anyone sewn anything inside the seams?”

“No, Agha!”

“Not even a tiny gold chain?”

“No, Agha.”

“I believe you.”

 He then tells you he has to pat you down. “I have a son your age,” he says, “around thirteen, right?” You nod, and don’t offer to correct him. He pats your shirt at the armpits and sides, then pats your behind and legs. He tells you he will not pat your private parts, and instead he will take a look.

He sneaks a peek, and you don’t know what will happen next. It is one of those instances when the next moment won’t arrive for a long, long time.

Then he steps back.

“That’s all,” he says.

“Oh?”

He steps behind the screen, and says, “Get dressed on the double, and leave this area.”  He leaves through the door you came in.

You do not linger.

You put your clothes on as fast as you can, and exit through the other door, out of that white and stained room.

You find yourself in a window-lined hallway. You can see a Lufthansa jet off on the tarmac.

The banging on the glass wall behind you turns you around. It is your mother motioning to you. You go closer, only to hear her muffled voice, unable to pick out the words. She shows her necklace in her hand, and motions to you.

You shrug your shoulders and squint.

She motions you to walk back through the vestibule to the other side.

No, you think to yourself, but you walk that way.

You crack open the second of the five doors, next to the one you have just exited. Inside, there is the man who wanted to punish you squatting behind another man who has his pants down, his legs apart. The officer keeps asking where it is hidden, and the naked man keeps swearing in a trembling voice that there is nothing he has hidden.

Neither of them has noticed you. You just back away and leave the door ajar. You go back to the glass wall where your mother sees you again. You just stand there and slowly shake your head no. Something in your face makes her understand, so she motions with the palm of her hand for you to stop and stay right there.

So you stop and stay right there, perilously close to the door through which adult voices of confrontation ooze out.

From another of the doors, the older border patrol steps out. He is holding the bag of cucumbers. He shoves them in your hands and says in a hushed forceful tone,

“Son, have you been eating donkey brains to make you stupid? I told you to move away from these doors. Do you not know what body search could mean? Get as far away from here as you can, and don’t look back, you understand?”

You don’t look at the half-open third door, and you say “Yes, Agha.”

By the time your mother makes it out, many others have come down the hallway from the border-patrol area: first the naked, straddling man, in shock and with teary eyes; then many women who come out two and two, whispering incredulous, indignant whispers and clucks. They all walk through the double doors where the airline desk and the staircase to the shuttle bus await their passage.

By now, it is noon. You and ten wilting cucumbers are all but stranded in this empty glass-enclosed hallway, thinking all manner of thoughts about the whereabouts of your mother for the past hours.

And then she walks out, cheeks flushed, headscarf clinging to the back of her head. She spots you, and scurries your way. She runs in that discrete manner of the women of your family, with feet moving and torso staying stationary, floating forward as if on a conveyor belt. Her eyebrows say she is angry; her dry eyes say she is determined. You want to scream and hug her, but instead you lift your luggage and speed up to meet her stride towards the airline desk.

Why all the delay, you ask, and she explains that the "sister" searching her refused to allow her to pass with her necklace, so she had to backtrack all the way to the parking entrance to leave her necklace with your grandfather, then had to wait in all the lines to get back to the "sister" and be searched again.

“Did you have to get naked?” you blurt.

“What?” her head snaps your way.

“Nothing.” You assume she didn’t. After all, you are sixteen, and no longer feel at ease talking about nakedness with her. But you cling to the belief that she has been one of the luckier ones.

As you climb the staircase among the last of the passengers, you concentrate on the open door of the plane, the dark portal away from the daylight of your last day at home. You hesitate a moment at the causeway and the flight attendant bids you welcome. You glance at her, and then at the dim silhouette of the Lufthansa emblem painted on the panel inside; a solitary, slender golden crane flying up and away. You don’t look behind at the terminal building where you passed through all the gauntlets. You don’t look to your right at the snowcapped mountains in the distance. A warm breeze rustles past as you step through the threshold. Your country’s goodbye is a last warm breath ruffling your head of hair. It will have to suffice.

Hours later, as you watch the mountains rolling slowly below like a sliding, crumpled, brown blanket, the captain announces that the plane has cleared Iran’s airspace. A spontaneous burst of applause is followed by some women taking off their scarves and overcoats, butterflies squeezing out of their cocoons into a new life. You look back out the window, craning your neck to see the imaginary border you crossed towards your supposed future. Inside you, a faint voice amidst all the excitement reminds you that somehow you have distilled your whole family into just your mother, and your life into a frantically bundled bunch of clothes in a red hard-shell Samsonite.

Ali Gharavi is an Iranian-Swedish writer and information technology consultant, who for 20 years has worked with human rights organisations to improve their digital strategy and security.

On 5 July 2017, Gharavi and a colleague were facilitating a workshop in Istanbul with eight activists from Turkish human rights organisations when they were detained by police. On 18 July they were all charged with “aiding an armed terrorist organisation” – six of the group, including Ali, remain in prison.

Gharavi has for several years been working on a fiction/memoir project about family and migration, from which this story is drawn.

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