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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Seasons change, Gilmores stay the same

Gilmore Girls is fundamentally about two things: inheritance and community. The four seasons are crucial in exploring those themes.

If you’re out on the road, feeling lonely and so cold / All you have to do is call my name / And I’ll be there. The Gilmore Girls theme, a special version of Carole King’s “Where You Lead” featuring extra vocals from her daughter, plays each episode over images of autumnal New England foliage, and always reminded me of another song on Tapestry, “You’ve Got a Friend”. Winter, spring, summer or fall / All you have to do is call / And I’ll be there.

“Winter”, “Spring”, “Summer” and “Fall” are the episodes that make up Gilmore Girls: A Year in the Life, Netflix’s revival of the Noughties TV series. Fans won’t be at all surprised to see Netflix lean on the four seasons to organise the new show, a fundamental principle of the original series. This integral structure remains even as they dispense with other structures of the previous seven seasons, instead of the original 22-episode year, there are just four episodes used to narrate the Gilmores’ 2016, and each one has ballooned from 45 minutes to 90. And that familiar opening? Gone.

MISS PATTY: And flutter, flutter, flutter, flutter, flutter… and leaves! Where are my leaves? I got pumpkins, I got Pilgrims, I got no leaves.

Until 2016, every episode of Gilmore Girls included the same opening credits, with shots of red and gold leaves, a Connecticut town in the throes of autumn. So, those leafy fall shots would appear at least once an episode, even though the show’s picture-perfect town, Stars Hollow, would spend each series transitioning in and out of each of the four seasons. Of course, Stars Hollow is not a real place under the influence of real changes in the weather: it’s filmed on the perpetually sunny Warner Brothers lot in Los Angeles. And New England is so inextricably associated with autumn splendour, Stars Hollow so relentlessly idyllic, you might have expected the makes of Gilmore Girls to suspend Stars Hollow in a perennial fall, with Rory and Lorelai clutching hot coffees as they tread autumn leaves underfoot all year round. (It might make thematic sense, too: Gilmore Girls’ narrative of a precocious 16-year-old, brimming with brains and potential, slowly failing to achieve her own impossible goals fits both with the season’s connotations of academic beginnings and promise, and with its longer-standing cultural affiliation with maturity, pensive reflection and wistfulness.)

DARREN: Stars Hollow is charming. The last time we drove through there, there was a pumpkin patch.
LORELAI: Sounds like us.
DARREN: In March.
LORELAI: Oh, that would be the year the pumpkins arrived late.

The idea of Stars Hollow in perpetual autumn even comes up in a few episodes. Pumpkins arrive in March, autumnal events continue until the very end of November. Fall decorations are seemingly mandatory for local businesses.  But while every Gilmore Girls viewer can immediately conjure an image of Stars Hollow in fall, so too will they have an equally memorable selection of images of the town in winter, spring, and summer. No season goes unmarked. In fact, in the hyperreal utopia of Stars Hollow, seasons are exaggerated and picturesque: an overabundance of harvest vegetables, fluffy snow, budding blossoms, or falling leaves.

LORELAI: Grass is just not this green — not outside of Pleasantville, it isn’t.
CHRISTOPHER: So, what exactly are you saying?
LORELAI: I’m suggesting they brought in sod.
CHRISTOPHER: You suspect sod.
LORELAI: Yes, or spray paint. Maybe they spray-painted the grass when they spray-painted these trees, ‘cause, I mean, there’s autumnal foliage and then there’s autumnal foliage. It’s over the top, people.

But the seasonal obsession is more than just a way to emphasise the perfection of Stars Hollow. It’s an organising principle for the show’s structure, action and themes.

***

When Kelly Bishop (the actor who plays the most senior Gilmore girl, Emily) received the script for Gilmore Girls, she was stunned by the sheer weight of it. “I kept flicking it over, and looking at the thickness of it,” she told EW. “It was too thick to be a sitcom.” Gilmore Girls, consisting of hour-long episodes that make little sense out of order, but with its emphasis on witty dialogue over dramatic plotlines, hovers in a strange space between sitcom and drama.

Sitcoms are, by definition, situational — they often rely on characters thrown together in a confined space, be it the family living room, friends flatsharing or colleagues in a shitty office space. Comedy is often drawn from the familiarity of the specific surroundings: as a result, fans of The Simpsons or Friends or The Office could accurately draw floor-plans of the shows’ unchanging sets. So, too, could you draw a map of Stars Hollow, if you’ve seen enough episodes (trust me, I’ve done it). The action of a sitcom is often suspended in time and space: episodes end back where they began, the next opening as though nothing of note has happened since. Dramas, though, tend to thrive on progression of both character and plot; casts moving inexorably forward through time and space.

LORELAI: God, the town looks beautiful.
LUKE: Same as always.
LORELAI: No, it’s always different this time of year. It’s magical.
LUKE: If you say so, sure. Oh look, there’s the magical plumbing supply store where I bought a magical float for my toilet last week.
LORELAI: You disappoint me.
LUKE: Oh look. There’s the magical Luke’s Diner, right underneath the apartment that Jess magically lit by leaving every stinkin’ light on.

So, for Gilmore Girls to straddle both these genres, Stars Hollow must hold most of the show’s action and the majority of its ensemble cast, while still allowing the passing year to make its mark on the town. The seasons allow this. Much of this work is done in the background, as the set design changes from episode to episode, but characters are also constantly remarking on the changes in the town with each passing month, as Lorelai does when snow envelops the square.

The result is not just a keen sense of place, but of a place moving through time.

***

TAYLOR: Every other store in town has fall decorations.
LUKE: Hoorah for the mob mentality.
TAYLOR: We’re talking a few streamers and a paper turkey. How’s it gonna hurt to have a paper turkey?
LUKE: No turkey, no squash, no pumpkins. Nothing colored orange.
TAYLOR: OK, you don’t like orange. That’s fine. Autumn has many varied hues to toy with. This is the Autumn Festival. Your shop is right across the street from the Horn of Plenty! You’re smack dab in the middle of everything. You have to decorate.
LUKE: I don’t have to do anything but serve food.
TAYLOR: We’re talking about the spirit of fall!
LUKE: You know where you can stick the spirit of fall?

Gilmore Girls, with its principle cast of family members, and its sprawling ensemble cast of Stars Hollow residents, is fundamentally about two things: inheritance and community. The four seasons similarly become an important device for exploring those themes.

Small rural communities have long organised themselves around the seasons. Stars Hollow is no different — except in the ridiculous extent of its embrace of all things seasonal. Each season of Gilmore Girls is organised around the constant onslaught of annual festivals: the End of Summer Madness Festival that, well, ends summer, the Teen Hayride, the 24-Hour Dance Marathon the Autumn Festival complete with Cornucopia Can Drive and Horn of Plenty, November’s Old Muddy River Bridge Knitathon, the commemorations of the Battle of Stars Hollow, the Winter Carnival, the Snowman-Building Contest, the Christmas Procession, January’s Founders’ Firelight Festival, the Bid-on-a-Basket festival, Groundhog Day, St Patrick’s Day, the Purim festival, a whole host of springtime weddings and engagement parties, the springtime Movie Night in the Square, the annual Easter Egg Hunt, the Hay Bale Maze at the Spring Fling Festival, and the Festival of Living Pictures are just selection of the events honoured in Stars Hollow.

LORELAI: Oh, hey! Turn out the lights.
LUKE: For what? It’s not the real procession, it’s just the rehearsal.
LORELAI: So, it’s pretty.
LUKE: And why do they need to rehearse it? It’s the same thing every year.
LORELAI: Come on Luke, please. It’s hard to imagine living somewhere else isn’t it?

These aren’t just background quirks, lending us an increased sense of familiarity with the town as we’re told over and over that these events unfold in the same, strange way every single year. They’re linchpins which hold key plot events in place. Both Jess and Dean tell Rory they love her, with less than positive consequences, during the supposedly romantic Founder’s Firelight Festivals. Rory’s romantic relationship with Jess speeds up when he bids on her basket at the Bid-on-a-Basket festival, which is also where Sookie and Jackson become engaged. Her relationship with Dean ends (the second time) in spectacular fashion at the Dance Marathon. Luke begins his romantic relationship with Lorelai when dancing with her amidst springtime decorations in the town square at Liz and TJ’s wedding. The list goes on.

The result is that the lives of our main characters, the lives of the smaller Stars Hollow characters, and small-town seasonal events are all inextricably linked to the same calendar. Particularly in the early seasons, every significant relationship, for both Rory and Lorelai, becomes rooted in the community of Stars Hollow. Public acts of citizenship and private expressions of love overlap. To live in Stars Hollow is to live every aspect of your life communally, communing with others, and with nature itself.

LORELAI: Do you know that the best things in my life have happened when it snowed?
RORY: Why, yes, I do.
LORELAI: My best birthday.
RORY: Your first kiss.
LORELAI: Your first steps. They all happened when it snowed.

***

The seasonal structure of the show also brings with it a sense of inevitability, as, in the midst of these reliable annual ceremonies, Gilmore Girls explores ideas of inheritance across the generations. In the grand houses of Emily and Richard’s world (and Lorelai, Christopher and Logan’s youths) inheritance both metaphorical and literal is an encouraged part of family life: but it feels forced and uncomfortable, restricting individuality in favour of decorum and reputation. In Stars Hollow, inheritance functions in a different, but no less crucial, way: more subtle and natural, as constant and eternal as the circles of life. For children who grow up with their parents in Stars Hollow, inheritance seems predestined, even if it didn’t seem so to the characters it affects.  

Many characters are surprised by what they inherit from their parents: Luke never expected to care so much for his father’s old hardware store, Lane is shocked to discover that after years of aching to break out of her mother’s conservative ideals, she’s not comfortable with having sex before marriage. Jess never thought he would pick up a book on intimacy from his uncle Luke, let alone read it sincerely, nor to learn so much valuable advice from him about communication in relationships.

LUKE: You do not want to grow up to be like your mom.
RORY: Sorry, too late.

Of course, that sense of inescapable legacies is taken to extremes in Rory and Lorelai’s relationship: in the very first episode, Lorelai exclaims to her daughter, “After all, you’re me!” While Rory at 16  is, in some ways, a vision of everything Lorelai at 16 was not (responsible, excited by her education, chaste, keeping a constant, serious eye on her future), as the series unfolds, that changes, as Rory becomes more impulsive, reckless and romantic. Viewers are relentlessly confronted by parallels between Rory and Lorelai’s romantic choices: Christopher is to Lorelai as Logan is to Rory, Luke is to Lorelai as Jess is to Rory. Seasons change, Gilmores stay the same.

LORELAI: He kind of looks like Christopher.
LUKE: The grocery kid?
LORELAI: Yeah. He looks like Christopher.
LUKE: And Christopher is Rory’s dad?
LORELAI: The hair, the build, something about the eyes. He reminds me of Christopher.
LUKE: Well that’s not too surprising.
LORELAI: You’re going to quote Freud to me? ’Cause I’ll push you in front of a moving car. This talk was going so well.
LUKE: You and Rory are a lot alike. It’s not surprising you would have similar tastes in men.

It is an inexorable, unavoidable logic, then, that sees Gilmore Girls: A Year in the Life, a show with more interest in the unfolding seasons and the passage of time than ever, that sees Rory finally become her mother. The show’s much-anticipated final four words (“Mom,” “Yeah?” “I’m pregnant”) see Rory at 32, the same age as her mother when the series began, in a similar position to her mother at 16: single, pregnant, unfocused in her career. Some found it frustratingly obvious and pessimistic, others found it optimistic and apt. I’d sum it up in the same way Lorelai comments on her repeating circumstances with her own mother: with a grimly ironic toast “to the circle of life”.

But however you feel about the ending, Gilmore Girls has pulled off one impressive feat. As Lorelai and Rory sit together in the bandstand, and the show cuts to black, it doesn’t feel like the show has ended at all. The fictional landscape of Stars Hollow has a life that extends beyond the screen, as inevitable as the seasons themselves.

Anna Leszkiewicz is a pop culture writer at the New Statesman.