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

H F Davis/Getty Images
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The dark shadow

The Brexit proposal springs from panic and would certainly be terrible news for Britain’s economy – but it carries a threat even greater than that.

It cannot be said that the European ­Union is doing particularly well at this time. Its economic performance has been mostly terrible, with high unemployment and low economic expansion, and the political union itself is showing many signs of fragility. It is not hard to understand the temptation of many in Britain to call it a day and “go home”. And yet it would be a huge mistake for Britain to leave the EU. The losses would be great, and the gains quite puny. And the “home” to go back to no longer exists in the way it did when Britannia ruled the waves.

We live in a thoroughly interdependent world, nowhere more so than in Europe. The contemporary prosperity of Europe – and elsewhere, too – draws on extensive use of economic interconnections. While the unacceptable poverty and inequality that persist in much of the world, including Britain, certainly call for better-thought-out public engagement, the problems can be addressed better without getting isolated from the largest economy next door. The remarkable joint statement aired recently, by a surprisingly large number of British economists, of many different schools, that Brexit would be an enormous economic folly, reflects an appreciation of this glaring reality. Apart from trade and economic exchange with Europe itself, Britain is currently included in a large number of global agreements as a part of the European Union. Britain can do a lot – for itself and for Europe – to correct some of the big mistakes of European economic policies.

The Brexit-wallahs, if I may call the enthusiasts that (without, I hasten to add, any disrespect), sometimes respond to concerns of the kind I have been expressing with the reply that Britain can surely retain the economic interconnections with Europe, and through Europe, even without being in the European Union. “Isn’t that what Norway largely did?” Norway has certainly done well, and deserves credit for it. But the analogy does not really work, not just because Britain is a huge economy in a way Norway is not, but much more importantly because quitting is not at all the same thing as not joining. Britain’s extensive economic ties with Europe, and a great many EU trade agreements that go beyond Europe in the multilateral global economy, are well established now and disentanglement would be a very costly process – a challenge that Norway did not have to face.

But perhaps most importantly, it must be recognised that quitting is a big message to send to Europe and to the world: a message that Britain wants to move away from Europe. As four decades of economic studies have shown, signals can be dramatically important for economic relations. Conclusions will certainly be drawn on how dependable and friendly Britain can be taken to be. A jilted partner has more reason for angst than an unapproached suitor.

***

While the economic arguments against Brexit are strong, the political concerns are even stronger. The unification of Europe is an old dream. It is not quite as old as is sometimes suggested: the dream is not of classical antiquity. Alexander and other ancient Greeks were less interested in chatting with Angles, Saxons, Goths and Vikings than they were in conversing with the ancient Persians, Bactrians and Indians. Julius Caesar and Mark Antony identified more readily with the ancient Egyptians – already strongly linked with Greece and Rome – than with other Europeans located to the north of Rome and the west. But Europe went through successive waves of cultural and political integration, greatly helped by the powerful spread of Christianity, and by 1462 King George of Podebrady in Bohemia was talking about pan-European unity.

Many other invocations followed, and by the 18th century even George Washington wrote to the Marquis de Lafayette: “One day, on the model of the United States of America, a United States of Europe will come into being.”

It was, however, the sequence of the two world wars in the 20th century, with their vast shedding of European blood, that firmly established the urgency of political unity in Europe. As W H Auden wrote in early 1939, on the eve of the Second World War:

In the nightmare of the dark
All the dogs of Europe bark,
And the living nations wait,
Each sequestered in its hate . . .

His worst expectations found chilling confirmation in the years that followed.

The fear of a repeat of what Europeans had seen in these wars continued to haunt people. It is important in this context to ­appreciate that the movement for European unification began as a crusade for political unity, rather than for an economic union – not to mention a financial unification, or a common currency. None of the follies that make the economics of the European Union so problematic arose from that vision. The remedies that are needed (on which I have written elsewhere: see “What happened to Europe?”, the New Republic, 2 August 2012) would need policy changes and institutional reforms, but not any rejection of the idea behind a united Europe.

The birth of the European ­federalist movement was motivated strongly by the desire for political unity, free from self-destructive wars, as can be seen in the arguments presented in the Ventotene Declaration of 1941 and the Milan Declaration of 1943. There was, of course, no hostility to economic integration (and its merits were understood), but the priority was not on banking and currency, nor even on trade and exchange, but on peace and goodwill and a gradually evolving political and social integration. That political unification has fallen way behind the ill-thought-out financial moves is a sad fact. The EU’s policy priorities need to be scrutinised and reworked – a process to which Britain can contribute, and from which it can benefit along with other Europeans.

***

No wars, of course, will result from Brexit, yet that does not mean that the sense of rejection and distancing will have no adverse impact on the way Europeans see each other. That the dislike of having other Europeans settling in Britain is a major reason given in favour of Brexit – playing up the fear of “our” jobs, “our” economic opportunities being taken by “them” – makes this human distancing even more poignant. It is hard not to miss the recognition that this fear, exaggerated by dubious use of numbers, has been fanned politically by the enthusiasts for Brexit. And that adds to the intensification of relational adversity. Being “sequestered in hate” is a bit of a nightmare in its own right, even without the open violence which followed that terrible nightmare, shortly after Auden wrote his poem.

The EU did not create the idea of ­Europe, just as the idea of India was not a ­product of the nationalist movement (even though an otherwise brilliant European, Winston Churchill, failed to see any more unity in India than could be found around the Equator). The message of Brexit would have huge implications, given where the world is at this time. The Polish philosopher Leszek Koakowski has rightly asked, “If we would like the EU to be more than just a place for money temples of banks and the stock exchange, but also a place where material welfare is surrounded by art and is used to help the poor, if we want freedom of speech, which can be so easily misused to propagate lies and evil, as well as be used for inspiring works – then what is to be done?” When, at the end of the Second World War and after the defeat of Nazi Germany, Britain established its National Health Service and laid the foundations of a welfare state, it was inspired not merely by ideas originating in this country, but by thoughts that had sprung up across Europe, including the ideas of Kant and Marx and even Bismarck, in the country just defeated. There was no conflict between innovative British ideas and broader European thinking, nor between British and European identities (there is no reason for us to be incarcerated in one identity – one affiliation – per head).

The proposal of Brexit is born out of panic, and it is as important to see that the reasoning behind the panic is hasty and weak as it is to recognise that wisdom is rarely born of fright. In his Nexus Lecture, called “The Idea of Europe”, given a dozen years ago, George Steiner wondered about the prospects for Europe playing a leadership role in the pursuit of humanism in the world. He argued: “If it can purge itself of its own dark heritage, by confronting that heritage unflinchingly, the Europe of Montaigne and Erasmus, of Voltaire and Immanuel Kant may, once again, give guidance.” Brexit would certainly be a bad economic move, but the threat that it carries is very much larger than that.

Amartya Sen is Professor of Economics and Philosophy at Harvard and won the 1998 Nobel Prize in Economics.

This article first appeared in the 09 June 2016 issue of the New Statesman, A special issue on Britain in Europe