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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The age of lies: how politicians hide behind statistics

Perhaps it is time to combine our Trump-era, heightened sensitivity to untruths with a new broadcasting technique or two.

The small slabs of crude election soundbites, with extra ornamentation in the form of half-true and meaningless headline statistics, clunk across the airwaves, and we grimace. The dead prose reaches us umpteen times a day – “an economy that works for all”, “the many and not the few”, “work is the way out of poverty”, “more being spent on our schools than ever before”, “the NHS is treating more patients than ever ­before”, “fastest growth rate in Europe”, “the national interest”, “the most ­important election in my lifetime” – and yes, let’s hear it for “strong and stable leadership”.

On 30 April, Andrew Marr tried a little witty and civilised pre-emptive mocking to stop Theresa May using soundbites in his interview with her, but it did not work because it could not work. Embarrassment about clichés and almost idiotic numbers is not what democratic politicians worry about at election time. Many of us may pine for the old American game-show device – where, for failing to amuse and divert the audience, contestants are removed from the fray by a man hammering a gong – but that is not on offer and, in election mode, the politicians will do as they have long learned to do. They will listen to the Lynton Crosbys and Seumas Milnes of this world and plough on – and on.

The soundbites are largely vacuous and we are more noisily sardonic about them than three decades ago (hooray for media literacy) but they aren’t worse than normal. There is no point expecting the debate to run on the lines of Gladstone’s Midlothian campaign 140 years ago, when he charged around Britain giving five-hour speeches – richly informed by Liberal philosophy – which did the trick for him and his party.

The clichés are, naturally, often interchangeable. Everybody running for high political office could quite contentedly utter any or all of the above phrases, though I concede it doesn’t require an inspired analyst of modern British politics to know what Theresa May is trying to do with her leadership riff – nor Jeremy Corbyn with his “rule for the many and not the few”, a phrase that has been used religiously since the adoption of universal suffrage. Only Jacob Rees-Mogg would put it to one side.

I spent almost 30 years at the BBC – working with a cadre of (mostly) hugely talented and impartial presenters and editors trying to find ways of injecting a bit more surprise or rigour into political interviews. (Surprise and rigour are often not the same thing.) I recall David Dimbleby reducing Alastair Campbell to semi-public fury in 1997 by excavating Tony Blair’s early political career and finding, neither surprisingly nor, in my view, particularly reprehensibly, that he had said Michael Foot-like things in a Michael Foot-like era. Oddly, nobody had thought to do this after he had been elected leader three years earlier, so Dimbleby’s approach to Blair had an element of ­surprise. And then there was John Humphrys’s relentless needling of Gordon Brown for his comic refusal after the 2008 financial crash to use the word “cuts” to describe what might have to happen to reduce the budget deficit, or even to agree with his own chancellor, Alistair Darling, that the global economic outlook was very bad. Brown had an on-air mega-curdle.

We know the score – the politicians find the rhetorical and statistical position that provides the best short-term defensive crouch, while the interviewer at least wants to make sure that the audience knows the question posed is relevant, fair and, if need be, that it has been dodged. Time presses on both participants – but the impact of the compression is unequal. The interviewee usually has the upper hand. In her early period Margaret Thatcher, who was a good deal more nervous than her subsequent reputation for clarity and authority would suggest, might well have been the all-time queen of interview delay tactics. However, most interviewees know that once they have found an answer to a question the first thing to do is to pad it out in case the next question is a little more difficult.

I am not outraged by any of this; nor do I believe these encounters should be dismissed as sterile, or that we should be contemptuous of the skills involved on either side of the exchange. The sort of one-sided triumph enjoyed by LBC’s Nick Ferrari with Diane Abbott is rare, and her numerical amnesia over policing made a whole argument go kerplunk – but even in more orthodox interviews you can often detect at the very least a broad weakness in a broad argument.

To my ear Corbyn sounds perpetually unsteady on defence policy (see his Marr interview in the first week of the campaign) and public finances, and neither May nor David Cameron before her manages much fluency on the impact of cuts on the working poor once they have uttered that threadbare soundbite about work being the route out of poverty. Would that it were so simple.

Our willingness to dismiss as boring these interviews, the staple of daily current affairs programmes, is overdone. And we have been a little graceless about the extent to which senior UK politicians do – or did – engage in at least some forms of public debate. Anyone who follows the US media will know how rare it has always been for senior members of the administration and White House staff to expose themselves to the sort of scrutiny still supplied by the Sunday political shows, Radio 4 current affairs programmes, Newsnight or Channel 4 News.

For decades, senior politicians in the UK turned up in the studios – often with scarcely concealed irritation – but they went through with it. In part because it was expected and in part out of self-interest. Good interview performances could lead to rapid promotion. Iain Duncan Smith was (you may be surprised by this) particularly effective in his early years at advocating his causes, and his party’s, in front of a microphone. But the studios did for him when he became Tory leader. As it turned out, his failings were more obvious when confronted by a skilled interviewer than in the House of Commons. His nervous coughing finally caught up with him one morning on the Today programme, and that was that.

Duncan Smith and Abbott are far from alone in seeing their currency plummet as a result of losing the plot in an interview. Harriet Harman, normally a highly fluent and agile politician, was sacked as social security secretary in 1998 after a grim outing, at least for her, with John Humphrys – caused not by his abrasiveness nor by any Abbott-like forgetfulness, but by her almost tangible unhappiness with a New Labour policy she was defending.

Even now, on BBC Question Time, some heavyweights will turn up only to be mauled by the voters on topics a long way away from the heart of their portfolio. Yes, they get copious notes from party researchers and have endless rehearsals to minimise the chance of saying anything too intellectually lively: but they should nevertheless get credit for risking it in the first place.

However, outside election time this tradition of broadcasting interrogation and debate, not much more than 50 years old, is under stealthy attack. The presenting team on Today is seriously good, but it is hard not to notice that the heavy hitters turn up less often for their ten minutes of duelling; similarly with Newsnight and Channel 4 News.

The Prime Minister’s Olympian approach to this sort of public engagement aggravates what was already a problem. The broadcasters may be losing ground. In this election there will be no head-to-head leaders’ debates featuring Labour and the Conservatives, and there is no great uproar about it. As it happens, I don’t believe that their absence is a disaster – not least because the format of individual leaders confronting an engaged Question Time audience one at a time (a “tradition” that began in 1997) provides far more substance and revelation than the 2010 or 2015 leaders’ debates did.

In the meantime, what can be done to the interview to improve the quality of public debate? Forcing out the clichés is not a realistic goal. Yet perhaps it is time to combine our Trump-era, heightened sensitivity to untruths with a new broadcasting technique or two. The BBC Trust (which I was part of for two years until it ceased to exist in April) commissioned its final independent editorial report on the BBC’s use of statistics from a panel of experts chaired by the former UK chief statistician Jil Matheson.

It is a superb piece of work. Above all it pleads with the BBC to do more to put statistics in context. The work was largely complete before the EU referendum so it did not pass judgement about either the veracity of the Brexiteers’ “extra £350m for the NHS” claim or the BBC’s coverage of that claim. I listened and watched a lot and, contrary to the views of many leading members of the Remain campaign, the BBC seemed to me to have consistently signalled to the audience the risible nature of the figure, if not as rudely as many would have liked.

Yet there is a different perspective on that cause célèbre. Only very rarely did the BBC on air (or anyone else, for that matter) compare the sums involved with total UK public expenditure: a net annual payment to the EU of about £8.5bn, compared to public expenditure of about £785bn. This £8.5bn is not a trivial sum – and it is likely to sound gargantuan to an unskilled worker on low wages in Hartlepool – but it hardly threatens the nation’s existence. We will have to think about that number all over again when the EU divorce bill gets paid.

In the past few years there has been a welcome growth online of fact-checking websites that get to grips with some of the half-sense or nonsense uttered – sometimes deliberately – in public debate. Among the broadcasters, Channel 4 News got in first with “FactCheck” and deserves great credit for having done so. The BBC has Reality Check; there are also the non-aligned Full Fact and others. And the Institute for Fiscal Studies (IFS) sits as a mega-authority when it pronounces on individual economic statistics. (It was a particularly dispiriting episode when the IFS took a pounding during the EU campaign.)

The good newspapers and the broadcasters have correspondents who can – and do – understand the context in which statistical argument takes place. They know the difference between a big number and a not-so-big number, the difference between an aggregate spending figure and spending per head of population, the difference in importance between a one-month figure and a trend – and a trend that does not change much over time.

This is all good, and better than it used to be. But perhaps more of this rigour can be woven into what is still the dominant form of political accountability in broadcasting: the interview.

So let us try a thought experiment. Imagine (though we don’t really have to imagine) that the Health Secretary, Jeremy Hunt, comes into a studio to say, surprise, surprise, that more is being spent in real terms on the NHS than ever before. Imagine that he is told there will be no questions on anything else until he can answer, let’s say, two obvious supplementary questions: in the course of the past 60 years how often has his assertion not been true? (Answer, says the IFS: four times, one of which was 2011/12.) And what has been the growth in per capita NHS spend, in real terms, since 2009/10, compared to the previous 15 years or so? (Answer: 0.6 per cent, as opposed to 5.4 per cent.) Answering these would show that his boast is one that almost all of his predecessors could have made, and also that the Conservative-led coalition was less generous to the health service than the preceding Labour government. It would be absolutely fair for Jeremy Hunt to respond vigorously about the need to cut the deficit or even to make points about who was in government when the crash happened – but he could not be allowed to get away with statistical near-rubbish.

Similarly, the mantra on English education (“Our schools are getting more money than ever before”) is a waste of air. It’s not that the cuts are “vicious” – just that the assertion when put in context is gibberish. The economy is growing and the school population is growing, fast. So if we were not spending more in total, and in real terms, then the cuts would be vicious. And yet, per head, there will be less in real terms for pupils. Period.

The front-line interviewers I know best are very skilled journalists and they often do try to get a jab in when the numerical nonsense gets going – but they have to move on, whether to other urgent matters or to seek a news headline from the interview, and there is not enough jeopardy for the press officer or spin doctor who wrote the politician’s brief to desist from writing the same stuff next time around.

There may be other ways of levelling up matters. The interview could proceed as normal; but at the end of it up could pop, say, Tim Harford (of the brilliant statistics programme More or Less on Radio 4) to put in the necessary corrections. It would have to be done within a few minutes or else the impact would dissipate. From time to time, Harford or his equivalent does appear after a political interviewee has spouted statistically illiterate twaddle – but not often enough, and usually this happens long after the attempted mugging of intelligent debate. Too little, too late.

It would be obligatory to ensure that this type of treatment, particularly at election time, was meted out to all the parties – but outside the election it is the government of the day and its news departments that are going to have to face most of the music. Fair enough.

My suggestion is not put forward because I am advocating a particular party’s reading of the state of the nation (or nations). There is no monopoly on vice. We should not forget Labour’s “triple counting” of health service spending after 1997 even if Blair/Brown subsequently, in benign economic circumstances, did indeed put their foot on the health-spending accelerator.

Rather, when the election dust settles and the media seminar post-mortems crank up yet again – about the level of turnout, political ennui, the particular disengagement of the young, the coverage of the leaders, the role of opinion polls and other staples – we need to keep working on how to improve the quality of public debate. It is not all awful, and a stylised contempt for what is good is itself corrupting of democracy. But the numbers nonsense needs fixing. 

Mark Damazer is Master of St Peter’s College, Oxford, and was the controller of BBC Radio 4 from 2004 to 2010

This article first appeared in the 18 May 2017 issue of the New Statesman, Age of Lies

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