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

JAVIER MAYORAL. IMAGE MANIPULATION BY DAN MURRELL
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A world unbalanced

Under Trump, the United States could turn away from Europe, leaving the continent exposed and vulnerable. So is it the destiny of the UK alone to stand for collective defence, free trade and fair play in a turbulent age?

Listening to the reading – from St Paul’s letter to the Corinthians – on Remembrance Sunday, the first Sunday after the earthquake of the US election, it seemed that someone, somewhere had a sense of ironic timing. “In a moment, in the twinkling of an eye, at the last trump [sic!],” the passage ran: “for the trumpet shall sound, and the dead shall be raised incorruptible, and we shall be changed.” Whatever the text really means, it brought home the fact that the election of Donald Trump has transformed, and transformed utterly, the world in which we live. We Europeans no longer know where we stand with the most powerful country on Earth, and whether it will deliver on its alliance obligations. Our world is out of balance. A terrible uncertainty has been born.

Looking out over the uniformed members of the congregation – army, RAF and Royal Navy – one couldn’t help thinking that next year they may be all that lies between Vladimir Putin’s Russia and the Baltic states. As our continent boils, the armed forces represent, to borrow the pathos of Dorothy Sayers’s 1940 patriotic verse “The English War”, “the single island, like a tower,/Ringed with an angry host”. If things continue to deteriorate, we may soon see the moment when, as the poem continues, “. . . Europe like a prison door,/Clangs, and the swift enfranchised sea [the Channel]/Runs narrower than a village brook;/And men who love us not yet look/To us for liberty”. It is in times like these, she writes, that “only England stands”.

In recent days, the shock of Trump’s election has started to wear off and the usual reading of tea leaves about the new administration has begun in earnest. Appointments and nominations are being scrutinised for clues to what a Trump presidency might mean for the world. These attempts are understandable, but they are also futile. It is clear that Trump, like all other presidents, is filling positions taking both ideology and party management into account – balancing the appointment as his chief strategist of Stephen Bannon, a leading light of the “alt right”, for instance, with that of Reince Priebus, a stalwart of the Republican establishment. Something similar is visible in the foreign policy sphere, where the two most important choices point in fundamentally different directions on one of the critical challenges facing the administration, namely Russia. General Mike Flynn, Trump’s nominee for national security adviser, is well known for his closeness to Moscow, at least in relation to Syria, while Mike Pompeo, the proposed CIA director, is deeply suspicious of Putin’s ambitions in the Middle East.

To infer from this fudge the future policy of the United States would be unwise. One should not assume that Trump’s lack of detailed knowledge of world affairs, or his rocky relationship with the Republican Party’s national security experts, will increase the influence of professionals in the state department. Nor is it right to expect the new president to fall back on Mike Pence, his vice-president-elect, as an inexperienced George W Bush did with Dick Cheney. Trump knows his own mind, especially on the big strategic challenges, and will not listen to the experts or party grandees. His estimation of Pence became clear when he almost forgot to thank him during his victory speech. Besides, Trump, who has spoken openly of possible candidate appointments as “the finalists”, in the manner of his TV show The Apprentice, can fire as quickly as he hires. There is no guarantee that anybody who is in his cabinet in January 2017 will be there a year or two later.

The speculation is pointless in another respect. We already know what kind of animal Trump is. His world-view is fully formed; his temperament is well known. Behaviourally, Trump is the silverback ­gorilla, the narcissistic peacock, the alpha male, the bull in the china shop. Politically, he is a Bourbon who has learned and forgotten nothing over the past three decades.

Here, it is essential to distinguish between rhetoric recently adopted to wage the election campaign, and long-standing positions that Trump has been espousing for 30 years. The good news for Americans is that most of the divisive language and proposed measures probably fall in the former category. His appalling inflammatory comments – too familiar and numerous to repeat here – were largely instrumental; they do not seem to have featured much in his vocabulary before his candidacy. America is not about to turn fascist. Trump is unlikely seriously to assault the constitution, and if he does so he will be repelled. There may be substantial economic and cultural rebalancing, and some pretty brutal measures against terrorism and illegal immigration, but the United States will probably be fundamentally much the same place in four or even eight years’ time. The bad news for the rest of world is that the beliefs most threatening to us are the ones Trump most genuinely holds, and that he is in the best position to implement. Europe, in particular, will be very different four years from now and it might well be unrecognisable in eight.

 

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The key to understanding Donald Trump is his quest for restoration of national “greatness” for the US, which he sees as having been lost in the retreats and compromises of the Obama years but also the interventionism of George W Bush. Economics is central to this vision, yet it is not the deciding factor. To be sure, re-establishing economic strength is important. It will enable the US to sustain Trump’s prohibitively expensive plans, especially the proposed huge infrastructure programme, his tax cuts, and the vast increase in military spending. The new president believes in not international, but national capitalism, based on construction and manufacturing rather than trade and finance. One may not share Trump’s vision of restoring prosperity and pride to America through civilian work creation, motorways, bridges and armaments, but it is a coherent programme. Unlike free-traders and globalisers, who see all boats rising on the tide of a growing world economy, Trump takes a much darker, mercantilist view. It’s not the economy: it’s the greatness, stupid.

Threatening US greatness, so the Trum­pian critique claims, are not only America’s enemies but America’s friends. Politically, the main threat is radical Islam, which he says the Obama administration refuses to call by its name, and which has been aggravated by a costly, failed “nation-building” project in Iraq. Economically, it is China and Latin America which have, in effect, stolen manufacturing jobs from America after the lowering of tariff barriers. Not much better, however, are America’s allies, such as the Japanese and the Europeans, who are free-riding under the US defence umbrella and taking unfair advantage in trade.

Globally, therefore, Trump’s administration will mark a change in four important respects. First, he will either abandon or ignore the institutions of international governance that the United States has done so much to establish. Trump will pay no heed to the United Nations whatsoever. He will not act against climate change. Here the ­appointment of Myron Ebell to lead the transition team for the Environmental Protection Agency is a straw in the wind: Ebell does not believe in global warming. Trump will press ahead with fracking and drilling on all fronts, not necessarily for economic reasons but in order to guarantee energy security for the US. He is unlikely to pull out of the World Trade Organisation but will abrogate the Trans-Pacific Partnership, “re-negotiate” the North Atlantic Free Trade Agreement and probably drop the Transatlantic Trade and Investment Partnership.

Second, there will be a “pivot” of US foreign policy towards the Middle East and the Mediterranean. In Syria, the new administration will seek co-operation with Russia and the Assad regime against Isis and other Islamist groups, if necessary in return for concessions elsewhere. That will be just the start, however. Trump’s hostility to Obama’s nuclear deal with Iran and to the Iranian regime is a matter of record, and Mike Flynn’s writings have been only slightly less anti-Iranian than they have been anti-Isis. There can be no doubt about it: for the Trump White House, Raqqa in Syria may come first but Tehran is next. How exactly it intends to go about this is not obvious, but it is clear that the planned new, 350-ship navy is needed not just to deal with Isis.

Third, Trump will take on China, at least over trade, not least because it will be critical to his domestic jobs programme. Early steps might include whopping tariffs on Chinese goods and designating China a currency manipulator. In this regard, it may be significant that Trump has expressed enthusiasm for Stefan Halper’s 2010 book, The Beijing Consensus, which takes an understandably dim view of China’s restrictive trade practices, authoritarian proclivities and regional belligerence. That said, economics aside, there is little sign that Trump has a broader political, ideological or military agenda with respect to China. His remarks, both recent and long-standing, suggest that he has little interest in maintaining the alliances with South Korea, Japan and other states keen to contain Beijing.

These plans not only risk failure, thereby causing great human hardship, but could also precipitate a major conflict. Trump fails to understand that, in Syria, most of the Syrian government forces and the vast majority of Russian air strikes are directed against the rebels: that is, the non-Isis Islamists and what is left of the Free Syrian Army. Since his election, he has reiterated his contempt for the Syrian rebels and indicated that we should wish for an Assad victory so that he can concentrate all his fire on Isis. One problem with this strategy is that it will increase the outflow of refugees – most of whom are already fleeing the Syrian regime, its Iranian allies and proxies, as well as the Russians, rather than Isis or the Western bombing. The other, and probably terminal difficulty, is the contradiction of wanting to co-operate with Tehran in Syria yet crush it in the Gulf.

In east Asia, the danger is that a trade war may precipitate another world recession, and also a full-scale military confrontation. China took its time responding to Trump’s victory, and did so with extreme truculence. Beijing vowed to retaliate against any tariffs. If backed into a corner, the Chinese might well try “horizontal escalation”– that is to say, using military demonstrations or even armed attacks to retaliate against US trade measures – in Taiwan or the South China Sea.

Unless Trump is entirely clear about how he will react, and this would require him either to reaffirm the existing strategic architecture of the region or to signal his withdrawal from east Asia, the chances of a catastrophic misunderstanding are high.

 

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By far the greatest risk to the international system, however, is not the wars that Trump will start, but the one he might not fight, and will thus fail to deter. His rallies often featured banners accusing Hillary Clinton of wanting to start “World War III”. These referred to her willingness to honour US commitments under the collective defence provisions of Article 5 of Nato’s charter. Trump, by contrast, has repeatedly questioned whether America should defend those allies that are not spending enough on their own protection. He has even referred to Nato as “obsolete”.

More worryingly, there has been a general whiff of pro-Russianism in the Trump camp. The president-elect makes no secret of his admiration for Vladimir Putin, the man who has annexed Crimea, unleashed a proxy war in eastern Ukraine and threatens Nato’s eastern flank, to say nothing of his other crimes. This summer, one of Trump’s leading backers, Newt Gingrich, described Estonia as a mere “suburb” of St Petersburg. The close Russian connections of many others in Trump’s penumbra are too well known to require repetition. The frightening truth is that, with regard to Russia, there is much more going in the Trump camp than the (entirely understandable) irritation with European free-riding.

All this reflects a much broader, and deeply troubling, “de-Europeanisation” of the American strategic mind, if not in national security circles then in politics and among the population at large. Once upon a time, a strong stance against the Soviet Union united Cold War liberals with the working classes, including many from Poland, Ukraine and the Baltic states. Gerald Ford’s gaffe in a televised election debate against Jimmy Carter in 1976, in which he denied Russian domination of eastern Europe, may have cost him the White House. Likewise, many of the “Reagan Democrats” of the 1980s were working-class “deer hunters” of eastern European origin who wanted him to stand up to the Kremlin.

That constituency is no more, and it is a sign of the times that Gingrich, who had written support for the integration of former Warsaw Pact countries into Nato into his Contract for America two decades ago, should now hold the alliance so cheap. All the same, it has been surprising to see the flippancy and vehemence with which a sixty-year transatlantic bond has been put in question, not reluctantly, but with a whooping rebel yell.

The president-elect poses another, more insidious, but no less fatal menace to Europe. His victory has blown wind into the sails of the European far right. “Their world is falling apart,” Florian Philippot of the French Front National (FN) exulted after the result. “Ours is being built.” France’s presidential election in April and May will be won by either Marine Le Pen’s FN or – more likely – François Fillon of the conservative Républicains; both candidates are pro-Russian. It is also likely that Prime Minister Matteo Renzi will be defeated in Sunday’s referendum on reforming the powers of the Italian parliament. If he resigns, the resulting election may well bring the Eurosceptic right to power. In Germany, Alternative für Deutschland is weaker, but growing.

Given all this, the capacity of the rump European Union to deal with the security, economic and migration challenges ahead will be severely tested. The weakness of mainland Europe is also manifest at a national level. Even its two most important countries, France and Germany, have ceased to exist as separate states in vital areas: neither controls its own currency or borders, and Germany does not even have a nuclear deterrent or (sufficiently credible) conventional capability.

As such, despite the hopes of many, Angela Merkel will be too weak to lead Europe even if she wins Germany’s federal elections next year. To be sure, she has pledged to work together with the new US president only if he respects people regardless of creed, sexual orientation and skin colour. Yet Chancellor Merkel lacks the instrument to protect Europe militarily, because of Germany’s largely pacifist political culture and the EU’s failure to provide itself with anything more than a shadow capability at supranational level. She is also losing ground steadily at home. A Trump-induced fresh wave of Syrian refugees may well finish her off.

 

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In democratic Europe, therefore, only the United Kingdom stands out. Here, the widespread continental European tendency to equate Brexit with Trump misses the point. Despite all the Brexit turmoil, Britain is likely to remain infertile soil for extremism, at least once the separation from the European Union has been completed. Although many of those who voted for Brexit did so for similar reasons to those of the workers who opted for Trump, the political mainstream in Britain, including those who supported leaving the EU, remains strongly in favour of free trade, and strongly committed to Nato. Moreover, the UK is still the world’s fifth-largest economy and a nuclear power, and it retains the principal characteristics of sovereign statehood – her own currency, parliament and control over her borders.

The result of all this will be a fundamental shift in European geopolitics in favour of Britain. The election of Donald Trump has four effects, the first two of which will probably cancel each other out. On the one hand, his protectionist instincts may make him less interested in a trade deal with the UK. On the other hand, he is less likely than a Democratic administration would have been to send Britain to “the back of the queue”. Trump’s impact will be felt elsewhere, however, in the field of geopolitics and global governance. Britain will now be one of the few large economies in favour of free trade. More important still is that, with a large question mark now hanging over Nato, the contribution made by the British armed forces to the defence of Europe as a whole, and to the defence of European values against President Putin, will take on a new significance.

Britain needs to rise to the challenge. Militarily, she may have to hold the line in Europe for at least four years – possibly for eight. Consequently, a full-scale rearmament must begin now, with increased expenditure on ships, aircraft, “heavy metal” for the army, and cyber-defence. The necessary shift is comparable to the one orchestrated by the chief of the imperial general staff Sir Henry Wilson in the early 20th century, when he began to change the military mission from imperial policing and small wars to preparation for war against a major power in Europe.

Politically, Britain urgently needs to clarify its relationship with the rest of the continent. It would have been better if Brexit had never happened, or at least not before the EU had sorted itself out, but now it should be expedited without delay so that we can all concentrate on the bigger challenges. This should be based on a grand bargain in which London retains a free-trading relationship with the EU, reserving the right to restrict immigration in return for our increased commitment to European security through Nato. Britain’s EU budget contribution could be reallocated as increased defence expenditure to help defend the EU in the east. Some continental Europeans, in German business circles as much as in Poland, have already begun to see the connection between the two spheres, and the need for a trade-off.

London thus needs to take two messages, one to the EU and the other to Washington, DC. It is a great pity that the Foreign Secretary did not attend the Trump post-mortem of foreign ministers in Brussels, not to join in the pointless therapy session, but in order to read the Europeans the riot act on Russia. They have already seen that one cannot have a common currency without a common treasury and parliament (in other words, a common state); and that one cannot have a common travel area without a common border – in effect, a common state.

Now they are planning to fill the potential American vacuum with a (much-needed) European army without a European state, something that can only end in more tears. Johnson should have told them that if they wish to survive they need to form a full political union, like that which has linked Scotland and England. If that does not appeal, they must increase their individual national military budgets and, if the Americans withdraw from Nato commitments, they must fall in behind Europe’s principal military power, the United Kingdom.

Rather than supplicating in Washington, Britain should speak to Trump in language that he understands: not of realpolitik, but of real estate. The problem is not so much his belief that diplomacy is “transactional” – all political relationships are – but that he takes a very short-term and narrow view, valuing the quick buck over long-term shareholder value. He should be reminded that the US holds the largest stake in a military consortium that owns the freehold of the property on which the EU is built; the UK is the next largest shareholder, whose interests are materially affected by any change. It is true that many of its tenants are not paying their contribution to the common defence, yet some are. The problem with Trump’s approach is that he has no satisfactory way of punishing the transgressors specifically. If he turns off the heating, everyone will freeze. Besides, some of the worst offenders, in the Mediterranean, live in south-facing apartments, away from the cold Russian wind. They will be the last to feel the drop in temperature.

 

***

 

Donald Trump must be told that the people most affected by his policies, especially those in the Baltic states, are guilty of nothing more than being born in the best property in a terrible part of town. If he withdraws Nato insurance cover, property prices will go down and people will move out. This is because collective security works rather like Bill Bratton’s New York: it depends on zero tolerance, on fixing the windows and apprehending the stone-throwers. The danger is that after four years of Trump, much of eastern Europe will resemble a declining neighbourhood in 1980s America, with broken windows, uncollected rubbish, and demoralised residents huddled around braziers trying not to catch the eye of the criminals stalking their streets.

If that happens, we may soon see a Europe where the Atlantic, once an enfranchised sea connecting America and Europe, has become an unbridgeable ocean culturally and politically; where the United States has left us to our fate; where the channel separating the home island from a turbulent continent once again runs narrower than a village brook; where Italy and France have given way to authoritarian, Russian-leaning populists; where Germany finally buckles under the strain; where the rest of Europe has scattered like minnows; where Putin rules supreme in the east; and only England stands for collective defence, free trade and fair play.

Brendan Simms is an NS contributing writer. His latest book is “Britain’s Europe: a Thousand Years of Conflict and Co-operation” (Allen Lane)

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage