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

Show Hide image

Michael Sandel: “The energy of the Brexiteers and Trump is born of the failure of elites”

The political philosopher on markets, morality and globalisation.

Jason Cowley: Shall we begin with Brexit? It’s very close here at the moment: the Remain side had big leads in the polls but it’s narrowed considerably since the conversation moved on to immigration, porous borders and freedom of movement of migrant workers within the EU. What forces are driving the desire for Brexit?

Michael Sandel: As an outside observer, I don’t feel it’s for me to offer a personal view about how Britain should vote. I think there are really two questions. One is whether Brexit would be good for Europe and the other is the question of whether it would be good for Britain. It seems to me that for Britain to remain in the EU would be a good thing for Europe, but whether it’s a good thing for Britain is something that’s for British voters to decide.

A big part of the debate has been about economics – jobs and trade and prosperity – but my hunch is that voters will decide less on economics than on culture and ­questions of identity and belonging.

JC Superficially, the United Kingdom seems a becalmed society, but we’re experiencing eruptions. We had the Scottish referendum in 2014, and we almost saw the break-up of the British state. Now we’re having a referendum on whether we should continue to be a member of the European Union. Why are there so many unsettled questions? Why are the people of the United Kingdom so restive?

MS I think the restiveness that you describe reflects a broader disquiet with democracy that we see in most democracies around the world today. There is a widespread frustration with politics, with politicians and with established political parties. This is for a couple of reasons; one of them is that citizens are rightly frustrated with the empty terms of public discourse in most democracies. Politics for the most part fails to address the big questions that matter most and that citizens care about: what makes for a just society, questions about the common good, questions about the role of markets, and about what it means to be a citizen. A second source of the frustration is the sense that people feel less and less in control of the forces that govern their lives. And the project of democratic self-government seems to be slipping from our grasp. This accounts for the rise of anti-establishment political movements and parties throughout Europe and in the US.

JC One of the key slogans of the Brexiteers is to regain control. Why does this resonate with so many? And are you somewhat sympathetic to that line of argument?
MS Well, I do think it resonates deeply. And I see this not only in Britain, I see this in the American political campaign, and I see it looking at the rise of anti-establishment parties throughout Europe. A theme running through these various political movements is taking back control, restoring control over the forces that govern our lives and giving people a voice.
As to whether I have some sympathy for this sentiment, I do. I don’t have sympathy for many of the actual political forms that it takes.

One of the biggest failures of the last generation of mainstream parties has been the failure to take seriously and to speak directly to people’s aspiration to feel that they have some meaningful say in shaping the forces that govern their lives. And this is partly a question of democracy: what does democracy actually mean in practice? It’s also closely related to a question of culture and identity. Because a sense of disempowerment is partly a sense that the project of self-government has failed. When it’s connected to borders, the desire to reassert control over borders, it also shows the close connection between a sense of disempowerment and a sense that people’s identities are under siege.

A large constituency of working-class voters feel that not only has the economy left them behind, but so has the culture, that the sources of their dignity, the dignity of labour, have been eroded and mocked by developments with globalisation, the rise of finance, the attention that is lavished by parties across the political spectrum on economic and financial elites, the technocratic emphasis of the established political parties. I think we’ve seen this tendency unfold over the last generation. Much of the energy animating the Brexit sentiment is born of this failure of elites, this failure of established political parties.

JC One particularly notable trend is the failure of mainstream social-democratic parties across Europe – the Labour Party included. Many people who might once have been inspired by or supported the centre left are now attracted by populist movements of both left and right. So why is social democracy failing?

MS Social democracy is in desperate need of reinvigoration, because it has over the past several decades lost its moral and civic energy and purpose. It’s become a largely managerial and technocratic orientation to politics. It’s lost its ability to inspire working people, and its vision, its moral and civic vision, has faltered. So for two generations after the Second World War, social democracy did have an animating vision, which was to create and to deepen and to articulate welfare states, and to moderate and provide a counterbalance to the power of unfettered market capitalism.

This was the raison d’être of social democracy, and it was connected to a larger purpose, which was to empower those who were not at the top of the class system, to empower working people and ordinary men and women, and also to nurture a sense of solidarity and an understanding of citizenship that enabled the entire society to say we are all in this together. But over the past, well, three or four decades, this sense of purpose has been lost, and I think it begins with the Ronald Reagan/Margaret Thatcher era.

JC You mean the neoliberal turn at the end of the 1970s – the advent of what you have called “market triumphalism”?
MS Right. It began there. But even when Reagan and Thatcher passed from the political scene, and were succeeded by the centre-left political leaders – Bill Clinton in the US, Tony Blair in Britain, Gerhard Schröder in Germany – these leaders did not challenge the fundamental assumption underlying the market faith of the Reagan/Thatcher years. They moderated, but consolidated the faith, the assumption that markets are the primary instrument for achieving the public good. And as a result, the centre left managed to regain political office but failed to reimagine the mission and purpose of social democracy, which ­became empty and obsolete. This remains an unfinished project.

JC Unfinished even after the financial crisis, when this was considered by many on the left to be a potential 
social-democratic moment?

MS That’s right, and I think many of us expected that the financial crisis would mark the end of an era of unqualified embrace of the market faith and the beginning of new debate about what should be the role and reach of markets in a good society. What happened, sadly, is that the financial crisis came and, although we did have some debate about regulatory reform, it was a rather narrowly cast debate. We have not yet had the more fundamental debate about what should be the role of markets in a good society. As a result, social democracy has not only lost the argument, it has failed to articulate a vision of a just society; it’s failed to articulate a conception of democracy as self-government. And so it is understandable that its traditional constituencies in working-class and middle-class communities lost confidence that social-democratic parties could be the vehicle either for a renewed sense of community and ­mutual responsibility or for collective democratic projects.

JC Is it also because trust has been lost in the state – because of the economic failures of the mid-to-late 1970s, the unravelling of the postwar consensus, stagflation and so on?

MS I think that has contributed to a loss of confidence in the state but I think a further source of lost confidence in the state is that, traditionally the democratic state has as one of its primary purposes to be a vehicle for self-government, to enable citizens to have some meaningful say in how they are governed. Whereas today the state seems more an obstacle to meaningful political participation and self-government than a vehicle for it. Any revival of social democracy would require not only an articulation of a conception of a just society, but also forms of political participation that could renew the democratic promise.

That’s as important as articulating a conception of a just society, working out institutions and civic practices that could revitalise the project of democracy as a vehicle for self-government. The existing state fails to do that and I think when people 
look to the European Union they also feel that it is not a vehicle for democratic self-government. So I think both the nation state and the European Union are seen to have failed in this regard.

JC So where does this leave us? I guess it leaves us in the UK approaching Brexit?
MS Where it leaves us is with a potent backlash. And it’s a backlash that is understandable. I think it’s a mistake to view the backlash – and it finds expression in the ways that we’ve been discussing – simply as people suddenly turning inward and against immigrants as if this were simply a matter of mindless bigotry by people, benighted people, who are ungenerous. It’s important for people who make the case for Remain to be able to offer a conception of Europe that could begin to address this unanswered hunger for meaningful self-government, for having a voice.

JC What about the EU as a social market with its own social standards and rules? Is that potentially progressive? It can impose certain transnational legislation on sovereign governments from outside that benefits workers.

MS It’s potentially progressive in the policy outcomes but that is not enough. A regulatory state, however effective and desirable its social regulations may be, is insufficient to win people’s allegiance unless the regulatory process is connected to a democratic process with which people identify as citizens who have a voice, who have a say.

It’s desirable to have the EU promulgate social regulations that moderate market forces and protect workers and protect the environment, protect health and safety. All of that’s good but it’s insufficient and I don’t think it can be supported politically unless it makes people feel they’re not being dictated to by faceless bureaucrats from Brussels. Even if those faceless bureaucrats promulgate very good social legislation, people want a voice, people want a say, people want a more robust democratic system. It’s a mistake to neglect that.

JC More generally, can free-market globalisation be tamed? And could we be entering an era of more protectionist economics? Consider the rhetoric of Trump.

MS I have no sympathy for Trump’s politics but I do think that his success reflects the failure of established parties and the elites in both parties to speak to the sense of disempowerment that we see in much of the middle class. The major parties have failed to speak to these questions. What Trump really appeals to is the sense of much of the working class that not only has the economy left them behind, but the culture no longer respects work and labour.

This is connected to the enormous rewards that in recent decades have been lavished on Wall Street and those who work in the financial industry, the growing financialisation of the American economy, and the decline of manufacturing and of work in the traditional sense. There is also the sense that not only have jobs been lost through various trade agreements and technological developments, but the economic benefits associated with those agreements and those technologies have not gone to the middle class or to the working class but to those at the very top. That’s the sense of injustice; but more than that, the fact that the nature of political parties – I’m speaking about those in the US – have become, since the time of the Clinton years, heavily dependent on both sides, Democrats and Repub­licans, on the financial industry for campaign contributions.

JC One thinks of the Clinton family’s relationship with Goldman Sachs, for instance.

MS Well, there you have an example of how the Democratic Party has become so Wall Street-friendly that it has largely ceased to be an effective counterweight to the power of big money in politics or to the financial industry and its influence in politics. And this is why Bernie Sanders was able, though he will not win the nomination, to have far more success than anyone imagined. He was originally thought to be a fringe candidate who would maybe get 5, 10 per cent of the vote. And yet he fought Hillary Clinton almost to a draw in many of the Democratic primaries. No one would have imagined that.

The mainstream of the Democratic Party had so embraced the financial industry that it was unable to provide an effective counterweight when it came to the financial crisis or to the aftermath, the regulatory debate. And oddly enough, Trump from the right and Bernie Sanders from the left have a good deal of overlap. They’ve both been critical of free-trade agreements that benefit multinational corporations and the financial industry but haven’t in practice helped workers.

Bernie Sanders has been a big critic of the role of money in politics, and Trump, though he’s a billionaire, also appeals to the anger about money in politics, when, at least during the primaries, he was able to claim that he was paying his own campaign costs and not depending on Wall Street. Despite their different ideological direction, they are both tapping in to the frustration that we’ve seen reflecting the failure of the mainstream parties.

JC What are the limits to markets? And what is the alternative to market triumphalism, especially when moderate social democracy is in crisis?

MS The only way of reining in the uncritical embrace of markets is to revitalise public discourse by engaging in questions of values more directly. Social democracy has to become less managerial and technocratic and has to return to its roots in a kind of moral and civic critique of the excesses of capitalism. At the level of public philosophy or ideology it has to work out a conception of a just society, it has to work out a conception of the common good, it has to work out a conception of moral and civic education as it relates to democracy and ­empowerment. That’s a big project and it hasn’t yet been realised by any contemporary social-democratic party.

A revitalised social-democratic response to the power of markets would also try to come up with institutions for meaningful self-government – forms of participatory democracy in an age of globalisation, where power seems to flow to transnational institutions and forms of association. It’s important also to find ways to promote participatory democracy. This requires political imagination and political courage. It’s a long-term project that remains as a challenge, but until we make some progress in that bigger challenge, I think that democratic politics will still be vulnerable to the backlash that we’re witnessing, with Brexit in Britain, some of the populist political movements in Europe, and Trump in the United States.

There is an alternative – but the alternative is to go beyond the managerial, technocratic approach to politics that has characterised the established parties and the elites, to reconnect with big questions that people care about.

Jason Cowley is editor of the New Statesman. He has been the editor of Granta, a senior editor at the Observer and a staff writer at the Times.

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