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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What would a Trump presidency mean for the rest of the world?

It would be wrong to hope that either domestic or international checks and balances will constrain Trump abroad. Geopolitically, the result would be unpredictable – at best.

The conventional wisdom about Donald Trump runs something like this. Trump is a buffoon. His solutions to world problems are not policies at all, but merely a set of contrarian reflexes. They will soon be ­exposed in the next televised presidential debate against his rival Hillary Clinton, who put in a strong performance during the first round. He is, critics say, a mere pied piper whose “deplorable” followers suffer from false consciousness about their true economic interest. Trump’s election would be a disaster, the argument runs, but his policies will soon prove impracticable.

The conventional view is wrong. Although his personal behaviour is often clownish or boorish, and he has shown astonishing ignorance of some important international issues, Trump has a perfectly coherent world-view and strategy which are rooted in certain established American traditions, even if these are now largely defunct. Most of his followers know exactly what they are voting for and they are right to believe that he will deliver, or at least attempt to do so. As for the idea that a Trump presidency would be a disaster, that is completely wide of the mark. It is actually much worse than most people think. President Trump has the potential to be an unmitigated catastrophe – if not for the United States, then certainly for the rest of the world.

Far from taking a leap in the dark, Trump supporters know that they will be voting for a clearly defined package of domestic and foreign-political measures. With Trump, in ways that are not really true of his predecessors, or of Hillary Clinton, the two spheres cannot be usefully separated. He stands for the protection of American jobs at home, and therefore for a restrictive trade policy abroad. He wants to get tough on terrorism by having recourse to torture, in both the United States and the rest of the world. He wants to increase military spending. He wants to “put America first” and increase investment in schools and infrastructure in the United States, and therefore eschews “nation-building” abroad.

We should not assume that this is just rhetoric. First, because Trump has been saying all this, or much of it, for years in his writings and in off-the cuff statements. He is no mere opportunist. Second, because we know from scholarly analysis of recent campaigns, such as the one carried out by the former White House adviser and political scientist Steven Schrage, that presidential policies often quite closely track those advanced during the campaign. Third, because Trump emerges from the confluence of two long-dormant but now resurgent American political traditions: the blunt, early-19th-century appeal of Andrew Jackson to the “common man” and the protectionist isolationism that produced the Smoot-Hawley tariffs and the Charles Lindbergh of the 1930s.

When contemplating Trump, critics often focus on his domestic consequences. They foresee an empowering of white supremacist discourses and a surge in hate crimes, especially against Muslims. These are reasonable fears, but the threat Trump poses to politics within the United States is probably overstated. There will certainly be an increase in racial tension and other forms of unpleasantness, but American society is resilient, diverse and fundamentally decent, even if some of it is currently trying to prove the opposite. The US is not seriously at risk of lapsing into the kind of populist authoritarianism we see in many other parts of the world. Moreover, the nature of the American constitution is such that Trump will be very constrained in what he can do at home: by Congress, by the courts and various other checks and balances.

There are far fewer impediments, however, to presidential power in foreign policy. As so much of Trump’s domestic programme depends on what he does abroad, the rest of the world will be much more exposed to a Trump presidency than the Americans themselves.

Trump’s impact on the world will initially be a matter of style. He has shown himself to be misogynistic, vindictive, xenophobic and unafraid to trample on the feelings of veterans or the bereaved. This would be neither here nor there – tastes differ, after all – were it not that Trump’s personality will translate internationally into an instinctive rapport with other “outspoken” leaders such as Vladimir Putin in Russia, Recep Tayyip Erdogan in Turkey or Rodrigo Duterte in the Philippines. In the event of disagreement between them and Trump, we might expect a degree of vituperation on both sides in ways that are not compatible with the long-established dignity of the presidency of the United States.

Style will soon become substance. At best, a Trump presidency will lead to the “Berlusconification” of international politics, which will become extended reality-TV events, at least in so far as they relate to the United States. More seriously, his antics will empower and encourage a coarsening of the discourse between states and about world problems. Here, the contrast with Presidents George W Bush and especially Barack Obama, whatever one thinks of their policies, could not be sharper.

Trump’s style will matter in international politics for another reason. First, despite all his rhetoric about deal-making, where his business experience is considerable – and he has sometimes shown a capacity to compromise – he seems to have a very limited and belligerent idea of what constitutes a successful diplomatic negotiation. Rejecting notions of “win-win”, Trump views a political “deal” as the imposition of his will on the other side. “In the end,” he writes of one successful transaction in his bestselling book The Art of the Deal, “we won by wearing everyone else down.” It is therefore no surprise that he cleaves to an essentially mercantilist view of world trade in which, say, Japan’s gain is America’s loss. Given his severe anger management issues, the great danger is that a clever adversary will get under his skin, provoke outbursts, and either make a laughing stock of the greatest power on Earth or precipitate a confrontation.

Second, Trump favours a particularly intuitive style of decision-making. He has gone on record as saying that people “are surprised by how quickly I make big decisions, but I’ve learned to trust my instincts and not to overthink things”. Of course, it is true that international politics often requires leaders to make speedy decisions, yet it is deeply worrying to think what Trump’s instincts will lead to when he has the proverbial finger on the button. This problem has already been commented on by a phalanx of Republican national security experts, none of whom thinks he should be entrusted with the nuclear codes.

No reliance should be placed here on the restraining force of his advisers, or of the bureaucracy in the US state and defence departments. Trump has already signalled that he will not listen. When asked a few months ago to identify those he consulted most often on foreign affairs, he replied: “I’m speaking with myself, number one, because I have a very good brain and I’ve said a lot of things.” The foreign policy “team” he has produced during the campaign is the weakest and most obscure that anybody has encountered in living memory.



The essence of Donald Trump’s vision for the world is the revival of American national greatness. He wants to “make America great again”. “Americanism, not globalism, will be our credo,” he says. His slogan “America First” is an unashamed borrowing from the isolationist platform of the 1920s and 1930s.

By contrast with every single Democratic and Republican president since the Second World War, including George Bush, Jr, Trump rejects the international liberal order. In office, this will be reflected in his opposition to global human rights initiatives, whether that be the banning of torture, or collective action to help Syrian refugees (whom he sees not as victims but as an Islamist national security threat). He will ride roughshod over human rights sensitivities when building his wall with Mexico. On the environment, Trump is likely to abrogate the Paris accord on greenhouse-gas emissions and to press ahead with work on the disputed Keystone oil pipeline between Canada and the US, as well as other projects.

He may well also play fast and loose with the national debt, having suggested that he may not repay it or the interest in full. “I’ve borrowed knowing that you can pay back with discounts,” he explains, adding that “I would borrow knowing that if the economy crashed you could make a deal”. But he may find that his ability to bounce back no fewer than four times from business bankruptcy may not be a transferable skill.

The other area in which Trump plans to tear up the international rulebook, and here the parallels with his opposition to gun control are evident, is the field of nuclear non-proliferation. He has repeatedly welcomed the idea of a Saudi, or South Korean, or Japanese nuclear bomb. The thinking is that this will achieve a balance of terror, which will keep the peace better than costly American intervention.

Cumulatively, all this will cause considerable disruption. It will unravel many of the webs of international society carefully woven over the past six decades or so. It may well make the Korean Peninsula or the Gulf even more unsafe. It will certainly make life unpleasant for Mexico. And it will lead to the end of the United States acting as the world’s policeman. The US will step up the number of global snatch-squads in the war on terror, certainly, but will cease to exercise a general superintendence over the defence of democracy and human rights. No Iraqs, perhaps, but also no interventions in Bosnia or Kosovo. The worst, however, is yet to come.

At the heart of Trump’s revolt against the liberal order, undoubtedly, is economics. Reviving the national economy is essential to his vision of making America great again. Central to that project is a revision of the terms of trade. Trump is convinced that the US is getting a raw deal, not only from its enemies, but also – and most importantly – from its friends. He might well overturn the North American Free Trade Agreement, will probably disavow the Trans-Pacific Partnership, and is most unlikely to go through with the Transatlantic Trade and Investment Partnership, assuming it is not killed off first on the other side of the Atlantic. He would not be above leaving the World Trade Organisation altogether. Above all, Trump will take on China, which he accuses – with considerable justice – of currency manipulation and sharp practices. At the very least, he will instruct the US ­department of commerce to take cases against China and he may well embark on a full-scale trade war.

If Trump’s grand strategy will begin with economics and trade, it will not end there. His measures will unleash their own, essentially geopolitical dynamic. At the moment, the Chinese are contemplating the prospect of a Trump presidency with remarkable insouciance. They seem to regard him as one of their own, a man who will not bother them with human rights sermons, and with whom they can do business. In some ways they are right: he is one of them. That, however, is the problem. Trump shares their ­zero-sum view of the world, and he explicitly intends to prevail at their expense.




Nobody has ever looked inside the “black box” of an all-out trade confrontation between China and the United States. Even if one thinks – as this author does – that some form of reckoning with China is necessary, Trump is surely the man temperamentally least suited to lead it. His strategy may revive American manufacturing, but modern supply chains are such that China is inextricably stitched into the US industrial ecosystem in ways that could defy safe unravelling. Yet one thing is clear: China, which holds a huge chunk of the US federal debt, will bitterly resist any attempt to repudiate it. Moreover, if unplugged from the US market, particularly at a time of falling European demand, China will face vast economic dislocation and consequent internal unrest. One way or the other, the reaction to any such measures by the Americans will be violent, with a countdown to conflict comparable only to the one triggered by Franklin D Roosevelt’s decision in 1941 to freeze all Japanese assets in the US and impose an oil embargo on Japan.

Another arena where Trump will give the kaleidoscope an almighty kick is Europe. His hostility to the European Union – the principal instrument of the continental order hitherto strongly supported by the United States – is well documented. This will add yet another problem to the long list already confronting Brussels and the national governments. As if that weren’t bad enough, Trump will encourage the European “deplorables”: Alternative für Deutschland in Germany, Jobbik in Hungary and the French Front National. His xenophobia and authoritarian personality will chime with them; his protectionism may even resonate on the European left. He will therefore be much less isolated in Europe than many like to think.

Worse still, the example of a wall with Mexico may well inspire similar endeavours in Europe – in the Balkans and the Mediterranean (where some barrier is necessary to defend the external boundary of the Schengen passportless travel zone), but also in central Europe and perhaps even within the core of the EU, thus destroying free movement of people on mainland Europe. The period from 1989 to 2016 may become known as “the interwall era”. The walls will go up across Europe and we may not see them brought down again in our lifetime.

But the deadliest threat to European security is Trump’s attitude to Nato. He has repeatedly questioned whether the United States should continue to protect Europe, most of which fails to pay its agreed contribution to the common defence. Here – unlike in the cases of South Korea and Japan, which largely pay their way on defence – he has a point. It is negated, however, by his undisguised admiration for Putin, the single greatest threat to the stability of the European order. One of Trump’s top military ­advisers, Michael T Flynn, a retired general, is a Russia enthusiast. One of his most trusted former confidants, Paul Manafort, served as a long-term political consultant to the disgraced ex-president of Ukraine and Russian stooge Viktor Yanukovych. One of his few named foreign policy advisers, Carter Page, also has close links to Russia.

Everything points to a President Trump lifting sanctions on Putin before time and recognising Russia’s annexation of Crimea. He is also highly likely to undermine the value of Nato’s Article 5 guarantee of collective defence, which will place the Baltic and Black Sea states and Poland in the firing line. Yet he seems oblivious to this danger, largely because he does not take Russia seriously in economic terms. It is one of the many failings of his foreign policy, and a surprising one, given his general belligerence, that he
does not take other factors, such as ideology or raw military power, much into account.

Geopolitically, the results of all this are entirely unpredictable and could lead to a different global strategic balance. In effect, Europe will be left on its own to stand against Russia and defend Western values worldwide. Putin may be emboldened to take risks, in Ukraine, in eastern and northern Europe, and elsewhere. On the other hand, he may prefer to explore a strategic partnership with Trump. That will surely begin with a joint effort to support the Assad regime in Syria, and probably develop into an alliance against China. In that case, we will be in a genuinely tripolar or even quadripolar world, in which the relationship between the Russo-American alliance, the British-European confederation and the other Eastern dictatorship, China, will be one of unstable equidistance.




Finally, it would be wrong to hope that either domestic or international checks and balances will constrain Trump abroad. The executive will be bound to obey most of his orders in theory and probably all of them in practice. It is true that the military, the CIA and law-enforcement officers might, as the former National Security Agency and CIA director Michael Hayden has suggested, refuse to follow an “illegal” order. It is also possible that Congress might hold up international trade measures in so far as they relate to treaties. The EU may even be so appalled that it rallies in the face of Trump.

Yet this is wishful thinking. Crucial questions, such as whether to deliver on a Nato Article 5 guarantee in Europe, are matters to be decided by the executive alone, and for good reason. Moreover, Trump will have much of the United States behind him in making his initial foreign policy moves. Demand that the Europeans “pay up” for their own defence? Why not? Beat up on China’s protectionism? What’s not to like? As for Isis, even Homeland’s Peter Quinn thinks that the solution is to “pound Raqqa into a parking lot”. It would take superhuman moral and political courage to stop Trump early on. And with Europe, the idea that it will show resolve in the face of an external threat is, sadly, a sign of the triumph of hope over experience. Many Europeans, in fact, will cheer him on. At home and abroad, Trump will the harvest low-hanging fruit first, and then invest the capital gained in riskier enterprises. When he does really overstep the mark, it will be too late.

There is a very thin silver lining in all of this, at least for Britain: Trump is a known enthusiast for the United Kingdom. He has come out strongly against Scottish independence. He will almost certainly favour London over Brussels in trade matters. Above all, with him in the White House, Theresa May will be the only grown-up left among the major military powers of the West. The EU will almost certainly try to compensate for the loss of an interlocutor in Washington by moving closer to London. Britain will probably also benefit from an outflow of American “creatives” after a Trump victory – at least, of those for whom Canada isn’t far away enough. Britain may well also attract talent from around the world that would otherwise have gone to Silicon Valley or other centres of innovation in the United States.

In short, President Trump is likely to deliver a severe shock to both the US and the rest of the world. Although at home there are clear limits to what he can achieve, there are far fewer constraints abroad. There is little doubt, therefore, that the Americans, and probably the British, will survive Trump. The question is: will the rest of us?

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 06 October 2016 issue of the New Statesman, Trump's triumph