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

James Graham. Photo: MIKE MCGREGOR/Guardian
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Love, Labour and loss: how James Graham became the king of political theatre

He captured the spirit of the Commons at the end of the Seventies in This House. Now, he’s turned his attention to the Labour Party.

London, 8 June 2017, 10.01pm

The minute the exit poll was announced, James Graham knew he had a problem. His latest play, Labour of Love, had been announced on 19 May when the opposition was polling a dozen points behind the Conservatives. The initial press coverage had mentioned plans to tweak the script right up until its opening night in September to chart “Labour’s changing fortunes – and any potential new leader of the party after the election”.

All that was swept away when David Dimbleby announced that the Conservatives had lost their Commons majority. Graham was having a party with friends, but he knew instantly that his script would need a significant rewrite. “I didn’t expect that election to happen, like everyone else. And I didn’t expect that result, like everyone else,” he told me one Friday afternoon in August, in a white-walled office above Wyndham’s Theatre in Soho. “So the questions the play is posing about the Labour Party and the direction of travel are not the ones I wrote in the drafts that the actors signed up to months ago.”

Luckily, Graham, who is 35, is used to working at a frantic pace – he writes early in the morning, before the emails start, and late at night. He hates starting to write, loving the possibility offered by a blank page and loathing the thought of muddying it with an inevitably imperfect script. But once he has begun, he charges through scenes, “so that when one character is responding to another, it’s instinctive and visceral. I don’t over-think it.”

That’s just as well, as there is a heavy weight of expectation hanging over Labour of Love. Not only does it have a starry cast – Sherlock’s Martin Freeman, playing a Labour MP, and Tamsin Greig of Black Books, playing his constituency agent – but there is a tingling anticipation that Graham, finally, might be the one to make some sense of our absurd, improbable, exciting, terrifying political moment. That’s because he writes “political theatre” with as much attention to the second word of that phrase as to the first. You will leave one of his plays bursting with knowledge about pairing MPs, or Einstein’s regrets over Hiroshima, or the Byzantine division of labour demanded by print unions in the 1960s. But you will also have watched an enjoyable play. It seems like that shouldn’t be too much to ask and yet, quite often, it is.

Graham’s breakthrough came with This House in 2012, a big, energetic piece about the whips’ offices in the House of Commons during the last years of the Callaghan government. In its climactic moment, Big Ben falls silent, suggesting that politics might offer the appearance of tumult but is too often grindingly cyclical. His previous work includes The Vote, set in a polling station during the last 90 minutes of an election day; Privacy, which grappled with the fallout from Edward Snowden’s revelations about NSA surveillance; and The Angry Brigade, about 1970s anarchists and the police sent to catch them. He has written small plays – The Man has just one character, Albert’s Boy has two – and huge, sprawling ones for the National Youth Theatre, with a cast list extending into the dozens.

Labour of Love is set in a single place – a constituency office in the Midlands – but spans 27 years of the party’s fortunes, from the dog days of late Thatcherism, through the pomp of New Labour, and right up to the present. Like all Graham’s plays, it is meticulously researched. The jargon is technically correct, and the references are contemporary: Tamsin Greig’s agent looks forward, if Labour loses the seat, to leaving the party’s WhatsApp group.

Kate Wasserberg of the theatre company Out of Joint, who directed several of Graham’s earlier plays, compares him to Hilary Mantel in his ability to see “how the follies of the human heart lead to seismic events”. He has, she says, “the soul of a playwright and the brain of a historian”. Harry Davies, his researcher, tells me that the pair conducted 50 interviews for Privacy.

In person, though, James Graham is remarkably unremarkable: average height, brown hair, neatly dressed, good-looking more through the absence of flaws rather than any particularly striking feature. If he mugged you and the case rested on identifying him later, he would get away with it.

Except that wouldn’t happen, because James Graham is nice. He has more than a thousand Facebook friends. He sends thoughtful emails and apologises for not being sufficiently interesting. Everyone in the theatre world likes him; more than that, they feel happy for his success. It’s profoundly disconcerting. (This is partly down to a recognition that he has paid his dues: he must have felt as if he had spent the first decade of his career living inside a perpetual three-star Michael Billington review.) When I ran into him at a bar in the course of writing this profile, he gallantly offered to buy me a drink, despite my only conversation-starter being that I had spent all week trying to get his friends to gossip about him.

Graham is a people-pleaser, something that leads him to accept too many commissions – “He’s always got three more projects on the go than he should,” says the BuzzFeed writer James Ball, who appears as a character in Privacy. As a result, Graham occasionally says yes when he should say no. In 2013, he signed up to rewrite the book for the musical Finding Neverland, a vanity project of the Hollywood über-producer Harvey Weinstein. “The reviews were hideous but it survived because it starred Matthew Morrison from Glee, and it had an advertising budget the size of Venezuela,” says David Benedict, a former London critic for Variety. “A show on Broadway may take a million dollars a week, and if you’re on a percentage, you’re quite happy. I can’t imagine someone as shrewd as him got into bed without knowing.”

Not that money seems to be much of a motivating factor in Graham’s life. Neverland provided him with the deposit for a house in Kennington, but there is a general agreement that by choosing to keep writing for theatres rather than taking a Netflix or film deal, Graham is losing out financially.

“It’s humility,” says Neil McPherson, the artistic director of west London’s Finborough Theatre, of both Graham’s personal civility and his inability to say no to commissions. “It’s possibly a class thing. I have a nightmare with my job with Oxford graduates who would kill their grandmother to run the National [Theatre] a year earlier. But James is humble before the work.”

Annesley, Nottinghamshire, 9 April 1992

It’s the day of the general election and there’s only one way this part of Nottinghamshire will go – Labour. But the nine-year-old James Graham is dimly aware that his parents, who separated when he was four but still live on the same street, are voting different ways. This is one of his first political memories – apart from seeing posters during the 1990 Conservative leadership election and deciding that Michael Heseltine was his guy, based solely on his hair. “That mane,” he says now. “It was purely on looks.” (When Heseltine came to see This House, he was reportedly unhappy with the wig used by the actor playing him. “He came about five times so he can’t have been that offended by any of it,” notes Graham drily.)

The playwright also remembers the closure of the mineheads in Annesley, the village where he grew up. Deindustrialisation hit the community hard, but it was already riven by the ideological disputes of the late 1970s and 1980s. Soon after Graham returned from university, there was a murder in Annesley: a miner who left the hard-line NUM during the strikes killed another who had not. It felt to him like an echo of the village’s deep divides. “I remember watching the mineheads come down, and the physical geography of my town changing,” he says. “I probably didn’t associate that with politics at the time.”

He is the youngest of three children, with an elder brother and a twin sister. After their parents separated, his brother lived with their father; he and his sister with their mother. The twins were the first in their family to go to university; he went to Hull to study drama and discovered a swath of northern playwrights: Willy Russell, John Godber, Jim Cartwright. At the Hull Truck Theatre, “It was like going to a working men’s club… You’d get a pint and go sit at a table and people would do you a play.” To the community there, watching a performance was an equal choice to the pub, bowling or bingo. “It was part of their experience. That will sound romantic or sentimental, but it just was.”

Accordingly, a fifth of the seats for Labour of Love cost just £10, something Graham calls “almost a socialist experiment”, as the discount is paid for by hiking the price of prime real estate in the stalls. “You can’t kid yourself that what you’re doing is engaging in a national conversation about the direction of the left, or of a party whose roots are in working-class trade unionism, if you’re going to fill your Victorian theatre with people who can afford expensive tickets,” he says, “and have already had the conversation with themselves anyway.”

It bothers him that it’s now harder to find working-class voices and experiences represented on television: his formative influences included Cracker, GBH and Auf Wiedersehen, Pet. The ITV regional producing bodies have been whittled away, the new English Baccalaureate curriculum discourages subjects such as drama and, Graham says, “With local authority cuts, the first thing that goes is funding to theatres and libraries. So you have to travel to London to see a new show.”

Graham is part of a generation of younger writers and directors who are fighting back against this trend. He gave evidence at a Commons inquiry into working-class participation in the arts, noting that he supported himself through his early days writing for the Finborough Theatre with bar and call-centre work; in his school years, he would go out window-cleaning with his stepdad. When he first moved to London, he sometimes had to walk home from meetings because he couldn’t afford the Tube fare. “Without being a wanker, he’s stayed in touch with his roots,” Neil McPherson says. “A lot of new writers are very middle class. It’s surprising how many haven’t had Saturday jobs.”

When This House was shown at cinemas across the country as part of National Theatre Live, people told Graham that audiences would cheer when their constituency was mentioned: “It’s a tribal thing, I guess, but you don’t expect to hear the name of your shitty town.” When his mum came to see the play, the crowd, knowing where its writer was from, went wild at the mention of the member for Mansfield. “I was so proud,” he says. “No one has ever cheered the word ‘Mansfield’ in a West End theatre.”

At the same time, the more you read of Graham’s work, the more you realise the pain and dislocation inherent in our model of social mobility. Working-class success is often measured by leaving. It’s an idea that crops up in other contemporary writers at the intersection between politics and comedy. Caitlin Moran confesses that she was thrilled to get a job on the Times at 18, as her options in Wolverhampton would have been “literally cheese counter or prostitute”. In How Not to Be a Boy, Robert Webb – a grammar school pupil from Lincolnshire – writes of his guilt at arriving at Cambridge University with his father and brother. “We find my room at Robinson College and Mark and Dad nearly piss themselves when they see a note on the bed, reading ‘YOUR BEDMAKER’S NAME IS ALISON’. Finally, Little Lord Fauntleroy has staff.”

In her 2016 book Respectable, Lynsey Hanley tackles this idea head-on. “It might be argued that another primary aspect of working-class experience, a feeling which most defines a certain way of being in the world, is loss.” That means the loss of jobs, the loss of a sense of place as a local factory or works closes down, and the loss of the environment that formed you when you have to leave it as an adult. “In doing so, you risk creating another disjuncture, another source of loss, in the history of your family. The place you came from, so this new story goes, wasn’t good enough for you.”

Several of Graham’s early plays are haunted by this idea. In Sons of York, three generations of men from the same family struggle through the winter of discontent of 1978-9. Mark, the youngest, likes the subversive comedian Kenny Everett and remarks on how much Eric Morecambe looks like Philip Larkin; his father, Jim, and grandfather (“Dad”) have no idea what he’s on about. His mother, Brenda, has to do all the emotional labour of the family and most of the practical stuff, too; when Mam dies, the three men struggle to make small talk, let alone share their grief. Dad wants to know who the union rep is at Mark’s work; neither Mark nor his father can bring themselves to tell Dad that he has stayed on for sixth form instead of following the family tradition and becoming a van driver.

Jim wants to be proud, but experiences his son’s social mobility as rejection:

Jim: D’yer’ark at him, eh? Smug little… gi’in it all working-class solidarity.

Brenda: You what?

Jim: When tomorrow he’ll have his nose back in a bloody textbook.

“I feel like there’s stuff in there that’s the best stuff,” Kate Wasserberg says of Sons of York. “It’s not the majestic flying buttresses of This House in terms of ability, but were he to put pain in…” She trails off. “James’s parents are clearly very proud of him but it was always interesting to me that I never got to know his siblings. Their lives are totally different. How many James Graham plays can you think of with brothers and sisters?”

For the record, there are a few. In one, The Man, the narrator even has a twin. His brother has a fatal degenerative disease, which causes injured muscle to grow back as bone. The narrator is racked by survivor’s guilt; haunted by the twist of fate that gave him one destiny and his twin another.

Finborough Theatre, London, 2005

Articles about political theatre have two settings. At any time that we are not fretting about the “death of political theatre”, we are apparently living through a golden age of it. The Iraq War produced the last great flowering, and Brexit now seems to be doing the same. Both are great engines of creativity because they are outrages perpetrated by the political class on the playwright and playgoer class: times when artists and writers have looked at politicians and felt, with a sensation like that sudden falling jerk when you’re nearly asleep, hang on, these people are not on our side.

In the summer of 2005, as hubristic US generals predicted a “fairly substantial” withdrawal of British and American troops from Iraq within a year, a new play opened at the tiny Finborough Theatre. Its author was a 22-year-old who was working as a doorkeeper at the Nottingham Playhouse, 11 miles from where he grew up.

When the script first arrived, unsolicited and unaccompanied by any agent’s recommendation, the theatre’s artistic director, Neil McPherson, was tempted to weigh it. “It was 250 or 300 pages long,” he says now. “He’d basically put in every single historical character you can imagine: Hitler, Napoleon, Pol Pot.” But it was funny – “he can write a zinging one-liner” – and it was ambitious, ending with Hiroshima live onstage. “I said: go away and write the Napoleon play or the Einstein play. He wrote the Einstein play.”

Albert’s Boy was recently revived at the Orange Tree Theatre in Richmond, and although Graham found watching it tough – “It was like watching your younger self trying to flirt or seduce somebody, and not getting it right” – it stands up better than other plays that engaged more directly with war and WMD. “I didn’t want to write the Basra play,” is how Graham describes it now.

Set in a single room (to allow it to be produced as cheaply as possible), it has two characters: Albert Einstein and Peter Bucky, the son of a family friend, who has just returned from the Korean War. Bucky, whose nerves are shot from his experiences as a prisoner, has little time for the older man’s recriminations over his involvement in the Manhattan Project. Is it really any worse, he says, to burn instantly in a nuclear fireball than to be bayoneted and left to die in the snow?

There are perhaps too many jokes about how a genius can be terrible at housekeeping (“Maybe the key to unifying your theory is unifying your socks!”) but there is also a light touch with pathos. Einstein’s cat disappears, and his fretting is ended only when he finds the creature’s body in the vegetable patch. It’s both a subtle echo of Stalin’s line about a single death being a tragedy and a reminder of the true danger and temptation of nuclear war: it renders the act of killing distant and bloodless. Death should be messy, never clinical, to stop us getting a taste for it.

Graham wonders if his first produced play accidentally set the course of his career, and whether, “had my first play been a relationship drama in a flat in Leeds… they would all have been that kind of stuff”. But that wasn’t to be. On the first night of Albert’s Boy, Neil McPherson brought in all his books about Anthony Eden. “I plonked them in front of [Graham] and said: get on with it.” The result was Eden’s Empire, which drew muted parallels between the Suez Crisis and the Iraq War. After that, Graham and McPherson spent three hours in a café in Smithfield, “and I talked him into the Margaret Thatcher play” – Little Madam, which dealt with the Conservative leader’s childhood in Grantham. “I didn’t need to give him any ideas after that,” McPherson says. “He had his own.”

Although Graham has since become famous for his big, public plays – and his television work, such as a Channel 4 dramatisation of the coalition negotiations – that doesn’t do justice to the range of his output. Many of his earlier plays are smaller, human dramas. The Whisky Taster, for example, tells the story of a pair of colleagues at an advertising agency trying to win a pitch for a new brand, while struggling to articulate their feelings for each other. A History of Falling Things shows a boy and a girl, both terrified to leave their houses because of their phobia of satellites crashing from the sky, who meet on an internet forum and communicate through webcams. Their bedrooms occupy opposite ends of the stage, with a gulf forever between them.

If you look at these plays, a different Graham emerges from the grand chronicler of political events. “There’s an ongoing theme in his work that is always quite cleverly obscured,” Kate Wasserberg says, “to do with people who cannot form intimacies for various reasons. For someone who everybody loves so passionately, there’s a loneliness… I feel like I’m being indiscreet but it’s all in the work.” (In interviews, Graham will not be drawn on his private life, instead saying things like, “I am not a monk.” He tells me that writing plays is an odd mix of solitude and bursts of public interaction: “I enjoy being by myself, probably a little too much. I have a few friends who live nearby who, if I don’t WhatsApp for while, risk banging on my door to bully me out.”)

Paul Roseby of the National Youth Theatre describes a similar experience when they worked together on Tory Boyz. The play juxtaposes Ted Heath’s relationship with his childhood friend Kay – who loves him but marries someone else when she realises her love cannot be reciprocated – with the macho, bullying world of young, gay Conservative parliamentary staffers.

Roseby admits that he worked on a political play with Graham for months without ever knowing what “his true political persuasion was”. (It seems unlikely to be Ukip, however; his friends include the Guardian writer Owen Jones.) When he saw The Whisky Taster, which ends with the colleagues failing to acknowledge their relationship, Roseby decided: “The thing is with James, he just needs to go out and shag more. I may have said that to him. Why aren’t these people sealing the deal? They don’t commit. It’s very tentative. But that creates a very interesting tension. Still, I didn’t pry too much. We were too busy trying to put a bloody play on.”

Like other friends, Roseby describes Graham as essentially “private”, adding: “I love that about him. In our world, we are so ready to spill everything, but drama is about secrets and lies. He has some secrets and I’m sure he’s told some lies.”

Almeida Theatre, London, 28 June 2017

It’s the press night of Ink, Graham’s play about Rupert Murdoch’s capture of the Sun newspaper, and as usual he has stationed himself at the back of the auditorium to drink in the mood of the audience. He is worried, because the play is showing just a few weeks after the Grenfell Tower fire tragedy. As journalists tried to report on the aftermath, they were shouted and sworn at. There’s an amorphous anger in the air, London’s version of the anti-establishment feeling that led other parts of the country – including Graham’s home town, Mansfield – to vote to leave the EU. “Walking out of that press night, I thought… people will accuse it of being completely toothless and being too kind to him [Rupert Murdoch],” he tells me.

The script of Ink had already been heavily rewritten from the first day of rehearsals. “When I brought the script in… I had one of those moments I thought I had got used to, which was the difficult read-through where it’s not quite there yet and you feel vulnerable and exposed,” he says. “It felt like a series of disconnected events – the thing I always hate and warn myself off when doing history, that it just becomes an episode tick list. This happened, this happened, in this order. But it doesn’t seem to amount to anything.”

He left the rehearsal room that night and stayed away for a week, rewriting the whole second act and most of the first. “I had thought the story was so amazing, the world was so vivid, that it would be great. Actually, I had to go back and do some proper play-writing.”

I was at that press night, and two things struck me. The first was the hilarious starriness of the audience, at least in journalistic terms: Kath Viner, the editor of the Guardian, to the right of me; Tony Gallagher, the Sun editor, in the row behind. Journalists love any art about journalism, no matter how brutal or condemnatory: it makes us feel that what we do might echo down the ages, instead of disappearing into chip-wrapping. The second was a feeling of surprise at the interval: hang on, this is Rupert Murdoch, portrayed on a stage in Islington, north London, and he’s… not the Devil?

Graham’s Murdoch is a bundle of contradictions, unsure of himself, still the Australian immigrant stung by being called a “sheep farmer” and on a mission to liberate the working class from what he sees as pointless self-improvement foisted on them by a paternalistic establishment. His key line comes when he marches into the Mirror Group’s boardroom, ready to buy its worst-performing title, and gets tired of the pleasantries: “That’s enough foreplay. Can we get down to the fucking?”

On the surface, it reads like a yahoo deliberately outraging the standards of people he doesn’t respect. But Graham’s portrait of Murdoch suggests another reading: a socially awkward man making sure that everyone else feels uncomfortable, too. “I hope it’s the latter,” Graham says. “And the way that Bertie [Carvel] performed it was the latter.” (I tell Graham it reminded me of my old editor Paul Dacre. I recently discovered a diary entry from 2008, when I wrote about nearly running into the Daily Mail supremo in the newsroom after emerging from behind a pillar into his path. “He looked tortured and mumbled apologies without making eye contact, before moving on. Five minutes later he was calling my boss a c***.”)

During his research, Graham discovered that the Sun’s first editor, Larry Lamb, had hidden the launch of Page Three from Murdoch. “Whether it’s true or not, books like Stick It Up Your Punter! and Larry’s memoirs suggest he was furious… And you think: my god, what did Rupert Murdoch learn about his anger and piousness about Page Three that he had to unlearn to become the most successful newspaper magnate in the world?”

During the interval, a friend suggested that Ink would inevitably be compared with David Hare and Howard Brenton’s Pravda, a savage satire of the press from 1985, in which the South African tycoon Lambert La Roux buys a newspaper from a bumbling old aristocrat who wants the money to buy a share in a racehorse. That play is far less interested in the motivations of its Murdoch figure. The last line, spoken by La Roux, is: “Welcome to the foundry of lies.” This is not something you could imagine one of James Graham’s characters saying.

Hare sees the even-handedness of Graham’s characterisation as a response to the prevailing political climate – just as Pravda was ahead of its time. “I remember Howard turning to me at the first preview when the audience started to laugh and [saying]: but they haven’t said anything funny yet. I said: no, but I think they want this play.”

Hare tells me that he thinks Pravda was a rare example of one of his plays “sailing downwind”. “By and large, if you write political drama, you’re sailing upwind – trying to persuade people of something that they don’t necessarily want to be persuaded of.” (Hare’s Iraq play Stuff Happens was written, he says, when supporting the war was still seen as a patriotic duty.)

Ink, which is just about to transfer from the Almeida to the larger Duke of York’s Theatre in the West End, sails defiantly upwind by depicting Rupert Murdoch as an iconoclast disrupting a self-satisfied elite, and showing why working-class Britons were so eager to buy the Sun. The most captivating scene is one in which members of the new editorial team interrogate what they really want in a newspaper: free stuff, gossip, football, sex and the weather. The discussion kicks off with Larry Lamb’s confession, delivered in a broad Yorkshire accent: “I don’t like brass bands. There.”

Hare also declares himself to be a great admirer of the way Graham shows “process” – deepening his audience’s understanding of a situation rather than trying to win it over to a cause. “The easiest kind of play to write is the left-wing play which takes an obvious injustice and stirs up feeling against it,” he tells me. Graham, on the other hand, “writes about the real world, not piety”.

None of this matters, though, unless we accept that theatre – and, by extension, any art – can have political consequences. Graham believes that it can, citing the way Tony Kushner’s Angels in America humanised the victims of the Aids outbreak in the 1980s. “Nothing I’ve done ranks on that scale in terms of influence,” he says. “Some people may tell me they had no idea parliament worked like that, say, or that that’s how the Sun newspaper began, and it has made them see things in a new light, perhaps. Oh, and when I did The Whisky Taster at the Bush in 2010, sales of whisky in the O’Neill’s downstairs went up around 200 per cent. So playwrights are good bootleggers, if nothing else.”

National Theatre, London, 2010

As soon as it became clear that there would be a hung parliament, James Graham decided to pitch a play about politics to the National Theatre. He had little hope of success – he assumed that one of the grand eminences would have bagged the subject – but came away with the commission from Nicholas Hytner for This House.

As ever, the research consumed him. He wanted to turn away from the Great Man version of history and show politics as an engine room. To that end, he placed the action in the whips’ office, as Labour and Conservative whips cajoled and sweet-talked their backbenchers into voting with the party line against a backdrop of recession.

“I was very reluctant at the beginning to talk to James or anyone else,” says Ann Taylor, a former Labour whip who now sits in the Lords. Whips traditionally never speak about their work: Gyles Brandreth, a former Tory whip in the Major government, recalls getting a literal black spot in the post when his memoirs were first published in 1999. But something about Graham’s approach persuaded Taylor: “He filled me with confidence that he was doing it for the right reasons – to portray the period.”

This House is a play without an obvious antagonist. The villain, if there is one, is the system, the great shuddering machine of parliamentary democracy, which gives everyone a little bit of what they want but always at a cost. Between the two sets of whips, the class divide is obvious, but the Labour side has what Graham’s other dislocated, upwardly mobile protagonists never have: comradeship. They swear defensively, talk about “birds” and football and regard themselves as a band of barbarians attacking a citadel, using amendments and points of order as their weapons.

Like Ink, This House sails upwind. It was written two years after Laura Wade’s Posh (filmed as The Riot Club) stormed the Royal Court, showing a Bullingdon Club mob trashing a restaurant and getting its thickest member to take the rap with the promise of a parliamentary seat. But in Graham’s vision, the Tories are not the villains, nor are they universally privileged. The central relationship is between the Labour deputy whip Walter Harrison and his Tory opposite number, Jack Weatherill, who left school at 17 to train as a tailor and always carried a thimble to remind him of his background. Jeremy Herrin, who directed This House, says its core is the idea that “dignity and honour are possible in politics… Like the man, [Graham’s] work is generous and humane.”

Once the whips had decided to talk to Graham, they couldn’t stop. The former Labour whip Ann Taylor even suggested toughening up a line of hers, when the team is discussing the recall of Alfred Broughton, a Labour MP who is at home dying of heart failure, because without his vote the government will fall:

Taylor: I don’t understand, we’re one man down, and the Doc wants to come.

Harrison: Ann, it’ll kill him!

Taylor: He’ll die happy.

“It came out in conversation,” Taylor says now. “I said – it’s reality. It was how a few of us felt at the time.” She has been to see This House four times and tells me how on the last day of its revival at the Garrick Theatre, Walter Harrison’s grandson came to the matinee and was so touched that he left one of his grandfather’s lapel badges for the actor playing him that evening. “Labour whips have been to see it, Tory whips have been to see it, and neither felt it was unfair,” Taylor says. “Maybe it’s because he’s so young, he’s so open-minded. I don’t understand how he understood so much.”

Graham attributes his desire to be even-handed partly to his background – “I’m sure the political divides, the split identity between northern and Midlands, the historical fault lines that ruptured through the towns in the 1980s and 1990s, have contributed to my desire to step back, to take in all sides, yes” – and to his natural temperament. “My family often – and not always as a compliment – refer to me as the diplomatic one in arguments,” he says. “There’s a risk, of course, and I’m not unaware of it, that you’re simply not picking a side.”

Among James Graham’s peers in the theatre, there is a general acknowledgement that This House is, technically, his masterpiece. But they want more. “I wonder if there will be a moment when he will come up against a subject that’s fully worthy of all his skill, that challenges him and is painful, and that will pull something out of him,” says Kate Wasserberg. Paul Roseby’s hopes are simpler: “There has to be more to life than plays. I hope it doesn’t pass him by, the emotional stuff.”

David Hare worries that Labour of Love will feel too reactive because it is tied so closely to current events. “That’s what I call ‘chasing the dustcart’,” he says.

Annesley, 8 June 2017, 10.01pm

It’s the day of the general election and there’s only one way this part of Nottinghamshire will go – Labour. And particularly on this night, surely, when the exit poll predicts Jeremy Corbyn making unexpected gains across the country. In Graham’s home constituency of Ashfield, Gloria De Piero hangs on with a majority of just 441. In next-door Mansfield, everyone expects Sir Alan Meale, the area’s Labour MP since 1987, to be returned to parliament.

But something is wrong. Since Tony Blair’s 1997 landslide, when Meale’s majority swelled to more than 20,000, Labour’s tide has gone out as old class loyalties have crumbled. By 2015, Ukip was in third place.

Still, no one expects it to go blue. At 4.10am, the returning officer Jacqueline Collins duly announces Alan Meale’s re-election. A few muted cheers, and then a dreadful pause. “I’m so sorry,” she starts again. “I declare that Benjamin David Bradley has been elected and I do apologise.” Mansfield has its first ever Conservative MP.

How did this happen, I ask Graham over email. He says that he knows miners and their children who voted Conservative, some of whom are ashamed to tell their families. For some, the motivation was Brexit; for others, it was a sense that “Corbyn’s Labour Party is not their Labour Party”. He adds: “I’m not saying they can’t be won over – and in fact, maybe [Corbyn’s] performance in the final weeks and post-election has helped. But Mansfield, since the blood spilled in the 1980s, has long had a suspicion, a dislike, of ‘the mob’. That militant side to the left, what they view as fanatics, hero-worshipping, political radicalism.”

He also attributes the Conservative win to a “bigger middle class, moving into estates on the outskirts” – and also to Labour’s fundamental problem in its former northern heartlands, as “young voters leave for education and then as graduates they don’t come back”. In other words, it’s partly down to voters like him, who might once have stayed and prospered in a village like Annesley but now find themselves at the back of an auditorium in London, trying to recreate a home from which they have been severed.

“Ink” runs at the Duke of York’s Theatre, London, from 9 September. “Labour of Love” runs at the Noël Coward Theatre from 27 September. “This House” tours Britain next year

James Graham’s selected work

Albert’s Boy (2005)

Graham’s first produced play featured Albert Einstein and a family friend debating the ethics of nuclear war.

Tory Boyz (2008)

In this sprawling epic, the story of young, gay Tory parliamentary researchers is juxtaposed with that of Ted Heath.

The Man (2010)

In this one-man show (sometimes performed by Graham), a man tells the story of his life through the receipts he has collected for his tax return.

This House (2012)

Graham’s breakthrough play followed the whips’ offices in the late 1970s, culminating in the fall of James Callaghan’s Labour government in 1979.

Privacy (2014)

Riffing on the revelations of Edward Snowden about NSA surveillance, this was rewritten for Broadway and starred Daniel Radcliffe as “the writer”.

The Vote (2015)

Broadcast live on election night from the Donmar Warehouse in real time, this followed 90 minutes in a polling station.

X+Y (2015)

Graham’s film debut followed an autistic prodigy (Asa Butterfield) competing in a maths Olympiad.

Quiz (2017)

This play about Who Wants to Be a Millionaire’s “coughing major” opens in Chichester in November this year.

The Culture (2018)

This commission was written in response to Hull (where Graham attended university) being the 2017 City of Culture. It is a farce in the style of the BBC’s W1A

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis