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

Picture: MILES COLE
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Ruth Davidson: “Brexit could deliver a hit we can’t recover from”

The Scottish Tory leader has revitalised the party north of the border. Is she now destined to occupy the hottest seat of all?

Ruth Davidson has had a good summer. At the age of 38, she has finally bought her first house. It’s a two-bedroom mid-terrace in an Edinburgh suburb that she will share with her Irish fiancée, Jen, and their cocker spaniel, a failed gun dog called Wilson (“It’s just as well he’s handsome because, by God, he’s stupid,” she tells me). The hyperactive leader of the Scottish Conservatives is eager to put down roots. “I’ve always moved for work,” she says. “I worked out that since I left home to go to uni at 17, I’d had more than 20 flats. This is the first time I’ve had a home. It’s nice.”

On 29 August, her opposite number in the Labour Party, the well-liked Kezia Dugdale, resigned. Her replacement is likely to drag the Scottish party in a more Corbynite direction on issues such as nationalisation, taxation and public spending. This will put pressure on the SNP – now the party of choice for many disaffected Labour lefties – to do the same. That would leave space in the centre ground that Davidson’s Tories will be more than happy to fill.

“If I’m perfectly honest, I am by nature a centrist,” she says. “I’m fairly hard-core on some justice and fiscal policies. I’m a proper Tory there. But in terms of social policy and things like that, I’m absolutely a centrist. But it’s because I think it’s right. It brings people with you and, if you’re looking towards [forming a] government in a way that as a party in Scotland, five to ten years ago, we could never have conceived, it’s about bringing people with you and making the arguments for being bold and radical.”

This sounds familiar. Is the great young hope of British Conservatism a much more youthful, female version of Tony Blair? That won’t go down well in the Shires or the leader columns of the Daily Mail. “No! I didn’t go to Fettes, I don’t own… rental properties around the world, I don’t holiday with pop stars, so I don’t consider myself to be a Tory Tony Blair. There’s some things I think he did very well. I think in terms of foreign policy, his idea of humanitarian interventionism that he used in Sierra Leone and in Kosovo was bang on. It was the right thing to do and it saved lives. However, I’m probably the only Tory leader who has been on one protest march in their life and that was against the Iraq War in 2003, so there are things I don’t agree with him on. Actually, I joined the Territorial Army about a month later because I wanted to serve in some way – though not in Iraq.”

Ruth Elizabeth Davidson grew up in a Presbyterian family in Selkirk, where her father worked in a wool mill and she attended a comprehensive school. After a career in broadcast journalism, she entered politics and became leader of the Scottish Tories in 2011; she has since revitalised the party in one of the great contemporary political feats. With Davidson at the helm, a party that was wiped out in the 1997 election (it won none of Scotland’s 72 Westminster seats) and that had shown only a flicker of life since then has supplanted Labour as the official opposition at Holyrood. In June’s general election, the Tories won 13 seats (out of 59) in Scotland, an increase of 12. Between the 2015 and 2017 general elections, the Scottish Tories put on more than 320,000 votes; in the May local elections, they more than doubled their share of Scottish council seats to 276.

There is a good chance that in 2021, when the next Holyrood elections are held, Davidson will find herself leading Scotland’s largest party and becoming first minister. Already she regularly attends Theresa May’s political cabinet in London and is spoken of at Westminster as a future prime minister – some would parachute her into No 10 tomorrow if they could. Members of her small back-room team say that they are besieged by media interview requests and invitations from around the world. Everyone wants a piece of Ruth Davidson’s magic.

***

When we meet in her small office on the Conservative floor of the Scottish Parliament, I sense the low hum of military-style planning, even though Holyrood is still in recess. After ten days in Ireland, Davidson is rested and recharged. “I think along with almost every other person involved in politics [or] journalism about politics, and the voters, I went into the summer absolutely knackered. But I’m ready to go again. We’ve had a really good 18 months. We’ve had three elections where we’ve come from third to second each time, we’ve more than doubled our number of MSPs, more than doubled our number of councillors. We’ve gone 13 times our number of MPs, though that maybe talks more about the base level than anything else…”

It’s certainly true that the old joke about there being more giant pandas in Scotland (there are two) than Tory MPs (there was one) has run its course. “The pandas are going to have to do a lot of listening to Barry White music to catch up with us now.”

Yet Davidson is far from satisfied. “I don’t want this to have been a peak. This is a platform for us to build on. In the five-and-a-half years I’ve been leader, between referendums and elections, I’ve fought eight national campaigns. Scotland is tired of politicians shouting at each other with no end product, and we need to use this period – which is the first we’ve had in years with no imminent election – to reduce the temperature in Scotland and in the political discourse. We need to use it to do some of the heavy intellectual lifting that’s not been done in this place [Holyrood]. We need to start asking questions about long-term solutions in important policy areas.”

The 20th anniversary of the referendum that licensed Tony Blair’s creation of the Scottish Parliament falls on 11 September and is inevitably inspiring some reflection and soul-searching north of the border. Not many would claim that the institution’s first two decades have been a shining example of policy innovation and political daring. “Are we as a country more dynamic, braver, more advanced, better educated, with better health than 20 years ago? I’m not so sure,” says Davidson. “Honestly, I think it’s been timid. I think devolution was designed to be more ambitious than what previously existed, and I’m not sure that ambition has been realised within this building at Holyrood.”

If given the opportunity, she wants to make good on the parliament’s potential. She accuses her SNP rivals of big talk but little action: “They’ve been very good at saying whatever issue of the week they’re getting hammered on is their top priority and that they’re going to have a commission, or there’s going to be a review. At some point, you actually have to start making tough decisions.”

The day after our interview, Davidson unveiled proposals for a series of new towns in Scotland and for 25,000 homes to be built annually. On education, she wants to encourage innovation by giving head teachers autonomy over budgets. She aspires to boost the status of the teaching profession, allow high- and low-performing schools in the same localities to “buddy up”, and encourage different types of school to open, including technical and state-funded schools that opt out of local authority control.

Davidson wants to introduce Teach First, which fast-tracks high-performing graduates into the teaching profession, to Scotland. “We used to pride ourselves at being the best in the world at education. Well, let’s have a bit of humility and let’s look at what’s happening in the world that’s better than what we’re doing.

“I understand that the SNP were trying to keep a broad collective together because they were working towards the goal of independence, but it’s not good enough that an entire generation’s life chances have been thwarted because you’ve been afraid to take on the teaching unions, or you’ve been afraid to make the changes that perhaps parents wouldn’t understand and you’d have to explain to them.”

Measures to tie the NHS and social care together will receive proper attention in the next few years, she says, as will the economy. “Part of centrism is about understanding the need for private industry, private enterprise, free trade, the idea that you can lift all boats. Inequality in the UK is at its lowest level for 36 years, but it doesn’t feel like that to people out there. They see these millionaire footballers or Russian oligarchs in London with their gold-plated Bentleys while they’re struggling and that disconnect is really tough.”

The ambition is clear, although the dissimulation and cant of the conventional political interview are replaced by a refreshing frankness. “We’re getting ready to change from a strong opposition to looking like an alternative government of Scotland,” she says. “We don’t look like that now. We know that. We’ve got a lot of work to do, but we’re up for it. I have to make sure I’ve got the team, the vision, the policies, the ideas, and that we’ve got the tone right – the civility that we can bring back into politics in Scotland, because it’s been at fever pitch for a really long time.”

She continues: “We have people who are serious, thoughtful, who probably ten years ago wouldn’t have changed career to do politics. But this big, cataclysmic referendum [in 2014] happened where people said, ‘The Scotland I want is worth fighting for.’ Whether you were for Yes or No, it dominated so much that a lot of people who would have just sat on the sofa and shouted at Question Time decided to get off their backsides and do something about it.”

In Scotland’s predominantly leftist political culture, there are those for whom a Tory – centrist or otherwise – can never be anything more than a stone-hearted friend of the moneyed elites. Davidson’s electoral success and personal popularity are all the more luminous when contrasted with the miscalculations and missteps that have gored the reputations of several senior London colleagues, including the Prime Minister and the Foreign Secretary.

Davidson says she isn’t worried about cross-contamination, but an indication of how Westminster decisions can trip her up came earlier this year when the UK government announced plans to restrict child tax credits to the first two children. An exemption was announced for women whose third child was a result of rape, but campaigners were furious that victims would be expected to prove their circumstances to the DWP.

Davidson defended the so-called “rape clause” and found herself in a difficult spot. “It was said I looked uncomfortable talking about it – well, yes. But do I want to make sure people who have had children in the very worst circumstances have the financial support that they need? Yes, I do. Nobody was putting forward a better way of doing this.”

Were her opponents in Scotland using the issue to tarnish her reputation? “Look, I’m not going to say that. But it’s interesting that even Jeremy Corbyn didn’t think it was an issue on the campaign trail.”

***

Davidson was a staunch Remainer. She aggressively debated Tory Leaver colleagues during the referendum campaign – most notably roughing up Boris Johnson, for whom she has little time, at a debate at Wembley Arena in London. She accepts that Brexit “is going to happen. You’ve got no major political party likely to be in government advocating that it doesn’t happen and no electoral event that would give them the mandate to stop it before it happens.”

Yet she is far from uncritical of the government’s performance. Of the fraught beginning to the Brexit negotiations, she says, “I think one of the things the UK government didn’t do that they should have done was pitch-roll this: remind the British public that when it comes to European negotiations – and we’ve had several decades of them – we are told no until five past midnight and then suddenly a deal gets done in the wee small hours of the morning. I don’t think the country was prepared for this period that we’re currently in. People in a room talking and then walking out and up to a bank of microphones and saying entirely different things while standing next to each other is part of what negotiation is. I think the UK government has not just an obligation but a duty to negotiate as hard as they can on behalf of the country.”

What is her biggest concern about the impact of Brexit? She pauses. “Interesting question… My real fear is that if there’s a short-term economic hit, we don’t bounce back from it.”

Would she like a prolonged transition period during which Britain maintains access to the single market? “I’m for free trade and want to make sure that people from Scotland and the UK have access to – and the greatest ability to operate within – the single market, which I believe are the exact words the Prime Minister used in her Lancaster House speech back in January. The mechanism for how we get to that I’m less aerated about, as long as that’s where we get to.”

We have reached, at last, a mention of the invisible Prime Minister, in office but not in power, counting down the days until her colleagues decide to free her from the burden of empty leadership. I say that it’s brave of Theresa May to get on with the job each day. It can’t be fun. “She’s absolutely straight down the line,” Davidson says. “She’s not a game player. And the kind of clichés that you hear about her, about her believing in service and public duty, are absolutely true. Everything that she said about being there for the long haul, as long as the party and the country want her – she will get up and she will put in a shift.”

Could Davidson end up occupying that hottest of seats? David Cameron once told me that he “never put a limit on her abilities and ambitions. She has got what it takes in politics. She’s got oomph, she’s got spirit, she’s got brains.”

One friend who has watched her astonishing progress concedes that even Davidson has been surprised by her success. “She has had to get her head around how good she is and how much potential she has – that she can play on the biggest of stages. Each time we think she’s reached a plateau, she climbs the next one. I genuinely think she could do just about anything she wants to, and maybe she’s starting to believe that.”

For Ruth Davidson, the next plateau is in sight. “When 2021 comes around, people will be looking for a first minister, and the option they’re going to have is Nicola Sturgeon again or me,” she says. It’s a remarkable statement, given recent history, to come from the lips of a Scottish Tory leader – but she means it, and we should take her seriously.

Chris Deerin is the New Statesman's contributing editor (Scotland). 

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