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

MILES COLE FOR NEW STATESMAN
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Meet the Three Brexiteers: the men who could change how we exit the EU

What is really going on between Boris Johnson, David Davis and Liam Fox over Britain’s exit from the EU?

For newspapers with only the Olympics to write about during August, the squabbling “Three Brexiteers” – the senior ministers supposedly tasked with executing the will of the British people to remove us from the European Union – came as a gift. The men concerned are David Davis, the new Secretary of State for Exiting the European Union; Boris Johnson, who is what our passports used to call Her Majesty’s Principal Secretary of State for Foreign and Commonwealth Affairs; and Liam Fox, the Secretary of State for International Trade. This odd trio amused the press for several reasons, mostly bogus: that they share responsibility for securing Brexit (untrue); that they all hate each other (untrue); that Fox has parked his tanks on Johnson’s lawn to the extent of demanding that some of the powers of the Foreign Office be transferred to his department (apparently true); and that they must take it in turns to use Chevening, hitherto the foreign secretary’s grace-and-favour, 115-room pile in Kent (certainly true, though none rushed to avail himself of the privilege). Inevitably, the whole question is far more layered and complex than the silly-season column fillers even began to suggest.

The dynamic between the three men is not straightforward. Davis and Fox are hardcore Brexiteers of long standing. In this year’s referendum campaign Davis was more closely associated with the unofficial Leave.eu group and its sister organisation Grassroots Out, and shared platforms with (among others) Nigel Farage and the Labour MP Kate Hoey. Fox, who announced just before Christmas 2015 that he would support Leave, appeared on various platforms and was more closely associated with the mainstream Vote Leave campaign, which was little more than a Tory front operation.

Davis was runner-up to David Cameron in the Tories’ 2005 leadership election, Fox an also-ran. There was little empathy between the two men during that race. Fox is immersed in US politics and has a wide range of senior contacts in the Republican Party, in and out of Congress, and in those days was seen as something of a neocon. Davis is a more conventional Tory, but with that 19th-century Liberal strain in his ­political make-up that also distinguished Margaret Thatcher (he calls himself a “Thatcherite”). He and Fox share many economic ideas as well as a dislike of the EU, but their ideas about foreign policy and, particularly, the degree of reverence with which the US world-view should be treated, differ sharply.

In June 2008 Davis resigned as shadow home secretary and from the Commons, triggering a by-election, in which he stood, to draw attention to the erosion of civil liberties in Britain. David Cameron, who found Davis wearing, saw this as a stunt and took the opportunity not to readmit him to the shadow cabinet after his re-election a month later. It was claimed Cameron offered Davis a place in the coalition cabinet in 2010 to appease the right, but Davis – disliking a range of the coalition’s policies –
preferred the back benches. His friends believed his leadership ambitions had not been quelled and that he would build up his constituency in the party better by not being in government with the Liberal Democrats. No offer of a job in cabinet came after June 2015, which seems to have hardened Davis further against the Cameron line on Europe; but Davis, not the most popular man in the parliamentary party, chose not to offer himself as a potential leader after Cameron’s auto-defenestration this summer.

Fox, however, did, even though there was equally scant evidence of his popularity. Finishing bottom of the first ballot, he then shrewdly put himself behind Theresa May, with whom he is said to have cordial relations, rather than one of the Brexiteer candidates. This helped ensure his return to cabinet. He had served in 2010-11 as defence secretary, departing in odd circumstances. It was disclosed that Adam Werritty, 17 years Fox’s junior and best man at his wedding, had been passing himself off as an adviser to Fox, but wasn’t on the official payroll and had no security clearance. Werritty reportedly attended 40 of 70 recorded engagements that Fox made as defence secretary, had been Fox’s business partner in his Atlantic Bridge charity, and had accompanied him on numerous official trips.

Though no harm had been done to British interests, Fox conceded that he had made an error of judgement and resigned. For him, too, the road back was long: he turned down the offer of a minister of state’s job at the Foreign Office in July 2014 in order to retain the freedom to criticise government (and particularly economic) policy. He became ever less warm to Cameron, who offered him nothing after the 2015 Tory victory. His Euroscepticism is of long duration, and it hardened in his absence from government.

***

Boris Johnson has no such pedigree, which begins to explain the suspicion in which Davis and Fox are said to hold him. It was shortly before the end of his second term as mayor of London, and the day after Michael Gove’s spectacular announcement that he would be voting to leave the EU, that Johnson decided which way to jump. Few in his party believed his choice to embrace Leave was made after anything other than a calculation about how best to further his rampant ambition to lead the Conservative Party and become prime minister. He had spent many years as a columnist being rude about Europe, but there is a world of difference between that and advocating complete withdrawal. Until Gove blew the whistle on Johnson as a potentially inadequate prime minister – to the relief of scores of Tory MPs who nonetheless do nothing to defend Gove against accusations of disloyalty – the plan seemed to be working perfectly.

Theresa May’s appointment of Johnson was cunning. Although pundits include him in the trio conducting Brexit, his role seems limited to maintaining friendships with those we are divorcing. An early engagement was a Bastille Day party in London, at which the French audience booed him. May’s establishment of the Brexit Department under Davis means the Foreign Office follows rather than leads on this most crucial question of foreign policy. She is no fool, and knows that among Johnson’s attested failings is his inability (apparently because of idleness) to acquaint himself with detail. The accomplishment of our departure from Europe is greatly about detail and the Prime Minister knew he could not master it.

Davis had been a successful minister for Europe in the 1990s, had worked in the private sector for years – he was an executive with Tate & Lyle – and, as a genuine Leaver, had the motivation as well as the experience to see that the job was done. However, making Johnson Foreign Secretary allowed May to appease that section of the party, mainly at the grass roots, that believes he is a great statesman. Yet word from Downing Street is that as well as Europe being parcelled off to Davis, the really important issues of foreign policy – notably relations with the US, China and Russia – will be handled from No 10, the Foreign Office again following rather than leading. This confirms a trend begun by Tony Blair nearly 20 years ago. So the powers Johnson will have are unlikely to make him the Anthony Eden de nos jours.

Davis surfaced for an anodyne speech in Ulster on 1 September confirming his desire to avoid tariffs when trading with the EU, but has kept a low profile since his appointment for, it seems, two reasons. First, his task is considerable, and while his department and the expert negotiators it requires are being assembled it was wiser to avoid saying anything, despite the growing restlessness of some of his allies on the right. His statement to the Commons on Monday was no more revelatory, serving to confirm what little we knew but to emphasise that it is not likely we will stay in the single market – the obvious conclusion to draw from May’s insistence that free movement of people is over. Even if the government has decided to leave by means of repealing the European Communities Act 1972, which many Tory Brexiteers think probable, there is nothing Davis can say about detail until the government decides exactly how to pursue that strategy – and that may be weeks yet.

Second, he knows Remainers outnumber Brexiteers in cabinet. He is deeply concerned to bring support with him, and knows he will do that best by keeping May close. Ministers who wouldn’t have a career in politics but for her will be careful to follow her lead. In July and August, May made it clear that she favoured caution, and caution was what her secretary of state provided. So, when she said (again) at last week’s special cabinet meeting at Chequers that Brexit means Brexit – that those Remainers in denial should recognise the inevitability of our leaving – and that immigration controls were inevitable, it seemed that she and Davis were united on the key questions, and the hardliners in their party could rest easy.

The tensions among the trio of ministers were really between just two of them, Johnson and Fox, and Fox appears responsible. Probably presuming on what he considered his good relationship with May, he asked during August that the Foreign Office should lose its role in trading relationships. May immediately voiced annoyance at what some of her colleagues and officials branded a “turf war”. Her anger may have been provoked in part by her failure to see the clash coming – she created overlaps between departments in her restructuring of Whitehall that a little more thought would have avoided – but also by her sense that a public which voted for Brexit would expect her ministers to be getting on with it, not jockeying for position and making the political class even more despised than it already was.

Fox asked to have “economic diplomacy” moved to his department in a “rational restructuring”. He had a point. He has no responsibility for securing Brexit – that lies squarely in Davis’s department – but until it is accomplished he cannot usurp the EU and make definitive trading arrangements with other nations. He can, however, hold preparatory talks with his American friends and others (he has just visited India). That does create an overlap of economic diplomacy, so one presumes the arguments between Fox and Johnson have only just begun. Fox claimed his acquisition of these powers was “crucial to the delivery of objectives I have been set by the Prime Minister”.

May slapped him down, to the amusement of Johnson partisans, but Johnson had to second some officials to Fox’s department. Fox found himself briefed against by a Foreign Office mandarin who called him “nutty and obsessive” and likened him to “Donald Rumsfeld on steroids”. This did not restrain Fox, who told a US radio show in July that his department would be taking over “a wing” of the Foreign Office, a reflection of the importance of its duties. He added: “We are effectively taking all of the elements that were UK trade and investment out of what was the Business Department. We’re taking defence and security exports from what was the Ministry of Defence where I used to be secretary of state. We’re taking UK export finance out of the Treasury, and we’re creating a totally new trade negotiation department all within itself.” Fox has also been given the venerable title of President of the Board of Trade, and has not been idle. Besides his mission to India, his department is about to open three new offices in the US – in Minneapolis, Raleigh and San Diego – to add to the existing 11.

After Fox’s spat with Johnson the two ministers, and Davis, who seemed merely an innocent bystander, held a “clear the air” meeting at the Cabinet Office on 24 August. In so far as differences between the three matter, the main one was over immigration: Davis and Fox wanted border controls with Europe reinstated, whatever the effect on the single market, but Johnson didn’t. Given May’s statement after the Chequers meeting, Johnson seems to have lost.

***

The initiative is now very much with Davis. Some backbench colleagues are telling him, in effect, there doesn’t need to be a negotiation: John Redwood has made this point seriatim on his blog, and vocally during a BBC Radio 4 documentary presented by Gus O’Donnell, the former cabinet secretary, at the end of August. Brexiteers have accused O’Donnell, and other former officials who have joined the debate, of talking up the difficulties of leaving. What the hardliners want is for Davis to announce the repeal of the European Communities Act, by which we joined what is now the EU. Given the EU’s net trade surplus with the UK – £70bn a year – the hardline view is that the EU has much more to lose than we do from denying us access to the single market.

As one of Davis’s friends told me: “There are 47 countries that have access to the single market without having to concede free movement of people. America, Russia and China have Most Favoured Nation status with the EU. Given all the money the EU makes from us, is it really in their interests to offer us a worse deal than any of those 50 countries?” This line is playing well in the Brexit Department. Davis is also being told that whatever the rhetoric of other nations – notably the doomed regime in France – ­Europe relies too much on doing business on favourable terms in the City of London to deny “passporting” rights (the ability to do business across the EU while based in the UK) to British financial institutions.

Backbenchers anxious for the process to start are telling Davis to say to the EU that it can either allow Britain access to the single market, without insisting on free movement, in return for tariff-free operation here; or the two parties can trade on World Trade Organisation terms, with tariffs, which will harm the EU more than it will harm the UK. The lack of hostile response from Germany, the biggest importer of British exports in Europe, gives the Brexiteers cause for hope that things may not be so acrimonious, and the reality far from the gloom of George Osborne’s Project Fear.

For the moment, the three ministers are not squabbling: but then it is a mistake to see them as interdependent. May will have to sort out the overlaps between Johnson and Fox’s departments: but Davis knows what he has to do, and what his remit is to do it. What remains to be decided is whether this will be a so-called hard Brexit (coming out on our terms) or “soft” (coming out on Europe’s). The rhetoric so far suggests the former; unless Davis forfeits May’s support, that is how it will stay. May must also remember that if she does feel she must stop backing Davis, she will not only have to find someone else to do his job, but deal with backbenchers who remain to be convinced that she will see the job through. In the end, as chief executive, fulfilling the will of the British people will be her responsibility.

Simon Heffer is a columnist for the Daily and Sunday Telegraphs

Simon Heffer is a journalist, author and political commentator, who has worked for long stretches at the Daily Telegraph and the Daily Mail. He has written biographies of Thomas Carlyle, Ralph Vaughan Williams and Enoch Powell, and reviews and writes on politics for the New Statesman

This article first appeared in the 08 September 2016 issue of the New Statesman, The Three Brexiteers