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

RALPH STEADMAN FOR NEW STATESMAN
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The Tory wars

How the EU referendum exposed a crisis in the Conservative Party that will endure long after the vote.

The Conservative Party is approaching not only a historic referendum, but a historic moment of crisis. It is deeply divided over whether or not to stay in the European Union, and the divisions are unequal. At the top, most want to stay in: not out of conviction, but because most ministers have found it politic to agree with David Cameron, even if they cannot support his view that he got a great deal from other EU countries after his supposed “renegotiations” with them. Among MPs generally the mood is far more hostile; and at the party’s grass roots it is predominantly in favour of leaving. Where this ranks in the history of Tory party crises is not easy to say.

It smells a little like the division over the Corn Laws in 1846, when Robert Peel needed to rely on the Liberals and Whigs to secure repeal, because most of his party was against him. It looks greater than 1903, when a minority of the party sympathised with Joseph Chamberlain over tariff reform. Where it differs from both of those is that for 28 and 19 years, respectively, the Tories had a long wait before coming back into power for a full parliamentary term after their split. Now, Labour itself is so divided, and its leader viewed as so marginal by people outside the party, that the prospect of the Tories losing power for a couple of decades is highly unlikely.

So perhaps we should look at 1922, when a rebellion in the party caused the end of the Lloyd George coalition and put Stanley Baldwin into Downing Street, first briefly, in 1923, and then, after the short-lived first Labour government, for five years; or the more drawn-out legacy of Neville Chamberlain, who left the stain of Munich on the party. In that case, the wound did not heal for 25 years: one of the reasons Harold Macmillan disapproved of R A Butler was that he had been an avid appeaser, and it helped lose Butler the Tory leadership – ironically, to a man, Lord Home, who had been Neville Chamberlain’s private secretary. Divisions over appeasement had already had the effect of putting Churchill into Downing Street in 1940 ahead of Viscount Halifax. Factionalism in the party was one of the causes of the 1945 landslide defeat by Labour, and of the narrow one in 1964.

The current division is open and is breeding hostility, luxuries afforded by one of the Tories’ few unifying beliefs: that Labour poses no threat at the moment, and they can have a quarrel that may even verge on civil war without fearing electoral consequences. Whatever the outcome, the present quarrel allows the opportunity for a major realignment of the party without it having to go out of office. A minister who is (just, and after much soul-searching) committed to our staying in the European Union told me frankly last week that the Tory party was “a mess” and that, whatever happened on 23 June, the referendum would be the beginning and not the end of a painful process for the Conservatives.

Whereas so much of what goes wrong for David Cameron has been down to his arrogance, and his failure therefore to grasp the likely consequences of his actions (think of the policy on Libya), the “mess” of a divided and recriminatory Tory party is, paradoxically, down to a fear of failure. He had, in the first instance, promised a referendum on our membership of the EU in order to see off Ukip. However, like the rest of us, Cameron had never believed he would be in a position where he would have to abide by his promise, because he had, like the rest of us, expected either to lose last year’s election or to be able to govern only with the help of the Liberal Democrats: who would, to his delight and relief, never allow him to call a plebiscite. But he and his party did not fail. The referendum is now just two and a half months away, and it is shredding the Tory party.

***

There is dismay among most of the pro-EU Tories, because they sense they are losing. In his now famous savaging of Boris Johnson in the Times last month, Matthew Parris, who has a record as a level-headed and, if anything, understated columnist, threw in the aside that he thought defeat for the Remain camp was increasingly likely. “I am aware,” another minister told me, “that I, like all of my colleagues, have so far failed to make a convincing case for staying in.” He expressed foreboding about how things could get worse for the Remainers: “One more terrorist outrage that can be attributed to open borders in Europe, or film of the Mediterranean full of boats of refugees, and we’re done for.”

A couple of ministers have told me that their personal loyalty to Cameron was what persuaded them to support him, but that such support is contingent on an understanding that they will not be asked to go out and make far-fetched claims about what will happen if the UK leaves. There is embarrassment even among pro-Europeans about some of the hyperbole retailed so far, not least because of the damage wild and easily disprovable claims do to the credibility of the Remain case. Such is the paranoia about the party post-23 June that no one sensible is keen to speak attributably about how things are, or how they might turn out.

Leading Tories note the disparity between the motivations of the two camps. Whereas groups such as Grassroots Out and Leave.EU have held rallies all over the country, some drawing in 2,000 people, there have been no comparable manifestations of popular enthusiasm to keep Britain in. There seems an inevitable inertia among those happy with the status quo that contrasts with the energy and dynamism of those who want change. And, for the avoidance of doubt, rallies by Leave campaigners have not been packed solely with Ukip stalwarts and disaffected Tories, but have included groups of Labour supporters and trades unionists who have cheered on speakers such as Kate Hoey. After all, many who put Jeremy Corbyn into the leadership are, like him, long-term Bennites, with a Bennite view of the EU: and, unlike their leader, they are saying so.

Tory MPs on the Remain side talk resignedly of the dislocation between them and their activists. Most Conservative associations are minuscule compared to what they were in the Thatcher era, and some MPs say they struggle to find a single activist willing to vote In. In the Commons, an estimated 150 Tory MPs out of 330 have indicated that they are Leavers, and many among the payroll vote who have declared their support for Cameron have done so purely for reasons of job security. Few believe that those who have exercised their right to differ and support Leave can be sure of keeping their jobs, with one or two important exceptions. The whips have been unpleasant and forceful about job prospects, as one MP put it to me, “almost to the point of caricature”.

The unpleasantness starts with David Cameron. The conversation the Prime Minister had with Iain Duncan Smith when the former work and pensions secretary decided to resign is characterised by Duncan Smith’s friends as one in which “expletives were used”. Insiders believe that some of those around Cameron are absolutely ruthless. They sense the argument is going against them and they will do what they must to turn it round. The Queensberry rules do not apply. Hence the threats by whips, the sendings-to-Coventry, the cutting people dead in corridors, the meetings of a “White Commonwealth” of ministers that excludes anyone known or feared to be opposed to Cameron’s view.

Of the six ministers with a seat in cabinet who came out in favour of Brexit, both Iain Duncan Smith and Chris Grayling are said to have long believed they would be sacked after the referendum, and so felt they had nothing to lose. Some think Theresa Villiers, the Northern Ireland Secretary, is in that category, too. John Whittingdale, the Culture Secretary, is treading carefully, and colleagues think Priti Patel ticks too many boxes to be sacked – being a woman from an ethnic minority who is good on television.

Michael Gove’s position is interesting, to say the least. He, unlike any of the other five ministers who came out in February as Leavers, was part of Cameron’s social circle, and clung on there even after his demotion from education secretary to chief whip in favour of the considerably less able Nicky Morgan. He alone of all the six has made a coherent and rigorous case for leaving the EU, and his combination of intellect and conviction makes him by far Cameron’s most dangerous opponent within the party.

He has studiously avoided any personal element in his criticism of the Prime Minister or his colleagues; he rushed to George Osborne’s defence after Duncan Smith’s resignation and when other Leavers were using the Chancellor’s failings to undermine him; and he is maintaining a general decorum at all times. “But the main reason they daren’t touch Gove,” an insider tells me, “is that he knows too much.”

What worries the Cameron camp, and invigorates Leavers, is the perception, shared by anyone over the age of 55, that what is going on now is totally unlike 1975, when the only other referendum on our participation in Europe was held and the United Kingdom decided by a margin of 2 to 1 to stay in the European Economic Community. Veterans remember people saying at the time that Britain had been in only two years, and it had to be given a chance to work. That argument no longer applies. Also, the cast list of serious politicians advocating exit, which in 1975 was Tony Benn, Michael Foot, Peter Shore and Enoch Powell, is now a widening array of people, in and out of politics.

Because a defeat for Cameron is so possible – a poll in last Sunday’s Observer showed Leave 4 points ahead of Remain, 43 to 39, with 18 per cent still to decide – many Tories are spending much time thinking and talking privately about potential outcomes. One that is ruled out by all is that either side will win by a substantial margin: whether we vote to leave or stay, it will be close.

“If we vote to leave, then we leave,” a ­Remain minister tells me. “That’s the end of it, and it’s the end of Cameron, too. It would be like a vote of confidence for him. We need a government to negotiate the terms of our exit and a shedload of trade deals, and it can’t be him in those circumstances. But the nightmare scenario is that we vote narrowly to stay in. That’s when things turn really ugly.”

The “nightmare” is what occupies the thoughts of an increasing number of Tories. The mood among the Remainers is already so bitter – especially, it seems, among those around Osborne, rather than those around the Prime Minister, for they see their man’s promotion prospects as hanging entirely on the outcome of the vote – that calls for magnanimity in victory may not be heeded. Given the profoundly anti-EU temper of the Tory party, such an attitude would be dangerous for its unity and health even if the victory were on the scale of that in 1975. If, as is more likely, the difference is of a few percentage points, the consequences of such an atmosphere of recrimination could be devastating.

“If David wins by a decent margin we can then settle down and face the important challenges the rest of the world offers us, and stop obsessing about Europe,” a close confidant of the Prime Minister told me. “Russia is a growing threat, China is a problem and America could end up being far from reliable. If we win well, then I and many like me will try to persuade David to change his mind about leaving before the next election [in 2020] come what may, as he is manifestly the best man to see us through these problems.” Such sentiments are widespread among Cameron’s friends, and reflect other factors of which they are keenly aware: the recognition that Osborne is deeply damaged, that Boris Johnson would be a disastrous leader and prime minister, and that Gove is rather better at politics than they might like.

***

There is an idea on both sides that scores will have to be settled after 23 June, and, the way things are going with party discipline and out-of-control aides in Downing Street, such an outcome is inevitable. Should Remain prevail, a wise prime minister would understand that this was a time to heal wounds and not deepen them. It remains a matter of conjecture how wise Cameron, whose vindictive streak is more often than not on the surface rather than beneath it, is prepared to be.

Those who work for his party at the grass roots, and on whom MPs depend to get the vote out at elections, will be unimpressed by a purge of those who have not backed him over Europe. There isn’t much of a voluntary party left, and there will be even less of one if he acts rashly in victory. If it is a narrow victory – and it is, at this stage, hard to envisage any other sort – his party could become unmanageable unless he acts with restraint and decency.

It won’t help Cameron, who is already considered out of touch because of his personal wealth and the life he leads as a consequence, that (as a result of the Panama Papers) we now know that part of his family’s wealth was based on precisely the sort of systematic tax avoidance that Osborne has branded “immoral”.

Yet things could be worse for the Prime Minister. Tory Leavers believe that if only Corbyn would say what he really thinks about the EU their side would be assured of victory. It does not seem to worry them that that, if true, would be the end of Cameron, for whom they have the sort of disdain the Heseltine faction had for Margaret Thatcher in the late 1980s, or the “Bastards” had for John Major after Britain ratified the Maastricht Treaty in 1993.

Conservatives worried about the stability of their party believe that only Labour under a new, more effective and less factional leader could present the serious electoral challenge to them that would shake them out of these unprecedentedly acrimonious and self-indulgent divisions. We can only imagine how differently the In campaign would be conducted if Labour had a nationally popular and an obviously electable leader.

As it is, many more dogs are likely to be unleashed. Things promise to become far nastier, dirtier and ever more internecine for the Tories, not just before 23 June but for a long time afterwards: and with the party in power for at least four more years, one can only guess what that means for the governance of Britain.

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 April 2016 issue of the New Statesman, The Tories at war