Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

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

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How the United Nations should respond in the age of global dissent

Three former UN insiders on the future of the world's most ambitious organisation. 

US President Donald Trump is ardently embracing a toxic form of messianic nationalism, while demeaning those who oppose him as corrupt, and dishonest enemies. His "America First" chant is creating severe international tension, promoting extremism - within and outside the US - and undermining the homeland security that he has so insistently pledged to enhance.

Trump seems determined to implement policies and practices that could signal the weakening of democracy, and possibly even herald the onset of fascism. His programme to deport undocumented immigrants and to exclude all visitors from six designated Muslim majority countries is illustrative of a regressive and Islamophobic outlook.

The groundswell of popular dissent is vibrant and worldwide, from Romania to South Korea, Gambia to Brazil, from the UK to the Ukraine. Trump is dangerously exploiting the frustration of citizens with the political establishment, which is unprecedented in its depth and breadth. The umbilical cord that connects those governing with those governed is becoming dangerously stressed. The digital revolution is endowing governments with horrifying capabilities for oppression and control but it is also enhancing the ability of the citizenry to mount resistance and mobilize opposition forces.

UN charter law and power politics

As UN veterans, we recall and affirm the preamble to the UN Charter that reads “we the peoples” - not we the governments! The trust of people in their governments to work for social and economic progress and to prevent war has dramatically weakened, if not disappeared.

The prediction made by the Mexican delegate at the founding of the UN in 1945 that “we have created an institution which controls the mice but the tigers will roam around freely” seems truer today than at the moment of its utterance. The UN Security Council’s permanent members – China, France, Russia, the UK and the US – indeed "roam around freely" lacking respect for international law or the authority of the UN, once more pursuing their respective nationalist agendas without any pretence of accountability. These countries are also the major consumers and exporters of military hardware, facilitating both militarism and "merchants of death".

The international war supposedly being waged against political extremism and terrorism has predictably deteriorated into a series of horrific wildfires and slaughter. Wars that should never have happened, neither the overt ones in Afghanistan, Iraq, Libya and Syria nor the partially covert ones in Yemen, Somalia, and a range of other countries in Africa and Asia have brought peace or stability, but a series of unspeakable ordeals of human suffering. Old struggles have been magnified while new ones have been created.

The US tiger, aged as it is, displays the most serious signs of political amnesia. Unilateralism and exceptionalism have just been reaffirmed as cornerstones of the current US worldview. The announced $54bn increase of the US defence budget is justified by Trump with the argument that "we must win wars again".

In contrast, the great majority of the other 192 UN member states have given notice that they clearly prefer a multilateral model premised on the equality of states and international co-operation. President Xi of China at the last Davos meeting of the global neoliberal elite gave voice to this more benign vision of world order.

The so-called "West" - the US, Canada, the EU including the UK -  is made up of 800m people, or a mere 12 per cent of the global population. These Westerners need to come to terms with growing de-Westernisation, a natural outgrowth of globalisation in all sectors of life.

Wise global leaders would respond by seeking an immediate realignment of international relations with a commitment to the promotion of principles of convergence, cooperation, and compromise. The objective would be a new world order based on mutual benefit, sustainability, prudence as well as a demilitarizing ethos.

The UN Security Council is the most important venue for making such an undertaking happen. It is here that bilateral and multilateral diplomacy takes place in a global setting. The primary goal remains to prevent the emergence of a world in which drones replace diplomats and inequality continues to undermine wellbeing.

The UN and civil society

The peoples of the world are confronted by a series of challenging global developments. Tectonic political changes are taking place in the US, Europe, and Asia, along with unresolved crises in the Middle East, Africa, and South Asia, and the formidable speed and effects of easternisation. Prospects for a politically effective UN, and most especially a robust UN Security Council, seem bleak - but hardly impossible. Globalisation potentially supports innovative expressions of multilateralism that are more oriented than in the past towards the global and human interest. The 2015 Paris Agreement on Climate Change is illustrative of such a hopeful turn.

The UN and Trumpism

It is our hope that Trumpism will not succeed in relegating the United Nations to a fringe role. The Mexicans refuse to pay for the wall that the US President insists on building, the UN will bear the costs of the invisible wall Trump and a subservient Republican Congress seems determined to construct between the US and the UN. If Washington goes ahead with its threats to reduce drastically UN funding and end cooperation with and participation in various UN organs, it should certainly be viewed as a significant setback for both the UN and its current US adversary. While we are confident that the UN as an institution would survive these financial and political setbacks, we are not so sure that Trumpism will long endure.

"Alternative facts" are set forth to demonstrate that the US is making sacrificial and disproportionate contributions to keep the UN alive. Real facts show a different picture: In 2016 the US Federal budget amounted to $3.2trn. The US assessed share of the UN budget of $2.7bn was $594m or 0.0019 per cent of the US federal budget!

At no time have US/UN relations been smooth. During the more than 70 years that they have travelled the same road, there have been many potholes along the way. The US often has been heavy-handed in a manner by which it exerted its influence on the UN’s agenda. It has often used its political leverage to weaken the organisation’s independence. Over the years it has manipulated the selection processes used to fill UN leadership positions. Washington has frequently flexed its muscles by delaying the annual payment of mandatory contributions to the UN budget. The US government has set some terrible examples by repeatedly violating the most fundamental provisions of the UN Charter governing the use of force. It has continuously defied international law in all parts of the world, including wars in Vietnam (1963), former Yugoslavia (1999), Afghanistan (2001), Iraq (2003), and Libya (2011). It has used its veto power in the UN Security Council to shield its allies from justifiable UN censure, while doing its best to punish its enemies with the threat of force.

West-centrism, alliances and UN multilateralism

Polarisation, alliance formation and West-centrism were central to the transformation of NATO from a Cold War arrangement intended to defend Europe from a Soviet attack to an American led global domination project with Europe as the junior partner. In this wider geographic setting the expanding eastern Shanghai Cooperation Organisation (SCO) can be understood as a geopolitical countermove led by China, which also has its own disturbing implications. In the face of these geopolitical initiatives, it becomes clear that the United Nations is being pushed to the outer margins of world politics in precisely those areas of peacekeeping and global security that were regarded as its primary mission when established in 1945.

The new US administration seems likely to fulfill another of President Trump’s ill-considered campaign promises to make a series of moves to weaken multilateral problem-solving even beyond damaging the UN. These dangerous and irresponsible manoeuvres may fail, as many governments around the world fully understand that multilateral diplomacy has become indispensable, and indeed needs to be strengthened to meet the global challenges facing humanity. It is our fervent hope that these governments will mobilise sufficient energy to rescue the UN in this hour of need. Dutch and Belgian authorities give us some slender hope that this might happen. The Netherlands goverment has already agreed to replenish funds if withdrawn by the US from certain international population programmes. Yet this is only a small and suggestive gesture of what must become a groundswell of support for the UN that will be needed to overcome the damage expected to be inflicted by this anti-UN activism of the US.

The politics of populism

What now appears to be a wave of resurgent nationalism around the world contains the potential to become a new internationalism. We have served in many parts of the world under UN auspices and therefore are keenly aware of the widespread anger and sharp demands for justice present among the peoples spread around the entire planet. These discontented multitudes share many of the same goals: peace, equity, an end to corruption, freedom from fear and want, the rule of law, accountability, and above all, a life of individual and collective dignity. In February 2017, during a meeting of the EU heads of government held in Malta, profound anxieties associated with political changes taking place in Washington were addressed. European leaders strongly reaffirmed their joint commitment to common principles and values as the continuing basis for interacting with the United States and the world, and in this way respond to the challenges being mounted by this ultra-nationalist thinking.

We believe that recent developments in Europe, the Middle East, and especially in the United States are reaching a boiling point. Many citizens are outraged and ready to challenge intolerable aspects of the global status quo. More than ever, Immanuel Kant’s wisdom is relevant and needed, especially his admonition to have the courage to use our brain for the construction of a benevolent public reality. In a similar spirit, we are encouraged by Hannah Arendt’s unforgettable reminder that “thinking gives people that rare ability to act when the chips are down!” And act we must.

The urgency of UN reforms and the incoming UN Secretary-General

For the political organs of the United Nations (the Security Council and the General Assembly) to play an influential role in conflict resolution in the 21st century, governments will have to act with resolve to overcome some formidable challenges. Such a resolve must include the renewed political determination by member governments to look afresh at some major UN reform proposals that are now collecting dust on the shelves of the UN Dag Hammarskjold Library in New York.

Let us also not forget that the UN is the most inclusive global institutional body that has ever existed. It is the only place on earth where there are, and can be, no foreigners. The UN therefore is the obvious venue at which to reflect upon how the increasing number of people throughout the world who have become forgotten could be given new and alternative perspectives.

The recently elected UN Secretary-General, António Guterres, if he acts to fulfil his role as the guardian of charter norms and values, including respect for international law, will face a daunting challenge. He will have to be prepared to remind the US administration and other political leaders of major UN members that peace can only be achieved when unilateralism gives way to genuine multilateralism, when monologues are replaced by dialogues, when convergence, cooperation, and compromise prevail, when civil society is respected and allowed to participate within the organisation, when root causes, not just symptoms, are recognised and understood and most importantly, when governmental decision makers, whether from large or small Member states, show respect for international law and are held accountable for their acts.

The peoples of the world need the United Nations more than at any time since 1945, the year the organisation was established “to save succeeding generations from the scourge of war". Only a strengthened, respected, and sufficiently funded UN can provide mechanisms for upholding global and human interest. It must not allow itself to serve any longer mainly as a vehicle for the aggregation of national interests, or worse, as an instrument of power to be deployed by the geopolitical giants, and especially by the United States.

The multiple challenges associated with climate change, nuclear weapons, sustaining biodiversity, and lessening global inequality put the future of civilization at great risk, and even endanger the survival of the human species. At such a time, we can only hope that enough political leaders are alert to this menacing situation, are emboldened by their citizens, and act with resolve and courage to create an alternative future for humanity that is responsive to the claims of peace, justice, sustainability, and community.

More than ever before in human history the peoples of the world are being severely challenged by problems of global danger that can only be solved globally. The best hope of humanity to meet these challenges is to abandon unilateralism and isolationism and instead empower the United Nations to become at last an effective mechanism for the protection of “fundamental freedoms for all without distinction as to race, sex, language, or religion”.

Hans-C. von Sponeck served in the UN from 1968 to 2000, from 1998 to 2000 as the UN Humanitarian Coordinator for Iraq and UN Assistant Secretary-General. Richard Falk is Milbank Professor of International Law Emeritus, Princeton University and served as UN Special Rapporteur between 2008 and 2014. Denis Halliday served in the UN from 1964 to 1998, from 1994 to 1998 he held the position of UN Assistant Secretary-General and UN Humanitarian Coordinator for Iraq.