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

Grammar school in 1962. Getty
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What I learned about class after my twin brother and I were separated by the 11-plus

When my twin brother went into a secondary modern school, and I went to a grammar, something more than a private rift opened up: we were assigned to different social classes. 

The cultural schism exposed by Brexit in Britain and the election of Donald Trump in the United States has been a long time in the making. It goes deep, and for many it has been not only a bleak social ­phenomenon, but also a profound personal experience.

When my twin brother went into the C stream of a secondary modern school in the 1950s, and I passed the examination for Northampton Grammar School, something more than a private rift opened up: we were assigned to different social classes. Apprenticed to a carpenter at 15, he did national service, while I remained at school until I went up to Cambridge University. By this time, the breach had become irreparable. Our separate lives were emblematic of divisions in Britain which have only recently been officially acknowledged. My brother made a success of his life restoring historic buildings, but many others did not, consigned to failure at 11, or subsequently ejected from employment that they had imagined would last a lifetime – work scornfully dismissed now as “jobs for life”, as though heavy manual labour were an idle sinecure.

 

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Why do we recognise the true nature of the society we live in only when it is on the verge of dissolution? Perhaps its passing shows up its certainties for the brief, shadowy arrangements that they are. Yet while it remains, it is life itself, the only possible way for human beings to be. No society is exempt from the cycle of ascent, momentary stability and decay, and this is as true in Britain of the industrial era as it was of a declining agrarian society in the 18th century.

In An Essay on the Principle of Population (1798), Thomas Malthus, echoing the French physiocrats, declared that manufacturing would never increase the wealth of the nation because food production was its primary economic purpose. The industrial worker “will have added nothing to the gross produce of the land: he has consumed a portion of this gross product, and has left a bit of lace in return; and though he may sell this bit of lace for three times the quantity of provisions he has consumed whilst he was making it . . . he cannot be considered as having added by his labour to any essential part of the riches of the state”.

Rarely can such predictions have been so swiftly disconfirmed. Industry was already sweeping up people in its compulsions, as Oliver Goldsmith had lamented of a wasting rural life in his poem “The Deserted Village” (1770): “Far, far away, thy children leave the land.” Industry effaced the sensibility of country people and remade it in the image of the rigid discipline of manufacturing, mining and mill. A new kind of human being came into existence: the industrial worker, whose disposition, mutinous and refractory, was observed by the rich with suspicion, as they could not assess its potential for disaffection and tumult. Little was known of the “alien” mentality of the people; as little, perhaps, as that revealed to an astonished establishment by the unanticipated result of the EU referendum.

No wonder the working class became a central preoccupation of governments, reformers and politicians. There was controversy from the beginning over the “true” temper of the worker, then predominantly male, engaged in the making of things, useful and necessary to the prosperity of Britain. Did the workers want a fairer share of the wealth of the country? Did they seek to overthrow the established order? What was simmering in their mysterious, impenetrable communities of poverty?

Researchers ventured into darkest England – to places frequently likened to sites of imperial conquest – and returned with lurid tales of squalor and discontent; at the same time, trade unions and friendly and burial societies were growing, the co-operative movement evolved, and eventually a Labour party emerged which at last appeared to be a definitive expression of the psyche of the working class.

Strengthened as the 20th century dawned, but weakened by war and the Depression, Labour gained new vigour after the defeat of Nazism. With the coming of peace in 1945, both the spread of communism and the dissolution of the European empires made it timely, just and prudent for ruling elites to make concessions to the working class. Hence the marriage of unequals between capitalism and welfare, which at the time promised to be a permanent settlement.

What was regarded as the enduring sensibility of the industrial worker was doomed to follow its agricultural predecessor. It, too, became fully defined only when close to disintegration. When E P Thompson published his splendid Making of the English Working Class in 1963, signs of its decomposition were already detectable. Similarly, The Uses of Literacy, Richard Hoggart’s tender depiction of working-class culture (first published 60 years ago this year), was based on his experiences as a child in the 1920s and 1930s. The historians Eric Hobsbawm and Raymond Williams also framed what looked like a definitive version of the ­working class even as workers from the Caribbean and south Asia, recruited for a waning textile industry and transport and health systems, were transforming it.

Similarly, the consolation that the gritty north was the true source of Britain’s wealth, in contrast to a soft, self-indulgent south, left a long afterglow; it persisted long after the factories had collapsed in clouds of brick dust and splinters of glass and the south, with its financial services and advanced technologies, had become the principal generator of wealth.

 

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Social class was always inflected by individual circumstances. There were other elements involved in the separation from my twin. Our mother’s husband was diagnosed with tertiary syphilis in 1939; at the time, this was curable only by prolonged treatment with injections of arsenic and mercury. Our mother, who looked after the butcher’s shop that we lived above, realised that there would be no children in the marriage. A strong and resourceful woman, she met an engineer working on a construction site near the butcher’s shop she ran while her husband drove his lorry, carrying timber, bricks and glass all over the Midlands. He also carried more tender cargoes, with whom he spent nights in the back of the truck under a tarpaulin intended to protect merchandise from the rain. From one of these cargoes he contracted the disease, the sibilant syllables of which struck terror into those touched by it, much as HIV/Aids was to do half a century later.

Our mother became pregnant with my brother and me. Perhaps it was a fear that the two men in her life might gang up on her that impelled her to keep me and my brother apart, distributing roles that would ensure we never learned truly to know one another, even though we lived in the same house, with its frozen atmosphere, numb with secrets, for the first 18 years of our lives. My brother was practical and good-looking, docile and sweet-tempered; I was clever and fat, demanding and devious. Our schooling played a secondary role, but it did succeed in driving us further apart. Class was only one element in the hidden geometry of kinship.

 

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Even in the 1950s, when the effect of ­prosperity on the working class was discussed in The Affluent Society by John Kenneth Galbraith and The Status Seekers by Vance Packard, it was difficult to sustain belief in the existence of a homogeneous class. In 1959, after three consecutive Conservative electoral victories, even the Daily Mirror doubted whether a Labour party had a future.

Writing In Pursuit of the English in 1960, Doris Lessing described her “search” for the working class as “a platonic image, a grail, a quintessence, and by definition, unattainable”. Having been assured in her native Southern Africa that black workers were “not working class in the true sense”, she came to Britain, where, after encounters with the Communist Party (“not typical”), miners and dockworkers (“very specialised” labour) and workers in a new town (“tainted by capitalism”), she was advised that the true working class could be discovered only somewhere like South Africa, where “the black masses are not yet corrupted by industrialism”.

The erosion of identity of the working class, as it existed between the mid-19th century and the end of the Second World War, went largely unrecognised by its defenders and representatives. It was certainly apparent in Blackburn in 1969, when, for my book City Close-Up, I recorded a torrent of racism and prejudice in working-class areas: this was the outrage of people who had never been consulted on the social and economic mutation of their world. Barbara Castle, the energetic and radical MP for the town, suggested I play down race, because “in a few years it will burn itself out”.

 

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Class itself was already in flux as a result of the unprecedented affluence of the time, and class consciousness was dissolving in the mild acid of consumerism. The differences between my twin and me appeared to be influenced by culture rather than class, because he was economically more successful than I was. This faltering of a sense of class was perhaps a symptom of the triumph of market-based relationships over those that are socially determined; and perceptions of the world had shifted in accordance with this reality.

 

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Distance grew between the way people actually were and an embalmed version of the working class which continued to animate the left. In 1977, I published What Went Wrong?, subtitled Working People and the Ideals of the Labour Movement. In the US the subtitle was presciently amended to Why Hasn’t Having More Made People Happier? – in that advanced country, ideals and the labour movement had become unintelligible concepts.

I interviewed hundreds of elderly Labour activists who, looking at a world changed beyond recognition, spoke of their younger selves with the sad detachment with which people usually speak of the dead; their tone bore the melancholy regret of In memoriam notices.

It was clear four decades ago that the northern industrial towns were “wanting in purpose, looking for the meaning they once derived from their role in producing goods”. In the 1970s the feeling was that immigrants from Asia had somehow usurped the people’s way of life: they lived in houses lately vacated by millworkers; they had a strong sense of family and neighbourhood, as well as powerful cultural and religious traditions – all characteristics supposed to “belong” to Lancashire.

During the economic restructuring in the 1980s, I compared (in my book Unemployment) the experience of being out of work in those days with that of the 1930s, with its poignant tales of officials from the ­Unemployment Assistance Board, sitting in the balcony at the Rialto Cinema to see who was in the stalls when they should have been pounding the pavement looking for work; or Means Test men compelling families to sell an upright piano or a wedding ring before they could receive a penny of state charity. In the 1930s, no one doubted work would return; in the 1980s, industrial work was vanishing.

It seemed the working class in Britain had attained quietus after the miners’ strike in 1984. High unemployment was said to be “frictional” as we moved between epochs, a “creative imbalance” that would one day make us all richer and happier, though not quite yet. The working class was eliminated from the very history that, in some versions of prophecy, was to have ensured its ultimate triumph. Had the working classes died and gone to a heaven shaped in the image of expropriated socialist utopias? Had they been drowned in prosperity or assimilated into an expanding middle class? Whatever their fate, they were no longer of any account in the version of society disseminated by the media. This was reinforced by the collapse of the USSR, and there ceased to be any interest in what might be happening to them. Their sometime heroic role had been unceremoniously annulled.

In the absence of the working class, the rich were transformed: employers no longer exploiters of labour, but philanthropic providers of work. Those amassing fortunes became authors of the doctrines of wealth creationism. The working class, far from the gravedigger of capitalism, was merely a transient irritant. The class reached its zenith, faltered and fell back; and the ­liberatory power once attributed to it was appropriated by the warriors of wealth, who assumed the mantle of destiny of those they had displaced.

The working class was fragmented and dispersed, like the migrants who now constituted such a significant segment of it. New generations grew, not as citizens of this or that town, with its place in a national division of labour, but as dependants of a global market. If “globalisation” is to the 21st century what industrialisation was to the 19th, its significance lies in its disarming of people, no longer able to answer basic needs in the places where they live, but compelled to buy in what they need from countries whose names are only a vague echo of forgotten geography lessons. As the market colonises society, we become subjects of a curiously dematerialising topography: Theresa May could not have expressed it better when she said that “if you believe you’re a citizen of the world, you’re a citizen of nowhere” – although this was not her ­intended meaning.

As the (welfare) state shrank, the market dilated, invasive and predatory. Our lives are so penetrated by its “values” that these now appear in our most intimate relationships – we speak of emotional investment and interrogate our deepest attachments, asking what returns we will get; should we cut our losses; what are our best assets; are we in the market for a new relationship; shall we take a gamble; what is to be gained out of profitless attachments; will it pay dividends; what will it yield? Just as “human nature” serves as a cover for the nature of capitalism, so society provides an alibi for market-induced disorders – obesity and pathologies around eating, unquiet addictions to alcohol, drugs, gambling, celebrity, sex, food; all facilitated by what money, in its own right the most addictive substance known to humanity, can buy.

No wonder this age is characterised by nostalgia for coherence and purpose. It focuses on the recent manufacturing era, even if this was shadowed by grim institutions of factory, chapel, pub, workhouse, cinema and cemetery and the oppression of women and children – just as the Industrial Age directed its yearnings towards a past of sunlit field and flower-filled hedgerow, despite the omnipresence then of overseer, magistrate, bailiff and parish pay-table.

 

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Despite a sense of continuous change, the wounds of social class continued to influence even those to whom it no longer appeared as a force in their lives. My twin brother paid for his early membership of the working class with his death 12 years ago from mesothelioma: his early construction work had exposed him to the baleful effects of asbestos.

 

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The disorientation is profound: demolition of the old workplaces also suppressed the way of life and sensibility that accompanied them. Progressives, no less alarmed by these developments than the reactionaries, applauded them, turning to the growing diversity and pluralism of the labour force. They welcomed the shifting composition of the working population, in which women, ethnic minorities and LGBT people were moulded into a fragile coalition for social progress. That such an alliance contained factions and some incompatible objectives (say, respect for same-sex relationships, at odds with many Muslims and evangelical black churches) was not its greatest failing. This lay in the elevation of social equalities over economic equality, which continued to get worse, even for most of those in the groups favoured by progressives. Moreover, “mobility” was interpreted as a one-way street; few considered the downwardly mobile, many of whom proudly acknowledged their working-class roots. Poverty, too, was redefined: no longer concerned with unanswered need, it was now measured against unattainable wealth.

 

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Personal relationships – which for most people are now more powerful than any sense of social influence – also help to conceal patterns of class and what in 1993 Richard Sennett called its “hidden injuries”. Our mother revealed to my brother and me the secret of our paternity only when both men were dead. This also exposed unsuspected inherited features: my brother had acquired from our biological father his love of restoring buildings, while I had the questionable gift of his radicalism. He had been a member of the Communist Party in the 1930s.

 

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The fluid nature of class complicates the re-emergence of a working class in its new, emancipatory alliance with the super-wealthy – Trump and the funders of Brexit. Its sudden resurrection is attended not by the solidarities of belonging, but by those of a graveyard ideology of hatreds thought to have been conquered. This is a gift to demagogues and “strongmen”, as it enables them to perceive once more the “true” nature of a class whose heart still beats to rhythms of imperial nostalgia and aggressive nationalism.

Perhaps, following the precedents of agrarian and industrial cultures, the cult of the market is finally being acknowledged, just as it, too, is on the point of eclipse. Beneath the chaos of a culture where even truth has become a kind of consumer choice, new patterns of resistance are forming: commitment to a more just distribution of the goods of the Earth and respect for a planet ransacked by an omnivorous market; a rejection of robotics displacing humanity; a rediscovery of our capacity to do and make things freely for ourselves and each other.

But the savage regressions of our time may be not just a momentary disturbance, any more than agrarian and industrial society were. The cycle may have to play itself out, in who knows what ugly and distressing scenes, before the time for remorse comes round once more; then, appalled by our destructiveness, we shall repeat the constantly broken resolution: Never Again.

The great Spanish humanist Juan Luis Vives, whose influence helped shape the Elizabethan poor law, wrote, in On Assistance to the Poor (1526): “. . . the poor are cast out of the churches and wander over the land; they do not receive the sacraments and they hear no sermons. We do not know by what law they live, nor what [are] their practices and beliefs.” After five centuries of upheaval and driven change, and in a radically altered context, his words still have a haunting, prophetic relevance.

Jeremy Seabrook’s most recent book is “The Song of the Shirt”, published in India by Navayana and in the UK by Hurst

This article first appeared in the 06 April 2017 issue of the New Statesman, Spring Double Issue

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