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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From wars to power ballads: the geopolitics of Eurovision

As the prospect of Brexit looms, the Eurovision song contest can tell us a lot about our place in Europe.

On the night of 14 May, a 92-year-old woman will be sitting somewhere in the Globe arena in Stockholm, amid glitter cannon and hopeful singers dressed in gauze. Her name is Lys Assia, and she was the winner of the first Eurovision Song Contest, held in the Swiss resort of Lugano in 1956. She will be attending this competition as its guest of honour.

In the past few years, “Lys’s List” – the 20 songs Assia believes have a chance of claiming the (cashless) prize and bringing the contest to their country next time – has become a tradition. Perhaps surprisingly, her 2016 selection is led by Malta, the tiny archipelago with a population of 414,000. Less surprisingly, it does not include the UK, a country of 64 million people.

Britain’s relationship with Eurovision is more tortured than anything involving this many sequins has a right to be – halfway between a superiority and an inferiority complex. Our attitude towards the music produced by the rest of the continent
was summed up by the New Yorker’s Anthony Lane in 2010, when he wrote that European pop “‘was all created by the great God of dreck, and Eurovision is his temple”. The problem is this: if the song contest really is just a camp parade of mediocre warbling, interspersed with yokels in twee national costume . . . why can’t we trounce the lot of them?

Even worse for a nation swollen with a maudlin sense of decline, Britain used to do far better. We have won five times in all, trailing behind only Sweden, Luxembourg and France (six) and Ireland (seven). Before 1999, we finished outside the top ten only twice; what screwed us over was the rule change that year which stopped countries having to sing in their national language. (Side note: the 1974 winner, “Waterloo”, which launched Abba’s career, sounds amazing in the original Swedish. It begins: “Jo, jo, vid Waterloo Napoleon fick ge sig . . .”) In all, songs in English have now won 26 times, but Britain hasn’t had a winner since 1997, when it sent Katrina and the Waves, whose earlier hit “Walking on Sunshine” has surely flogged a thousand high-fibre breakfast cereals in its time. We have, however, come last three times since then.

In the year of a Brexit referendum, the parallels between Eurovision and the European Union are too obvious to avoid. Both started small – six nations signed the Treaty of Rome in 1957, and the song contest had seven competitors in 1956. (Britain was not a founder of either, joining the European Community in 1973 and missing the first Eurovision by filing its papers too late.) Both are now bigger than originally envisaged: 52 countries have competed in Eurovision at least once, and today the EU counts 28 members. In the mid-2000s, both expanded east, provoking the same fears about identity and a shift in power. Both have struggled to negotiate where Russia ends and Europe begins. Oh, and both have Byzantine voting procedures, the European Parliament favouring the proportional d’Hondt system, and Eurovision choosing from this year to record the votes of juries and the public separately, rather than combining them before dishing out the points.

Yet there is one big difference. Eurovision has far greater popular appeal. Although only 6.6 million Britons watched last year’s final in Vienna, compared to the 16.5 million who voted in the European Parliament elections in 2014, the winners of the former often have more name recognition. Abba, Céline Dion (drafted in by Switzerland from Canada in 1988 to sing in French), Lordi, Conchita Wurst, Bucks Fizz . . . versus Jean-Claude Juncker, Jeroen Dijsselbloem and Jacques Delors. No contest.

So when did Britain, which once sent Cliff Richard and Sandie Shaw to Eurovision, fall out of love with the contest? And when did the contest fall out of love with Britain? The temptation is to follow the line advanced by the long-term Eurovision commentator Terry Wogan and claim that it’s all political. Countries support their neighbours – Scandinavia and the former Soviet states in particular – and diasporan voters support their home countries. After the former X Factor contestant Andy Abraham, the “singing binman”, came last in 2008, Sir Tel declared that it was “no longer a music contest”. Russia had received maximum points from Estonia, Latvia, Lithuania, Ukraine, Belarus and Armenia (can you spot a theme?) while the UK received just 14 points in total. “Western European participants have to decide whether they want to take part from here on in because their prospects are poor,” Wogan said.

There are many academics who study Eurovision – oh come on, don’t tell me you’re surprised – and they take issue with Sir Terry’s analysis. In an essay titled “‘It’s Just Not Funny Any More’: Terry Wogan, Melancholy Britain and the Eurovision Song Contest” the Canadian critic Karen Fricker attributes Sir Terry’s grumpiness to ­“feelings of unprocessed anger, frustration and loss about the country’s changing relationship to Europe and the rest of the world”.

To Fricker, Wogan’s “increasingly paranoid tales of political voting conspiracies” were unsubstantiated: statistical analyses suggest that neighbour voting, though it undoubtedly exists, does not influence the final choice. Russia’s triumph in 2008 was the result of a “focused, well-researched, and well-funded campaign on the part of Russian political and broadcasting elites to master the codes of Eurovision ­success”, rather than frightened satellite states awarding douze points in the hope of not having their gas supply cut off. If we took the competition more seriously, we would do better. (Insiders are fond of pointing out that Britain’s record of bumping along the bottom of the table was alleviated in 2009 when we entered a song by Andrew Lloyd Webber, a writer with undoubted commercial appeal.) In other words: send for Adele!

The Irish journalist Julian Vignoles, who sat on Eurovision’s ruling body, the Reference Group, agrees. Since televoting began, Germany has given high points to Turkey, and Spain to Romania – reflecting diasporan populations “voting home”. But he points out that some neighbour voting springs from a shared language and culture: a big pop star in Serbia will be known in other parts of the former Yugoslavia.

Vignoles also has harsh words for Wogan: “There has been something of a bias against former communist countries and their efforts at popular music by some Western commentators – a kind of ‘Western chauv­inism’,” he writes in his 2015 book, Inside the Eurovision Song Contest. “This, I believe, is partly a taste issue.”

Whatever the truth, by 2009 Wogan had had enough. He vacated the presenter’s chair – now occupied by Graham Norton – and told a conference of Broadcasting Union bigwigs that the contest should not be “an opportunity to show your neighbours how much you love them. It is about picking the best popular song in Europe.”

It isn’t, though, is it? The Eurovision Song Contest is unavoidably political, because it presumes to rule on what counts as a country, and what counts as Europe. Take the inclusion of Israel, which has long baffled casual viewers. It gets a place because it’s a member of the European Broadcasting Union (EBU), which stretches from Iceland to Egypt and as far east as Azerbaijan.

To get into the EBU, a country must be within the European Broadcasting Area, or a member of the Council of Europe, and it must pay its dues. At present, Palestine and Kosovo do not meet the first of these criteria, and Romania falls foul of the second. (It owes the EBU 16 million Swiss francs – £11.4m – and has therefore been cast out of the 2016 competition.) Syria could enter, but understandably feels it has bigger fish to fry. Lebanon almost entered, once, in 2005, but had to withdraw when its national broadcaster refused to transmit the Israeli entry.

Exactly how thorny the issues involved can be was demonstrated on 30 April, when the venue for this year’s competition in Stockholm accidentally published a draft list of banned flags. The Palestinian flag was not allowed in the arena, it declared, alongside that of the Basque Country, the Welsh dragon and Scottish saltire – and nor was the black flag of Islamic State. Rainbow flags, a popular symbol of the LGBT rights movement, are permitted as a symbol of diversity, but only if they are not wielded “as tool to intentionally make a political statement” (in other words, while booing Russia).

Unsurprisingly, grouping together gay rights campaigners, Isis, Scottish nationalists and Basque separatists managed to upset just about everyone. The document was hurriedly unpublished, but the ban on “regional” flags remains. And the one on Isis.

If you think getting worked up about rectangles of cloth sounds awesomely petty, that’s just the beginning. In 2009 Azerbaijan and Armenia decided that the song contest was the perfect forum for their long-running dispute over the contested Nagorno-Karabakh region. During rehearsals, Azerbaijan complained that the introductory “postcard” to Armenia’s song contained footage of a statue in territory it claims as Azeri; the section was duly removed. Armenia was not beaten that easily: on the night of the final, its presenter read out the results from a clipboard adorned with a picture of the statue.

The fight didn’t stop there. It soon turned out that the Azerbaijani broadcaster, Ictimai Televiziya, had also blurred out the number to vote for Armenia from its terrestrial signal. Then in August that year, the ministry of national security in Baku summoned several Azeri citizens who had voted for Armenia to explain themselves. Eurovision threatened to ban Azerbaijan from the contest, but in the end settled for “undisclosed” damages and a rule change designed to ­suggest that countries probably shouldn’t set their secret police on citizens who vote in unpopular ways.

Talking of unpopularity, it’s probably a good time to mention Russia. That vast state has an uneasy relationship with Euro­vision. On the one hand, it clearly wants the prestige of winning (as it did in 2008) and when it hosted the competition in Moscow the following year the Russian government spent a record €35m. (It recouped only €8.9m in ticket sales, sponsorship and payments from the EBU.) Yet in the past decade, Russia has also brought in draconian anti-gay laws and banned Moscow’s Pride march. This has not gone unnoticed among the competition’s many LGBT fans. And make no mistake: Eurovision is pretty gay. One super-fan told me that when he arrived in Ukraine for the 2005 competition, there were “lots of women sitting on their own in the bar; we assumed they were prostitutes. But by the third night, they had realised they wouldn’t make any money, ­because the men were all gay.” Hence the ban on passive-aggressive rainbow flag-waving and the suggestion that last year’s contest in Vienna deployed “anti-booing” technology to drown out any protests.

Russia’s imperialist ambitions also make it unpopular. In 2008, Vladimir Putin’s government backed the creation of breakaway republics in South Ossetia and Abkha­zia, leading to a short war with Georgia. The next year, Georgia was told to amend the lyrics to its Eurovision entry, “We Don’t Wanna Put In”, after organisers saw through the cunning coded message of its chorus: “We don’t wanna put in/ The negative move/It’s killin’ the groove . . . Put in/Don’t wanna put in.”

***

“War is the continuation of politics by other means,” the Prussian general Carl von Clausewitz once wrote. Defenders of the European Union often point to its success in bringing decades of peace to a troubled continent, but perhaps it’s time to acknowledge that the Eurovision Song Contest has become a continuation of war by other means. The organisers of the competition are never going to succeed in making it apolitical, or “about picking the best popular song in Europe”, because an audience of 200 million people is too big an opportunity for any pressure group to pass up.

In 1956, no one could have predicted that the premier arena for political statements about European identity would be a music contest variously won by a bearded drag queen, a Finnish heavy metal group and a temporarily Swiss Céline Dion, but there you go. Still, no matter how much you hate disco or power ballads, they are infinitely preferable to a ground invasion. We should probably just let the Russians win it every year to keep them happy.

As for who will win this year, an insider tells me to look carefully at Australia, which came fifth in 2015 (I know, I know. Not even the EBU’s definition of Europe stretches that far; it was invited as a “special guest”). I like the idea of Australia taking the prize, for two reasons: a) shipping the whole circus to Sydney next year would be appropriately bonkers; b) a load of academics would have to come up with a grand thesis for What This Says About Being European Today.

The answer to that, I suspect, is that being European is about being part of a club that half a dozen countries are queuing up to join, but Britain regards as vaguely below its dignity. Which is why I’ll be voting Remain in June, even if I wouldn’t vote for our Eurovision entry, Joe and Jake, who appear to be two prepubescents with a guitar and the pained expressions of the severely constipated. And why, frankly, I would like to see Jean-Claude Juncker rock big hair and a sparkly jacket more often.

The Eurovision semi-finals will be broadcast on BBC4 on 10 and 12 May (8pm), and the final on 14 May (BBC1, 8pm)

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 05 May 2016 issue of the New Statesman, The longest hatred