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

New Statesman composite.
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What to read in 2017

From rebellion and religion to swimming and surrealism – these are the books to look out for in the new year.

How does the publishing industry reflect on such a politically momentous year? One urgent task is to tell us about our new leaders. Six months after the United Kingdom’s second female prime minister took office, Biteback supplies, on 24 January, her first serious biography, Theresa May: the Path to Power, by Rosa Prince. Given how little we know about this very private politician, it will be pored over for insights.

Sadiq Khan’s story is better known – I remember him saying something about being a “bus driver’s son” – but George Eaton, the New Statesman’s political editor, has delved deeper for his biography (Sadiq: the Making of a Mayor and London’s Rebirth, also from Biteback), based on exclusive access to Khan and more than 100 interviews with those around him. It is expected in May, to mark the one-year anniversary of Khan taking office as the first Muslim Mayor of London.

Since becoming a Labour MP in 1982 and joining a House of Commons that was 97 per cent male, Harriet Harman has fought for women’s rights and helped to drag parliamentary culture out of the Stone Age. Her account of those struggles, A Woman’s Work, will be published by Allen Lane next month. Jess Phillips, the 35-year-old self-described “gobby MP”, brings the feminist fight into the digital age with Everywoman (Hutchinson, March). At the “old guard” end, another Westminster memoir worth noting is Chris Patten’s First Confession (Allen Lane, June). And although it looked for a moment as if Vince Cable might have written a whole book about his time on Strictly, it turns out that Open Arms (Corvus, June) is a work of fiction: a political thriller about Westminster, India and big business.

Last year, Miles Cole assembled a cover for the NS in which Iain Duncan Smith, Douglas Carswell and Daniel Hannan figured as the three heads of a Brexit hydra. How blessed we are that the last two have books out: Hannan’s Europe primer What Next (out now) is joined by Carswell’s “radical manifesto” Rebel in April, both published – appropriately – by Head of Zeus.

What next, indeed? For the US, it’s too early to answer that question, but Melville House has put together a gutsy collection, What We Do Now: Standing Up for Your Values in Trump’s America, with contributions by 27 leading progressives, including Bernie Sanders and Gloria Steinem, suggesting paths of resistance. It’s due to be published on 17 January, just before the presidential inauguration.

Resistance will be in the air, not least because 2017 is the centenary of the two uprisings that became known as the Russian Revolution (in February and October). The avalanche that began last year will continue with Victor Sebestyen’s Lenin the Dictator: an Intimate Portrait (Weidenfeld & Nicolson, February), Robert Service’s The Last of the Tsars: Nicholas II and the Russian Revolution (Macmillan, also February) and China Miéville’s narrative take on the events of 1917, October: the Story of the Russian Revolution (Verso, May). Other books on Lenin are due from Tariq Ali (The Dilemmas of Lenin, Verso, April) and Slavoj Žižek (Lenin 2017, Verso, July). His ideas were built on those of Marx, so it’s neat that 2017 also marks the 150th anniversary of Das Kapital. New reflections on that work include Marx and Capital by David Harvey (Profile, July).

In 1917 Russia was in the grip of financial crisis, revolution and terror and a world war was raging. A century later, are we going the same way? It is clear, at least, that many of our liberal assumptions about progress are being upturned. Age of Anger: a History of the Present by Pankaj Mishra (Allen Lane, January) explores the origins of our “great wave of paranoid hatreds”, while populist politics and nationalism are examined in The Road to Somewhere (Hurst, March) by David Goodhart, The Rise of the ­Outsiders: the Anti-Establishment and Its March to Power (Atlantic, June) by Steve Richards and Grave New World: the End of Globalisation and the Return of Economic Conflict (Yale University Press, May) by Stephen D King. The former Economist editor Bill Emmott offers a slightly less gloomy spin in The Fate of the West, which considers the decline but also the possible “revival” of liberal democracy (Profile, March).

Having got his grandly titled history of the eurozone – And the Weak Suffer What They Must? – out of the way last year, the former Greek finance minister Yanis ­Varoufakis unleashes the gossip, telling the “extraordinary tale of brinkmanship and backstabbing” behind the 2015 EU negotiations in Adults in the Room (Bodley Head, May). A fellow economist, Evan Davis of Newsnight, adopts the phrase of 2016 for his book Post-Truth (Little, Brown, August), about how “bullshit” became “the communications strategy of our imes”.

There is plenty of “post-truth” written about Britain’s Muslims, as was illustrated last month when the Mail Online paid out £150,000 to a family that the columnist Katie Hopkins had accused groundlessly of having extremist links. Attempts to bring some honesty and clarity come from Sayeeda Warsi, Britain’s first Muslim cabinet minister, in The Enemy Within (Allen Lane, March), and Omar Saif Ghobash, in his Letters to a Young Muslim (Picador, January). Another counterblast to those who see Islam as incapable of modernising, The Islamic Enlightenment (Bodley Head, February) by Christopher de Bellaigue shows that, from the 19th century onwards, the faith has been transformed by progressive thinking.

These books will sadly be outweighed by writings on Islamic State, of which The Way of the Strangers by the Atlantic correspondent Graeme Wood (Allen Lane, January) is the most anticipated. Catherine Nixey has found a historical parallel with the destruction wreaked by IS: The Darkening Age (Macmillan, September) describes how a militant religion “comprehensively and deliberately extinguished” the teachings of the classical world, “ushering in centuries of unquestioning adherence to ‘one true faith’”. That religion was, of course, Christianity.

In biography, we will get two grand surrealists and two great engineers. The Surreal Life of Leonora Carrington by Joanna Moorhead (Virago, April) coincides with the centenary of the painter and writer, while ­Jenny Uglow takes on the author of “The Owl and the Pussy-Cat” in Edward Lear: a Life of Art and Nonsense (Faber & Faber, October). Bloomsbury pits two engineering geniuses, one Scottish and the other American, against each other, with Man of Iron: Thomas Telford and the Building of Britain by Julian Glover (January) – which celebrates the “colossus of roads” and designer of the 1826 Menai Suspension Bridge – and Chief Engineer: the Man Who Built the Brooklyn Bridge (June), in which the NS contributing writer Erica Wagner tells the story of Washington Roebling against a backdrop of civil war, family strife and superhuman achievement in construction. Peter Ackroyd is already London’s biographer laureate but in Queer City (Chatto & Windus, May), he views the capital through its gay population, from the pleasure-filled lupanaria (“wolf dens”) of Roman times to the present day.

Sexuality errs towards the non-binary these days and a raft of books reflects that. Trans Like Me by C N Lester (Virago, May) is joined by The Gender Games by Juno Dawson (Two Roads, July) and Man Alive by Thomas Page McBee (Canongate, May). There’s possibly more fun to be had in One of the Boys by the comic actor Robert Webb (Canongate, July), a coming-of-age memoir that builds on a piece he wrote for the NS in 2014: “How not to be a boy”.

Two other memoirs stand out. When the cultural theorist Stuart Hall died in 2014 he left behind a manuscript – Familiar Stranger: a Life Between Two Islands (Allen Lane, April) tells the story of his early life, from growing up in 1930s Jamaica to dealing with the thorny politics of 1950s and 1960s England. Glimpses of a great English institution are given in Balancing Acts: Behind the Scenes at the National Theatre (Jonathan Cape, May) by Nicholas Hytner, who stepped down as artistic director in 2015.

Beyond our cities, we have become a nation of dippers and 2017 is the year of the swim-moir. There’s Turning: a Swimming Memoir by Jessica J Lee (Virago, May), Leap In: a Woman, Some Waves and the Will to Swim by Alexandra Heminsley (Hutchinson, January) and I Found My Tribe by Ruth Fitzmaurice (Chatto & Windus, July), an Irish writer’s account of her “Tragic Wives’ Swimming Club”. In June Philip Hoare, the King Neptune of literature, returns with RisingTideFallingStar (Fourth Estate), a wide-ranging examination of our relationship with this watery planet.

On dry land, too, big ideas flourish. In Selfie (Picador, June) Will Storr traces the roots of our “age of perfectionism”, and Adam Alter’s Irresistible (Bodley Head, March) looks at addiction in the ­internet age. Bullshit Jobs: a Theory by David Graeber (Allen Lane, September) explains why we are trapped in a cycle of meaningless work, and in The Knowledge Illusion (Macmillan, April) the cognitive scientists Steven Sloman and Philip Fernbach claim that true intelligence “resides not in the individual but in the collective mind.”

The essay continues to enjoy a renaissance. There are offerings from the author of The Wake, Paul Kingsnorth (Confessions of a Recovering Environmentalist, Faber & Faber, April); Rebecca Solnit, whose Mother of All Questions (Granta, October) is a collection of “further feminist essays”; Teju Cole, whose “multimedia diary” Blind Spot, coming from Faber & Faber in July, pairs images with text; and Martin Amis, who has assembled his criticism and reportage from 1986 to 2016 in The Rub of Time (due from Jonathan Cape in the autumn). Amis is also working on a novel about three of his friends – Christopher Hitchens, Saul Bellow and Philip Larkin – all of whom have died since he began writing it. “That gives me a theme,” he said recently. “Death.”

In fiction, the year begins with Paul Auster’s first novel in seven years, 4 3 2 1 (Faber & Faber, January), charting a baby boomer’s four divergent life paths. From the US, too (now that an American has won the Man Booker Prize we’d better pay closer attention), there comes Lincoln in the Bardo (Bloomsbury, March), the debut novel by the short-story supremo George Saunders. Set in 1862 in a cemetery in Washington, it has drawn high praise from first readers. Also arriving with Stateside acclaim is Homegoing (Viking, January), a story of two sisters and the slave trade in the Gold Coast by the first-time novelist Yaa Gyasi.

If we are – pace Stephen D King and others – seeing the end of globalisation, it’s not showing in fiction, which in 2017 feels anything but insular. The Indian author Arun­dhati Roy returns to fiction, 20 years after The God of Small Things, with The Ministry of Utmost Happiness (Hamish Hamilton, June), described as “a love story and a provocation”, while the new novel by the Man Booker-shortlisted author Neel Mukherjee, A State of Freedom (Chatto & Windus, September), is a “fierce and often devastating portrayal of contemporary India”. From Turkey, Orhan Pamuk’s The Red-Haired Woman (Faber & Faber, September) is a short philosophical novel about a murder that took place 30 years ago near Istanbul. Emerging from the Iraq War is Spoils (Jonathan Cape, May), a debut novel by a former US sergeant, Brian Van Reet, centring on three characters: a young female soldier, a jihadi and a male tank crewman. Germany and the UK are the settings for the first novel by the prize-winning biographer (and contributor to these pages) Lucy Hughes-Hallett – Peculiar Ground (Fourth Estate, May), which spans the 17th and 20th centuries.

And here’s a rare event: the publication of fiction from North Korea. A cache of stories by the dissident writer “Bandi” has been smuggled out and translated by Deborah Smith, and will be published by Serpent’s Tail in March under the title The Accusation. (Smith also translates Han Kang, who won the Man Booker International Prize in 2016; a new novel by the South Korean writer is to come from Portobello in November.)

Elsewhere, strong literary names dot the lists. There are novels by Jon McGregor (Reservoir 13, Fourth Estate, April), Hari Kunz­ru (White Tears, Hamish Hamilton, April), Will Self (Phone, Viking, June), William Boyd (The Dreams of Bethany Mellmoth, Viking, September) and Ali Smith (Winter, Hamish Hamilton, November). We just have to hope that bookshops aren’t too busy ordering extra copies of Into the Water (Doubleday, May), Paula Hawkins’s follow-up to The Girl on the Train, to notice.

Tom Gatti is Culture Editor of the New Statesman. He previously edited the Saturday Review section of the Times, and can be found on Twitter as @tom_gatti.

 

This article first appeared in the 05 January 2016 issue of the New Statesman, Divided Britain