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

Show Hide image

The English question

The political community that is England is neither stable nor settled. But something is stirring among Chesterton’s secret people.

From the late 18th century to the early 20th, Britain’s political class wrestled with an Irish Question: how could the British state govern “John Bull’s Other Island” in a way that kept the native Irish quiescent, without jeopardising its own security? When Ireland was partitioned in 1921 the question disappeared from the British political agenda – only to reappear in another guise during the Troubles in Northern Ireland half a century later. It was not laid to rest until the Belfast Agreement of 1998. More recently, politicians and commentators on both sides of the border have had to come to terms with an increasingly intractable Scottish Question: how should the ancient and once independent Scottish nation relate to the other nations of the United Kingdom and to the Westminster parliament? As the convoluted debate provoked by the coming EU referendum shows, a more nebulous English Question now looms in the wings.

Like the Irish and Scottish Questions, it is the child of a complex history. England became a united kingdom in Anglo-Saxon times. It faced external enemies, notably invading Danes, but its kings ruled their own territory with an iron hand. The Norman Conquest substituted francophone rulers and a francophone nobility for these Anglo-Saxon kings; the new elite spoke French, sent their sons to France to be educated and polished and, in many cases, owned territory in France. Simon de Montfort, once credited with founding the English parliament, was a French nobleman as well as an English one. But the kingdom remained united. The Celtic people who had once inhabited what is now England were driven out by the Anglo-Saxons; Lloegr, the Welsh word for England, means “the lost land”. It stayed lost after the Conquest; and indeed, the Norman rulers of England pushed further into Wales than their Anglo-Saxon predecessors had done.

United did not mean peaceful or stable. Henry II, William the Conqueror’s great-grandson, ruled a vast Continental empire stretching from the English Channel to the Pyrenees, as well as England. Inept kings, uppity barons, an aggressive church, restive peasants, a century-long war with France and bitter dynastic rivalries undermined his achievement. But there was no English equivalent to the powerful, de facto independent duchies of Burgundy or Aquitaine in what is now France, or to the medley of principalities, city states and bishoprics that divided Germans and Italians from each other until well into the 19th century. That was still true after the Welshman Henry Tudor defeated Richard III at the Battle of Bosworth in 1485 and seized the English crown as Henry VII. His son (who became Henry VIII) was not content with keeping England united. Having broken with the Catholic Church when the Pope refused to annul his first marriage, he made himself head of the Church in England and proclaimed that the realm of England was an “empire”, free from all external authority.

From the upheavals of Henry’s reign and the subtle compromises of his daughter Elizabeth’s emerged the Church of England – an institutional and theological third way between the Catholicism of Rome, on the one hand, and the Protestantism of John Calvin’s Geneva and Martin Luther’s Germany on the other. The Church of England has spoken to and for the English people ever since. Sometimes it has spoken feebly and complacently, as in the 18th century. At other times it has been outspoken and brave, as in the Second World War, when William Temple was the archbishop of Canterbury, and during the 1980s, when a Church of England commission excoriated the Thatcher era’s “crude exaltation” of “individual self-interest”. Despite (or perhaps because of) the subtle compromises embodied in it, the Anglican Church has been prone to schism. “High Church” Anglicans have stressed its Catholic inheritance; followers of the “low” Church have insisted on its Protestantism. Two charismatic High Anglican priests – John Henry Newman and Henry Edward Manning – converted to Catholicism and ended as cardinals.

Yet these schisms did not affect the laity or diminish the Church’s role in English life. From the end of the English civil wars in 1660 to the late 19th century, England was ruled by the Anglican landed class, the most relaxed and confident governing class in Europe. A bien-pensant, easygoing and undogmatic latitudinarianism shaped relations between church and state. Doctrinal precision was tiresome, even a little vulgar. Wherever possible, differences were fudged: the very Thirty-Nine Articles of the Anglican Church are a fudge. There were exceptions. Gladstone’s restless, sometimes tormented religiosity and baffling combination of high ideals with low cunning could hardly have been less easygoing. And as the 19th century wore on, Protestant dissenters, Catholics and even Jews and unbelievers were slowly incorporated into the political nation. Joseph Chamberlain, who did more to make the political weather than any other leader in the late 19th and early 20th centuries, and contrived to split both the Liberal and the Conservative parties, was a Unitarian, contemptuous of fudge.

However, the style and mood of English governance were still quintessentially Anglican. Fudge prevailed. Trollope’s political novels are a hymn to fudging. Disraeli, ethnically Jewish, though baptised into the Church of England, was a fudger to his fingertips. In his low-cunning moods, even Gladstone was not above fudging. After the Act of Union between England and Scotland in 1707 the monarchy itself rested on a mountain of fudge: the monarch was an Anglican in England, but a Presbyterian in Scotland. The English and Scottish parliaments were merged into a British parliament, but because England was far more populous and far richer than Scotland, it was the English parliament writ large, and embodied English constitutional doctrine. Equally, the Scots became junior partners in a new British empire, ultimately controlled by the Anglican elite. It won the race for empire against France, but the stiff-necked, pernickety legalism of successive London governments drove its colonies on the seaboard of what is now the United States into revolt and eventual independence.

The Anglican elite learned their lesson. Thereafter, imperial governance was English governance writ large. From an early stage the colonies of settlement, later known as the “white dominions”, were, in effect, self-governing. At first sight, India, “the brightest jewel in the British crown”, was an exception. It was acquired by force and maintained, in the last resort, by force. The Great Rebellion of 1857, once known as the Indian Mutiny, was brutally suppressed. In the Amritsar Massacre of 1919, Brigadier General Dyer ordered his troops to fire on an unarmed and peaceful crowd; they went on firing until their ammunition was exhausted. But the most astonishing feature of the British Raj is that a tiny sliver of British soldiers and administrators somehow managed to govern a subcontinent populated by roughly 250 million subjects. Force alone could not have done this. The Raj depended on indirect rule, on adroit accommodation to local pressures. It would not have survived without the collaboration of Indian elites, and the price of collaboration was a willingness to temper the wind of imperial power to the shorn lamb of Indian hopes and fears.

***

 

The Anglo-British story echoed the Indian story. The political, administrative and financial elites in Westminster, Whitehall and the City of London viewed the kingdom they presided over through an Indian lens. British subjects in the mother country were treated like Indian subjects in the Raj. Force lurked in the background, but most of the time it stayed in the background. The Peterloo Massacre of 1819, in which mounted cavalry charged into a crowd of as many as 80,000 people demonstrating for greater parliamentary representation at St Peter’s Field in Manchester, was a paler precursor of the Amritsar Massacre; the Rhondda township of Tonypandy, where hussars helped crush a “riot” by striking miners in 1910, lived on in the folk memory of the labour movement for decades. Yet these were exceptions, just as Amritsar was an exception.

Co-option, accommodation and collaboration between the governing elites and lesser elites beyond them were the real hallmarks of British governance. The French saying that there is more in common between two deputies, one of whom is a communist, than there is between two communists, one of whom is a deputy, also applied to Britain. In the cosy Westminster village, insurgent tribunes of the people, from the popular radical John Bright to the fulminating socialist Michael Foot, slowly morphed into grand and harmless old men. Outside the village, subjects were inescapably subjects, not citizens, just as their Indian counterparts were. Sovereignty, absolute and inalienable, belonged to the Crown-in-Parliament, not to the people. And the whole edifice was held together by layer upon layer of fudge.

Now the fudge is beginning to dissolve. The Raj disappeared long ago. The fate of steelworkers in South Wales depends on decisions by an Indian multinational whose headquarters are in Mumbai. The empire on which the sun never set is barely a memory. Unlike her great-great-grandmother Queen Victoria, the present Queen is not an empress; she has to make do with leading the Commonwealth. In law, the Crown-in-Parliament remains absolutely sovereign and the peoples of the United Kingdom are still subjects, not citizens. But legal principles and political realities diverge. The Anglo-British state whose capital is London and whose parliament stands on the fringes of the Thames is no longer the sole institution that shapes and reflects the political will of the people over whom it presides. There are now four capital cities, four legislatures, four governments and four political systems in the United Kingdom.

The devolved administrations in the non-English nations of the kingdom control swaths of public policy. The parties that lead them vary enormously in ideology and history. The Scottish National Party, which has governed Scotland for nearly nine years, stands for an independent Scotland. In Wales, Labour has been the strongest party since devolution, but it and Plaid Cymru (the “Party of Wales”) have already formed one coalition and may well form another after the elections to the Welsh Assembly next month. No great changes are likely. Almost certainly Wales will continue to be a social-democratic candle in a naughty world. Since the Belfast Agreement, Northern Ireland has been governed by a power-sharing executive, representing both the republican tradition, embodied in Sinn Fein, and the loyalist tradition, embodied in the Democratic Unionist Party. The sovereign Westminster parliament has the legal right to repeal the devolution statutes, but doing so would amount to a revolution in our uncodified constitution and would destroy the Union.

England is a stranger at the feast. It towers above the others in wealth, in population and in political clout. It has almost 84 per cent of the UK population. Scotland has just under 8.5 per cent, Wales just under 5 per cent and Northern Ireland less than 3 per cent. Yet there is no English parliament or government. In times past, English people have often treated the words “English” and “British” as synonyms, but devolution to Scottish, Welsh and Northern Irish legislatures and administrations has made a nonsense of this lazy conflation.

***

England and the English now face the primordial questions that face all self-conscious political communities: “Who are we?”, “Who do we want to be?” At bottom, these questions are philosophical, in a profound sense moral, not economic or institutional. They have to do with the intangibles of culture and sentiment, not the outward forms that clothe them. In stable and settled political communities they are rarely discussed. They don’t need to be. But the political community that is England is neither stable nor settled. Fuelled in part by resentment of the alleged unfairness of the devolution process and in part by the psychic wound left by the end of the Anglo-British empire, an inchoate, grouchy English nationalism is now a force to be reckoned with. St George’s flags flying on 23 April; the extraordinary rise of Ukip; David Cameron’s panic-stricken attempt to “renegotiate” Britain’s role in the European Union – all tell the same story: the “secret people of England”, as G K Chesterton called them, are secret no longer.

But that is not an answer to my questions. It only shows that they are urgent. At the moment, two answers hold the field. The first – the answer embodied in the Cameron government’s “Project Fear” over the UK’s membership of the EU – is essentially deracinated. For the globetrotting super-rich, the financial services sector, the Bank of England and the managers of the Union state, England consists of London and the more salubrious parts of the south-east. The answer to the English Question is that there is no such question. The notion that the English have to decide who they are and who they want to be is a backward-looking fantasy. Globalisation has overwhelmed the specificities of English culture and experience. The English buy and sell in the global marketplace and they face global threats. Membership of an EU made safe for market fundamentalism offers the best available route to security and prosperity in an ever more globalised world.

The second answer – the answer implicit in Eurosceptic rhetoric – is romantically ­archaic. At its heart is a vision of England as a sea-girt and providential nation, cut off from the European mainland by a thousand years of history and a unique constitutional arrangement. It harks back to Shakespeare’s hymn to England as a “jewel set in the silver sea”; to Henry Newbolt’s poem “Drake’s Drum”, evoking the memory of gallant English mariners driving the top-heavy galleons of the Spanish Armada up the Channel to their doom; and to Nelson dying gloriously at Trafalgar at the climax of his greatest victory. It fortified Margaret Thatcher during the nail-biting weeks of the Falklands War; it inspired Enoch Powell’s passionate depiction of post-imperial England as the reincarnation of the England of Edward the Confessor: an England whose unity was “effortless and unconstrained” and which accepted the “unlimited supremacy of Crown-in-Parliament so naturally as not to be aware of it”. As Powell saw more clearly than anyone else, this vision rules out EU membership.

No one with progressive instincts can possibly be satisfied with either of these answers. The great question is whether there is a better one. I think there is, but I can’t pretend that it is easy or comfortable. It is republican in spirit – which does not entail getting rid of the monarchy, as the many Continental monarchies show. It embodies a tradition stretching back to England’s brief but inspiring republican experiment during the civil wars of the 17th century, and before that to Renaissance Italy and Republican Rome. Central to it is the notion of “neo-Roman liberty”: of liberty as freedom from domination, from dependence on another’s will. John Milton was its most eloquent English exponent, in prose and verse, but it also inspired Tom Paine’s contempt for hereditary rule and the “foppery” that went with it. In the 20th century its most engaging champion was R H Tawney, the ethical socialist, economic historian and foe of the “religion of inequality”, its “great God Mumbo-Jumbo” and the “servile respect for wealth and social position” it inculcated.

The goal is clear: a republican England in a republican Britain and a republican Britain in a republican Europe. The obstacles are formidable. As the founders of the American republic discovered, republican liberty entails federal union, combining diversity at the base with unity at the centre; and for that there are few takers. But Gramsci was right. Pessimism of the intellect should go hand in hand with optimism of the will. There is all too much pessimism of the intellect on the British left. It is time for some optimism of the will.

David Marquand’s most recent book is “Mammon’s Kingdom: an Essay on Britain, Now” (Allen Lane)

This article first appeared in the 08 April 2016 issue of the New Statesman, The Tories at war