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

Chris McKenna/Wikimedia
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A night in my old room, with the sink, the Wisdens, and the prospect of “full genitality”

The mirror is still there, though, into which I would, as Nigel Molesworth put it, gaze at my strange unatural (sic) beauty, and ask what purpose it served.

In my old bedroom, again. This is, at least, a matter of choice. Monday evenings and Tuesday mornings are now spent in the family home so that I can keep my father company and give my mother a chance to go to her choir practice, on Mondays, and her art class, on Tuesdays. (I suddenly asked myself today: what if my mother were rubbish at these things? She’s not, though – especially not at the singing, as anyone who saw her on Broadway or NBC back in the day can attest. As for her art, I couldn’t paint to her standard even if I applied myself to nothing else for years.)

Anyway: I find myself, after a 12-year hiatus, once again intimately concerned about a close family member’s capacity to eat, sleep, and move without injury, only this time the concern is directed towards the previous generation rather than the next one. That’s the way it goes, and from the way events are moving, it looks as though I will have only the briefest of respites from such cares until the close family member whom I worry about falling over, or worse, will be me.

And as if this temporal confusion were not enough, I now find myself once again in the room where I spent the years 1972-85, from childhood to young adulthood, learning how to leave the room. I didn’t have an unhappy childhood, apart from the unhappiness I brought to it. Which was considerable, and not so much from a gloomy nature as from the early realisation that anyone who thought things in the outside world were just dandy really wasn’t paying attention. The chafing, constantly under-entitled condition of childhood itself didn’t make things any better.

The old room has been repurposed now as a kind of art studio: but the thick blue curtains are still there, there is a sofa-bed in place of my own old bed (on which my youngest son now sleeps, perhaps absorbing its melancholy, like radon seeping from the rocks, while he sleeps), but it is in the same place; the little sink in the corner, into which I would piss and occasionally puke, is still there, but the taps have jammed solid. The mirror is still there, though, into which I would, as Nigel Molesworth put it, gaze at my strange unatural (sic) beauty, and ask what purpose it served.

For the main thing that bothered me in that room, from 1975 on, was of achieving, in the Freudian phrase, full genitality – or getting laid. Once this question arose, it became impossible to dislodge, and when I say I spent every hour of every day worried that I would somehow die before I lost my cherry, I do not mean I thought about it once an hour. No: I thought about it through all of every hour, of every day. And night. Even my dreams had only one subject.

Of course, it wasn’t just the brute urges of the body. The heart, or the soul, if you wish, yearned, too; and the idea of finding someone who could satisfy both carnal and spiritual selves seemed so perfect that it also seemed unattainable. So, to distract myself, I would read; and once I was tall enough to peer over a bar without standing on tiptoe, I would go to the local pub and have a couple of pints of Guinness, which would be enough to get my 14-year-old body sozzled. (How on earth did I manage that? I was small for my age and shaving was as remote a prospect as sex, but somehow I had the kind of bearing which convinced barmen that it was OK to serve me. I wonder if it is somehow my fault that there are now signs everywhere saying you’re going to be asked for proof of age if you look under 25. Twenty-five!)

So, in 2015, as I retrace the familiar steps and retire to bed, I look for reading matter. Most of my books are dispersed (quite a few of them in boxes in the loft above, creating ominous cracks in the ceiling beneath), but there are a few survivors; a P G Wodehouse or two, a set of Wisdens, much loved, from 1974-85. I pull out the 1974 edition and read of the promising young Somerset players Ian Botham and I V A Richards and their proud captain, Brian Close. I had forgotten he’d captained Somerset. (This was a week before his death.)

I turn the light off. The curtains in my old room shut out the light; in the Hovel it never gets dark, the street never wholly quiet. East Finchley, at night, is as silent as the grave. And the lines from Marvell pop into my head before I fall asleep. You know the ones? “The grave’s a fine and private place,/But none, I think, do there embrace.” 

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide

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A letter to Rosa Luxemburg

The socialist pioneer Rosa Luxemburg was killed in Berlin in 1919. In 2015, John Berger sits down to write a letter to her.

Rosa! I’ve known you since I was a kid. And now I’m twice as old as you were when they battered you to death in January 1919, a few weeks after you and Karl ­Liebknecht had founded the German Communist Party.

You often come out of a page I’m reading – and sometimes out of a page I’m trying to write – come out to join me with a toss of your head and a smile. No single page and none of the prison cells they repeatedly put you in could ever contain you.

I want to send you something. Before it was given to me, this object was in the town of Zamosc in south-east Poland. In the town where you were born and your father was a timber merchant. But the link with you is not as simple as that.

The object belonged to a Polish friend of mine called Janine. She lived alone, not in the elegant main square as you did during the first two years of your life, but in a very small suburban house on the outskirts of the town.

Janine’s house and her tiny garden were full of potted plants. There were even potted plants on the floor of her bedroom. And she liked nothing better when she had a visitor than to point out, with her elderly working woman’s fingers, the special particularity of each one of her plants. Her plants kept her company. She gossiped and joked with them.

Although I don’t speak Polish, the European country I perhaps feel most at home in is Poland. I share with the people something like their order of priorities. Most of them are not intrigued by Power because they have lived through every conceivable kind of power-shit. They are experts at finding a way round obstacles. They continually invent ploys for getting by. They respect secrets. They have long memories. They make sorrel soup from wild sorrel. They want to be cheerful.

You say something similar in one of your angry letters from prison. Self-pity always made you angry and you were replying to a moaning letter from a friend. “To be a human being,” you say, “is the main thing above all else. And that means to be firm and clear and cheerful, yes, cheerful in spite of everything and anything, because howling is the business of the weak. To be a human being means to joyfully toss your entire life in the giant scales of fate if it must be so, and at the same time to rejoice in the brightness of every day and the beauty of every cloud.”

In Poland during recent years a new trade has developed and anyone who practises it is called a stacz, which means “taking the place”. One pays a man or a woman to join a queue and after a very long while (most queues are very long), when the stacz is near to the head of the queue, one takes his or her place. The queues may be for food, a kitchen utensil, some kind of licence, a government stamp on a document, sugar, rubber boots . . .

They invent many ploys for getting by.

Illustration: John Berger

In the early 1970s, my friend Janine decided to take a train to Moscow, as several of her neighbours had done. It was not an easy decision to take. Only a year or two before in 1970 there had been the massacre of Dzank and other seaports, where hundreds of shipbuilding workers on strike had been shot down by Polish soldiers and police under orders from Moscow.

You foresaw it, Rosa, the dangers implicit in the Bolshevik manner of arguing with all reasoning, you already foresaw it in 1918 in your commentary on the Russian Revolution. “Freedom only for the members of the government, only for the members of the Party – though they are quite numerous – is no freedom at all. Freedom is always the freedom of the one who thinks differently. Not because of any fanatical concept of justice, but because all that is instructive, wholesome and purifying in political freedom depends on this essential characteristic, and its effectiveness vanishes when ‘freedom’ becomes a special privilege.”

Janine took the train to Moscow to buy gold. Gold cost there a third of what it did in Poland. Leaving the Belorussky Station behind her, she eventually found the backstreet where the prescribed jewellers had rings to sell. There was already a long queue of other “foreign” women waiting to buy. For the sake of law and order each woman had a number chalked on the palm of her hand which indicated her place in the line. A cop was there to chalk the numbers. When Janine eventually reached the counter with her prepared roubles she bought three gold rings.

On her way back to the station she caught sight of the object I want to send to you, Rosa. It cost only 60 kopeks. She bought it on the spur of the moment. It tickled her fancy. It would chat with her potted plants.

She had to wait a long while in the station for the train back. You knew, Rosa, these Russians stations that become encampments of long-waiting passengers. Janine slipped one of her rings on to the fourth finger of her left hand, and the other two she hid in more intimate places. When the train arrived and she climbed up into it, a soldier offered her a corner seat as she sighed with relief; she would be able to sleep. At the frontier she had no problems.

In Zamosc she sold the rings for twice the sum she had paid for them, and they were still considerably cheaper than any which could be bought in a Polish shop. Janine, after deducting her rail fare, had made a little windfall.

The object I want to send you she placed on her kitchen windowsill.

The goal of an encyclopaedia is to assemble all the knowledge scattered on the surface of the earth, to demonstrate the general system to the people with whom we live, and to transmit it to the people who will come after us, so that the works of centuries past is not useless to the centuries which follow, that our descendants by becoming more learned, may become more virtuous and happier . . .

Diderot is explaining in 1750 the encyclopaedia he has just helped to create.

The object on the windowsill has something encyclopaedic about it. It’s a thin cardboard box, the size of a quarto sheet of paper. Printed on its lid is a coloured engraving of a collared flycatcher, and underneath it two words in Cyrillic Russian: SONG BIRDS.

Open the lid. Inside are three rows of matchboxes, with six boxes to each row. And each box has a label with a coloured engraving of a different songbird. Eighteen different songsters. And below each engraving in very small print the name of the bird in Russian. You who wrote furiously in Russian, Polish and German would have been able to read them. I can’t: I have to guess from my vague memories of sporadic birdwatching.

The satisfaction of identifying a live bird as it flies over, or disappears into a hedgerow, is a strange one, isn’t it? It involves a weird, momentary intimacy, as if at that moment of recognition one addresses the bird – despite the din and confusions of countless other events – one addresses it by its very own particular nickname. Wagtail! Wagtail!

Of the eighteen birds on the labels, I perhaps recognise five.

The boxes are full of matches with green striking heads. Sixty in each box. The same as seconds in a minute and minutes in an hour. Each one a potential flame.

“The modern proletarian class,” you wrote, “doesn’t carry out its struggle according to a plan set out in some book or theory; the modern worker’s struggle is a part of history, a part of social progress, and in the middle of history, in the middle of progress, in the middle of the fight, we learn how we must fight.”

On the lid of the cardboard box there is a short explanatory note addressed to matchbox-label collectors (phillumenists, as they are called) in the USSR of the 1970s.

The note gives the following information: in evolutionary terms birds preceded animals, in the world today there are an estimated 5,000 species of birds, in the Soviet Union there are 400 species of songbirds, in general it is the male birds who sing, songbirds have specially developed vocal chords at the bottom of their throats, they usually nest in bushes or trees or on the ground, they are an aid to cereal agriculture because they eat and thus eliminate hordes of insects, recently in the remotest areas of the Soviet Union three new species of singing sparrows have been identified.

Janine kept the box on her kitchen windowsill. It gave her pleasure and in the winter it reminded her of birds singing.

When you were imprisoned for vehemently opposing the First World War, you listened to a blue titmouse “who always stayed close to my window, came with the others to be fed, and diligently sang its funny little song, tsee-tsee-bay, but it sounded like the mischievous teasing of a child. It always made me laugh and I would answer with the same call. Then the bird vanished with the others at the beginning of this month, no doubt nesting elsewhere. I had seen and heard nothing of it for weeks. Yesterday its well-known notes came suddenly from the other side of the wall which separates our courtyard from another part of the prison; but it was considerably altered, for the bird called three times in brief succession, tsee-tsee-bay, tsee-tsee-bay, tsee-tsee-bay, and then all was still. It went to my heart, for there was so much conveyed by this hasty call from the distance – a whole history of bird life.”

After several weeks Janine decided to put the box in her cupboard under the stairs. She thought of this cupboard as a kind of shelter, the nearest she had to a cellar, and in it she kept what she called her reserve. The reserve consisted of a tin of salt, a tin of cooking sugar, a larger tin of flour, a little sack of kasha and matches. Most Polish housewives kept such a reserve as a means of minimal survival for the day when suddenly the shops, during some national crisis, would have nothing on their shelves.

The next such crisis would be in 1980. Again it began in Dzank, where workers went on strike in protest against the rising food prices and their action gave birth to the national movement of Solidarnosc, which brought down the government.

“The modern proletarian class,” you wrote a lifetime earlier, “doesn’t carry out its struggle according to a plan set out in some book or theory: the modern workers’ struggle is a part of history, a part of social progress, and in the middle of history, in the middle of progress, in the middle of the fight, we learn how we must fight.”

When Janine died in 2010, her son Witek found the box in the cupboard under the stairs and he brought it to Paris, where he was working as a plumber and builder. He brought it to give it to me. We are old friends. Out friendship began by playing cards together evening after evening. We played a Russian and Polish game called Imbecile. In this game the first player to lose all his or her cards is the winner. Witek guessed that the box would set me wondering.

One of the birds in the second row of matchboxes I recognise as a linnet, with his pink breast and his two white streaks on his tail. Tsooeet! Tsooeet! . . . often several of them sing in chorus from the top of a bush.

“The one who has done the most to restore me to reason is a small friend whose image I am sending enclosed. This comrade with the jauntily held beak, steeply rising forehead and eye of a know-it-all is called Hypolais hypolais, or in everyday language the arbour bird or also the garden mocker.” You are imprisoned in Poznan in 1917 and you continue your letter like this:

This bird is quite an oddball. He doesn’t sing just one song or one melody like other birds, but he is a public speaker by the grace of God, he holds forth, making his speeches to the garden, and does so with a very loud voice full of dramatic excitement, leaping transitions, and passages of heightened pathos. He brings up the most impossible questions, then hurries to answer them himself, with nonsense, making the most daring assertions, heatedly refuting views that no one has stated, charges through wide open doors, then suddenly exclaims in triumph: “Didn’t I say so? Didn’t I say so?” Immediately after that he solemnly warns everyone who’s willing or not willing to listen: “You’ll see! You’ll see!” (He has the clever habit of repeating each witty remark twice.)

The linnet’s box, Rosa, is full of matches.

“The masses,” you wrote in 1900, “are in reality their own leader, dialectically creating their own development procedure . . .”

How to send this collection of matchboxes to you? The thugs who killed you, threw your mutilated body into a Berlin
canal. It was found in the stagnant water three months later. Some doubted whether it was your corpse.

I can send it to you by writing, in this dark time, these pages.

“I was, I am, I will be,” you said. You live in your example for us, Rosa. And here it is, I’m sending it to your example.

“Portraits: John Berger on Artists” will be published by Verso on 6 October

John Berger will be in conversation with Ali Smith and Tom Overton at the British Library, London NW1, on 18 September

This article first appeared in the 17 September 2015 issue of the New Statesman, Corbyn's Civil War