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

Photo: Getty/Julia Rampen
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Can Jeremy Corbyn win back Scotland for Labour?

“At the end of the day, the referendum was about half the bloody things Corbyn was talking about.”

On a sunny Wednesday morning in mid-August, a small group of local Labour activists stood outside The Carloway Mill, on the Isle of Lewis in the Outer Hebrides. Gazing out at the tawny, rolling scrubland and glittering blue lochs, they waited for the man they had invited, who lived nearly 700 miles south. A minibus pulled up, the door rolled open and out stepped Jeremy Corbyn.

During the election campaign, when the idea of Labour winning two seats in Scotland still seemed mildly optimistic, Corbyn held rallies in Edinburgh and Glasgow. Now, with seven Labour seats, the Labour leader has the country in his sights. His trip to Lewis was the first day of a week-long tour of a country governed by the Scottish National Party.

Scottish Labour is not known for its Corbynism – a YouGov poll found a majority of members voted for Owen Smith in the 2016 leadership battle – but the conversion of local Labour voters has been swift. “Some people who voted Labour all the time said six months ago ‘[we] don't think we'll vote Labour because of Jeremy’,” Matt Bruce, the tweed-jacketed local party chair, told me. “Two weeks ago, it was ‘Jeremy's coming’. He's changed things.”

Harris Tweed may be associated with the elite lifestyle shops of Oxford Street, but manufacturing it is a humbler process. The wool is spun at mills like The Carloway, before being sent to individual crofters for the weaving process.

Inspecting the mill, Corbyn seemed genuinely fascinated. He entered a room of spinning cylinders, where green and pink wool streamed back and forth, and disappeared to inspect the looms. A worker in a black waistcoat showed him how to iron on the quality label on finished tweed. Corbyn’s wife, Laura, meanwhile, rifled through the hangers of finished, mossy green jackets (they each bought one).

Brian Wilson, a former minister in the Blair government, who lives on the island and works in the tweed business, watched approvingly.

“Against the predictions of people like myself, Corbyn really struck a chord with a lot of voters who maybe didn't vote Labour,” he said. “These are the realities and I recognise them.”

After Kezia Dugdale’s resignation, most pundits expect the next Scottish Labour leader to be someone who at least nominally supports Corbyn. But three years on from the independence referendum, will the energy of Corbynism be enough to transcend Scotland’s constitutional politics?

"There was a village with no road – the EU built it"

To get to the island of Lewis in the Outer Hebrides from Westminster, you need to first fly to Glasgow, and then board a propeller plane for a further hour to reach Stornoway. Lewis, in turn, is only the northernmost in a string of islands which make up the constituency of Na h-Eileanan an Iar (the Western Isles). The islanders’ self-sufficient outlook is countered by a deep dependence on the timetable of the ferry. There is little materialism, faith is everywhere, and yet every conversation comes back to economics. Residents have elected a stream of centrist representatives, from early 20th century liberals, to New Labour’s Calum MacDonald and since 2005, the Scottish National Party’s Angus MacNeil, or “Angus Brendan” as he is known to locals.

Centrism may well be a cover for a hard-defended consensus. When asked about Jeremy Corbyn, the default answer in Stornoway was “no comment”. Most locals seemed surprised to hear he was even there. “I haven’t heard much, and I live here in the centre of town,” said Annalisa Engebretsen, a retiree in pink-framed sunglasses. I told her he was at the other end of the street. “Was he?” There was a pause. She pointed to the sky in front of her. “About an hour ago I saw the most amazing group of seagulls.”

The Scottish Nationalists, too, wear their ideology lightly on the island. Alasdair Allan’s office has a copy of the Declaration of Arbroath, the 1320 declaration of Scottish independence, hanging on the wall. But the MSP was more interested in talking ferry fares than freedom fighters.

He was, however, outspoken about a different constitutional issue. “I would be telling a lie if I told you the fishing community took the same view as me in the EU referendum,” he said. “However since then we have had fishermen saying 'we wanted to leave the common fishing area'. The industry didn't realise it meant leaving the single market.” Some of the biggest export markets for Scottish fishing produce, he pointed out, were Spain and France. 

Allan said the EU had been almost solely responsible for funding the expansion of roads on the island: “There was one village in Harris that had no road to it at all and the EU built one.”

“People do have concerns about the common fisheries policy but their biggest concern is the future,” he added. “With respect to Jeremy Corbyn, the biggest question has been left unanswered is on Britain's relationship with the European Union.”

"We need many changes here"

After visiting the mill, Corbyn’s next stop was an empty classroom in a Stornoway school, to answer questions from pupils beamed on to a screen. Some of the students were from Castlebay, more than 100 miles away, on the isle of Barra. Their questions were no less direct than a journalist’s, but Corbyn seemed to prefer answering them. One pupil asked him about leaving the single market and the customs union.

“The UK as a whole voted to leave the EU,” Corbyn said. He talked about getting tariff-free access to the European market, and then asked: “Do you feel we should keep very close trading with Europe?”

“Yes,” she said. “I do.”

In the months after the EU referendum, when Labour dissolved into civil war, the SNP stood out for its clear opposition to Brexit. Its position has since looked less wise, given a third of SNP voters backed Leave, and Nicola Sturgeon was forced to retreat from a call for a second referendum.

On Lewis, though, I found that Brexit was more than just a handy SNP rhetorical device. Elly Fletcher, chief executive of the An Lanntair Arts Centre, showed me around a smart auditorium which doubles as the island’s cinema. The building was funded in part by EU grants. “Brexit is a worry,” she said. Another institution at risk is the Stornoway campus of the University of Highlands and Islands, which has already put projects on hold.

John MacLeod, standing by the quay, had a different point of view. Dressed in a blue boiler suit, open to reveal a knitted jumpers, and leather boots to match his tanned skin, MacLeod claimed at 56 to be the oldest fisherman in town.

He remembered how, 30 years ago, the fishing boats in the harbour used to be 10-12 boats deep, compared to the single line bobbing there that day.

“This island is just dying on its feet in the fishing industry,” he said. “Even in the past 10 years it has changed. This place has been decline, decline, decline.” Brexit he saw as just one of many shake-ups required: “We need many changes here, or these islands are going to die a death.”

Corbyn told The New Statesman a "jobs-first Brexit" was "essential to local economies, industries and businesses in Scotland".

He added: "We are pushing for a Brexit deal that protects the interests of the many and repatriates powers from Brussels to every nation and region in the country."  

 

"Corbyn's message chimes with independence voters"

Corbyn finished his day in Stornoway with a rally which attracted several hundred supporters. The next day, he flew to Glasgow, where his first appointment was a photo-op at a building site. TV crews in loose hard hats and luminous jackets waited outside. Crammed into the Portakabin with him was Paul Sweeney, the newly elected Labour MP for Glasgow North East, and Frank McAveety, the leader of Glasgow City Council until the SNP shook it out of Labour’s grasp in the 2017 local elections in May.

In May, with Labour’s polling in the doldrums, the loss of Glasgow Council was seen as a harbinger of what was to come. McAveety disagreed. “Clearly there was something already happening,” he said. “The gap between the SNP and Labour on the council elections wasn't as profound as it had been in 2016 Scottish Parliament election. The glamour was coming off the SNP.”

Sweeney, on the other hand, thought it was Labour’s message of hope that persuaded some Yes voters to back him. “We have perhaps framed things too much in terms of our opponents,” he said. “The best way to defeat our opponents is to ignore them.”

Since 2014, Glasgow has been the spiritual capital of the independence movement. Campaigners gathered in George Square, its iconic Victorian centre, to cheer at rallies, and later to weep, after Scots voted No. Along with Dundee, it was one of only two major cities to vote Yes.

The trade unionist Cat Boyd was at the heart of the independence movement. In 2017, she publicly declared she voted Labour. An articulate trade unionist with striking black hair, I met her in a café near Glasgow’s busy Central Station. She recounted the reaction with rueful laughter. “People see Corbyn as a unionist who does not support Scottish independence, but a lot of the background to that is people’s complete disillusionment and anger with Scottish Labour,” she said.

Boyd, who came to political activism through the anti-war movement, retains a personal respect for Corbyn and she is not alone. Since going public with her vote choice, she has received messages from other Yes voters saying they had done the same. “Corbyn’s message chimes with them,” she said. “At the end of the day, that was what the referendum was about - half the bloody things Corbyn was talking about.”

The problem for Corbyn in Glasgow, it seems, is less his personality and more the party. Matt Kerr, a Labour candidate who narrowly missed out on Glasgow South, a constituency where turnout was also down, told me left-wing supporters could be split into three groups. There were those who switched to Labour, those who stayed at home, and those who were tempted to vote Labour but “believed that ‘Scottish Labour’ didn’t back Corbyn”.

"There's a feeling the establishment's against them"

The SNP, on its tenth year in power in Scotland, knows the danger of complacency. “Glasgow is a vivid illustration of the success of our party,” Nicola Sturgeon told the 2016 party conference. “But it also stands as a lesson. Labour lost because they took the voters for granted. They became arrogant on power.”

The question remains as to whether a Corbyn-led Labour party can win over such voters. I visited Mhairi Hunter, an SNP councillor with a big grassroots following in the party’s recent prize – the marbled halls of Glasgow City Chambers. Hunter, whose blue-and-gold walled office would put Westminster ones to shame, was quick to point out the SNP’s hold was a fragile one. “We’re a minority administration, which I’m quite happy with,” she said. “That’s the way proportional representation is supposed to work.”

Hunter believes Labour made gains in the 2017 general election because SNP voters stayed at home. The numbers suggest she is right. In Glasgow North East, Sweeney’s seat, 37,857 turned out to vote in 2015, of which 21,976 voted for McLaughlin. Two years later, the turnout was down by 6,082 voters, and votes for McLaughlin fell by 8,581. Similar patterns were evident in other seats where Labour won.

Yes voters’ attachment to Corbyn, Hunter thought, is more about his story than their politics. “There has been a feeling of the establishment being against them, and not getting a fair hearing. That resonated with a lot of people.”

The distinction between the man and the party was repeated again and again. Outside, in Glasgow’s shopping streets, 25 year-old George Dalkin, 25 told me he had “always been Labour” but “Jeremy Corbyn brought a bit more faith back in me”. Shona Joyce, 20, also voted Labour, but added: “I feel even if you vote for Corbyn you don't get the changes in the local party.”

Natalie Muir, 38, a conveyancer, repeated the same concerns I had heard across Scotland about Labour’s unclear stance on Brexit. She was relatively happy with the Scottish government, and respected Sturgeon.

She told me: “In terms of down south and Westminster, Jeremy Corbyn seems like a more sensible option.” Then she added: “What he says seems different from what Scottish Labour says.”

One structural difference between Corbynism in England and Scotland is that Momentum has little presence here. Since 2017 it has created a joint membership with the long-running Scotland-based Campaign for Socialism, but the two remain separate organisations. Whether Corbynism can organise at the grassroots level remains to be seen. 

"The party needs a new leader"

In August 2016, it was common to hear Scottish Labour activists bemoaning that “the axis of politics has shifted” to a pro-union argument dominated by the Scottish Tories, and the independence camp commandeered by the SNP. In August 2017, the SNP is playing down independence, a resurgent Scottish Tories are talking about housing policy and Corbyn enjoys at least part of the credit for six new Labour seats in Scotland without devoting much time to unionist politics at all.

The SNP looks tired. The problem for Dugdale’s successor, is so, too, does Scottish Labour. "I am convinced that the party needs a new leader with fresh energy," wrote Dugdale in her resignation letter, just two years after she took the job of leader. It may be tempting for London HQ to cultivate a mini-Corbyn, but this too has risks – one of the reasons Labour fell from grace in Scotland was a prolonged feeling that the absentee landlords were in power, and that Labour First Ministers were merely departmental heads of the branch office. 

Much also depends on the SNP, which holds many of the central belt seats ripe for Labour’s picking. The party has lost seats in its old stronghold of north-east Scotland, home to the old SNP of Alex Salmond, comfortable on the golf course. It has spent the summer soul searching, torn between left and right, Brexit and independence, and the different priorities of urban seats in Glasgow and the needs of places like Lewis. Despite its stumbles, the SNP is still capable of winning, as the Glasgow council result shows. On 5 September, Sturgeon unveiled the Holyrood government's latest programme, with policies including scrapping the public sector pay cap and a Scottish National Investment Bank. With the consequences of Brexit still playing out, it should not be underestimated. 

The SNP and Scottish Labour may be mortal enemies, but Corbynism and the wider independence movement have much in common. They both offer hope, an idealistic vision of the future, and a vision of "the early days of a better nation", whether that is renationalisation of the railways or reform of feudal land laws. Both are anti-imperialist, sceptical of centrism and driven by left-wing creatives and the young. The challenge for Scottish Labour is whether it can, as the SNP did, harness that idealism, yoke it to a party machine and turn it into practical politics. And that will take more than a Harris tweed photoshoot. 

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines. 

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis