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: Copyright Natural History Museum
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One man and his whale: how an iconic Natural History Museum exhibit fought class divides and transformed science

As a blue whale skeleton replaces the entrance hall’s historic dinosaur cast, curator Richard Sabin reveals the secrets of the giant mammal’s much-loved replica.

On 25 March 1891, a female blue whale was harpooned by a whaling vessel and fatally injured. She was in the Irish sea, and ended up beached on a sandbank at the entrance of Wexford Harbour, on the south-east Irish coast.

Local fishermen discovered her floundering and thrashing around, four-and-a-half times the size of their boat, significantly taller, and more than 25 metres long. They had never seen a creature this size. A fisherman called Ned Wickham eventually put her out of her misery with a blade, and, according to contemporary reports, “succeeded in dispatching the big fish”.


The blue whale skeleton, c.1950-74. Photo: © Trustees of the NHM, London​

Over 126 years later, and that same creature that caught a handful of fishermen’s attention will be seen by millions. Her 4.5 tonne skeleton is going on display in London’s Natural History Museum entrance hall, replacing the traditional Diplodocus cast in the grand Hintze Hall. It’s a controversial move. Dippy ­– who received his nickname from an adoring public – is an iconic part of the Natural History Museum’s history, wowing visitors since 1905.

A special panel of collection managers, curators and scientists was put together to choose Dippy’s replacement. Specialists across the museum were invited to make a case for their preferred exhibits.

“Will our blue whale skeleton become iconic like Dippy?”

Richard Sabin, the resident whale expert, won them over. “What makes a specimen iconic? Will our blue whale skeleton become iconic?” he frets, when I meet him before the skeleton is unveiled. “I think so. It can’t fail to be, because of its very nature, but also because of where it is in the museum’s history and what we’re actively doing, in the field, with our researching.”

“It’s an interesting one because Dippy is of course part of people’s memories, childhood, and bringing their own children and so on,” he adds. He admits that his specimen of choice doesn’t even have a name – it’s been “lost over the years” – but says it’s “inevitable that she’ll get a nickname” now.


What the skeleton will look like in Hintze Hall. Photo: ® 2015 Casson Mann 

Sabin, 51, is a marine mammal curator, and has been working at the Natural History Museum for 25 years, where he’s the collections manager for the vertebrates division. But wandering among the Victorian grandeur in his camouflage hoodie, blue jeans and battered trainers, you wouldn’t tell that he is one of the museum’s senior figures.

We enter a dimly lit hall closed off to the public, where the exhibition for the Natural History Museum’s special whale season – which opens this week, along with Hintze Hall’s new resident – is being prepared. With its high brick arched ceiling and stained glass windows, it has the hushed atmosphere of a church. It is here that exhibitions are prepared before going on show.

Specimens, lit up and attended to by blue lab-coated conservators, loom out of the gloom like stalagmites. The corkscrew-shaped jaw of a deformed sperm whale; the rib cage of a bottle-nosed dolphin; giant toothed whale skulls gazing up at the ceiling – some with bandages, others being cleaned with cotton buds.


A whale conservator working on a flipper. Photo: © Trustees of the NHM, London​

“When they [visitors] leave the exhibition, we want them to have connected with whales and dolphins in an emotional way, but a way that hopefully makes them want to take some kind of an action,” Sabin says, referring to marine exploitation and mankind’s gruesome whale-hunting past.

The Wexford whale was discovered just before the rise of commercial whaling, and a decade ahead of the industry dominating the Irish coast. She was on one of the last migrations of blue whales unthreatened by an industry that would come to endanger the species by turning them into oil, soap, perfume, candles, margarine, corsets and even umbrellas.

 “Welcome to the blue whale, the biggest mammal in the world!”

Although Sabin has been working on this exhibition for years, he looks wide-eyed at the assorted bones and skulls with boyish delight. Aside from his white hair and grey speckled stubble, he probably had the same expression when he first visited the Natural History Museum on a school trip at ten years old.

It was then that he first saw the Wexford whale skeleton. Until last year, it was suspended above the museum’s world famous blue whale replica.

“My first and overwhelming memory of the museum was the whale hall,” Sabin grins, as we walk towards it through the echoing corridors. The blue whale replica is especially sign-posted. “You walk in at ground level as a tiny child and you’re just presented with a wall of blue. And then you look up above the blue whale model and you see all the other skeletons. That was really the memory that I took away from the museum back then.”



The blue whale replica with the skeleton above. Photo: © Trustees of the NHM, London​

Sabin remembers asking a gallery attendant if the blue whale, suspended like a big blue zeppelin from the ceiling, was real. She said no. And so he asked about the Wexford skeleton above it, where it had been until last year. She told him it was genuine, and that these animals were still out there in the ocean. “My imagination just went off on one,” he recalls.

As a child, Sabin was fascinated by bones. He used to collect roadkill from a main road near where he grew up in north Birmingham, and bring it home. His “very understanding parents” let him have a little patch of ground at the bottom of the garden to bury the carcasses, “so I could rot away the flesh and look at the bones”, he explains.

“I wanted to know what was inside these animals. I wanted to know how they moved and how they supported themselves.”

“It's not always the case that people are able to afford visiting London”

When he returned to the museum in 1981, having just finished school, he says he was “absolutely sold”. He applied for an archaeology degree, specialising in osteology, at Sheffield University, and then ended up working with marine mammals.

We gaze at the blue whale replica from a viewing gallery. Its ridged jaw slopes up at such an angle that it appears to be half smiling, its tiny eyes creased. It has been here since 1938. It is the first lifesize scale model of a blue whale ever built, at 29 metres long (later, the Smithsonian in Washington DC would build theirs a few inches longer to make it the biggest in the world). We now know that it’s inaccurately rotund, but that doesn’t stop it stunning first-time visitors.



The whale hall. Photo: © Trustees of the NHM, London​

Most children who see it for the first time share the schoolboy Sabin’s reaction – we can hear them gasping and shrieking below as we speak. I remember being flabbergasted by its size when I visited on a school trip; I’d never realised – and can still hardly comprehend – that such large creatures exist. A model like this brings it to life more than any documentary I’ve seen.

“It was borderline whether I went on that school trip in 1976, because money was tight”

Although our ancestors’ thirst for replication has fallen out of fashion, we have them to thank for these reactions. Models such as this one make scientific research part of our cultural memory, as well as a key part of the museum’s body of research. This makes the study of science more accessible, Sabin believes. From the meticulous collecting and cataloguing of the Victorian era to the modern push for digitising the museum’s vast data records, it’s about bringing information to everyone, whatever their background. “I am a great proponent of that, because as a child, visiting London for the first time on a school trip from Birmingham, we didn’t really have a lot of resources at my school.”

Sabin was brought up in a working-class household; his father was a lorry driver and his mother worked in a factory. “It was a good life, but not a family with a huge amount of cash; we had holidays to Wales every other year in a caravan,” he says. “It was borderline for me whether I went on that school trip in 1976, because money was a bit tight.”

But it was his last year of primary school, and “it was the big trip,” he recalls. “So my parents were like he’s got to go to London to see these things, but it's not always the case that people are able to do that.” For this reason, Dippy will be taken on a tour around the country, hoping to attract five million new viewers.

Hundreds of people affected by their first impressions of the blue whale replica have told Sabin their stories. A woman whose mother ran a nearby coffee shop in the 1950s used to visit it every morning as a child. She told him about a security guard walking in at 10am on the dot each day and shouting, “Welcome to the blue whale, the biggest mammal in the world!” and then turning around and walking out. “It’s a pity we don’t do that anymore,” smiles Sabin.



The blue whale replica being built in the Thirties. Photo: © Trustees of the NHM, London​

He shows me a big leather-bound volume of photos of the model being built in the Thirties, by a father-and-son team of the zoology department, Percy and Stuart Stammwitz. Men in aprons and flatcaps climb all over its wooden skeleton, like the hull of a ship. Some, like regular painter-decorators, apply individual plaster strips to its throat, to make a pleat effect. A man on a step ladder cleans the whale’s back with a long broom.

As they built it, some of the workers suffered motion sickness, as the suspended model used to sway. Nevertheless, they would occasionally take cigarette and lunch breaks inside the whale.

“It’s about making people realise that science really is for everyone”

Myths swirl around the museum about the whale’s hollow belly, which is said to have housed everything from a secret gambling den to romantic liaisons to a makeshift distiller. These aren’t true, but the team did put a 1937 telephone directory and change from their pockets inside before sealing it. “Like a time capsule,” Sabin says.

Although the blue whale model is so adored, it was important to Sabin for a real-life specimen to replace Dippy. “Moving away from using casts, putting the actual specimens into the space, puts it into a context,” he tells me, as we walk back through the museum’s halls. “It breaks down the barriers between the behind-the-scenes work of the scientists and what goes on in the gallery . . . . It’s about making people realise that science really is for everyone.”

Hintze Hall reopens with the blue whale skeleton, along with the exhibition “Whales: Beneath the Surface”, on Friday 14 July 2017.

Anoosh Chakelian is senior writer at the New Statesman.

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