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

AN AUDIENCE IN ATHENS, WILLIAM BLAKE/BRIDGEMAN IMAGES
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Revenge of the Greats

Today, few teenagers learn Latin or Greek. But would we understand the world better if we read and studied classics?

On a blustery evening in November, more than 2,000 people flocked to Central Hall in Westminster, London, to watch a debate between Boris Johnson and Mary Beard about classics. The “Greece v Rome” debate was never supposed to have been that big. When the discussion forum ­Intelligence Squared announced the event in March, it planned for 1,000 tickets at £50 each. They sold out in three weeks. Relocating the debate from a smaller auditorium to the large hall at Westminster, the company released a further 1,200 tickets. When these, too, were snapped up three days later, an arrangement was made to stream the event on Curzon Home Cinema.

Forty years ago, the idea that classics would become so embedded in mainstream culture that crowds would turn out for this debate as if it were a pop concert would have been ridiculous. Latin, already unfashionable by the 1960s, was squeezed out of many schools with the introduction of the National Curriculum from 1989. By the early 1990s, classics was commonly being dismissed as a stale and arcane subject, beyond the reach or interest of anyone outside the old public schools or Oxbridge.

Now all that has changed. For classicists, that the Boris v Beard contest was taking place at all was proof that their subject is thriving. The Greeks invented the agon (contest); the Romans prized oratory above almost anything else. Both Beard and Johnson knew they owed a significant debt to the rhetoric of Demosthenes and Cicero.

This was, in fact, the second chance the public had had in recent months to ponder the merits of two extinct cultures. The Bloomsbury Institute staged its own agon to a full house in October, as the writers Harry Mount and Harry Eyres debated the superiority of Greece (Mount) and Rome (Eyres).

The debates followed a season of Greek drama, talks and 12-hour readings of Homer’s Iliad and Odyssey, hosted by the Almeida Theatre in London, out of which came a West End transfer for Robert Icke’s version of Aeschylus’s Oresteia. Plays inspired by the same tragic trilogy were performed in the past few months at Shakespeare’s Globe and HOME in Manchester. On the Roman side, books by Tom Holland, Robert Harris and Mary Beard have become bestsellers.

The mystery is, why now? That Boris, Beard and others have achieved a platform from which to popularise the ancient world can’t be the only explanation for this revival. Tristram Hunt has a thing for Victorian architecture. So far, there’s no fan club for portes cochères.

Although classics also peaked under the Third Reich, the Nazis championed Rome, Sparta and Greek figurative sculpture because they considered them worthy of emulation, rather than as entertainment. Taken to represent the ideals of human virtue and beauty, Greek statues (white, as the original colour paint did not survive) were placed in stark opposition to modern “degenerate” art, which was purged from German museums and held up to public censure at the notorious exhibition of 1937.

The following year, Hitler purchased an ancient Roman sculpture of a discus-thrower, based on the bronze Discobolus of the Greek sculptor Myron, as a gift to the nation. Urging the German people to visit it at the Glyptothek museum in Munich, Hitler spoke of achieving progress “when we have not only achieved beauty like this, but even, if we can, when we have surpassed it”.

A version of the same sculpture went on display at the British Museum in London this year as part of an exhibition dedicated to the Greek aesthetic. “Defining Beauty” provided a showcase – visited by more than 100,000 people – of Greek and Roman craftsmanship, as well as of contemporary thought about the past. In a broadcast on BBC Radio 3, Edith Hall of King’s College London challenged the curator Ian Jenkins’s decision to display Persians and Africans in a section of the exhibition tagged “Characters and Realism”, rather than “Beauty”. This division, she felt, carried an uncomfortable echo of Aryanism. But was that to impose too modern a view upon it?

There is a growing school of thought that says that classicists have been too binary in their approach to the ancient world. What if it is never about Greece v Rome? What if the dividing line between Greeks and “other” people – Persians, Africans – was not clear enough for us to value “Greek” beauty or “Greek” anything else so exclusively?

In a debate between Greece and Rome, Boris might delight with his wit and intellectual gravitas. Beard, marshalling the techniques that made Cicero and Quintilian famous, might dazzle with her elocutio (rhetorical style) and glitter-flecked cardigan. But if ­either side gives the impression that the competition stops with Greece and Rome – or, indeed, with Greek and Latin – it runs the risk of being distinctly unfashionable.

***

Many of the people at the Boris v Beard debate had come to the subject through English rather than Latin and Greek. It is fair to say that these languages have suffered tremendously in our time, and are only now beginning to flourish again. After five centuries as a mainstay of British classrooms and self-education books, Latin was already falling out of favour in the late 18th and early 19th centuries, when some teachers (not to mention pupils) were heard grumbling about the endless hours of grammar. Thomas De Quincey even cursed the text used to teach Latin at Eton for having caused “more human suffering than Nero, Robespierre, or any other enemy of the human race”.

That knowledge of Latin used to be prerequisite for studying at the top universities, including Oxbridge, helped to fuel its elitist image. In her 1933 memoir, Testament of Youth, Vera Brittain described vividly her attempts “to tussle, often lacrimoniously, with mathematics and Latin” in preparation for her examination to read English at Somerville, Oxford. Had she been applying in 1960, she would have been relieved of the strain, because that was the year in which both Oxford and Cambridge dispensed with Latin (or knowledge of it) as an entry requirement for non-classics candidates.

This decision was thoroughly in tune with the revolutionary atmosphere of the 1960s. Latin lessons were still heavily dependent on old-fashioned grammar drills, which had less obvious purpose in the modern world than the more hands-on approach of the vocational subjects. In 1960 it was decided that Latin would no longer be obligatory at O level.

The next great blow to the languages came with the Education Reform Act 1988, when Kenneth Baker was secretary of state for education and science. This law brought in the National Curriculum, which ring-fenced ten “core” and “foundation” subjects to fill much of the weekly timetable in comprehensive schools; Latin was not one of them. The classical subjects had to compete for attention against several other non-core subjects in the few periods left available.

Between 1965, when Harold Wilson was in his first term as prime minister, and 2000, entries for Latin A-level fell from 7,901 to 1,237 and those for classical Greek from 1,322 to fewer than 200, with state schools enduring the most precipitous drop.

“The Greeks had far more words to play with than Latin,” said Boris Johnson during the debate at Central Hall, “including rhaphanido-o [to insert a radish in the anus], which was something involving a vegetable, and they had all those wonderful short words . . . how did the Romans manage without ge [‘well, then’]”?

It is shocking to learn how few now can read those brilliant words of Greek. Across all schools in England last year, there were only 253 entries for classical Greek at A level. Latin is faring better, partly because measures to modernise the subject have been in place for longer. After the crisis of the 1960s, and under the aegis of two new organisations, the Joint Association of Classical Teachers (JACT) and the Cambridge School Classics Project (CSCP), Latin lessons were thoroughly transformed. Pupils began to study Latin using lively textbooks including a series peopled by an affable banker named Quintus Caecilius Iucundus and the various members of his household, who spend their daily lives in triclinio (in the dining room) and in horto (in the garden). There is far less emphasis now on reciting verbs and on prose composition. At the beginning of this decade, I worked for JACT as an executive officer and trustee, and watched as the numbers of pupils taking up Latin rose steadily.

Approximately 50,000 pupils now start to learn the language every year, with the number of non-selective state schools offering the subject even higher than that for independent and selective state schools combined – 553, compared to 515. In the region of 11,500 pupils take the Latin GCSE in England and Wales, and in England last year there were 1,285 entries for Latin A-level. Where it has been harder to recover the numbers is at A level in the state sector.

Most young people in state schools now study classics in quite another way. Indeed, if the new popularity of the ancient world owes something to the number of people exposed to the languages at school, it also owes much to the rise of ancient history and classical civilisation as subjects in their own right. In 2013, 3,580 state-school students took these subjects for A-level – far more than those who opted for Latin or Greek.

The truth is, these pupils often have little choice. To work in the state sector, teachers usually require a qualification such as the PGCE. Currently, owing to a lack of staff able to teach it, the classics PGCE is on offer only at Cambridge, King’s College London and Sussex universities. There are 46 places in total. The number of classics teachers retiring each year often exceeds the number being trained. Part of the appeal of classical civilisation and ancient history is that they can be taught by staff from the English and history departments, because no Latin or Greek is required. The thinking is that some classics is better than none.

Much has been invested in this so-called democratisation of classics. When OCR (the Oxford, Cambridge and RSA exam board) threatened to discontinue ancient history as a stand-alone A-level in 2007, there was a huge protest outside parliament. But it is not quite the coup that it seems. Anyone who wants to go on to teach in a university classics faculty is likely to come unstuck if he or she lacks proficiency in both Latin and Greek. Departments depend on their junior staff and doctoral students for language teaching. As things stand, the next generation of classics scholars is likely to be drawn predominantly from those who have had the opportunity to excel in the languages. The legacy of the Boris v Beard debate may just be the most important thing about it, because a percentage of the ticket proceeds will go to Classics for All, a new charity dedicated to introducing Latin and Greek to comprehensive schools.

***

The drive against elitism in classics education has helped to shape a new acceptance of the importance of the ancient world. There were nothing but murmurs of agreement and support when Boris Johnson praised Greece for having given birth to “people power” – meritocracy, democracy – and Beard attributed to Rome the beginnings of the debate we are still waging over the limits of civil liberty. No less egotistic than Homer’s heroes, we happily impose our lives upon those who came before us, in the hope of affirmation. Studying the Roman Republic is no longer seen as a self-indulgent exercise, but as a means of understanding how precarious political alliances can still be. Archaeological museums pose a fun challenge to the idea of modern progress by displaying Roman colanders, cake-pans and ladles that could come straight out of the Lakeland catalogue.

The Trojan War has lived on as the touchstone of human experience. The Homeric epics continue to draw us back into the debate, not so much between war and peace as between the two parts of the self. Achilles, the most formidable Greek warrior of them all, could place great store by his own sense of worth and the “meritocratic indignation”, as Johnson brilliantly put it, of having to bow to the authority of an inferior man – but when his comrades were falling around him, we now wonder, what sense was there in pursuing glory? The very survival of Homer’s epics is yet testament to the immortality of the fallen. The “catalogue” of men who fought in the Iliad was the equivalent of the modern war memorial.

The ancient sources, so temptingly scanty and malleable to interpretation, appeal as much to military strategists as they do to authors and screenwriters. At the start of the Cold War, the then US secretary of state, George Marshall, read the histories of Herodotus and Thucydides, convinced that the events of the Peloponnesian War and the fall of Athens were worthy of review in those unprecedented times. Thucydides’s History of the Peloponnesian War is still studied at many military academies, including West Point, the Command and Staff College of the US marine corps, and the United States Naval Academy at Annapolis. Recruits at some army and naval colleges are encouraged to study what the text has to say about strategic leadership, garnering support in a protracted war and the impact of biological warfare. The “Melian Dialogue” is considered particularly important, containing as it does the Athenians’ justification for conquering Melos in what was one of the bloodiest conflicts of the late 5th century BC. Whether Thucydides should be taken as an exemplary model is another question entirely.

Also known to have studied Greek military texts are Colin Powell and David Pet­raeus, whose fall from grace in 2012 after the revelation that he had leaked classified information to his mistress has often been couched in Sophoclean terms. It did not go unnoticed at the time that “Petraeus” was the name of a centaur, a half-man, half-horse figure of Greek myth, renowned for his sexual appetite.

Performed in translation, the Greek tragedies of Sophocles, Aeschylus and Euripides continue to provide a powerful lens through which to examine modern conflicts. In a recent book, the director Bryan Doerries describes his work with Theater of War, a travelling drama collective that performs Sophocles’s most intense explorations of the psychological impact of war, Ajax and Philoctetes, for US soldiers and veterans. In Amman in 2013, a group of female refugees from Syria performed a version of Euripides’s Trojan Women. Here in London, the Almeida Oresteia took its cue from the Iraq War. If the truths of Greek tragedy are often more penetrating than those in the history books, it must be because they prove their strength by emerging so remarkably intact from the emotional, sometimes irrational, situations out of which they are born.

***

The new classical revival is joyous, but it is one grown in no small part out of tragedy. We are in a better position now than we were 50 years ago to understand why there is nothing arbitrary about the links that modern playwrights, novelists, scholars and strategists draw between ancient Melos and modern Syria, or Greece and modern Iraq.

“I’m afraid in many ways the Romans were bastards,” Boris Johnson said, conceding that, for all their valour, the Greeks ultimately succumbed to Roman brutality. “The fact is all ancient cultures were horribly brutal by our standards,” Mary Beard said, accepting his point that the Romans carried out public floggings, punishment of adulteresses, and the sacking of Corinth in 146BC, when their legionaries looted Greek sculptures and “used priceless pictures to play chequers on” (a paraphrase of the Greek historian Polybius). Horribly brutal, but sadly familiar.

Palmyra now lies in ruins. The site in modern Syria, an erstwhile Roman province, was once a trading post between East and West. On its magnificent sculptural relief panels were men dressed in a combination of Greek and Persian clothes. There was Hellenistic and Roman architecture, precincts dedicated to Phoenician, Aramaean and Mesopotamian gods.

A new exhibition on Egypt at the British Museum, “Faith After the Pharaohs”, has been carefully curated to illustrate a similar point. In the pages of manuscript and fragments of fresco lies evidence of the fruitful possibilities of syncretism and coexistence between the pagan worlds of antiquity, Christianity, Judaism and Islam. If a survey of classical history seldom offers such a rosy picture, these artworks and texts still provide a crucial space to debate what it means to
value one culture at the expense of another.

While not doing down the achievements of the Greeks and Romans, we are no longer in a position to forget that the “East” wasn’t just at the mercy of West, waiting to be brain-drained or reduced. It has, in short, become deeply unfashionable to conceive of “classics” as the history of the West. There is considerable interest now, for instance, in recognising the influence of Persia (modern Iran) on “Greek” culture. It is telling that the Oxford classicist and Byzantinist Peter Frankopan chose to begin his “new history of the world”, The Silk Roads, with the rise of the Persian empire, not Greece. We are, after all, seeing again the importance of the networks through which Greece and Rome both flourished and declined.

It is and always was about more than Greece and Rome. The Greeks enjoyed assimilating the ideas of their neighbours. The Romans led the way when it came to granting asylum. Their inclusivity and magnanimity in awarding citizenship to people as far afield as our own remote shores seemed to be what swayed the audience to give Rome 56 per cent of the vote in November at the London debate. Whether unconsciously or for the pure thrill of it, thousands of years after Greece and Rome first made the world that little bit smaller, we are finally doing something to repay the debt.

Daisy Dunn’s “Catullus’ Bedspread: the Life of Rome’s Most Erotic Poet” and “The Poems of Catullus: a New Translation” will both be published on 28 January by William Collins

This article first appeared in the 17 December 2015 issue of the New Statesman, Christmas and New Year special