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

Manhattan in the 1970s. Photo: Getty
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How Woody Allen's Manhattan became Donald Trump's New York

Trump took everything that Allen hated about California - charity galas, golf, awards fever, architectural bad taste - and brought it to New York.

The transformation of faded, fire-ravaged, job-bleeding ‘third-world’ New York (signature headline: “President to City: Drop Dead”) into a safe, clean, smug, wealthy, first-world-problems kind of place (presiding logo: “I ❤ NY”) is popularly associated with the work of three men, Ed Koch, Donald Trump, and Woody Allen.

In their different ways, they embodied – when they didn’t help to engineer – all manner of civic, fiscal, economic, municipal, cultural, and spiritual change. 1978 was the turning-point. That year, Koch became mayor and went about healing the crises that had occurred under the previous incumbent, Abe Beame. Trump, exploiting the city’s new tax incentives, bought the decrepit old Commodore Hotel – later the Grand Hyatt – and began negotiating the sale of the Bonwit Teller flagship store, just south-east of Central Park, the future site of Trump Tower. In that same year, Allen – who was born in Brooklyn in 1935, the year that Trump’s developer father, Fred, began to concentrate his business in that borough – co-wrote, directed, and starred in Manhattan, which was released the following April.

The film, which has just been reissued in a 4K print, is an attempt to salvage New York from its scuzzy 1970s manifestation, and an exercise in what the cinematographer Gordon Willis called “romantic reality”. In glistening widescreen black-and-white, abetted by a Gershwin score, Manhattan presents the borough as an assemblage of highlights: Bloomingdale’s, John’s Pizzeria, the Dalton School, Hayden Planetarium (actually a set), 30 Rock, MOMA, the Guggenheim, Elaine’s, the Russian Tea Room, and so on. Sitting in the park at Sutton Place, in sight of the Queensboro Bridge, Allen's character Isaac Davis says, “This is really a great city. I don’t care what anybody says. Really a knockout.” (The moment required some airbrushing. The crew had to find a bench from somewhere and on the original poster the image was tinkered with, to reduce the size of the buildings in the background.)

The case-against had been made, or at least heard, two years earlier, in  Allen’s first proper New York film, Annie Hall. At one point, Alvy Singer (Allen) says that his friend Rob (Tony Roberts), who loves Los Angeles and thinks Alvy ought to move there, should be doing Shakespeare in the Park. “I did Shakespeare in the Park," he replies. "I got mugged.” In Manhattan going to Shakespeare in the Park is invoked as just another pleasant thing to do and the only threat to safety is the occasional rain storm. Nobody troubles to talk up LA. (The reasons that praise for that city falls on deaf ears in Allen’s work include its lack of seasons, its love of prizes, its congenital faddishness, and the necessity to drive.)

The film’s opening is a montage of over thirty images (pedestrian excitement, New Year’s fireworks, a pre-Trump skyline), garnished with Gershwin, and set to a voiceover of Isaac contemplating possible first paragraphs for a novel. It’s also the sound of Allen airing his conflicted feelings. The first begins, “He adored New York City. He idolised it all out of proportion.” He proceed to dismiss draft versions as too corny, too angry, too preachy. He eventually settles on one that begins, “He was as tough and romantic as the city he loved” and ends “New York was his town and it always would be.” But in every version, there is some acknowledgement of Isaac's romanticism – the rosy tint of his perspective.

On Manhattan's release, the New Statesman film critic John Coleman, used it as an occasion to knock Annie Hall and Interiors (1978), in the process eliding some very large differences. He described the films' shared setting as “elitist, snob-cultural New York chic, full of encounters in OK restaurants between people with time on their hands and themselves on their minds”. Coleman was following a critical agenda set by Joan Didion in the New York Review of Books (“the sense of social reality in these pictures is dim in the extreme”). However, Didion was a self-confessed apostate from New York worship – leaving the city was the subject of her essay “Goodbye to All That” – so maybe she was just the person to miss the point entirely? James Wolcott, looking back in his memoir Lucking Out – in some ways a riposte to Didion's neuroses – calls the film's opening “a balm for every bruise that New York had taken in the seventies, a relieved sigh from the trenches signaling that perhaps the worst was over, somehow we had come through”.

Allen made no attempt to defend the city against a more general, less time-specific charge – what might be considered the "Manhattan libel".  As Alvy Singer puts it, “The rest of the country looks upon New York like we’re left-wing Communist Jewish homosexual pornographers.” He speaks for his creator when he adds, “I think of us that way, and I live here.” In Allen’s view, New York was not just decaying but decadent, heaving with snobs as well as lowlifes, its integrity under threat from above and below. Sitting with Annie on a park bench, he pokes fun at the passersby, among them a cigar-chewing mafioso and “the winner of the Truman Capote lookalike contest” – in fact, Capote himself. The film stages encounters with both kinds of bad New Yorker, who are placed in implicit contrast with a pair of European film-makers who, to Allen, embodied the right balance of refinement and modishness, sophistication and popular appeal. Waiting outside a cinema to see Bergman’s Face to Face, Alvy, a stand-up comic, is accosted by a pair of Italian-Americans who vaguely recognise him from television. Queueing elsewhere for a documentary, he winces as a academic from Columbia complains about the new Fellini.

In Manhattan, the gangster types are gone, but the film reinforces the idea of New York as a phoney-magnet. After bumping into his married friend Yale (Michael Murphy) with his lover Mary (Diane Keaton), Isaac complains to his girlfriend Tracy (Mariel Hemingway), a seventeen-year-old high-school student, that Yale has always been a sucker for the kind of women who involve him “in discussions of existential reality.” Though Isaac soon falls for Mary himself, a glimpse of their first date shows him throwing up his hands as they emerge from a screening of the silent Soviet film Earth, and we cut to them reentering her apartment as he says that as far as he’s concerned, a great movie is something with W.C. Fields. In the next scene, standing before a sculpture, he mockingly deploys Mary-ish terms like “negative capability”. She ends up back with Yale.

***

Allen managed to sustain his adoration of the city by associating its true nature exclusively with things and types he doesn’t loathe. It’s an incoherent vision – or at least fixed according to his unique set of peccadilloes, his narrow definition of what isn’t philistine and what isn’t pretentious, what occupies the space between the anti-rational and hyper-rational. Alvy Singer calls himself a “bigot but for the left,” but Allen's position is a little more paradoxical. He abhors mass-culture phenomena like pop music and television, but worships baseball and basketball and old movies (often watched on late-night cable). He looks with equal disdain on haute couture and academe, corruption and radicalism, accountancy and flower power. He loves museums and jazz and Chinese takeaways but is suspicious of conceptual art and rock and fast food. He likes pizza but not punk, smutty jokes but not foul language, gazing at bridges but not crossing them, psychoanalytic vocabulary but no other kind of jargon, Broadway but not modern theatre, cultural references but not high-culture seriousness (what Alvy calls “fake insights”), city parks and rivers but not the country, kooks and innocents but not hippies, the yuppie-crowded Upper East Side – “the zone” – but not Wall Street or, really, any of the downtown area. (Gershwin is a kind of ideal – a graduate of Tin Pan Alley, immersed in the French art song and Austrian modernism, who wrote jazz and "folk opera".)

At the end of Manhattan, Allen names eleven things that make life worth living – a hodgepodge that reflects his arbitrary high-low aesthetic. Seven of them are strongly associated with New York: Groucho Marx, Willie Mays, Louis Armstrong, Brando, Sinatra, the crabs at Sam Wo’s, “Tracy’s face.” Even Cézanne’s "incredible" Still Life with Apples and Pears is housed at the Met.

The gentrifying processes that occurred during Ed Koch’s administration made Manhattan-worship a more obvious pastime – and an easier position to maintain. There were fewer problems of the crime-and-garbage variety, although it’s possible Allen over-stressed the revamp. Less overly romantic than ManhattanHannah and Her Sisters (1986), which concerns the extended circle of an Upper West Side family, prompted the charge of white-washing. Even Mia Farrow’s mother, Maureen Stapleton, who appears as the matriarch, said that the film was so beautiful “it almost makes you forget all the dog poop on the streets.”

Allen has said that his 1989 film Crimes and Misdemeanors was intended as a retort to Hannah and Her Sisters, in which, he felt, he’d been too easy on the characters. (His original title was Brothers.) But there are also signs of Allen becoming tougher on his setting. Early on, Clifford Stern (Allen) and his niece emerge from a screening of Hitchcock’s Mr and Mrs Smith and confronts “awful”, rain-lashed Greenwich Village, the real city diverging from the sparkling pre-war paradise.

And if the city's economic revival had done something to bridge this chasm and return Manhattan to its pomp, it had its downside – no, not the escalating rents but the influx of vulgarians, responding to the re-found hipness. As Allen softened on artsy types, he redoubled his aversion to the airhead. In Hannah and Her Sisters, there's a young record company executive – Dusty – whose approach to art collection is entirely determined by size and colour scheme. And in Crimes and Misdemeanors, Clifford’s brother-in-law Lester (Alan Alda), a television producer with a “closet full of Emmys”, a dyed-in-the-wool Los Angeleno, is considering a move to the city, a place he describes, in one of many pseudo-epigrams, as “thousands of straight lines looking for a punchline.” (Allen’s twin bugbears, philistinism and prentension, are perfectly combined in Lester’s reference to a university course on “existential motifs in my situation comedies”.) Husbands and Wives (1992) revealed more fears of a total Californification of the city's tastes and habits, the full list of pathogens that had blown eastwards including charity galas, long speeches, astrology, aerobics,  golf, health food, cocktail dresses, awards fever–and architectural bad taste.

The chief representative of these changes – the vulgarian-in-chief – was Donald Trump, another immigrant from the outer-boroughs (Queens, in this case) who as a boy had made saucer-eyed visits to Manhattan. To the adolescent Allen, New York was the place depicted by Hitchcock in Mr and Mrs Smith, the formula he lovingly re-created in the film within The Purple Rose of Cairo (1986): tuxedos, evening gowns, white telephones, theatre trips. For Trump, it was the Midtown bustle and neon that made New York feel like “the center of the world.” Allen, starting out, aspired to be like S.J. Perelman, or Groucho. Trump emulated his developer hero Bill Zeckendorf. Fred Trump did most of his work in the outer boroughs. (He even inspired a song by another Woody, Guthrie, who was appalled by the segregation policies in Trump senior's housing projects.) But in The Art of the Deal, Trump recalls that he had “loftier dreams and visions” and couldn’t shake his determination that Manhattan was where the action was – or would be. He claimed that though the city was at a low – “suffering from a crisis of confidence” – it didn’t keep him “up nights”.  Things “ultimately” had to turn around. In the meantime, “I saw the city’s trouble as a great opportunity for me.”

In 1971, the year he became head of his father’s company, Trump Management, Donald Trump moved into a run-down flat on the Upper East Side – with the coveted 10021 zip code – which he jokingly called his penthouse. Meanwhile, Allen was living barely three blocks away in a penthouse duplex that Dick Cavett likened to the hero’s home in the 1930s New York film The Man Who Played God. But Trump soon caught up in the grandeur stakes, nabbing the penthouse triplex atop the Trump Tower, and a Park view from 57th and Fifth rather than 74th and Fifth. Allen was chauffeured round the city in a cream Rolls-Royce, Trump in a silver Cadillac (with his initials on the number plate). With Ed Koch being perennially single, Trump and Ivana competed with Woody and Mia as the leading couple of 80s Manhattan – both relationships lasted the whole decade before hitting the buffers in similar tabloid style – but they represented altogether different versions of the new New York. 

There’s a brief, almost perfunctory moment in Manhattan where Isaac notes a group of construction works pulling down an old building. “Can’t they have those things declared landmarks?” Mary asks, and Isaac reflects that the city’s “really changing”. The next film Allen made in modern New York, Broadway Danny Rose (1984), was supposed to have a 1940s setting, but Allen said that he couldn’t find “a half block” of Times Square that hadn’t been “junked up”. In Hannah and Her Sisters, an architect whose own work strains to respect the atmosphere and proportions of the surroundings does a tour of local charms which ends with a concrete, hole-punched slab on the Beaux-Arts-heavy East 62nd Street, an edifice that the journalist Joe Klein described as resembling a cheese grater. “What’s permitted in this city is just terrible; it’s a crime,” Allen said, the year the film came out. (In Annie Hall, architectural inconsistency is strongly associated with Beverly Hills: “French next to Spanish next to Tudor next to Japanese.”) By the time of Husbands and Wives, he had a character who worked for the Landmarks Trust. A magazine editor played by Liam Neeson tells her, “I don’t believe in capital punishment except for certain New York developers.” (Preparing the way for the Tower, Trump had refused to preserve – in fact, cosigned to the jackhammer – the bronze grillwork and a pair of art-deco fifteen-foot-high bas-relief of goddesses dancing over Fifth Avenue.)

Trump had received a name-check in Crimes and Misdemeanors when Lester says into his dictaphone: “Idea for series: a wealthy, high-profile builder who’s always trying to realise grandiose dreams à la Donald Trump, to be shot in New York.” Though the idea is supposed to reveal Lester’s frivolity and self-absorption – he's mid-conversation at the time – it’s telling that even he shows a hint of scepticism. 

Then came Celebrity (1998), the satire which to date remains Allen's final statement on modern New York. The film is a reply to Manhattan, its use of black and white and an opening onslaught of New York locales seeming darkly ironic – as if this hell-hole is worthy of monochrome and montage! Although the central character, the journalist Lee Simon (Kenneth Branagh), seems to be writing the same book as Isaac in Manhattan, this time the city fails to come through. At one point, a mad young movie star (DiCaprio) takes Lee to the Trump Marina in Atlantic City for a boxing match and a foursome. Later, Lee’s ex-wife, a teacher-turned-TV host, wanders around a fashionable restaurant, Le Bijou, making small talk for the camera with an estate agent to the stars, a disgraced senator, a gossip columnist – and Trump himself. It was an inspired manipulation of available resources. Le Bijou was really Jean-Georges, which is based at the lobby level of the Trump International Hotel and Tower–an attack on New York in the 90s could hardly do without one of his branded buildings – and Trump often demanded an appearance in films that made use of his buildings. (Ed Koch’s cameo, in the short film Oedipus Wrecks, came at Allen’s request.) Here Trump reports plans – invented, but only just – to erect a "very, very tall and beautiful building" on the site of St Patrick’s Cathedral. The new fame-and-lifestyle obsession is aligned with the desire to dislodge a priceless monument in favour of a shear-wall phallus.

Manhattan could only have been made during a very short period.  It’s a snapshot of a city in transition, at just the point when the horrors of the 70s were beginning to fade and the horrors of the 80s – by Allen’s lights – had yet to declare themselves. For the next twenty years, even as he yearned to idealise New York, Allen couldn't ignore the new realities, and Celebrity marked the point at which the scales tipped. Since then he has sought alternative routes to a romanticism of place, setting his films against an unspecific, attractive New York movie-backdrop (Anything Else, Melinda and Melinda), venturing to Europe (London, Barcelona, Paris, Rome), and travelling back in time. Starting with Zelig (1983), he has paid half-a-dozen visits to New York’s hallowed past. After all, the decades of greed, kitsch, and indifference to history furnish varied opportunities for nostalgia. His next film, Wonder Wheel, concerns a Coney Island amusement park, and takes place in the late 1950s – just moments before Fred Trump started work on Trump Village, the twenty-plus-storey apartment complex that overshadowed Steeplechase Park and dwarfed its prize ride, the Parachute Jump, the so-called Eiffel Tower of Brooklyn.

Leo Robson is the lead fiction reviewer for the New Statesman.

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