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
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A to Z of the 2017 general election

Our strong and stable guide – for the many, not the few.

A is for the Andrews

Although Theresa May spent the election campaign dodging debates (and, consequently, an unhappy junior reporter from the Mirror in a chicken costume) there were a few live interviews for masochistic audiences. The BBC’s Andrews – Neil and Marr – both had a go.

On 30 April, Marr made it harder for the Prime Minister by telling her before they started that she wasn’t allowed to use the phrase “strong and stable” or other soundbites. (She lasted 30 seconds before cracking.) “People can listen to that sort of thing and think it’s a bit robotic,” he told her, foreshadowing later criticism. By the time of Andrew Neil’s BBC1 interview on 22 May the conversation had moved on. “You started this campaign with a huge double-digit lead in the polls. It’s now down to single digits in some polls. What’s gone wrong?” Mrs May’s answer? “Well, Andrew, there’s only one poll that counts . . .”

B is for Brenda

Brenda, a resident of Bristol, spoke for the nation on 18 April when she heard the news that an election had been called. “You’re joking. Not another one?!” she said, her face a cross between overheated aunt at village fete and Edvard Munch’s Scream. “Oh for God’s sake, I can’t, honestly – I can’t stand this,” she told a BBC reporter. “There’s too much politics going on at the moment. Why does she need to do it?” Judging by Brenda’s subsequent internet fame, much of the country was asking the same thing.

C is for clinky

Boris Johnson was mostly kept on the bench during the campaign but he did surface from time to time. He began the campaign by insulting Jeremy Corbyn (see M), and on another occasion he put in an awkward appearance at a Sikh temple. “I hope I’m not embarrassing anybody here by saying that when we go to India, we have to bring ‘clinky’ in our luggage,” he told the audience. “We have to bring Johnnie Walker.”

The Foreign Secretary added that, after Brexit, we could reduce the stiff import tax on alcohol. The audience told him that Sikh teachings forbid drinking alcohol. “How dare you talk about alcohol in a Sikh temple?” said one. Johnson’s plan to visit a mosque to talk about the pork trade was presumably cancelled.

D is for dementia tax

David Cameron, George Osborne, Theresa May – all came a cropper because of a tax that isn’t really a tax. While Cameron and Osborne opted for taxes on spare bedrooms and hot pasties, the 2017 Conservative Party manifesto announced a raid on your ailing granny. The principle of the so-called dementia tax was that those with assets of more than £100,000 would have to pay for their social care. (Those with assets of less than £100,000 would escape paying anything.)

The world quickly turned on its head: the left-wing Momentum group defended the right of the middle classes to large inheritances, and the once-obdurate PM was forced into a hasty U-turn (lamely stating that “nothing has changed”).

E is for Emmanuel Macron

Be still, notre beating coeurs. On 7 May, the pragmatic centrist Emmanuel Macron beat the far-right Marine Le Pen in the run-off of the French presidential election. After Brexit and the success of Donald Trump, it felt like a ray of sunshine to Europe’s weary liberals – proof that Euroscepticism, isolationism and anti-immigrant rhetoric are not the only ways to win.

Since taking office, Macron, 39, has consolidated France’s commitment to the EU and eurozone, naming a minister for “European and foreign affairs”. He has condemned Russian state news outlets as “organs of influence” while standing next to Vladimir Putin, and he shook Trump’s hand (above) for a really, really long time. “My handshake with him – it wasn’t innocent,” Macron said. “It was a moment of truth.”

F is for Fallon

Michael Fallon has many roles: Defence Secretary, “Minister for the Today Programme” and Smearer-in-Chief. An otherwise unremarkable cabinet member, he was happy to be drafted in by CCHQ as an attack dog – unleashed to make personal gibes about the opposition whenever it looked as if the Tory campaign was wobbling.

In 2015, he warned that Ed Miliband had “stabbed his own brother in the back” to become Labour leader and would be “willing to stab the UK in the back” by doing a deal with the SNP to cancel Trident. This time around, Fallon branded Jeremy Corbyn a “security risk” because of his stance on the nuclear weapons. A bit rich, when you consider that the pompous Fallon presided over a failed Trident missile test.

G is for go-karting

“Labour is in pole position to beat the SNP”, proclaimed Scottish Labour’s Twitter account on the day of the party’s manifesto launch. Accompanying this optimistic statement were three pictures showing the regional party’s leader, Kezia Dugdale, as she won a go-kart race against a black-helmeted racer wearing an SNP rosette. If only it were that easy to defeat First Minister Nicola Sturgeon.

H is for hairstyles

The Andrew Marr Show is best known for its interviews (and end music) rather than its style tips. Yet during this campaign, two politicians used it to share their grooming tips with a grateful nation. First up, Labour’s Diane Abbott told us that in the 1980s she used to have an afro (and strong opinions about the need for armed struggle in Ireland) but has since “moved on”.

The Home Secretary, Amber Rudd, then responded by saying that she had “changed her hairstyle a few times in 34 years, too” but her opinions on public safety had not shifted. Let us know if you move away from 2017’s shoulder-grazing blonde bob, Amber. We’re waiting for your update.

I is for ivory sales ban

It isn’t every day that Britain’s “powerful antiques industry lobby” – presumably made up of those interchangeable men in tweed jackets on Antiques Roadshow – makes headlines. However, after the Conservative manifesto launched without a pledge to ban the ivory trade in Britain, Theresa May was accused by animal rights campaigners of U-turning on David Cameron’s previous commitment.

Given that Prince William is one of the ban’s most vocal advocates, you would have thought Theresa the Traditionalist might have happily ditched the antiques dealers in favour of the royal seal of approval.

J is for java

Dark, bitter and scalding: coffee has become the latest accessory of class war. While out in his constituency, the Tory candidate for Wakefield, Antony Calvert, caused outrage by tweeting about a mere proletarian’s audacity in entering a branch of that renowned aristocratic haunt, Costa: “Man recognises me at #Wakefield Westgate. ‘These f*ckin Tories, always looking 2 trample on t’working class, like me’. Man walks into Costa.” Working-class people can’t drink competitively priced caffeine products in popular high-street chains, so the guy must have been a faker, right?

And it’s not just Tories who think an espresso is la-di-da. The Mayor of Manchester, Andy Burnham, suggested that only rich people buy coffee from shops when he condemned the government’s proposed “barista visa” as a Tory plan for avoiding “waiting longer in the morning for their posh coffee”. Workers of the world, percolate!

K is for Katie Hopkins

For the past few years, it seems, no news event has escaped the attention of the former LBC shock jock and Mail Online columnist Katie Hopkins, formerly a candidate on The Apprentice. After expressing her hatred of tattoos, the obese, mobility scooters, maternity leave, the McCanns and redheads, and her admiration for ebola (“Malthusian”), she finally lost her LBC gig after tweeting, then deleting, a call for a “final solution” to Muslim terrorism in Britain after the Manchester bomb.

L is for Lynton Crosby

Nicknamed the Wizard (or Lizard) of Oz by unimaginative Westminster insiders, Lynton Crosby is the Australian election campaign guru who delivered David Cameron’s surprise general election victory in 2015. He is known for his colourful metaphors: the need to “get the barnacles off the boat” (ditch any baggage that might impede a campaign); “you can’t fatten a pig on market day” (voters’ preconceptions are hard to overturn); and, of course, the “dead cat”, which is irrelevant to the argument but nonetheless changes the conversation (often thrown by Michael Fallon; see F).

M is for mugwump

On 27 April, an attention-starved Boris Johnson momentarily forgot that everyone stopped finding his sub-Wodehouse shtick amusing some time ago. Writing in the Sun, he claimed that Labour voters didn’t realise what a grave danger Jeremy Corbyn posed to Britain. “They say to themselves: he may be a mutton-headed old mugwump, but he is probably harmless.” Cue a day of people googling “mugwump”, which turns out to mean: a) someone who left the US Republicans in the 19th century because they found the Democrat Grover Cleveland more appealing; b) the supreme wizard in Harry Potter; c) a predatory species from William Burroughs’s Naked Lunch that “have no liver and nourish themselves exclusively on sweets”.

In its response, Labour went both high (“It is the sort of look-at-me name-calling that you would expect in an Eton playground,” said the shadow housing secretary, John Healey) and low: “Boris Johnson is a caggie-handed cheese-headed fopdoodle with a talent for slummocking about,” said the deputy leader, Tom Watson.

N is for Natalie

“I’m not Natalie,” said Plaid Cymru’s Leanne Wood, after Ukip’s Paul Nuttall twice got her name wrong in the second-tier leaders’ debate on 18 May. Later, Natalie (Bennett of the Greens) tweeted: “The only time I can recall being in the same room as Paul Nuttall was #BBCAQ in 2014. He clearly hasn’t recovered.” No wonder Ukip wants to ban face coverings (see V). Nuttall already has difficulty telling women apart.

O is for The One Show

After the rigours of the set-piece political interview, Theresa May (with her husband, Philip, above) and, later, a solo Jeremy Corbyn had a chance to show their softer side on BBC’s teatime chatfest The One Show. Revelations from the Mays included that their household has “boy jobs and girl jobs” (ie, Philip puts the bins out), that it was “love at first sight” and that “the Red Box has never made an appearance in the bedroom”.

Poignantly, May recounted how when she was a young Conservative candidate she received a phone call from her shocked mother-in-law, after a local newspaper mistakenly printed that she had a new baby. For his appearance, Corbyn was in full-on affable uncle mode, talking about his allotment and his love of decorative drain covers and presenting the show’s hosts with a jar of his home-made jam.

P is for polling

In the final days of the 2015 campaign, the pollsters were accused of “herding”: massaging their raw figures with turnout filters and other wizardry to produce what they thought was the most plausible election result, and therefore missing the possibility of a Tory majority. No such problem this time: there were double-digit differences between pollsters’ estimations of the Conservative lead over Labour, indicating that they were prepared to go out on a limb and take some risks.

Q is for the Queen

“I had a very nice chat with the Queen,” said Jeremy to Jeremy on 29 May. Paxman had been trying to press Corbyn on why his republican leanings hadn’t led to Labour calling for the abolition of the monarchy. “You don’t like her, though – you don’t like what she represents,” Paxman said. But Monsieur Zen was untroubled. “We got along absolutely fine.” Are you thinking what we were thinking? What a pair of replacements they would make for Paul and Mary on Channel 4’s Great British Bake Off . . .

R is for regressive alliance

In the early stages of the campaign, left-wing idealists and disillusioned tribal politicians alike turned to the prospect of a “progressive alliance” as the only hope of challenging the Tories. (And Theresa May invoked it herself with her line about a “coalition of chaos” propping up Labour.) However, commentators largely ignored the emergence of the Regressive Alliance: that is, a Conservative Party boosted by Ukip’s decision not to run in nearly half of the 650 seats. Forget a progressive realignment – this is the big shift in British politics.

S is for strong and stable

It was Lynton Crosby’s New Coke moment: out with the lame old Conservative brand, in with unfussy Theresa May and her “strong and stable leadership”. The campaign began with May and the cabinet – fresh from unlearning the phrase “long-term economic plan” – dutifully parroting their new line. Destination: landslide? Not quite. “Strong and stable” lost much of its rhetorical power when it turned out that the equivocating May was, in the words of Channel 4’s Michael Crick, more “weak and wobbly”. Soon afterwards, Jeremy Corbyn’s performance in the polls began to improve.

T is for terror

The horrifying terror attacks on Manchester and London led to temporary suspensions of the national election campaign. Theresa May and her Home Secretary, Amber Rudd, faced questions about cuts to police numbers and the ability of the security services to monitor known extremists.

The Manchester bomb prompted an outpouring of solidarity and fellow feeling, with thousands of people gathering in the city’s Albert Square for a vigil on 23 May. There they listened to Tony Walsh’s moving performance of his poem “This Is the Place”: “And there’s hard times again in these streets of our city/But we won’t take defeat and we don’t want your pity/Because this is a place where we stand strong together/With a smile on our face, Mancunians for ever.”

U is for Ulster

“Can we ever have too much democracy?” ask the people of Northern Ireland. Having stoically endured decades of tumult and violence, this was their fourth national election in 13 months (after two assembly elections and the EU referendum).

V is for Vitamin D

Ukip’s election manifestos have often been very odd (anyone remember their 2010 pledge to reintroduce “proper dress for major hotels, restaurants and theatres”?) but their 2017 offering surpassed all expectations. Under its “show your face in a public place” policy, Paul Nuttall’s party suggested that the UK should implement a ban on the burqa and niqab: partly because they are a “barrier to integration”, but also because these face coverings “prevent intake of essential Vitamin D from sunlight”. Unsurprisingly, the science was a bit whiffy. Sunlight causes the body to make Vitamin D; we don’t “intake” it from sunrays.

W is for worker bees

The Manchester attack led to a quirky fundraising attempt for the victims’ families as tattooists donated their time to create a permanent symbol of Manchester’s resilience and unity. Among those who got a worker bee tattoo – taken from the city’s coat of arms – was Labour’s Jonathan Reynolds, who was first elected the MP for Stalybridge and Hyde in 2010.

His only worry, he wrote on Facebook, was how his mum would react. Less than quarter of an hour later, we found out. Luckily, although Judith Reynolds expressed shock, she thought her son’s action was for a good cause. “OMG this is your mother!!! I hate tattoos but under the circumstances totally support you.” By early June, the appeal had raised more than £300,000.

X is for xeroxed

As the Labour Party was preparing to launch its general election manifesto, the entire draft was leaked in the Daily Mirror and the Telegraph. This allowed the Daily Mail and other right wing newspapers the opportunity to run pearl-clutching “Back to the 1970s” headlines a few days earlier than they would otherwise have done.

Although the usual accusations of incompetence were levelled at Jeremy Corbyn’s office, the leak might have been deliberate – it gave Labour two days of coverage rather than one for its policies, most of which polled well with the public.

Y is for Yotam Ottolenghi 

When the celebrated restaurateur appeared on the Today programme to discuss the Conservatives’ plan to scrap free school lunches, it was hard to tell what shocked Middle England more: that Theresa May’s favourite chef strongly disagreed with her proposals, or the revelation that he sometimes sends his children to school with ham-and-cheese sandwiches for lunch, rather than a fancy fattoush salad topped with pomegranate and baba ganoush.

Yotam Ottolenghi argued that a hot school lunch was an important social, as well as nutritional, experience for children. Friends and relatives of the Prime Minister should be on high alert for regifted copies of his cookbook Jerusalem this Christmas.

Z is for Zac Goldsmith

It’s just traditional now, innit? Yes, Z for Zac is standing again, mere months after he lost his Richmond Park seat to the Liberal Democrats’ Sarah Olney in a by-election he had called over the proposed expansion of Heathrow Airport. No, he didn’t get the concession he wanted from the Conservatives. Yes, people still remember his dog-whistle campaign for the London mayoralty, which was run by the “strategic mastermind” Lynton Crosby (see L).

We are caught between admiring Goldsmith’s commitment to public service and wondering whether he should just find a hobby. 

This article first appeared in the 08 June 2017 issue of the New Statesman, Election special

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