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

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The working class revolts

In the spirit of William Cobbett, a young writer travels by bicycle through Britain’s former industrial heartlands before and after the vote for Brexit.

One recent afternoon I set out on my old Raleigh bike on a tour of post-Brexit Britain. Two years earlier I had travelled the country on my bike as I researched a book. Now, after the vote for Brexit, I began another journey, this time with an even stronger sense of political disorientation. I wanted to discover what had become of the euphoria and, indeed, anger so present after the referendum of 23 June. For two weeks I cycled through the ex-industrial towns and cities of the Midlands and the north of England, two of the regions I visited in 2014.

My method then had been basic and, to some, ill-advised. Over the four months I cycled, I either wild-camped or stayed in the homes of people who had heard about my venture by word of mouth, or whom I’d met along the road, and I asked people, simply: “What is life like here?” I received a bewildering range of responses, from ­worries about wages or what world their children might inherit, to explanations about ecological and community projects built on a sense of renewal and hope. I encountered generosity and insight into different ways of life in Britain, and last summer published my findings as Island Story, a travelogue in the spirit of William Cobbett and Orwell.

Many of the areas I had written about are now readily associated with Brexit, such as Barnsley (68 per cent Leave), the former mining town in South Yorkshire. Covering the immediate aftermath of the referendum, Channel 4 News sent a crew there. Its report featured a local man who explained why he had voted Leave: “It’s not about trade or Europe or anything like that, it’s all about immigration. It’s to stop the Muslims coming into the country, simple as that.”

The presentation of what people in this town or Sheffield and Wakefield nearby had called “Barnsley Man” had been a sore point. In Sheffield (51 per cent Leave) Allie, an artist and teacher, felt it absolved the wealthier south of responsibility, even though the south had voted in far greater numbers to leave. Barnsley Man – old, white, working class, ignorant, racist, and unable to speak without losing his temper – was a sign of a prevailing narrative of Brexit as a catastrophic revolt by a misinformed and alienated northern working class, an explanation that became increasingly unsatisfactory as I travelled and talked to people.

“Damn good thing it were, too,” said one former miner at a working men’s club, as we discussed Barnsley’s vote to leave. Some agreed, others shook their head. I had passed “Vote Leave” stickers plastered on the walls of a derelict social club, and encountered common justifications that cited uncontrolled eastern European migration, resulting in the loss of local jobs. But people’s concerns were not about immigration itself, or cultural identity; rather, they centred on low wages and employment. “There’s nowt round ’ere ’cept call centres,” said Rory, a young betting-shop worker.

Many customer-service centres operate in the nearby Dearne Valley. The work is insecure, stressful and subject to a demeaning level of surveillance (call response rates, targets met, time spent in the toilet). Other sources of employment include distribution warehouses and factories of several major clothes retailers. I was told repeatedly that these companies recruited and bussed in Polish workers from Warsaw to work on a seasonal basis for low pay, at the expense of local people.

“I’ve been trying to take it to the papers,” a young woman said to me as the issue was raised in the back room of the Red Shed, the Labour club in Wakefield, West Yorkshire (66 per cent Leave). She had become aware of the practice of bussing in through a friend at one factory, but my later research showed that it’s an open secret. One must attribute some validity to such stories, at least in terms of how local people feel. They hint at the complex and contradictory stories and motivations behind Brexit in former industrial areas such as these.

“It’s divide and rule,” said a woman who had earlier told me about her involvement in the miners’ strike pickets thirty years earlier. “We have to fight to push up their wage, and challenge the bosses.”

 

***

 

In what the political economist William Davies calls a “shadow welfare state”, many people across the north are employed in poorly paid call-centre or service-sector jobs, subsidised by in-work tax credits. Child and working-tax credits, implemented by the New Labour government, in effect benefit low-wage employers as much as workers, and cost the state £30bn a year. A further £9.3bn in housing benefits was paid to private landlords last year. Though tax credits and housing benefits provide a lifeline to workers and their families struggling to make ends meet, they do nothing to address the underlying problems of low wages or unemployment, or the need for a new public strategy to encourage higher-skilled, higher-waged work.

Cycling from one former industrial town to the next, I observed that the primary contributions to the built environment in the past three decades or so are the retail park and out-of-town supermarket. Like the call centre or the distribution warehouse, they are the principal points of Britain’s service sector, and are enabled by unskilled local workforces on state-subsidised low wages and the complex logistics of globalised trade. Spread across Britain and similar in appearance everywhere, these bland structures signal the possibilities and pitfalls of state investment guided by short-term economic gain.

Workers are increasingly caught in a cycle of insecure and unpredictable shift patterns, thanks to zero-hours contracts. This makes claiming housing benefit difficult, and includes spells of unemployment during which credit cards, payday loans or borrowing from friends and family become the main means of subsistence. A recent Trades Union Congress report found that 3.2 million households were in “problem debt”, spending more than 25 per cent of their household income on unsecured debt repayments. Of this number, 1.6 million households are in “extreme debt”, handing over more than 40 per cent of their earnings to creditors. Some of the poorest households choose not to join the electoral register, fearing that their details will be shared with debt collection agencies, and are thus locked out of political representation.

In the wilted yet cheerful seaside town of Morecambe, Sonya painted a stark picture of her work as a private lettings agent. Over £9.3bn of public money was paid to private landlords in housing benefit last year, a doubling over ten years, and far more expensive than building affordable accommodation. Sonya’s tenants are “trapped” in cycles of poverty and debt, with no obvious reprieve or refuge. “What good are food banks when people can’t afford to pay their gas or electricity to heat the food?” she said.

Although such stories illustrate the UK’s gaping wealth inequalities, they also show the dismal progress in some areas in the quarter-century since John Major’s pledge of a “classless” society and the infamous (mis)quote of John Prescott that “we are all middle class now”. The political effects of such social shifts have not yet fully come to light. The surge in support for Ukip across the ex-industrial north and east over 2014-15 has been stalled, for now, by uncertainty about the party’s leadership since Nigel Farage’s resignation. But I was struck by a pessimism in these communities, so many of which felt overwhelmed by an unfair fate. The horizons of political possibility had been hemmed in by the miseries of economic hardship.

Many I met felt untouched by politics, perhaps because politicians of all stripes rarely speak with any insight into the difficult decisions involved in juggling household debt, or the mixed feelings involved in claiming benefits. It has become a banality to invoke the Stakhanovite image of “hard-working families”; less often do we hear directly from these individuals, with the occasional exception of exploitative TV series such as Channel 4’s Benefits Street or The Great British Benefits Handout (Channel 5).

On the road, few people spoke about political leaders, and Labour’s spate of self-flaying in its second leadership election since May 2015 prompted indifference or disappointment. Talk of Trident or renationalising the trains may be too theoretical, even middle class, in places where basic poverty is an elementary concern. Usually, luminaries on the left, such as the polemicist Owen Jones, address the comfortably converted, gathered punctually in town halls, immune from the debate among the depoliticised masses in the pubs, supermarkets and bedrooms of this island.

 

 

***

 

Cycling around Britain, I would set out most days without knowing where I’d end up. Such nomadism came not without stresses. But it was a fair exchange for serendipity – sunset conversations with shepherds along Loch Eriboll, blue jokes in the lock-ins of Liverpool and Dalmellington, or the drama of lugging a weighty steel mule up the steeps of Snowdonia and the eye-watering wonder of plunging down the other side.

I had no map, and sometimes relied on the tent and a discreet field or park for a place to kip, but more often I found contacts through a blog and social media. Pulling over on street corners or stopping at fast-food outlets, supermarkets and pubs, I would mine passers-by for clues.

As I travelled through Northamptonshire, Lincolnshire and Yorkshire, I listened to people projecting the effects of austerity on to migrants. In Corby, Scottish workers told me that Poles had “overrun” the area. “I just don’t like the ones claiming [benefits],” said a barmaid in one town-centre pub. Others such as Ashgar, a former steelworker in Rotherham, blamed the “greed” of “London” or factory owners for the loss of local steel jobs, rather than any government policy or trend towards deindustrialisation.

Stories of feeling left behind by the economic development of “London” were common. “London” had privatised industries and utilities, and cut funding from communities to prop up a corrupt banking system while people outside the capital were sanctioned for minor or non-existent benefit improprieties. “London” had imposed a narrow political and cultural vision on the rest of the country which gave communities no great say in how they were governed. To many of the people I met, the word “London” carried the same negative connotation as “neoliberalism” or “globalisation”, and had a similar meaning.

The chain stores may stock the latest cheap gadgets and clothes from the Far East, but for many communities the loss of jobs, community buildings, social care and affordable rents has been too high a price to pay. Voting Leave became a kind of protest button, pushed in anger at decades-long disempowerment. Brexit, a largely English independence movement ostensibly against the EU, is at times indistinguishable from a movement for independence from “London”. Voters judged that the potential hardships associated with leaving were a price worth paying to regain sovereignty from the capital.

In Nottingham (51 per cent Leave), David talked of friends in his home town of Long Eaton, Derbyshire, who had voted overwhelmingly in favour of Brexit. “A whole two generations of massively disenfranchised people put two fingers up to the elite,” he said. To Jeremy Corbyn’s chagrin, many Brexiteers live in safe Labour seats.

For the painter John Wilkinson, the problem was clear: “In England it is already yesterday.” Among left-wing artists in the exhibition “Fighting for Crumbs” in Sheffield, the mood was disillusioned yet reactive. In these pessimistic visions, the future seemed lost or abandoned. Beside Wilkinson’s paintings were photos by Connor Matheson capturing teenage ravers, food banks, Grimethorpe miners celebrating Thatcher’s death, and more mundane moments amid allotments and council estates festooned with St George flags. Reconstructions of the past seemed to preoccupy many people, as they struggled to identify new sources of pride in their decaying environment.

Dependency on benefits to subsist in boring, insecure or difficult low-wage work does not inspire gratitude. Writing in June in the London Review of Books, James Meek made a similar observation about farmers, many of whom supported Brexit even though they are heavily reliant on EU subsidies to augment the plummeting prices paid by supermarkets. “It’s an unholy mess that’s developing,” said Eden, as we spoke on his sheep-rearing smallholding beside a large Argos distribution centre in Darlington, on Teesside. Globalisation has reduced prices and forced many farmers into a race to the bottom. “People want to blame the poor for the situation they find themselves in,” he said.

But it’s not only farmers who feel beleaguered, their pride or way of life tested by recent developments. The collapse of manufacturing, mining and steel since the late 1970s has resulted in what Jeremy Seabrook, interviewing people in the West Midlands last summer, called “unhealed social and psychological lesions of class”. In his book Cut Out: Living Without Welfare, Seabrook argues that these areas were not given the chance to grieve for the industries they have lost and around which generations of communities had developed.

Travelling through the same parts, I found it common to hear of cities spoken about in the past tense. In Wolverhampton it was locks and furniture; Nottingham, bicycles and lace; in Bradford and Halifax, textiles. Each town had its trade. “It’s got a lovely history,” said Ian in Wolverhampton. “Shame it’s a s***hole now.” For there is no belonging or co-ownership in the glut of retail parks left behind, nor in the finance sector or on the property ladder. “We used to make things,” said Steve in Derby, using his own city’s economic uncertainties as a symbol of something broader.

Emma, a part-time teacher working in the Midlands in Tipton and Dudley, told me about young mothers to whom she taught basic budgeting and childcare. “People complain about scrounging . . . Most people I meet, they’re just trying to get by.”

The Brexit vote has exposed rather than initiated this incoherence. If a shared sense of place or identity is defined by making or doing, then those who cannot make or do – from welfare recipients to foreign nationals who use the NHS – become, in the eyes of some, despised. Two implications follow. First, pride in work correlates to a misleading notion of a “traditional working class”, readily linked to manual work, social conservatism and older age, such as that of Barnsley Man. This understanding of class as primarily cultural (through which the concept of a beleaguered, mythically homogeneous “white working class” often arises) obscures what is the original and more obvious economic definition of “the working class”: those who must work, will work, or have had to work full-time for a basic living. Class is no longer clear.

A second implication of pride in work emerges in how this is internalised where such work isn’t readily available, as in Barnsley or Rotherham, or the struggling former industrial cities of the north-east, such as Ashington and Middlesbrough, or Newport in south Wales. In Langley Moor, County Durham, Clarissa and her daughter told me about the high suicide rate among young men. Elsewhere I heard tales told, in hushed tones, of brothers, fathers and friends who had taken their own lives – each for different reasons, but so often in places bereft of investment and hope. Where communities, certainties and “jobs for life” are disarrayed by forces so distant and complex they might well be confused with fate, the individual effects can be terrible.

 

 

***

 

Pessimistic narratives of decline and “Broken Britain” are tedious, and also stand as obstacles to imagining political alternatives. Seismic changes to the fundaments of the United Kingdom will have consequences over the coming decades, but exactly how so remains unclear. Absent from most of the debate during the Brexit campaign was a discussion about the future of the political union between not only Britain and Europe, but also the UK’s member states. What kind of society do, say, the English desire? How will it be powered, how will its people house and employ themselves, and how will it be governed?

Across my post-Brexit journey, I quizzed people about the kinds of political transformation they would like to see. In Nottingham, I heard compelling arguments for a universal basic income and a 30-hour working week, aided by automation and progressive taxation. In Sheffield, the artists Glen Stoker and Anna Chrystal Stephens invited me on a group trespass of a patch of derelict wasteland near the city centre. Discussions about what this site could become in public hands led to wider questions about who owns much of Britain. In Manchester (60 per cent Remain), Jen enthused about rediscovering politics along with neighbours in her community and Steve refused to acknowledge what some would call realism – the necessity of compromising one’s political intentions. In Liverpool (58 per cent Remain), Brian, an indefatigable trade unionist, debated with international students the need to invest in green energy.

All were inspired by developments in Scotland, where a very different-natured independence campaign has led to lasting discussions about a progressive and better future for all. Instead of reactions against low wages, or perceptions of immigration or the effects of austerity, here there are ­discussions about renewable power, buying back local land into common ownership, as well as rediscovering local histories and the Scots Gaelic tongue.

Is it naively idealistic to imagine that the same could happen here, elsewhere in our post-Brexit land? Perhaps, but within such hope lies the motivation to act.

J D Taylor’s book “Island Story: Journeys Through Unfamiliar Britain” is published by Repeater

This article first appeared in the 02 February 2017 issue of the New Statesman, American carnage