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

REGIS BOSSU/SYGMA/CORBIS
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How memories of the Battle of Verdun inspired a new era of Franco-German co-operation

The fight at Verdun in 1916 set a precedent for peace that lives on at the heart of Europe.

How do you clear up after a battle that took the lives of more than a quarter of a million men? In Britain we don’t have much experience of this kind. There hasn’t been a major war on British soil since the 1640s, and that wasn’t a shock-and-awe inferno of industrial firepower (although it is estimated that a greater percentage of Britain’s population died in the civil wars than in the Great War).

The French, however, fought the Great War on home soil. The ten-month Battle of Verdun in 1916 stands out as the longest of the conflict, and one of the fiercest, with fighting concentrated in a small area of roughly 25 square miles. The terrain was pounded by heavy artillery and poisoned with gas; nine villages were reduced to rubble and never rebuilt – remaining on the map to this day as villages détruits.

In November 1918, soon after the Armis­tice, Monseigneur Charles Ginisty, the bishop of Verdun, was appalled to see mounds of unburied corpses and myriad bones still scattered across the blasted landscape – what was left of men who had been literally blown to bits by shellfire. “Should we abandon their sacred remains to this desert,” he asked in anguish, “littered with desiccated corpses . . . under a shroud of thorns and weeds, of forgetting and ingratitude?”

Ginisty became the driving force behind the ossuary at Douaumont, at what had been the very centre of the battlefield. This he intended to be both “a cathedral of the dead and a basilica of victory”. It is a strange but compelling place: a 450-foot-long vault, transfixed in the middle by a lantern tower, and styled in an idiosyncratic mix of Romanesque and art deco. To some visitors the tower looks like a medieval knight stabbing his broadsword into the ground; others are reminded of an artillery shell, or even a space rocket. Creepiest of all is what one glimpses through the little windows cut into the basement – piles of bones, harvested from the field of battle.

Sloping away downhill from the ossuary is the Nécropole Nationale, where the bodies of some 15,000 French soldiers are buried – mostly named, though some graves are starkly labelled inconnu (“unknown”). Each tomb is dignified with the statement “Mort pour la France” (no British war grave bears a comparable inscription). The nine villages détruits were given the same accolade.

For the French, unlike the British, 1914-18 was a war to defend and cleanse the homeland. By the end of 1914 the Germans had imposed a brutal regime of occupation across ten departments of north-eastern France. Verdun became the most sacred place in this struggle for national liberation, the only great battle that France waged alone. About three-quarters of its army on the Western Front served there during 1916, bringing Verdun home to most French families. Slogans from the time such as On les aura (“We’ll get ’em”) and Ils ne passeront pas (“They shall not pass”) entered French mythology, language and even song.

Little wonder that when the ossuary was inaugurated in 1932, the new French president, Albert Lebrun, declared: “Here is the cemetery of France.” A special plot at the head of the cemetery was set aside for Marshal Philippe Pétain, commander at the height of the battle in 1916 and renowned as “the Saviour of Verdun”.

The ossuary must surely contain German bones. How could one have nationally segregated that charnel house in the clean-up after 1918? Yet officially the ossuary was presented as purely French: a national, even nationalist, shrine to the sacrifice made by France. Interestingly, it was the soldiers who had fought there who often proved more internationally minded. During the 1920s many French veterans adopted the slogan Plus jamais (“Never again”) in their campaign to make 1914-18 la der des ders – soldier slang for “the last ever war”. And they were echoed across the border by German veterans, especially those on the left, proclaiming, “Nie wieder.”

For the 20th anniversary in 1936, 20,000 veterans, including Germans and Italians, assembled at Douaumont. Each took up his position by a grave and together they swore a solemn oath to keep the peace. There were no military parades, no singing of the Marseillaise. It was an immensely moving occasion but, in its own way, also political theatre: the German delegation attended by permission of the Führer to show off his peace-loving credentials.

Memory was transformed anew by the Second World War. In 1914-18 the French army had held firm for four years; in 1940 it collapsed in four weeks. Verdun itself fell in a day with hardly a shot being fired. France, shocked and humiliated, signed an armistice in June 1940 and Pétain, now 84, was recalled to serve as the country’s political leader. Whatever his original intentions, he ended up an accomplice of the Nazis: reactionary, increasingly fascist-minded, and complicit in the deportation of the Jews.

***

The man who came to embody French resistance in the Second World War was Charles de Gaulle. In 1916, as a young captain at Verdun, he had been wounded and captured. In the 1920s he was known as a protégé of the Marshal but in 1940 the two men diverged fundamentally on the question of collaboration or resistance.

De Gaulle came out the clear winner: by 1945 he was president of France, while Pétain was convicted for treason. The Marshal lived out his days on the Île d’Yeu, a rocky island off the west coast of France, where he was buried in 1951. The plot awaiting him in the cemetery at Douaumont became the grave of a general called Ernest Anselin, whose body remains there to this day. Yet Pétain sympathisers still agitate for the Marshal to be laid to rest in the place where, they insist, he belongs.

After 1945 it was hard for French leaders to speak of Verdun and Pétain in the same breath, although de Gaulle eventually managed to do so during the 50th anniversary in 1966. By then, however, la Grande Guerre had begun to assume a new perspective in both France and Germany. The age-old enemies were moving on from their cycle of tit-for-tat wars, stretching back from 1939, 1914 and 1870 to the days of Napoleon and Louis XIV.

In January 1963 de Gaulle – who had spent half the Great War in German POW camps – and Chancellor Konrad Adenauer, who first visited Paris to see the German delegation just before it signed the Treaty of Versailles, put their names to a very different treaty at the Élysée Palace. This bound the two countries in an enduring nexus of co-operation, from regular summits between the leaders down to town-twinning and youth exchanges. The aim was to free the next generation from the vice of nationalism.

France and West Germany were also founder members of the European Community – predicated, one might say, on the principle “If you can’t beat them, join them”. For these two countries (and for their Benelux neighbours, caught in the jaws of the Franco-German antagonism), European integration has always had a much more beneficent meaning than it does for Britain, geographically and emotionally detached from continental Europe and much less scarred by the two world wars.

It was inevitable that eventually Verdun itself would be enfolded into the new Euro-narrative. On 22 September 1984 President François Mitterrand and Chancellor Helmut Kohl stood in the pouring rain in front of the ossuary for a joint commemoration. In 1940 Sergeant Mitterrand had been wounded near Verdun, and Kohl’s father had served there in 1916, so personal memories sharpened the sense of political occasion. During the two national anthems, Mitterrand, apparently on impulse, grasped Kohl’s hand in what has become one of the most celebrated images of Franco-German reconciliation.

“If we’d had ceremonies like this before the Second World War,” murmured one French veteran, “we might have avoided it.”

Institutional memory has also moved on. In 1967 a museum dedicated to the story of the battle was opened near the obliterated village of Fleury. It was essentially a veterans’ museum, conceived by elderly Frenchmen to convey what they had endured in 1916 to a generation that had known neither of the world wars. For the centenary in 2016 the Fleury museum has undergone a makeover, updated with new displays and interactive technology and also reconceived as a museum of peace, drawing in the Germans as well as the French.

With time, too, some of the scars of battle have faded from the landscape. Trees now cover this once-ravaged wasteland; the graveyards are gardens of memory; the EU flag flies with the French and German tricolours over the battered fort at Douaumont. Yet bodies are still being dug up – 26 of them just three years ago at Fleury. And even when the sun shines here it is hard to shake off the ghosts.

Exploring the battlefield while making two programmes about Verdun for Radio 4, the producer Mark Burman and I visited l’Abri des Pèlerins (“the pilgrims’ shelter”) near the village détruit of Douaumont. This was established in the 1920s to feed the builders of the ossuary, but it has continued as the only eating place at the centre of the battlefield. Its proprietor, Sylvaine Vaudron,
is a bustling, no-nonsense businesswoman, but she also evinces a profound sense of obligation to the past, speaking repeatedly of nos poilus, “our soldiers”, as if they were still a living presence. “You realise,” she said sternly at one point, “there are 20,000 of them under our feet.” Not the sort of conversation about the Great War that one could have anywhere in Britain.

David Reynolds is the author of “The Long Shadow: the Great War and the 20th Century” (Simon & Schuster). His series “Verdun: the Sacred Wound” will go out on BBC Radio 4 on 17 and 24 February (11am)

This article first appeared in the 11 February 2016 issue of the New Statesman, The legacy of Europe's worst battle