How beauteous mankind is! O brave new world,

That has such people in’t!

(The Tempest Act 5 Scene 1)

Shakespeare’s irony did not escape the novelist Aldous Huxley. His 1932 novel, Brave New World, takes place around the year 2500. The people are oppressed by ruthless authorities, distracted by inane televisual ‘entertainment’, controlled by genetic and social engineering and numbed into conformity by a tranquilising drug called ‘soma’.

Brave New World (1932) preceded the more famous but similar  novel, 1984, written by George Orwell in 1949. The contemporary world seems to be approaching these novelists’ apocalyptic vision with alarming speed. As a doctor, I am most concerned by the exponential increase in the prescription of antidepressants and tranquilisers – especially during the present recession. The Guardian reports that the prescription of antidepressants has increased by 20% in just three years.

This is particularly outrageous because two years ago a major study warned that antidepressants were no better than placebo in mild and moderate depression (surely the majority of cases) as I mentioned in a post at the time. My point was that it was the height of hypocrisy to criticise NHS homeopathy (drug budget £10 million) when the budget for these less-than-evidence-based antidepressants was £232 million!

At the time, the medical profession vowed to ‘do something’ about it. What has been ‘done’ is that the prescription of antidepressants in the UK has – in the words of the Guardian – soared. The situation across the Atlantic in the USA which offers the best medicine money can buy – is even worse. The use of anti-depressants in the ‘home of the brave’ has in the words of USA Today ‘skyrocketed’ by 400% (sic!) since 1988.

The situation with highly addictive tranquilising drugs is another horror story that I’ll leave to somebody else to write about. Both sets of drugs have potentially dangerous side effects and patients really should be monitored carefully on them – if their doctors can find the time of course. But it seems nobody cares that much about these horrific statistics. After all should we really be knocking such a profitable industry during a recession? Much better to start a new organisation protesting against all that money wasted on treating naive patients who want NHS homeopathy. And don’t read Huxley’s Brave New World either – read his last novel, Island. It’s about a type of Utopia and much more optimistic than Brave New World.

Stay optimistic and banish your fears

Orwell was out by at least forty years.

(from Instructions for Androids)

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The denialists, detractors and critics of homeopathy were back in action this week.  In a critical letter to the BMJ protesting against the Government seeking advice (sic) from experts on the registration of homeopathic products. Referring to homeopathy as ‘naked quackery’ and ‘pseudoscience’, the letter was written by Susan Bewley (an obstetrician) ‘on behalf’ of a list of names including the usual suspects, Ernst, Baum, Rose etc.) It seems the letter section of the BMJ has become a popular forum for these doctors to spout their vituperative, amateur homilies on medical politics.

So let us look at the history of the politics of homeopathy in the UK. It is important to acknowledge that throughout its history homeopathy has been attacked for the same reasons: Dilutions, implausibility, quackery and now ‘pseudoscience’, ‘bad science’ etc.

19^th Century: Dr F. Quin studies homeopathy in Germany, brings it to the UK, treats the Prince of Wales and builds the London Homeopathic Hospital.  Several other homeopathic hospitals are built in England and Scotland.

1948: The NHS is formed and all the homeopathic hospitals are INVITED to become part of it. This is the reason why homeopathy (unlike aother forms of CAM) is so strongly integrated into the NHS. Homeopathic doctors and their benefactors had built hospitals staffed by doctors specialising in homeopathic treatment prior to the formation of the NHS.

1948-1990: Homeopathy becomes more and more popular both on the NHS and in private medicine. However the opposition movement becomes more determined to end NHS homeopathy. They attack on two main fronts: PR & Media and direct political attack. On the media front, The Guardian newspaper and the supposedly neutral BBC prove to be particularly useful allies to their cause but in the realm of official politics they suffer serious defeats.

December 2009 Political Defeat I: The denialists manage to get a Science and Technology Subcommittee to do an ‘Evidence Check’ on homeopathy. The findings of these controversial hearings is voted on by only 4MPs of a possible 12-13 and only 2 of those 4 actually attended the hearings!  Mike O’Brien, the then Minister of Health in the Labour government speaks at the hearings. He famously describes the draconian anti-homeopathic suggestions of the Committee as ‘illiberal’ and makes it clear that GPs and local health authorities are best placed to decide if their patients should get NHS homeopathy or not.

July 2010: Political Defeat II: The report (with its authoritarian anti-homeopathic and anti-democratic  recommendations) passes to the new Coalition Government for consideration. The new Health Minister, Anne Milton thanks the S&T Committee for their work but then kicks all their recommendations into touch. Her reasons for doing so are much the same as the Labour minister’s: GPs and local health authorities should be trusted to make the best decisions for their patients. An infuriated Michael Baum pours scorn on her in a well-publicised letter to the Lancet concluding with a condescending “Shame on you Minister!”  I was personally astonished by the aggressive, rant-like nature of this letter as Baum had only a few months before called for the debate on homeopathy to return to the ‘realm of polite disputation’.

So summing up:

Government under Labour: supported homeopathy on the NHS.

Government under Coalition: reiterated this support almost to the letter.

Head of State and family: are known to use and have used homeopathy for several generations.

The detractors, denialists and illiberal, wannabe Statist authoritarians  have tried to thwart GPs (rather than dissuade them which would at least be respectable) from referring patients for NHS homeopathy by insisting that their scientism trump due democratic process – but it hasn’t worked. Despite what Ben Goldacre writes in the Guardian, despite the letters to BMJ and Lancet, and despite inexplicable and inexcusable BBC bias against homeopathy, both Labour and Coalition Governments have seen fit to protect the significant minority support for homeopathy in the UK as well as the rights of British GPs to send their own patients for NHS homeopathy if they so wish. In doing so Government has so far managed to resist a serious, concerted attempt to undermine the democratic provision of health care in this country.

The attack on homeopathy has been a veritable Pandora’s Box of vitriol and bias that has certainly damaged British homeopathy by it’s sheer persistence and seemingly well-funded mass pressure at a PR level. It is heartening to know that at least at a pure political level, there has been unequivocal support by both Labour and the Coalition not only for homeopathy, but for something equally as important –  liberal democracy itself. Fortunately the last thing to come out of this particular Pandora’s Box was still Hope.

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Once again a major politician has said something good about homeopathy – and this time it was the Prime Minister, the right honourable David Cameron himself. In defence of his NHS reforms on Channel 4, the main man said: ‘I’m going to sound like a homeopath but this is like looking at the whole of the patient.’ Well I don’t know how much the top dog in the country knows about homeopathy but he seems to understand that classical homeopathy does try to treat the whole person by trying to use a medicine to stimulate the body to heal itself. Nice one, Dave!

It’s interesting to reflect that when a major politician has something to say about homeopathy, it is usually positive or supportive of it remaining on the NHS.

Mike O’Brien: Labour’s Minister of Health (Feb 2010) ‘We take the view that it is not our job to stop clinicians prescribing these medications if they feel they are appropriate.’ 

Anne Milton: Coalition Minister of Health (July 2010) ‘The Government … remains of the view that the local National Health Service and clinicians are best placed to make decisions on what treatment is appropriate for their patients’ – as she kicked into touch recommendations to scrap NHS homeopathy.

The Queen: Well the Queen has not said anything and we don’t expect anything. Nevertheless it is well known that the Royal Family appoints a Royal homeopathic doctor and has supported homeopathy since the early 19^th Century.

I find it interesting indeed that although major politicians and the head of state clearly do not support the current assault on homeopathy and CAM by the sceptics, the media are only too keen to put the boot in and seldom allow homeopaths a level playing field to defend what they do.

From Great Britain to Sad Britain Meantime Great Britain seems to have become Sad Britain, as the prescription of anti-depressants has hit an all time high. Actually in spite of a huge NHS bill for these drugs alone (it dwarfs the bill for NHS homeopathic prescriptions by at least 20 to 1) there is little evidence that they are much better than placebo for mild and moderate cases of depression – and that does mean the majority of cases of depression. A major study showed that most prescribed anti-depressants are no better than placebo for most cases of depression – but you don’t see much about that in the media. It’s a pity that these drugs don’t work on the managed depression of the Economy (aka ‘The Recession’)  either.  I’m starting to think of Aldous Huxley and Soma now – but I digress…

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The recently released and well-reviewed film, The King’s Speech, tells the story of how King George VI overcame a crippling speech defect with the help of an unorthodox and unqualified speech therapist by the name of Lionel Logue. Directed by Tom Hooper from a screenplay by David Seidler, the film features the cream of British acting talent including Colin Firth (as George VI), Helena Bonham Carter, Derek Jacobi, Timothy Spall, Michael Gambon and many others. Geoffrey Rush is cast perfectly as the Australian speech therapist.

As portrayed in the film, Logue employs three main strategies in helping George VI drastically improve his speech which proved to be very important for both a monarchy wounded by the abdication of Edward VIII and a country facing war with Germany.

1. Standard speech therapy exercises (of the time): He gets the King to swear, to sing, to relax, to breathe better etc. The film portrays these to be of some use.

2. Psychoanalytic Psychotherapy: He seeks a source of the problem by exploring the King’s early childhood in which he was clearly intimidated by both his father and elder brother. As portrayed in the film, this approach has little effect.

3. Techniques of Reverse Psychology and Provocative Therapy: I cannot say whether this happened in real life or not, but in the film itself, Logue uses many of the tools of Provocative Therapy (reverse psychology and contrarianism) to provoke his patient therapeutically to assert his voice clearly and confidently. In the film we see the King respond dramatically to classic Provocative Therapy tactics. Here are some examples:

a. Logue ‘disrespectfully’ sits on the coronation throne during a rehearsal for an address by the King at Westminster Abbey.

King George VI: Get up! Y-y-you can’t sit there! Get up!!
Lionel Logue: Why not? It’s a chair.
King George VI: Th-that… that-that is Saint Edward’s chair.
Lionel Logue: People have carved their names on it. (and something about not caring about how many ‘royal arseholes’ have sat on it)
King George VI: L-listen to me… listen to me!
Lionel Logue: (cheekily) Why should I waste my time listening to you?
King George VI: Because I have a voice!
Lionel Logue: (with genuine respect) Yes, you do.

b. The King lights a cigarette (He was a heavy smoker and died at 56 from lung cancer)

Lionel Logue: Don’t do that in here.
King George VI: Why not?
Lionel Logue: Sucking smoke into your lungs will kill you.
King George VI: My physicians tell me it helps to relax the throat.
Lionel Logue: They’re idiots.
King George VI: They’ve been knighted.
Lionel Logue: Makes it official then!

And later when the King finally thanks him for his services and asks if there is anything he can do for him, Logue replies: “How about a Knighthood?”

This is very much the kind of thing a Provocative Therapist would say and Logue does seem to obey the Golden Rule of Provocative Therapy – Only ever therapeutically provoke when you have affection in your heart and a twinkle in your eye. The rule he doesn’t obey is to ask the King’s permission to say things that could be seen to be provocative or offensive. Provocative Therapists must never ambush patients and always gain explicit permission from their patients before using the unusual techniques of Provocative Therapy.

Interestingly King George VI was treated by the Royal homeopathic physician, Sir John Weir, who was knighted for his services to the Royal Family by the father of George VI, George V. At the funeral of George VI, Dr Weir used the homeopathic remedy, Ignatia, to treat no less than 5 kings and 3 queens, a feat that is unlikely to be repeated in these days where homeopathy is relentlessly smeared in the media. Here is a rather unorthodox photograph of the good doctor, taken at the Royal London Homeopathic Hospital over 50 years ago.

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Professor David Nutt, the former UK chief drugs adviser thinks that he has statistical evidence that alcohol is more harmful to society than heroin or crack cocaine! Nutt’s politically outrageous (but annoyingly scientifically sound) views about the relative dangers of various drugs got him fired by former home secretary, Alan Johnson from the Governments Advisory Council on the Misuse of Drugs last year. Now Nutt has simply gone too far.

Its empirical formula is C2H60. It’s certainly a chemical but is it a ‘drug’? Surely not. Surely all you boozers, barflies, alkies, dipsos, dredge-heads, dronkies, shickers, waste cases, winos and international piss artists aren’t drug addicts?

How could any of you heavy hitters, gin-soaks, rumheads, brandy-shunters, hop-heads, old soakers, grog artists, toss pots, beerheads, barstool jockeys, brew hounds, ale-knights and other aristocrats of the bottle be considered to be addicted to anything?

How dare anyone suggest that you lovely lushes from bag ladies to queens of Scotch are addicted to a drug? This country – and many others besides – would have an even more serious ‘drug problem’ if it irrationally counted every harmless drunkard as part of the enemy in our ongoing war on drugs ?

Calling all drinking class people drug addicts is a politically incorrect insult. Your beverage of choice is legal, socially acceptable and generates huge revenue for hard-pressed governments all over the world.

What’s wrong with that?

Cheers!

Legal Disclaimer: This post has been written in the spirit of Provocative Therapy, the cutting edge in the use of reverse psychology and humour in psychotherapy. Thus nothing above should be taken ‘seriously’. As Oscar Wilde put it: ‘Life is far too important a thing ever to talk seriously about it’.

So remember to DRINK RESPONSIBLY

Now watch Liz & Ed discuss the issue of alcohol the non-drug.

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The Government’s chief scientific adviser, Sir John Beddington said this week that ‘patients might believe that homeopathic treatments could protect them against serious illnesses, or treat existing conditions, because GPs and hospitals are allowed to prescribe them on the NHS.’

Does this really constitute scientific advice? Is it appropriate to make such an authoritarian comment after this issue has been fully debated in Parliament and two successive Governments have given considerable thought to this issue and then expressed very different views to his about NHS homeopathy:

Labour Minister of Health, Mike O’Brien: (Dec 1, 2009) “We take the view that it is not our job to stop clinicians prescribing these medications if they feel they are appropriate… cutting the (NHS) funding would be “illiberal” and “a denial of personal choice”

Coalition Minister of Health, Anne Milton: (July 26, 2010 – the official government decision on the issue) Homeopathy has a “long tradition… and that local National Health Service and clinicians are best placed to make decisions on what treatment is appropriate for their patients”.

Sir John Beddington is not a medical doctor. He is however an internationally renowned specialist in the economics and biology of sustainable management of renewable resources and has previously advised UK ministers on scientific and environmental issues. May I humbly suggest that instead of insulting GPs who choose to send their patients for homeopathic treatment with the full support of this government and the last, he pays some attention to the connection between his specialist field, the environment, and homeopathic medicine.

I recommend he google the words: ‘Sustainability’ ‘Homeopathy’ ‘Environment’. In an excellent article on this, Joel Kreisberg, writes: “In ecological terms, homeopathic remedies never exhaust natural resources; there is negligible environmental impact and no question of over-consumption. Remedies meet the criteria for both renewable and sustainable sources of medicine. Compared to the waste stream produced by pharmacological manufacturing and by hospitals, the waste produced by a homeopathic pharmacy is infinitely small. No waste is produced from the original material; it is all used. And no harmful chemicals or complex reagents are used in the manufacturing process.”

I do not wish to denigrate pharmaceuticals, many of which have tremendous value in medicine. But homeopathy has value too and is clearly also very, very environment friendly.

Ed and Liz discuss this in Episode 3.

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The Debating Society of University College London met last night. The motion was: This House would stop the funding of homeopathy on the NHS.

The result was close but a heart-warming win for the supporters of NHS homeopathy.

For the Motion: 71
Against the Motion: 78
Abstentions: 41

This was most heartening as there were very few outside people present. The room was packed with students and the atmosphere was lively.

Some of you might remember the last time UCL debated this topic. That was two years ago, when the result went against the provision of NHS homeopathy. You can see my report on that debate here.

The only survivor from the first debate was Prof. David Colquhoun who gave his boiler plate speech about the implausibility of homeopathy while having little to say about freedom of choice and democracy. Clare Stanford, opposing him, seemed to agree that homeopathy might be placebo (sic), but argued that it should still be on the NHS. I managed to speak from the floor and get a few words in about liberty, democracy, and freedom of choice for patients and GPs.

It’s hard to say if this signifies that the tide is turning towards homeopathy but at least the students of UCL did not vote for a Soviet Union style motion emphasizing the need for State control and coercion of doctors. As I’ve always said: You can only get to see a doctor on the NHS if your GP refers you. We don’t need diktats from Westminster restricting and thwarting the clinical judgement of our NHS GPs, thank you very much. So well done UCL!

Episode 2: Scientism with Liz and Ed.

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The New York Times published an excellent article on how doctors have neglected learning or practising one of the most important aspects of their art – the physical examination.

The fact that many doctors order sophisticated tests without examining their patients properly is no less than a tragedy for medicine. There will never be any machine that can diagnose as accurately as a human being trained to be a doctor.

When I was at medical school in the late 70s, we were taught that you should make about 70% of your diagnoses from talking to the patient alone. Another 20% can be made from your physical examination. Sophisticated tests could pick up another 5-10% but they were mainly there to confirm what one already thought was wrong with the patient.

Things might have changed a little since then – not because the art of talking to patients and the art of examining patients have changed that much in the last 30 years – but because tests and technology have become more sophisticated. However there can be no excuse for refraining to examine our patients and there are many vital signs that can be detected by a doctor at the bedside that are invisible to the most expensive of medical investigative machines. I was taught in no uncertain terms that: ‘If you don’t put your finger in, you put your foot in!’ and the great physician, Professor Harry Seftel advised me to ‘wallow in the secretions’ of my patients.

Let us never abdicate the responsibility of diagnosis to machines. Machines are there to help doctors – not the other way around.

Event: There will be a debate at UCL on Monday night(25th October) on This House Would Stop Funding Homeopathy on the NHS This is the second one they have had on exactly this subject. Details can be seen here. The speakers announced are both pharmocologists. Am I alone in thinking it odd that a clearly political debate will be discussed by pharmocologists? If UCL debated: This House Would Abolish The Royal Family, would it be appropriate to have two professors of genetics arguing whether the superiority of the Royal chromosomes justify the amount of taxpayers’ money spent on the Royal Family? To be fair, I was invited to speak at this debate (with 4 days notice!) but was advised to decline on this occasion because of the ridiculously short notice given to me. I’ll come along anyway though and perhaps say something from the floor if invited to do so. Why not come along yourself and watch how pharmacologists debate an issue that is essentially about liberty and democracy?

Meanwhile Ed and Liz continue their conversation about Homeopathy, the NHS, Science, Scientism and Democracy.

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I found a recent documentary on Homeopathy made by BBC Scotland particularly biased and disappointingly undemocratic. You can see some of it here.

BBC Scotland will of course say something like they represented both sides of the argument but in my opinion the programme can objectively shown to be against the provision of NHS homeopathy. For example the programme casually mentioned that a parliamentary committee in England had ‘recommended’ that funding for NHS homeopathy should be withdrawn. This is true because the Science and Technology Parliamentary Committee did indeed ‘recommend’ this. What the programme did not bother to say was that the Government comprehensively rejected all the recommendations of this committee on the 26th July this year.

So I thought to myself: How can I personally make a movie to show that the attack on NHS homeopathy (provided since homeopathic hospitals were invited to be part of the NHS in 1948) is both anti-democratic and illiberal?

Although I had a small script, I had no actors, no director, no producer, no editor, no set and most importantly a budget of zero. Undaunted by these apparent disadvantages, I managed to make this movie with the help of a wonderful website called xtranormal.

I am entering this movie for a BAFTA award in the category Best film made without any budget. Please wish me good luck.

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Comedians may be taking over American politics. Or so hopes John Avlon in The Daily Beast. And that does not mean that all USA politicians are clowns. Actually ‘I forgot to duck’ uttered by the shot Ronald Reagan were the last words of a President that made me laugh – but then again, according to Gore Vidal, Reagan was a professional actor ‘hired to impersonate a president’ so he doesn’t count. Avlon reckons that ‘laughter and satire is the only sane response to the sickening spin cycle we’re subjected to on a daily basis’ To which I say: ‘Congruence at last!’

Comedians and satirists have philanthropically been doing their best for humanity for centuries. Think Shakespeare, Swift, Mark Twain, Lenny Bruce, Bill Hicks and our very own Chris Morris and Howard Jacobson. However such comic prophets have been far outnumbered by the ludicrously rich, mind-numbing, ‘Have you ever noticed?’, socially irrelevant blabbermouth ‘funnymen’ who are irritatingly ubiquitous. Maybe this is about to change in America. Two men are leading the Comic Revolution, John Stewart and Stephen Colbert.

John Stewart,voted ‘most trusted man in news’ last year plans a pre-election ‘Rally to Restore Sanity’ in which he has advised people to wear banners saying “9/11 was an Outside Job” and “I disagree with you, but I’m pretty sure you’re not Hitler”.

My personal favourite Che Guevara of comedy is Stephen (“Keep your facts, I’m going with the truth”) Colbert who also plans a ‘Keep Fear Alive’ rally which as a Provocative Therapist, I might feel obliged to attend! Just watch him testify at a real Government Congressional Immigration Hearing which explains why the ‘audience’ only chuckled while I cried with laughter.

Comedy has the capacity to mirror truth in medicine as well a politics. Anyone want to invite me to testify to a select committee on Health in the House of Commons? Accept it dear readers, America is always going to be two steps ahead of us in everything.

Provocative Therapists know the power of satire in counselling. When patients get their Inner Joke (the joke of how they are preventing themselves from finding happiness) they change. And people can change. And America can change. And it wasn’t a comedian who said that, it was President Barack Obama.* Hear! Hear! and Ha! Ha!

* Well he was only a presidential candidate when he carved the word ‘change’ in stone but that’s not important as long as he doesn’t lose his sense of humo(u)r now.

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