MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

These days, I spend much of my time in France (my wife is French), and one striking thing about this country is the popularity of homeopathy. For instance, it is hard to find a pharmacy where the pharmacist does not approach you trying to sell you a homeopathic remedy for your health problem. But, of course, this is all far too anecdotal. The question therefore is, are there any reliable data on France’s usage of homeopathy?

The answer is YES: the aim of this new paper was to analyse data on medicines, prescribers and patients for homeopathic prescriptions that are reimbursed by French national health insurance.

The French national health insurance databases were used to analyse prescriptions of reimbursed homeopathic drugs or preparations in the overall French population, during the period July 2011-June 2012.

The results show that a total of 6,705,420 patients received at least one reimbursement for a homeopathic preparation during the 12-month period. This number equates to 10.2% of the French population, with a predominance in females (68%) and a peak frequency observed in children aged 0-4 years (18%). About one third of patients had only one reimbursement, and one half of patients had three or more reimbursements.

The cost of all homeopathic treatments prescribed during the 12-month period was approximately €279 million (based on the retail price). The observed mean reimbursement rate was 34%. This cost corresponded to nearly €98 million for the French national health insurance and amounted to 0.3% of France’s total drug bill. The most commonly prescribed stock was ‘Arnica montana’, followed by ‘Influenzinum’, Ignatia amara’ and ‘Gelsemium sempervirens’.

A total of 120,110 healthcare professionals (HCPs) prescribed at least one homeopathic drug or preparation. They represented 43.5% of the overall population of HCPs, nearly 95% of general practitioners, dermatologists and pediatricians, and 75% of midwives. Homeopathy accounted for 5% of the total number of drug units prescribed by HCPs. Conventional medicines were co-prescribed with 55% of homeopathic prescriptions.

From these data, the authors concluded that many HCPs occasionally prescribe reimbursed homeopathic preparations, representing however a small percentage of reimbursements compared to allopathic medicines. About 10% of the French population, particularly young children and women, received at least one homeopathic preparation during the year. In more than one half of cases, reimbursed homeopathic preparations are prescribed in combination with allopathic medicines.

So, my impression that homeopathy is much more popular in France than elsewhere was not entirely correct. Like in most other countries, it is used by a minority; but this minority is fairly vocal and gets plenty of press coverage. When discussing homeopathy with friends in France, I have regularly discovered that they have very little understanding about what homeopathy is truly about; they seem to favour it because it is heavily advertised as a harmless solution to benign health problems. In no other country have I seen regular TV commercials for homeopathy! The ones who earn by far the most from this is, of course, the pharmacist – in France, homeopathic products can only be found in pharmacies!

Seen from this angle, the French usage of homeopathy is a triumph of profit over reason: the two most popular preparations (Arnica and Influenzinum) are not just not evidence-based (like all other homeopathic remedies), they have been shown in systematic reviews not to work better than placebos.

27 Responses to Homeopathy in France: a triumph of profit over reason

  • I’m glad to see the latest study being misinterpreted by homeopaths has finanlly been explained so that laymen like me can understand it.

    Needless to say Ullman will certainly go on claiming this means 95% of French GPs regularly prescribe homeopathy.

    • Robert G Hahn http://www.karger.com/Article/Pdf/355916

      Note
      The author has never practiced, received, or studied homeopathy, but has worked in clinical medicine and performed traditional medical research in anesthesiology and surgery for the past 30 years

      Conclusion

      Clinical trials of homeopathic remedies show that they are most often superior to placebo.

      Researchers claiming the opposite rely on extensive invalidation of studies, adoption of virtual data, or on inappropriate statistical methods.

      Further work with meta-analyses should abandon the concept of summarizing all available clinical trials and focus on the effects of homeopathy versus placebo or other treatments in specific diseases or groups of diseases.

      One way to reduce future emotional-driven distortion of evidence by investigators and skeptics would be to separate the evidence-seeking process from the formulation of clinical guidelines more clearly.

      • BRAVO!
        With R G Hahn, you have found the true expert.

      • How curious! Hahn doesn’t list this article among the 446 in his CV. Is he not pleased to have written a paper for the journal Research in Complementary Medicine?

        • The last article in CV: 2011.
          Donky Franko!

          • ???
            a) We’re talking about a paper from 2013, not 2011 (see comment from andyourewonderful above)
            b) In any case there is no publication in Hahn’s CV that I linked to that appears in Forschende Komplementärmedizin.
            So what the heck are you on about?

  • Sadly, in Paris homeopathy is ubiquitous. If there is a pharmacy that does not stock homeopathy of some description, I have yet to find it. Virtually everywhere, oscillococcinum is displayed right in the centre of the cold remedy displays behind the counter. The words “Homéopathie” and “Phytothérapie” are displyed in most pharmacy windows and it’s not uncommon to see them in large illuminated letters on the store front, right next to “Pharmacie”.

    Fortunately at no point in 15 years has anyone ever suggested a homeopathic remedy to me and I struggle to recall even more than one or two of my entourage who have ever mentioned it. Based on my own purely anecdotal evidence with no serious study, I have little reason to believe that the use of homeopathy is in any way as widespread as its appearance in pharmacies might suggest. Sadly, I can have confidence in that assertion looking to the future. Boiron advertised heavily this last winter. «Les medicines douces» (literally “soft medecines”, a term which covers everything imaginable form of CAM) seem to be getting more press coverage.

    For a country so proud of it’s scientific and intellectual heritage, I find it pretty depressing.

    • Spain, too…at least, Catalunya: if you go into a chemist, you are surrounded by this (and other) rubbish: chemists pride themselves on being a source of health advice, but sell these foolish nostrums every day.

      If you go into a pharmacy for anything, it is assumed you want something “natural” and if you grow your own veg., it is assumed you are “organic”, anti-GMOs and a host of etceteras: it’s the zeitgeist or summat….

    • Do they stock it because they want to, or because rules force them to? Norwegian pharmacies are obliged to sell homopathic remedies because (as far as I’ve understood as a layman) said remedies are covered by medical regulations and as such only pharmacies are allowed to stock them. Which could theoretically, funnily enough, mean that homopathy could at some point be “banned” in Norway, if pharmacies stop selling them due to lack of effect, and no one else are allowed to stock them.

      ^^layman’s post, take with a grain of salt.

      • @Øyvind

        I find it strange that pharmacies would be forced to sell any particular product: do you actually mean that or do you simply mean that they are the only places permitted to sell homeopathic products and can do so if they so choose?

  • Sorry, in the last paragraph, that should read “Sadly, I can have no confidence in that assertion…”

    K.

  • Yesterday I spent half an hour talking to a lady (in Scotland) who has used homeopathy several times on herself, her dogs and her horses, and who has twice send some hair to a person who “accurately” diagnosed a painful tooth abscess on the first occasion and an injured leg on the second. Like all people who believe this stuff is real (from my conversation I’m sure the hair diagnoses were based on cold reading) this lady was utterly oblivious to what homeopathy is about. “It lists all the stuff that’s in it on the bottle” was her response when I asked her if she knew the principles of homeopathy.
     
    My UK friends are just like your French friends, Edzard. They are genuinely ignorant of the “reasoning” that underpins the various forms of CAM, and — as the French statistics show — the usage is mainly complementary, rather than alternative. I’d have hoped that anyone taking two therapies — orthodox and occult — for the same condition would realize they’ll never know which of the two actually effected the cure (if either). But the default always seems to be to praise the Big Snakeoil product and take proper medicine for granted.
     
    Maybe the time has come for us to stop impressing small children with fairy tales. We have a pretty massive population of adults who seem unable to distinguish batshit crazy fantasies from reality.

  • I often think that placebo is the wrong word for homeopathic ‘remedies’: they are pacifiers. Giving a homeopathic ‘remedy’ to a child does not help the child at all, it just pacifies the parent(s).

  • Unhappily is the same here in Brazil, the only country in the world where homeopathy is a medical specialty recognized by law like neurology and cardiology and the number of “homeopathic physician” is the half of the number of cardiologists.

    All because some homeopaths and homeopathic pharmacists who made pressure on the Physician Association that approve this because it would give more clients to the doctors.

  • “In no other country have I seen regular TV commercials for homeopathy!”
    Interestingly, in France advertising for drugs is absolutely forbidden. But not advertising for homeopathy, since these are not drugs, they do not contain any active ingredient, so they’re entirely harmless! It is by the same reasoning that French law does not require homeopathic treatments to prove any efficacy and any absence of harm. Talk of double standards…

  • As far as I know, Arnica exists as a real treatment, with meaningful dosage (e.g., http://www.medicinenet.com/arnica_arnica_montana-topical/article.htm). Therefore I don’t understand why it is systematically described as homeopathic.

    • arnica is toxic; therefore the herbal version can be used externally only. all oral arnica is homeopathically diluted and thus harmless – but also ineffective.

  • Hi Edzard,

    I currently live in Austria and I find it incredible that Homeopathy is placed on a par as real medicine. You can only buy it in a pharmacy, and most Dr’s here will attempt to prescribe it. Many Austrians will proclaim “oh its accepted here” in a tone that implies the Austrian’s have enough evidence, or know something we don’t. I find its something you can’t really discuss without upsetting people here, not sure why it provokes such a response.

    You’ll even find it in the intensive care units (although its the nurses pushing it not the Dr’s there).

    A pharmacist friend tried to push some homeopathic Zäpfchen (en: suppository) on my partner for our newborn. I can understand why parents wouldn’t want to give paracetamol to a young baby unless absolutely necessary, but why give something which causes distress and is ineffective.

    Another worrying aspect of the homeopathic suppositories is that they have some ingredients in extremely high doses (relatively speaking).
    E.g. Bella Donna D1.

    For me this is worrying, why would I give a 1 in 10 dilution of a toxic substance to a baby? The other problem with Homeopathy is that they don’t say what the original concentration of the original substance was. What is D1 in this case? 1 in 10 of the pure substance, or it was already just a few molecules?.

    Somehow it feels like there is an active propaganda campaign in Austria in support of Homeopathy. Despite that I don’t think that many people actually understand what Homeopathy really is.

    Anyway thanks for your interesting articles, and I loved your Trick or Treatment book you did with Simon.

  • I’m happy that at least the pharmacists in France haven’t completely bowed down to the pharma vampires. I stopped being a skeptic when a remedy cured my gastritis that doctors were killing me with regular meds.

    The problem is, that for some medical problems, homeopathy works too well. This scares big pharma, so they’re up in arms about it.

    I stopped taking about three different types of meds, in exchange for 1 remedy for a month, and I was cured. That’s lost profit for them right there.

    Why it gets people’s knickers in a bunch, especially those who don’t use it, I can’t say. What I can say, is that they’re attempting to take away a health choice from people, that’s just plain evil.

    • “…for some medical problems, homeopathy works too well…”
      PLEASE TELL US WHICH ONES

    • @Alex
      Any “Big Pharma” CEO who doesn’t immediately start manufacturing homeopathic “medicines” on the basis of the anecdotal evidence that you (and many others who’ve commented on this blog) provide is not doing his job properly for her or his shareholders. Water and sugar pills are dead cheap to put in bottles, there’s no expense on research required, and the sheer size of the pharmaceutical infrastructure with its marketing and sales divisions would wipe out the smaller existing competition. The profits are immense (as balance sheets from companies like Boiron will confirm).
       
      So why don’t the big pharma people sell the (widely popular) witchcraft products? Is it possible they’re ethical about the businesses they run?
       
      “…they’re attempting to take away a health choice from people, that’s just plain evil.” As a matter of fact, we usually expect governments and knowledgeable experts to take away consumer choices that are shown not to work or to be dangerous. There is no consumer choice for new cars not to have exhaust emission controls, for electrical goods to have unsafe chargers, or for tobacco and alcohol to be sold to people regardless of age: the list goes on endlessly, and few people would regard these choice limitations as ‘evil’. For some inexpicably curious reason, matters related to health seem for ever to exempt themselves from the same umbrella of rational protection. Is healthcare in fact the last bastion of consumer life in which we are totally free to fool ourselves?

    • Alex said:

      This scares big pharma, so they’re up in arms about it.

      Are they? What makes you believe this?

    • Hey, Alex

      “I stopped taking about three different types of meds, in exchange for 1 remedy for a month, and I got better

      Fixed that for you.

  • Can someone explain to me why arnica is considered homeopathic? I use the topical form to reduce the appearance of bruises (doesn’t help the pain), but I’m not using arnica to treat arnica poisoning (or something), so how is that homeopathic?

    • this is from my book HOMEOPATHY, THE UNDILUTED FACTS about to be published by Springer:

      Homeopathic Arnica is made from ‘Arnica Montana’, a perennial herbaceous, toxic plant, which grows abundantly in the Alps and many other mountain ranges worldwide. Homeopathic Arnica remedies must not be confused with herbal preparations of the same plant. The latter are poisonous, if taken by mouth, and therefore only for external use.
      Homeopathic Arnica products are highly diluted; therefore, they are non-toxic and for both external and internal administration. Homeopathic arnica is used mostly in ‘clinical homeopathy’; that is to say it is employed by clinicians and patients – it is readily available as an OTC-product – for ‘cuts and bruises’ without the need to account for the individual characteristics of the patient.
      Several clinical trials have tested whether homeopathic Arnica is better than placebo for healing injuries. Two independent systematic reviews evaluating the totality of this evidence have cast serious doubt on its effectiveness.

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