MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

I have written about the use of homeopathy in France before (as I now live half of my time in France, this is a subject of considerable interest to me). After decades of deafening silence and uncritical acceptance by the French public, it seems that finally some change to the better might be on its way. Recently, a sizable number of prominent doctors protested publicly against the fact that, despite its implausibility and the lack of proof of efficacy, homeopathy continues to be reimbursed in France and scarce funds are being wasted on it. This action seems to have put pressure on officials to respond.

Yesterday (just in time for the ‘HOMEOPATHIC AWARENESS WEEK’) the French minister of health was quoted making a statement on homeopathy. Here is my translation of what Agnès Buzyn was quoted saying:

“There is a continuous evaluation of the medicines we call complementary. A working group* at the head office of my department checks that all these practices are not dangerous. If a therapy continues to be beneficial without being harmful, it continues to be reimbursed… The French are very attached [to homeopathy]; it’s probably a placebo effect. If it can prevent the use of toxic medicine, I think that we all win. I does not hurt.”

Agnès Buzyn

  • I would like to know who they are, how they can be contacted, and whether they would consider recruiting my assistance in evaluating alternative therapies.

So, if I understand her correctly, Agnès Buzyn believes that:

  1. the French people are fond of homeopathy;
  2. homeopathy is a placebo-therapy;
  3. homeopathy does no harm;
  4. homeopathy can even prevent harm from conventional medicine;
  5. on balance, therefore, homeopathy should continue to be reimbursed in France.

My views of this type of reasoning have been expressed repeatedly. Nevertheless, I will briefly state them again:

  1. true but not relevant; healthcare is not a popularity contest; and the current popularity is essentially the result of decades of systematic misinformation of consumers;
  2. correct;
  3. wrong: we have, on this blog, discussed ad nauseam how homeopathy can cause serious harm; for instance, whenever it replaces effective treatments, it can cause serious harm and might even kill patients;
  4. if doctors harm patients by needlessly prescribing harmful treatments, we need to re-train them and stop this abuse; using homeopathy is not the solution to bad medicine;
  5. wrong: the reimbursement of homeopathy is a waste of money and undermines evidence-based medicine.

So, what’s the conclusion?

Politicians are usually not good at understanding science or scientific evidence. They (have to?) think in time spans from one election to the next. And they are, of course, keenly aware that, in order to stay in power, they rely on the vote of the people. Therefore, the popularity of homeopathy (even though it is scientifically irrelevant) is a very real factor for them. This means that, on a political level, homeopathy is sadly much more secure than it should be. In turn, this means we need to:

  • use different arguments when arguing with politicians (for instance, the economic impact of wasting money on placebo-therapies, or the fact that systematically misinforming the public is highly unethical and counter-productive),
  • and make politicians understand science better than they do at present, perhaps even insist that ministers are experts in their respective areas (i. e. a minister of health fully understands the fundamental issues of healthcare).

Does that mean the new developments in the realm of French homeopathy are all doomed to failure?

No, I don’t think so – at least (and at last) we have a vocal group of doctors protesting against wasteful nonsense, and a fairly sound and accurate statement from a French minister of health:

HOMEOPATHY, IT’S PROBABLY A PLACEBO EFFECT!

 

46 Responses to Finally! An official statement about homeopathy from a French health minister

  • Politicians are usually not good at understanding science or scientific evidence.

    That is largely a problem caused by democracy in a poorly educated society, isn’t? What I find rather worrying in this specific case is that she is a medical doctor. That seems to indicate that she is a bad doctor, is willfully ignoring her knowledge or both.

    • I did not know she was a doctor!
      that is worrying

      • It’s worse. She is not only a doctor, but also a haematologist, cancer researcher and university professor. If anything, she seems to be living proof that qualifications are not all they are cracked up to be. She is also from my generation, one year younger than I am. My own experience at Ghent university in Belgium was not good. If anything, she seems to be at least a very serious indication that there is still a lot of work to do. She brings back bad memories.

        • I just found this quote of her (www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32869-6/fulltext):
          “I want to see scientific rationality brought into our political decision making.”
          It seems to me that she has quickly abandoned her ideals [Boiron is very influential in France!]

          • Terrible, isn’t it, how fast politics can destroy someone’s resolve. Hopefully, my native Belgium will help keep her on the right path. It seems that its Maggie De Block, who is also a doctor, has more resolve. Which is actually refreshing after recent governments all but encouraged quackery (and, although it is now decades ago, I have never forgotten how they named an incompetent to head the anatomy department in Ghent, just to keep a very competent woman away). One has to be grateful for Mickey Mouse steps, I guess.

            Who knows what Agnès Buzyn is really thinking? I sort-of dare hope/fantasise she wants to use all the quacks as lion food in the zoo.

          • Placebos cannot cure and cannot harm. They are truly powerless in and of themselves.

            Is it rational politics to enact policies costing public money but producing no public benefit (or harm)?

            In the case of placebos, a profit is generated for private businesses selling nonsense under false pretences.

            This is good and rational if it helps reduce prescription of toxic treatments?

            What if it doesn’t?

            Why not simply prohibit the prescription of toxic and/or useless treatments?

            Or at the very least oblige doctors to inform their patients when recommending toxic and/or useless treatments?

          • they are already obliged – it’s called ‘informed consent’.
            NO doctor can administer chemotherapy [an example of a toxic drug] without it.
            …and ‘toxic’ drugs are, of course, extremely useful when administered responsibly.
            if they are administered irresponsibly [or uselessly which is the same] the doctor is to blame.

          • Why not simply prohibit the prescription of toxic and/or useless treatments?

            I understand what you mean, but you have to be careful because people may misunderstand it. I hear the demand for non-toxic treatments all the time and sometimes, I can’t help but giggle. It occurs to me that non-toxic treatments are not unlike surgery with scalpels that don’t cut, and I would definitely like my surgeon to use the sharpest scalpel he/she can find.

          • I assume Buzyn does not think it is rational to prescribe placebos for cancer rather than toxic life-savers, as in chemotherapy.

            Prescribe placebos in preference to toxic, useless treatments? No. Better not to prescribe useless treatments at all, toxic or otherwise. Let the state not pay for useless treatments just because patients believe otherwise.

  • Britain, let’s not forget, currently has a ‘Health Minister’ who uses the ‘popularity’ argument.

  • know what happens when we let popularity define medicine:

    https://www.youtube.com/watch?v=zrzMhU_4m-g

  • Prof. Ernst, I do not understand why you interpret Agnès Buzyn´s statement as “some change to the better might be on its way”. Why so optimistic?! According to your translation, she seems to be well aware what a placebo is, that homeopathy indeed is a (quite expensive) placebo, but still she concludes that it “does not hurt” and “everybody wins” when it is prescribed.
    As we know, many (a cynic might even say most) political decisions are made not based on rational conclusions, but are made because of popularity. So if it´s true that the french people do not mind -or even like- homeopathy, I very much doubt that a person like Ms. Buzyn would want to be responsible for any unpopular decisions against it (thus her conclusion).
    And the protests of doctors agains CAM, which have occured for many years in many countries, did not seem to have led to dramatic changes in other EU countries, e.g. like Germany or Austria, as you as a member of the “Münsteraner Kreis” of course know better than most people.

    • I think that protest of experts (not just doctors) has changed a lot. the best example is the UK where NHS expenditure for homeopathy has dropped by >90% in recent years.
      I do not interpret Agnès Buzyn´s statement as “some change to the better might be on its way”” . I did write: “at least (and at last) we have a vocal group of doctors protesting against wasteful nonsense, and a fairly sound and accurate statement from a French minister of health.”
      the two together are encouraging after so many years of apathy in France, I feel – but perhaps I am an incorrigible optimist [as a researcher into alt med, you have to be!].

      • I think it is encouraging. While Agnès Buzyn’s message is certainly worrying given that she is a doctor, she also has to deal with Boiron, one of the world’s biggest quack firms, and a popular one at that. As a politician, that can’t be an easy situation to deal with. Small, almost imperceptible steps may not be ideal, but they might also be the only possibility open to her.

  • it’s a shame for us, french doctors.

  • Brazil’s leading medical journal just published a special edition on homeopathy and homeopathic research. Homeopathy is not alternative medicine…it is MEDICINE! http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302018000200093&lng=en&nrm=iso&tlng=en

    • you are pulling our leg, aren’t you?
      this journal is about as objective about homeopathy as the ‘Vatican Gazette’ about Catholicism.
      “Brazil’s leading medical journal’ – you truly are priceless!

    • Brazil’s leading medical journal

      “Revista de Homeopatia”. Really?

  • “HOMEOPATHY, IT’S PROBABLY A PLACEBO EFFECT!”

    The probability is 1.0.

    ‘Placebos are harmless’. That may be generally true, but it is the use of placebos and the mindset which endorses and tolerates the use of placebos which is so harmful to attempts to advance scientific evidence-based medicine – and that is to be deprecated.

    If a patient gives fully informed consent (‘this pillule is a placebo…’) but finds taking a placebo triggers beneficial emotions and feelings – so be it. But for a state health minister to endorse such nonsense is unethical. And as she is a doctor – unethical squared. She should resign as a minister, or doctor (or both), or face up to the elephant in her consulting room. That is the standard of intellectual and moral probity she owes patients and the French public.

    • But for a state health minister to endorse such nonsense is unethical. And as she is a doctor – unethical squared. She should resign as a minister, or doctor (or both), or face up to the elephant in her consulting room. That is the standard of intellectual and moral probity she owes patients and the French public.

      While I wholeheartedly agree in principle, my conviction wavers in fact: what would resignation accomplish except for a continuation of the sorry policies France has had so far?

      • It would set an example of the standard of probity citizens have a right to expect from ministers.

        • True, but would citizens even notice? As far as I can tell, resignations on principles go largely (or entirely?) unnoticed. I may be wrong. I would hope I am.

  • So what is the worst that could happen id she actually stood up to Boiron? She could suggest that if peoplw really want thier placebos, then they must pay for them themselves. Now th
    at a compromise to me–who would immediately ban them an proscute Boiron for fraud an theft.

    • who would immediately ban them an proscute Boiron for fraud an theft

      As far as I know, homeoquackery – just like religion and a few other rackets – is getting a free ride by law, meaning that even if you can prove that it is nothing more than a thinly and badly disguised swindle (which should be easy, provided you find a judge with half a brain), you will probably be out of luck because of legal safeguards against prosecution.

      Unfortunately, in a democracy, being right is not enough, you have to convince the lawgivers and they are voted in by largely ignorant and uninterested voters, and they are usually expert ignoramuses themselves. As Minister Jim Hacker said in ‘The greasy pole’: “Ministers are not experts. They are chosen expressly because they know nothing.”

      • how is it that, in North America, there is one class action against Boiron et al, and in Europe none?

        • how is it that in North America, there is one class action against Boiron et al, and in Europe none?

          Actually, as far as I know, there have been several. US people love to sue each other, but whether these actions are successful, is an open question I think.
          I see that, here in Toronto at least, Boiron’s quackery is still available everywhere. I haven’t looked closely at them recently due to lack of time, but next time I go to Loblaws, I will try to remember to take a few pictures. I remember they are forbidden from making precise claims on the packaging, but they circumvent that by providing (dis)information on the shelves where the products are displayed for sale.
          The most hilarious thing they do, is a message in almost microscopic letters on the package sending the buyer to Health Canada’s website for more information about their products. Needless to say that Health Canada’s website contains no such information.

          Also, where Europe is concerned, I remember that they are exempt from doing tests “because double-blind trials don’t work for homeopathy”. I have the references somewhere, but if legislation in Europe hasn’t changed in the past few years, it should be relatively easy to find it on the site of European Union.

          Oeuf corse, the claim is wrong. Double-blind trials work perfectly for homeopathy, they show that it is nonsense with – on the whole – indistinguishible from placebo.

        • how is it that, in North America, there is one class action against Boiron et al, and in Europe none?

          I just happened to come across this unsuccessful case against a well-known peddler of quackery and other ‘natural’ nonsense:
          https://docs.justia.com/cases/federal/district-courts/florida/flsdce/0:2014cv61909/447288/45

  • When you know the huge conflicts of interests in the French medical system (including the Mediator case, the infected blood scandal, mandatory vaccines, etc…) , reimbursement of sugar pills may look like a lesser evil.

    • you says we have to chose between corrupt medicine and quackery. why not make sure we have good medicine [in recent years, I have seen better medicine in France than anywhere else – and I had more occasion than I ever wanted to study it close-up]

      • Yes, indeed, you can see good medicine in France. This does not mean that political decisions on medicine are made in the interest of the citizens.

        • This does not mean that political decisions on medicine are made in the interest of the citizens.

          Political decisions rarely are, why would medicine be any different? In democracies, political decisions are usually constructed in ways that are thought to increase the chance of winning the next vote. Changes in the interest of the citizens are usually both inadequate and slow, because the citizens tend to dislike decisions that are in their interest, but they do happen, in ways that are somewhat comparable to evolution by natural selection: only when we look back do we see how far we have come.

          • What I mean is that there is less consequences when the political decision is about sugar pills than about real interventions with possible benefits and harms. In this cases conflicts of interest may be criminal.

          • I am not sure that it is a difference between criminal and non-criminal. arguably, wasting scare funds is criminal too.

          • In this cases conflicts of interest may be criminal.

            When an honest attempt is made to make people better, that is hardly criminal. Mistakes *are* being made. That’s what humans do. Mistakes are not criminal unless they are intentional, and they are not mistakes in that case.
            When people are being lied to, such as promoting homeopathy over vaccines or chemotherapy or insulin, that is criminal.
            The Mediator scandal seems to have been a sad event, but not having studied the case, I would first ask how many people have had better and longer lives thanks to Mediator, before I start to accuse them. I have the impression (I may be wrong, evidence is welcome) that accusations were a bit cheap. When compared to the damage homeopathy is doing by encouraging people to forgo treatment, the latter seems – a priori – far more criminal to me.
            Mandatory vaccines are – as far as I can see – a complete non-issue. Just look at what happens when people get exemptions for religious and other reasons: people start dying. I think I’d prefer to be mandatorily vaccinated than unknowingly being infected and dying as a result. What good is freedom when it doesn’t give you a chance to live? This is one example of the government making the correct decision in the best interest of the citizen, and being accused of wrong-doing. Politicians can’t win, even when they are doing the right thing.
            The French blood scandal seems to have more flesh on the bones, but when I hear about the government not acting on *assumptions* I can’t help but think that a scandal is being created where there should not be one. Even governments are not clairvoyant and it is not particularly honest to accuse them of not making use of scientific *knowledge* that did not exist or was not widely accepted at the time decisions were made.
            Once again, homeopathy is far more criminal, at least from a moral standpoint.

  • You want to put all the French politicians in jail, don’t you? I was talking about homicides.

    • You want to put all the French politicians in jail, don’t you? I was talking about homicides.

      This comment seems to belong somewhere else. Nobody was talking about putting French politicians in jail, and nobody was talking about homicides either.

  • https://en.wikipedia.org/wiki/Benfluorex
    Each decision should be in the interest of the patients. If there is COI, it can’t be. Obviously, having such a COI as to say that homeopathy should be reimbursed suggests that in more difficult questions, with real treatments, there is a risk to create more damage.

  • From the article referred to:

    However, Servier is suspected of having marketed Mediator (benfluorex) at odds with the drug’s medical properties.

    That says a lot, doesn’t it? In a civilised society, people are – in principle and hopefully – not punished for someone else’s suspicions.

    • “The drug is thought to have caused between 500 – 2,000 deaths”. How many deaths with homeopathy?

      • “The drug is thought to have caused between 500 – 2,000 deaths”.

        How many lives has it saved? And how was the combination of deaths/lives saved worse (or better or similar) than competing products? Put another way: how many people would have died without the Mediator treatment?

        Note that I am not defending anyone. I am only pointing out that the information in the media – as usual – is sensationalist and less than objective.

        How many deaths with homeopathy?

        Nobody knows: homeopaths are very thorough in their avoidance of records and statistics. Lack of knowledge is not proof of guilt, but it is also not proof of innocence, and given the zeal with which homeopaths avoid records and statistics, there are good reasons to suspect they know that their practices are no good. Suspicion is not enough for conviction, however. And let’s not talk about the fact that they are impressively unqualified for practicing medicine in the first place. Medicine is about reality, not poetry.

        • Mediator can’t be said to have saved any live. It was sold for “glycemic control” but it was an anorectic drug not better than other amphetamines, and had specific side effects on the heart and vessels that were highly predictable.
          Homeopathy could cause death if it induced a delay in cancer treatment, but there is no proof of that. It may be that homeopathy believers do not believe in conventional medicine, and for that reason, would have delayed treatment anyway.
          Another way to see the problem, a thought experiment : you have a chronic disease, you must see only one GP, the guy believes in homeopathy, and he prescribes you sugar pills and a potent drug with side effects. To get reimbursed from the consultation, you must buy at least one product. Which one would you choose? I’d choose the sugar pills.

          • “I’d choose the sugar pills.”

            Then you’re blindly failing to take account of the detail. What is the chronic disease? Is it expected to shorten your life? Cause a lot of pain? What is the “potent drug with side effects”? How efficacious is it proven to be in relieving the symptoms of your chronic disease? What are the side effects? Do you have any pre-existing conditions that make severe side effects more likely in your own case?

            In other words, it’s the specific risk:benefit ratio that’s important in judging appropriate medication, and any competent doctor will be aware of that in recommending an individualized treatment for you. (Yes, real medicine takes account of individual circumstances.)

            Your thought experiment is over-simplified nonsense. Any GP who “believes in homeopathy” has failed to understand her science training. A recent paper suggests that doctors who prescribe homeopathy tend to be less competent at prescribing conventional medicine. (This story has also been reported here and here and here.)

            Unlike you, I’d personally shy away from any qualified medic who recommended homeopathy, particularly if they didn’t provide any opportunity for ‘informed consent’ — including a statement that there’s no evidence for any effects of homeopathy beyond placebo.

          • I would not be so absolute. I have not studied the case in any depth, but my first impressions based on the article you referred to (https://en.wikipedia.org/wiki/Benfluorex) are different. The very first reference in that article, a study made in 2006, conludes this:
            Benfluorex as an add-on therapy was superior to placebo in lowering A1C with a between-group difference of 1% in type 2 diabetic patients whose disease was insufficiently controlled with sulfonylurea alone and in whom metformin was contraindicated or not tolerated.
            1% does seem ridiculously small and it seems unlikely that this would have any clinicallly noticeable effects. It may well be one of those statistical flukes homeopaths so eagerly exploit.

            Also, it was used in the *hope* it would make a difference in patients who are not reacting well to more conventional medications, as well as to help them lose weight. In other words, these were patients who were already in more trouble than the average diabetic and could therefore use every bit of help available.

            What seems far more troublesome – again, at first sight – is this:
            It was also hugely misprescribed, with doctors routinely handing out Mediator as an appetite-suppressant for people with common or garden weight problems.
            Source: http://www.bbc.com/news/world-europe-12155639

            Doctors should not prescribe treatments, any treatments, when they are not necessary. They should prescribe the ‘best available’ treatments. But what can they do with patients who are unwilling or unable to do their part of the work?

          • Unlike you, I’d personally shy away from any qualified medic who recommended homeopathy

            Which is exactly what I have done myself a week or two ago. There is no way I am going to seek advice from someone who has proven herself/himself to be incompetent.

Leave a Reply

Your email address will not be published. Required fields are marked *

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories