“Le Figaro” has published two articles (one contra and one pro) authored by ‘NoFakeMed’ (an association of health professionals warning of the danger of fake medicine) signed by a long list of healthcare professionals (including myself) who argue that so-called alternative medicine (SCAM) should be excluded from public healthcare. It relates to the fact that, since last June, a committee set up by the French government has been bringing together opponents and supporters of SCAM. At the heart of the debate is the question of how SCAMs should be regulated, and the place they should occupy in the realm of healthcare. Should they be included or excluded?
Here is the piece arguing for EXCLUSION (my translation):
They’re called alternative medicine, complementary medicine, parallel medicine, alternative medicine, SCAM, and other fancy words. The authorities prefer to call them “non-conventional healthcare practices” (NCSP), or “non-conventional health practices” (NCHP). The choice of terminology is more than just a parochial quarrel: it’s a question of knowing what quality of medicine we want, and whether we agree to endorse illusory techniques whose main argument is their popularity. This raises the question of how to regulate these practices. Some people want to force them into the healthcare system, hospitals, health centres and nursing homes. And they are prepared to use all manner of oratory and caricature to legitimise questionable practices.
Unconventional healthcare practices are on the up, and the number of practitioners and practices has been rising steadily since the 2000s; there are now around 400 therapeutic NHPs. But their success is often due to a lack of understanding of the philosophy behind them, and their lack of effectiveness beyond context effects. This was seen in the debate surrounding homeopathy, which lost much of the confidence placed in it as soon as it stopped to be reimbursed in France and was confronted with the work of popularising it on its own merits among the general public. The ethical imperative of respect for patients means providing them with reliable information so that they can make a free and informed choice.
This raises the question of the place or otherwise to be given to NHPs within the healthcare system. Although there are many different names for them, they are all practices that claim to relate to care and well-being, without having been proven to be effective, and based on theories that are not supported by scientific evidence. Admittedly, the evidence is evolving, and a practice can demonstrate its usefulness in healthcare. This is true, for instance, of hypnosis, whose usefulness as a tool in certain situations is no longer debated since it has become possible to measure and explain both its benefits and its limitations.
However, there is no question of legitimising the entire range of NHPs on the pretext that they are supposedly harmless. Many of them do have adverse effects, sometimes serious, either directly or because they lead to a lack of care. These effects also exist with conventional treatments, but the risks must always be weighed against the proven benefits. The risks associated with NHPs are therefore unacceptable, given their ineffectiveness.
Furthermore, there are abuses associated with NHPs, even if (fortunately!) they are not frequent. Sectarian aberrations are not systematically linked to NHPs, but here again the risk is unacceptable. In its 2021 activity report, Miviludes indicates that 25% of referrals concern the field of health, and that 70% of these relate to SCAM. The number of health-related referrals has risen from 365 in 2010 to 842 in 2015, and exceed 1,000 in 2021.
Conventional medicine is of course not immune to such aberrations, and Miviludes estimates that 3,000 doctors are linked to a sectarian aberration. But the health professional associations have tackled the problem head-on, notably by setting up a partnership with Miviludes and multiple safeguards (verification of diplomas and authorisation to practise, obligation to undergo continuing training, codes of ethics and public health codes, professional justice, declaration of links of interest, etc.). The professional associations have raised awareness of sexual and gender-based violence, universities are providing training in critical reading of scientific articles, and community initiatives are flourishing to improve public information.
We agree that the choices of our patients must be respected, and everyone has recourse to the wellness practices of their choice. But, at the same time, patients have the right when they consult a healthcare professional, a hospital or a health centre, to know that they will be looked after by healthcare professionals offering conscientious, dedicated, evidence-based care.
In view of the current challenges facing our healthcare system, the response must not be to offer more pseudo-medicine on the pretext that people are already using it. The real answer is to rely on evidence, to provide resources for more research, to continue with research, to rely on social work, not to neglect mental health, to improve disease prevention, and to keep pressure groups at bay, whether they come from pharmaceutical companies or the promoters of esoteric, costly and sometimes dangerous practices.
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Tomorrow, I will translate and comment on the pro-piece that ‘Le Figaro’ today published alongside this article.
PS
The list of signatories can be found in the origninal paper.
8 Responses to ‘Le Figaro’: Should unconventional healthcare practices be integrated into the public healthcare system?
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Wow that’s a cogent piece. I especially like the last two paragraphs.
This guy is interested in the frauds, no matter who promotes them:
https://robertyoho.substack.com/p/i-went-to-vegas-and-snuck-into-an
Ernst, Dear chap.
This topic is similar to the longest-ever running debate on the Economist online. If memory serves, “should medical students be taught about alternative medicine?”
It ran so long presumably because it did not come up with the “right” answer.
That debate (but not the others) – fascinating as it was – vanished from the online archive when the Economist group changed ownership in 2015.
Mainstream cancel culture, well under way. But a takeover at that level seems extreme. Or else, mere coincidence.
My view is that yes, practitioners should know something about what their patients are doing, keep an unprejudiced mind, and learn when something seems to be helping. Pretty much what old-school doctors did before the pseudo-skeptic nonsense.
And that there should be freedom to choose, and financing available without prejudice where appropriate.
Anecdotally, I had a brief conversation with a young man years ago, in a bookshop where I noticed he was researching herbal topics. It transpired he had a liver disease. His specialist had told him he was doing the best of his cohort, he said. He was using an adjunct herbal treatment, he told me, but his specialist was vehemently against such things, so had not been told.
Thus no learning, no proper assessment, no potential research. Not even any awareness if there were adverse outcomes.
Incidentally, he was using aloe vera juice.
Various reports suggest this may be helpful, but only if the juice is unpasteurised.
And yet, under marketing rules, companies selling the juice when it has been pasteurised, are permitted to do so without stating that fact.
Strange and devious regulation.
Merry Christmas, old bean.
I would agree that prospective doctors should learn something about alternative medicine. Mainly so that they will be aware of its potential dangers whether that be patients neglecting prescribed medicines in favour of ‘alternatives’, presenting with the harmful side effects of such treatments or risking interactions between prescribed medicines and herbal remedies.
Know your enemy is good advice.
that was my thinking while teaching medical students
Socrates: ah, but that was not the main thrust of the debate (Economist). As I said, it didn’t produce the “right answer”.
At length.
A good doctor would also know when adjunct therapies may be useful, and not think of them as the enemy.
On the other hand, an uninformed, ignorant, censorious attitude will ensure that your patients do not share information, and you learn nothing.
But certainly you must know when foods and other remedies might turn your medications into lethal poisons, and be able to recognise the signs.
Am I wrong?
yes
If you look again you will see I’m not advocating ignorance, quite the opposite.
I’ve no issue with a doctor saying “by all means take x if it makes you feel better, so long as you keep taking your medicine”. But the doctor needs to know that x will not prove harmful and must make it clear to the patient when that is the case. This need not be in a censorious or patronising way.