By Jack Aslanian
Since I last commented in this forum (see EMWA Webeditorials, Exacerbated Antipathies) things have moved along in France — to the detriment of homeopathy and users of homeopathic pharmaceuticals...
In 1984 the French government had concluded that it had the means to offer citizens a Social Security benefit consisting of a 30% reimbursement on the cost of homeopathic preparations they purchase. Now, following hearings and debates dragging over a couple of years or so, the Ministry of Health finally has ruled to reverse 35 years of tradition, declaring that homeopathic preparations have no scientifically determinable benefits, no proof at all that they are effective (but also none to the contrary, one must note here for full transparency), and therefore they are not entitled to favourable treatment in the national budget. So, the government progressively will eliminate that particular subvention — pare it down to 15% in 2020 and abolish it by the end of 2021. In comparison with the ravages fervidly and insatiably meted out in France by the Gilets Jaunes (Yellow Vests) (and other coincident movements) the polemic that has besieged homeopathy has been — though not negligible — rather tame and pale by French standards of contentious activism, protest and confrontationalism.
This update to my Exacerbated Antipathies would deserve closure at this point but for the fact that the coverages of the topic in the mass media come across as patchy and scattered with facile over flights and double-edged assertions susceptible to conflicting and questionable interpretations. In rationalizing the abolition of reimbursement for homeopathic formulations various concepts, mainly epithets have been bandied by public figures and professionals (among the latter mainly allopaths and health scientists) and have been rehashed in the media: placebo, quackery, charlatanism, chicanery, sham, “fakemed”, patient safety, greed, lobbies and interest groups, health care economy, pharma industry, fiscalisation of pharma, pseudo science, pseudo religion, scientific methodology, conventional versus unconventional medicine, and most crucial among them the cost of health care and the need to have scientific, replicable proof of efficacy of any treatment — especially those to be financed by taxpayers. The proponents of homeopathy in turn have concerns that deserve at least mention here: the government’s decision is going to result, they aver, in fewer jobs in the pharmaceutical industry; institutions that have been teaching homeopathy will close [some have already]; the relationship between homeopathic practitioners and their patients will be influenced by the government’s public disapproval of homeopathy; the two-centuries old public image and credibility [such as it has been] of homeopathists will be eroded.
I must confess here being spellbound by the concept of “granules”, which are iconic to homeopathy, but for the sake of brevity I will detour widely around the often sanctimoniously delivered echogenic judgments that there is no scientific proof that homeopathy has any benefits. Skirt also around “integrative or alternative medicine” and etcetera. It is very disheartening, however, that the debate on the fate of homeopathy has not manifested a logical symphony of facts. On the fiscal side for example, the Minister of Health, apparently an allopathist by training, sounded that it was time to “place scientific rigor in the heart of policy”. Prudent governance and periodic reviews of budgets of course are in the purview of, in fact incumbent on, governments, but the published figures invoked to castigate homeopathic practices invite concerns about the expediency of focusing on cost as a prime, even if not the sole, justifier of policy change.
Dear cost-conscious Messieurs et Mesdames, can you not discern here a storm in a teacup? To wit, the total spent by the French treasury, therefore ultimately by French taxpayers, on the health of its residents in one recent year was 200 billion (“milliard”) Euros; included in which is the cost of all pharmaceutical products consumed nationwide, 20 billion €. Whereas the 30% of out of pocket cost government reimbursed to consumers in the same year for the purchase of homeo-pharmaceuticals amounted to 126.8 million. Voila! That makes the cost of that budget item 0.635 percent and 0.0635 percent of national totals for all medicinals and all health care, respectively. That is such a miniscule fraction — Mais oui mon ami — and certainly not an unsupportable amount when some other benefits of homeo-therapy, perhaps less easily quantifiable ones, or ones more open to debate, are given the benefit of doubt and taken into the equations. Those of us familiar with the theories and practices of homeopathy cannot avoid noting the irony, the poetic justice one could say, in juxtapositions of those figures. For homeopathic preparations in use are super dilutions in water or alcohol of allegedly bioactive compounds — in the order of, say, 1:50,000 or 1:500,000, or even more dilute. (These magnitudes of dilution have been chosen to exemplify the point here: homeopathic preparations could in fact be many, many, many times more dilute.) Draw any conclusions you will keeping in mind the underlying tenet of homeopathy — that likes cure likes. Rebuffed homeopaths may take perverse pleasure and gloat that in the total costs of pharmaceuticals or of health care in France the portion attributable to homeo-pharmaceuticals is as infinitesimally dilute in the national budget as are the concoctions of homeopathic pharmacies bundled in their charming granules.
The national figures I highlighted above and those that follow below are sourced, for the most part, in articles in various issues of Le Figaro, Le Parisien and a few other newspapers (spring and summer of 2019). They are the most often cited in the media, but there are inconsistencies in reportage between newspapers and over time. Despite such inconsistencies, the figures are useful enough, however, for making a few points and questioning the logic of the final decision of the Ministry of Health. One cannot, for example, help but to wonder, if in the haste to achieve de-reimbursement, the decision makers are not dumping the baby out with the bathwater. The mass media tell us that 70% of the French use some kind or another of homeotherapy, and that some 20,000 French physicians (about 4,000 of them considered trained and/or formally qualified in homeotherapy) resort to homeopathic treatments. And we are told that patients followed by homeopathic physicians use overall 3.4 times fewer psychotropic compounds and half as many antibiotics! [Emphasis is mine, and intentional.]
Well, ahem! Don’t you see cost cutting here? Is patient safety in greater jeopardy? Is there causality or just a correlation? Could these very compelling observations be the consequences directly of the activity of the homeopathic preparations themselves? Of their fortuitous combinations with other compounds and applications concomitantly prescribed by physicians? Or of the placebo effect?
Placebo has often been highlighted as a culprit to malign homeotherapy, but please let us be indulgent, and avoid bias and blind dogma. After all, if a medical condition improves because a placebo has been administered, what is wrong in that usage? As long as it is not harmful. Inefficacy is not the same as harmfulness. Or is the placebo effect when conscripted into alliance by allopaths (Oh, yes, they do!) more conscionable than when mobilised by homeo-pharmaceuticals? The “transference of expenditures” also is an issue here. You pay for increased use of allopathic preparations, or you pay for reliance on homeopathic ones. Allopaths often use treatments that have not been proven effective or beneficial. Allopathic pharmaceuticals are in general more costly than homeopathic preparations. And who these days could dismiss as irrelevant a 50% reduction of antibiotic usage or hugely reduced use of psychotropics. Whether achieved with the help of a placebo or not? Or on the other hand, is the French emasculation of homeopathy, specifically, and the disfavour meted on integrative medicine, in general, part of machinations to ensure that in a very competitive market allotherapists and allo-pharmaceuticals [sic] thrive — with fewer competitive hurdles and fewer partitions of the proverbial pie?
So who are the losers and who the winners, also? Down the near and, eventually, far range, allopathists' egos will be inflated, and they’ll soon clamour to demand dispensation of shares from the 127 million Euros the French Ministry of Health and the French treasury have plucked away from the homeopaths. Further, there will be among citizens now restive about the government’s fiscal policies those who may find a bit of comfort and hope for the future in the very token budgetary adjustment thus achieved by the Minister of Health. Yet, it is unlikely that homeopathy, over two centuries in longevity, will be universally or perpetually abandoned by its practitioners and lay adherents. Reimbursed or not, it has been around too long. Any new system or systems of health care we invent, or adapt by tweaking existing systems, is eventually — sooner rather than later — going to manifest inherent, unforeseen weaknesses and unsuitabilities. Homeopathic preparations more than likely will yet endure and be used — perhaps sedately acting only as placebo standbys when other health crises have emerged, or have failures of allotherapies... Vide the destabilisations wreaked by the recent emergence of the opioid crisis... As for ups and downs in the fortunes of nations, those occurrences and recurrences are more certain than any definitive demise of homeopathy.
A physician, medical editor, and member of EMWA and AMWA, Jack Aslanian maintains an ongoing interest in alternative medicine.