The placebo defect: battle lines drawn over the French love of homeopathy

Looming standoff gets to the heart of conflicting visions of the state’s involvement in the country’s health system at a time of eroding quality and services

(FILES) This file photo taken on September 3, 2018 shows tubes of homeopathic granules at a pharmacy in Lille. Defenders of homeopathic medicines were heard by the French High Health Authority (Haute autorite de sante) on June 12, 2019 to try to maintain their reimbursement. It will give its final decision on June 28, 2019. / AFP / Philippe HUGUEN
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In virtually every French family’s medicine cabinet, there is at least one tube of spherical pills that look something like Tic Tacs. Just like the mints, they consist mainly of sugar and melt pleasantly under your tongue, but these are not candies. They are homeopathic medicine with Latin names such as Arnica montana and Passiflora that many French and their doctors swear by.

Now these alternative remedies for aches, stress, insomnia and more are under siege as a debate rages over whether the government, which subsidises about a third of their costs, should continue to pay.

A health panel is set to rule at the end of the month on the future of funding for homeopathy, a 200-year-old practice that critics dismiss as ineffective and possibly dangerous. Unlike the riotous Yellow Vest movement, this controversy has not spilt on to the streets. Instead, the pro-homeopathy forces are mobilising for a fight via social media, organised meetups and leaflets handed out in pharmacies across France.

Critics say the pills are no more beneficial than the Tic Tacs they bring to mind, and that state funding legitimises homeopathy.

The looming brawl gets to the heart of conflicting visions of the state’s involvement in the country’s health system at a time of eroding quality and services. Jobs are also at stake: France is home to Boiron, the leader in a global homeopathy market estimated at more than $30 billion (Dh110bn).

Boiron’s pills and tinctures have long coexisted with conventional care in France, prescribed by regular doctors and dispensed in almost every pharmacy. Ending public support for the remedies would discredit homeopathy and “send a shock wave” through the industry worldwide, says Boiron’s chief executive, Valerie Poinsot.

“We’ve been caught in this storm for the past year,” Ms Poinsot says. “Why the hostility, when we contribute to caring for patients?”

Critics say the pills are no more beneficial than the Tic Tacs they bring to mind, and that state funding legitimises homeopathy, encouraging some to shun conventional medicine just when they need it most – treating a deadly cancer, for instance.

Facing a possible backlash, Boiron, in Lyon, teamed with rivals Weleda of Switzerland and closely held family group Lehning to fund a campaign called MyHomeoMyChoice. The push has garnered a little more than a million signatures in an online petition and placed bright-coloured posters framed with the recognisable little white pills at pharmacies across the country.

“Homeopathy has treated generations of French patients,” says one slogan. “Why deprive future generations?”

For now, French people can walk into any pharmacy and buy a tube of Arnica granules – recommended for shocks and bruises – or roughly a thousand other similar remedies for €1.60 (Dh6.70) with a prescription, because the state health system shoulders about 30 per cent of its cost. In some cases, private insurers cover the remainder and patients pay nothing. That may all soon change. A science agency is wrapping up a study of the relative benefits of alternative medicine that will inform the government’s position: keep the funding, trim it or scrap it altogether.

If the government cuts funding, Boiron would instantly feel the pain. Ms Poinsot estimates that sales of reimbursed treatments could plummet by 50 per cent in France, where the company brings in almost half its revenue. The company’s stock price has lost about 13 per cent since May 15, when a French newspaper wrote that the panel reviewing homeopathy funding would probably rule against it.

France’s public health system needs money and the government is cutting costs, but homeopathy does not weigh heavily in the balance. The cost to the public health system was about €127 million last year, less than 1 per cent of overall pharmaceutical spending. This fight is more about diverging views of alternative medicine and the state’s role than savings.

The tide has already turned against homeopathy elsewhere in Europe, notably in Spain and the UK, where the National Health Service advised doctors to stop prescribing such remedies in 2017, saying it is “at best a placebo”.

In France, the controversy first erupted last year when the influential Le Figaro newspaper published a letter from a doctor's collective called FakeMed lambasting alternative medicines. The authors called for ending support of "irrational and dangerous" therapies with "no scientific foundation". The ensuing debate prompted Health Minister Agnes Buzyn to place funding under review and ask the country's High Authority for Health to rule on homeopathy's scientific merits.

That is where things got complicated. Homeopathy’s purported method of action requires a little suspension of disbelief. The medicines are made by diluting an active ingredient (think tree bark, squid ink or snake venom) to the point where there is little or no discernible trace left – suggesting the water that held them retains some memory of the original structure.

If that sounds wacky, plenty of French say “au contraire”. Boiron’s Ms Poinsot points to a five-year series of surveys among physicians, funded by the Lyon company and conducted by independent scientists. It found that patients treated with homeopathy for muscle and bone pain, anxiety and respiratory infections had outcomes similar to those consuming more costly conventional remedies such as antibiotics, antidepressants and painkillers.

It is unclear whether anyone in France has been harmed as a result of using homeopathy. Some regulators warn of quality risks and few high-profile scientists endorse the approach or its underlying system. But one who does is a star – Luc Montagnier, the French virologist who shared a Nobel Prize for discovering the HIV. He says water appears to retain a signal from substances that dissolve in it, lending credence to the dilution concept.

Critics see homeopathy through an entirely different lens and dismiss Mr Montagnier as an aging eccentric. They view alternative medicine as unscientific, dangerous and a waste of public funds.

David Beausire, a doctor in palliative care at the hospital in Mont de Marsan, in southwest France, is among those who signed the FakeMed letter. Mr Beausire, who sees many terminally ill patients, said he regularly gets people who consult too late because they first explored alternative medicine paths that include homeopathy.

"I am not an extremist," he says. But homeopathy's reimbursement by the state health system gives it legitimacy when "there's no proof that it works". The takeaway from clinical studies is murky at best. A review by the charity organisation Cochrane Collaboration found no impact beyond a placebo in children with respiratory tract infections. Similarly, Australia's medical research council concluded after a review of 157 studies that the evidence did not provide a high enough level of confidence to support efficacy.

Proponents say trials intended to evaluate a single drug targeted to a single ailment do not work well for homeopathy, which tailors remedies to patients based on their profile and personality – not their symptoms, as is the case with conventional medicine. So two people with an ear infection may not walk out of the doctor’s office with the same prescription.

“Homeopathy is a form of personalised medicine,” says Florian Petitjean, president of Weleda in France and a pharmacist by training.

“That’s really the crux of the problem.”

Stung by accusations of quackery, Antoine Demonceaux, a doctor and homeopath in Reims, founded a group called SafeMed last November to relay the message that homeopathy has a role to play alongside standard care. He points to the growing number of cancer centres offering consultations to relieve treatment-related symptoms, such as nausea, with homoeopathic medicine.

Mr Demonceaux says neither he nor his colleagues would ever use homeopathy as a substitute for treatments intended to, say, shrink tumours.

“A general practitioner or a specialist who’d claim to be a homeopath and to cure cancer with homeopathy? Just sack him,” he says. “Let’s get real. We are doctors.”