fake médicine: Science-based medicine versus homeopathy in France

Homeopathy Awareness Week started three days ago, on April 10, as it does every year because that’s the birthday of Samuel Hahnemann, the man who dreamt up homeopathy roughly 220 years ago. As I said at the time, I, like so many other skeptics, wanted to help celebrate this yearly occasion by reminding everyone that homeopathy is The One Quackery To Rule Them All. I figured that I couldn’t let the week go by without at least one more post about homeopathy, and, in fact, I couldn’t avoid the topic. While on Twitter, I saw something about “fake médicine”:

Yes, it’s from France. It reminded me of another story I discussed from France a while ago, in which Nobel Laureate turned antivaccine and pro-homeopathy crank Luc Montagnier made an appearance in which he tried to argue that vaccines could cause sudden infant death syndrome. This time around, it’s more about homeopathy. Unfortunately, like the story about Montagnier, there is very little in the way of English language reporting on this story. That always makes me leery of taking on a story, because I fear that I’ll miss something important and get the story wrong. On the other hand, I have a great antipathy towards quacks who try to silence critics with legal thuggery, as my posting history makes plain. Also, even after 30 years I can still read and speak French well enough to get the gist of most articles I read without using Google Translate. So I decided to dive in and see if I could figure out what’s going on.

It didn’t take me long to come across at least one interesting Tweet:

This is Agnès Buzyn, ministre des Solidarités et de la Santé (Minister of Solidarity and Health), stating support for homeopathy, specifically, “If it continues to be beneficial, without being harmful, it will continue to be reimbursed.” This is a pretty damned irresponsible thing for any minister of health in any country to say. Twitter was not pleased:

But what is this all about? It didn’t take me long to find a website called fake médicin, which contains a statement by 124 French doctors condemning alternative medicine and homeopathy in particular and calling on the French government to stop funding homeopathy and other alternative medicines. There’s an English version there too, but the statement is still worth citing fairly extensively. The doctors behind this statement begins by invoking the Hippocratic Oath as one of the oldest known ethical commitment that “requires a physician to provide the best possible care to his patients, in the most honest way,” noting that these two obligations “require a physician to continually seek to improve his or her (medical) knowledge and to inform his patients about what he can reasonably offer, as well as what treatments are unnecessary or contra-indicated.” It also cites French law:

…they forbid charlatanism and deception, impose the prescription and distribution of treatments for which the efficacy was established. They also proscribe the use of obscure remedies or remedies which do not clearly list the substances that they contain.

You can see where this is going with respect to homeopathy. The statement goes on to point out that the French General Medical Council is responsible for ensuring that its members “do not use their credentials to promote practices for which science was unable to demonstrate their usefulness or practices which can even be dangerous” and “do not become sales representatives of unscrupulous industries.” Here’s where the hammer falls, when the statement points out that the General Medical Council still tolerates practices that “are at odds with its own code of ethics” and that “public bodies organise or even contribute to the financing of some of these practices.”

Before I get to the meat of the statement, I was wondering just who was behind the fake médicine website. The site’s authors describe themselves as:

We are a group of health professionals with a wide variety of specialties and methods of practice. Our common viewpoint is that medicine must adapt its practices to the facts and seek to disseminate these facts by popularizing via Youtube videos, blogs, or through social networks.

We are not an association, we are perfectly apolitical and we are not driven by a conflict of interest, except perhaps the promotion of critical thinking.

In the era of “fake news”, fashionable term but serious issue, we have long noticed the activism of pseudo-medicines on the internet, trying to discredit our discipline to better sell theirs. We have also seen the damage that such speech can produce in the health field, such as anti-vaccine movements, or other conspiracy movements.

Yes, support for science-based medicine is important, and this group has it. The authors note:

The so-called “alternative” therapies are ineffective beyond any placebo effect and can even prove to be dangerous.

  • They can be dangerous because they treat irrelevant symptoms and over-medicalise populations, giving the illusion that any situation can be solved with a “treatment”.
  • They can be dangerous because they fuel and rely on a fundamental distrust of conventional medicine as shown by the unjustified polemics surrounding vaccines.
  • Finally, They can be dangerous because their use delays the diagnoses and necessary treatments, sometimes leading to dramatic consequences, especially in the treatment of serious diseases such as cancers.

I couldn’t have said it better. It’s also noted that support for pseudomedicines (i.e., quackery) is also a waste of money that taxpayer francs should not be spent on. Indeed, in France, homeopathic products can be reimbursed at a rate of 30% (but up to 90% in the Alsace-Moselle region) and benefit from a preferential status that exempts their manufacturers (like Boiron, a French multibillion dollar company) from having to demonstrate their efficacy.

So here’s what fake médicine calls for:

We urge the French General Medical Council and the French public authorities to make every effort to:

  • No longer allow physicians or healthcare professionals to continue to promote these practices using their professional credentials.
  • No longer recognise in any way homeopathy, mesotherapy or acupuncture diplomas as medical university degrees or qualifications.
  • Ensure that Medical Schools or institutes which deliver health trainings, may no longer issue diplomas covering medical practices for which the efficacy was not scientifically demonstrated.
  • No longer reimburse health care, medicines or treatments from disciplines which refuse to subject themselves to a rigorous scientific assessment.
  • Encourage initiatives aimed at delivering information on the nature of alternative therapies, their deleterious effects, and their real efficacy.
  • Require all caregivers to abide to the deontology of their profession, by refusing to deliver useless or ineffective treatments, by offering care in accordance with the recommendations of learned societies and the most recent scientific evidence and by demonstrating pedagogy and honesty towards their patients and offering an empathic listening.

Each and every one of these demands is something that I can get behind totally. Some of them are even applicable to the US.

So far, as of my writing this, there are 1,929 signatories:

of which 822 in medicine, 111 in care, 99 pharmacy, 75 in physiotherapy
229 in education education or research
253 in engineering or computer science
7 in dental, 5 in midwifery
and 329 in many other activities and who feel concerned.

The complete list of signatories is here.

It also didn’t take me long to find out that there’s a hashtag created by these same French physicians, #fakemed. The activity on this hashtag has not gone unnoticed:

More importantly:

And:

And:

And:

Just click on the Tweets and hit the “translate” button if you don’t know enough French to figure out what is being said.

And:

It turns out that the statement caused a major kerfuffle in France, as alluded to in the first Tweet I cited above. I looked for an English language story about the dustup, but basically failed to find a good one. I did, however, find a story in the French version of Slate, Fake médecines, vraies questions de société, or Fake medicines, real issues for society. Here’s what’s been happening.

On March 18, the fake médicine text was published in a column in Figaro. Addressed to the National Council of the College of Physician, the initiative and statement were spearheaded by doctors who are active on YouTube and other social media, François, author of the Youtube channel Primum non nocere and Jérémy Descoux, of Asclepios. The reaction was swift and nasty (translation a combination of Google Translate and myself changing the wording when I can to make it less clunky English):

The next day, reactions were not delayed. On March 19, Jérémy Descoux was invited on the set of LCI to defend the terms used in his statement . Its opponents unanimously condemned the approach: The benefits of popular medicines would be misunderstood; the practice of these by medical doctors would protect risks of abuse; and we should not risk undermining the flourishing French homeopathy industry. On March 20, it was the turn of science journalist Mathieu Vidard, host of the radio show La tête au carré, to express in an editorial his disagreement with the terms of the platform : according to him, this one would continue the chimeric ideal of a purely rational medicine. Those of you who pay attention to these things will recognize the sorts of logical fallacies, bad arguments, and misinformation used by Vidard. First, Vidard accused the doctors of “arrogance”:

Surfing on the theme of fake news, our doctors disguised as white geese drape themselves in the arrogance of their scientific respectability to knock – I quote – these false therapies with illusory efficacy.

Then there was the predictable appeal to popularity:

If this statement was not frankly insulting to practitioners as well as to the 40% of French people who resort to alternative medicine, we would have fun arguments of these fathers morality.

I like to respond to this by saying that the fact that one third of Americans believe in ghosts doesn’t mean that ghosts are real. The same is true of homeopathy. That 40% of the French public has used homeopathy doesn’t mean homeopathy works.

There was an invocation of the “magic” of placebos:

And they are right since no serious study has proven so far any effectiveness of this therapy [homeopathy]. The scientific content of alternative medicines is empty. Nothing but the placebo effect. So what?

Can all the allopaths boast of being able to treat each disease rationally? No, of course not.

So is not it possible to admit that there is sometimes a part of magic to cure?

At least he admits there’s no science behind homeopathy and alternative medicine.

Next up, the appeal to “holism” and the “human touch”:

In the conclusion of their statement, the 124 demand that all caregivers respect ethics and that they offer to their patients a benevolent listening. We had to dare! Because it is precisely because of dehumanized conventional medicine that patients who are tired of being considered as mere limbs turn to practitioners who can spend time with them and listen to them.

As I like to say, if the problem in modern medicine is insufficient empathy and not enough time to give the patients a “benevolent listening,” the solution is not to farm that function out to quacks. It is to train doctors to do better and change the financial incentives in the system to value face-to-face time with patient far more than our current reimbursement system does. Hilariously, right after this passage, Vidard claims that attacking the “humanistic function” of homeopaths and doctors using alternative medicine, the 124 risk driving patients into the arms of real quacks. Yes, I’ve lost track of how many fallacy-filled articles like Vidard’s I’ve deconstructed over they years, just in English.

Helpfully, Beatrice Kammerer, the author of the Slate.fr article, lists the fallacies used by defenders of homeopathy and gives several examples. Here are the fallacies:

  1. “Medicine is not only rational.” My response: True, but that does not mean medicine should embrace the irrational and pseudoscientific.
  2. “Scientific medicine is cold and dehumanized.” See my answer above.
  3. “The doctor’s role is not to tell me what to believe in.” My response: No one says that it is, but a doctor’s role is to recommend therapies and treatments with scientific evidence supporting their efficacy and safety. Homeopathy fails on that account.
  4. “If doctors are forbidden to prescribe homeopathy, people will rush to charlatans!” See my answer above.
  5. “Just because science does not understand how unconventional medicines work does not mean that they are ineffective.” My response: This is putting the cart before the horse. Show compelling evidence of efficacy. Then we’ll talk. Many of these medicines are claimed to work through impossible mechanisms. Homeopathy is an excellent example. For homeopathy to work, several well-established laws of physics and chemistry would have to be not just wrong, but spectacularly wrong.
  6. “Homeopathy may not cure, but it is good for many people.” My answer: The only people homeopathy is good for are homeopaths and the stockholders of Boiron and the owners of companies manufacturing homeopathic remedies.

Of course, homeopaths being homeopaths, the entirely predictable result of a serious threat to homeopathy has resulted in complaints to the College of Physicians about some of the doctors behind the fake médicine:

Here’s a story in Le Monde telling the tale:

The tension hasn’t decreased among doctors after the publication of a statement signed by more than 120 health professionals, March 19 in Le Figaro, against homeopathy and other alternative medicines . Following this text, the daily affirms, Thursday, April 12, that trade unions of homeopathic doctors, mesotherapists or accupuncturists have filed a complaint with the council of the order of the profession against 10 of 124 signatories – five doctors who expressed themselves in the media after the publication of the podium, and five others who signed it.

The statement castigated in particular “practices neither scientific nor ethical, but very irrational and dangerous” and spoke of “fake medicine ” (“false medicine”). The signatories asked the Council of the Order, “do not allow doctors or health professionals to use their title who continue to promote” these practices.

The unions criticize remarks as “offensive, defamatory and even insulting” and “contrary to the ethical principles of confraternity, consideration of professsion”, reports Le Figaro. They demand a “public apology.”

When a complaint is lodged with the Medical Association, the first step is an attempt at conciliation. If the mediation fails, “we will then draw lots of doctors from the list of [the signatories] every fortnight for new complaints,” warns Dr. Meyer Sabbah, the source of the complaint.

This is, of course, typical thuggery that homeopaths engage in. It reminds me of the time that Andy Lewis, a.k.a. Le Canard Noir, who ten years ago endured similar threats after he wrote a brilliant article, The Gentle Art of Homeopathic Killing, which showed that such claims actually violate homeopaths’ own code of ethics, resulted in a legal threat from the Society of Homeopaths. I’ve also documented similar types of legal thuggery from quacks directed at skeptics speaking out. Many have been victims, ranging from Paul Offit to Brian Deer to Ben Goldacre to Simon Singh to Rhys Morgan to Steve Novella, all of whom have had legal threats directed at them or been sued outright. The most recent example is a naturopath quack (but I repeat myself) who is suing ex-naturopath and current skeptic and scientist Britt Hermes. This is what homeopaths and other quacks do when criticized. Add to this the likelihood that the statement by the 124 French doctors threatened a huge French company (Boiron), business considerations and national pride probably amplified the usual thuggish reaction.

It is to the credit of the 124 French doctors who spoke out about The One Quackery To Rule Them All. Their statement needs to be publicized near and far during Homeopathy Awareness Week.