Sep 04 2018

French University Dumps Homeopathy

France is the world’s biggest consumer of homeopathic potions. According to a study by Edzard Ernst:

The results show that a total of 6,705,420 patients received at least one reimbursement for a homeopathic preparation during the 12-month period. This number equates to 10.2% of the French population, with a predominance in females (68%) and a peak frequency observed in children aged 0-4 years (18%).

This is unfortunate, because homeopathy is pure pseudoscience, costing French taxpayers €279 million in one year. But there is some good news – homeopathy has been in retreat around the world, at least in terms of official recognition and reimbursement. Homeopathy hospitals are closing in the UK, the FDA has decided to finally start regulating at least the worst homeopathic offenders, and now a French university, Lille, has decided to suspend its homeopathy degree for the 2018-19 academic year.

Further (and here is the big lesson here, in my opinion) this is mostly in response to scientists taking the time to review homeopathy and declare that it is not based in science and does not work.

So what happened in France, where homeopathy is very popular? Well, in March 2018, 124 French doctors signed a statement taking a strong stand not only against homeopathy, but all kinds of pseudoscience in medicine. The entire statement is worth a read, but here are some highlights:

The obligation of honesty is enshrined in the Codes of ethics of the medical professions and the Code of public health (article 39 of the Code of ethics and article R.4127-39 of the Code of public health). The codes forbid charlatanism and deception, impose to prescribe and distribute only proven treatments. The codes also proscribe the use of secret remedies or not clearly mentioning the substances they contain. The Council of the Order of Physicians is responsible for ensuring that its members do not use their title to promote practices whose science has never proven useful or even dangerous. The Council must ensure that doctors do not become trade representatives of unscrupulous industries.

Homeopathy, like other practices called “alternative medicine”, is in no way scientific. These practices are based on beliefs that promise a miraculous and safe recovery.

They go on to reference a recent review of the scientific evidence concerning homeopathy conducted by the European Union Scientific Advisory Council. Part of their summary reads:

Scientific mechanisms of action—where we conclude that the claims for homeopathy are implausible and inconsistent with established scientific concepts.

Clinical efficacy—we acknowledge that a placebo effect may appear in individual patients but we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect. There are related concerns for patient-informed consent and for safety, the latter associated with poor quality control in preparing homeopathic remedies.

This is in line with other reviews by (to use their words) “Authoritative and impartial” expert panels. A 2010 report in the UK concluded, essentially, that homeopathy was “witchcraft” and should be completely abandoned. A 2013 review by the Australian government concluded that there was no convincing evidence that homeopathy works for any condition.

A 2010 systematic review of systematic reviews came to the same conclusion – “The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.”

There was also the 2012 Swiss report, but this was a bit of an outlier. The Swiss government originally concluded, like everyone else, that the evidence does not support homeopathy, but homeopaths did not like that conclusion. So they created a panel packed with homeopaths to produce the desired outcome. As I wrote at the time:

The Swiss report represents a biased review largely by homeopaths who changed the rules of evidence in order to declare that homeopathy works. Other homeopaths then present this review as unbiased and definitive. This is behavior that would make even the most unscrupulous pharmaceutical rep blush.

So this was not an authoritative or impartial review. What the Swiss panel essentially did was admit that high quality evidence does not show that homeopathy works (so even then had to agree with this), but because of reasons that are not clear they thought it better to rely on weaker evidence (the kind not meant to determine efficacy). They decided to blame the negative studies on the studies, not the utter pseudoscientific nature of homeopathy.

But despite still occasionally putting their thumb on the scale, homeopaths appear to be fighting a losing battle. It is way too early to declare victory, but the tide is moving against allowing people to sell or prescribe magic water as medicine. Even in France, which is the bastion of homeopathy, it is possible to embarrass a university into dropping its “Degree in bologna.”

Lille University, however, only suspended its degree, pending another review of the scientific evidence for homeopathy by the French government, due in February 2019. The question is – will this be an impartial review by proper scientists (as in the UK, Australia, and EU model), or a rigged review by French homeopaths (in the Swiss model). We have some clue – Ernst reports on a statement in April 2018 by the French Health Minister:

“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. It does not hurt.”

So, like many apologists for alternative medicine, she acknowledges that homeopathy is probably a placebo (which is doctor-speak for “it doesn’t work”). But she points out that the French people like it, which is entirely irrelevant. Worse she argues that homeopathy is harmless and that it may replace toxic medicine. Homeopathy is not harmless, as it may replace or delay effective treatment. Neither is promoting pseudoscience in medicine, which has far-reaching negative effects.

Further, medicines and the standard of care are regulated so that they should provide benefit in excess of risk, so replacing “toxic” treatments makes no sense. If a treatment is a net negative it should not be used. We don’t need to replace it with magic water.

The minister’s statement concerns me. Hopefully, however, science will still prevail. We will have to wait and see.

The biggest lesson in all this, however, is that scientists and experts, especially in the field of medicine, have to come out of their ivory towers and engage with society on issues of pseudoscience. There is a strong consensus among doctors, academic, and health scientists that treatments should be science-based (we can quibble about the fine details of exactly what this means, but the general idea is accepted). But if they remain silent about it, or think that pseudoscience is something sufficiently on the fringe that they don’t need to give it their attention, then pseudoscience will slowly creep into medicine, which is what is happening.

When scientists get together and simply state what to them is obvious, it can have a powerful effect of clearing the air of all the confusion and misdirection created by the purveyors of nonsense. We need a lot more of that.

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