France moves to stop reimbursing homeopathy

France's health watchdog has recommended that homeopathic medicines should no longer be paid for by the country's health system because there is insufficient evidence to show they work. But homeopathy is very popular here; users and homeopaths insist it offers a cheap, environmentally-friendly and above all holistic approach to healthcare. 

Homeopathy was created in 1796 by German physician Samuel Hahnemann. He died here in France and left behind generations of adepts.

Many a French child has grown up taking little white sugar granules containing plant-based active substances, but which are so diluted there's little or no discernible trace left.

Despite this, a survey by Odoxa in January 2019, showed that 72 percent of French people believed homeopathy had benefits.

Arnica is one of the most popular.
“We've all been treated by a bit of arnica when we fell and hurt ourselves as children,” says Caroline, a pharmacist in Paris. “Our mums gave it to us, so we've grown up with it. Homeopathy has no side effects or toxins so you can give it to adults, children or animals.”

Nathalie, a youthful-looking radio producer in her fifties often treats her eight year old with homeopathic remedies. 

When her daughter's foot got hit by a car wheel she gave her arnica 30CH straightaway "because it helped with the shock, both emotional and physical shock," she explains handing over €2.35 for another dose at her local pharmacy.

"The next day she was less stressed about what had happened and it helped relieve the pain.”

Insufficient scientific evidence
Close to 60 percent of people in France say they use homeopathic remedies, most commonly to relieve aches and pains, ward off or treat colds, reduce stress and insomnia.

They're available over the counter at most pharmacies. And if prescribed by one of France's 4,000 qualified homeopathic doctors, are reimbursed by the Assurance maladie (social security) to the tune of around 30 percent.

That could soon change if the government decides to follow the recommendations of France's health watchdog (HAS). 

After nine months investigating the effects of homeopathy on 24 medical conditions, including anxiety, foot warts and acute breathing infections, it concluded on 28 June that there was insufficient scientific evidence to justify continuing the reimbursement.

That position already had the backing of the Academy of Medicine (ANM) and the Academy of Pharmacy (ANP).

My Homeopathy, my choice
The HAS investigation came after 124 doctors published an open letter in Le Figaro in March 2018 condemning homeopathy as “dangerous and fantasist […] practiced by charlatans of all kinds”.

The SNMHF - French syndicate of homeopathic doctors - riposted with the campaign “Mon homéo Mon Choix (My Homeopathy, My Choice). Funded by Boiron, Weleda and Lehning, Europe's leading manufacturers of homeopathy, the petition has since gathered more than one million signatures. 

Not all of France's 4,000 qualified homeopathic doctors may be competent, but having gone through the compulsory eight years of medical school plus a complementary course in homeopathy, they refute the term "quacks".

“I'm an average GP, I treat all my patients from baby to grandmother for any kind of disease,” says Dr. Hélène Renoux, president of the European committee for homeopathy, and who has been practising homeopathy at her surgery in Bourg-la-Reine for 25 years.

“When my patient is in front of me I've got one more tool in my suitcase [...] if I see homeopathy is not able to treat a disease, that it's not the [most] appropriate treatment for this disease, of course I'm completely able to use other tools.”

She says she's flooded with requests and can't satisfy demand.

“There's really a gap between the claim of some of the medical doctors against homeopathy and the global population that is more and more interested, saying 'this is what we are waiting for, this is what we need'.”

Faced with criticism over the lack of clinical data proving homeopathy has a physical effect, she says it's work in progress.

“It's true that for the moment we have no definitive conclusion that we can say it works. But we cannot say it doesn't work because we have some findings that are very promising. It's likely that in the years to come we will find more and more things that can give a hint on what's happening when we are giving homeopathic medicine.” 

Placebo effect
Sceptics claim that homeopathy has no more than a placebo effect because the substances used are too diluted to have a physical impact. That said, French scientist Jacques Beneviste made a strong case that water molecules retained a memory of the antibodies that they had previously been in contact with.

But even if homeopathy works only with a placebo effect, for some users that's enough.

“It may well be just a placebo effect but providing it works I'm happy with that,” Pauline told RFI. “If I can heal myself with three granules of sugar I'd rather do that than take antibiotics. It's more natural, it doesn't feel like I'm hurting my body whereas there are loads of medicines I don't trust.”

But detractors say France's social security system, already deep in debt, shouldn't be financing "beliefs". 

Members of the No Fakemed collective are waging an vigorous online campaign against reimbursement.

“We're not trying to change people's beliefs, but beliefs should not be financed through public coffers,” says pediatriatrian Maxime Bacquet, a member of No Fakemed.

“Church and state have been separated for a long while, the separation of medicine and beliefs should be done once and for all in 2019," he told RFI.

For Dr Jérémy Descoux, head of Fakemed, the collective acts as a "counterweight to pseudo-science in the media [...] and the propaganda aimed at discrediting scientific authorities" and which has recently found an echo in skepticism over vaccines.  

Baquet claims that the French are so enthusiastic about homeopathy partly because they over-medicate in general. And it's time they were encouraged to take less, not more, medicine.

“We want people to take less medicine, for them to realise that their slight symptoms aren't always serious and don't need treatment.

“Most of the time things heal naturally, we prescribe too much medicine in France and yet an explanation is worth a lot more than a lengthy prescription. If we had more time to explain to patients, we wouldn't have to reassure them by giving them long prescriptions.”

Having time to talk
The issue of spending time with the patient is one of the keys to understanding the controversy over homeopathy in France. 

Whereas most GPs are conventionné (charging a set fee of 22 euros per consultation), many homeopathic doctors are non-conventionné (allowed to set their own fees). The latter are able to spend more time with their patients, offering a more tailor-made, holistic response.

Remedies are based on patients' profile and personality, not their symptoms. So two sore-throats would not necessarily walk away with the same prescription. 

Renoux says she's always felt the majority of the medical profession were respectful towards homeopaths, and explains the recent outbreak of disdain by the steadily degenerating conditions many GPs are working in.

“General practice is not respected enough in our country," she says, "and when you feel bad you put the problem onto someone else.”

Homeopaths, she feels, have become the bêtes noires of the medical profession.

“I think these people would dream [of being able] to ask for more money for a consultation, to have more time for a consultation, to consider each patient as a single person and not as a global public health issue.

"We should become the standard," Renoux continues. "Please learn what homeopaths are doing because at the very end we are saving lives, saving money and protecting the environment. We should be a model."

€126 million could be saved each year
The government is due to make a decision in the coming days or weeks, but has already suggested it is inclined to follow HAS's recommendations. 

An end to reimbursement would save the social security department €126million per year. But compared to the 20 billion it spends on reimbursing conventional medicine, this seems like a drop in the ocean. 

Pharmaceutical lab Boiron, one of the world's leading homeopathic drug makers, has sounded alarm bells. It depends on the French market for about 60 percent of its 605 million euros of revenue per year and has warned that an end to reimbursement in France could threaten up to 1,300 jobs here.

Last Friday, about 600 Boiron employees, along with doctors and patients dressed in white demonstrated in Lyon, near to Boiron's headquarters.

Several users of homeopathy told RFI they would carry on buying homeopathy whether it was still reimbursed or not. But if homeopathy is no longer reimbursed, it will no longer be regulated and Boiron warns prices could go through the roof.

In Italy, for example, where homeopathy is not reimbursed, a tube can cost eight euros.

In addition, private health insurance would have no obligation to continue reimbursing. 

Future of teaching homeopathy at risk
But the impact could be more than just financial. 
“Non-reimbursement would have a psychological impact too,” says Fabienne Courtray, a pharmacist with Boiron. “It would discredit homeopathy.”

Homeopathy is currently taught in 15 medical schools in France. In September 2018, the Lille Faculty of Medicine suspended its diploma in homeopathy, pending clarification of HAS' position.

There are fears other medical schools could follow suit, endangering the training of future homeopaths in France, and ultimately its future full stop. 

"We are demanding a moratorium and parliamentary debate followed by a public debate," said Valérie Lorentz-Poinsot, director general of Boiron, on behalf of three laboratories.

One option is for the government to reduce reimbursement from 30 to 15 percent, as suggested by the Minister for the economy. Prices would still be regulated, private health insurance would still reimburse its part, and France's social security would still make savings: around 65 million euros a year.

A pragmatic solution in a country not always renowned for its pragmatism.

This story was first relayed in Spotlight on France. Listen and subscribe to the podcast here