It’s nice to occasionally see elected officials do the right thing, especially when it is against popular opinion. Earlier this year a French independent health scientific advisory group, HAS (Haute Autorite de Sante, or French National Authority for Health) was tasked with evaluating the effectiveness of homeopathy. Health minister Agnes Buzyn agreed at the time to abide by their recommendation.
It’s always easy to predict what such reviews will find, although it can be difficult to predict how they will spin the results. There is now overwhelming scientific evidence, including hundreds of studies, that show that homeopathy does not work for any indication. This is now supported by multiple independent systematic reviews. Even if we put aside the scientific plausibility question (which we shouldn’t) and just look at the clinical evidence – that evidence is overwhelmingly negative.
Of course, if you do look at plausibility this result is no surprise, as homeopathy has a scientific plausibility as close to zero as you can get. When a UK science advisory panel reviewed the evidence, they concluded homeopathy was witchcraft.
France, however, has always been a bastion of support for this particular pseudoscience. The company Boiron, which is the largest manufacturer of this magic water, is located in France, employs about 3,600 people, most in France, and 60% of its sales are in France.
So it reaffirmed my faith in the ability for some people, sometimes, to put good quality science ahead of ideology when the HAS concluded its review and found that homeopathy does not work:
For nine months the HAS watchdog investigated the effects of the alternative medicine on 24 medical conditions, including anxiety, foot warts and acute breathing infections and said it did not find sufficient scientific evidence to justify continued state reimbursement of homeopathic drugs.
Now, I have to point out that, the way scientific evidence works, it is technically more accurate to say that there is insufficient evidence to support the conclusion that there are any specific effects of homeopathic potions beyond placebo for any indication tested. But after hundreds of studies for dozens of indications, all failing to find sufficient evidence for efficacy, we can fairly summarize that result by saying that homeopathy does not work (at least that is the simplest interpretation of the data).
I still get the tingles when I think of a government looking for objective scientific evidence to inform a specific policy decision. Better yet – imagine if they actually act appropriately on that evidence. Apparently, that is exactly what happened. True to her word, the Health Minister announced that France will phase out reimbursement for homeopathic products by 2021.
The government initially aims to cut refunds for the drugs from 30% of their cost to 15% as of January 2020 as a first step, she added. “That will give manufacturers time to get organised,” Buzyn said.
This was in the face of protests and opposition from – you guessed it – Boiron. They whined that this will cost them money. Uh – that’s the point. They also played the “freedom” card:
“Depriving French people of their freedom to choose (their treatment) is totally misaligned with the demands and needs of patients,” Boiron said in a statement, adding it had been due to meet Buzyn this Thursday and was shocked by the decision.
No – what patients need is transparency to make proper informed decisions, and a reasonable standard of evidence to determine safety and efficacy. Selling patients worthless magic beans with false claims and misleading and confusing labeling is not freedom.
What about homeopathy is other countries? Europe has always been the cultural center of homeopathy. It has been traditionally very popular in Austria, when it was first developed. If you ever visit Austria you will see homeopathic pharmacies everywhere – it is incorporated into the culture.
In the UK the popularity of homeopathy has historically been boosted by the royal family, who are fans. Prince Charles, in fact, recently became a patron of the Faculty of Homeopathy. There were even, until recently, homeopathic hospitals. But a relentless campaign by scientists and science advocates, led by the Good Thinking Society, has chipped away at NHS support for homeopathy. If you read the NHS website on homeopathy, it is a reasonable good treatment of the topic, that plainly states the scientific status of this pseudoscience but without using inflammatory language.
In the US our regulatory infrastructure is different. Homeopathy was essentially grandfathered into the FDA, where all homeopathic entries in the Materia Medica (and its supplements) are considered drugs. The FDA has the power to regulate homeopathic “drugs” but has mostly chosen not to, because the market was too small to be worth their limited resources.
However, recently the FDA has reconsidered this policy, and decided that it would crack down on what it considers to be the most harmful homeopathic products, those targeted to serious medical illnesses, like cancer.
On December 18, 2017, the U.S. Food and Drug Administration (FDA) proposed a new, risk-based enforcement approach to drug products labeled as homeopathic. FDA re-examined its enforcement approach because the homeopathic drug industry has grown and we need to better address situations where homeopathic treatments are being marketed for serious diseases and/or conditions but where the products have not been shown to offer clinical benefits.
The FTC has also reconsidered its policy toward the marketing of homeopathy, and has rolled out harsher regulations requiring greater transparency and understandability in labeling:
The policy statement explains that the FTC will hold efficacy and safety claims for OTC homeopathic drugs to the same standard as other products making similar claims. That is, companies must have competent and reliable scientific evidence for health-related claims, including claims that a product can treat specific conditions. The statement describes the type of scientific evidence that the Commission requires of companies making such claims for their products.
However, even though this statement was made in 2016, I do not see any effect as of yet. If you look at homeopathic products, like the one above, a flu “remedy” from Boiron, it still contains all the elements that the FTC said would no longer be acceptable. It makes false claims about effects, it does not explain was “300CK” means, it lists “active ingredients” in Latin names, not plain English, and even when they are not present in the final product. This is the exact false and misleading advertising the FTC said it would crack down on.
Homeopathy remains a giant scam on the public with essentially zero plausibility and copious evidence for lack of efficacy. Governments around the world are moving in the right direction, but not nearly enough. We need to keep the pressure on, and keep educating the public about what homeopathy actually is, i.e. nothing.