While in France, the Minister of Health Agnès Buzyn has just confirmed that the rate of reimbursement of homoeopathic treatments will gradually decrease to arrive at a non-reimbursement in 2021, EuropeanScientist interviewed Guy André Pelouze on this highly controversial topic.
EuropeanScientist: Since the announcement of the Minister this morning the controversy does not disarm. Also, the voices who claim this derogation denounce the placebo effect. What is your opinion on this subject?
Guy André Pelouze: The most extraordinary news of this crusade anti-homoeopathy and homoeopaths – doctors that we hear very little by the way – is that the French have not even benefited from quality information on what is the placebo effect. We have like animals, buried in our brain and covered with cultural and social inhibitory mediation a series of self-healing programs. We react to adversity by our neuro-vegetative, immune, anabolic systems to survive and heal. We can drastically reduce pain, influence our food choices and our sleep in the face of infection, trauma, etc. In the Paleolithic human group, these programs were activated spontaneously or under the mediation of the old people. We have referred these cases to the doctor for centuries. Any act of care produces an effect most often placebo but in some, nocebo. This is a fairly well-known topic in evolutionary psychology. So the homoeopathic dilutions with or without sugar have a placebo effect like the manipulations of an osteopath, like the bites of an acupuncturist, like the bite of the mesotherapist like any allopathic medication, like, I repeat, any act of care. This placebo effect is the brain of the patient that generates it and can for some symptoms improve 30% of patients including durably. The observation that in the case of homoeopathy there is only the placebo effect is interesting because double: it is impossible to demonstrate the experimentally intrinsic effect of the dilution, but there is no more side effects, complications, we will come back.
So let’s summarize: the placebo is the act of care (including granules but not only that), the placebo effect, it is your brain that triggers it. So let’s try to ensure that the placebo effect is as strong as possible in the interest of our patients since the specific therapeutic effect is fixed, for example when we use an allopathic drug but do not make us believe in a conflict between the two. They are linked.
Now, with regard to the issue of the cancellation, we must first of all say that it is the payment of homoeopathic medicines by compulsory deductions (wrongly called social contributions) of which we speak. They may be reimbursed by additional insurance even beyond the date of the total stop of the reimbursement; it will be enough to take out a contract and pay the premium. So far, nothing to make a national debate except that Pandora’s box of unnecessary expenses was opened by Ms Buzyn very cleverly and that given the lack of political opposition she will close it with the best opportunities for growth, the economy in it without anyone objecting to it. Spa treatments, daily allowances, so-called medical transportation extravagant benefits will always be paid by mandatory costs. Well done, mayors, taxis and others are reassured but they will still complain about the cost of work; the health insurance contributions will not fall and the social security will always be in deficit. After convincing the French that the placebo was not worth a refund, it was easy to explain to them that the effect “nothing at all” was worth more than the billions it is spent instead of buying MRI or pay the caregivers.
ES: How is homoeopathy seen in other care systems?
Guy André Pelouze: In France homoeopathy has suddenly become a target. There was nothing there for him, neither his cost, nor the placebo effect, nor his dangerousness except maybe his success, which is real. One explanation is that homoeopathy and homoeopaths irritate conventional doctors and especially hospital doctors. The spirit of the Open and Tolerant Schools of Medicine is gone. Medicine lives at the discretion of Yuka’s, especially the state’s ones. The result is tragic. But there is also a technical aspect. Let’s think about other alternative practices. They are without adjoining prescription. So elusive if practised by doctors. Acu, meso, osteo, naturo, and others do not prescribe or refund anything. As the coding of the acts of consultation does not exist in France (what good, any act of consultation on all the territory whatever the motive and the complexity whatever the speciality is at the price of 25 €, which of course contributes to the scarcity of supply …), it is impossible to deride the acts of these practices. Yet the evidence of effectiveness is also of the order of the placebo which is not an offence I already said… What would be logical is that the courageous proponents of hyper-rational medicine who cry to the scandal of the placebo (see above) in “tribunes” say a word on the irrationality of spending 4 billion for 700 000 stays cures thermal baths, the vast majority of which is an application of various sludge on the joints, that is to say 31 times the refunds of granules, like many billions in taxis-like transport in a country with so many personal vehicles, buses, train and others (I quote these amounts easily available on the website of the DREES) … I would have applauded.
To my knowledge, there is no hostility from other European governments and health professions towards homoeopathy. In part, this is because their care systems are much more readable. They have long defined a basket of essential care, funded by mandatory contributions, alongside which alternative non-conventional care, alternative, supported by insurance under a contract additional to the basic contract. I remind you that we have done the opposite which is very expensive for us in management and which reduces the supply. Thus Switzerland does not reimburse homoeopathy in the basic contract. In the Netherlands, no reimbursement by the basic contract. A co-payment with complementary is possible according to a list of alternative medical practices. In Germany, it depends on the Landers. There is a logic to this approach: indeed, why should we pay taxes for treatment that is choice, convenience, comfort? However, we understand that it is imperative to keep and fund a common pot for serious diseases. Nobody in Europe disputes it. This separation is very clear in many countries: on the one hand, there are expenses that must be financed by pooling, on the other those that are a personal choice.
ES: How would you define the European health system model, where should we go?
Guy André Pelouze: Generally, I would say that there is no model in Europe and it is very good because any model is frozen. There are different systems in Europe that have two characteristics: there is a guarantee of market dynamics on the one hand and, on the other hand, the resilience of the mandatory basic contract. This hybrid system is extremely powerful. Because we have a story. Great medical inventions in the field of care have emerged in Europe, our professionals are well trained and our care networks are still quite dense. Alas, in this rather positive picture, France stands out because it has progressively excluded all the market mechanisms in the healthcare system and has made it operational with the Juppé ordinances. In doing so, it has completely rigidified the whole, which has deleterious consequences: planning of the numerus clausus for more than 40 years, hospital-centrism, unnecessary expenses not related to care, the dramatic impact of the 35 hours.
ES: what future for homoeopathy in France?
Guy André Pelouze: I am optimistic. Cleared from the tutelage of the health insurance guardianship who holds by the reimbursement homoeopathy will continue to attract patients. Firstly because the consultations remain reimbursed. Then because homoeopathy is very popular all over Europe. This makes the proponents of hospital-centred medicine jump, but it is so. Europeans and therefore the French are free to buy their non-essential care as they see fit. As they are free to buy the food that suits them or take the risks they consider interesting. “Having a nanny” is not medicine. Homoeopathic doctors in the current demographic configuration are not risking anything. They will develop a special relationship for patients who ask for homoeopathy and continue to care for others. The producers of homoeopathic medicines play a classical partition because this announcement even progressive in its implementation places them in a configuration of decrease of their capacities of production and thus of economic dismissal. Except that I consider that they will go very quickly for those who are actively managed and whose product quality will allow a price increase. Yet there is a but … And if the 128.6 million € announced (we can not check anything since the open data of the system of care is refused by the CNAM) were transformed into increased spending? Frédéric Bastiat’s aphorism about what is visible and what can not be seen in economics could well apply. What will happen to the expenses of patients who will switch to allopathy, ie conventional medicine? If we take into account French habits (I mean the patient-doctor couple) conventional prescriptions will multiply by 3 or 4 the price for the same symptoms. There will also be a layer of complications and side effects. Ms Buzyn had promised us the balance of accounts and then changed after the “benefits” granted to yellow vests, it could well be that the deficit is growing a little more if patients listen to thuriféraires medical orthodoxy in mass … It does not matter it’s the state that pays by indebting us.
This post is also available in: FR (FR)