The University of Lille is the latest European higher education institution to suspend its provision of training in homeopathy. Is the tide turning against a complementary medical practice that relies on the "memory" of the remedies it proposes? We investigate.
September, 2018: across Europe, students eagerly anticipated the start of their degree courses, hoping that their studies would open up a path to their chosen career.
"Homeopathy must be held to the same scientific standards of proof as any other form of medicine."Chair of the EASAC Biosciences Steering Panel
Not so those who had hoped to study for a diploma in homeopathy from the medical faculty of the University of Lille. Professor Didier Gosset, the doyen of the medical faculty, announced on Twitter that the course would be suspended with immediate effect. The faculty is seeking the view of the French national health authority and the outcome of a national debate before making a decision about whether to continue offering the subject to students in the longer term.
Homeopathy has always been a contentious issue in medical circles. Despite this, in many European countries, homeopathy has formed part of the State's official treatment policy: it is regulated and, in some cases, subsidised.
Professor Gosset's announcement is part of a wave of backlash against State-funding of homeopathy, which has been gathering momentum particularly in France and Spain, but also more widely across the continent.
What is homeopathy?
Homeopathy was created in the late eighteenth-century by Samuel Hahnemann, a German doctor. It relies on the twin doctrines of "like cures like" (the substance that caused your illness can cure it), and "potentization", which essentially states that the less active ingredient is present in a remedy, the more potent it becomes.
Active ingredients can range from the best-selling oscillococcinum, a flu remedy, to Berlin Wall, a remedy for, amongst other things, asthma, fear and depression.
Under the principle of "potentization" homeopathic remedies are dilulted to varying degrees. A potency of 6X means that there is one part of the active ingredient to one million parts sugar water; at 6c there is one part per ten trillion of sugar water.
Homeopathy: the picture in Europe
The legal status of homeopathy varies widely across Europe: some countries have laws or regulations in place, but in some countries homeopathy is completely unregulated.
In Bulgaria, Hungary, Latvia, Romania and Slovenia, for example, the practice of homeopathy is confined by law to medical practitioners only. In Slovenia, however, if doctors actually exercise their legal right to practice homeopathy, the national medical assosication will withdraw their license.
In 2016, the member states of the European Committee for Standardization (CEN) adopted a new standard which specifies minimum requirements for medical doctors with an additional qualification in homeopathy, and for the services they provide.
Homeopathic medicinal products are regulated by EU Directive 2001/83/EC. Under the directive, member states are required to ensure that homepathic products meeting certain conditions can be authorised by means of a simplified registration procedure, which, amongst other things, means that they do not need to prove therapeutic efficacy.
Homeopathic medicines do not come under the centralised procedure regime by means of which all conventional human and veterinary medicines are authorised.
What do you think?
France is home to Boiron, the world's biggest manufacturer and distributor of homeopathic remedies, and has traditionally been seen as a friend to this particular branch of complementary medicine.
Some homeopathic remedies are eligible to receive state funding in France by means of reimbursed prescription costs. One study, for example, found that in a 12-month period in 2011-2012, 6,705,420 patients received at least one reimbursement for a homeopathic preparation. The same study found that 120,110 (43.5% of) healthcare professionals had prescribed a homeopathic preparation in that period. At least 10% of the French population had been treated homepathically within the time frame.
Within this context, homeopathy has traditionally been seen by many as, at worst, a harmless counterweight to French over-dependence on antibiotics. That was until March 2018, when the national medical council launched an offensive in le Figaro, dismissing homeopathy as charlatanism, and suggesting that, in some cases, it might actually do harm, for example by delaying the uptake of conventional treatments which, the doctors argue, are more effective at treating disease.
The national union of homeopathic doctors lodged a formal complaint against the authors of the letter. This sparked an inquiry by the national health authority into the efficacity of homeopathy, the basis on which prescription costs are refunded, and the suspension of the diploma previously offered by the University of Lille. The outcome of the inquiry is not expected until February 2019.
In Spain, too, university courses in homeopathy have been scrapped in recent years. In 2016, the University of Barcelona cancelled its masters degree in homeopathic medicine "because of the doubt that exists in the scientific community", and because it was no longer approved by the Spanish health ministry.
One lobby wants to go further, arguing for the abolition of the simplified registration procedure for homeopathic medicines. In a recent public letter to the Spanish health ministry, the Association for the protection of patients from pseudo-scientific therapies (APETP) cited the recent death of a cancer patient who had abandoned chemotherapy in favour of alternative therapies.
Fernando Frias, the Association's lawyer told Euronews:
"Health authorities should not fund homeopathy simply because it is not medical practice. It is based on a set of out-dated and scientifically unsustainable beliefs and it has not been proven to be an effective treatment for any medical condition. Thus, best case scenario, it is a useless practice and its funding a waste of public money, but, worst case scenario, it may convince patients to trust homeopathy and delay a needed medical treatment, sometimes with tragic consequences."
However, Spanish homeopaths have responded with indignation, saying that "patients who use homeopathy in an oncology treatment have a very high degree of satisfaction".
Prince Charles, the heir to the British throne, is a strong proponent of homeopathy. Recently, however, his future subjects have proved themselves to be rather less enthusiastic about it.
In 2017, the UK's National Health Service (NHS) was spending over 103,000 euros on homeopathic prescriptions each year. At a time when many in the country believed the free health service to be in crisis, Simon Stevens, the head of the NHS stopped funding general practitioners to prescribe homeopathic treatments, stating that homeopathy was "at best a placebo" and that funding it was a "misuse of scarce NHS funds".
The British Homeopathic Association (BHA) responded by challenging the decision in the courts on the basis that Simon Stevens was biased. A judicial review subsequently concluded that homoeopaths had been given a fair chance to prove "that homeopathy actually works", and ordered the BHA to pay legal costs of around 135,000 euros, the NHS arguing that British taxpayers should not have to pay for "tap water masquerading as medicine".