Osteopathy, chiropractic, hypnosis, mesotherapy, auriculotherapy, acupuncture, fasting, raw foodism, anthroposophic medicine, homeopathy… Unconventional care practices, or “alternative medicine”, are the subject of fierce debate. Since last June, a committee set up by the government has brought together opponents and supporters of these practices. At the center of the debate: the question of the supervision of these practices, and the place that the world of health should give them. Should they be included, or excluded?
“Le Figaro” publishes two columns answering this question. On the “against” side, the collective of caregivers No FakeMed (born from the “tribune of 124” published in March 2018 in our columns demanding the delisting of homeopathy), several orders of health professionals, associations supporting victims of sectarian aberrations and numerous researchers and professors of medicine. On the “for” side, four medical professors who are members of CUMIC (University College of Integrative and Complementary Medicine), which brings together academics and teaching managers from several disciplines concerned with this theme. The complete list of signatories of the two texts is indicated at the end of the article.
“They are called soft, complementary, parallel, alternative medicines, and other fantasies. The authorities prefer to say “unconventional care practices” (PSNC), or “unconventional health practices” (PNCS). But beyond a simple parochial quarrel, a whole principle of health arises from this lexical choice: it is a question of knowing what quality of medicine we want, and whether we agree to endorse illusory techniques having their popularity as their main argument. . The question of regulating practices then arises. Some want to force them into the healthcare system, hospitals, health centers and homes. And they are ready for all oratorical artifices, caricatures, to legitimize questionable practices.
“Unconventional care practices are on the rise, and the number of practitioners and practices has been increasing steadily since the 2000s ; Today there are around 400 PSNCs with therapeutic purposes. But their success is often linked to a misunderstanding of the philosophy that underlies them, and their lack of effectiveness beyond a contextual effect; we could see this during the debate around homeopathy, which lost a large part of the confidence placed in it as soon as it was confronted with the popularization work carried out among the general public. Respect for patients requires providing them with reliable information to allow them to make a free and informed choice.
“The question therefore arises of the place that should or should not be given to PSNCs within the healthcare system. Although there are many names, they are all practices claiming to be care and not well-being, without however having provided proof of their effectiveness, and relying on theories not supported by acquired scientific knowledge. . Certainly, these evolve, and a practice can show its usefulness in health; thus with hypnosis, the interest of which as a tool in certain situations is no longer discussed since it became capable of measuring and explaining its contribution as well as its limits.
“There is no question of legitimizing a whole panel of PSNCs, even under the pretext of their alleged safety. Many of them, directly or because they lead to a lack of care, present undesirable effects, sometimes serious. These effects also exist with conventional treatments, but the risks must always be weighed against the expected benefits. Those linked to PSNCs are therefore inadmissible given the uselessness of the latter.
“Moreover, abuses around PSNCs exist, even if (fortunately!) they are not in the majority. Misuse of care, fraud, mental control, sectarianism… Sectarian abuses are not systematically linked to PSNC, but here again the risk is unacceptable. Miviludes indicates, in its 2021 activity report, that 25% of referrals concern the field of health, and that 70% of them relate to unconventional care practices. The number of health-related referrals increased from 365 in 2010 to 842 in 2015, then more than 1,000 in 2021.
“Medicine is of course not immune to these abuses, and Miviludes estimates the number of doctors linked to sectarian abuse at 3,000. But the Orders of health professionals have been able to tackle the problem head on, notably setting up a partnership with Miviludes and multiple safeguards (verification of diplomas and authorization to practice, obligation of continuing training, codes ethics and public health, ordinal justice, declaration of links of interest, etc.). The Orders have raised awareness of sexual and gender-based violence, universities provide training in the critical reading of scientific articles, associative initiatives are flourishing to improve public information.
“Our patients’ choices will always be respected, and everyone uses the wellness practices of their choice. But patients have the right, when they turn to a health professional, a hospital, a place of care, to know that they will be taken care of by health professionals, offering conscientious, dedicated, and based on care. data acquired from science.
“Faced with the current challenges of the health system, the response must not be to offer more pseudo-medicines under the pretext that people are already using them. The real answer is to rely on what has been proven, to provide resources for research, to continue evaluations, to rely on social work, not to neglect mental health, to improve prevention , and to keep pressure groups at bay, whether they come from pharmaceutical companies or promoters of esoteric, costly and sometimes dangerous practices.”
“So-called unconventional care practices, or PSNC (osteopathy, naturopathy, acupuncture, homeopathy, hypnosis, according to the Ministry of Health) worry the health authorities and Miviludes, who set up a support committee in June 2023 for the supervision of PSNCs, responsible for enlightening users, patients and professionals on their benefits and risks, in town and in hospitals. Various reports, surveys and press articles have then highlighted the risks linked to PSNCs, without pointing out their potential benefits in numerous indications, as long as they are well supervised. We were panicked by the “booming” use of these practices, by the “explosion” of abuses, by the “boost effect” of the pandemic.
“But what is the reality of the figures? Apart from osteopathy, we lack reliable data in France to confirm a strong increase in the use of these practices. In Switzerland, where we chose to integrate them into university hospitals and regulate the status of non-professional health practitioners, the use of PSNCs has increased very slightly. Concerning sectarian abuses linked to health, referrals to Miviludes have been stable since 2017 (around 1000 per year), but it should be noted that they are a poor indicator of the “risk” linked to PSNCs (contrary to reports). The eloquent contrast between encrypted data and communication is striking. Could we be facing a drift in communication about the risks of “alternative” therapies? Would this distortion of reality be necessary to justify altering informed information and patients’ freedom of therapeutic choice, which are ethical and democratic imperatives?
“It is the inappropriate use of certain PSNCs that is at risk, more than the PSNCs themselves! Patients who hope to treat their cancer solely with acupuncture and refuse anticancer treatments then have an alternative, clearly dangerous use. But acupuncture used to relieve nausea due to chemotherapy, in addition to the latter, is recommended by the French Supportive Care Association. The press makes a lot of noise about the dangers of alternative uses, but they are rare: less than 5% of patients treated for cancer according to a European study. It’s still too much. Supervision would further reduce this risk.
“Talking about risky use is therefore more relevant than listing “illusory therapies”, vaguely defined as “not scientifically validated” and which are in essence “risky”. In addition, this suggests that conventional treatments would still be validated and without risk. It’s wrong ! Drug-induced iatrogenesis causes more than 200,000 hospitalizations and 10,000 deaths per year in France. Yes, some self-medication in herbal medicine or aromatherapy carries risks… like all self-medication with conventional medications. Yes, acupuncture can cause damage to deep organs, but these accidents affect less than 5 patients out of 100,000. Yes, cervical manipulations by osteopaths can cause serious or even fatal lesions, but these exceptional situations are the work of practitioners. who do not respect the decree governing their practice. Yes, patients can be defrauded by charlatans, but there are also therapeutic and financial abuses in conventional medicine, for example those reported in dental or ophthalmological centers.
“Are patients so naive? No. 56% are aware that “natural” remedies can cause harmful side effects and 70% know that there is a risk of sectarian drift or influence. Faced with strong patient demand, we believe that the guarantee of secure access to certain PSNCs is consubstantial with their supervision, based on regulation of the training and status of non-professional health practitioners, on transparent communication, on adapted research, on the development of hospital services and outpatient networks of so-called “integrative” medicine linking conventional practices and PSNC, on care pathways structured by qualified professionals, precise indications and a secure care context. This pragmatic approach to reducing risky use has demonstrated its effectiveness in addiction. It should inspire decision-makers to use PSNCs.”
*Signatories of the text “Against”: “The response to current challenges is not to offer more pseudo-medicines”: NoFakeMed Collective; National Order of Masseurs-Physiotherapists (Cnomk); National Order of Midwives (Cnosf); National Order of Nurses (ONI); Didier Pachoud, president of GEMPPI (Study group of thought movements with a view to the protection of the individual); Catherine Kartz, representing UNADFI (National Union of Associations for the Defense of Families and Individual Victims of Sects); Francis Auzeville, representing the CCMM (Center against mental manipulation); Professor Edzard Ernst (University of Exeter; Professor André Grimaldi (Pitié-Salpêtrière); Professor Jean-Francois Bergmann (Lariboisière Hospital); Professor Jean Paul Vernant (Pitié-Salpêtrière); Professor Nicolas Pinsault (Université Grenoble Alpes); Professor Karine Lacombe (Sorbonne University ) ; Professor Marc Braun (dean of the faculty of medicine, midwifery and health professions, University of Lorraine, Nancy); Professor Dominique Le Guludec (Bichat Hospital, former president of the High Authority of Health; Richard Monvoisin , teacher and researcher, science education, (Grenoble-Alpes University); Dr Nicolas Winter, pediatric emergencies at Lille University Hospital; Dr Matthieu Calafiore, general practitioner, university lecturer (Lille); Dr Julie Chastang, general practitioner, university lecturer (Sorbonne University); Dr Vincent Jedat; Dr Thomas Pipard; Dr Stéphanie Marsan, general practitioner, lecturer (University of Versailles-Saint-Quentin-en-Yvelines); Stéphanie de Vanssay teacher and creator of the site “School Deviations”; Natalia Trouillier accompanying victims of sectarian aberrations; Leo Druart, physiotherapist, teacher at Grenoble-Alpes University, vice-president of Cnmok; Dr. Vincent Jedat; Dr Thomas Pipard; Grégoire Perra, whistleblower on anthroposophy; Chanology France collective; Association Les Markabiens; Kalou, content creator (information and prevention on the dangers of the sectarian phenomenon); Marie Cachera, doctor in ecology.
**Signatories of the text “For”: “Secure access to certain practices would be guaranteed by supervision”: Professor Fabrice Berna, psychiatrist (University of Strasbourg); Professor Laurence Verneuil, dermatologist (Paris-Cité University); Professor François Paille, addictologist (University of Lorraine); Professor Julien Nizard, therapeutics teacher (University of Nantes). All signatories are members of the CUMIC office (University College of Integrative and Complementary Medicine).
