Pierre de Bremond d'Ars, MD

Pierre de Bremond d'Ars: So a short introduction. I am a French GP. I studied in Lile for the beginning of my medical studies, and I work where you see the red star on the base Paris in a town called Moulineaux where I am a GP working with 7 other GPs, 3 nurses in something that would look like a GP Clinic of the NHS, which is not usual for France. I've been a part of the no fake med collective since 2018. I was among the first ones, who wrote the of Op-ed we're going to talk about, and who is now President of the Collective since last year.

As this is a presentation, I gave my conflicts of interests. I have no ties with the pharmaceutical industries. I’m a GP. I’m elected on the equivalent to your British Medical Board in the outskirts of Paris, and I work also sometimes for a teaching, company, and doing research with an institute college which works with health centres across the country. If you scan the QR code, you can have my ties which are none. So everything's okay.

So I'll start with a brief history of homeopathy in France, and how we became so fond of those little sugar pills. So I will not tell you all about homeopathy. If you have questions maybe, you can talk about the how it's made how it was discovered and so on. So how did it become so popular in France? In 1845. Samuel Inman, who was Percy, who had legal issues in Germany move to France and at this time there was not much to do in the pharmaceutical area, and so what he proposed health care guidelines that we know are good today, like walking more, airing the rooms, and sometimes doing nothing just so the disease could run its course, was successful and so he was quite popular in France. So it was quite popular. We had many schools and many collectives who defended homeopathy until today, and in 1965 we had the Health Ministry who decided to reimburse homeopathy fully, so it became reimbursed like paracetamol until 2021. In 2,018, what was not yet the Fake med collective published an Op-ed which you can find on the website which asked our government and the faculties, and also the social security, to stop funding alternatives and medicines, and things that we're not based on science. I will dig down on the details afterwards, but there were some SLAPP suits. There were also a lot of ads and advertisement and political pressures from the big sugar lobby, which is the main producers of homeopathy in France, and also all the doctors who were defenders of homeopathy, who were well installed in France, who had schools, who had centres, and also had a lot of money. In 2018, there were the HAS. HAS Is our supreme authority in health care, who decides what is funded and what is not reimbursed by the social security and so as of today, since 2021, homeopathy is no longer reimbursed in France.

In late 2017, late in November we were a few doctors on Twitter, making fun of homeopathy, and we were just discussing about it on the public threads and journalists who was on leave at the time, they decided to give us room in the figaro sante, to publish about that, and to describe the situation. We were just people who just exchange online. We almost never saw any each other in real life, and there was at the time a really small and active community on twitter of medical doctors a few many GPS who did a lot about for information on health care, sometimes even interacting with patients. But in order to just give general information on health care. And there was also a lot of fun. Always a lot of humour and a lot of tongue and cheek. Small images which we now call memes, where the base of what was really a small community of maybe a few 1000 people who talked a lot, maybe sometimes, saw each other in Congress, at some events, but and we felt that as a group we could do something. so we started with 10 people making first drafts, and in the end 124 health care professional decided to publish, to sign in their names on the Op-ed. It was published in March 2018. We thought it was a fire and forget Op-ed, something that we could do, and maybe forget afterwards we were quite proud of having the ability to publish it. We had no idea of what would follow, and so I will take you to the next slide

SLAPP suits. Okay, homeopathy is quite popular in France. I think maybe 70 to 75 of the French people at 1 point in the life just had to take some sugar pills and so there's a lot of doctors to prescribe homeopathy,  and a lot of people who live by homeopathy, and some of them are members who created their own unions and so 2 Unions, one in the south of France, and one in the east of France, decided that if we did not, as people who would sign the Op-ed,  if we did not apologize publicly or retracted our OP-ED, they would sue one person for every day until we retracted the op-ed. They had never learned about the Streisand effect, and so the press actually quite liked the idea, and begin to talk about it. The health ministry was interviewed on the subjects, even if they were just coming on the Radio for something else. And so they just started a big machine that they really couldn't stop, and so the slapp suits really gave visibility to what was just a small Op-ed in the journal, and it began snowballing. There were first journals, who begins to make some small articles, then the radio took it and then TV sometimes talked about it and so forth. For a few months, even though at the time our former president, was being you scrutinized and had legal issues where people were still talking about homeopathy, because I think it was just a part of how French thought they should be cured and so we were just a small bunch of Twitter medical student. I was actually still a student at the time. I had not sustained my fees, and so we were maybe a group of 100 to a few 1,000 people online who just started responding to the people on the Internet and Twitter is this magical social network, where, even though you have a small account, even though you're not you just talk to some friends for years, one day some journalists decide that he can talk to you, and you can talk to him, and so you have about the same audience as someone who has been working as a lobby for years, so it was quite exhilarating, and we use the tools we had at the time, which was humour most of the time, and the scientific methods. And so we begin that, digging deep into homeopathy, learning about how it was really created so we could answer the journalists when they asked questions, and so we have actually quite a lot of fun, just discovering how homeopathy, was made and created. And so when we're invited on TV, on radio, it was actually quite funny just to put homeopath doctors in front of your contradictions and asking them if they really thought that X-rays diluted into sugar would really have an effect on someone. Actually the suits, the legal issues are still running, so the groups, the unions of homeopath doctors really attacked in front of the GMC medical board about the hundreds of people who had signed the op-ed, and so we also discovered how our medical board on the national scale works and how people who do alternative medicines have infiltrated this institution. So we're still in waiting for the legal issues. 

Afterwards, as we had legal issues, we had to form ourselves as a collective. So we had to face as a small collective who was based, maybe with a 100 of medical lectures, we created the no fake med collective and facing us was all the doctors who prescribe and who love homeopathy and also the producers who decided to do a campaign which was called MonHomeo, MonChoix which means my homeopathy, my choice and they actually recruited people like Xavier Bertrand, highly known, and highly popular political figures, who almost a shot at being President in France in recent elections. The small green cards, you see, were in pharmacy  in France. The picture with the people in the white T-shirts, this is the manifestation in the heart of Paris, and so it was actually quite funny to see a small group of the doctors facing this lobby with so much so much cash and so much power, so we had to rise up, we had to wise up as Hamilton would say, and so we created the no fake med collective. In order to organize ourselves we created the website first and also some other tools.

 The first Presidents, which is Dr. Jeremy Descoux is a cardiologist in the south of France, and so under his lead we decided to participate in the health care auditions. With the help of anyone who we needed to help who had the scientific background, we answered the auditions and so we did a scientific study homeopathy with all the bibliography and augmentation that was needed. It was a hard time because we discovered it was not just a scientific debate, but for some people really it touched how they felt, and it was a really deep personal thing for them. So I know that Jeremy was actually threatened a few times, he received some unpleasant packages. Afterwards, also some letters of threats. For my part fully, I didn't get any threats yet, but we will see that Covid was even worse afterwards. So in 2019 the HAS, The Healthcare Institution decided to finish its audition and decided that homeopathy would be defunded progressively. So it was progressively, it's now not reimbursed at all, and so we did on a progressive scale. But today we still have deputies and people in France who still ask that it should be funded again, and we should pay you for the sugar with our social security. For the numbers per year, in 2016 it was accounted, but just the pills costs the social security 200 million euros, not counting the formations that were reimbursed by our social security for doctors who were paid to do lifelong learning about homeopathy which, to my point is quite surprising, and also of the time it took in faculties who taught homeopathy and all the rest of the consultations of a doctors who only did on homeopathy were a waste and so one of our main arguments as we went on the radios and the press and the TVs was okay we don't have enough nurses. We don't have enough doctors. We don't pay enough our nurses and our health care provider, so that's really a 200 million we could use elsewhere, and it worked, so that's a win. Afterwards Cyril Vidal took the presidents of the no fake med collective, and we thought we could have a rest and focus on the role we were set, which was really talking about dis-information in science, and how we could really work with the health ministry and the faculties to just exist, to train students who have critical thinking.

We started creating a Fakedex, which is a small, one page or two page slides that any doctor could have access to which give information and scientific information about fake meds or what we call fake meds which are alternative and complementary medicines so here you have homeopathy and a form of acupuncture which is injecting saline solution under the skin, and so we tried to do a bibliography and research on what it's based on, how it's taught, what should be its principles. Sometimes we don't really have an answer for meditation, for hypnotherapy. It's not black or white, it's more a grey area but for example, with homeopathy we can talk about the side effects, and so we were really focusing on making a tool who could give patients and give healthcare providers useful information when they were faced with people who were really into a fake med.

Yes, I think you all lived through it, and we're still in it. It's Covid. The wave of disinformation we had to face, both on the Internet and in everyday life. Even though Covid pandemic was really a hard time for every association because we had a lot of work, and we were under a lot of pressure again. Really it was not easy every day to go to work as a GP during this period. As a collective we saw the reactions and the debate. How people were really violent about Covid about Hydroxychloroquine, and how in France, people really were really aggressive and were spreading a lot of disinformation and we saw that as a collective we actually became not just our collective, with the people who formed the collective, but the brand. And we were not a brand in the mercantile form, but just a way to say, okay, “I'm a no fake med health care provider, and I just want to give my patients something based on science.” The people who spread this information use this term now as no fake med science and health care providers. But they never really attack us. But, on the contrary, when people rise up, and when people begin to go, not as a collective, but as themselves on the air on radio on TV, they were systematically attacked, and we found out during the pandemic that being a collective, having the possibility to really send. Maybe the president, maybe the treasurer, or maybe someone we just have relations with and say, okay, just go for us and talk about this subject. You know more about. This was a way of protecting ourselves also, and maybe the best way that could, even if we don't impersonate the answer to some questions, we protect ourselves in these critical moments, and we did not suffer as much as maybe people, like for example someone who was quite vocal at the beginning of the pandemic, and then was just harassed by hordes of people on Internet, and was a difficult time for her. As a collective, hopefully we wouldn't have these issues. 

And so now we have as a collective tried to up our game because we are now something that is recognized by both Media and the some of our administrative and political forces. We were received, and we had a face-to-face meeting at the end of Covid, at the end of last year, which was quite fun, and then we also are currently trying to work with faculties to promote critical thinking, to fight this disinformation. And so after the first years of the collective which were really a bunch of people trying to make fun of homeopathy online, we are now trying to evolve, and wise up, and try to walk on 2 feet, which is trying to provide useful and clear and scientifically based information to health care providers and patients. This is the role of our website. This is the role of the fakedex I have shown you. It's free of charge. You can use it and use the slides. You can use everything you want. And the other thing we try to do is also to not leave the room to people who spread dis-information both on the air when we worked with the media, with the journalists. We try to give them solid and useful information, and also on the legal side, when people just go too far, the Slapp suits we've been through have given us an expertise on our legal system in France. Considering the suits that can be held in ethical courts and on other board courts. And so we decided to sometimes act, and this is what we've done with French doctor who was a psychologist in the east of France, was also a deputy, and who was with other people spreading loads and loads of misinformation online line and so the collective decided to act and to sue her, and we should have the answer of this legal suit at the end of the month. 

Elizaveta Osipenko: The fact that you were so brave, and I have a lot of questions for you. So please do raise hands, anyone who has questions. But A is I hope you're not being charged for these lawsuits? Because if this was happening in the US and if somebody was coming after you financially, it's probably unsustainable, that’s one question. And how much of a headache does this give you? Was it a headache at all?

Pierre de Bremond d'Ars: 0 headache. It’s not a lawsuit that would end up with me, being charged on the financial level. It's more the ethical side of and the professional side of lawsuits, and at the worst I know I would get sentenced to not be elected in the Medical Board for 3 years. It would be almost a way to say your system is just rotten, because you're defending people who defend homeopathy, and you sentence me for not being polite and not being as polite as you wish I would be with them as I'm just stating facts, and I'm just trying to inform people about what SCAM homeopathy is, and if you want to sue me, fine, if you want to sentence me to not being elected to your medical board fine I’ll resign, but I will carry this blame as a decoration along with many others and I'll just be fine. Financially the collective created itself, so we could also take one lawyer who would know all the suits and who would accept to charge us for amount our insurances would cover, so I would not have money taken from my pocket, I would be reimbursed by my own insurance. So it's not a lot of pressure on the side.

Elizaveta Osipenko: Has all this work been done Pro Bono? Do you have anyone supporting you, or have you received people who said, Okay, we're proud of what you're doing. How can we support you? Did you get any financial support? You don't need to disclose who it was from it's just the fact

Pierre de Bremond d'Ars: We don't have any financial sponsors. All our money is from the people who signed up with the collective. We don't need a lot of money and everything. We just have a website, and also people who agree to move. So today we don't have the need to have sponsors, and so on. Also it’s a way for us to be independent. Really, our strength is our humour and our network, and then that we have some brilliant people Francois being one of them in our network who can really help us understand how some of the things work for example, on the European scale, and also to begin to work with the administrative and the state side of the lobbies. We have to be a lobby, so we have to understand how it works, but we're just trying to do it on the humour , and then on our spare time. 

Elizaveta Osipenko: I have a fundamental question where whether you answer Francois, David, or Ian, because it's more of a system question. What do you think is a dream or an objective in terms of homeopathy, it doesn't matter which health care system would take. Is the objective to completely separate it from mainstream medicine and say, okay this is success, and we have this and okay, there are some groups, who want to practice it but this is unregulated. This is not reimbursed. Or should the goal be to eliminate it completely. Or it's something else. Again, what is a realistic objective? What is a dream? 

Francois Maignen:  I can try to answer this question, Leeza. I think that it's a very important question definitely. I think we should get rid of these SCAM medicines, quite clearly. As you know Leeza, I met Pierre in France just by chance. I was on Twitter, and I started to see. Then I started to, because I was so angry, I sent an email complaining about the ambiguity to one answer. So when Pierre and colleagues received legal suits from the GMC,  I started to write some kind of assessment of the evidence. What I discovered, and what was utterly shocking, and it is still it's very shocking is that it unravelled some very sad stories. People were using homeopathy to allegedly treat autism in children. People were prescribing homeopathy to treat cancer. Clearly there was in this story, in the simple story, let's say, funny story of prescribing sugar and making fun homeopathy. Behind that there was some very nasty and very sad stories and people dying from these diseases. So personally, I think we should have a very strong stance against this SCAM, they should be banned. The ambiguity is homeopathy is this state of the art, medical practice and I think that we should really get these messages across, and we should get rid of these practices, Realistically, can we achieve that? No, I'm not sure because you've got a lot of them which are now protected or officialised by the legislation like osteopathy. Osteopathy in France has formal recognition by the government, so realistically it would be extremely difficult to get rid of these practices, but I think we should try to make sure that they don't get recognized. They don't any get any kind of protection from the state, you see that from the government on the legislation, and when there are some excesses in the prices they should be condemned, but I mean legally condemned. Physicians who practice this medicine should be subject to  legal proceedings.

Elizaveta Osipenko: Any other comments on this question, what should we do?

David Colquhoun: You, you will never get rid of the High Street homeopaths, and it would be counterproductive to do so probably. Maybe they give a little consolation to some people but you can, and it's largely happened now, after 200 years of effort, get rid of it from universities and from the National Health Service. I mean the aim is to stop the taxpayer paying for it. If people want to pay for it, you could never stop that. 

Pierre de Bremond d'Ars: Yes, I think on the subject. We should separate wellness from health care, and so the collective has its faults against homeopathy, and considers the fact that it's no longer paid by taxpayer as a win and it's a big win, it's not something we thought we would achieve. But it's more global fight against disinformation. Tragic stories that Francois told about, and that people really should know about. You talked about people who treated cancer with homeopathy, but also people treating autism with Reiki, or the fact that people treat diabetes with natural remedies or for my part, on a personal scale, I started to fight and to refuse the role of homeopathy in France when I saw this young girl who was 6, who had epilepsy, who was having seizures all day long, and why? When I asked her mother why she wasn't taking her treatments, she answered me that oh no, her neurologist is a homeopath, and she gives them pills. Okay, so you stop the medical part, and just having your daughter seizing all the time and having huge health problem because it was really a shock to me. That’s when I really start to take things seriously. And so on the legal side, on the achievable side of the fights, our credible end goal would be to have an educated population, who knows what health care is, and what is wellness. Who has information. Who has been informed.  Who can choose to take pills so go to an osteopath to take needles and have the possibility to say, Okay, stop. I did it for wellness. I will not treat my cancer with that, and that is something we can achieve by taking it out of anything that is health care, including faculties, our clinics, and our system.

David Colquhoun: The only thing you can do to stop high street homeopaths Is to stop them, making false claims. In the UK, we have the advertising standards authority, but it's completely toothless. They can't do much. They just say stop saying that. So they just carry on and ignore it. I think if they, and trading standards, which is a sort of legal arm of it, were a bit stronger, that would help a bit. But you know, while Doctor Oz and Alex Jones make Mega millions out of it, you're not going to stop it are you.

Francois Maignen:  No, and I think you make a very good point, and the point is at least in France, the French agency grants indications to homeopathic remedies, and it opens the doctor up to advertising. What I always find extremely shocking when you go to France, is that you might have noticed to yourself when you see the pharmacies, they are selling homeopathy, it’s the first thing you see. I don't know whether any studies were conducted to assess or quantify the prevalence of these therapies in different countries, but I find it extremely shocking. That you've got such a prevalence of these practices in France. It seems to me that it's completely subjective. It seems to me that it's much less prevalent, it’s much better education on on this side of the channel. 

David Colquhoun: Well in Germany, too. It's absolutely right. I once went to a meeting of single molecule physicists because my previous existence was within the single Ion channel analysis, and this was in Germany. I was astonished to discover that most of them were quite trusting of homeopathy. These are physicists, they just didn't know what it was I didn't think.

Francois Maignen:  But I think if we were to stop the institutionalization of these practices, so if the French were to stop granting these nonsense indications, if homeopathy was taken out, The European legislation of medicines. This would be a major step for the world. At least we could have a way to tell people, okay these are unsubstantiated practices. At the moment they are using this ambiguity of getting some partial recognition from government bodies to make some claims to capitalize on their reputation.

Elizaveta Osipenko: I have a question about doctors because a dream that we will have an educated society at some point who will know about wellness, and who will know about evidence and medicine, it will always be limited to extremely small proportion of people and majority will be looking for miracles, and that's where homeopathy is winning big because people want the easy solution, and it kind of pushes itself this way. So my question about doctors, correct me if I am wrong, If we take mainstream word certified physicians, clinicians in any country. Not homeopaths, so to speak, Just doctors. As I understand some of them like homeopathy and some of them actually prescribe it, at the same time being qualified doctors and prescribing other medications. Is there a solution there? Can we separate one from the other to make sure that doctors practicing proper medicine say, look if you want to drink lemon juice, it's not with me. Go somewhere else and try it. So what are the steps? Because I think, David you started this saying: Okay, We need to take this out from the universities. Should they have a legislation framework, should each country kind of take this forward, saying, look, let's separate the 2, and from your perspective, maybe Pierre, you would know this what proportion of doctors in France are kind of pro homeopathy, and would prescribe it. And what proportion is definitely adhering to medicine, and say, you want homeopathy, go elsewhere?

Pierre de Bremond d'Ars: It's difficult to have numbers because the only numbers you have are the numbers that we got during the debates, which were about 70% of doctors had at one time prescribed homeopathy. But the problem is that as homeopathy is in every counter in every pharmacy and in everybody's life, if you were a kid growing up in the 80s, you obviously had to have homeopathy if you had a bump, or a scratch, or flu, you would. Take it. For a bump you would take arnica and it was the way most French mothers would cure the kids at first. So there’s really social pressure to prescribe. But what we saw as we worked on the subject is that real homeopaths, people who really believe in homeopathy who just don't prescribe it because they think that the patient wants it or because the patient asks for it are quite rare and quite old, and most of the time, struggle to have people who want to take on the burden to start with. There are still young homeopaths that are being trained but the fact that it's no longer funded makes it less of a calling than it was at the time. On the political scale homeopathy was also maybe developed in the 1970s and 80s in France because, ironically, we had too much doctors, and so in order to have patients, doctors had to have a little plus, something that would attract the patient, and so many doctors actually went on having claims like “I will treat you with a natural remedies” “I would treat you with homeopathy” and if homeopathy kept this biological and ethical and  natural side which it doesn't have, It was also on the marketing and on the advertising, and so now there's the people who are really fond of homeopathy are rarer and rarer. But we have other issues like osteopathy, which is growing fast, and which is also giving us problems in health care, and that's what actually we tried to do in our latest op-ed we did it again, but this time it was about saying that we shouldn't give SCAMs to kids. So the op-ed was about osteopathy and essential oils, which are sometimes used in pregnancy and for young kids and students, and something that is quite popular in France, with our amber necklaces for teeth. We did it again, and we had less success in the media. But it was also because we started from higher. So, many people actually understood what we say, and the landscape has changed. People are okay with science and know the cost of fake meds in our society. Posterior tongue ties, I don't know if you have a problem in the UK with posterior tongue tie sections, but in France it became a trend and every little infant had it’s posterior tongue tie cut because everyone was saying, “Oh it would help with breastfeeding.”. And so it was a problem

Ian Tannock:  Yeah, I mean I've been listening. I think there are separable problems with how homeopathy, and we had a former Consilium talk not long ago about alternative medicines. I mean ideally we'd like everybody to use evidence-based medicine, but in terms of homeopathy on the one hand, you hate to see a lot of people giving useless, but perhaps not harmful medications and making a profit from it. And that's one side, but the other side is where people are persuaded to take these medications, not in addition to, but instead of medications that can really help their disease.  You mentioned for example, Pierre, a woman not treating her child for seizures when there's effective medication available and using some medication that does nothing, and of course we see this in cancer and that came up actually in the last time we discussed in Consilium. What is even more tragic is where you see people using useless medications for diseases that could be potentially cured, and that does happen quite widely. I would say that in my own experience I see more often people taking a homeopathic medication in addition to standard treatment, and most of them are not harmful. For example in Toronto we have huge Chinese population, and people take Chinese traditional medications, which are probably not very different, but we do also see people who refuse to take effective treatments, say women with breast cancer have refused to take hormone therapy, and have taken some homeopathic medication instead, and that is particularly harmful and particularly worrying and that's something we need to stop. Interestingly and anecdotally Steve Jobs, who died of a tumour of the pancreas, he had a different type of pancreatic tumour that was quite treatable and refused regular treatment and apparently had homeopathic treatment and of course died. So it's not only the uneducated who go along these pathways.

Francois Maignen:  Just to comment and elaborate on what Ian said, about the evidence based medicine. I'm still astonish that Nice has published some guidelines and I was looking at on Monday, the guideline on the palliative care in cancer and this guideline for NICE explicitly mentions use of complementary therapies in palliative care in cancer so I don't know how these recognitions crept into the guideline but it gives you an idea of how institutional bodies like NICE, can be infiltrated by these SCAMs and how very reputable bodies like NICE, can publish some more recommendations based on no evidence whatsoever. So I think there is some policies to be made in terms of evidence based medicines recognition for SCAMs

Elizaveta Osipenko: Actually I'm not surprised Francois, because I remember it was a field trip from NICE for our team in London. I don't know if you were with us or not. We went to the health Select Committee in the Parliament, and NICE was called to the floor. I don't remember what the case was about. I don't think it. It wasn't verdict. It was before, and we just went to see the process and what surprised me so much is one of the Parliamentarians was completely getting off the subject. It was nothing to do with that particular question, and pushing NICE to focus on homeopathy and complete guidelines. So it was not the one person, and I was actually quite shocked about how strong this push was, not that it's influenced NICE in any way, but at the same time, I don't think there is a very clear guidance within the organization about it, and it's a separate thing which I think needs to be looked into. It's not just NICE, I'm sure there are other HTA bodies that probably raise the question.

David Colquhoun: Nice has never recommended homeopathy, though?

Elizaveta Osipenko: Correct.

Francois Maignen:  To make another point we are also in a very difficult situation. If you look at and compare the issues associated with homeopathies which in Europe and the and the US for example. In the US, the issues with homeopathies are very nasty. Patients use products which contains some heavy metals, or these kinds of things, because homeopathic remedies are absolutely unregulated by the FDA in the US. And the FDA has been asked to regularly put out of the market or recall some counterfeit homeopathies. So it tries the issue that all these therapies must be regulated to guarantee some kind of quality of their materials, but on the other hand, we should not give them any kind of scientific credentials, but it’s a fascinating subject.

Elizaveta Osipenko: So Pierre,  I think many other countries have to learn from you and from your team, and there's a lot of work to do. So I think we do deserve a better health care service which guides population, because, as you say, resolving this completely, it might not be possible. But at least we need professional organizations really taking a stand and regulating this as much as we can.