The Boucicaut district in Paris is a paradise for sick people and hypochondriacs: there are, at the very least, half a dozen pharmacies around. Wanting to take advantage of this density, L’Express went there in mid-January, five years after the start of the gradual delisting of homeopathy, in the hope of meeting pharmacists who no longer sell it. And left empty-handed.
What should have been a formality has turned into an obstacle course: not a single pharmacy in the sector has given up the famous white beads, entirely at the expense of patients since 2021. Same observation at Convention, at Beaugrenelle, at Commerce, as much residential areas of the 15th arrondissement of the capital, particularly equipped with green storefronts and sellers in white coats.
The fact that it is so difficult to find such an establishment is not insignificant. Normally, this type of store is required to only sell products whose effectiveness is supported by scientific studies. At least this is what the Public Health Code imposes, in these articles R4235-10 and R4127-39. However, this is not the case for homeopathy, insufficiently proven, in the opinion of the authority in force, the High Health Authority (HAS).
Exemption from evidence
The phenomenon is all the more surprising as it is not specific to the capital. L’Express compiled press clippings, posts on social networks, official press releases, without ever finding trace of a single pharmacy having taken this type of initiative. Neither the order of pharmacists nor the unions have heard of such a pharmacy. It seems that in France there is no pharmacy up to date with the scientific consensus.
The reality is more complex: if, in 2019, homeopathy was defunded precisely because it had not shown any health benefits beyond the placebo, it never lost its title as a medicine. In fact, pharmacists are therefore not obliged to remove it from the shelves. They are even surprised to be asked the question: “Why shouldn’t I sell it? It’s authorized, and people want it,” one of them annoys.
A situation made possible thanks to a decree dating from 1998. It gives homeopathy a very special place in the medical arsenal. “Given its specificity, the applicant is exempt from producing all or part of the results of pharmacological, toxicological and clinical tests,” it is indicated. In other words, these products are exempt from effectiveness studies. No other “treatment” benefits from such privilege.
Legal, but not very medical
Contacted, the National Medicines Safety Agency (ANSM) did not wish to comment. Same story for the order of pharmacists, required to enforce professional ethics. Internally, an employee of the jurisdiction still recognizes a “tension”. “It is indeed not easy to fight against quackery while selling homeopathy, the foundations of which, like the memory of water, are considered esoteric by scientists.”
Apart from a few well-informed specialists, few people know of the existence of this anomaly. It is insane from a strictly scientific point of view. “It’s a scandal,” takes offense Mathieu Repiquet, member of the No Fakemed collective, which launched the debates on delisting in 2019. “Selling ineffective products by presenting them as useful for various pathologies, under the name medicine , in a place where care products are dispensed, this poses a real ethical problem.”
The activist and his collective are calling for a change in the law to put an end to this “legislative absurdity”. But, as the little white balls are still in high demand and provide jobs and revenue, few voices are raised against this preferential treatment. “Financially we could do without it, other products are much more profitable. But we have to satisfy the patients,” regrets Dr Gautier Blondin, of the Midi pharmacy, avenue Félix-Faure, in Paris. Skeptical about these products, he sticks to the strict minimum: around ten references, no more.
Marbles, quick marbles
In fact, the pressure is strong on pharmacists. More than 45% of French people still “treat” themselves with homeopathy, according to a survey carried out by Odoxa for the National Union of Associations for the Defense of Families and Individuals Victims of Sects (Unadfi) in 2023. So much so that It is still sold for more than 308 million euros each year, according to exclusive estimates obtained by L’Express from the firm IQVIA PharmaOne. If the delisting caused a drop of around 42% in sales, it therefore did not kill the market, contrary to what was mentioned in 2019.
A predictable trend: the attraction to alternative therapies has continued to grow in recent years, as has distrust of institutions. “There are still many regulars, doctors and patients, who swear by it,” illustrates a pharmacist in Cambronne, specializing in homeopathy. He took advantage of the delisting: he manufactures his own products, to compensate for the drop in industrial production, diluting and rediluting his molecules in water, until there is only one left. imperceptible quantity.
Like this pharmacist, many pharmacy technicians take the promises of homeopathy theorists at face value: “It has its virtues, people say they are relieved,” says a technician, rue Lecourbe. “We often see stories of animals cured by homeopathy, for example, it’s disturbing,” says another, in the same sector.
Pharmacists and science
A common position, even at the management of pharmacist representative bodies. “I have already seen people recover from cancer or urinary problems after taking it,” defends pharmacy doctor Pierre-Olivier Variot, president of the Union of Community Pharmacists’ Unions (Uspo) . However, he knows that a simple correlation has never been enough to demonstrate the effectiveness of a pharmaceutical product.
These persistent beliefs are also combined with the need to reassure patients who are most worried by their daily worries. “It is the only unconventional medicine to present no side effects. Faced with a patient who does not accept that nothing can be done for him, I prefer that we give that rather than substances with which he risks to poison yourself”, recognizes Philippe Besset, president of the Federation of Pharmaceutical Unions of France.
“If we refuse them this treatment, they will be more inclined to turn to more dangerous alternatives,” agrees Milou-Daniel Drici, professor of pharmacology at Nice University Hospital. For this specialist, a collaborator of the European Medicines Agency, it is impossible to sell homeopathy anywhere other than in pharmacies: “If we remove the drug status, there will no longer be any control over the composition and dosages. This opens the door to poor quality products,” he defends.
Put an end to pharmacy sales?
The question is delicate: “It is used as a medicine by people who may have a real pathology. Not sure that the Carrefour cashier will refer them to the doctor if they need it,” translates a pharmacist at Convention. Removing homeopathy from pharmacies could thus worsen the delays in care, and ultimately the loss of opportunities that alternative medicines can represent. Or divert patients to riskier pseudotherapies.
Homeopathy also has the advantage of easily causing a placebo effect. A good thing, contrary to popular belief. “It is wrongly believed that placebo means no effect. But the simple fact of expecting positive effects from a treatment leads to very real reactions in the body, which can help. In this, homeopathy helps to improve certain symptoms”, recalls Nicolas Pinsault, professor at Grenoble-Alpes University.
The specialist is not pro-homeopathy, however: “Suggesting that an unknown, quasi-mystical element without materiality can help puts a damper on the scientific approach. Patients also risk being disappointed, or submit more easily to fallacious arguments, in the long term, they risk having more difficulty sorting between justified therapies and those involving charlatans,” he recalls. So many undesirable effects that, according to him, should be added to the “benefit-risk balance” of homeopathy.
Cultivating placebos
In 2023, the researcher showed that it was possible to create as much of a placebo effect by explaining the phenomenon, without lying about its origin. “Of course, it takes longer, and it doesn’t suit everyone. There are people who don’t want an explanation but just a pill. But, in that case, why big companies like Should Boiron or Weleda benefit from it? Any substance without specific effect would also do the trick, like all our grandmother’s remedies”, underlines the scientist.
There is, according to Nicolas Pinsault, a ready-made compromise: not to ban the principle of resorting to placebo in medical practice, but to build a real ethics and a “policy” around these mechanisms. “Too few studies have been carried out on the issue, even though it is of health interest. We know, for example, that just by being attentive to the care environment, by being interested in the patient, we potentiate the patient’s expectations and symptom improvement We should take these results into account.”
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