The controversy swelled all weekend before rising to the heights of the state. Doctolib, the main online medical appointment booking platform in France, is the target of strong criticism from doctors, pharmacists, etc. The latter denounce the presence on the platform of “well-being practitioners” who are indistinguishable from real health professionals. Among the profiles targeted, sophrologists, iridologists, psychoanalysts of quantum therapy or even naturopaths, professionals with legal practices but without regulation and some of whose representatives have dangerous practices, close to charlatanism and sectarian excesses.
After initially responding that it was not up to them to decide who has the right to exercise or not and having called on Internet users to file reports on its site themselves, the Doctolib group finally announced , Monday, August 22, that he was suspending 17 profiles and that he was undertaking “substantive work” with the site’s medical committee, the orders and health professionals. The 17 profiles concerned are those of naturopaths – who aim to maintain the body in good health thanks to a set of “natural” methods, but which have no proven scientific or medical basis -, who put forward their training with Thierry Casasnovas or Irène Grosjean. These two influential personalities in the world of so-called alternative medicine have positions that have been denounced for years by health professionals. The first has been pinned on multiple occasions for the dangerousness of his advice and worries the authorities. The second is under fire for having recommended that parents practice acts on their children that would amount to sexual assault on minor.
The situation went up to Sonia Backès, Secretary of State in charge of Citizenship to the Minister of the Interior and Overseas Territories, who asked Christian Gravel, prefect and president of the Interministerial Mission for Vigilance and against sectarian aberrations (Miviludes), to organize “a working meeting to discuss this issue and draw all the useful lessons”, tweeted the latter, Monday, August 22. A positive reaction that should not mask a deeper problem and the need to draw clearer boundaries between well-being and health, believes Pierre de Bremond d’Ars, general practitioner and president of (No) FakeMed, a collective that brings together health professionals fighting against health misinformation and who notably participated in the sling against Doctolib.
Doctolib presents naturopaths, iridologists or other quantum therapy psychoanalysts as “health professionals”. The platform would thus be guilty of false advertising and moral fault according to you. Is there also professional and legal misconduct?
Pierre de Bremond d’Ars: It is complicated to decide on a “guilt”. But the vagueness voluntarily generated by the referencing on the same site, with the same color codes, the same presentations, of health professionals, caregivers, alongside people with unconventional practices and not based on much scientific asks questions. This endangers patients by legitimizing the outlandish practices of some, and it leads to confusion, whether voluntary or not.
In a nursing home, it is not allowed to have a common waiting room with unconventional professions. Why not the same on a website?
Access to caregivers is complicated, we know it, we experience it every day in our consultations. That a search on the first site of medical appointments in France for a tobacco problem directs towards a practice at risk of sectarian drift, because the doctors are not available during the week, is unacceptable.
But in a nursing home it is not allowed to have a waiting room or common premises with unconventional professions, so as not to give them legitimacy (items 20 and 30 of the code of medical ethics). Why not the same on a website? It would be quite possible for Doctolib to create a specific “Wellness” version of its site, with a new name, another color code, and separate and distinct databases.
You write that Doctolib puts forward “practitioners promoting dangerous practices or at risk of sectarian aberration”. What practices have you been most concerned about?
Those suspended in emergency this day, in particular the naturopaths claiming to teach Irène Grosjean and Thierry Casasnovas, several times pinned for dangerous practices and fanciful assertions. Some encourage patients to stop their treatment for diabetes or their chemotherapy.
The most risky practices are known and referenced by Miviludes. These are reiki, naturopathy, extreme fasting and raw food, neoshamanism and access bars [NDLR : la Miviludes souligne également que les psychothérapies et le développement personnel “continuent de compter parmi les portes d’entrée d’influence sectaires”]. Access to vulnerable populations – children, people in a reproductive/fertility process, with disabilities, cancer, psychiatric illnesses – is also a major concern.
Doctolib initially refused to clean up and instead invited its users to report potentially dangerous profiles themselves. According to you, it is not up to users to know who is a real health professional and who is not. Is there nevertheless a list of unrecognized care practices?
Health professionals are referenced in the public health code:
- The professions: doctors, midwives and odontologists (art. L4111-1 to L4163-10).
- Pharmacy and physics professions: community pharmacists (practicing in town) and hospital pharmacists and medical physicists (art. L4211-1 to L4252-3).
- The professions of medical auxiliaries (nurses, physiotherapists, chiropodists, occupational therapists and psychomotor therapists, speech therapists and orthoptists, medical electroradiology or ERM manipulators and medical laboratory technicians, audioprosthetists, spectacle opticians, prosthetists and orthotists, dieticians), – carers, childcare assistants, paramedics and dental assistants (art. L4311-1 to L4394-4).
Some professions are governed by decrees but do not appoint health professionals: the status of osteopathy is unclear, for example. The 2007 decree mentions it, but in order to frame the acts and to prohibit a lot of things. Osteopathy has not yet proven its effectiveness on anything apart from a moderate improvement in simple low back pain, equivalent to conventional practices (including physiotherapy), and is not devoid of undesirable effects and risks, hence the framing in particular of cervical manipulations, infants, etc.
You said, on the NoFakeMed Twitter account, that “Doctolib must set up a watch, a moderation in the diagnostic, therapeutic claims or the dangerousness of the practices”. But doesn’t establishing a list of good and bad practices and banishing them from Doctolib risk giving free rein to these practitioners on other platforms? Doesn’t the solution lie in the hands of the State and, in this case, where is everyone’s freedom to “treat” themselves as they see fit?
That’s a big question, how many hours do you have? For the moment, we are in the time of the media agitation. But there is an important question behind it: how do we manage in a digitized world where the boundaries between well-being and health are blurred? How to frame things for the good of the patient, to ensure that everyone is well cared for and not to create confusion, that a patient can consult a health professional in the event of a health problem, and a well-being professional be when he wants?
In summary, we must inform patients of the risks, give the means to the institutions in charge – Miviludes, the regional health agencies, the General Directorate for Competition, Consumer Affairs and Fraud Prevention -, put the orders before their responsibilities for continuing medical education, control and follow-up of practices.
How to place the cursor between “good” and “bad” wellness practitioners?
It is not desirable to put everyone in the same basket or to throw everything away. Take yoga. There are many good practitioners, but also many excesses, as noted by Miviludes. Banning the practices is futile. What is needed is to educate the general public. The purpose of our collective is to fight against people who drift and above all to give information to patients allowing them to treat themselves safely, for example to show what the “red flags” are so that people who choose practices ” well-being” may have them in mind. There is an article from the professional journal Prescribe which is very good. This information can also be found on the Ministry of Health website.
The excesses do not only exist among well-being professionals, but also among health professionals…
Of course that the cleaning is to be done at home too [NDLR : le collectif FakeMed s’est créé à l’origine autour de la lutte contre le remboursement de l’homéopathie et ses membres ont été la cible de procès de médecins homéopathes]. What we are calling for is that the universities, the ministries and the orders take up the problem and give a framework to the practices, that they cease their historical tolerance vis-à-vis practices which have no scientific foundations and who ridicule us internationally. When we tell foreign doctors that we were reimbursing homeopathy a few years ago [NDLR : le déremboursement total a été acté en 2021]they can’t get over it.
You believe that Doctolib is in a monopoly situation. What risk does this represent? What is the State’s responsibility?
Doctolib was able to respond during the vaccination campaign to the State’s request to streamline access to appointments for vaccines. It’s a huge job and they were there. They have thus acquired a monopoly situation in this area with implicit validation from the health authorities and the State. We are therefore entitled to expect a form of exemplarity and honesty in the provision of care. With great power comes great responsibility, as Peter Parker said. [NDLR : Spiderman].
Why does Doctolib put well-being professionals first and on the same level as health professionals, andis this par ignorance, or as you write itfor pecuniary reasons?
Is it the fact that the caregiver market is saturated or that there is a lack of knowledge of the public health code and the status of health professionals? What other interest would there be in proposing practices that flirt with the illegal practice of medicine or scams? But the important thing is that they correct the situation, that they make things evolve for the good of the patients and not to maintain confusion.
Have you contacted the Order of Physicians and do you think that it will act, given its usual reluctance regarding these subjects?
Ordinal time is not buzz time. We have alerted the Order several times to the danger posed by the dissemination and promotion of unproven care practices on social networks and the Internet. Eventually, at the end of the crisis, this may be an opportunity for orders to reflect on this aspect of digital health and the separation between health and well-being, by protecting patients from sectarian aberrations and misinformation. . We are indeed awaiting clarification from the supervisory bodies and professional orders.