An often repeated and largely accepted assertion is that homeopathy has never responded favorably to double-blind clinical trials, currently presented as the ultimate in evaluation, and has therefore never proven its effectiveness. I will not enter here into a pointless controversy on the arguments on which this assertion is based, but I invite each reader to change perspective, to wonder if in essence the idea of efficiency is as obvious and well defined as supposed. Indeed, what do we really and concretely mean by efficiency? Is the notion as obvious as one would like to believe?

The problem is that no-one usually asks the question of what effectiveness is, or how to define it. Everyone considers it obvious that an effective drug is, by definition, a drug that brings real and indisputable health benefits. But the term effectiveness comes from the Latin efficax which designates “something which produces the effect that one expects". We can see, therefore, that the concept is not as "objective" as one might think and that it refers to the valuation of an effect expected by someone. The challenge therefore shifts to the side of knowing what to expect.

A somewhat naive approach would lead one to think that the idea of effectiveness must by definition have only a positive and useful action for the patient. So there is a tendency to think nowadays that a drug is effective when it meets these criteria. That is to say, it leads to an improvement in the patient's condition, his health problem, a benefit and a usefulness of the prescription in terms of health. It seems obvious, but it is not always so, and it is important to clarify this. Indeed, the expected effect, especially in clinical trials, is nowadays not always a benefit duly noted and observable but only assumed and postulated.

Effectiveness often comes down to normalizing one or other biological parameter or improving one or other symptom. The problem is that it is far from established that "normalizing" one or other parameter or "relieving" a symptom is truly beneficial in terms of health, ie in the reality of the patient. More generally, one is content with the efficacy of the biological parameter or the symptom targeted to establish the legitimacy of the use of the drug in practice. However, this complacency with such a concept of the effectiveness of a treatment poses important problems and gives little guarantee of its real interest from the point of view of health.

For years, hormone replacement therapy has been prescribed for menopausal complaints, which improved certain discomforts (hot flashes, tone and texture of the skin) by postulating that in cardio-vascular cases this could only be beneficial, that it would be harmless from a cancer point of view. Decades later, studies have showed, on the contrary, the harmful effects on the cardiovascular system and breast cancer.

This has been and remains the case with fibrates in the treatment of high cholesterol. What is the expected effect? Lower cholesterol. There, these drugs fulfill their mission and are very effective. On the other hand, one suppose and postulates that their cholesterol-lowering effect is necessarily beneficial in terms of health, and of benefit for the patient. However, after years of prescription without asking too many questions, studies have shown that not only did they did not improve the life expectancy of the patients, but on the contrary, reduced it. Digestive cancers have been provoked, particularly gallbladder cancer. Thus, although effective in lowering cholesterol, they prove harmful to the health of the patient. Note that these drugs are still prescribed daily to millions of patients around the world.

What about Proton Pump Inhibitors (PPIs)? Everyone sees that they often relieve, quickly and therefore effectively (if this is the expected effect) the symptomatology such as gastric burns and / or gastro-esophageal reflux), but everyone also knows that these PPIs should not be prescribed for more than 12 weeks in a row to avoid harmful side effects.

But what use is a treatment which has only symptomatic efficacy without changing the problem which causes the symptoms, when the pathology in question is eminently chronic and will last for years?

One last example, flecainamide. This is an anti-arrhythmic drug that effectively normalizes the electrocardiogram (ECG) of some people with a certain type of heart rhythm disorder.

Note that we are, with these four examples, outside the only notion of adverse effects. I am not talking here of the harmful side effects of an otherwise useful medicine, but of the lack of interest in the health of the patients, or even the harmfulness, of medicines which are deemed to be effective.

By which we see that it is appropriate to :

Thus we need to reconsider things. Labeling a treatment "effective" is not enough. We must question the nature and the value of the expected effect, be critical of it, define it very precisely and never leave room for assumptions or preconceptions. Lower cholesterol? Why not if that translates into real health benefits and prevention of future problems?

But this needs to be proven, not just claimed.

Normalize a rhythm disorder? Why not? But just because it seems “obvious” does not necessarily mean that normalizing the ECG will actually improve the life of the person. The benefit in terms of morbidity and mortality must be duly noted over the months and years (not only over a few weeks). A treatment can bring short term relief but prove harmful with prolonged use. In short, we as physicians should…

Health is a complex, global data, which is registered and proven over time. Its (appreciation? DC, What do you mean by this?) is delicate. Subjective criteria are to be coupled only with double-blind trials. More global, broader criteria, epidemiological studies, frequency of work stoppages, "medical consumption", subjective assessment by the patient himself of his condition, etc. These must, moreover, be based on a much more rigorous definition of the expected effect which must represent a benefit for the patient's health and not solely aim at the correction of a parameter which is assumed to be accompanied by said benefit.

We must also learn to think globally (holistically? DC). Efficiency in one sphere can be accompanied by harmfulness in another. This is the whole question of so-called side effects, which are by no means secondary but "collateral" effects because any molecule always has a more global action than the target which is claimed to confine it. And finally, we need to learn to think long term. Today's apparent "good" may turn out to be bad in the near or far future.

Remain careful, attentive, modest and vigilant. In fact, it is truly ecological thinking that we need.