For the sake of a handful of votes, politicians are prepared to treat the limits established by science as negotiable

From disregistered healthcare professionals to homeopathy, the majority seeks the support of cohesive minorities – regardless of their size, provided they can be mobilised – demonstrating that scientific evidence can become negotiable when it stands in the way of a political manoeuvre. On 14 July, two formally distinct events took place, both of which can be traced back to the same conception of the relationship between politics and scientific knowledge. In the Chamber of Deputies, the Social Affairs Committee approved an amendment tabled by Fratelli d’Italia that opens an extraordinary procedure for the reinstatement of certain healthcare professionals who had been struck off the register for matters related to the pandemic; in the Senate, during a conference organised by FdI Senator Giovanni Satta, the Under-Secretary of State for Health, Marcello Gemmato, discussed with representatives of the homeopathic sector a review of the sector’s regulations, including the possibility of providing more comprehensive information via package leaflets. There is no evidence to suggest that the two initiatives were coordinated, although the political logic linking them is clear: when an electoral community is sufficiently united, organised and vocal, the majority appears willing to offer it institutional recognition, even at the cost of weakening the scientific criteria put in place to protect public health.

The amendment concerning healthcare professionals is described in the press as a measure to reinstate anti-vaccine doctors, but the wording used risks obscuring the true nature of the measure. Failure to be vaccinated normally resulted in suspension from practising, whereas the provision approved by the Committee concerns individuals subject to striking off, which is the most severe of disciplinary sanctions and implies conduct incompatible with continued membership of the professional body. The group affected could therefore include healthcare professionals sanctioned not only for their views on vaccines, but also for promoting therapies lacking scientific evidence, for disseminating anti-scientific medical information, or for other behaviour deemed to be in breach of their duties towards patients. The FNOMCeO has interpreted the measure precisely in these terms, denouncing an attempt to undermine the legitimacy of the professional bodies and emphasising that medical prescriptions must be based on available evidence, clinical efficacy and safety.

The possibility of being reinstated on the register already exists and did not require the creation of a special political procedure reserved for cases arising from the pandemic. The standard rules stipulate that at least five years must have elapsed since removal from the register, that the person concerned must have conducted themselves beyond reproach and that, in the event of a criminal conviction, they must have been rehabilitated. The new amendment, however, allows those who have been struck off for ‘non-culpable acts related to the pandemic’ to submit an application within sixty days of the law coming into force, provided that an appeal is still pending before the Central Commission for Healthcare Professionals. The wording chosen does not clarify what conduct is to be considered pandemic-related, what the reference to "non-malicious" conduct means in disciplinary proceedings, or why a healthcare professional struck off during the pandemic should receive more favourable treatment than someone struck off for similar breaches committed at another time. Added to this lack of clarity is a practical contradiction, as an appeal against a disciplinary measure normally has suspensive effect. The fact that an appeal is pending – which the amendment has made a prerequisite for accessing the extraordinary procedure – may therefore coincide with a situation in which the striking off has not yet taken full effect. The law would thus risk creating a fast-track for the re-registration of individuals who, precisely because of the pending appeal, may not have been definitively struck off the register. This is not merely a technicality for legal experts, as it affects the very applicability of the provision.

There are also constitutional concerns that cannot be dismissed, even without seeking to pre-empt the Court’s ruling. As mentioned, the measure would distinguish between healthcare professionals struck off the register on the basis of a very vague link to the pandemic, favouring those who still have an appeal pending over those whose appeals have already been decided or who have not lodged an appeal, without there being any public interest justification proportionate to the derogation. The principles of equality and the protection of health are at stake, because the disciplinary activities of the professional bodies are not intended to punish unwelcome opinions, but to protect patients from professional conduct that is incompatible with scientific knowledge and professional ethics. The Constitutional Court has clarified that legislative measures concerning the appropriateness of therapeutic practices cannot be based on purely discretionary political assessments but must be grounded in scientific knowledge and experimental evidence verified by the competent bodies.

What seems to matter to the government, however, is that even if the text were amended by the House, and even if it encountered difficulties in implementation or were struck down by the courts, the political effect would already have been achieved. The anti-vaccine minority, which for years has interpreted the decisions of professional bodies and health authorities as acts of persecution, is being told that those decisions can be called into question through a special law. There is no need to assume an explicit electoral pact, because the political advantage lies in the symbolic recognition offered to a group that has built its identity on opposition to the institutions dealing with the pandemic and which can be drawn towards the government’s camp through the promise of a comeback. The legislation might not even achieve its legal objective, whilst it would already have achieved its electoral one; empty slogans to deceive a tribe that recognises itself in those slogans, and to win their vote. And never mind if this manoeuvre presupposes that evidence-based medicine is portrayed as just one political stance amongst others, opposed to the views of dissident healthcare professionals. In other words, it does not matter to the politician chasing votes that this is a false representation, because a doctor is not struck off for expressing an opinion on the government or for joining a political movement, but may be struck off when they use their professional authority to disseminate unfounded claims, promote ineffective treatments or breach obligations designed to protect patients. 

In reality, freedom of opinion concerns the citizen; the practice of medicine, however, entails a particular responsibility, since those who seek medical care often find themselves in a vulnerable state and lack the necessary tools to independently assess the validity of a diagnosis or treatment. Professional bodies, regulatory agencies and clinical trials do not constitute a bureaucratic superstructure devised to restrict individual freedom. They are the response that an advanced society has developed to the asymmetry of knowledge between those who treat and those who need treatment, between those who sell a product and those who buy it in the hope of recovery. Without these safeguards, the patient does not become freer, but is left more exposed to the doctor’s authority, to commercial pressure and to the persuasive power of those who promise benefits without being obliged to prove them. Defending scientific standards therefore means defending a concrete form of freedom – the freedom that allows the patient to make decisions based on verified information, rather than on claims made credible by a white coat, a label or political endorsement.

The very subordination of science to political expediency is evident in the initiative on homeopathy. Undersecretary Gemmato took part in a meeting organised in the Senate, on the initiative of a member of Fratelli d’Italia, during which discussions took place with representatives of the homeopathic sector and with stakeholders in favour of a regulatory review. The event, moderated by the president of GUNA, a manufacturer of homeopathic medicines, did not take the form of a scientific assessment in which AIFA, independent pharmacologists or experts in clinical methodology were also represented, but rather that of an initiative aimed at giving institutional consideration to the demands of an economic sector. During the debate, using a hackneyed and overused rhetorical ploy, reference was made to the number of Italians who use homeopathic products, presented as the reason why the legislator should address the sector and provide more comprehensive information. The fact that millions of citizens purchase a product is certainly an economic and social reality, but it says nothing about its ability to treat a disease. Sales measure commercial success, whilst therapeutic efficacy is measured by comparing clinical outcomes under controlled conditions, eliminating as far as possible the effect of expectations, spontaneous fluctuations in symptoms and other factors that may make a treatment appear effective when it is not.

Furthermore, in the case of homeopathy, we are not dealing with a new therapy that has not yet had time to be studied, but rather with a system that has been subjected to decades of experimentation, review and institutional evaluation without any robust and reproducible efficacy superior to that of a placebo having emerged. European scientific academies have concluded that there is no reliable evidence of efficacy for any condition and that the mechanisms proposed by homeopathy are incompatible with established knowledge of chemistry and physics. This judgement does not stem from hostility towards so-called alternative medicines, since any treatment capable of producing a reproducible benefit can be incorporated into medicine regardless of its origin; it stems from the fact that a therapeutic claim must be proven before it is offered to patients. Italian regulations already reflect this distinction. A homeopathic product may be registered via a simplified procedure solely because it does not carry specific therapeutic indications, whilst the possibility of attributing a clinical use to it requires a process in which adequate evidence is presented. There is therefore no ideological ban preventing homeopathy from demonstrating its efficacy; there is, however, an obligation – common to other medicines – to support claims with verifiable data. If the call for more comprehensive package leaflets concerns composition, dilutions, excipients and precautions, there is no conflict with science; if, on the other hand, it were to serve to introduce references to treatable conditions or clinical benefits without producing the necessary evidence, the State would be asked to replace, through a regulatory act, what research has not demonstrated.

The fact that Gemmato is a pharmacist makes his reliance on the popularity of products as a political argument all the more puzzling, because anyone with that background understands the difference between safety, marketing authorisation and clinical efficacy, just as they understand the public responsibility associated with the information contained in the patient information leaflet. Taking part in a meeting with companies in the sector is entirely legitimate; however, accepting their demands without prioritising the quality of the evidence would mean allowing commercial and identity-related considerations to influence the definition of therapeutic standards.

In this context, science does not represent a closed group defending its power against the public, but rather the public method by which it is decided which medical claims can be considered sufficiently reliable to guide treatment. Its authority does not stem from the infallibility of scientists – who are capable of making mistakes – but from the existence of procedures that make errors recognisable and correctable through accessible data, critical scrutiny and reproducibility. When politics replaces this method with the electoral clout of an organised community, it does not broaden pluralism in medicine, but simply makes the standard of evidence variable depending on the lobbying power of the groups concerned.

The two incidents on 14 July thus demonstrate a shared willingness to regard the limits established by science as negotiable. In the first case, a special procedure offers political rehabilitation to healthcare professionals who were struck off the register, partly for anti-scientific conduct during the pandemic; in the second, a sector lacking convincing evidence is granted institutional attention for demands that could blur the distinction between a registered product and an effective treatment. In both cases, the majority turns to groups capable of transforming a health issue into a matter of identity and of rewarding, at the ballot box, those who recognise their demands. A parliamentary majority can change the laws, but it cannot make an ineffective product effective, nor can it transform conduct that is incompatible with the evidence and dangerous to the public into good medicine. It does, however, succeed very well in confusing the public, weakening the bodies tasked with protecting them, and politically rewarding those who have built their support on mistrust of science. When the mere prospect of a handful of votes is enough to produce this result, public health ceases to be the criterion for decision-making and is replaced by the currency of electoral support.