MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The Subject of the German ‘Heilpraktiker’ has recently been the topic of one of my blog-posts. In Germany, it has been a taboo for decades, but now the ‘Frankfurter Allgemeine Zeitung’ (FAZ) have courageously addressed the problem. In today’s article, the FAZ reports that, Josef Hecken, the chair of the an organisation called ‘Selbstverwaltung im Gesundheitswesen’ (self-administration in healthcare), demands that “health-insurers should be forbidden to pay for treatments that are not supported by evidence.” Hecken, is also the chair of the Gemeinsamen Bundesausschusses, an umbrella organisation of doctors, insurers and hospitals which determines which services are paid for and which not. He stated that even paying for homeopathy out of your own pocket when treating diseases like cancer must be forbidden and stressed that “this is not about well-being but human lives.”

Hecken’s views are partly supported by Rudolf Henke, the chair of both a German doctor’s union and of the Marburger Bund, a union of hospitals: “the regulations regarding the Heilpraktiker have to be re-considered entirely… I do not believe it to be acceptable that Heilpraktiker are able to treat cancer patients.”

These remarks relate to the deaths that recently occurred in a clinic led by a Heilpraktiker. About two thirds of all German health insurers seem to pay for consultations with a Heilpraktiker. Vis a vis the fact that most of their treatments are not evidence-based, this situation seems intolerable and deeply unethical.

Hecken’s stance seems clear, rational and, in view of the popularity of homeopathy in Germany, even courageous: “The government should charge the ‘Gemeinsamen Bundesausschuss’ or another organisation with the task of conducting a meta-analysis on the evidence of homeopathy and then draw the appropriate conclusions… We have reached a point where we need a public discussion, and I am prepared to take the flack.”

10 Responses to More on the German ‘Heilpraktiker’: are his days counted?

  • I am nervous about any state dictating that patients ‘must be forbidden’ from even paying for homeopathic treatment for cancer out of their own pockets.

    Are prayers going to be forbidden? Or at any rate, donating to a churchs’ collection plates?

    If people are foolish, in spite of the state’s best endeavours to educate them, so be it.

    I do think insurers should have policies which encompass payments for homeopathy (and other non-evidence based therapies), and policies which do not offer such cover.
    And there should be different premia.
    And patients should be able to choose which they use.

    The state can legitimately and ethically determine which treatments it is not prepared to pay for. E.g. twentieth round of IVF? 10,000 euros on a cancer drug for a patient with a life expectancy of a week?.
    But banning faith (which is how homeopathic remedies ‘work’)?
    I think not.

    I do hope the meta-analysis will come out soon, if that is what the German state requires, though surely we know the result don’t we?
    The BMA’s policy is that homeopathic remedies should not be used unless and until NICE reports. NICE has failed to respond tho the BMA’s call for a report on homeopathy, probably because it knows the answer which would not be comfortable to ‘certain persons of influence’. (See ‘Real Secrets of Alternative Medicine’ (Amazon/Kindle) page 24.

    • “I am nervous about any state dictating that patients ‘must be forbidden’ from even paying for homeopathic treatment for cancer out of their own pockets.”

      This is actually already the case in that drugs have to be approved, and cannot be prescribed if they are not – except in very limited cases. To be approved, efficacy and safety need to be shown, among others. The special case here is homeopathy, which in Germany is only registered, and efficacy does not need to be shown.

      Restricting the use of homeopathy would therefore simply right an already skewed situation.

    • I agree that naive, misinformed patients have the right to be mislead and can buy snake oil if they want. However, the tax payers should not be forced to pay for scams and nonsense. More should be done to fine and prevent blatant con artists from making profit from the vulnerable.

  • The special case here is homeopathy, which in Germany is only registered, and efficacy does not need to be shown.

    As far as products go, that situation is similar in most Western countries. The argument is usually that since it is hard or impossible for “natural health products” to be proven efficacious/effective, they do not have to demonstrate efficacy/effectiveness, they merely have to show that there is a traditional use. Which makes me wonder: how traditional are Berlin Wall and Black Hole, even in something as wacky as homoeopathy?

    • Within the EU the directive on human drugs regulate under which conditions a drug is “registered” or “approved”. Registration can be done for herbals based on traditional use within the union and for homeopathic nostrums at safe dilutions (minimum 1:10000). Such registered drugs can only be for oral or topical use, and no good clinical evidence of efficacy can be available (in which case the the drug must be “approved” based on that clinical evidence!). Unless the specific country has applied article 16.2 homeopathic remedies can only be sold without information on purpose and dosage, while article 16.2 gives countries the opportunity to register homeopathic products with indications and for other means of administration (such as injections by licensed healthcare staff).
      Thankfully I live in an EU-country without 16.2 recognition and homeopathy first aid kits can thus not be “registered” and selling such items is illegal. Thankfully we also have a patient safety law forbidding unlicensed healthcare providers (i.e. physicians, surgeons, nurses etc.) to treat cancers, children under 8 years of age, diabetes, HIV and other infectious diseases with mandatory public health reporting, and other specified cases… Registered healthcare providers must also act in accordance with scientific evidence – which means that in most cases they can not peddle homeopathy or other SCAMs.

      • @Pharmacist-in-Exile

        Sadly, the UK took advantage of 16(2) (presumably at the behest of homeopathy manufacturers)
        and created the National Rules scheme, allowing some homeopathic products to have indications, but only for ‘symptoms or conditions which can ordinarily and with reasonable safety be relieved or treated without the supervision or intervention of a doctor’. So, it can only be indicated for things that get better by themselves anyway! And they can only be intended for oral administration – no injections, etc allowed, thank goodness.

        Although introduced in 2006, there are only about 20 such authorised products – even though not a jot of good evidence is required for those indications, homeopathy manufacturers still don’t seem to be too keen on them.

      • Registration can be done for herbals based on traditional use within the union and for homeopathic nostrums at safe dilutions (minimum 1:10000).

        Something similar is the case in Canada. I don’t know if you can see the programme, but CBC’s Marketplace even went so far as to create their own nonsensical “remedy” and got it effortlessly approved: http://www.cbc.ca/marketplace/episodes/2014-2015/drugstore-remedies-licence-to-deceive

    • I see that we are in agreement over homeopathy, but I just wanted to add how bogus that “argument” is. I see “Big Pharma” using that argument in their favour:

      “The stuff we sell is not effective, so we cannot prove it. It is the same as with homeopathy, and we have a right to be treated the same, haven’t we? So why should we be barred from selling our ineffective ‘medicine’, while homeopaths are allowed to?”

      If that special condition for homeopathy is not removed, I see glorious days coming up for “Big Pharma”, don’t you? 😉

      • I see “Big Pharma” using that argument in their favour:

        And they would be right to at least attempt it. Unfortunately, we have a profit-driven healthcare system. In such a system, players are required to make as much profit as possible. To make things worse, we also have a system where blame is routinely laid on the lowest echelons when things go wrong, while profits go to the highest. There is something perverse about that system. When people get all the glory and the profits when things go well, should they also not get all the blame and jail terms when things do not go so well?

  • The main message by Josef Hecken is, that it should, (for health authorities) by law, be able to forbid Heilpraktiker (naturopaths) to use treatments which are not proven and backed by science. Klaus Roß used 3-BP and other unproven products because it isn’t forbidden, not because it is allowed to use in humans (in Germany).
    About what is allowed to be used in another human being, state, province and city authorities differ of opinion. Where the prosecutor said that Klaus could use 3-BP within the law, the Kreis (city) said that it’s use by heilpraktiker isn’t within the spirit of the Heilpraktikergesetz (nathuropath-law). Because there it says (according to them) that a Heilpraktiker has to have full insight of all things (medical/chemical) concerned to the used product. The authorities at the Kreis Gesundheitsamt (department of health) where this did happen, doubt that any Heilpraktiker, while they have zero state-controlled (or even approved) medical or chemical eduction, are not able to have the full insight of a(ny) product. After getting the certificate, without ever seeing a patient before, before having proven that they are able to heal/help people with their chosen version of witchcraft, they can inject whatever they want into another person as a treatment.
    Not 1 hour of education is needed to be proved upon requesting an exam by the Gesundheitsamt. 53% fail at the tests.

    Hecken says further that it should be forbidden to be able to get homeopathic treatment, even if you want/have to pay it for yourself, in cases of serious illnesses like cancer as long as there is no proof it works in studies. A bit different then what is discussed in the comments. Although he is against homeopathy, he didn’t say there should be a total ban (in this interview) He says, it should be forbidden for health plans (Krankenkasse) to pay for any unproven treatments by law. Even premium health plans.

    I do not understand people who will defend the right to get scammed by a fraudster when being sold water at premium charge, but want a man who sells 11 dollar bills in prison because it is ‘faith’ based. Of course people can believe anything they want (behind their own front door), but why can’t they be protected by the state against homeopathy which clearly is nothing more then a scam. Using it might be ‘faith’ (in a product) (it’s just hope, not faith of course in my eyes), buying it is being scammed, selling it is criminal. A bottle with water/alcohol/sugar with nothing of what is on the label in it. The label showing a product that has no proof of said/predicted/guaranteed outcome of taking the product, of which isn’t even a single atom in the bottle in the first place, and the seller knows this even before having a client for this bottle in his storage. Scam.

    From what I read in the German press, most calls are for regulating heilpraktiker. Regulate education and the exam, control their work and (only) a few new restrictions on what they can do or use. The provinces healthcare ministers all 16 now ask for better laws on heilpraktiker, not on stopping them. The province health minister (Barbara Steffens) that leads the heilpraktikerlaw renewal group, is a homeopath and acupuncture believer, an advocate for naturopath theories to be taught at higher education institutes (Those don’t want to do that!), so in all to professionalize quack-med. Not a good start.

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