MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Two of my recent posts directly related to the German ‘Heilpraktiker’ (here and here) and to the risks which this profession poses to public health in Germany. As this is a very German phenomenon, it might be time to provide some explanations to my non-German readers.

The German ‘Heilpraktiker’ (literally translated: healing practitioner) is perhaps best understood by its fascinating history. When the Nazis came to power in 1933, German health care was dominated by lay practitioners who were organised in multiple organisations struggling for recognition. The Nazis felt the need to re-organise this situation to bring it under their control. At the same time, the Nazis promoted their concept of ‘Neue Deutsche Heilkunde’ (New German Medicine) which entailed the integration – perhaps more a shot-gun marriage – of conventional and alternative medicine. I have published about the rather bizarre history of the ‘New German Medicine’ in 2001:

The aim of this article is to discuss complementary/alternative medicine (CAM) in the Third Reich. Based on a general movement towards all things natural, a powerful trend towards natural ways of healing had developed in the 19(th)century. By 1930 this had led to a situation where roughly as many lay practitioners of CAM existed in Germany as doctors. To re-unify German medicine under the banner of ‘Neue Deutsche Heilkunde’, the Nazi officials created the ‘Heilpraktiker‘ – a profession which was meant to become extinct within one generation. The ‘flag ship’ of the ‘Neue Deutsche Heilkunde’ was the ‘Rudolf Hess Krankenhaus’ in Dresden. It represented a full integration of CAM and orthodox medicine. An example of systematic research into CAM is the Nazi government’s project to validate homoeopathy. Even though the data are now lost, the results of this research seem to have been negative. Even though there are some striking similarities between today’s CAM and yesterday’s ‘Neue Deutsche Heilkunde’ there are important differences. Most importantly, perhaps, today’s CAM is concerned with the welfare of the individual, whereas the ‘Neue Deutsche Heilkunde’ was aimed at ensuring the dominance of the Aryan race.

The Nazis thus offered to grant all alternative practitioners official recognition by establishing them under the newly created umbrella of ‘Heilpraktiker’. To please the powerful lobby of conventional doctors, they decreed that the ‘Heilpraktiker’ was barred from educating a second generation of this profession. Therefore, the Heilpraktiker was destined to become extinct within decades.

Several of the Nazi rulers were staunch supporters of homeopathy and other forms of alternative medicine. They hoped that alternative medicine would soon have become an established part of ‘New German Medicine’. For a range of reasons, this never happened.

After the war, the Heilpraktiker went to court and won the right to educate their own students. Today they are a profession that uses homeopathy extensively. The German Heilpraktiker has no mandatory medical training; a simple test to show that they know the legal limits of their profession suffices for receiving an almost unrestricted licence for practicing medicine as long as they want.

You may not believe me – many readers of my blog seem to think that I spend my time spinning the truth – therefore let me show you an article by another author on the same subject:

In Germany, the naturopathic practitioner, the “Heilpraktiker”, is allowed to practice medicine, like medically trained physicians. The German heilpraktiker, a specific German phenomenon embedded in the country’s history, practices medicine without being obliged to undertake any medical teaching or training. Anybody 25 years old or older, with a secondary school certificate, and free of disease can participate in a test, conducted by the local health authorities to “exclude danger to the health of the nation.” In the case of failure, this test can be repeated ad libitum. Having passed this test, the heilpraktiker is allowed to practice the whole realm of medicine, except for gynecology, dentistry, prescription of medication, and healing infectious diseases. There is no more state control during the heilpraktiker’s working life, except in those practices applying invasive methods, such as infusions, injections, oxygen therapy, and acupuncture. These practices are inspected by the public health department based on the Infection Protection Act. Although several cases of fatal errors in treatment are known, the greatest risk in the heilpraktiker’s practice is the omission of proper diagnostics and therapies, which is risk by omission. In this paper, the history of the heilpraktiker in Germany as well as the task of the Public Health Departments in testing the candidates are shown. The data of 345 tests from 2004-2007 in the Rhein-Main area are presented, with 53% of the participants failing. Concerning the hygiene control visits, a concept for hygiene was lacking in 79% of 109 practices, while in 49% a concept for cleaning and disinfection was also missing. In 60% of the practices, a dispenser for hand disinfection was lacking. Recommended improvements were quickly performed in most practices. In conclusion, the current legal regulation, i.e., testing the candidates only once before practicing for a lifetime, does not sufficiently protect the population against danger caused by false diagnostics and (invasive) therapy of the heilpraktiker. Considering the population’s increasing interest and use of complementary and alternative medicine (CAM) with a heilpraktiker being frequently consulted, there are growing concerns in health services, regarding (1) how to regulate CAM professions and natural health procedures, (2) how to incorporate safe CAM into school medicine, and (3) how best to protect the public from a wide range of possible CAM-conventional medicine interactions.

There have been very few investigations into the Heipraktiker phenomenon. Recently, however, an excellent book has been published, and here is the abstract of a rare study of the subject:

We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers’ professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable ‘customer loyalty’ towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient’s well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their ‘psychotherapeutic’ attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.

Unsurprisingly, there are numerous reports of Heilpraktiker doing harm to their patients. However, such cases hardly ever get reported in the medical literature. Because there is no effective post-marketing surveillance system in this area, the frequency of harm is essentially unknown.

In my view, it is high time that German officials cast a critical eye on this sector. The incidents mentioned above seem to confirm the urgency of this view.

18 Responses to The German ‘HEILPRAKTIKER’ is a relic from the Nazis that endangers public health

  • Let’s hope that the Klaus Ross case will motivate authorities to take some significant action. Traditionally, quacks have had little to fear, and it has been extremely hard to find any of their victims. It seems that quacks tend to be very good at hiding their victims. That may be unintended, but I can’t help but think it is all rather too convenient to be above suspicion.

    Since police is now said to be investigating some 70 cases of people who died, it seems that there is a (slight?) chance that the Klaus Ross case may be the watershed event needed to wake up authorities and quack lovers from their comfortable slumber.

    Obviously, one needs to be careful. Just because these people died after filling the pockets of Klaus Ross, does not mean that he killed them with his ministrations, and there is – and should be – the presumption of innocence until proven guilty, but it also does not mean that he did not. Serious investigation should shed light on at least some cases.

    If – and only if – it all works out as I hope, these people may not have died entirely in vain, which might give some minor comfort to those who now have to live their lives without them, and – maybe – we will be able to remember them as involuntary heroes who made life safer for all of us.

    • A German source (http://www1.wdr.de/nachrichten/rheinland/krebsklinik-brueggen-mehr-faelle100.html) also reported that the authorities are now investigating 70 fatalities at Ross’ clinic:
      Nach Informationen der Lokalzeit aus Düsseldorf ermittelt die Krefelder Staatsanwaltschaft mittlerweile bereits in siebzig Fällen, in denen Patienten des Brüggener Krebszentrums nach der Behandlung verstarben. Dabei muss jetzt geklärt werden, ob die Patienten an den Folgen ihrer Krebserkrankung starben oder an der Verabreichung des umstrittenen Präparats 3-Bromopyruvat. NRW-Gesundheitsministerin Barbara Steffens (Grüne) forderte am Freitag (19.08.2016) strengere Regeln für Heilpraktiker. Steffens kritisierte, dass sich jeder ohne jegliche Ausbildung für die Prüfung anmelden könne. Nach Bestehen der Prüfung sei man dann zugelassener Heilpraktiker. Das entsprechende Gesetz von 1939 müsse reformiert werden.

      Vor einem Monat wurde bekannt, dass drei Krebspatienten einer Brüggener Praxis für Naturheilverfahren kurz nach der Verabreichung des umstrittenen, aber nicht verbotenen Präparats verstorben sind. Zwei weitere Patienten erkrankten schwer nach der Einnahme.

      Leichen müssen wohl exhumiert werden

      Die Behörden haben jetzt offenbar die Patientenakten systematisch auf Behandlungen mit dem umstrittenen Wirkstoff geprüft. Noch ist unklar, was ursächlich für den Tod der Patienten war: Die Krebserkrankung oder die Behandlung mit dem umstrittenen Präparat in der Brüggener Praxis. Möglicherweise müssen viele dieser Leichen exhumiert werden, um eine Obduktion zu ermöglichen.

      In dem Zentrum wurden zahlreiche Krebspatienten aus Deutschland, Belgien und den Niederlanden behandelt. Eine Behandlung kostete rund 10.000 Euro. Die Krefelder Staatsanwaltschaft hat vor einer Woche gegen den Leiter des Krebszentrums Ermittlungen wegen fahrlässiger Tötung und Körperverletzung aufgenommen. Er ist auf freiem Fuß.

      Wirkstoff nur an Tieren getestet

      BIOLOGISCHES KREBSZENTRUM / STADT BRÜGGEN – BRACHT / NIEDERRHEIN / TODESSERIE IN ALTERNATIVEM KREBSZENTRUM / POLIZEI ERMITTELT / KREBSZENTRUM WURDE GESCHLOSSEN UND VON DER POLIZEI VERSIEGELT /
      Das Mittel 3-Bromopyruvat ist zwar nicht verboten, aber doch umstritten. Bisher ist es kaum erforscht, das heißt, es gibt keine Studien, die eindeutig sagen können, ob der Wirkstoff überhaupt wirkt. Bisher wurde er nur an Tieren getestet, sagt die Wissenschaftsjournalistin Claudia Ruby: “Danach kämen, wenn er denn eine Wirkung hat, noch drei klinische Stufen, um diesen Stoff am Menschen zu erproben. Allerdings scheiden die meisten Wirkstoffe auf diesem Weg irgendwann aus, das heißt, es ist sehr fragwürdig, ob aus diesem Stoff irgendwann mal ein Medikament wird. Man weiß nicht, was die Nebenwirkungen sind; man weiß nicht, ob er überhaupt Krebs heilen kann.”Mit der Verabreichung dieses Wirkstoffs sind also viele Unwägbarkeiten verbunden. In den Niederlanden darf das Mittel – ein sogenannter Glukoseblocker – zur Therapie nicht benutzt werden. Für die Patienten war es vermutlich oft der letzte Strohhalm, an den sie sich klammern konnten.

      Niederländische Medien erheben Vorwürfe

      Der Telegraaf, die größte Tageszeitung des Landes, titelte am Freitag (19.08.2016) groß: “Schuld am Tod von 70 Niederländern?” Dazu ein halbseitiges Foto von dem Betreiber des mittlerweile geschlossenen Zentrums, den das Blatt als “Heiler” bezeichnet. Ein Großteil der Patienten des Heilpraktikers waren Niederländer. Für das Wochenende Tage kündigte die Zeitung weitere Enthüllungen an.

      Angehörige einer Verstorbenen äußert sich

      Eine Belgierin, deren Ehefrau nach einer Behandlung in Bracht gestorben ist, sagte dem WDR am Telefon, dass ihre Partnerin im niederländischen Nijmegen laut Ärzten keines natürlichen Todes gestorben ist: “Für die Ärzte auf der Intensivstation des Krankenhauses war ganz klar, dass es sich nicht um einen natürlichen Tod handelte. Und dann kam auch schon die Polizei mit Pathologen.” Nächste Woche sollen die Ergebnisse der Autopsie vorliegen. Die Frau, die namentlich nicht genannt werden will, hat Anzeige gegen den Heilpraktiker erstattet und ist “böse darüber, dass der Mann noch immer frei herum läuft”.

      • It is great that this information became available to Germans as well, but it is too bad that the German police later stated that there were no plans to investigate all these deaths.

        I understand that, one death is enough, adding any number of others is not going to change much, criminally speaking, but it could make for some significant changes in legislation later on as people are bound to be more impressed and alarmed about dozens of deaths as opposed to “just” a handful.

        On the other hand, one of the important Dutch newspapers, the Algemeen Dagblad, said on 31 August that the Dutch police will assist in the investigation by interviewing 130 people to find out – among other things – if they would be willing to cooperate with the investigation: http://www.ad.nl/dossier-nieuws/nederland-gaat-duitsers-helpen-met-onderzoek-klaus-ross-kliniek~a75d6d15/

        Regardless of how many people are involved and how many of them died as a direct result of the Ross treatment, it is clear that he should at least be held accountable for his false claim of using completely organic products, i.e. false advertising.

        I also just noticed that his website (http://www.klausross.com/) is no longer on line.

    • I fear that “quack lovers” will not wake up. And they are not really to blame here – at least not those of them who are cancer patients.

      We’re talking about alternative cancer therapies. If you are looking at those as a patient, you have (possibly recently) been confronted with a devastating diagnosis, heard about the standard therapies, which, while in most cases quite effective, come with a pretty intimidating list of possible side effects, some of those long-lasting.

      Or you might be through with the standard therapies and might be looking for the last straw to cling to, the one thing that might keep you from dying.

      I wouldn’t blame you for looking for alternatives. And I wouldn’t blame you for sticking with them should they be challenged. For trying to protect what seems to be your last hope from the prying grip of the authorities or “skeptics” and whatnot. That is entirely human and understandable.

      The authorities should wake up. But I’m not getting my hopes up. The “Heilpraktikergesetz” is not the only weird thing in German law that favours quacks. All drugs need to be licensed, requiring proof of efficacy and safety, but homeopathic stuff and some other woo only needs to be “registered”. This distinction has been in the books for quite some time and no variation of majorities in the federal parliament has led to any change here.

      Sometimes even the discussion comes up to loosen the requirements even further, or to generally reimburse the costs for this woo from general medical insurance. Yes, we have that reimbursement, but whether that is legal is an issue of contention and those who could challenge it don’t do so. You guessed right: There is a government office for that.

      Combined with what I got as reply from my representative regarding the “Heilpraktikergesetz”, I fear that there is a majority consensus in parliament to provide protection for woo or at least to not cut back on what “safe space” they have been provided.

      • I wouldn’t blame you for looking for alternatives. And I wouldn’t blame you for sticking with them should they be challenged. For trying to protect what seems to be your last hope from the prying grip of the authorities or “skeptics” and whatnot. That is entirely human and understandable.

        I totally agree with that. The quack victim should not be blamed. Our democracy is to be blamed. People are not being taught critical thinking skills at school. Voters don’t want it, so it is not taught. As a result, people who are eager to believe the quacks are defenceless.

  • There is an interview in a Dutch newspaper with a family member of a previous client, the former business partner and the ex wife of the former business partner of the ‘clinic’ in Bracht.
    The mother of an former client eye witnessed discussions between Andre Hartel, who financed the clinic in Bracht, and Klaus Roß. The dispute was about the timing of the preparation of the 3-BP because of the instability of the stuff. Roß made it in the morning even before a client was in and used it later in the day. Hartel told Roß he had to ‘make’ it maximum 20 minutes before use.
    The differences in opinion got thus far that Hartel ( Dutchman, no medical training, not a heilpraktiker) left the business in Bracht. He went to Nederweert, the Netherlands, got an other business partner to front a new ‘clinic’ (Global Health Center) and kept pushing alt med cancer ‘cures’ including 3-BP in ‘granulated form’. He needed a new front man because, according to his ex wife, he is in dept.
    http://www.ad.nl/dossier-rivierenland/in-de-schaduw-van-klaus-ross~a92859b9/ (in Dutch)

    The DZA (a website for Pharmacists) writes about the legal side of Heilpraktiker using untested ‘drugs’. State and Kreis (city) have a different opinion.
    https://www.deutsche-apotheker-zeitung.de/news/artikel/2016/08/16/durfte-der-heilpraktiker-das-ungetestete-arzneimittel-abgeben (in German)
    https://www.deutsche-apotheker-zeitung.de/news/artikel/2016/08/05/wirkte-das-alternative-krebsmittel-todlich (in German)

  • I am a long-time reader of this blog, living in Germany at the moment. I find it almost unbelieveable that there is no legal framework that would prevent Heilpraktiker from “treating” cancer patients. And, to be honest, as a patient I find it worrisome that there is so much CAM influence in medicine. When looking for a doctor praxis, it is rather difficult to find any that don’t offer some sort of a CAM modality, making me wonder if doctors in a particular praxis are using these methods simply to calm the “worried-well” or do they actually believe in them, which would be even worse. I cannot use the services of a pharmacy without being offered homeopathy.

    On the other hand, it looks like Germany is not the only country where state does not sufficiently protect the patients. I am originally from Latvia where a “Global virotherapy” cancer clinic opened this year (http://www.virotherapy.eu/), working with Rigvir virus, that has no 3 phase clinical studies behind it, only questionable Soviet time research and 1 retrospective study and 3 case reports in recent years. Somehow they managed to get it registered for melanoma in 2004, just before Latvia joined EU, without sufficient evidence, the drug is now even compensated by state, included in melanoma guidelines, and the clinic happily emphasises the fact that Latvia is an EU country, falsely implying Rigvir has passed all stages of clinical studies.

    And now this clinic is offering to use this Rigvir for all sorts of cancers, has partnered up with Hope4Cancer.com quacks in Mexico as well as “natural healing” cancer clinics in Germany (http://www.virotherapy.eu/treatment-availability.php) and every day I see new cancer patients in GoFundMe.com and other sites, asking for donations to fund this miracle treatment – 46 stories are currently publicly available.

    Until recently I had no clue that such clinics can operate in European Union, it is almost unthinkable. I have submitted a complaint to Latvian health inspectorate regarding illegal advertising of prescription medicine (Rigvir), hoping that they will look into their activities, but I do not have high hopes – after all there had to be quite a bit of willful oversight from the authorities to create such a situation in the first place…

  • More and more information is coming through. Another patient was interviewed by the national broadcasting company in the Netherlands. He still is positive about what he got for his money in the ‘hope for sale’ shop in Bracht.

    But he also tells that Roß very recently had started with stem cell therapy. The patient had 2 injections in the Roß shop, one ‘to prevent calamities’ and one ‘pointed towards the healing process’.

    Curious is also that the client claims that a professor working at the Erasmus hospital in Rotterdam, the Netherlands advised him to use turmeric ‘because that is more effective then chemo therapy’.
    Then he went to Roß and got the full package incl 3-BP. But… Roß wasn’t in it for the money…
    https://translate.google.com/translate?u=http%3A%2F%2Fnos.nl%2Fartikel%2F2127239-oud-patient-klaus-ross-gelooft-nog-steeds-in-behandeling.html Source dutch, translated by google.

  • Some time ago I contacted my representative in the Bundestag about the Heilpraktikergesetz (law about the accreditation of Heilpraktikers) and essentially asked why it is still there.

    The answer: “Berufsfreiheit” (“freedom of profession” – a consistutional right in Germany, but with restrictions being possible) and “freie Behandlerwahl” (“free choice of medical care”). It all boiled down to how anybody must have a right to medical practice. My question, how this interpretation of “Berufsfreiheit” could be compatible with the high requirements for becoming a medical doctor was never answered.

    Mind you, this was not a representative from the Greens or the Left, from which I would have had expected this kind of pseudo-liberal rubbish, but from the CDU (“Christlich-Demokratische Union”, “Christian-Democratic Union”).

  • I wonder how much the Nazi promotion of so-called integrative therapies had to with an anticipated shortage of drugs that would inevitably result from going to war. As I recall, in anticipation of serious shortages of food as a result of war, the Nazis also promoted the gathering of plant-foods from the forests.

  • Today according to the newspaper NRC Handelsblad police officers are interviewing 130 patients or relatives of patients of Klaus Ross. The Dutch minister of Health is not planning to intefere with the German legislation and will not urge her German colleague to take action and improve the Heilpraktikergesetz.

  • In this article we explored a theory; would it be better to not utilize a heap construct when dealing with very large objects in.

    • In this article we explored a theory; would it be better to not utilize a heap construct when dealing with very large objects in.

      English is not my native language, so I may be missing out on something. What does this sentence, if it is one, actually mean?

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