MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I have mentioned the German alt med phenomenon of the ‘Heilpraktiker’ before. For instance, a year ago I wrote this:

…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…

END OF QUOTE

Since about two years, a group of German scientists, clinicians and various other experts (I was a member of the panel), led by a prominent ethicist, worked on a document that was published this week. Here are its conclusions (in German):

Medizinische Parallelwelten mit radikal divergierenden Qualitätsstandards, wie sie aktuell im deutschen Gesundheitswesen in Form von Doppelstandards bei Ergebnisbewertung und Qualitäts kontrolle bestehen, sind für eine aufgeklärte Gesellschaft nicht akzeptabel. Bei Heilpraktikern stehen aufgrund ihrer ungenügenden, kaum regulierten Ausbildung die Qualifikationen und Tätigkeitsbefugnisse in einem eklatanten Missverhältnis. Heilpraktiker bieten schwer punktmäßig alternativ­ oder komplementärmedizinische Verfahren an, die in den meisten Fällen wissenschaftlich unhaltbar sind. Dies führt zu einer Gefährdung von Patienten. Abhilfe verspricht nur ein gleichzeitiges Vorgehen auf mehreren Ebenen:

(1.) eine einheitliche Bewertung der Patientendienlichkeit in allen Bereichen der Medizin;

(2.) ein verstärktes Engagement für die Erfordernisse einer gelingenden Kommunikation mit Patienten;

(3.) eine verstärkte Förderung wissenschaftstheoretischer Kompetenzen in Ausbildung und Studium gesundheitsbezogener Berufe; sowie

(4.) eine Abschaffung des Heilpraktikerwesens oder eine radikale Anhebung und Sicherstellung des Kompetenzniveaus von Heilpraktikern.

Wir haben uns hier auf die Reform des Heilpraktikerwesens konzentriert und dafür zwei Lösungsvorschläge skizziert: Wir empfehlen entweder die gänzliche Abschaffung des Heilpraktikerberufs oder dessen Ablösung durch die Einführung spezialisierter „Fach­Heilpraktiker“ als Zusatzqualifikation für bestehende Gesundheitsfachberufe. Für die Übergangsphase empfehlen wir eine gesetzliche Beschränkung des Heilpraktikerwesens auf weitgehend gefahrlose Tätigkeiten. Auf diese Weise ließen sich die Gefahren für Patienten reduzieren und die Patientenversorgung langfristig wesentlich verbessern.

END OF QUOTE

Essentially, we are saying that, the Heilpraktiker has introduced two hugely different quality standards into the German healthcare system. In the interest of the patient and of good healthcare, this double standard must be addressed. We are demanding the profession of the Heilpraktiker either is completely abolished, or is reformed such that it no longer poses a threat to public health in Germany. Our document makes concrete suggestions for such reforms.

Our suggestions have already received lots of attention in Germany, and we are therefore hopeful that they will be taken seriously, start a much-needed debate and eventually bring about progress.

19 Responses to The German ‘Heilpraktiker’ is a dangerous and anachronistic nonsense

  • Thank you for this work!

    It would be good if this at least encourages GPs not to emulate Heilpraktiker standards or recommend their practices. Even those rare GPs (at least here in Berlin) who don’t have a sideline in homeopathy, acupuncture or TCM, usually recommend such things.

    • UK standards are under our GMC – but we must accept EU doctors onto our register! (For now).

      I have worked with a East German junior doctor who came over soon after the wall fell. An excellent doctor, now a consultant.

      If EU doctors come to UK and promote/endorse CAM, this could be a bigger issue than it is.
      There are about 400 UK doctors who ‘practice homeopathy’ and they are largely ignored as being silly.
      But all must comply with GMC requirements that they obtain fully informed consent from their patients – and in this they tend to fail.
      They do not tell the truth about homeopathy and they are conducting their practices under false pretences.

      I am trying (but failing) to get the BMA geed up – are there no senior investigative journalists as concerned as I (us)?

      The biggest danger in allowing practice by doctors using false medicine is not that the remedies have side effects (they don’t), nor that some patients fail to seek timely care (true, but not often a problem, and caveat emptor), but that patients’, politicians’, the press’s and the public’s mindsets are reset – there are failings in critical thinking and a flight from science.
      That harms us all.

      • the ‘Heilpraktiker’ is not a doctor – she has not been even near a medical school.

        • What kind of training, if any, does a Heilpraktiker receive?

          • no mandatory training/education; they have to pass a simple test to show that they are not a danger to the public. some go to special colleges for up to 3 years, others don’t and learn the essentials at home through books.

        • Reply to Edzard:
          Indeed, the heilpraktiker is not a doctor.
          Apologies, my posting was poorly focussed.
          I am concerned about doctors who are sympathetic to the concept of using homeopathy.
          The heilpraktiker concept has engendered sympathy amongst may EU doctors who are or might come to the UK.
          The problem of the psychological paradigm shift.
          Encouragement of a flight from science.

          I do hope the reported German inititiatives are successful, but just as chiropractors cannot give up their faith in subluxations (or they wouldn’t have chiropractic, and they would be masseurs or unqualified physiotherapists) – so, will heilpraktikers give up homeopathy?

      • @Richard
        You forgot to mention the question of legality in marketing and selling fake goods and services. The fight against quackery can be seen as consumer protection.

  • I’ve asked Microsoft to translate the German recommendations, and one is for the creation of a ‘fachheilpraktiker’ which seems to mean ‘specialist healing practitioner’.
    Wouldn’t that make matters worse?

    And ‘heilprakitiker’ is translated as ‘naturopath’. Correct?

    • the FACH-HEILPRAKTIKER would be a qualified healthcare practitioner [for instance a nurse] who then gets trained in those alt meds that are supported by evidence.
      HEILPRAKTIKER differ from naturopaths in that they also use methods not provided by nature.

  • I came across this heilpraktiker clinic in Frankfurt: http://infusio.de/therapieprogramme/

    How is it legal to do what they are advertising? I could not find a doctor of medicine on staff, so it seems like this guy, Philip Battiade, is performing intravenous injections and other quack treatments, but he is just a heilpraktiker.

    Is this a place that needs to be reported to the authorities? They also have a branch in Beverly Hills of all places, so that tells us a lot!

    • it is probably legal – this is why we propose to change the law.

    • Seriously, QT? Who are you to judge if a treatment is quack. What is your contribution to the world, oh learned one? At least Infusio is trying to help people, and based on their reviews and success stories, they seem to be getting it done. With medical doctors performing the stem cell transfer, I would say they should be applauded for the progress vis a vis Lyme disease, MS, CFS, etc. –not condemned.
      Stem cell technology, fyi, has been used by athletes and their medical doctors for the last decade–injected directly into problematic areas. So the technology is already out in the mainstream.
      But oh that’s right. How silly of me. We should depend on western medicine and big pharma because they have been doing such a stellar job of healing the general populace so far. (Eye roll.)
      Gimme a break. I have a feeling you will soon be forced, in one way or another, to expand your limited in the box pedantic point of view regarding health care and healing. Good luck with that.

  • German Heilpraktiker are regulated since 1939 and according to this law should be examined in a way to secure “not to be a risk for the public health”.

    That sounds pretty good. But the problem is the examination. How this examination is done is regulated very individually and independendly in every county (Bundesland) in Germany and depends on the examinating physician!

    The exam is always done by physicians leading officially the regional health departments (Gesundheitsamt). There is a written and a practical exam. There are cities with very poor exam standards done by such physicians!!!

    First step could be to rise the exam standards to the level of an exam of a physician and this can be done without any change of the law for non physician naturopaths (Gesetz zur Ausübung der Heilkunde ohne Bestallung). E.g. Bayern is on the way to do this.

    Second step could be to stop the German Heilpraktiker from doing primary care. Therefore the blue print of Rhode Island’s new law on Naturopathy could be used for a new official legal advice (Durchführungsverordnung) in Germany without changing the law at all.

    Naturopaths in Rhode Island need a written collaboration and consultation agreement with a primary care physician:
    https://sciencebasedmedicine.org/legislative-alchemy-2017-naturopathy/

    From my own experience I would add and suggest that a new “Durchführungsverordnung” for the “Gesetz zur Ausübung der Heilkunde ohne Bestallung” could regulate that officially licensed naturopaths need to have a professional licence first related to a medical profession like being a nurse or MTA or a diet assistant and they must have a time of practical training in a clinic or in a physicians office for one year having done their job very good (certificate of the trainer).

    Such modifications only by changing the “Durchführungsverordnung” and the internal regulations to rise the exam standards would be the way to fulfill the will of this law of 1939 without changing the law at all.

    • I forgot to mention that the problem of CAM cannot be solved by forbidding the legalized profession of naturopaths in Germany. Following the discussion in another Blog here:
      http://edzardernst.com/2017/12/electrohomeopathy-endangering-lives-since-almost-200-years/
      you might understand that nearly the same amount of physicians “trained” in natural sciences are practising CAM like Heilpraktiker do. (officially or not officially just selling it together with medical drugs).

      Just to forbid the legalized profession of naturopaths without changing the medical trainings of physicians to stop them to be involved in CAM quack would just transfer 20 to 25 billions of Euros per year earned in Germany by CAM into the pocket of such CAM practising physicians alone.

      The clients still remain the same and will not change their desire for receiving CAM dorsn’t matter who sells it.

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