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

About 7 months ago, I contacted a German journalist who I knew and trusted to tell her about the incredible quackery-promotion performed by Germany’s institutes of adult education, the ‘Volkshochschulen‘ (VHSs). After I had been invited to give a few lectures for the VHSs, I had conducted some preliminary research and realised that, nationwide, they run hundreds of courses promoting the worst types of quackery.

My journalist friend, Veronika Hackenbroch, who works for DER SPIEGEL liked the idea of conducting an in-depth investigation into the matter. What it revealed became the centre-piece of a theme issue published today. Here is its title page:

In a nutshell, the key finding is that every 5th course offered by the VHSs in the area of healthcare is steeped in woo. Considering that their funding comes mainly from the public purse, this is intolerable. When asked why they offer so much quackery, some heads of local VHSs said that they are not competent to evaluate the science; they simply assume that, if doctors in Germany use these treatments – specifically homeopathy – and if the public wants to learn about them, they have to offer them.

When I first heard this argument, it made me speechless. It has some undeniable logic behind it. The heads of VHSs are not medical experts. Thus, they cannot do their own research or evaluations. To just follow what the doctors must therefore seem reasonable to them.

So, where is the crux of the problem?

I think, it lies in the vicious circle that inevitable unfolds such a situation:

  • some people like homeopathy (or other bogus treatments),
  • therefore, they ask their doctors to provide it,
  • therefore, some doctors offer it,
  • therefore, the VHSs feel they can promote if,
  • therefore, people like homeopathy (or other bogus treatments).

This circle has no beginning and no end; it just turns and turns. And it is difficult to stop, not least because it is driven by the relentless promotion of interested parties, such as the manufacturers of woo. Yet, if we want to make progress and are serious about improving healthcare, we have to try stopping it!

But how?

Through providing information and fighting misinformation (of course, some rules and regulations would help as well).

That’s exactly what we tried to do – thank you Veronika Hackenbroch!

10 Responses to The vicious spiral of German adult education steeped in woo

  • I am pleased to see this. I will now run out and buy a few copies.

    I can *kind of* partially sympathise with the VHS directors. It is hard for non-doctors to declare things like homeopathy etc not-medicine when real doctors routinely promote and prescribe it and many medical insurers even cover it.

    Even legislators have decided it’s easier to just evade this problem (as I’m sure Dr Ernst has already covered elsewhere). The German Ministry of Health decided to hand over the decision for what is and what is not medicine to a committee of doctors, who unfortunately swiftly declared that homeopathy and Anthroposophical Medicine [sic] are exempt from normal testing standards.

  • In the UK, doctors are ethically obliged to get fully informed consent – so, if they want to appease the whims of patients with fanciful ideas about healthcare, they should be explaining how conventional doctors view the proposed modalities.

    Those who don’t do this are unethical, quacks, frauds and crooks. e.g. Dr Peter Fisher ex of the RLHIM.

    What are a German doctor’s ethical obligations on getting consent?

    • same!
      trouble is lack of control, I think.

      • Edzard

        “………they simply assume that, if doctors in Germany use these treatments – specifically homeopathy – and if the public wants to learn about them, they have to offer them.”

        1. some people like homeopathy (or other bogus treatments),
        2. therefore, they ask their doctors to provide it,
        3. therefore, some doctors offer it,

        I knew many Germans because of my working with them for over 10 years. I never found them to be so stupid and gullible as you portray them. Rather, they seemed to really know the subject they handled, were extremely professional and would say “NO” to the extent of being rude, if their understanding was to the contrary.

        I am extremely surprised at your assessment of German doctors. Should I be glad that I was never sick during my many stays in Germany?

        • can you not read?
          SOME DOCTORS OFFER IT…

          • Edzard

            “SOME DOCTORS OFFER IT…”

            Have you ever bothered to check with doctors who moved to homeopathy after learning allopathy?

            “I believe new science will explain how homeopathy works,” says Ellen Feingold, a Wilmington, Delaware, pediatrician who left conventional medicine to practice homeopathy. “But research is not my concern. I want to heal patients. As an M.D., I mostly suppressed symptoms. Now I truly heal people.”

            “Critics of homeopathy say that because its mechanism of action can’t be explained, it can’t possibly work,” says Michael Carlston, a Santa Rosa, California, physician who has combined mainstream medicine and homeopathy for more than 30 years. “But that’s hypocritical. Aspirin was used for 90 years before its efficacy was explained—and no doctors shunned it.”

            “I was a strong supporter of allopathy and hated the sight of my patients taking homeopathy pills. Then In 1993-94, my mother (then 48-years-old) fell seriously ill. She was diagnosed with diabetes, cardiomyopathy and multi-organ failure with shock. Being a chest physician and having worked in the intensive care setups, I knew all the critical care treatment methods. But despite various treatments, her spitting of blood (hemoptysis) was not stopping,” Dr Patil told Sakal Times. All specialists had given up on his mother.
            But when allopathy treatment failed to help his ailing mother, in desperation, he switched over to homeopathy treatment. Within 48 hours, his mother was back on her feet and that eventually led to Dr Patil becoming a full-time homeopathy practitioner.”

            And off course, numerous doctors who put in responses under “Should doctors recommend homeopathy? BMJ”

            This happens every where. There is no reason to pick out German doctors (some or more) and paint them as stupid or easily succumbing to pressure.

          • @Iqbal–

            I’ve never seen a doctor who learned “allopathy”.

    • Same here in the Netherlands. Alternative practitioners are required by law to inform their customers that the treatments they offer have no scientifically proven efficacy.
      I never heard of a practitioner who actually complied with this legal obligation – quite the contrary actually: many quacks and frauds advertise their services as being “scientifically proven”.

      I tried bringing this to the attention of our Dutch Health Inspectorate, but they are not willing to take action. Presumably due to a lack of manpower, this organization only goes after quacks who have caused actual damage or injury, and even then only if the injured party lodges a complaint. Also, it is not clear what sanctions may be imposed(*), unless the case can be treated as a criminal case; the latter virtually never happens.

      *: As most alternative practitioners have no medical license that can be withdrawn.

      This means that alternative practitioners are above the law for all intents and purposes, and can defraud their customers with impunity, as long as no-one is killed or seriously injured.

  • The Spiegel says that most (90%) of the questionable adult education courses are about Yoga and Qui Gong. These gymnastics are, of course, based on utterly nonscientific thoughts. Their disciples might losen their connection to rational, logical reasoning. On the other hand, I’d judge Yoga/QuiGong generally harmless to public health. Well-off people use it as a not-too-hard physical training. They wouldn’t rely on it as a treatment for serious medical conditions.

    Fortunately, only few VHS courses refer to really dangerous practises like „cancer dieting“ or kinesiology.

  • Excellent article!
    I appreciate that for once, the journalists took a clear position in favor of evidence. Quite often, journalists shy away from doing this and prefer “presenting both sides of the argument” in a misguided attempt to appear objective.
    How often have we seen TV debates where evidence based medicine and SCAM are presented as being equally valid concepts? These journalists misunderstand that presenting both as equal is not objective, but is in fact strongly misleading, since the facts, science and logic clearly favor the side of evidence-based medicine.

    Since „Der Spiegel“ has had considerable political impact in the past, let´s hope that the persons in charge at the Ministry of Health will take notice and the appropriate actions to prevent such dulling VHS courses as soon as possible. I consider public funding for bogus VHS courses a big scandal, one that I was not fully aware of.

    Thanks also to you, Prof. Ernst, for your input for the article. Your continuous efforts to critically evaluate the risk vs. benefit balanced of SCAM are invaluable and form a big part of the foundation that articles like this one can be written.

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