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

As often mentioned in previous posts, the ‘Heilpraktiker’ is a recognized healthcare professional in Germany that was established during the Third Reich. Despite the fact that a Heilpraktiker doesn’t necessarily undergo any meaningful medical training, they are permitted to do almost all the treatments a medically trained practitioner can carry out. This situation has created a two-tier healthcare system in Germany which many experts find unacceptable. Reports of patients being seriously harmed are reported with depressing regularity.

It has been reported that a German woman suffering from cancer discontinued her conventional oncological treatments and had herself treated with preparations made from snake venom. After she died of her cancer, the practitioner of so-called alternative medicine (SCAM), a Heilpraktiker, was ordered to pay compensation for pain and suffering. The practitioner must now pay 30,000 Euros in compensation for pain and suffering to her son. This was decided by a court in Munich in a landmark ruling on Thursday. The boy’s father had originally demanded 170,000 Euros.

The deceased patient had been suffering from cervical cancer with a good prognosis. She decided to abandon radiation and chemotherapy and instead opted for preparations made from snake venom, which she received from her SCAM practitioner.

“The defendant did not actively advise her patient to discontinue the life-saving radiation therapy,” the court found, but “she did not oppose her decision, which as a Heilpraktiker would have been her duty.” In the court’s view, the Heilpraktiker should have advised her patient to resume chemotherapy. “This continued omission by the defendant over a period of weeks was irresponsible and, from the point of view of a responsible healthcare practitioner, utterly incomprehensible.” In addition to damages for pain and suffering, the Heilpraktiker was ordered to pay damages for lost child support, among other things. The court did not allow an appeal against the verdict.

The case seems unusual in that the court found a SCAM practitioner guilty not because of administering a bogus or harmful treatment, but because of failing to provide essential advice. This could have consequences for many legal cases in the future.

If I understand it correctly, it means that, according to German law, healthcare practitioners can be held responsible not just for what they were doing, but also for what they were not doing, and that this form of neglect extends not just to treatments and procedures, but also to advice. If that is true, a German homeopath treating an asthma patient, for instance, could be sued if he fails to advise that his patient also takes essential conventional medications.

It would be valuable to have the opinion of legal experts on this point and on the question of how the law in other counties would apply in such matters.

5 Responses to An unusual court case against a German practitioner of so-called alternative medicine

  • I am not a lawyer, but as a UK practising surgeon, I was expected to provide patients with any and all information they might reasonably need to have in order to give properly informed consent to treatment.
    And that should surely mean telling a patient: “There is no scientific or medical consensus that my proposed treatment has any effect beyond the placebo, but I believe it does.”

    A relevant case was that of ‘Ali’ who would not have consented to spinal surgery had he beeen told paralysis of a lumbar nerve root was a (small) possibility.

    The judge determined it was reasonable for Mr Ali to have been informed of that small risk – he had not been, and the surgeon was held liable for the misadventure and surgical complication.

    All UK surgeons now make sure all complications are listed when taking consent. Very few patients raise issues, but they can – and can choose to decline treatment.
    So too in the US. Can the world be far behind?

    If only scamists were as conscientious – but I suppose that if they were, they would not be accused of operating scams.

  • I don’t know the details of this particular case, but I thought it might be helpful to add something about the treatment of cervical cancer, with the caveat that I have been away from clinical practice now for over four years and prior to that I was mainly treating genitourinary rather than gynaecological cancers.

    The treatment of cervical cancer is mainly surgical, but for more advanced, inoperable tumours that are still localised, radiotherapy and chemotherapy in combination can cure a high proportion of patients.

    The treatment is fairly tough to go through. It involves daily radiotherapy to the pelvis for five weeks, and although this only takes about ten minutes per session there is often a fair amount of travelling involved to get to the cancer centre. The radiotherapy is supplemented by weekly doses of cisplatin, a chemotherapy drug which has to be given by a drip together with a lot of fluid, which therefore takes most of a day. The cisplatin acts primarily as a radiation sensitiser and increases the proportion of patients who are cured long-term. Finally the radiation dose to the cervix itself is boosted by a temporary radioactive implant. There are a number of different techniques for this but generally they involve placing an applicator, consisting of hollow metal tubes and plastic spacers, into the vagina against the cervix and with one tube going through the cervix into the uterus. Radioactive sources are then placed into the applicator, usually for two or more short treatments over the course of 24 hours. Although the applicator is put in under a general anaesthetic, the patient has to remain fairly still in bed for all the time it is in place, which is not very comfortable.

    Cisplatin is one of the more toxic chemotherapy drugs. In the short term it causes vomiting (which can generally be prevented), fatigue and taste disturbance, as well as being immunosuppressive. In the long term it usually causes some high frequency hearing loss and often damages the kidneys, reducing their ability to remove waste and also causing them to lose magnesium from the body. The radiotherapy causes fatigue and a degree of bowel and bladder upset. In the longer term, scarring can cause vaginal narrowing, shortening and dryness, and sometimes scarring in the bowel leading to persistent problems.

    All this, of course, is very much preferable to uncontrolled cervical cancer, the symptoms of which are a great deal worse and which is ultimately fatal. However, I can well understand why people would seek alternatives.

    The irony is that cervical cancer is now almost completely preventable by a vaccine against human papilloma virus given in before the individual becomes sexually active, i.e. during puberty. Boys as well as girls should be vaccinated to reduce the spread, and also because the virus can cause penile cancer, and anal cancer in both sexes. However, as well as the usual anti-vax activists, many people object to this vaccine on the grounds that it encourages pre-marital sex, though I am not sure that I agree that a cancer risk decades in the future is a very strong disincentive to teenagers; it certainly doesn’t stop them smoking.

    • thank you; most helpful.
      I had assumed the patient had already had surgery [not sure why I thought this, because there is no mention of the medical history]

  • Turnabout is fair-play. CON-med doctors should be required to tell patients about how poor the results are for most CONventional cancer treatments, that the cancer will not be cured, only suppressed to re-emerge later more malignantly and about all the other types of treatment that are available for their condition, so alternative medicine can get some free publicity. Instead what we have is monopoly sick-care without transparency.

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