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

Guest post by Hans-Werner Bertelsen

As a self-confessed Asterix fan, I made a proposal to the Bremen Medical Association in 2019 that it should no longer orient itself towards the mainstream in the area of further training, but rather towards Klein-Bonum. The board found my proposal very good and unanimously deleted “homeopathy” from the postgraduate training regulations at the next board meeting. The media echo was tremendous. Words of “dam bursting” and “revolution” did the rounds. The “domino effect” was also often quoted in this context, because in the following years, many other German state medical associations followed the Bremen example and removed “homeopathy” from their further training regulations: Saxony-Anhalt, North Rhine, Schleswig-Holstein, Baden-Württemberg, Hamburg, Hesse, Brandenburg, Berlin, Mecklenburg-Western Pomerania, Lower Saxony, Saarland, and Bavaria.

Following the principle of logical plausibility, according to which it makes no sense to support dubious therapies that are not in one’s own training portfolio, but are still reimbursed by many health insurance funds, by convenient billing modalities, the Association of Statutory Health Insurance Physicians Bremen (KVHB) drew a line under the matter and terminated corresponding contracts on my advice. With the termination of the criticized selective contracts, the small federal state of Bremen thus set new standards in 2021. Since the termination, doctors can no longer conveniently provide “homeopathic services” online but have to bill their patients for their services.

But that was not all: the drumbeat of terminated billing contracts had not yet died down in the ears of the “homeopaths”, when only 3 months later, at the meeting of the Federal Medical Association, the next one followed: After a delegate from Bremen (do you want to know if this was a coincidence?) had submitted a motion for the deletion of “homeopathy” from the Model Continuing Medical Education Ordinance (MWBO), this was carried out after a democratic vote at the medical congress in Bremen. The Federal Medical Association thus officially declares this type of sham therapy to be no longer up-to-date, dispensable, and unworthy of further training.

In view of the vote democratically given by the Board, it seems bizarre that the Bavarian Medical Association, despite its own decision to remove “homeopathy” from the WBO, now invokes prolongations because of “transitional periods” in order to be able to continue offering courses in “homeopathy”. Contracts in this regard are to be considered secondary and no longer current. Therefore, the justification given by the ÄND proves to be flimsy and not stringent. The protection of patients from dangerous sham therapies in the case of the omission of indication-appropriate therapies saves lives and thus clearly represents the higher legal interest. Calls for “transitional periods” are redundant and negligently endanger the health of many people. On top of that, an unnecessary extension is a disrespect to the decision made by its own members in the democratic process.

But I remain optimistic that logical plausibility – free of backlogs (!) – will prevail in Bavaria as well. The vote has proven that there is a majority for this and that this majority will not be dominated by money or self-deception.

References

https://www.dr-bertelsen.de/documents/Screenshot_2023-02-10_at_11-36-05_Warum_eine_Aerztekammer_noch_immer_Homoeopathie-Kurse_anbietet-AEND.png

https://publikum.net/die-konigl-bayerische-zuckerkugel/

Ärztetag Bremen – Tooor!

 

10 Responses to Why the Bavarian Medical Association continues to offer postgraduate courses in homeopathy

  • Bavaria has a long tradition of being not exactly at the forefront of rationality.
    Keep in mind that this is also the region of Germany where in 1775, the last death sentence was imposed on a woman (Anna Maria Schwegelin), because officials were convinced that she was a “witch”.

  • Perhaps someone should write the Bavarian Board to ask if they’d like to institute other delays involving recalls of unsafe medical products. And why not see if they can expand it to food products, as well.

    Findings of pharmaceuticals or food contaminated with heavy metals or listeria or other substances? They can take it off the “approved list” but simply allow the products to be sold without any notice to the sellers or the public.

    BTW, I had hoped that kind of thing in Bavaria had been long gone. Years ago when I lived in Munich, the “doctor” filling in over the holidays one year was a homeopath – and the list of providers didn’t warn anyone, but in any case, he was the only physician in the area covering the holiday. I was prescribed a homeopathic “remedy” that landed me in hospital for several days. That’s when I first heard of homeopathy.

    • Wow. You took a homeopathic medicine and ended up in the hospital. It is so convenient that you left out all context. How convenient indeed.

      It is so much fun to read this blog and to read responses by people who insist upon “evidence,” and yet, so little evidence is really provided.

      And because so many people here insist upon understanding the mechanism of action of homeopathic medicines, it is more than reasonable for me to ask you what was the mechanism of action that led this prescription of a homeopathic medicine to need to be hospitalized? Curious minds want to know…

      • @Dana Ullman
        Wow. You consistently fail to address the questions and other issues raised by the regulars on this blog about your claims and assertions – and instead scold someone who appears to be a complete newcomer.

        It is so much fun to read this blog and to read responses by people who insist upon “evidence,” and yet, so little evidence is really provided.

        A situation to which you contribute in no small way by in fact consistently failing to contribute something: the aforementioned evidence.

        And because so many people here insist upon understanding the mechanism of action of homeopathic medicines …

        I think this is not true. Questions about homeopathy here are not primarily about mechanisms of action, but if homeopathy has any real effects in the first place, and what evidence exists (or rather: does not exist) to that extent. You consistently fail to address those fundamental questions, and instead steer the discussion towards any purported mechanisms, usually your ‘nanodose’ theory. And yes, the discussion then briefly shifts to those mechanisms of action – including what evidence supports those mechanisms. And once again, such evidence is never forthcoming, apart from some claim that ‘nanodoses’ were observed by one or two people, and that this explains everything. Which it doesn’t.

        So summarized: there is no good evidence that homeopathy does anything beyond placebo, nor is there good evidence supporting any of its proposed mechanisms of action. And when we ask you about those rather fundamental problems, silence ensues.

      • ” It is so convenient that you left out all context. How convenient indeed.

        It is so much fun to read this blog and to read responses by people who insist upon “evidence,” and yet, so little evidence is really provided. ”

        Yes, personal experience doesn’t count, and I thought if anyone was interested, they’d ask targeted questions: that’s what I typically do.

        At the time this happened I was not a health care provider. If I had been, I would not have filled a prescription for a “remedy” for severe influenza that should have contained no active ingredients. But I also would have thought that it couldn’t cause anaphylaxis.

        The mechanism of action is unknown: shouldn’t the substance that the pharmacist compounded based on the prescription have contained nothing active? Yet, the second time I used the sublingual liquid per orders (it was ordered BID, x number of drops sublingual), within minutes my friend had called the emergency medical service, and I was treated for anaphylaxis and taken to hospital. Verified via tryptase labs to be IgE mediated. The homeopath-prescribed liquid was the only medication that I was on, and there was no exposure to food that thorough testing showed were allergens, nor any known exposure to anything unusual in the environment. Hospitalization duration was several days because the substance caused hives throughout the mouth and esophagus, and bronchospasms.

        As a case study, it was written up by my GP. However, I do not have a copy or know if or where it was published.

      • Here’s one review of the lit. It isn’t unheard of for homeopathy to cause anaphylaxis. Do you happen to have a lit reivew that shows it isn’t possible? Would be interested to see that.

        https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijcp.12026

        “Direct AEs included abdominal pain, flatulence,acute erythroderma, acute pancreatitis, severe allergicreactions, atopic dermatitis, burning lips, nausea,emesis, apnoea, cyanosis, regurgitation, anaphylaxis,arsenical keratosis and cancer, bladder cancer, bul-lous pemphigoid, severe asthenia, cardiac arrest, cog-nitive-behavioural disorders, coma, death, dermatitis,severe pulmonary involvement, emesis, euphoria,extreme agitation, hyponatraemia and hypoalbumin-aemia, erythaema, limb oedema, irritability and albu-minuria, melanosis and keratosis, skin lesions, acutegastrointestinal illness, leukopaenia, thrombocytopae-nia, diffuse dermal melanosis, metabolic acidosis,weight loss, chronic diarrhoea, morbiliform and pru-ritic rash with hospital admission, multiple alopeciaand hair loss, pain, pancreatitis, problem with bal-ance, somnolence, pruritus, swelling and erythroder-ma, renal failure with metabolic acidosis, interstitialnephritis and hyperkalaemia, severe acute tubuloin-terstinal nephritis, severe bradycardia, reversible pan-conduction defect, hypotension and syncope, severeswelling, bleeding, rashes, sneezing, rhinitis, slightlethargy, symptoms of thall poisoning, tachypnea,high fever, lower limb areflexia, hypotension, pupil-lary abnormalities, gait ataxia, widespread leukocyto-sis and widespread maculopapular vesicular rash.Direct AEs of homeopathy occasionally resulted inserious outcomes including cancer, death, dialysis,toxic polyneuropathy and quadriparesis. In severalinstances, patients presenting AEs required hospitaladmission (7,14,18,19,24) and pharmacotherapy(5,18,29,35,36).”

        • These cases of active harm caused by homeopathy are pretty rare.
          Much more common is passive harm. Most homeopaths are medically completely incompetent, yet present themselves as knowledgeable about disease and health. Their ‘success’ is fully predicated on the expectation that there’s nothing serious wrong with people who consult them, and that most of these people will get better in the longer term. Which in fact is not an unreasonable expectation.

          However, this strategy causes serious problems with the rather smaller number of people with a serious condition: they will not be correctly diagnosed, nor will they receive effective treatments. These people run a very high risk of serious injury and even death.

          A point in case is what happened to a good friend of my parents: he had consulted a homeopath several times before for vague but ultimately innocuous problems, and every time he was quite happy about the outcome.
          So when he experienced recurring and ever more serious bouts of fatigue, he once again consulted this lady, who almost treated him as a close friend (as she did with all her patients), and always had the answers. She prescribed a homeopathic remedy which should restore his energy. When, after 4 weeks, this did not appear to have any effect, she told the man that this was to be expected – his condition had emerged over a longer period of time, so the (‘mild, natural’) homeopathic remedy should also be given time – a couple of months at least. As the man’s condition worsened, she told him “To first reach the lowest point, and climb back to health from there.” According to her, there was no need to consult a regular doctor.
          To make a long story short: after some 9 months of messing around with homeopathic sugar crumbs, the man collapsed completely and ended up at the ICU, where he died only days later, only 60-something years old. It was determined that he had developed terminal heart failure as a result of a leaking heart valve – something that could have been fixed easily, had he consulted a real doctor early on instead of this quack lady.

          The problem is that cases like this are almost certainly quite common – but that ‘death by quackery’ almost always remains unreported, as these patients usually end up in the care of real doctors prior to their demise. At which point a simple ‘natural death’ is recorded, completely leaving out the fact that it was in fact reliance on quackery that caused these patients’ serious problems to remain untreated – until it was too late.

  • Conventional medicine is well documented to be much more dangerous for patients than homeopathy. Lets ban that also.

    • @stan

      Conventional medicine is well documented to be much more dangerous for patients than homeopathy.

      Indeed it is. Now here’s a question for you: why do you think that the overwhelming majority of people turns to real medicine instead of homeopathy – especially in case of more serious health problems – if that real medicine is so much more dangerous?

    • “Conventional medicine is well documented”

      Exactly!

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