neglect
The full title of this paper is “Role of Energy Medicine in enhancing hemoglobin levels – A case study”. Readers who thus expect to learn about the effects of ENERGY MEDICINE (a branch of so-called alternative medicine based on the belief that healers can channel “healing energy” into patients and effect positive results) might be disappointed.
The abstract reveals that the article “explores the potential benefits of Acupuncture and Energy Medicine as energy therapies in managing anemia”. If you now expect to learn something about the combination of ACUPUNCTURE and ENERGY MEDICINE, you would be mistaken.
Here is the abstract of the case report:
A 43-year-old female with severe anemia (hemoglobin 6.5 g/dL) participated in a three-month treatment plan that combined acupuncture and energy therapy. Acupuncture targets specific points to enhance Qi flow, stimulate blood production, and restore energy balance. The energy therapy plan focused on blood-nourishing foods aimed at supporting hematopoiesis.
After three months of treatment, the patient’s hemoglobin levels increased by 4.9 g/dL, reaching 11.4 g/dL. Clinical symptoms, including fatigue, dizziness, and weakness, showed marked improvement. Additionally, the patient reported better sleep, enhanced mood, and an increase in appetite, all of which contributed to an improved overall sense of well-being.
The authors concluded that the results suggest that Acupuncture and Energy Medicine can serve as effective energy therapies in managing anemia, particularly for cases that do not respond well to conventional treatments. This case study provides preliminary evidence of their potential to improve hemoglobin levels and alleviate anemia-related symptoms. However, further research is necessary to validate these findings and explore the broader application of acupuncture and energy medicine in anemia management.
The authors of this paper, who come from the ‘International Institute of Yoga and Naturopathy Medical Sciences‘, Chengalpattu, Tamilnadu, India, never bothered to explain what type of ENERGY MEDICINE they applied to their patient. As it turns out, they used no ENERGY MEDICINE at all! Here is what they disclosed about the treatments in the full paper:
The patient was treated with energy medicine and the treatment protocol includes Acupuncture, Diet therapy that was designed in such a way to improve the blood circulation, balance energy flow, and address underlying deficiencies in Qi and blood, particularly in relation to the Spleen, Liver and Kidney meridians, which are believed to play a role in blood production in Traditional Chinese Medicine.
So, we now know that the case report entitled “Role of Energy Medicine in enhancing hemoglobin levels – A case study” was, in fact, about a patient receiving ACUPUNCTURE and DIET.
Next, we might wonder what condition the patient had been suffering from (anemia is not a disease but a sign that can be caused by a range of diseases). All we learn from the paper is this:
She had been diagnosed with anemia three months prior and had been taking iron supplements without significant improvement in her hemoglobin (Hb) levels.
So, we now know that despite the title of the paper ( “Role of Energy Medicine in enhancing hemoglobin levels – A case study”), the authors used no ENERGY MEDICINE. We also know thet they did not bother to adequately diagnose the patient. But we are told that the case shows that Acupuncture and Energy Medicine can serve as effective energy therapies in managing anemia, particularly for cases that do not respond well to conventional treatments. Just to be clear: if a doctor sees a patient with a dangerously low hemoglobin and does not bother to establish the cause and treats her with acupuncture and diet, the physician is, in my view, guilty of criminal neglect.
At this point, I have to admit that I lost the will to live – well, not quite, perhaps. But I certainly have lost the will to take the ‘International Institute of Yoga and Naturopathy Medical Sciences‘, Chengalpattu, Tamilnadu, India, seriously. In fact, I seriously doubt that this institution should be allowed to educate future doctors. If they are able of doing anything useful, they could try to publish a book on:
HOW NOT TO WRITE A MEDICAL PAPER.
The ‘Code of Professional Practice‘ for UK chiropractors (applicaple from 1.1.2026) has just been published by the UK General Chiropractic Council (GCC). It demands in no uncertain terms numerous things from chiropractors:
- You must put the interests of patients first
- You must ensure safety and quality in clinical practice
- You must act with honesty and integrity and maintain
- You must provide a good standard of clinical care and professional practice
- You must establish and maintain clear professional
- You must obtain appropriate, valid consent from patients
- You must communicate professionally, properly and effectively
- You must foster collaborative healthcare, effective professional relationships and safe, supportive workplace practice
- You must maintain, develop and work within your professional knowledge and skills
- You must maintain and protect patient information
It seems obvious to me that many of these demands cannot possibly met. Let me just pick two examples. The code explains that, as a chiropractor, you must:
- protect patients by promoting and maintaining a culture of safety, seeking to prevent harm before it occurs.
- use the findings of the clinical assessment and the best quality of evidence that is available at the time, to propose (and record) a plan of care for the patient. You must tell the patient where your proposals are not supported by evidence of accepted quality and record your rationale and discussions.
Ad 1
Chiropractors administer spinal manipulations to well over 90% of their patients regardless of their condition or complaint. As we have often discussed on this blog, such treatments are not free of serious risks. It follows that preventing harm from patients and earning your living as a chiro is not really possible. Either you do one or you do the other; to be able to do both at the same time seems pure fantasy.
Ad 2
If chiropractors were to use the findings of the best quality of evidence that is available at the time, they would have to stop using spinal manipulation, a treatment that is, for many indications chiros use it, not supported by the best available evidence. But, as I already mentioned, spinal manipulation is the main therapy of chiros. Following the GCC’s demand is therefore an impossibility.
What is the solution?
Will the new code really disallow UK chiropractors to practice?
No! I fear that the solution is much simpler than it may look at first glance.
The GCC has in the past issued similar demands only to then do nothing to enforce them. Like past documents, the new code will turn out to be a document that changes nothing, except that it makes GCC members feel good: it allows them (and some consumers) the illusion that UK chiropractic an evidence-based, ethical and well-regulated profession.
This could well be one of the toughest jobs that I have ever tackled!
But now it’s done.
And I am glad!
“Hitler’s Female Physicians – Women Doctors During the Third Reich and Their Crimes Against Humanity” (nothing to do with SCAM, sorry) is a collection of biographical sketches of female doctors who committed crimes against humanity during the Third Reich.
The initial chapters provide some context by briefly reviewing some of the worst atrocities of the Nazis:
- the mass sterilisations of citizens who were deemed to be genetically inferior,
- the killing of disabled patients who were considered unworthy of life,
- the mass murder of Jews and other unwanted people.
The book highlights the central role of the German medical profession in all of these barbarities. It explains that, far from being bystanders, German doctors first adopted essential elements of the Nazi ideology, such as ‘race hygiene’, developed the necessary methodologies for mass murder, and later put them into action.
Studying the vast literature on the Third Reich, one easily gets the impression that the monstrosities that followed were an almost exclusively male affair. Many of the most famous Nazi villains were men. What is often forgotten is the fact that women were involved as well – and this is particularly true for medicine.
The main part of the book provides biographical sketches of 38 female physicians who committed highly unethical acts in the name of Nazi ideology. The actions of these women varied greatly; some murdered with their own hands, while others merely promoted or sanctioned such criminality.
When I studied medicine in Munich during the 1970s, some of the ‘doctors of infamy’ became my teachers (either in person or through their textbooks). As students, we had the option of ignoring all this by persuading ourselves that “it has nothing to do with me”. Most of us did exactly that. However, some took a different path, and it is not least thanks to their research that today we know more about the involvement of the German medical profession in the horrors of the Third Reich. My book summarises a hitherto much-neglected aspect. If it can make a small contribution to our understanding of the Nazi doctors’ crimes against humanity, the often depressing process of writing it will have been worthwhile.
Being a dedicated crook and a liar himself, Donald Trump has long had an inclination to surround himself with crooks and liars. As discussed repeatedly, this preferance naturally extends into the realm of healthcare, Some time ago, he sought the advice of Andrew Wakefield, the man who published the fraudulent research that started the myth about a causal link between MMR-vaccinations and autism.
Early November this year, Trump stated that, if he wins the election, he’ll “make a decision” about whether to outlaw some vaccines based on the recommendation of Robert F. Kennedy Jr., a notorious vaccine critic without any medical training. The president doesn’t have authority to ban vaccines but he can influence public health with appointments to federal agencies that can change recommendations or potentially revoke approvals.
Now that he did win the election, Trump suggested that Robert F. Kennedy Jr., his pick to run Health and Human Services, will investigate supposed links between autism and childhood vaccines, a discredited connection that has eroded trust in the lifesaving inoculations.
“I think somebody has to find out,” Trump said in an exclusive interview with “Meet the Press” moderator Kristen Welker. Welker noted in a back-and-forth that studies have shown childhood vaccines prevent about 4 million deaths worldwide every year, have found no connection between vaccines and autism, and that rises in autism diagnoses are attributable to increased screening and awareness.
Trump, too stupid to know the difference between correlation and causation, replied: “If you go back 25 years ago, you had very little autism. Now you have it.” “Something is going on,” Trump added. “I don’t know if it’s vaccines. Maybe it’s chlorine in the water, right? You know, people are looking at a lot of different things.” It was unclear whether Trump was referring to opposition by Kennedy and others to fluoride being added to drinking water.
Kennedy, the onetime independent presidential candidate who backed Trump after leaving the race, generated a large following through his widespread skepticism of the American health care and food system. A major component of that has been his false claims linking autism to childhood vaccinations. Kennedy is the founder of a prominent anti-vaccine activist group, Children’s Health Defense. The agency Trump has tasked him with running supports and funds research into autism, as well as possible new vaccines.
The debunked link between autism and childhood vaccines, particularly the inoculation against mumps, measles and rubella, was first claimed in 1998 by Andrew Wakefield who was later banned from practicing medicine in the UK. His research was found to be fraudulent and was subsequently retracted. Hundreds of studies have found childhood vaccines to be safe.
Autism diagnoses have risen from about 1 in 150 children in 2000 to 1 in 36 today. This rise has been shown to be due to increased screening and changing definitions of the condition. Strong genetic links exist to autism, and many risk factors occurring before birth or during delivery have been identified.
If Trump does, in fact, ‘outlaw’ certain vaccinations, he would endanger the health of the US as well as the rest of the world. Will he really be that stupid?
We had to deal with Hongchi Xiao several times before:
- Slapping therapy? No thanks!
- China Power and Influence
- Slapping therapy: therapist arrested and charged with manslaughter by gross negligence
Slapping therapy is based on the notion that slapping patients at certain points of their body has positive therapeutic effects. Hongchi Xiao, a Chinese-born investment banker, popularised this SCAM which, he claims, is based on the principles of Traditional Chinese Medicine. It is also known as ‘Paida’—in Chinese, this means ‘to slap your body’. The therapy involves slapping the body surface with a view of stimulating the flow of ‘chi’, the vital energy postulated in Traditional Chinese Medicine. Slapping therapists believe that this ritual restores health and eliminates toxins. They also claim that the bruises which patients tend to develop after the treatment are the visible signs of toxins coming to the surface. Hongchi Xiao advocates slapping as “self-healing method” that should be continued until the skin starts looking bruised. He and his follows conduct workshops and sell books teaching the public which advocate slapping therapy as a panacea, a cure-all. The assumptions of slapping therapy fly in the face of science and are thus not plausible. There is not a single clinical trial testing whether slapping therapy is effective. It must therefore be categorised as unproven.
Now it has been reported that Hongchi Xiao has been sentenced to 10 years in prison for the death of a 71-year-old diabetic woman who stopped taking insulin during one of his workshops.
Hongchi Xiao, 61, was convicted of manslaughter by gross negligence for failing to get medical help for Danielle Carr-Gomm as she howled in pain and frothed at the mouth during the fourth day of a workshop in October 2016. The Californian healer promoted paida lajin therapy which entails getting patients to slap themselves repeatedly to release “poisonous waste” from the body. The technique has its roots in Chinese medicine and has no scientific basis and patients often end up with bruises, bleeding — or worse.
Xiao had extradited from Australia, where he had been convicted of manslaughter after a 6-year-old boy died when his parents withdrew his insulin medication after attending one of his workshops in Sydney. “I consider you dangerous even though you do not share the characteristics of most other dangerous offenders,” Justice Robert Bright said during sentencing at Winchester Crown Court. “You knew from late in the afternoon of day one of the fact that Danielle Carr-Gomm had stopped taking her insulin. Furthermore, you made it clear to her you supported this.” Bright added Xiao only made a “token effort” to get Carr-Gomm to take her insulin once it was too late and had shown no sign of remorse as he even continued to promote paida lajin in prison.
Carr-Gomm was diagnosed with type 1 diabetes in 1999 and was desperate to find a cure that didn’t involve injecting herself with needles, her son, Matthew, said. She sought out alternative treatments and had attended a previous workshop by Xiao in Bulgaria a few months before her death in which she also became seriously ill after ceasing her medication. However, she recorded a video testimonial, calling Xiao a “messenger sent by God” who was “starting a revolution to put the power back in the hands of the people to cure themselves and to change the whole system of healthcare.”
Xiao had congratulated Carr-Gomm when she told other participants at the English retreat that she had stopped taking her insulin. By day three, Carr-Gomm was “vomiting, tired and weak, and by the evening she was howling in pain and unable to respond to questions,” prosecutor Duncan Atkinson said.
A chef who wanted to call an ambulance said she deferred to those with holistic healing experience. “Those who had received and accepted the defendant’s teachings misinterpreted Mrs. Carr-Gomm’s condition as a healing crisis,” Atkinson said.
______________
A healing crisis?
A crisis of collective stupidity, I’d say!
More reason to worry about our royal family? Apparently, Camilla (I apologise for calling her thus, as I am never entirely sure whether she is Queen or Queen Consort: Camilla, the wife of Prince Charles, will be formally known as Queen Consort now that her husband is King12. When Camilla and Charles married in a civil ceremony in 2005, it was announced Camilla would become known as Princess Consort – rather than Queen Consort – due to public sensitivity3. However, Queen Elizabeth II granted her the title of Queen Consort in February last year during the Platinum Jubilee45.) has been urged to take more time to recover after a bout of pneumonia.
At the start of November it was announced that she had been diagnosed with a ‘chest infection’ and was under doctors’ supervision. The 77-year-old Camilla was forced to withdraw from her engagements so she could rest at home. She has now revealed that she was suffering from a form of pneumonia.
It is understood Camilla’s condition was viral. She seems to be suffering significantly diminished reserves of energy following her chest infection. This led to her having to pull out of a number of events over recent weeks. Even though the lung infection has now cleared, she says she is still feeling tired. She has been advised by her doctors to take more time to recover. It was confirmed yesterday on the eve of the state visit that the Queen was also reducing her role at the glam state banquet later on Dec. 3 in light of her health.
So, is there anything special that might have triggered this unfortunate turn of events? To answer this question, I refer you to my post of 31 October this year:
… King Charles arrived in Bengaluru directly from Samoa, where he attended the 2024 Commonwealth Heads of Government Meeting from October 21-26. His visit to Bengaluru was strictly kept under wraps, and he was directly taken to Soukya International Holistic Health Centre (SIHHC), where he was also joined by his wife, Camilla.
According to sources, the couple’s day begins with a morning yoga session, followed by breakfast and rejuvenation treatment before lunch. After a brief rest, a second round of therapies follows, ending with a meditation session before dinner and lights out by 9 pm. They have been enjoying long walks around the campus, visiting the organic farm and cattle shed. Considering the high-profile secret visit, a high-security ring was thrown around SIHHC.
The health centre, founded by Dr. Issac Mathai, is located in Samethanahalli, Whitefield, on Bengaluru’s outskirts. This integrative medical facility combines traditional systems of medicine, including Ayurveda, Homoeopathy, Yoga, and Naturopathy, along with over 30 complementary therapies like reflexology, acupuncture, and dietetics.
… The royal couple has earlier taken wellness treatments, including anti-ageing, detoxification and rejuvenation. On November 14, 2019, the couple celebrated the then Prince Charles’ 71st birthday at SIHHC, an event that attracted a lot of publicity, unlike this visit.
Yes, you may well ask: isn’t Ayurvedic medicine supposed:
- to strengthen the immune system,
- to fortify you against infections,
- to replenish your reserves of energy,
- to enable you to recover swiftly from infections?
Of course, I know, correlation is not causation! Perhaps the recent Ayurvedic pampering in India and Camilla’s inability to make a timely recovery from what started merely as a ‘chest infection’ are not at all linked in any way. Yet, it does seem tempting to speculate that the stay in the SIHHC with all the Ayurvedic medicine did her not a lot of good.
Whatever might be the case, I would like to take this opportunity to wish Camilla a full recovery for her condition.
If you live in the UK, you could not possibly escape the discussion about the ‘Assisted Dying Bill’ which passed yesterday’s vote in the House of Commons (MPs have voted by 330 to 275 in favour of legalising voluntary assisted suicide). Once the bill passed all the further parliamentary hurdles – which might take several years – it will allow terminally ill adults who are
- expected to die within six months,
- of sound mind and capable of managing their own affairs
to seek help from specialised doctors to end their own life.
After listening to many debates about the bill, I still I have serious concerns about it. Here are just a few:
- Palliative care in the UK is often very poor. It was argued that the bill will be an incentive to improve it. But what, if this is wishful thinking? What if palliative care deteriorates to a point where it becomes an incentive to suicide? What if the bill should even turn out to be a reason for not directing maximum efforts towards improving palliative care?
- How sure can we be that an individual patient is going to die within the next six months? Lawmakers might believe that predicting the time someone has left to live is a more or less exact science. Doctors (should) know that it is not.
- How certain can we be that a patient is of sound mind and capable of managing their own affairs? By definition, we are dealing with very ill patients whose mind might be clouded, for example, by the effects of drugs or pain or both. Lawmakers might think that it is clear-cut to establish whether an individual patient is compos mentis, but doctors know that this is often not the case.
- In many religions, suicide is a sin. I am not a religious person, but many of the MPs who voted for the bill are or pretend to be. Passing a law that enables members of the public to commit what in the eyes of many lawmakers must be a deadly sin seems problematic.
In summary, I feel the ‘Assisted Dying Bill’ is a mistake for today; it might even be a very grave mistake for a future time, if we have a government that is irresponsible, neglects palliative care even more than we do today and views the bill as an opportunity to reduce our expenditure on pensions.
I was recently invited to give a lecture to the local medical association in Graz Austria. It was a pleasure to be in Austria again and a delight to visit the beautiful town of Graz. They had given me the following subject:
Mythen in der sogenannten Alternativmedizin [Myths of so-called alternative medicine (SCAM)]
In my lecture, I thought it prudent to relate to the situation of SCAM in Austria which is rather special:
- The seem to Austrians love the SAM; the 1-year prevalence of use is 36%!
- In Austria, SCAM is only allowed to be practised by doctors.
- Often SCAM is paid for by patients out of their own pocket.
- For many, SCAM is a question of belief.
- SCAM is being promoted by VIPs and loved by journalists; one politician even sells his own brand of dietary supplements!
- In Austria, SCAM is heavily promoted by the Austrian Medical Association who currently runs courses and issues several SCAM diplomas.
The Austrian newspaper DER STANDARD then decided to interview me on these issues. The interview has been published today, and I thought I might take the liberty of translating the central part for you:
Q: In Austria, the Medical Association offers diplomas in various alternative methods. Why is this problematic?
A: I am aware of no less than 11 such diplomas offered by the Austrian Medical Association. While in England, France or Germany, for example, homeopathy has been considerably restricted by the medical profession due to the largely negative evidence, in Austria it continues to be promoted by the medical associations. This makes Austrian medicine the laughing stock of the rest of the world. More importantly, it violates the principles of evidence-based medicine. And even more importantly, it seems to me that the Austrian Medical Association is neglecting its ethical duty towards patients for purely pecuniary reasons.
Q: But the Medical Association is only complying with the regulations.
A: The Medical Association boasts that the quality of medical care and patient safety are at the centre of its work. In view of these diplomas, this mission almost sounds like a bad joke. They claim that the diplomas comply with the regulations. But firstly, this is a question of interpretation and secondly, regulations can – I would say must – be changed if they run counter to the quality of medical care. Finally, according to its own statements, the Association is obliged to adapt the Austrian healthcare system to changing conditions. This means nothing other than that it must take account of changing evidence – for example in the field of homeopathy.
Q: And what do the many doctors who use homeopathy say?
A: They often claim that they are only following the wishes of their patients when they prescribe homeopathic remedies. This may be true, but it is certainly not a valid argument. It ignores the fact that it is a doctor’s damned duty to provide patients with evidence-based information and to treat them accordingly. After all, medicine is not a supermarket where customers can simply choose whatever they happen to like.
It should also be emphasised that the practitioners of homeopathy also earn a good living from it. The fact that there is resistance from them when it comes to prioritising evidence rather than earnings in this area is thus hardly surprising.
But of course there are also a few doctors who use homeopathy primarily because they are fully convinced of its effectiveness. I think that these colleagues should consider self-critically whether they are not violating their ethical duty to be at the cutting edge of current knowledge and to act accordingly.
Perhaps unsurprisingly, my lecture prompted a lively discussion. Those doctors in the audience who spoke were unanimously in favour of my arguments. I was later told that many of those people who are responsible for the 11 diplomas were in the audience. Sadly, none of them felt like discussing any of the issues with me.
Perhaps the interview succeeds in starting a critical discussion about SCAM in Austria?
While the evidence base on web-based cancer misinformation continues to develop, relatively little is known about the extent of such information on the world’s largest e-commerce website, Amazon. Multiple media reports indicate that Amazon may host on its platform questionable cancer-related products for sale, such as books on purported cancer cures. This context suggests an urgent need to evaluate Amazon.com for cancer misinformation.
This study sought to
- (1) examine to what extent are misleading cancer cure books for sale on Amazon.com’
- (2) determine how cancer cure books on Amazon.com provide misleading cancer information.
The investigators searched “cancer cure” on Amazon.com and retrieved the top 1000 English-language book search results. They reviewed the books’ descriptions and titles to determine whether the books provided misleading cancer cure or treatment information. They considered a book to be misleading if it suggested scientifically unsupported cancer treatment approaches to cure or meaningfully treat cancer. Among books coded as misleading, they conducted an inductive latent thematic analysis to determine the informational value the books sought to offer.
Nearly half (494/1000, 49.4%) of the sampled “cancer cure” books for sale on Amazon.com appeared to contain misleading cancer treatment and cure information. Overall, 17 (51.5%) out of 33 Amazon.com results pages had 50% or more of the books coded as misleading. The first search result page had the highest percentage of misleading books (23/33, 69.7%). Misleading books (n=494) contained eight themes:
- (1) claims of efficacious cancer cure strategies (n=451, 91.3%),
- (2) oversimplifying cancer and cancer treatment (n=194, 39.3%),
- (3) falsely justifying ineffective treatments as science based (n=189, 38.3%),
- (4) discrediting conventional cancer treatments (n=169, 34.2%),
- (5) finding the true cause of cancer (n=133, 26.9%),
- (6) homogenizing cancer (n=132, 26.7%),
- (7) discovery of new cancer treatments (n=119, 24.1%),
- (8) cancer cure suppression (n=82, 16.6%).
The authors concluded that the results demonstrate that misleading cancer cure books are for sale, visible, and prevalent on Amazon.com, with prominence in initial search hits. These misleading books for sale on Amazon can be conceived of as forming part of a wider, cross-platform, web-based information environment in which misleading cancer cures are often given prominence. Our results suggest that greater enforcement is needed from Amazon and that cancer-focused organizations should engage in preemptive misinformation debunking.
This is an excellent paper that is long overdue. The plethora of dangerous books on so-called alternative medicine (SCAM) targeted at lay people is nothing short of a scandal. It was high time that we expose it, because it kills vulnerable patients. It is difficult, if not impossible, to quantify the damage done by such books but I am sure it runs in the thousands.
I have been aware of this scandal for a long time, in fact, it was the main motivation for publishing my own book on the subject. Obviously, it is not much more than a drop in the ocean.
Tragically, this scandal is not confined to just cancer. It relates to all potentially serious conditions. What could be more despicable and unethical than earning money through making desperately ill patients suffer? As the authors point out, Amazon urgently needs to address this problem. Failing this, Amazon should be legally held responsible, in my view.
‘DOC Check’ just published an interesting article. Allow me to translate some passages for you:
In 2023, the German Federal Insititute for Drugs and Devices (BfArM) stated: ‘To date no homeopathic medicinal product has been authorised by the BfArM based on a study submitted by the applicant.’ So why are homeopathic medicines still covered by statutory health insurance? Jörg Windeler, then head of IQWiG (the German equivalent of NICE), gave an indication in 2019: ‘It is simply a way of attracting customers. Homeopathy is popular, and customers are more likely to go to the health insurance fund that pays for homeopathy.’ This laissez-faire attitude is expensive. And not just in terms of the cost of medicines.
If you delve a little deeper into the world of homeopathic medicine, further grey areas emerge. They concern the doctors’ fees that are charged as part of the therapy.
In Germany, the normal billing of fees by doctors follows strict rules. To rule out fraud, they are subject to a plausibility check by the health insurance. Among other things, the time profiles are checked to ensure that the practitioner is billing the number of examinations correctly. There are also fee budgets. If these are exceeded, doctors will only receive a pro rata payment for their services.
Doctors have different possibilities for homeopathic services. One popular version is the billing option that the German Central Association of Homeopathic Doctors (DZVhÄ) offers its members. In this case, the plausibility checks of the insurance are not carried out. Furthermore, the services are extra-budgetary. This is possible because the DZVhÄ has concluded selective contracts via its own management company, MGL Managementgesellschaft für Gesundheitsleistungen mbH.
Access to participation in these selective contracts is gained via a ‘homeopathy diploma’, which is awarded by the DZVhÄ after 6 weeks of training. Trainee homeopaths have to fork out around 3,000 Euros to obtain this document – but the expense is well worth it. Once a doctor has obtained the homeopathy diploma, he/she participates in the selective contract. Subsequently, the health insurance pay fixed fees beyond the hotly contested pot. Only a few rules have to be adhered to: a time frame of at least 60 minutes for an initial homeopathic history and at least 30 minutes for a follow-up session. There is no evidence that these time limits are strictly monitored.
This uniquely lax construction in the German healthcare system is a potential gateway for abuse and fee fraud. It is easy to cheat on the time used for medical histories without a plausibility check. A practitioner can even conduct the initial homeopathic history and the ‘conventional medical’ consultation in parallel. The conventional medical service could then be billed via the health insurance, the homeopathic service again via the DZVhÄ route.
We asked the DZVhÄ in an editorial enquiry whether they were aware of this problem and how they ensure that everything is carried out correctly. The association remained silent – a tactic they have been using for years. The DZVhÄ only get vocal when they suspect attacks on their business model.
It would be interesting to know the volume of fees billed in Germany via the DZVhÄ’s selective contracts. Unfortunately, these figures are difficult to determine. A homeopath receives 97 Euros for the initial consultation. If each of the approximately 7,000 members of the DZVhÄ took an initial medical history on 200 working days per year, this would translate into a fee volume of more than 130 million Euros per year. This does not include follow-up sessions and so-called ‘repertorisations’. In other words, 200 million Euros could quickly be spent of doctors’ fees. Admittedly, these figures are speculative. However, the DZVhÄ could easily clarify the matter – if only they wanted to do so.
German health politicians ignore these hidden costs of homeopathy. They like to point to the notion that ‘only’ around 22 million Euros are spend on homeopathics.
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It would be a mistake, I think, to assume that financial reasons provide the only motivations for German doctors to use homeopathy. There are, in my experience, several others:
- Some occasionally use homeopathy as a placebo for patients where they feel a placebo is the best solution.
- Some use homeopathy for patients want it.
- Some use homeopathy because they are not fully aware of what it is.
- Some use homeopathy because they are ill-informed about the evidence.
Very few German doctors who I know have ever used it because they are convinced that it is effective.
