Will there soon be a reform of the alternative medical profession in Germany?
The interdisciplinary group of experts at the Münsteraner Kreis calls for a new regulation of the alternative practitioner profession in Germany. The emeritus professor of alternative medicine, Edzard Ernst, is one of the experts. The aim is to prevent wrong treatment of patients through quality assurance standards.
Mistreatment by alternative practitioners
According to the Münsteraner Kreis, the problem includes mistreatment by alternative practitioners, especially with complementary and alternative medicine (KAM) methods.
Death in an emergency
The “Biological Cancer Center” on the Lower Rhine is an example of such incorrect treatment. At least four patients died there after questionable alternative medical cancer therapy.
Science and self-determination
The team of authors are trying to tackle the problem in a scientifically determined manner and based on the patient's right to self-determination.
Alternative and complementary medicine
By alternative medicine, the authors understand “the entirety of the procedures that are offered in competition with treatment procedures in science-oriented medicine. Complementary medicine (…) is the procedure that its operators offer in addition to science-oriented medicine. ”
There would be large overlaps, depending on the provider and patient. That is why the authors use the collective term complementary alternative medicine (KAM). These included, for example, acupuncture, homeopathy or Bach flowers.
KAM would conceptually differentiate itself from science-oriented medicine, which was based on its treatment prospects with a sufficient level of evidence. Many advocates of KAM would be skeptical or reject scientific justification and clinical evidence.
Why alternative practitioner?
KAM used naturopaths as common practice, as well as techniques of science-oriented medicine.
Alternative practitioners often see themselves as an independent pillar in the health system and offer numerous healing concepts that are explicitly not scientifically based.
Many doctors offer KAM procedures as integrative medicine, but are not allowed to operate as alternative practitioners because an alternative practitioner examination does not certify them as additional qualifications. It is different with dentists, psychologists or physiotherapists. With the title of alternative practitioner, they are also allowed to work outside of their “actual profession”.
The state recognition of naturopaths as "practitioners of healing" and the recently fixed term "naturopath" suggest that they are state-certified healers with training comparable to that of doctors.
No comparison to medical graduates
The Münsteraner Kreis writes: “However, this would be a clear fallacy. Medical students go through a course of study committed to science, which ends in a state examination. In contrast, alternative practitioners only have to pass a single examination in which they have to demonstrate that they are aware of certain limits in their area of competence, for example in the treatment of infectious diseases. ”
No state-regulated training
In addition, there is no state-regulated training. Doctors are obliged to undergo regular further training, which is subject to control by the state medical associations, in contrast to non-medical practitioners who have no comparable training system.
The experts write: “Doctors are allowed to care for patients because it is reasonably assumed that they have the appropriate academic knowledge and skills.
In order to be approved by the health insurance fund, all doctors - from general practitioners to urologists - have to have a medical degree in addition to medical license. ”
High standards for doctors
“So you have at least six years of study and at least five years of specialist training behind you. Even doctors without a health insurance license have to treat according to specialist standards, such as liability law. ”
Low level for naturopaths
Science-oriented medicine therefore trains doctors to high standards, while the laws for alternative practitioners do not require scientifically sound, standardized or controlled training. Prospective alternative practitioners could prepare themselves for the required examination without ever seeing a patient.
Minimal print runs
Licenses for alternative practitioners should only be refused if those affected pose a risk to the health of the patient or the population.
The Münster group considers this to be inadequate: "This minimum requirement does not do justice to the complexity of the disease spectrum known today, nor does it take into account the various risks from side effects of KAM preparations or their interactions with drugs in science-oriented medicine."
Medical powers without medical knowledge
Alternative practitioners are expected to make diagnoses, perform treatments, give injections, and give infusions. You just shouldn't prescribe any prescription drugs or treat certain infectious diseases.
Esoteric parallel world?
Naturopathic practitioners mainly operate in a “parallel world with their own, mostly dogmatic, traditional concepts of illness and healing. Depending on the teaching, these contain more or less scientifically unfounded or unsustainable elements: In many cases, these are beliefs, many of which contradict scientific findings or are empirically refuted by modern medicine. ”
Exams are sketchyO
The border between knowledge and belief is not in demand in alternative practitioner exams and is difficult to see for many patients. Due to a lack of qualifications, many naturopaths would intuitively come to diagnoses and therapies, but not on the basis of a scientifically developed system.
The Münster circle chooses a comparison: “It would be inconceivable to allow bridge building based on spiritual statics or to entrust the control of an aircraft whose full competence consists in a successfully completed workshop on the legend of Ikarus. As absurd as this would appear, alternative practitioners in Germany may examine and treat patients on the basis of comparable professional requirements. ”
Abstruse special regulations
There are abstruse special regulations for preparations of homeopathy, phytotherapy and anthroposophic medicine. These are exempt from proof of efficacy and safety that apply to all other medicinal products.
The experts demand: “A health system that is committed to patient care must be kept completely free of undocumented and excessive promises of salvation. This follows directly from the ethical principle of truthfulness when dealing with vulnerable patients and their relatives. ”
The situation would be different with complementary procedures which serve to increase the comfort of treatment and do not undermine the treatment strategies of science-oriented medicine or question its principles. "Doctors who take this into account work in the best sense of science."
Freedom of therapy
The Münsteraner Kreis sees freedom of therapy not as a legitimation of arbitrary interventions, but as "meaningful adaptation of guideline-compliant therapies to the individual patient."
What should change?
The authors call for science-oriented medicine to be acutely and urgently dedicated to successful communication and to oppose an economically motivated consolidation of treatment processes.
Strengthen scientific judgment
Academically mediated medicine had to promote the scientific judgment of aspiring doctors more than before in order to recognize pseudoscience and to inform patients about it.
Qualification of naturopaths
The mismatch between the qualification and the authority of the alternative practitioner had to be corrected without restricting the self-determination rights of the patients.
One solution would be to limit the powers of alternative practitioners to their real knowledge and, for example, subject them to medical instructions. However, this would effectively deprive medical practitioners of their patients, as there was no based indication for prescribing alternative medicine or placebos.
Abolish alternative practitioner?
A second solution is to abolish the state-protected profession of alternative practitioner based on the model of the abolition of the training as a dentist in favor of the trained dentist. This would have the advantage of closing the quality gap between medical healthcare and alternative practitioners.
The competence solution is based on training medical practitioners in a science-oriented manner and examining them by the state. State-recognized naturopaths may only become those who have completed training in a recognized health profession, such as occupational therapists, nurses, speech therapists or physiotherapists.
Such people should be able to complete an education at a technical college level as a naturopath, which qualifies them in their area as a naturopath. One focus would be on communication and empathy, an education in science theory would also be necessary to enable them to reflect critically.
Medical parallel worlds
The Münsteraner Kreis came to the following conclusion: “Medical parallel worlds with radically divergent quality standards, as currently exist in the German healthcare system in the form of double standards in the evaluation of results and quality control, are not acceptable for an enlightened society.” (Dr. Utz Anhalt)