The Heilpraktiker (translated literally as healing practitioner) is an officially recognized healthcare professional practicing so-called alternative medicine (SCAM) in Germany. The profession is seen as exemplary by many proponents of SCAM, while others feel that it presents an unacceptable danger to health and progress. The Heilpraktiker might be perhaps best understood by looking at its fascinating history (Ernst 1997).
When the Nazis came to power in 1933, German healthcare was inundated by lay practitioners who were grouped into multiple organizations vying for official recognition. Many of the Nazis were in favor of SCAM (e.g., Himmler and Hess) and felt the need to restructure German healthcare to bring it under their control. They promoted their concept of Neue Deutsche Heilkunde (New German Medicine), which entailed the integration—more of a shotgun marriage—of conventional medicine and SCAM (Ernst 2001).
The “flag ship” of the Neue Deutsche Heilkunde was the Rudolf Hess Krankenhaus in Dresden, which attempted a full integration of SCAM into conventional healthcare. An intriguing example of research into SCAM is the Nazi government’s large-scale project to validate homoeopathy. Even though the data are now lost, the results of this research seem to have been negative. It seems hard to ignore the intriguing similarities between today’s integrative medicine and the Neue Deutsche Heilkunde of the Third Reich (Ernst 2001). The Nazis decided to grant all SCAM practitioners the official recognition they craved by establishing them under the newly created umbrella of Heilpraktiker. But, not least to appease the medical profession, they also decreed that the Heilpraktiker was barred from educating a second generation of this profession. The Heilpraktiker was thus destined to become extinct within just a few decades.
After the war, the Heilpraktiker organization went to court and won the right to educate its own students. For this reason, the profession has survived to the present day. Around 50,000 Heilpraktiker currently treat patients with SCAMs such as homeopathy, acupuncture, herbal medicine, energetic healing, etc. Even today, the Heilpraktiker has no mandatory medical training; a simple test to show that they know the legal limits of their profession suffices for receiving an almost unrestricted license to practice medicine. The Heilpraktiker can employ, largely without control, the whole spectrum of medicine, except for gynecology, dentistry, prescription of medication, and the treatment of infectious diseases (Heudorf et al. 2010). When struck off the medical register for practicing quackery, some German medical doctors carry on as Heilpraktiker, enjoying the absence of scrutiny over this profession (Ernst 2016b). Unsurprisingly, reports of Heilpraktiker causing serious harm emerge regularly (Ernst 2016a).
Heilpraktiker are known to advise against using conventional treatments, including vaccinations. One Heilpraktiker school, for instance, offers the following information about “homeopathic vaccinations” called nosodes (my translation):
The Heilpraktiker is legally authorized to prepare the nosodes of medium potency (>D12) himself and to give them to the patient. This method, by the way, corresponds much better to the original approach of this very effective therapy, because the pathogen (the pathogen composition) in the nosode is identical with the causative agent of the clinical picture, and homeopathy, which cures like with like (or their oscillation patterns), can develop its full effect. In order to avoid legal problems, the nosodes themselves should not be itemized on the bill. (Nosodentherapie, Impfen mit Homöopathie 2009)
Most German medical doctors have no confidence in the competence of the Heilpraktiker and see little reason for cooperation (Thanner et al. 2013). Many are concerned about the harm the Heilpraktiker might cause, and several attempts to change the situation have been made. However, so far, none of them has been successful. In 2017, a group of German scientists, clinicians, ethicists, and other experts (I was a member of the panel) published a document critically assessing the situation and calling for change (Anlauf et al. 2017). Here are its conclusions (my translation):
Parallel medical worlds with radically divergent quality standards, such as currently exist in the German health system in the form of double standards in the evaluation of results and quality control, are unacceptable for an enlightened society. In the case of nonmedical practitioners, due to their inadequate, barely regulated training, there is a glaring disproportion between qualifications and powers to practice. Heilpraktiker offer alternative or complementary medical procedures that are in most cases scientifically untenable. This puts patients at risk. Only a simultaneous approach on several levels promises success:
(1.) a uniform assessment of patient utility in all areas of medicine;
(2.) an increased commitment to the requirements of successful communication with patients;
(3.) an increased promotion of competences in scientific theory in education and studies of health-related professions; and
(4.) an abolition of the Heilpraktiker system or a radical raising and ensuring the level of competence of the Heilpraktiker.
We have focused here on the reform of the Heilpraktiker system and have outlined two proposed solutions: We recommend either the complete abolition of the Heilpraktiker profession or its replacement by the introduction of specialized Heilpraktiker as an additional qualification for existing health professions. For the transitional phase, we recommend a legal restriction of the Heilpraktiker profession to largely nonhazardous activities. This would reduce the dangers for patients and significantly improve patient care in the long term.
Because Heilpraktiker tend to advise their patients against vaccinations, the current pandemic has brought the Heilpraktiker profession back in focus. The German newspaper Die Zeit recently reported about the dire state of the pandemic in some German regions (Vooren 2021). In one district, for instance, only about 58 percent of the population were fully vaccinated, far below the German average. The article blamed a distrust in conventional medicine, the media, and politics for this situation and pointed out that the higher the density of Heilpraktiker, the lower the uptake of immunizations.
The Heilpraktiker is a relic from Germany’s Nazi past. The profession endangers the health of those who rely on it, and the sooner this problem can be addressed, the better for public health in Germany.
References
Anlauf, M., N. Aust, H.-W., Bertelsen, et al. 2017. Münsteraner Memorandum Heilpraktiker: Ein Statement der interdisziplinären Expertengruppe “Münsteraner Kreis” zu einer Neuregelung des Heilpraktikerwesens. Münsteraner Kreis (August 21). Online at https://www.aerzteblatt.de/down.asp?id=19264.
Ernst, E. 1997. Heilpraktiker—ein deutsches Phänomen. Welche Rechte und Pflichten haben Heilpraktiker? [Healing practitioner—a German phenomenon. What are the rights and responsibilities of healing practitioners?]. Fortschritte der Medizin 115(4): 38–41. Online at https://pubmed.ncbi.nlm.nih.gov/9157042/.
———. 2001. ‘Neue Deutsche Heilkunde’: Complementary/alternative medicine in the Third Reich. Complementary Therapies in Medicine 9(1): 49–51. Online at https://www.sciencedirect.com/science/article/pii/S0965229900904163.
———. 2016a. Fatalities in a German alternative medicine clinic caused by 3BP? Edzard Ernst MD, PhD, FMedSci, FRSB, FRCP, FRCPEd (August 6). Online at https://edzardernst.com/2016/08/fatalities-in-a-german-alternative-medicine-clinic-caused-by-3bp/.
———. 2016b. Another death by quackery. Edzard Ernst MD, PhD, FMedSci, FRSB, FRCP, FRCPEd (September 4). Online at https://edzardernst.com/2016/09/another-death-by-quackery/.
Heudorf, U., A. Carstens, and M. Exner. 2010. Heilpraktiker und öffentliches Gesundheitswesen. Bundesgesundheitsblatt 53: 245–257. Online at https://doi.org/10.1007/s00103-009-1024-0.
Nosodentherapie, Impfen mit Homöopathie. 2009. Paracelsus Magazin 3. Online at https://www.paracelsus.de/magazin/ausgabe/200903/nosodentherapie-impfen-mit-homoeopathie.
Thanner, M., E. Nagel, J. Loss. 2013. Möglichkeiten und Grenzen einer Zusammenarbeit mit Heilpraktikern aus ärztlicher Sicht. Forschende Komplementärmedizin 20: 23–32. Online at https://www.karger.com/Article/Abstract/346608.
Vooren, C. 2021. Die Triage findet im Stillen statt. Die Zeit (November 12). Online at https://www.zeit.de/gesellschaft/zeitgeschehen/2021-11/rosenheim-corona-inzidenz-intensivbetten-heilpraktiker-impfung.