Homoeopathy at its origins
(Written
as part of a project “Germany and India – Transnational Networks
and Health” at the Bielefeld University, Germany in December 2012 )
Dr Harikumar Sivanandan
The
writer is an Indian physician and public health scholar, who is working in the
state of Kerala, India as part of its primary health care system.
Homöopathische
Behandlungen werden in Indien kontrovers diskutiert. Oft wird behauptet, dass
Homöopathie in Deutschland, ihrem Ursprungsland, sogar verboten sei. Dieser
Artikel gibt einen Überblick der aktuellen Situation der Homöopathie in
Deutschland. Der Fokus liegt dabei auf rechtlichen Vorschriften und Regelungen,
der Ausbildung sowie Kostenübernahme durch Krankenkassen.
Homoeopathic practice in India
has been plagued by controversies and often alleged to be banned in Germany,
the country of origin of homoeopathy. This article attempts to give an overview
of the current status of homoeopathy in Germany with particular reference to regulation,
training, and insurance coverage.
Homoeopathy originated in the
late 18th century when Dr Samuel Hahnemann, a German physician
disillusioned by the methods of biomedicine, put forward his doctrine of similia
similibus curentur or 'like cures like'. Since then, it has grown into a
popular system of alternative medicine with its attractive holistic approach of
'treating the patient rather than the disease', its palatable medicines having
almost no side effects and its claims of treating chronic conditions.
Homoeopathy has its own views on illness, its own diagnostic and therapeutic
approaches, as well as its own medicines. Homoeopathic medicines are prepared
from a variety of sources, such as medicinal plants, minerals, animal
materials, and are typically administered in high dilutions. However, the claim
of increasing potency with increasing dilution has also been the main point of
criticism, as it does not conform to natural logic and modern pharmacological
tenets. Opponents argue that homoeopathic medicines only have a placebo effect.
In addition, homoeopathic practitioners are reluctant to test their methods in
a randomised controlled trial, which is considered the gold standard for
determining the efficacy of a treatment modality.
Homoeopathy in India
Homoeopathy in India was
officially recognised as a form of alternative medicine from the
pre-independence era and continues to enjoy governmental patronage. Homoeopathic
education and practice is regulated by the Homoeopathic Central Council Act of
1973. The Central Council for Research in Homoeopathy was established as an
autonomous organisation in 1978 under the Department of AYUSH, Ministry of
Health and Family Welfare, Government of India. With considerable governmental
support, India has become a world leader in homoeopathy with a vast
infrastructure of hospitals, dispensaries, research institutions, medical
colleges, registered practitioners and pharmacies. Main-streaming of
homoeopathy along with traditional Indian systems of medicine is an official
and prominent strategy to help strengthen the public health system as envisaged
under the National Rural Health Mission.
Similar to other countries,
homoeopathic practice in India has always been plagued by controversies. Apart
from the usual debates about the scientific validity of homoeopathic principles
and methods, homoeopaths are accused of practising modern or allopathic
medicine. They are also accused of misleading clients to follow ineffective
treatments when better choices are available. The homoeopathic practitioners
also campaign against modern medical practices such as immunisation for
prevention of diseases. There have been demands to subject homoeopathic
practice to the same standards as evidence-based modern medicine to ensure
effectiveness and safety. One often heard argument against homoeopathy in India
is that it has been banned in its country of origin, namely Germany. This
article tries to provide a picture of the current status of homoeopathy in
Germany without going into the debates surrounding it.
Regulation of homoeopathy in Germany
Even
though homoeopathy is not separately recognised as a part of the German
healthcare system, it finds a place under complementary and alternative
medicine. Homoeopathy is considered the most popular among the different types
of complementary medicine prevalent in Germany. In 2008, homoeopathic medicines
had a market share of 346 million US dollars in Germany, according to an
article cited by the World Health Organisation. It indicates that a significant
proportion of the population depend on it partially or completely. Homoeopathic
drugs are registered by the Complementary and Traditional Medicinal Products
division of the BfArM (Federal Institute for Drugs and Medical Devices).
Homoeopathic medicinal products only need to be registered, provided that no
indication claims are made for them and that adequate quality is demonstrated.
If indication claims are made, the homoeopathic medicinal product has to
undergo an authorisation procedure. Homoeopathic products are treated as
medicinal products under Article One of the European Council Directive 65/65
EEC and in Article Two of the German Medicines Act (AMG). The legal and
terminological framework for homoeopathic medicinal products in Germany and the
European Union is laid down clearly in the German Homoeopathic Pharmacopoeia
(HAB1), the European Pharmacopoeia and the European Council Directives 92/73
and 92/74 EEC. According to the BfArM website, there are 1,261 registered
homoeopathic medicinal products available in the German market, in addition to
a host of herbal and anthroposophic products. Homoeopathic medicines are
available in most pharmacies across Germany.
Who practises homoeopathy in Germany?
In
Germany, licensed medical practitioners are allowed to practise complementary
medicine if they undergo some training and they may also opt for post-graduate
specialisation in complementary medicine. Basic knowledge of complementary or
alternative medicine is also part of the standard medical curriculum. In
addition Germany has the unique Heilpraktiker system. Introduced in
1939, the Heilpraktiker license allows those without a recognised medical
degree to practise medicine. Any German citizen aged 25 years or more, who has
undergone primary school education, has a good reputation and is physically and
mentally fit, can obtain the Heilpraktiker license by passing an exam testing
his basic medical knowledge. They are not required to undergo standardised
training to undertake the exam, but most of them undergo some form of training
organised by any of the Heilpraktiker professional associations. However, they
are specifically prohibited from practising in specialised fields like
obstetrics, venereology and dentistry. There are an estimated 13,000
Heilpraktiker practising in Germany, and they practise different forms of
alternative medicine such as homoeopathy, naturopathy, acupuncture, etc. Thus,
in Germany, homoeopathy is essentially practised by two categories: the
conventional physicians with additional homoeopathic training or qualification
and the Heilpraktiker. The titles of 'Homoeopathic physician' and
'Heilpraktiker' are legally protected.
Conventional medical doctors
can obtain the additional designation of homoeopathic physician by undergoing
homoeopathic training, which include theory sessions, supervised practical
sessions and case seminars. In 2006, there were 6,073 medical doctors with
additional qualifications in homoeopathy in Germany. The training is based on a
MusterWeiterbildungsordnung (MWBO 2003) or model training order and
guidelines from the German Medical Association. The state medical associations
provide the additional designation after an internal review. The German Central
Association of Homoeopathic physicians (DZVhÄ
) also offers an additional diploma in homoeopathy to those who fulfil certain
criteria for continuing education. Such additional diplomas are claimed to
result in better opportunities and remuneration through selective insurance
contracts. The homoeopathic physicians use different strategies in their
medical practice to integrate homoeopathy and modern medicine whose conceptual
differences are very sharp. There are physicians who perform parallel practice
of homoeopathy and modern medicine by segregating patients according to the
diagnosis, prior experience of therapeutic success and patients’ preference.
There are others who predominantly practice homoeopathy and complement it with
the diagnostic capabilities of modern medicine to rule out dangerous conditions
even as they criticise the therapeutic options. Still others rigidly follow the
tenets of classical homoeopathy and have a negative attitude towards modern
medicine.
Due to the absence of
regulations for the training and the continuing education of Heilpraktiker,
several associations have been formed with the aim of quality management and
standardisation in the field of classical homoeopathy. Examples of such
associations include Bund Klassischer Homöopathen Deutschlands (BKHD), Stiftung Homöopathie-Zertifikat (SHZ) and the
Verband Klassischer Homöopathen Deutschlands (VKHD). These associations have
set up standards for training, continuing education and supervision of
homoeopathic practise. Some universities also offer bachelor degree programmes
in complementary medicine.
Insurance coverage for homoeopathy
Insurance coverage and
reimbursement of homoeopathic treatment in Germany is a complex and
heterogenous issue. It has been argued that the practice of classical
homoeopathy is difficult to sustain within the German public insurance system
due to economic reasons. The economic pressures may force them to either open a
totally privately run practice or deviate from classical homoeopathy by
adopting shortened case histories and combination drug therapies. However
conventional physicians who practice homoeopathy often adopt a dual strategy of
private payment for the lengthy case histories and insurance coverage for
follow-up consultations.
In general, compulsory
insurances do not reimburse the treatment of a Heilpraktiker. However, it may
be refunded if it is provided by a medical doctor and if the national
healthcare provider has a special contract with medical doctors. It also varies
depending on the federal state the patient and doctor live in. Private
insurance companies may refund homoeopathic treatment provided by Heilpraktiker
and medical doctors with varied terms and conditions. There are maximum levels
for refunded fees, both per consultation and per annum with a minimum annual
amount to be covered by the patients. Refunding for homoeopathic treatment
provided by Heilpraktiker is limited compared to treatment provided by medical
doctors. The Beihlife, an insurance system for German civil servants
covers homoeopathic treatment by Heilpraktiker to a limited extent.
Thus, homoeopathy
has its own place in Germany's pluralistic medical system, even though
officially it is seen as part of complementary or alternative medicine. Like in
India, a significant proportion of people use homoeopathic medicine for
treatment, especially for chronic conditions and childhood illnesses. However,
the institutional mechanisms are less formal and, a mixed system of statutory
requirements and voluntary self-regulation by various professional
organisations is in place. Like elsewhere, homoeopathic practitioners in
Germany are also trying to gain greater societal and political acceptance by
presenting evidence adapted according to the principles of homoeopathy, even
though they do not depend on such evidence for their daily practise. The task
remains, of getting such adapted evidence accepted in modern scientific
circles.
Source: filorosso.eu - Manfred
Gerber / pixelio.de
Dr Harikumar Sivanandan
