Homoeopathy at its than the disease', its palatable medicines

having almost no side effects and its

origins claims of treating chronic conditions.
Homoeopathy has its own views on illness,
its own diagnostic and therapeutic
approaches, as well as its own medicines.
Dr Harikumar Homoeopathic medicines are prepared
Sivanandan from a variety of sources, such as
The writer is an medicinal plants, minerals, animal
Indian physician materials, and are typically administered
and public in high dilutions. However, the claim of
health scholar, increasing potency with increasing dilution
who is working has also been the main point of criticism,
in the state of as it does not conform to natural logic and
Kerala, India as modern pharmacological tenets.
part of its Opponents argue that homoeopathic
primary health care system. medicines only have a placebo effect. In
addition, homoeopathic practitioners are
reluctant to test their methods in a
randomised controlled trial, which is
Homöopathische Behandlungen werden in considered the gold standard for
Indien kontrovers diskutiert. Oft wird determining the efficacy of a treatment
behauptet, dass Homöopathie in modality.
Deutschland, ihrem Ursprungsland, sogar
verboten sei. Dieser Artikel gibt einen Homoeopathy in India
Überblick der aktuellen Situation der
Homöopathie in Deutschland. Der Fokus Homoeopathy in India was officially
liegt dabei auf rechtlichen Vorschriften recognised as a form of alternative
und Regelungen, der Ausbildung sowie medicine from the pre-independence era
Kostenübernahme durch Krankenkassen. and continues to enjoy governmental
patronage. Homoeopathic education and
Homoeopathic practice in India has been practice is regulated by the Homoeopathic
plagued by controversies and often Central Council Act of 1973. The Central
alleged to be banned in Germany, the Council for Research in Homoeopathy was
country of origin of homoeopathy. This established as an autonomous
article attempts to give an overview of the organisation in 1978 under the
current status of homoeopathy in Department of AYUSH, Ministry of Health
Germany with particular reference to and Family Welfare, Government of India.
regulation, training, and insurance With considerable governmental support,
coverage. India has become a world leader in
homoeopathy with a vast infrastructure of
Homoeopathy originated in the late 18 th hospitals, dispensaries, research
century when Dr Samuel Hahnemann, a institutions, medical colleges, registered
German physician disillusioned by the practitioners and pharmacies. Main-
methods of biomedicine, put forward his streaming of homoeopathy along with
doctrine of similia similibus curentur or traditional Indian systems of medicine is
'like cures like'. Since then, it has grown an official and prominent strategy to help
into a popular system of alternative strengthen the public health system as
medicine with its attractive holistic envisaged under the National Rural Health
approach of 'treating the patient rather 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 Source: filorosso.eu - Manfred Gerber /
by Heilpraktiker to a limited extent. pixelio.de

Thus, homoeopathy has its own place in

Germany's pluralistic medical system,
Dr Harikumar Sivanandan
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.