How physicians treat patients best, they learn during their studies and later in further education. But how is it decided which therapies should be useful, effective, safe and therefore part of this training? The best answer would be: scientifically, based on studies that analyze the benefit for patients. The situation is different with the Federal Dental Association (BZÄK).
In order to clarify for the dental training, which natural remedies are classified as "useful, effective and safe" and thus "advanced education", she launched a mini-survey - with three experts. Each had the task to specify in eleven alternative medical procedures succinctly, whether dental chambers should award continuing education credits. References to studies or other sources were not necessary.
"This is not possible at all," criticized Gerd Antes, former director of Cochrane Germany, a central institution of evidence-based, ie evidence-based medicine. "There is an established set of rules that should be respected." Antes speaks of "patient injury and waste of resources".
Further education is required
The training officers of the state dental associations saw this less critical. They unanimously adopted the results of the mini-poll at their coordination conference. These serve according to BZÄK now the competent national dental associations as "decision guidance" thereby, which training contents they offer and how many training points they give for it.
Doctors, dentists and psychotherapists need to educate themselves, they provide evidence by means of continuing education credits. The basis is the Fifth Social Code (SGB V). It states: "The training content must correspond to the current state of scientific knowledge in the field of medicine, dentistry or psychotherapy and must be free of economic interests." Those who can not or do not fully demonstrate the prescribed training must expect sanctions in the form of reduced fees or withdrawal of admission.
more on the subject
According to the BZÄK, the BZÄK said that the document was being "updated on a larger scale." However, the reason for the mini-survey as a review tool was not its own skepticism, but came from the outside , which is the SPIEGEL, it says: "With regard to critical inquiries from politics and media (...), the competent bodies for dental training increasingly ask the question of the delineation of serious / unserious training offers, especially in the field of natural remedies."
Influence the "long-term effect" of chronic inflammations?
One of the three experts was Karin Kraft, professor of natural medicine at the University of Rostock. She classified eight of the procedures as training credits, including Interference Field Tests. These are to detect as part of the so-called neural therapy chronic inflammation, which cause a distant disease sequelae in other parts of the body. They are "useful, effective and safe".
The Federal Court had ruled differently in May 2017 in a lawsuit: A dentist had a "hearth and StörfeldToung" made and as a treatment against "multiple dental hearings" four molars pulled in the upper jaw and the jawbone "thoroughly" milled. "According to the Higher Regional Court to serious, irreversible damage to health (Ref .: VI ZR 203/16).
According to Kraft, tongue diagnostics also have "some scientific evidence" in the meantime, and chiropractic TMJ manipulation is "probably effective and safe" in courses for manual medicine or chiropractic.
The other two experts limit their evaluations to a small amount of "yes", "no" or "no answer". They were Sabine Möddel, Deputy Head of the Department of Continuing Education / Quality Assurance at the Berlin Medical Association, and Peter Matthiessen, Chairman of the Discussion Group of the Dialogue Forum Pluralism in Medicine (DPM) and head of the working group "Methodology in Medicine" at the University Witten / Herdecke.
After all: The method "healing touch" got from all three experts a "No", 2017 she was still offered at the training institution of the Bavarian State Dental Association (EAFZ). Bach flower therapy also rated all experts negative. This assumes that all organic diseases are due to mental problems that can be resolved with high dilutions of certain plant extracts.
Rating is more thorough and better
How easy BZÄK does with the procedure is shown by a comparison with the work of the Institute for Quality and Efficiency in Health Care, IQWiG for short. This evaluates, among others, on behalf of the G-BA, the highest decision-making body in the German health system, the benefits and harms of medical measures. The analyzes serve as a basis for which therapies health insurance companies pay for.
The IQWiG final report alone on the question of how diseases of the periodontium should be treated has 407 pages and cites 60 studies. "Relying on three professors without an examination of the sources is not acceptable 20 years after the establishment of the medicine based on medical records," says Klaus Koch, head of the IQWiG Health Information Division. Expert consensus can not compensate for the uncertainties caused by the lack of good studies. "If there is no good evidence, you have to openly admit the uncertainty."
Gregor Bornes, spokesman for patient representation in the G-BA subcommittee on dental treatment, finds that the Federal Dental Association "beyond any professional methodology, can ultimately question any selection of 'experts'". "The fact that she does not ask these people for justification or evidence shows once again that in dentistry scientific thinking is still far too limited."
The statutory health insurance usually does not cover the costs of alternative dentistry methods. This would be possible as a voluntary statutory benefit such as in homeopathy. However, the large health insurance technicians and Barmer do not do this, the DAK only in individual cases on the "individual health account".