A controversial alternative medicine that treats cancer patients by making them drink their own blood was denounced in Germany years ago. But in Bulgaria, a court ruled that the treatment is scientifically sound, and children are being sent to Germany for treatment, with expenses reimbursed by the state.
The name of Dr Nikolaus Klehr, deceased in 2016, has been at the center of scandals in Germany for the past 20 years. He has treated cancer patients from Germany, Austria and Slovenia.
In 1991, Dr Klehr patented what he called “auto-chemotherapy”. According to his method, the patient’s blood is treated so that a protective reaction is triggered in the human body, resulting in partial or complete destruction of the tumor.
These patients paid for Dr Klehr’s treatment with their own money – between €13,000 and €35,000. The treatment consisted of making the patient drink its own blood, supposedly processed. But many complaints from patients began, and a dedicated internet forum to denounce it was set up. Dr Klehr was called a charlatan, both by the scientific community and by German investigative journalists.
Strange as it may sound, many years later, the same business continues – this time with patients from another EU member country – Bulgaria. And more surprisingly, with money from the country’s health insurance system. The scheme works under the leadership of an associate of Dr Klehr of Bulgarian origin, and with the assistance of the Bulgarian authorities and judiciary.
Strange court decisions
For several months now, successive decisions of Bulgaria’s Supreme Administrative Court (VAS) have obliged the National Health Insurance Fund (NZOK) to spend public money for such a practice considered as useless – if not harmful – in another EU member state where it was developed.
According to these court decisions, the Fund is obliged to pay the parents of sick Bulgarian children for their treatment at the “Institute for Immunology and Cell Biology – Dr Klehr” in Munich, Germany.
Thus, both the Administrative Court in Sofia at first instance and VAS annulled the previous decisions of various directors of the Center for the Treatment of Children Abroad, who had declined organisational and financial support for the treatment in question. And since the Children’s Treatment Fund has recently changed its structure under the NZOK, now, according to these Court rulings, the state must pay with public money the treatment of children with immunological diseases treated by Dr Klehr’s method, at €40,000 per child, per year.
A 2016 decision by VAS mentions 13 Bulgarian children who were being treated at Dr Klehr’s Institute. But talking to the parents of one of the children, we learnt that the number has already grown to 18. And two already grown children, over the age of 18, are now applying again to receive funding for this treatment, this time directly before NZOK.
Since the Fund is obliged by law to control how public money is spent, its manager, Dr Decho Dechev, sent a letter to this “clinic”, as the court decision calls it. Dr Dechev stresses that “the Munich clinic in question refuses to answer questions regarding the individual components of the offer as well as the therapy.”
Indeed, a letter arrived at the NHIF back in May comes from the same address in Munich and is signed by “Dr L. Hadjieva-Bauer of Clinical Practice in Immunology and cell biology”.
She wrote: “Clinical practice in immunology and cell biology is a private medical institution registered and managed under German law and law. The amount to be paid has been communicated to you by a price quote on 03/04/2019 for both patients, €40,000 per patient, per year. The cost of laboratory testing is between € 1000 and € 1500 and these tests must be carried out at least every 2 months. The cost of personalized immunotherapy and the treatment of comorbidities is between € 2,500 and 3,000 per week. Patients should come every 6-8 weeks for 1-2 weeks. Payments are made to the following account […]. ”
Surprisingly, the letter only outlines what money the clinic wants to receive, and not the treatment it will provide.
The Children’s Treatment Fund had motivated its refusal to finance the treatment in question with the reports of three external experts – two rheumatologists and one immunologist. They stated that they were “unfamiliar with the “auto-chemotherapy” treatment used at this Institute. One expert claims that, as a pediatric rheumatologist, he “knows and uses the therapeutic protocols and treatment recommendations that have been adopted by international organizations (ACR, PRINTO, PRES, EULAR).” Those, he adds, “are evidence-based medicine. They do not mention auto-chemotherapy. ”
Consequently, the Children’s Treatment Fund decided “to refuse to provide the requested assistance, as there is no clear data on the positive effect of the method of treatment applied on the disease of the child”.
‘Expert’ doesn’t have a clue
However, the court was presented an expert opinion from the Acibadem City Tokuda Clinic in Sofia. Its conclusion is positive with regards to the treatment, citing “the overall positive opinion of the immunologist Professor Maria Nikolova from the National Center for Infectious and Parasitic Diseases”.
When we asked if she knew what Dr Klehr’s Institute was, and if she was familiar with its method, Nikolova answered that she did not know. She said she only wrote an opinion on the basis of documents that were given to her.
We went to the address in Munich – “Oberanger” 30. There is a sign on the front door that says the “Clinical Practice Lubov Hadjieva-Bauer” is on the first floor.
The private practice is registered as a company, with a tax number and registration with the Chamber of Commerce.
The doctor, Ms. Lubov Hadjieva-Bauer, was born in Bulgaria and was an assistant to Dr. Nicolaus Klehr. She poses publicly with or without a doctor title in medicine (Dr.med.).
For example, in the letter to the NZOK, as well as in medical records in one of the cases in the SAC, she is referred to as Dr. Lubov Hadjieva-Bauer. But on the placard of her own practice in Munich, she calls herself only: “Lubov Hadjieva-Bauer, doctor.”
According to German law, a practitioner in Germany is a physician licensed to practice medicine, but when he or she has no specialisation in a particular field, the German doctoral title (Dr.med.) cannot be used.
Ms. Hadjieva-Bauer’s practice, based in Munich, is registered in the database of the Creditreform’s company as specialised medical practice business. The official name of the company is “Dr. Lubov Hadjieva-Bauer, Immunology”, with business as its main field of activity.
Ms. Hadjieva-Bauer claims that in the Munich practice, specific immunotherapy for immunological diseases and underage Bulgarian patients is performed.
The question is, does she have a medical license and dissertation (Dr.med.) from a German or European university, is she an immunology specialist or does she have another specialty? And does she run a clinic (institute for immunology and cell therapy), or is she a general practitioner? And whether in her practice there are registered inpatient beds or only outpatient (day beds)?
Waiting for answers
There was no one in the Oberanger medical practice on the day of our visit. That is why we sent our questions in writing to the Bavarian Chamber of Physicians, as well as to the government of Upper Bavaria. For the second month, we have been waiting for their answers.
One thing is clear – the German health insurance funds does not pay for the treatment by the method of Dr Klehr. And since the practice of Oberanger 30 does not have a contract with the Health Funds, so there is no medical control over them. Control of medical practices in such a framework is performed only by the local Chamber of Physicians, in this case Bavaria.
But a routine check of the treatment and bills will be carried out only if there are complaints from patients or other doctors. Otherwise, no one controls the medical practice. This structure of a private cabinet uses the weaknesses and loopholes in German law.
But Ms. Hadjieva-Bauer is not just an alternative medic. She probably has a medical degree and a license to practice medicine. Some of its methods may be generally accepted and paid for by some health insurance companies in Germany.
However Dr Klehr’s method is not among them. Therefore, Dr Klehr’s cancer patients in Germany went with hope and paid with their own money. In Bulgaria the picture is quite different. All judgments of both the Sofia Administrative Court and the SAC refer to Dr Klehr’s “clinic” or “institute”.
Over the years, a lot of public money has been paid from the Bulgarian Fund for the treatment of children. And more public funds are yet to be paid by the NZOK following the court decisions.
That is why we asked Prof. Tosho Mitov from the St. Petka Eye Clinic in Varna, where some of Dr Klehr’s patients were being treated, and why does this controversial therapy in Germany is considered lawful in Bulgaria?
Striving to make money
It turns out that Prof. Mitov has also been a member of the German Ophthalmic Society in Germany for many years. He commented:
“This whole story is about striving to make money. This is alternative medicine. The German Ophthalmic Society, of which I am a member, does not recognise their methods at all. I know that they treat all kinds of patients, including cancer. The results can always be manipulated. We have a subjective examination of visual acuity. If the child has gone with 1% vision, it can safely be stated that it has improved at 2%. And to write that the treatment had an impact. A very elementary method, yes. ”
And the question is fundamental: How did a treatment, which was not accepted as a scientific method in Germany, suddenly turned according to the Bulgarian Court into… a scientific method?
Are we a united European Union? Or loopholes are so big that charlatans can do whatever they want?
Valia Ahchieva is an award-winning Bulgarian investigative journalist, author of the weekly program ‘Otkrito’ on the national television BNT, broadcast since 1994. However, last January the BNT director stopped ‘Otkrito’. Since then Ahchieva has published her reports on the website EUelectionsBulgaria.com. She joined EURACTIV Bulgaria from the day of its inauguration, 20 September.