Do the right thing and don’t talk about it

In recent weeks, several reviews on the use of probiotics for a wide variety of disorders have been published. These deal with known areas, including the use of probiotics to treat constipation and the finding that this simple remedy receives far too little attention in practice (Dimidi 2019). Or that the combination of lactobacteria and bifidobacteria shows better effects on irritable bowel syndrome than the administration of a monopreparation (Liang 2019). The administration of probiotics can also be helpful for treating depression, especially when used in combination with antidepressants (Nikolova 2019). Another overview deals with the use of probiotics in acne. These can regulate inflammatory reactions in the skin by activating special immunological reactions (Lee 2019).

The use of probiotics in infants and young children is particularly relevant for young parents. A probiotic intervention for cow’s milk allergy can lead to faster tolerance to the allergen. Although this result is based on only one large study (Qamer 2019), the use of probiotics is definitely recommended considering the high level of suffering among children and their parents. Equally interesting is an evaluation of the renowned Cochrane database on probiotics and infant colic. However, six studies with 1,886 participants did not provide any clear evidence that using probiotics during pregnancy and in infants prevents the occurrence of colic better than a placebo. Nevertheless, the “daily crying time” of infants receiving probiotics decreased (Ong 2019). This would already be a great relief for many parents.

There are many positive findings to report. However, doctors and patients don’t hear about them. This is due to the Austrian Health Claims Ordinance, which still does not allow any health-related statements to be made about probiotic bacteria. Of the 300 applications submitted for evaluation in 2011, none were approved by EFSA. The main reasons at the time were the incomplete microbiological descriptions of the probiotic bacterial strains (which were only later recorded in databases) and an inadequate study design.

However, because it is still unclear which study details the EFSA expects from applicants in order to provide scientific assurance, manufacturers are reluctant to submit further applications. Unfortunately, the EFSA continues to show little interest in levelling the difficult terrain for probiotic research. It seems that the EFSA and the EU Commission generally do not want to allow any probiotics claims. It is now feared that the lack of information will severely hinder progress in probiotics research and future research activities.

The German legislation has gone even further. For example, the German Federal Supreme Court ruled that based on life experience, consumers associate the term “probiotics” with an improvement in health. However, this is already an unlawful (because not approved) health-related statement. The consequence: In Germany, probiotics may no longer be called probiotics. Let it be understood that all this is for the protection of the consumer.

The example of probiotics once again illustrates how a well-intentioned regulation can be reversed. If doctors and therapists are not allowed to be thoroughly informed and consumers are made insecure because of a lack of information, this is neither compatible with the duty of care of doctors and therapists (or their freedom of information and therapeutic independence) nor does it serve to protect consumers. Some disobedience is in order here. With your help and understanding, we will find ways to regularly inform doctors and therapists about new and important scientific findings.