The doctor they call 'Healing Hans'

Healing Hans, as Muller-Wohlfahrt is affectionately known, ranks as either the greatest healer since Hippocrates or is a quack with a hyperactive syringe, depending on whom you believe.

Over the years, the A-list of believers has run the gamut from tennis icon Boris Becker to soccer's Ronaldo to the late Italian opera tenor Luciano Pavarotti to seemingly every top German soccer player since Franz Beckenbauer four decades ago. The American followers, though late to the show and heavy on those traveling overseas to compete, have included sprinters Tyson Gay and Maurice Greene as well as bad-boy skier Bode Miller.

The American connection runs deeper, though. Muller-Wohlfahrt and the Vail, Colo.-based Steadman Clinic, a leading sports orthopedic group, enjoy a healthy patient-referral relationship. Muller-Wohlfahrt and Dr. Richard Steadman, the clinic's founder, also have a personal friendship of nearly three decades.

Muller-Wohlfahrt isn't an ordinary doctor, and his treatment methods at first blush sound dangerously primitive. Though conventionally trained in medicine and orthopedics, he practices a unique mixture of homeopathic medicine -- treatment with natural substances -- and acupuncture. The lifeblood of his treatments is what Muller-Wohlfahrt calls "infiltrations," in which homeopathic preparations and other substances are injected into the injury site: exotic stuff like Actovegin, an amino acid preparation derived from calves' blood, and lubricating substances containing purified hyaluronic acid and antioxidants.

Muller-Wohlfahrt, who rarely grants media interviews, says he has administered "far beyond" a million such injections through the years, at least half to athletes.

Injecting patients with loaded syringes of Actovegin (pronounced: act-o-VEE-gin) is viewed suspiciously in many global outposts and, while not banned, the substance remains on the radar of sports anti-doping bodies. Actovegin is not approved for use in either the United States or Canada. Of late, it's been in the news as central to the U.S. criminal case against Toronto-based sports doctor Anthony Galea, who has pleaded guilty to a reduced charge of bringing unapproved substances, specifically Actovegin and human growth hormone, into the United States. Galea faces up 12 to 18 months' imprisonment at sentencing on Friday.

None of Muller-Wohlfahrt'swork in Munich has been peer-reviewed. Nor has he published any studies related to his use of Actovegin in any major medical journals. And that leaves people like Travis Tygart, the United States Anti-Doping Agency boss, calling Muller-Wohlfahrt's heavy dose of injections a "Frankenstein-type experiment." He is simply unable to accept that athletes dabble in substances not approved by the Food and Drug Administration.

"If you are truly motivated by the health of your populations, why wouldn't you want to spread that?" asks Tygart, referring to the lack of documented research. "I mean if you had a cure for cancer, you are too busy not to let the rest of the world have it? Come on. You're too busy making a profit off it to let the rest of the world have it. And you might have serious questions whether it would pass the smell test of the rest of the world.

"There are witch doctors out there. It was the same with Victor Conte. And he was pushing illegal drugs. And now he is a convicted felon. It is the same with Galea. These sorts of gurus get a reputation within athlete populations. And these high-dollar athletes who are desperate to do anything and everything to win, even at the jeopardy of their own health, go to these guys. That is the culture. It is not right, but that is the culture."

In simplest terms, he's a celebrity healer

W
hile his name isn't familiar to the American sports crowd, Muller-Wohlfahrt enjoys celebrity status in his homeland, where he can be found on a list of the 100 most influential personalities in German sports. His face is recognizable as team physician for the German national soccer team since 1996. For even longer, dating to 1977, he's tended to the medical needs of the Bayern Munich soccer club, which is the German equivalent to the New York Yankees.

Yet it remains a leap of faith for the athletes who hobble through the doors of his clinic. Muller-Wohlfahrt, who has used all of the treatments at one time or another on himself, describes himself as an "empirical doctor," saying he's driven almost exclusively by his hands-on experience while acknowledging the minimal research behind his unorthodox treatments. The athletes, though, are less concerned with scientific methodology or peer review studies published in prestigious medical journals than with how they feel after coming under his care.

Consider a recent late-morning visit by Britain's Paula Radcliffe, the marathon world-record holder.

Radcliffe, 37, has been a faithful patient since Muller-Wohlfahrt first treated her for a foot stress fracture 17 years ago. Now deep in preparations for the 2012 London Olympics, Radcliffe returned last spring from altitude training in Albuquerque, N.M., complaining of tightness in her lower back and legs. "Not feeling strong," in the words of Muller-Wohlfahrt.

As an "Outside the Lines" reporter watched, the doctor spent an hour listening patiently while tending to Radcliffe. As she lay on a treatment table, the sinewy, muscled distance runner gradually morphed into a human voodoo doll. The doctor went about sticking her with a bevy of needles, injecting a numbing agent and then leaving the needles in place. Into the needles' plastic base or hub that remained above the skin, he followed with injections of natural lubricants and hyaluronic acid.

Radcliffe sighed as the initial injections penetrated deep beneath the skin, with some needles 2 to 3 inches long. Muller-Wohlfahrt used his right hand to deliver 14 injections into her lower back. Another two were directed into the front of her right hip, followed by four into the top of her left foot. He then manipulated her legs wildly -- left and right, up and down.

A grinding, high-maintenance athlete like Radcliffe finds herself returning to Muller-Wohlfahrt's office every two or three months for similar treatments. "I call it coming for a tune-up or checkup," says Radcliffe, effusive and back to her perky self after the session, which she allowed a reporter to watch. "Because I have worked with the doctor so long, he knows right where to check."

She prefers his use of natural substances, saying athletes have become wary of doctors who rely on cortisone to deal with inflammation and to mask pain.

"A lot of athletes know about him," she says of Muller-Wohlfahrt. "He is someone they trust."

Perhaps top among them is Usain Bolt.

Though he's not in the office this day, the name of the sprint king from Jamaica is dropped often. The doctor acknowledges his clinic has evolved into a haven for muscle-injured sprinters over the last two decades. To illustrate the point, Muller-Wohlfahrt brings up the IAAF World Championships held two summers ago in Berlin, claiming that five of the eight sprinters in the men's 100-meter final were patients -- led by Bolt who clocked a world record.

A pair of autographed Puma spikes sits in a bookcase in Muller-Wohlfahrt's office, a visible statement of his relationship with Bolt. "He came here from Berlin to say thank you," he says. "I have many trophies and items, but I don't display. These are special."

Muller-Wohlfahrt says they were first introduced when Bolt's coach brought Bolt, then a quiet 16-year-old, to his Munich clinic. Over the years, the doctor says, he has become a fringe member of Bolt's support staff, his duties ranging from tending to Bolt's aches and pains, to analyzing his sprint mechanics during track workouts when he's in town, to crafting specific exercises aimed at helping him withstand the rigors of the sport.

"The first time he came nobody knew him, but his coach sent him here to ask me whether it was worth it to train him," says Muller-Wohlfahrt, who himself trained as a track athlete growing up in a small town in northern Germany, by the Baltic Sea. "He [the coach] was not sure whether he was able to train very, very hard. I said, 'If he does this and this exercises -- yes, then he can.' So he started to do exercises and then the success grew more and more. For example, yesterday he phoned and he does his exercises. We have a very good connection, very good correspondence."

His most trusted medicine is illegal in America

T
he celebrity doctor swears by the straw-colored liquid drawn into his needles and injected freely as his healing agent of choice. Asked how many of his rounds of injections include Actovegin, Muller-Wohlfahrt answers matter-of-factly, "Nearly every one."

Muller-Wohlfahrt proudly notes Actovegin's development years ago by a Munich doctor. Later, he says, it was manufactured in Denmark, though now he receives shipments of it from Austria. He mentions its use in other parts of Europe, Russia, China and South Korea.

"I am convinced this is one of the best medicines on earth," he says. "I helped so many people [with it]. And it should be taken everywhere. It is not only for muscle injuries, it is for spasms in the muscle -- spasm in the neck and then you get headache. So I loosen the muscle with Actovegin and then the headache goes away. Migraines and other muscle injuries, they heal much better because this Actovegin helps better metabolism, better blood circulation, better energy and a better regeneration."

In time, Muller-Wohlfahrt suggests that current research by a German university will confirm what he's come to know over 30 years by instinct, watching and listening.

What's known now is this: The Food and Drug Administration has never approved Actovegin for sale in the United States. Galea, the Toronto-based sports doctor, appears headed to jail for bringing it across the border to treat professional athletes. Meanwhile, sports bodies and anti-doping agencies are suspicious, even though it's not banned, nor is it construed to be a performance enhancer. The International Olympic Committee went so far as to place Actovegin on its banned list briefly in 2000 before reversing course, believing at the time that it was being abused by cyclists when taken intravenously.

But generally, there's more confusion and mystery about Actovegin than hard facts. FDA officials contacted by OTL can't explain why the substance has not been approved and won't say whether an application has ever been submitted. Some in the medical community suggest there may be public health concerns because Actovegin is created from calves' blood, which could potentially be a source of transmittable disease.

William Hochul Jr., the U.S. Attorney in Buffalo, N.Y., doesn't have the answers either, even after his office prosecuted the case against Galea. Asked about the extract obtained from calves' blood, Hochul responded squeamishly: "Calves' blood, huh? You wonder, why not lambs' blood or something else?"

"The stuff is pseudoscience in a way," says chemist Patrick Arnold, who worked with BALCO founder Victor Conte to create the then-undetectable steroid THG, also known as "the clear." "A lot of stuff out of eastern Europe is like that. There are a lot of anecdotal reports that it helps with oxygenation of tissues and there are some studies. So a lot of people use it, usually for muscular injuries. It promotes healing. I don't know why it has become such a controversial thing, because it is not a steroid or growth hormone."

Arnold acknowledges that he experimented a few years ago, injecting Actovegin into his knees. "I don't think it is anything great or to get excited about," he says. "It is no miracle. It is one of these things they throw in the mix and hope it does something."

To this point, independent laboratory analyses of Actovegin have uncovered no traces of growth hormone or prohibited substances, according to World Anti-Doping Agency officials. The group's lead scientist, Dr. Olivier Rabin, refers to it simply as a "supervitamin for blood." But the concern of anti-doping officials is what else athletes may be mixing it with, specifically banned substances like human growth hormone or IGF-1.

"The reason why we have an interest and keep monitoring it is because it has been found in many seizures by police forces," says Rabin, the WADA science director. "It is a product we see on a regular basis, which is not surprising because Actovegin is not allowed for commercial distribution in many countries. So athletes who are interested would try to, of course, have it brought to them not necessarily very legally. Or maybe they want to be as discreet as possible because in some countries you are not supposed to have it without a special importation permit. So we know it is a product of interest.

"I also had some personal discussions with some doped athletes who mention Actovegin as part of their regimen. Not necessarily their doping regimen, but a substance they were using as a part of their global regimen. And I was interested in their description of their use of this product."

Muller-Wohlfahrt understands doping suspicions in sports, but says he isn't about to hurt his lucrative medical practice or reputation. He denies any "secrets" are involved in his treatments, his code for performance-enhancing drugs like the currently difficult to detect human growth hormone.

"You risk your career," says Muller-Wohlfahrt, solemnly. "They [keep] the urine sample for years. So if they have technique to detect it later, then it will be found. That is all of my thinking."

Because he's working with so many world-class athletes, the doctor routinely communicates with WADA about his treatment methods, including his use of Actovegin. Rabin vouches for Muller-Wohlfahrt's operating a clean practice, but he isn't ready to speak to the purported healing qualities of Actovegin.

"There are many techniques being used all over the world by different physicians who strongly believe that they work," Rabin says. "I am not saying Actovegin doesn't work, but looking at its composition there are no growth factors, there is no protein and only good nutrients in there. I tend to be skeptical personally on the direct impact. And I haven't seen any solid publication that indicates Actovegin would work for muscle injury, for example.

"So I am always very aware of the placebo effect. I am not saying this is a placebo effect, but if you inject 100 athletes, even with the placebo you will have 20 or 30 who will say that that greatly improved their physical condition. So you have to be very careful. When there is no well-conducted scientific study, to me there is no proof that it works or it doesn't work."

The proof, Muller-Wohlfahrt argues, can be seen in the improvement of patients, a fair number of them athletes and celebrity-types who line up waiting for appointments. But he also acknowledges the positive mindset folks bring to his office helps. "I can answer the questions [about the] psychological side -- it is if you believe in something,'' he says. "And this helps a lot … You have seen my red [guest] book. It is all variety of people. You see they wanted to see me. They had big hopes."

Franco Renzo, the CEO and partner in Muller-Wohlfahrt's management group, adds, "Half the time it is they think it helps."

However, those championing Muller-Wohlfahrt's use of Actovegin include Steadman, the esteemed Colorado-based knee surgeon, whose wife was treated with the substance by Muller-Wohlfahrt more than a decade ago. She had experienced a "lack of mobility in the spine" following neck surgery, Steadman says. After she received injections and treatments over five days, Steadman says, her range of motion improved 70 percent over what it had been before seeing the Munich doctor -- an improvement in her condition that she has maintained through the years.

"As far as I am concerned, it should be approved," Steadman says of Actovegin. "But there is some reason it is not approved. I don't know the details. It is something I was extremely happy to have him use on my wife. [Actovegin] is part of the formula. I think he, in fact, made up the formula himself.

"I watched him do it on my wife. He is very meticulous. He seems to know exactly what he wants to achieve, and it is pretty painful. I thought my wife was getting tortured. But it had such a favorable result."

And what does a visit to and treatment by Muller-Wohlfahrt cost? It's unclear, though an office assistant says he follows the standard "German medical fee schedule."

"We don't have a fixed price per treatment. It's a complicated system and varies from patient to patient depending on complexity, time and other
factors," she said.

No published or peer-reviewed research

T
he skeptics want research that validates the healing powers of Actovegin and the other medicines dispensed from Muller-Wohlfahrt's syringes. They want to read a well-crafted medical journal article, something more substantial than Muller-Wohlfahrt's earlier writing attempts, such as "Injured … What Now? How to Handle Sports Injuries."

"He never does publish something about this," says Dr. Ulrike Muschaweck, a Munich surgeon who is an international leader in treating sports hernias. "It is kind of a secret. He has a big group of doctors sending patients to him and believing in this success, so it must work. But I don't know how it works. So then I must know. You couldn't ask him. I have never seen a report of this. Never have I seen an article or anything. Never. And he never would give a presentation. I never have seen the results of this work."

Muschaweck is in her fourth-floor office in a Munich medical building, a 20-minute cab ride from Muller-Wohlfahrt's clinic, but their approach to medicine seems worlds apart, even though both attract international sports patients. Muschaweck reveals that they had a working relationship until about 10 years ago; she then ends the discussion with only, "but we are not a good team together."

One apparent issue was Muller-Wohlfahrt's increasing reliance on injections. In simple terms, he believes in avoiding surgery, whereas Muschaweck is of the mind that injections serve as a mere stopgap in putting off the inevitable need for surgery.

"I am not a fan of injections all over and not facing the real problem, do you know what I mean?" she says. "If you have an injury of a joint or of a ligament, then you could inject whatever you would like. It wouldn't help. So there is no [complete] healing. Only for some time, but not [long-term] healing only if you do the injections."

The use of injections, however, is an accepted German medical practice. And while Muller-Wohlfahrt understands why skeptics question his failure to document his work more thoroughly, he promises that is changing. In recent years, he's added two young doctors to his staff and hopes his son, 30-year-old Kilian, will join the practice soon, thus freeing him to champion his work in journals and on the lecture circuit and to train other doctors.

"My problem is I work really hard and all day long, from early morning to night," he says. "So the people miss scientific work. Today you have to do scientific work to provide this proof. I can't do. It is my experience and I talk about empirical medicine. And when you do so many cases, then it is a sort of science. You can't say it is nonsense, not after so many years of successful work.

"For me, I am here to help patients and not to do science. That is not my destination. I feel that the people need me. And you see how many want to come. And I have to work to do as many as I can.

"Because I work so hard, I have no time for educating others. Now I started and that is my destiny, to give my knowledge away. It is in my head. Before I stop one day, I have to have [train] enough young people who do the same like me now."

But even friends of Muller-Wohlfahrt in the medical community say he has been too tardy embracing evidence-based medicine. They vouch for his clinical judgment, yet they're concerned that he doesn't publish supportive data. To them, if doctors are going to operate outside the mainstream, they have an even greater obligation to prove that their medical treatments work.

At this late juncture in his career, Muller-Wohlfahrt can't be bothered by the white noise. What matters to him is that his patients believe in him and his waiting room is full. Equally important, he says, is having stood the test of time in the sports world.

The role of tending to Bayern Munich is hugely prominent and important. The squad is composed of pricey, high-end talent. The average player salary approaches $6 million -- ranking ahead of the NBA champion Dallas Mavericks, World Series champion St. Louis Cardinals and a host of big-money franchises like the Boston Celtics and Philadelphia Phillies. You don't keep this kind of gig for nearly 40 years if you're a quack.

There were also doubters in the 1970s, when the up-and-coming Muller-Wohlfahrt was brought in from Berlin.

"I was very young, and they expected big success," he recalls. "This was a world of superstars. [Bayern Munich] was the European champion three times in a row. It was [Franz] Beckenbauer, [Gerd] Muller, [Sepp] Maier, [Hans-Georg] Schwarzenbeck. They were my patients. I was very young. I had to be successful.

"By this, I invented or tried therapies which didn't exist until then. It was one needle [of homeopathic medicines], it was two, three, four. The thinking behind it was to look for the function and to listen to the patient. What does he say? Did it hurt? No effect? He says, 'What you did last time that was very good.' So we write down every time what we do, so I repeat it and then maybe even a little more. So by this I develop a treatment as you saw it now. This is standard. And this works."

'They come all the way because they believe in me'

W
ith his clinic rounds in the rearview mirror, Muller-Wohlfahrt heads to the outskirts of Munich on a sunny late Saturday morning. His destination is Allianz Arena. The stadium, which seats nearly 70,000, is the most impressive of the facilities built or renovated for the 2006 World Cup in Germany. It now serves as home to Bayern Munich.

The team doctor pulls his luxury SUV into a reserved spot 30 yards from the players' entrance. He carries a black duffel bag that contains his needles, Actovegin and other medical supplies.

Two hours before the game, he and a reporter are standing smack dab in the center of the field surveying the scene as the hometown Bayern fans slowly filter in. The place will soon be packed. "The feeling when you come out is incredible," he says, speaking of the emotional pregame entry alongside the players.

The doctor later laments the club's uninspiring 1-0 win against an overmatched Borussia Monchengladbach. But the star of the game is midfielder Bastian Schweinsteiger, who was treated with injections two days earlier in Muller-Wohlfahrt's downtown clinic. Another prominent player who also stopped by that same day, Turkish-born Hamit Altintop, remains unable to play after receiving six injections to quiet a calf injury.

After the game, Muller-Wohlfahrt reports that a handful of Bayern players required injections in the locker room, including shots of the straw-colored-liquid Actovegin.

That the doctor has a reputation to protect is easy to tell in the short walk back to his SUV. The guy is famous. Fans rush forward for his autograph. He poses for snapshots with others. To the old-timers, he is Dr. Bayern.

The scene is repeated later, to a lesser degree, when he stops to proudly show a reporter Englischer Garten, Munich's lush equal of Central Park in New York or Hyde Park in London. Muller-Wohlfahrt suggests a trek deep into the park to a popular beer garden. Less than 10 minutes in, the doctor's knee gives out.

He's limping badly. He's supporting himself with his right hand on the reporter's shoulder. He's shaking his knee, wildly kicking it out to the side. He manages to "get it back in place" and resists the suggestion to call it a day. He soldiers on to the beer garden. Along the way, he reveals having had surgery on his other knee last year.

So finally, it turns out the well-preserved doctor with the normally peppy gait is human. He too copes with aches and pains. And, while still swearing by the odds, his trained hands and injected medicines can't cure all. He acknowledges surgery can't always be avoided.

"People say 'miracle' -- I don't like this," he says of the reaction from some patients. "But they think, 'If we get a day in his office, then we get healthy.' They come and say, 'Now you are my last hope.' I don't like this miracle image. I don't know the right word. It is not a miracle, but they look upon me as somebody who is a healer or whatever.

"They come all the way because they believe in me. And it is a high responsibility. This is because the name is growing, expanding."

Mike Fish is an investigative reporter for ESPN.com. He can be reached at michaeljfish@gmail.com.