Legal Status of CAM in Europe (Christian Dadomo)

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Berührung ist Begegnung
Shiatsu-Ausbildungen Austria
Dr. Eduard Tripp
A-1120 Wien, Schönbrunner-Schloss-Str. 21/8
Tel: +43 (676) 61 74 970
[email protected], www.shiatsu-austria.at
Legal Status of CAM in Europe (Christian
Dadomo)
Im Rahmen des 3. Europäischen Shiatsu-Kongress 2011 (13. bis 16. Oktober) präsentierte
Christian Dadomo die rechtliche Situation von CAM in den EU-Mitgliedsländern ("Legal Status
of CAM in EU Members").
Christian Dadomo ist Senior Lecturer in European Union Law, Faculty of Business and Law,
University of West of England, Bristol (UK)
What is Complementary and Alternative Medicine (CAM)?
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Complementary medicine is commonly used to refer to those methods which can be
used alongside or to ‘complement’ conventional medicine
Alternative medicine often refers to the use of therapies as substitutes for conventional
medical treatment
But the distinction between alternative and complementary medicine is not absolute and
may depend on the context
CAM conceived as “a group of diverse medical and health care systems, practices, and
products that are not presently considered to be part of conventional medicine”
(NCCAM1)
The World Health Organization: “CAM refers to a broad set of health care practices that are not
part of a country’s own tradition and not integrated into the dominant health care system”.
Institute of Medicine in the USA (2005): “….a broad domain of resources that encompasses
health systems, modalities, and practices and their accompanying theories and beliefs, other
than those intrinsic to the dominant health system of a particular society or culture in a given
historical period.
CAM includes such resources perceived by their users as associated with positive health
outcomes.
1
NCCAM: National Center for Complementary and Alternative Medicine; http://nccam.nih.gov
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Dr. Eduard Tripp
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Boundaries within CAM and between the CAM domain and the domain of the dominant system
are not always sharp or fixed”
Cochrane Complementary Medicine Field: “Complementary medicine includes all such practices
and ideas which are outside the domain of conventional medicine in several countries and
defined by its users as preventing or treating illness, or promoting health and well being. These
practices complement mainstream medicine by:
1) contributing to a common whole,
2) satisfying a demand not met by conventional practices, and
3) diversifying the conceptual framework of medicine.”
A diverse range of autonomous health-care practices used both for health support and
prevention and for care in illness.
Taxonomy of CAM (NCCAM)
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Whole Medical Systems: medical systems of theory and practice
- Anthroposophic Medicine,
- Homeopathy,
- Naturopathic Medicine,
- Acupuncture,
- Culture specific systems (Traditional Chinese Medicine, Ayurveda, Unani)
Mind-Body Medicine: minds capacity affects bodily functions
- Meditation, Imaging
Biologically Based Practices: use of natural substances (e.g., herbs, vitamins)
- Phytotherapy,
- Aromatherapy
- Flower remedies
Manipulative and Body-Based Practices
- Chiropractic,
- Osteopathy,
- Massage,
- Shiatsu
- Reflexology
Energy Medicine
- Biofield Therapies: affect energy fields of the human body
- Bioelectromagnetic based therapies: use of electromagnetic fields
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Dr. Eduard Tripp
Tel: +43 (676) 61 74 970
How Widespread is CAM in Europe?
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Use of CAM has grown and continues to grow at a significant rate across Europe year
after year.
CAM is becoming increasingly popular in Europe with up to 65% of the population
reporting that they have used this form of medicine.
Approximately 30-50% of the European population use CAM as self-support and 10-20%
of the European population has seen a CAM physician/practitioner within the previous
year.
Large numbers of mainstream doctors are either referring to CAM practitioners or
practising some of the more prominent and well-known forms of CAM
In the European Union there are approximately 150,000 medical doctors who have taken
training courses in a particular CAM therapy such as Acupuncture, Homeopathy,
Anthroposophic Medicine or Natural Medicine, with figures for each therapy that are
comparable to those of mainstream medical specialties.
Most doctors practising CAM work in the ambulatory sector as GPs or medical
specialists (any sort of specialty), in several European countries some of them work in
mainstream hospitals including university teaching hospitals
(Quelle: CAMDOC Alliance2, 2010)
European Citizens´ Primary Motives for Choosing CAM
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Seeking a different philosophical view which perceives health in a holistic way and
connects the physical, mental, emotional and spiritual aspects of their lives
Dissatisfaction with biomedical treatment because of its ineffectiveness
Worries about issues such as the adverse effects and toxicity of many conventional
drugs and the growing resistance to antibiotics leading to a search for less-toxic
alternatives
Biomedical treatment is seen as impersonal and too technologically oriented
to be given time and to be listened to, and alternative therapies are perceived as less
authoritarian giving patients more personal autonomy, input and control over the
decision-making regarding their care.
2
CAMDOC ALLIANCE: The European Committee for Homeopathy (ECH), the European Council of Doctors for
Plurality in Medicine (ECPM), the International Council of Medical Acupuncture and Related Techniques (ICMART)
and the International Federation of Anthroposophic Medical Associations (IVAA), constitiute the CAMDOC Alliance
representing 132 European associations of medical doctors practising Complementary Medicine (also called
Complementary and Alternative Medicine - CAM); http://www.camdoc.eu
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Dr. Eduard Tripp
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They are also looking for a more intimate relationship with their health care providers.
They want health professionals who respect them as partners in their care and who see
and understand them as whole people with complex lives.
CAM therapies are attractive because they are seen as more compatible with patients’
values, ethics, world-view, spiritual philosophy or beliefs regarding the nature and
meaning of health and illness.
Who Provides CAM?
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Practitioners who have trained wholly in the CAM disciplines
Conventional health care professionals - doctors, nurses, physiotherapists - who have
done postgraduate training
How Is It Regulated?
• CAM regulation
varies from country to
country
• The variation is
between the extremes of
- Certain
therapies being legally
restricted to doctors only
(e.g. homeopathy in
France, Austria)
-A
common law situation
where
anyone
can
practise any „therapy“
(e.g. Netherlands, United Kingdom, Ireland)
Trends in Regulation
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Moves towards recognition and regulation: Belgium, Netherlands, Portugal (legislative
moves to positively recognize and regulate Acupuncture, Homeopathy, Chiropractic,
Osteopathy), United Kingdom (statutory regulation of the professions of Osteopathy and
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Chiropractic achieved with Acupuncture and Herbal Medicine soon to follow), Austria
(recognition of Shiatsu as a
profession),
Slovenia
(2007
Alternative Medicine Act)
• Moves
towards
restriction: Bulgaria, Italy (limit
Homeopathy to doctors only)
Why Is the Regulation of
CAM an Issue of Equity?
Significant limits to patient choice
and access:
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Availability:
- lack of
qualified or recognised practitioners
Accessibility: - restriction of practice to doctors only; restriction of products and
medicines; lack of information about skills and education
Quality:
- lack of minimum standards, ethical guidelines
Financial :
- mostly private provision
Patients accessing the benefits of CAM in their home country cannot necessarily access them in
other Member States.
What is the EU Position on CAM?
No official EU position on CAM particularly because healthcare services remain a national
responsibility (Art 168 TFEU): “1. A high level of human health protection shall be ensured in the
definition and implementation of all Union policies and activities.
Union action, which shall complement national policies, shall be directed towards improving
public health, preventing physical and mental illness and diseases, and obviating sources of
danger to physical and mental health. Such action shall cover the fight against the major health
scourges, by promoting research into their causes, their transmission and their prevention, as
well as health information and education, and monitoring, early warning of and combating
serious cross-border threats to health.
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Dr. Eduard Tripp
Tel: +43 (676) 61 74 970
The Union shall complement the Member States’ action in reducing drugs-related health
damage, including information and prevention.”
Union action shall respect the responsibilities of the Member States for the definition of their
health policy and for the organisation and delivery of health services and medical care.
responsibilities of the Member States shall include the management of health services and
medical care and the allocation of the resources assigned to them.
European Parliament Resolution (1997)
Called on the Commission to:
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Carry out studies into the safety, efficacy, & use
Launch a process of recognising CAM
Encourage the development of research programs
Create a directive on food supplements
What Is the EU Position on CAM?
WHITE PAPER: Together for Health: A Strategic Approach for the EU 2008-2013 COM (2007)
630 final 23.10.2007: No specific references to CAM; “health policy must be based on the best
scientific evidence derived from sound data and information, and relevant research.” (page 4)
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Products:
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Herbal and homeopathic medicines together with food supplements are
regulated by EU Directives.
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Seventh Framework Programme (FP7) Health theme: CAMbrella3 kickstarts on 1 January 2010. (1.5 million euros)
A pan-European research network for complementary and alternative
medicine (CAM) designed to boost the well-being of European citizens
by creating an EU-wide road map that encompasses the preconditions
for future research within complementary and alternative medicine in
Europe.
The project's specific objectives include:
Research:
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CAMbrella: CAMbrella is a pan-European research network for complementary and alternative medicine (CAM);
www.cambrella.eu
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Dr. Eduard Tripp
Tel: +43 (676) 61 74 970
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Development of consensus-based terminology widely accepted
in Europe to describe CAM interventions,
• Creation of a knowledge base that facilitates our understanding
of patient demand for CAM and its prevalence, and
• Exploration of the needs, beliefs and attitudes of EU citizens
with respect to CAM.
Free movement of services/establishment
• Freedom of choice of therapy
• But Medical System can still restrict practice of CAM to medical doctors
or qualified practitioners
• Any restrictions to FMS4 and FE5 must be justified on the EU Treaty
exceptions / issue of mutual recognition of qualifications
• EU citizens are free to move and therefore to receive treatment in
another EU country
What Could the EU Do For CAM?
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Positively encourage national governments to legislate in a way which respects the
diverse philosophical and theoretical bases of different CAM disciplines.
Analyse the models of regulation that promote freedom of responsible practice, eg the
Irish consultative model which seeks to both protect the rights of citizens to safe
treatment and to support the right to practise of practitioners through regulation of
training. Other excellent examples include recommendations and guidelines from the
Council of Europe (1999) and WHO (2002).
Promote the effective legal right of the professions to practise as access is entirely
dependent on this.
What Can You Do?
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Citizens’ initiative
Article 11(4) TEU: “Not less than one million citizens who are nationals of a significant
number of Member States may take the initiative of inviting the European Commission,
within the framework of its powers, to submit any appropriate proposal on matters where
citizens consider that a legal act of the Union is required for the purpose of implementing
the Treaties.”
FMS: Family Medical Services
FE: Further Education
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Dr. Eduard Tripp
Tel: +43 (676) 61 74 970
_____________________________________
Quelle: Präsentation von Christian Dadomo am 3. Europäischen Shiatsu Kongress in Kiental 2011
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Legal Status of CAM in Europe (Christian Dadomo)

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