Exercising choice in health treatment

1
Exercising choice in health treatment

• Improving Access to Complementary and Alternative
  Medicine (CAM) in Europe
• A joint presentation by the
• European Council for Classical Homeopathy
• and the European Shiatsu Federation
• for the first EU Open Health Forum 17 May 2004

2
What is Complementary and Alternative Medicine
(CAM)?

• A diverse range of autonomous health-care
  practices used both for health support and
  prevention and for care in illness.
• WHOLE PERSON - WHOLE SYSTEMS
• COMPLEMENTARY ALTERNATIVE
• Acupuncture
• Chiropractic/Osteopathy
• Herbal Medicine(Phytotherapy)Aromatherapy
• Homeopathy/Flower Remedies/Shiatsu
• Reflexology/Massage
• Culture specific approaches
• Traditional Chinese Medicine, Ayurveda, Unani

3
How widespread is CAM?

• Use of CAM has grown and continues to grow at a
  significant rate across Europe year after year.
• Around 40 EU citizens use or have used CAM,
  notably women and those with high levels of
  education. CAM is experiencing rapid growth in
  EU.
• This means CAM is an issue for 150 - 200 million
  EU citizens and can be of particular interest for
  individuals with chronic conditions and
  psychosomatic disorders.

4
Benefits of CAM for citizens

• Individuals choose CAM because they are seeking a
  different philosophical view which perceives
  health in a holistic way and connects the
  physical, mental, emotional and spiritual aspects
  of their lives and benefits them at all those
  levels.
• There is much reported evidence of a range of
  health benefits from CAM treatment even though
  research in this area is very poorly funded.
• Citizens are actively involved in improving their
  health. They take more responsibility for their
  own health and reduce on the burden health
  services. This has the potential to reduce the
  need for costly, conventional interventions.

5
Who provides CAM - how is it regulated?

• CAM is provided by
• practitioners who have trained wholly in the CAM
  disciplines
• conventional health care professionals - doctors,
  nurses, physiotherapists - who have done
  postgraduate training
• 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)

6
Current trends in regulation

• Moves towards recognition and regulation
• Belgium, Netherlands, Portugal
• Legislative moves to positively recognise and
  regulate acupuncture homeopathy, chiropractic,
  osteopathy.
• United Kingdom
• Statutory regulation of the professions of
  osteopathy and chiropractic achieved with
  acupuncture and herbal medicine soon to follow.
• Austria
• Recent recognition of shiatsu as a profession.
• Moves towards restriction
• Bulgaria, Italy
• Legislative proposals to limit homeopathy to
  doctors only.

7
Why is the regulation of CAM an issue of equity?

• Significant limits to patient choice and access
• 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.

8
What is the EU position on CAM?

• Practice and delivery
• No official EU position on CAM particularly
  because healthcare services remain a national
  responsibility. (Art 152 EU Treaty of
  Amsterdam).
• This means no recognition of professional
  qualifications or agreed criteria for competence,
  skills or education for CAM.
• Products
• Herbal and homeopathic medicines together with
  food supplements are now regulated by EU
  Directives .

9
European Parliament Resolution (1997)

• Called on the Commission to
• 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
• A Directive on food supplements is the only
  concrete response from the Commission and Council
  so far.

10
What could the EU do for CAM?

• Implement the European Parliament Resolution !
• Address the legalisation of CAM
• positively encourage national governments to
  legislate in a way which respects the diverse
  philosophical and theoretical bases of different
  CAM or NCH 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 practice 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 practice as access is entirely
  dependent on this.
• implement a specific research budget line for CAM.

11
The EU should focus on maintaining choice and
quality in health for all

• CAM can contribute to better health status and
  quality of life by empowering citizens to have
  more responsibility for their health and control
  over their lives.
• There should be a variety of professional
  training available and recognised which respects
  the different CAM approaches.
• CAM disciplines should not be forced to operate
  under the control of conventional medical
  thinking.
• The EU has a clear role in ensuring a harmonised
  environment for CAM and ensuring that all EU
  citizens have the right and opportunity for
  choice in health treatments.

12
The way forward for the EU Integrated
Healthcare

• Conventional and non-conventional approaches to
  healthcare and those that practise them working
  together in an integrated approach offer a wider
  range of options for the greater benefit of
  patients.
• The recommendations of the Council of Europe and
  WHO both offer good guidance on a constructive
  way forward for the EU and all individual Member
  States of Europe.