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 citizensuse 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 CAMfor 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 thelegalisation 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 qualityin 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.