February, 2016 |226
It is a striking fact that complementary and alternative medicine (CAM) is now used by every other citizen of the European Union (EU) because more people are seeking natural and more gentle treatments, increasingly supporting integration of CAM within existing healthcare systems. This increased demand seems to create a favourable position for CAM within this area. However, because Europe as a whole—and even the EU in particular—cannot be viewed as a homogeneous structure, CAM practice and its application is different across the continent.
The main cause of this difference lies in the fact that social and health-related topics are excluded from the so-called “Maastricht Treaty,” which seeks to unite the EU legislations. Therefore, we face a huge diversity in regulation across the EU with regards to who can practise CAM, what qualifications are required and how the services are offered and financed. For instance, in Austria, France, Spain and Italy, only medical doctors can practise acupuncture while in the Netherlands, Germany and the UK, it is widely performed by non-medically qualified practitioners. This “patchy” provision means that EU citizens experience certain barriers that limit their access to CAM.
The European Union DG Research funded the CAMbrella Project (2010 – 2012), a 3-year European survey aimed at reviewing the CAM provision in Europe in order to come forward with recommendations as to its viability and place within the established healthcare system. Findings of the CAMbrella Project were published online in April 2013 under the “CAMbrella-Roadmap.” This document presents the findings of the eight work packages of this project, which include different legal situations related to the industry, applications of CAM throughout the EU as well as European citizens’ expectations regarding CAM. Below, are some main findings of the CAMbella project.
Definition of CAM
In recent years, several definitions of CAM have been suggested, which vary both geographically and contextually. The CAMbrella Project defined CAM in Europe as follows: “CAM, as utilized by European citizens, represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM therapies are mainly used outside of the conventional health care, but in many countries, some therapies are being adopted by or adapted to conventional health care .”
Number of practitioners
Approximately 145,000 doctors, dually trained in both conventional medicine and a particular CAM modality, practise CAM in the EU. Additionally, around 160,000 trained CAM practitioners (with or without a statutory regulation) practise various CAM modalities. This means that there are about 65 CAM providers (30 dually-trained doctors and 35 CAM practitioners) per 100,000 people compared to some 475,000 general practitioners (GPs) working in the EU, which accounts for about 95 GPs per 100,000 EU citizens.
CAM products in the EU
Unharmonized and onerous EU requirements and national regulations have been increasingly limiting the availability of CAM products, such as homeopathic, anthroposophic, herbal and Asian therapeutics. This is leading to both prohibitive costs for manufacturers and the effective removal of traditional medicines from the market altogether. Limited availability of these products thwarts the European citizens’ growing demand for more natural, health-enhancing and low-risk medicinal products and food supplements, driving people to purchase unregulated and inherently dangerous products over the Internet.
European research on CAM is limited as no significant investments have been made by any EU Member State towards this cause. A low level of public investment in CAM research in Europe stands in stark contrast to that in Australia, Asia and North America. Unfortunately, an attempt to get a new CAM-related research project into Horizon 2020, the biggest EU Research and Innovation program, as well as researchers’ attempts to apply for CAM-related projects funding were unsuccessful.
“Integrated healthcare” is a relatively new term that describes the CAM-and-biomedicine (conventional medicine) combination. It emphasizes a collaborative approach to patient care of conventional, complementary and alternative healthcare practitioners. In the U.S., this amalgamation of CAM and conventional medicine is known as integrative medicine.
CAM delivery to the EU citizens
Over the years, many different models of CAM delivery have been developed. These models include a single doctor or practitioner operating out of a private practice or multi-disciplinary CAM clinics with joint approaches to patient care with cross-referrals. Another model is CAM doctors and practitioners working collaboratively in conventional healthcare settings, such as GP and specialist practices, and university- or hospital-based in-patient and out-patient clinics. CAM has also been increasingly practised by European dentists and veterinarians.
The main CAM modalities that European practitioners utilize are acupuncture, anthroposophic medicine, ayurvedic medicine, herbal medicine/phytotherapy, homeopathy, naturopathy, osteopathy, chiropractic and traditional Chinese or Tibetan medicine, aromatherapy, kinesiology, massage, reflexology, shiatsu, yoga and qigong.
CAM training and education
European CAM training is designed and delivered by non-profit associations and institutions, and by private teaching or training centres for each CAM modality. However, in some member states, CAM therapies are now taught at universities at a Bachelor’s degree level. Curriculum content, knowledge and skill levels as well as examination procedures are generally overseen by individual professional bodies of each CAM modality, which are based on defined standards of training and particular systems of accreditation, registration and on-going CPD/CME of CAM health professionals. Currently, there is no common European legal framework for CAM modalities training.
As mentioned above, CAM training and education for medical doctors is mostly provided through non-profit associations and privately run schools and courses, but also at a number of European universities as postgraduate training courses. Professorial chairs of CAM exist in at least eight EU member states and in some of them, there are also chairs in a specific CAM modality. Familiarization courses in CAM modalities are included in the medical undergraduate curricula of most EU member states—optional in most countries and obligatory in some.
EUROCAM was founded a few years ago in response to the CAM situation in Europe. The organization is a network of European CAM patient organizations, medical doctors practising CAM and trained CAM practitioners.
The objective of EUROCAM is to promote and facilitate CAM’s role in maintaining the EU citizens’ health; emphasize the importance of including the health promotion and illness prevention aspects of CAM in the EU public health policy and programs; advance the accessibility, affordability and availability of CAM; and generally promote CAM at the European level.
For more information, visit www.cam-europe.eu.
EUROCAM unites European umbrella organizations of patients, doctors and practitioners with different backgrounds in the field of complementary and alternative medicine (CAM), offering them democratic membership and decision-making structures and procedures. The main aim of EUROCAM is to achieve a significant political presence within the European Union (EU) so as to influence the European Commission, European Parliament and the Member States to support and provide the means for CAM integration into European healthcare systems as well as to fund research into its benefits and cost effectiveness. This collaboration recognizes the EU institutions’ wish to deal with the CAM sector as a whole.