CAMBRELLA in Documents

CAMbrella Final Report

(selected passages from the document (72) )

CAMbrella (GA No. 241951) Final Report

Executive summary

Background: The status of complementary and alternative medicine (CAM) within the EU needs clarification. Terminology of CAM, therapies, legal status, regulations and approaches used vary from country to country but there is widespread use by EU citizens.

Objectives and Methods: The project aimed to evaluate the conditions surrounding CAM use and provision in Europe and to develop a roadmap for CAM research in Europe. Specific objectives were to establish an EU network involving centres of research excellence for collaborative projects, to develop consensus-based terminology to describe CAM interventions, to create a knowledge base that facilitates the understanding of patient demand for CAM and its prevalence, to review the current legal status and policies governing CAM provision, and to explore the needs and attitudes of EU citizens with respect to CAM. Based on this information a roadmap was to propose that will enable sustainable and prioritised future European research in CAM.

Findings: Due to various language dependent cultures and traditions in Europe the consensus process regarding CAM terminology proved to be difficult. The broad scope of CAM is reflected by a pragmatic definition of CAM which the group could agree on. There is no common approach to the regulation of CAM practice in Europe. All 39 countries that were studied do it their own way. However, market authorization of herbal and homeopathic products is regulated similarly in each country in accordance with EU Directives. Several EU Directives and other legal and informal documents have a direct and indirect influence on how patients, practitioners and researchers can relate to CAM in Europe.

Many citizens in Europe have positive attitudes to CAM although their attitudes and needs have not been consistently researched across Europe. They wish to have access to increased and diverse CAM provision, they need easily accessible and trustworthy information regarding CAM and they require the transparent regulation of CAM and the training of those who practise CAM.
A literature review on CAM use provided inconclusive data. Reported prevalence rates were between 0.3 and 86%. Many of the studies are of poor methodological quality. There are reliable data in a few countries but in the majority of the 27 EU member states there is no data. However, use of herbal medicine was reported most frequently. Musculoskeletal problems were the most reported condition. Piloting an existing questionnaire translated into 4 languages resulted in the finding that the questionnaire still has many weaknesses and will require major revision.

No common approach could be identified as regards the provision of CAM practice in Europe. Both medical and non-medical practitioners play an important role in the provision of CAM in Europe. Teaching and certification are subject to international, national or in some countries even regional regulations. There is a complete lack of coherence in training, education and provision of CAM.

Key stakeholders on the global arena of CAM R&D vary greatly in terms of capacity, mission, and funding source (private/public). A common shift in R&D strategy was noted. Where ten years ago research focused mainly on exploring efficacy and mechanisms, the majority of stakeholders today emphasise the importance of a broad spectrum of research including methodologies exploring context, safety and comparative effectiveness of whole systems of care. Compared to other regions such as North America, Asia and Australia the level of investment in CAM is low in Europe.

A literature review including 170 scientific papers identified the following key issues in CAM research: practical problems in CAM research (e.g. randomization, blinding), use of quantitative and qualitative research methods, research strategies/priorities and issues related to specific modalities of CAM. Based on these findings and a comprehensive discussion process the proposed roadmap for European CAM research results in following conclusions:
1) CAM is a neglected area of research which needs more activities.
2) CAM research must reflect the needs of citizens, patients, providers and other stakeholders.
3) It must reflect the real-world settings of health care in Europe.
4) Consequently, a centralized and academically supported EU CAM centre would be welcome to facilitate this process.

Communication and dissemination of CAM research played an essential role in this coordination project. It proved important to support capacities, coherence and collegiality of any multicentered research group, to ensure the sustained dissemination of the results to the public at large and the stakeholder groups in particular, and to translate the scientific results into public outreach for the general public.

Summary description of project context and objectives

The status of complementary and alternative medicine (CAM) in Europe is characterised by enormous heterogeneity in all aspects, including the terminology used, the methods provided, the prevalence, as well as the national legal status and regulation. The diversity and plurality of opinions and attitudes towards CAM, even within a relatively small academic CAM community, renders a coordinated European approach to CAM research difficult. On the other hand, utilisation of specific methods such as acupuncture, homeopathy, herbal medicine, massage, reflexology and Reiki healing has increased exponentially in Western industrialised nations over the last 25 years. There is an urgent need to gather more information to gain an overview of the issues surrounding the availability and the safe and legitimate provision of CAM to EU citizens. Due to the use of different definitions with respect to CAM and the associated treatment methods, reliable comparisons between EU member states are currently unavailable. EU-wide consensus in this field is essential to develop an understanding of EU citizens' behaviour with respect to CAM and establish appropriate health policies in this area.
A comprehensive coordination action was designed and launched in response to this challenge: 'CAMbrella – a pan-European research network for Complementary and Alternative Medicine'.

CAMbrella is designed to fulfil the following objectives:

1. To develop consensus on a series of definitions for the terminology used to describe the major CAM interventions used clinically in Europe.
2. To create a knowledge base that allows an accurate evaluation of patient demands for CAM and the prevalence of its use in Europe.
3. To review the current legal status of CAM in EU member or associated states.
4. To explore EU citizens' needs and attitudes with respect to CAM.
5. To explore the providers' perspectives on CAM treatment in Europe.
6. To propose an appropriate research strategy for CAM that will help develop an understanding of CAM use and its effectiveness within an EU context in response to the needs of healthcare funding bodies, providers and patients. This will take account of the issues of effectiveness, cost, safety, and the legal requirements for the production of medicinal substances. To develop a process for prioritising future EU research strategy, current policies within the EU have to be considered.
7. To facilitate and foster sustainable, high quality collaboration and networking of European CAM researchers.

To achieve the project’s goals, a consortium was established which encompasses 16 partners predominantly affiliated to universities from 12 European countries with nearly 40 scientists and experts in research and clinical practice directly involved. CAMbrella is coordinated and monitored by a management board and directed by a scientific steering committee with support of an advisory board and involves all the major stakeholders in CAM research in Europe including consumers, practitioners, clinical providers, and manufacturers of CAM medicinal products. The board members provide advice on healthcare and technical and political issues, thereby complementing the scientific perspective of the consortium. Most of the institutions that have joined the board are umbrella organizations which operate at European level and thus represent a significant number of members.

The basic concept of the project, its objectives, the consortium members and the organization of the work plan are depicted in an article published during the early phase of the project run-time (Weidenhammer W et al. EU FP7 Project ‘CAMbrella’ to Build European Research Network for Complementary and Alternative Medicine. Forsch Komplementmed 2011;18:69–76) (73).

Main results

The following part provides an overview on the specific objectives, the methodology and working procedure, and the main findings of all eight CAMbrella Work Packages generating the overall project’s results. Most results are already published in a peer-reviewed scientific journal and available on an open-access basis (see the references in the following chapters).

Work package 1: Terminology and definitions of CAM methods

Work package 2: Legal status and regulations

Work Package 3: Needs and attitudes of citizens

Work package 4: CAM use – the patients' perspective

Work package 5: CAM use – the providers' perspective

Work package 6: The global perspective

Work package 7: The Roadmap for CAM research in Europe

Work package 8: Communication and dissemination