Varying Approaches to CAM in Europe
European countries differ in their approach to CAM. The first country to systematically integrate CAM into its healthcare system was Switzerland. (179) Non-conventional medicine has been part of the Swiss federal constitution since 2009.Certain selected therapies have even been included in the compulsory health insurance. (180) Traditionally, Great Britain is very progressive in regards to CAM and CAM treatments may be provided by people without a medical education. Some therapies are regulated by the state while others are guaranteed by national professional organizations. Great Britain is also home to some important CAM organizations, such as the Institute for Complementary Medicine, which carries out CAM research and provides information to the public. (181)
However, in some countries of the former Eastern Bloc, including the Czech Republic, the situation differs a fair amount from the situation in the "old" EU states. There are no specialized departments within public institutions or academic workplaces at universities. Research is almost non-existent, legal grounding is inadequate, there is no public debate – and if there is, it is emotional rather than factual as the debaters are seldom sufficiently informed about all aspects of the subject matter.
CAM methods are still sought after and used by patients, but there is a lack of reliable information on the quality of CAM options and reputable providers. It is, therefore, easy to become a victim of fraudsters. This situation, in both Europe and around the world, is unsatisfactory and literally unsustainable.
George Lewith, a professor of medical research at the University of Southampton, England, also highlighted this problem in his article Why we need to research the use of complementary medicine (The Guardian 2012) (182).
Professor Lewith draws attention to the fact that, although complementary and alternative medicine is used by 100 million European citizens, there is not yet a common approach to CAM within the EU. Efforts in this direction, however, struggle with the enormous differences among EU states regarding the accessibility of CAM. Coordinated action at EU level requires, above all, enough reliable information on the CAM situation in all EU member states. High quality data, however, is currently mainly available from western and northern European countries, while the "new" member states are clearly lagging behind in this respect:
“The UK has one of the most organised approaches to registration and regulation for non-medically qualified practitioners who provide most of these clinical interventions. In the rest of the EU, particularly in Germany and France, these treatments are almost always part of medical practice in both the community and in hospitals.” (183)
“The lack of good quality research, indeed its total absence in some of the new EU members in eastern Europe countries, is a major problem. We have derived most of our information from Germany, Switzerland, the UK and Scandinavia. It is very difficult to provide or legislate for medical services in this diverse population without good information.” (184)
EUROCAM also drew attention to the varying situations in the EU countries in the document CAM 2020 – The contribution of CAM for Sustainable Health Care in Europe, under the section on equal access to health services:
“The different regulatory framework for CAM across the EU further adds to such inequalities, as patients in some Member States have access to more treatment choices than do the populations of other Member States.” (185)
The practical implications of this situation were also addressed in the final report of the CAMbrella project (WP2):
“The organisation and regulation of health care is a national responsibility within the European Union. There is no common approach to the regulation of CAM practice in Europe. This results in a considerable variety in regional, national, European and international legal regulations, which make any comparison of CAM practice and provision in any respect almost impossible.”
“As regards legislation of CAM, 19 of the 39 countries have a general legislation, of which eleven have a specific CAM law and eight have sections on CAM included in their health laws (such as ‘Law on health care’ or ’Law on health professionals’). In addition to general CAM legislation, some countries have regulations on specific CAM treatments. Several EU directives and other legal and informal documents have an indirect influence on how patients, practitioners and researchers can relate to CAM in Europe. However, the heterogeneity of the legal status and regulations for CAM in Europe creates the following obstacles:
for patients: when patients cross borders in search of CAM treatment, they may encounter substantial differences in the professional background of apparently identical CAM providers, who in addition tend to work under completely different reimbursement systems. This situation influences CAM patients’ rights, access and potential safety, and constitutes a challenge to a harmonized national and European follow-up of the new patients’ rights according to the cross-border health care Directive 2011/24/EU.
for practitioners: when practitioners cross borders they will encounter a substantial variety of CAM practice in Europe. While CAM professions in some countries are tightly regulated, the same professional categories in other countries are totally unregulated, meaning that it is almost impossible to establish professional common ground.
for researchers: when researchers cross borders they will experience that practices and practitioners are not comparable across national boundaries, and any observational or experimental study can therefore be generalised only within a narrow national or cultural context.” (186) (CAMbrella WP2, see page 173 for more details.)
An overview of CAM-related EU resolutions, according to CAMbrella’s final report (selected passages from the 3rd part of WP2) can be found on page 173.