The regulatory status of Complementary and Alternative Medicine for medical doctors in Europe
CAMDOC Alliance published this document in January 2010 as a preliminary description of the current regulatory status of CAM in the EU member states. It is based on data provided by their national member organisations.
Physicians specialised in one or more CAM modalities integrate these therapies into patient care within the context of general medical practice, conventional specialist practice or may practice CAM full-time. CAM treatment is provided within a care plan that includes conventional medical diagnosis, prognosis and treatments.
Introduction
Complementary and alternative medicine (CAM) is becoming increasingly popular in Europe with up to 65% of the population reporting that they have used this form of medicine. Approximately 30-50% of the European population use CAM as self-support and 10-20% of the European population has seen a CAM physician/practitioner within the previous year.
The most commonly used CAM therapies in Europe that are practised by medical doctors are acupuncture, homeopathy, phytotherapy, anthroposophic medicine, naturopathy, Traditional Chinese Medicine, osteopathy and chiropractics. The popularity of the individual therapies, however, differs widely between countries. This diversity is both a challenge for examining the state of CAM in Europe and an opportunity since its inherent plurality gives Europe a unique richness and leading position in the world in terms of the variety of approaches, high quality, integrated, holistic and patient oriented healthcare.
The regulatory status of CAM in Europe reflects the diversity of acceptance, use and availability of these treatment approaches in the EU Member States. Due to a great variety of medical cultures and traditions in different parts of Europe, CAM looks back on a well-established tradition in some countries or is hardly recognized and available in others.
Models of statutory regulation
There are three main models used to regulate the practice of medicine, namely direct government-administered regulation, government-sanctioned self-regulation and independent self-regulation[1]. These models differ in the depth of direct government involvement and are often used in tandem with other acts, which may regulate certain aspects of the health service and medical practice.
1. Direct government-administered regulation
In most European countries the government authorises, registers and supervises the personnel. The authorities can withdraw the authorisation of health personnel if the law is violated. If the violation is serious, the authorities may also ask the police to investigate the matter. This implies that the government through the appropriate authorities decides to what extent the use of CAM by regulated personnel can be designated as “responsible professional conduct”.
2. Government-sanctioned self-regulation
In some countries the law delegates the tasks of authorisation, registration and supervision of practitioners to the national medical associations. If the rules are violated, the national medical association may withdraw the authorisation and may ask the police to investigate the matter. This implies that the national medical associations decide to what extent the use of CAM by authorised personnel can be designated as “responsible professional conduct”.
3. Independent self-regulation
Some federations of CAM providers are developing what they call “self-regulation”.
“Self-regulation” is a process in which associations of individual therapies develop their own statistics, educational programmes, code of ethics, research programmes and standards of competence. In some countries, self-regulation is required for an association to be approved by the government.
Different models of providing medical services in Europe
The regulatory status of CAM is complicated by the different models applied in the EU Member States to provide medical services in their respective countries. CAM is primarily provided by physicians in Middle and Southern Europe, the practice of CAM outside of regulated health care is illegal and violations are considered an offence.
In Northern Europe anybody may provide CAM whilst only specific medical acts (e.g. treating people for infectious diseases, performing surgery, administering anaesthetics, prescribing drugs that require a prescription, giving injections, using X-ray) are restricted to medical practitioners with a university degree, although the range of these medical acts may differ from country to country. This implies that the practice of CAM by non-medically qualified practitioners is allowed which has led to a situation where treatment providers outside of the established health service constitute the core CAM providers.
In Hungary and Slovenia the law allows some CAM modalities to be practiced by non-medically qualified practitioners, some only by medical doctors. In Slovenia homeopathy acupuncture and chiropractic/osteopathy are only permitted to medical doctors, in Hungary homeopathy, anthroposophic medicine, traditional Chinese medicine and acupuncture, chiropractic/osteopathy, ayurvedic medicine and traditional Tibetan medicine.
Where is CAM statutorily regulated?
The extent to which countries have established a statutory regulation of CAM and how such regulation is performed varies widely. Some countries have government-administered regulations or laws about the practice of CAM in general, some regulate specific CAM therapies, while still others have no CAM regulation at all.
In 18 of 29 EU and EEA countries specific CAM therapies are statutorily regulated although wide variations exist throughout Europe regarding the types of CAM that are regulated (see table below and graph).
Government-administered regulation |
Number |
Country |
CAM legislation |
10 |
Belgium (1999), Bulgaria (2005), Denmark (2004), Germany (1939), Hungary (1997), Iceland (2005), Norway (2004), Portugal (2003), Romania (1981), Slovenia (2007) |
CAM legislation in preparation |
4 |
Ireland, Luxembourg, Poland, Sweden |
Legislation of some CAM therapies |
|
Cyprus, Finland, Italy, Lithuania, Latvia, Liechtenstein, Malta, Romania, United Kingdom |
No CAM legislation |
|
Austria, Estonia, France, Greece, The Netherlands, Spain, Slovakia, Switzerland |
Adapted from “Concerted Action for Complementary and Alternative Medicine (CAM) Assessment in the Cancer Field”
The next table shows details of the regulation of specific CAM therapies adopted by the European countries. The type of CAM therapies that are regulated differs between countries, and the most commonly regulated are acupuncture and homeopathy. In some countries specific CAM therapies are defined as medical specialties.
Countries |
Statutory regulation of CAM by Government (G), by Government for MDs only (GMD), or by medical association (MA) |
|||||
|
Acupuncture |
Anthroposo-phic medicine |
Homeopathy |
Naturopa-thic medicine |
Chiropractic |
Osteopathy |
Austria |
MA |
MA |
MA |
|
|
|
Belgium |
1999 G |
|
1999 G |
|
1999 G |
1999 G |
Bulgaria |
2005 GMD |
|
2005 GMD |
|
|
2005 G |
Cyprus |
|
|
|
|
|
|
Czech Republic |
Yes GMD |
|
|
|
|
|
Denmark |
Yes G |
|
|
|
1992 G |
|
Estonia |
|
|
|
|
|
|
Finland |
|
|
|
|
1994 G |
1993 G |
France |
|
|
MA |
|
|
2002 G |
Germany |
MA |
MA |
MA |
MA |
|
|
Greece |
Yes GMD |
|
|
|
|
|
Hungary |
1997 GMD |
1997 GMD |
1997 GMD |
|
1997 GMD |
1997 GMD |
Iceland |
|
|
|
|
1990 G |
2005 G |
Ireland |
|
|
|
|
|
|
Italy |
|
MA |
MA |
|
yes |
yes |
Latvia |
Yes GMD |
MA |
1998 GMD |
|
|
|
Liechtenstein |
|
|
|
|
1985 |
|
Lithuania |
|
|
Yes G |
|
|
|
Luxembourg |
|
|
|
|
2003 G |
|
Malta |
2003 G |
|
|
|
2003 G |
2003 G |
Netherlands |
|
|
|
|
1988 G |
|
Norway |
|
|
|
|
1988 |
|
Poland |
|
|
|
|
|
|
Portugal |
2003 GMD |
|
2003 GMD |
2003 G |
2003 G |
2003 G |
Romania |
1981 G |
MA |
1981 G |
|
|
|
Slovakia |
|
|
|
|
|
|
Slovenia |
1979 GMD |
|
2007 GMD |
|
2007 GMD |
2007 GMD |
Spain |
Yes GMD |
|
MA |
|
|
|
Sweden |
|
|
|
|
1989 G |
|
Switzerland* |
MA |
MA |
MA |
|
Yes |
Yes |
United Kingdom |
in prep G |
|
1950 GMD |
|
in prep G |
1993 G |
NUMBER |
|
|
|
|
|
|
1) Ersdal G (2005). How are European patients safeguarded when using complementary and alternative medicine (CAM)? Jurisdiction, supervision and reimbursement status in the EEA area (EU and EFTA) and Switzerland. Concerted Action for Complementary and Alternative Medicine (CAM) Assessment in the Cancer Field, Tromsø, Norway.
