Feature

Therapy sans frontières?

Ken Shifrin asks whether complementary medicine can survive in the EC

The practice of complementary medicine varies widely in Europe. Most member states restrict it and there is little doubt that Britain, with its common law basis of practice, is almost unique in the freedom it offers citizens to select their healthcare. Complementary healthcare has flourished on a non-statutory basis, with millions of consultations annually.

Elsewhere in Europe the situation is quite different. Under the Napoleonic Code, medicine may be practised only be doctors. Doctors may offer a wide range of services and enjoy an effective monopoly on healthcare provision in many countries.

Countries such as Italy, France and Belgium have highly restrictive laws under which therapies such as acupuncture and osteopathy are illegal unless practised by a doctor. Others such as Spain, Portugal and Greece appear to have a laissez faire attitude, with laws restricting practice rarely being enforced. The relatively small numbers of practitioners in these countries may help to explain the ‘laid back’ approach. With the increasing popularity of complementary healthcare, it seems inevitable that restrictions will be more rigorously applied.

The European Commission has frequently been asked to state its position on complementary healthcare. Over the past 10 years it has consistently stated that it has no plans to introduce legislation on complementary medicine, nor does it think it advisable to contemplate harmonisation of these practices at community level. Such reassurances should serve to quieten some of the more irrational fears about 1992.

But complementary healthcare is expanding rapidly. It cannot be long before the European medical profession grows increasingly restive at its resulting loss of monopoly and the rise of unregulated treatment. Doctors have a powerful voice in Brussels, especially when combined with their natural allies, the multinational drug companies, who will see a clear threat to their profit margins if the growth in ‘non-chemical healthcare’ continues unchecked.

’Public safety’ is cited as one of the reasons for the UK government’s current review of licences for herbal medicines. These licences, granted in 1971, allow herbal medicines to be sold in accordance with EC directives. Since the review began in 1987, over 2,500 herbal medicines have ceased to be available in this country, with many more awaiting a similar fate.

Homeopathic medicines have also come under scrutiny. A draft directive planned for 1992 envisages a licensing system covering the entire EC. This may require proof of the effectiveness of certain medicines, in addition to safety and quality control. The licensing system may exclude such products as Bach flower remedies and others which are not included in the European Homeopathic Pharmacopoeia which will form the basis of the system.

Britain stands almost alone in the wide range of products and services available to the public. The common law basis of our work has served well for many years, yet the norm throughout Europe is that such activities are regulated by statute (in theory if not always in practice). Whether the protection of common law will be adequate as we move towards full European union is the crucial issue.

Many organisations, including those within the Council for Complementary and Alternative Medicine, think statutory registration is the way forward if our professions are to maintain their independence and integrity at home and also build truly European professions of complementary healthcare. One of the major reasons for the current chaotic situation is that none of the professions involved has been granted full state registration in its own right in any EC country.

The UK is uniquely well placed to change this, having some of the best trained and best organised groups.

Our efforts need to be threefold. First, each profession needs to organise itself coherently with well formulated, publicly accountable standards. Practitioners need to demonstrate that they are safe, competent, ethical and effective, and that their standards are commensurate with the status they claim for themselves. One practical step towards this goal is the formation of accreditation procedures, created by the professions themselves, in which educational standards may be examined, organised and enhanced.

Second, we can begin to establish a more visible, active presence in European affairs, providing information to policy makers and public bodies concerned with healthcare provision. We need to articulate, at every opportunity, the fact that complementary healthcare may offer the ideal solution to the problem of the increasing costs of providing healthcare, by conventional means, via services overburdened by an ageing population and increasingly unable to meet either their statutory obligations or the needs and expectations of patients. The World Health Organisation’s ‘Health for All’ campaign could actually become a reality if complementary healthcare was allowed its rightful place.

Perhaps most importantly, complementary practitioners need to remain true to their calling. The range of services we provide is hugely diverse, and such diversity is one of the cornerstones of our work. Most of us entered these professions because we sought something different, beyond convention and orthodoxy. We sought forms of healing and caring which valued each individual as unique, and which attempted to restore health at all levels.

While we work towards ‘organising’ and ‘professionalising’ our activities, it is essential that we do not lose sight of these values. It would be tragic indeed if, in our quest for ‘respectability’ we were to lose those things which make us special, and merely create a new ‘orthodoxy’ of our own.