Integrated health care in Europe

Europeans want non-conventional medical therapies integrated into mainstream medicine, according to Stephen Gordon of European Council for Classical Homeopathy.

Across Europe a significant and growing proportion of the public, and increasing numbers of health care professionals, are actively choosing to integrate various forms of traditional, alternative, complementary or non-conventional medicine into their health care provision and practice. Interventions such as acupuncture, homeopathy, phytotherapy, osteopathy, chiropractic, shiatsu, reflexology, anthroposophical medicine, ayurvedic medicine, and traditional Chinese medicine are being chosen by increasingly well-informed patients and health care professionals as either alternative or complementary approaches to the mainly technological and pharmaceutical based interventions of mainstream medicine.

A valued approach

There are many areas of ill-health in which the approaches of complementary and alternative medicine, CAM as it shall be referred to in this article, are valued by patients. Setting aside for the moment the question of effectiveness, CAM appears to be appreciated for its more person-centred, gentle, less invasive, less drug dependent interventions. CAM practitioners also place great emphasis on exploring with patients why they have become ill as a basis for initiating life-style changes that will underpin the benefits of their therapeutic interventions.

This advance in popular and professional use has been made despite frequent negative reactions from the scientific, medical and political establishment. It appears that while modern medicine continues to make advances on many fronts, its approach is found wanting in many areas by patients. However, the popular tendency is not to reject the positive benefits of conventional diagnostics and interventions but to make increasingly informed choices on when to utilise CAM therapies as alternatives or complements alongside them. Integrated health care can therefore be defined as an approach to healthcare which involves developing the most appropriate treatment plan for each patient based on an assessment of their overall individual needs and an understanding of the potential benefits of a widened range of diagnostic and health care options combined with appropriate lifestyle changes.

The evidence of efficacy

The lack of sufficient evidence of efficacy and lack of understanding of the mechanism of action of CAM interventions have been cited by orthodox science and medicine and governments as justification for rejecting these health care approaches. CAM’s major problem in the area of research is one of resources. There is no large pharmaceutical industry to fund research. The continued growth in use of CAM by citizens would seem therefore to place a responsibility on national governments and the EU Commission to fund an initial research capacity.

In 1997, the European Parliament adopted a report on CAM. (1) Greatly weakened in its legislative passage, it nonetheless called on the Commission "to carry out a thorough study into the safety, effectiveness, area of application and the complementary or alternative nature of all non-conventional medicines and to draw up a comparative study of the various national legal models to which non-conventional medical practitioners are subject". The Commission has not so far responded to the contents of this resolution.

However, two significant developments have taken place. First, the European Parliament has adopted a report on the proposed EU framework programme for Research and Technological Development. (2) It calls on the Commission to establish studies aimed at:

 understanding the "mechanism of action" of non-conventional therapies
 evaluating the cost benefit and effectiveness
 understanding the effect of non-conventional therapies in farm livestock with regard to public health and animal welfare.

Second, following recommendations in a report from the House of Lords, the UK Government has recently agreed a significant investment programme. (3) Thirty university-based collaborative projects will be established over the next three years involving researchers and practitioners.

Conventional research theory and practice applied to CAM approaches has proved relatively unfruitful. The individualised holistic approach to patient care that characterises so much of CAM practice must be accommodated in research methods if the positive results which so many patients appear to experience are to be replicated and recorded in research trials.

Market regulation

Although the delivery of health care services is the domain of Member States, EU legislation affects the marketing of pharmaceutical products. Two existing directives regulating the marketing of homeopathic medicines are about to be joined by a new directive on Traditional Herbal Medicines. (4,5) The first draft is currently being commented on by the Environment and Industry Committees of the European Parliament. In addition, a Directive covering the sensitive area of labelling food supplements is moving towards approval and implementation. (6) It will require that labelling includes information on vitamin and mineral content, daily use and possible health risks.

Legal basis

Establishing a firm legal basis for CAM is a pre-requisite for its integration. A survey report carried out by The European Council for Classical Homeopathy in 2000 revealed that the underlying legal situation for CAM practice across the EU is extremely heterogeneous. (7) For example, doctors are forbidden from practising homeopathy in Sweden while in France and Germany, doctors not only prescribe homeopathic and phytotherapeutic medicines but the costs are reimbursed by private and public health insurance schemes. The UK Government has recently introduced statutory regulation for the osteopathy and chiropractic professions, and the French Government is currently legislating to recognise these two professions. Up until now, osteopaths and chiropractors in France have been regularly taken to court charged with "illegal practice of medicine" by French doctors who have a monopoly on medical practice.

The Dutch and Belgian governments have legalised the practice of CAM disciplines by doctors and practitioners in the past few years; in Norway, Ireland and the Netherlands, CAM professionals are in dialogue with their governments on developing statutory regulation of their professions.

In the United Kingdom, the "Common Law¹" legal system has allowed a "free market¹" situation to exist such that anyone can practise any form of CAM providing they do not falsely call themselves a doctor or treat a small range of specified conditions. In response to the growing public demand in the UK for CAM, the influential House of Lords Science and Technology Committee initiated a major report. (8)

It recommended:

 improved regulation for all CAM professions;

 that acupuncture and phytotherapy professions should follow the osteopaths and chiropractors in seeking statutory regulation (9);

 that doctors practising CAM therapies should be appropriately educated and regulated;

 that research capacity in the area must be developed, and

 that the most effective therapies should be integrated into the UK National Health Service (NHS).

In a parallel development in the United States, a White House Commission on Complementary and Alternative Medicine Policy reported an almost identical set of recommendations to the US Government in March 2002. (10)

Why integrated health care now?

While on the one hand, CAM is rapidly growing in popularity, on the other, conventional medicine is under huge pressure. A major category of pharmaceuticals ­ antibiotics - is failing. Over-use in medicine and the animal food industry has led to the problem of resistance, (11) and the creation of super-bugs in hospital operating theatres. Such is the scale of the problem that the EU Commission has recently adopted a community strategy against anti-microbial resistance.

Many categories of drugs have harmful and sometimes fatal side-effects. Patients are increasingly wary, and court cases against pharmaceutical companies are growing. A recent report by the UK Audit Commission showed that while £1.5 billion (2.25 billion Euro) a year was spent on drugs prescribed in hospitals, a further £500 million (750 million Euro) was spent on dealing with medication errors and patients’ adverse reactions.

Cost is a major factor that Governments cannot ignore as health care budgets climb ever higher. Osteopathic and chiropractic interventions are labour intensive but they often save the social cost of millions of days off work resulting from back and musculo-skeletal complaints, and the increasingly common repetitive strain injuries.

CAM’s strong focus on lifestyle factors may also contribute significantly to reducing health care budgets by gradually slowing down the rise in chronic disease due to lifestyle. These conditions include obesity, diabetes, heart disease, cancer and asthma - all of which have rising tolls. CAM places a great importance on naturopathic principles of proper nutrition, exercise, clean air, clean water and so on - factors that are increasingly being rediscovered in the conventional field.

Working together, practitioners of conventional medicine and CAM have much more to offer the patient and much to learn and understand from each others’ approaches. Europe’s new agenda must be integrating the best of both approaches into one health care system for the benefit of the patient.

The European Council for Classical Homeopathy represents homeopaths in Europe and is a member of EPHA.

References available upon request.

Info:

Stephen Gordon, RSHom FSHom

European Council for Classical Homeopathy

School House, Market Place,

Kenninghall

UK-Norfolk NR16 2AH, United Kingdom

Tel/Fax: +44 1953 888 163

Mobile: +44 7767 360944

Email: ecch@homeopathy-ecch.org

Website: http://www.homeopathy-ecch.org