Changing the conversation about health

Complementary Medicine Roundup – February 2019

COMPLEMENTARY AND ALTERNATIVE MEDICINE IN EUROPE: WHAT NEXT FOR THE UK AFTER BREXIT?

As long ago as 1994, the growing popularity of CAM across Europe was being monitored in articles and research papers, including by the greatly-missed Dr Peter Fisher in his article Complementary Medicine in Europe (P. Fisher and A. Ward, BMJ. 1994 Jul 9; 309(6947): 107-111and herewhich, in part, concluded:

‘…Complementary or unconventional treatments are used by many doctors and other therapists throughout Europe. The major forms are acupuncture, homoeopathy, manual therapy or manipulation, and phytotherapy or herbal medicine. The relative popularity of therapies differs between countries, but public demand is strong and growing…Harmonisation of training and regulation of practitioners is the challenge for the future…”

Eighteen years later, on the 5th November 2012, the CAMbrella project, ‘a pan-European research network for Complementary And Alternative Medicine’, published The Roadmap for European CAM Research (Parts 1, 2 and 3). The Report compares the CAM legislation and regulations of 39 countries (27 EU member states and 12 associated states) and describes in detail 12 common treatment modalities in each country. It focuses on the legal and regulatory status of CAM, the governmental supervision of CAM practices and the reimbursement status of CAM practices.

In Part 1 (CAM regulations in the European countries) at page 3, the Roadmap defined the project’s goal as (note: bolding of text inserted by me):

‘…The goal of this collaboration project was to look into the present situation of CAM in Europe in all its relevant aspects and to create a sustained network of researchers in the field that can assist and carry through scientific endeavours in the future. Research into CAM – like any research in health issues – must be appropriate for the health care needs of EU citizens, and acceptable to the European institutions as well as to national research funders and health care providers. It was CAMbrella’s intention to enable meaningful, reliable comparative research and communication within Europe and to create a sustainable structure and policy…’

Pages 213 to 217 (paragraph 8.39) of Part 1 specifically refer to the practise and status of CAM in the United Kingdom.

In Part 3 (The Legal Status and regulation of CAM in Europe – CAM regulations in EU/EFTA/EEA) the Report concludes (page 35) that:

‘…The European Parliament Resolution on non-conventional medicine from 1997 [Brussels: The European Union, 1997 OJ C 182, 16/06/1997 P. 0067] stated that non-conventional medicine disciplines should be clearly identified and defined. The Resolution also calls on the Commission “to launch a process of recognizing nonconventional medicine and, to this end, to take the necessary steps to encourage the establishment of appropriate committees”.

In contrast to this, the EU treaties have repeatedly established that health policies are a national responsibility for the member states even if several EU Directives, Regulations and Resolutions influence how member states organize their national health policy and services.

The Cross-border healthcare Directive, in particular, respects the established differences in national healthcare systems. It aims to remove obstacles to the fundamental freedom that enable patients to choose to seek treatment across borders. This could potentially also include CAM treatment in countries where CAM treatment is included in the public health services. Regional collaboration between providers, purchasers and regulators from the different member states can ensure safe, high quality and efficient cross-border healthcare at a regional level. Historical and cultural similarities between neighbouring countries would thus seem to have the best chance to facilitate cross-border opportunities in the CAM area more than EU-wide Directives, Regulations and Decisions.

We think it is important to encourage individual states within culturally similar regions to voluntarily harmonize their CAM legislation and regulation. If this does not happen, and the EU sees such harmonization as valuable, it might need to reconsider its general respect for member states’ health care organizational diversity…’

[Note: brackets and bolding of text inserted by me]

Part 2 of the Road Map relates to Herbal and Homeopathic medicinal products.

Further research, relevant to the above Report, is A research roadmap for complementary and alternative medicine – what we need to know by 2020 (2014; Fischer F, Lewith G, Witt CM, Linde K, Cardini F, Falkenberg T, Fønnebø V, Johannessen H, Reiter B, Uehleke B, Weidenhammer W, Brinkaus B), the aim of which is to:

‘… present the CAMbrella research roadmap based on the key results of the main CAMbrella work packages to a wider audience of scientists, health care providers, decision makers and the public…’

It concludes, in part, as follows:

‘…With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens…’

With reference to this research, refer also to the Biomed Central CAM article published on 6th February 2014, an excerpt from the Abstract of which informs further about the CAMbrella project:

‘…The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives…The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens’ needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems…’

As, at the time of writing, the United Kingdom prepares to leave the European Union, CAM practitioners and patients will be concerned about the future. How long will the objective of ‘harmonisation’, identified as ‘valuable’ in the Report and as being a ‘challenge’ in Dr Fisher’s 1994 article, apply to the UK? If this aim is not to be pursued, what will take its place and with what consequences? Are CAM practitioners and their professional organisations and regulators and also the NHS and other UK public health and social care organisations and the charities that use and promote CAM, planning for the future? Have they fully reviewed the CAMbrella project work packages? Similarly, is this the case with regard to UK business owners trading in CAM remedies, equipment and other products?

Answers to these and to many other questions are needed now.

BRISTOL UNIVERSITY RESEARCH INITIATIVES ON CAM

Researchers at the University of Bristol have published the results of a national survey of CAM use in England, as part of a wider scoping study on the potential for the integration of CAM for musculoskeletal and mental health problems in primary care. 

Refer to the media release: 

More adults are using complementary and alternative medicine in England but access is unequal, finds survey

And see also the following related academic papers:

Complementary medicine use, views and experiences – a national survey in England by Deborah Sharp, Ava Lorenc, Richard Morris, Gene Feder, Paul Little, Sandra Hollinghurst, Stewart Mercer and Hugh MacPherson. Published in BJGP Open (14 November 2018);

Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions by Ava Lorenc, Gene Feder, Hugh MacPherson, Paul Little, Stewart Mercer and Deborah Sharp. BMJ Open (October 2018);

Complementary medicine and the NHS: Experiences of integration with UK primary care by Deborah Sharp, Ava Lorenc, Paul Little, Stewart Mercer, Sandra Hollinghurst, Gene Feder and Hugh MacPherson. European Journal of Integrative Medicine. Forthcoming: December 2018;

‘Trying to put a square peg into a roundhole’: a qualitative study of healthcare professionals’ views of integrating complementary medicine into primary care for musculoskeletal and mental health comorbidity by Deborah Sharp, Ava Lorenc, Gene Feder, Paul Little, Sandra Hollinghurst, Stewart Mercer and Hugh MacPherson. BMC Complementary and Alternative Medicine (October 2018);

If you would like more information about the national survey or the academic papers, please contact Helen Bolton (helen.bolton@bristol.ac.uk), Communications Officer, Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS (on Wednesday, Thursday or Friday). CAPC is a member of the NIHR School for Primary Care Research.

Information about the scoping study on the potential for the integration of CAM for musculoskeletal and mental health problems in primary care may also be found in the section of my December 2017 blog headed CAM RESEARCH SCOPING STUDY APPROVED.

THE WITHDRAWAL OF NHS FUNDING OF HOMEOPATHY AT THE PORTLAND CENTRE CONTRASTED WITH THE RESULTS OF A SURVEY BY THE FEDERAL ASSOCIATION OF THE PHARMACEUTICAL INDUSTRY (GERMANY): THE NEED FOR POLITICAL ACTIVISM TO REPRESENT THE INTERESTS OF CAM

Regrettably and as anticipated, the Governing Body of Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG) approved as follows on the 7th August 2018 (excerpt):

‘…NHS funded homeopathy will only be available in exceptional circumstances in the area. The changes will mean the CCG’s Individual Funding Request (IFR) Panel would need a clinician to set out why the patient is clinically exceptional before treatment could be provided… CCG Clinical Chair Dr Jonathan Hayes said, “We are working hard to become an evidence-informed organisation because we need to make the best use of all resources to offer treatment and care to the widest range of people. The decision on homeopathy funding today is a step towards this and brings us in line with national guidelines.”…’ 

In response, The Portland Centre (now renamed The National Centre for Integrative Medicine) issued a statement (no longer available on its new website) that included the following:

‘…Following a decision by the local Clinical Commissioning Group (CCG) in August 2018, we will no longer be able to offer NHS appointments for homeopathy from February 2019 …We recognise that changes to this NHS service is going to impact those of you who otherwise can’t afford complementary and holistic approaches to healthcare. We are seeking to make medical homeopathy as accessible as possible and hope to have more low-cost options for patients in Bristol in the near future…’

The CCG changes were reported by BBC Online (07.08.18) under the caption NHS-funded homeopathic treatment to end in Bristol: The last place in England to offer publicly-funded homeopathy is to stop providing the practice on the NHS.

The history of Homeopathy in Bristol (commencing 1832) at The Portland Centre (now renamed as above) may be viewed here.

With the outcome of the events at The Portland Centre in mind, contrast the announcement by the BNSSG CCG with the results of a survey recognising Homeopathy as a proven therapy for patients in Germany.

There the Federal Association of the Pharmaceutical Industry e.V. (BPI), which represents the broad spectrum of the pharmaceutical industry at national and international level (around 255 companies with approximately 78,000 employees have joined forces in the BPI), has posted a message titled Patients trust homeopathic medicines (09.06.17) that confirms the result of a Forsa survey commissioned by the BPI. The message reports, among other things, the finding that ‘almost two-thirds of those surveyed consider it important or very important that… politicians, in addition to traditional medical treatment methods, also actively promote healing medical methods such as homeopathy or anthroposophic medicine’. The survey also provided findings as to the importance of health insurance companies reimbursing their insured for the costs of selected services in the field of homeopathic medicine.

Information regarding the political representation of the BPI may be viewed here.

Observations regarding the need for political activism to represent the interests of CAM may be reviewed in my October 2018 blog and, in particular, its sections respectively headed:

  1. COMPLEMENTARY MEDICINE & THE WORLD HEALTH ORGANISATION (WHO): ARE UK HEALTH AND SOCIAL CARE LEGISLATORS, POLICY MAKERS AND MANAGERS AWARE?
  2. OBSERVATIONS ON CAM: IN A GERMAN LEGISLATIVE DEBATE AND AT A EUROPEAN UNION (EU) POLICY WORKSHOP