‘CAM utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM therapies are mainly used outside conventional health care, but in many countries some therapies are being adopted or adapted by conventional health care.’ Worldwide, the terms used for defining complementary and alternative medicine (CAM) and CAmethods, procedures, or therapies related to CAM vary greatly. A certain method, procedure or therapy might be regarded as part of CAM in one country while in other countries the very same procedure might not be related to CAM, but to normal life style, conventional medicine, psychology or philosophy. There is also a huge variety of definitions which is impractical, both for research purposes and with regard to EU conformity.
The European Union has decided that the organization and regulation of health care is a national responsibility, while medicinal products are regulated at the Union level. The situation with regard to CAM regulation can be summarized in three points: • There is no common approach to the regulation of CAM practice in Europe. All 39 countries that were studied do it their own way. • Herbal and homeopathic products are uniformly regulated with regard to market authorization throughout Europe. • 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. Although diversity in health care regulation enables a wider choice of options with regard to CAM aspects of health care, the same diversity seriously hampers any efforts to establish EU-wide predictable conditions for both treatment and research.
Many citizens in Europe have positive attitudes to CAM, and although their attitudes and needs have not been consistently researched across all European countries, some further tendencies can be noted: • Citizens in Europe wish to have access to increased and diverse CAM provision • Citizens in Europe need easily accessible and trustworthy information regarding CAM and CAM-safety • Citizens in Europe require the transparent regulation of CAM and the training of those who practice CAM The attitudes and needs of citizens in Europe concerning CAM have been researched in just 18 of 39 European countries; substantial research based knowledge is only available from the UK. This calls for more research in this field.
We are unsure about the exact extent of CAM use within the EU. The data available from our systematic review are inconclusive and of very variable quality. Many of the studies are of poor methodological quality. We do have reliable data in a few countries but in the majority of the 27 EU states we have no data. How do we reliably measure CAM prevalence: 1. We have piloted an existing questionnaire (the ICAMQ) in 4 EU states. 2. We need a questionnaire-based tool to measure the prevalence of core CAM practices and to obtain reliable population based data. 3. Unfortunately the ICAMQ in its present form has many weaknesses and will require major revision before it can be widely utilised for this purpose. Another tasks was to develop a standardized questionnaire for CAM use in at least 3 European languages, in order to find out details about the usage of CAM.
CAM provision in Europe comprises health care practitioners and physicians with different healing attitudes, medical background, training, certification, and practise. Data are only available if they are registered in any specific body open to the public, and are therefore scarce, scientific publications are almost lacking completely. For these reasons, some public demand can be noted: • CAM provision in Europe requires the transparent harmonisation of CAM training, medical education and certification. • CAM provision in Europe requires the standards of the regulation and registration bodies for both, therapists and products, to be open to the public. • CAM provision in Europe requires prospective and and publicly funded studies of prevalence and clinical as well as cost effectiveness. CAM provision in Europe has not yet gained governmental interest at large; state funded research based knowledge is mainly available for Denmark, Germany, Norway, Switzerland, and the UK. This calls for more research in this field throughout the EU and associated countries.
• A broad range of mixed methods research strategies should be used to investigate CAM within the EU. The choice of method(s) for any particular project or experiment should be based on the specific scientific question and should focus on delivering safe and effective health interventions to EU citizens. • The CAM research strategy for Europe should be based on the popularity of a specific intervention and related to the national or regional public health needs and disease burden. • We suggest the formation of a centralised EU CAM centre with the responsibility to operationalise the CAMbrella recommendations in collaboration with selected EU member states and appropriate (worldwide) academic institutions to enable evidence based health sector reform with appropriate CAM interventions in the EU.
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