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CAM is in high demand by the citizens of Europe: as many as half of all citizens in Europe use complementary and alternative medicine for their healthcare needs; speaking at the final conference in Brussels, project coordinator Dr Wolfgang Weidenhammer, centre for CAM research at the TU Munich said, “Citizens are the driver for the use of CAM. Their needs and views on CAM are a key priority and their interests must be investigated and addressed in future CAM research.”
There are more than 150,000 registered medical doctors with additional CAM certification in Europe and more than 180,000 registered and certified non-medical CAM practitioners, meaning up to 65 CAM providers per 100,000 inhabitants compared to the EU figures of 95 general medical practitioners per 100,000 inhabitants. However, regulation of and education in CAM is different in each of the 39 European countries. Speaking at the conference, Prof. Vinjar Fønnebø, director of the Norwegian Institute for CAM research at the University of Tromso said: “The current EU regulation and education chaos for CAM provision makes it impossible for health professionals to give safety and security to their patients and clients.”
Substantial lack of data about CAM
To date, there has been no thorough investigation of this field of health care in Europe. There is almost no knowledge about the prevalence of CAM use by European citizens and patients. In most European countries, there has been no research into the needs of citizens regarding CAM provision and nothing much is known about the providers’ concerns.
What is CAM and what do people use it for?
CAM is an umbrella term for popular treatment strategies mostly outside conventional medicine. Practices such as herbal medicine, homeopathy, manual therapy (massage, osteopathy and reflexology), acupuncture, anthroposophic medicine or naturopathy are applied in the care of chronic conditions, disease prevention and health management. Herbal medicine is the most frequently reported CAM practice, and musculoskeletal problems the most reported conditions for the use of CAM.
The CAMbrella “Roadmap for European CAM research”
The CAMbrella researchers call on the EU to support and implement CAM research that pays proper attention to the real world conditions of European healthcare. Professor Jarle Aaarbacke, rector of University of Tromsø explains, “CAM is not part of the medicine we teach and learn in European universities – but it is nevertheless used by large numbers of patients and providers across Europe, so better we understand more about it.”
“If CAM is to be employed as part of the solution to the health care challenges we face in 2020, it is vital to obtain reliable information on its cost, safety and effectiveness in real world settings. CAMbrella’s vision is for an evidence base which enables European citizens and policy makers to make informed decisions about CAM,” adds Prof. Dr. Benno Brinkhaus, who led the roadmap workpackage, at the conference today.
CAMbrella recommends the establishment of a European research centre for CAM, allowing researchers to develop a uniform and scientific approach to CAM research, and thereby to determine the prevalence of CAM in Europe, research the most promising CAM treatments for the most common health problems such as obesity, diabetes and cancer; review patient safety, and evaluate the integration of CAM into routine healthcare treatments. And Dr. Weidenhammer sums up: “The CAMbrella project thus plays a central role for CAM and healthcare in Europe, it alls depends now on taking up the proposals and put them in action.”
Comprehensive information on the CAMbrella project can be found here
Members of the European Parliament, health professionals, patients and policy makers gathered in the European Parliament to hear and debate presentations on the innovative added value of Complementary and Alternative Medicine (CAM) for European Healthcare. The potential that CAM has to maintain health, prevent ill-health, promote healthier lifestyles and contribute to the sustainability of health systems should not be disregarded by the European Union at a time when health funding is under so much pressure from economic and demographic pressures, the Conference forcefully concluded.
The event was hosted by MEP Elena Oana Antonescu (EPP, Romania) and co-hosted by MEPs Sirpa Pietikäinen (EPP, Finland) and Alojz Peterle (EPP, Slovenia). It was moderated by Harald Walach, Professor of Research Methodology and Complementary Medicine, European University Viadrina, Frankfurt/Oder, Germany.
Across Europe at least 25% of the population use CAM, currently largely paying for it out of their own pocket. Despite clear citizen use and demand, CAM has not received a proper consideration by the European institutions, despite a call to do so from the European Parliament as far back as 1997.
"We are very grateful to the European Parliament for having hosted this landmark conference, and to the Commission for having part funded it. The EU faces a serious economic crisis that puts its Member States' healthcare systems at risk and requires them to fundamentally reform. The impact of increased life expectancy, the alarming rise in chronic diseases, growing health inequalities and shortages in health workforces s are overstraining health care services in a way unseen before. We believe that investing in a CAM Innovation Partnership will support reforming health systems to focus primarily on prevention and complement conventional care in a way that benefits healthcare systems and people across Europe", stressed Ms Enid Segall on behalf of EUROCAM, one of the organisers.
“The fact that more and more Europeans live longer requires the adaptation of entire healthcare systems. I believe that complementary and alternative medicine can help promote a healthier and more environmentally aware lifestyle, with significant benefits to personal and societal health. Complementary and Alternative Medicine has the capacity to change the medical treatment philosophy, by adopting a more holistic outlook on illness and its effects”, echoed Elena Oana Antonescu, Member of the European Parliament and co-host of the event.
"CAM is reality. Research has shown that millions of patients do use CAM when diagnosed with different diseases. On the other side, we see how different is legal status of it in the Member States which is considered by patients as a kind of discrimination to them. Not much has been done so far at the EU level. I plead for a higher level of attention in this regard and call on Commission action to start a new initiative, in cooperation with the stakeholders concerned, for the regulations on the licensing and use of CAM medicinal products in Europe and in particular to act upon the suggestions outlined in the Commission Communication 2008, notably that the suitability of a separate legal framework for products of certain traditions should be assessed. For me, this is a very important element of the closeness to our citizens", echoed Alojz Peterle, Member of the European Parliament and co-host of the event.
“There is a growing demand for CAM therapies in Europe. We as the European legislators need to facilitate safe accessibility to these therapies by providing a functioning, legal framework. The next EU Health Strategy needs to set a clear and enhanced role for CAM therapies with a view to European level regulation to be established in the future", stressed Sirpa Pietikainen, Member of the European Parliament and co-host of the event.
Across Europe there are in the order of 300,000 CAM practitioners and 150,000 medical doctors practising a range of modalities such as acupuncture, anthroposophic medicine, aromatherapy, ayurveda, herbal medicine, homeopathy, kinesiology, naturopathy, massage, reflexology, shiatsu, traditional Chinese medicine, etc. They offer a whole person approach to health with a focus on supporting the person’s health-maintaining capacities and within which illness is treated according to the distinct diagnostic and treatment methods of the modalities used. This can be on a stand-alone basis and/or in ways complementary to conventional medicine. Currently CAM is mostly provided privately but in a growing number of cases in some countries in collaboration with conventional medical practitioners.
"Up to 80% of citizens in the EU Member States have used complementary and Alternative Medicines in their health care. Their hopes are to get relief from concerns that the conventional medical services do not meet, and to improve general wellbeing. And yet, access to CAM with rare exceptions is limited to those who can afford to pay for it", said Helle Johannessen, Professor of Social Studies in Health and Medicine, Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Denmark.
"Equitable access to healthcare, including CAM, and the sustainability of health services requires a shift towards health promotion and prevention of illness. CAM has the potential to support strategies to increase critical health literacy amongst EU citizens in collaboration with conventional medicine”, echoed Andrew Long, Professor of Health Systems Research, University of Leeds, United Kingdom.
The Conference concluded by outlining how CAM can fit into the Health for Growth Programme and the economic and innovation priorities of the European Union. "The growth potential of the sector, both in terms of GDP, savings on healthcare, healthier citizens, CAM workforce and innovative competitiveness is enormous. For this to happen, we need the EU to give it its due consideration and adequate resources, as well as a framework for professionals to operate in", concluded Harald Walach, Professor of Research Methodology and Complementary Medicine, European University Viadrina, Frankfurt/Oder, Germany.
At the end of the conference EUROCAM issued a call for action addressed to the European Commission, the European Parliament and the EU Member States. It is available here.
The study included a survey on use, attitudes and disclosure of CAM, an e-panel consultation and focus group among patients with joint diseases. A total of 416 patients responded to the survey who suffered from osteoarthritis (51%), rheumatoid arthritis (29%) or fibromyalgia (24%).
The following four research questions were addressed: (1) What is the prevalence of CAM use among Dutch patients with joint diseases? (2) What are these patients’ attitudes toward CAM use? (3) Do these patients disclose CAM use to their GP? (4) How do these patients envision integration of CAM therapies in primary care?
The study demonstrated a high prevalence of CAM use among patients with joint diseases. A two-year prevalence of 86%, including the use of CAM home remedies, and 71% of patients visiting a CAM practitioner. Reasons for CAM use include a wide range of factors. The primary pull factors were an integrative approach to disease management, advice from a different angle and having received positive information about CAM practitioners. Push factors for CAM use were searching for an alternative to conventional medication and no further progress with conventional treatment. These results largely confirm earlier observations, that nowadays patients intentionally seek CAM because they want to be treated in an integrative or holistic way, rather than for reasons of negative experiences with conventional treatment.
Manual therapies, acupuncture and homeopathy were most frequently used. Currently, there seems to be a gigantic gap in conventional medicine between patients who would like to discuss CAM and physicians who do not talk about it with their patients. A minority (30%) actively communicated CAM use with their General Practitioner (GP). The majority (92%) preferred a GP who informed about CAM, 70% a GP who referred to CAM, and 42% wanted GPs to collaborate with CAM practitioners. Similar attitudes were found in the focus group and upon e-panel consultation.
Interestingly, almost one quarter of patients with joint diseases reported to use less conventional medication and to pay less visits to their GP upon CAM use. Since conventional medication, especially those for rheumatoid arthritis, is associated with high expenditure of healthcare costs, this observation may indicate possible cost-effectiveness upon CAM use.
The authors conclude that most patients in primary care want a GP who listens, inquires about CAM and if necessary refers to or collaborates with CAM practitioners.
To meet needs of patients, primary care disease management would benefit from an active involvement of GPs concerning CAM communication/referral. This study presents a model addressing the role of patients and GPs within such an integrative approach.
Jong MC, et al.(2012) Integration of complementary and alternative medicine in primary care: What do patients want? Patient Education and Counseling, http://dx.doi.org/10.1016/j.pec.2012.08.013 [PubMed]
A major challenge in basic research into homeopathy is to develop bioassays that yield consistent results. During recent years various studies have been reported that successfully used healthy plants (e.g., wheat, peas, duckweed) as test organisms.
Stannum metallicum 30x (or D30) is an ultramolecular preparation. It contains tin from the starting material in a nominal dilution of 10^−30 (8.4 × 10^−30 M). This preparation was compared to water 30x (or D30), that is, water that has undergone 30 analogous steps of dilution and agitation.These ultra-molecular dilutions are the main cause of scientific scepticism surrounding homeopathy because they are diluted beyond the point at which theoretically any molecule of the starting substance is present.
In a series of 15 independent experiments, evaluation of the resulting biocrystallograms with computerized texture analysis yielded highly significant differences between the two groups, i.e. there were some specific biological effects of Stannum metallicum 30x on the germinating cress seedlings, compared to water 30x as control.
Experiments were performed independently in two laboratories in Denmark and in the Netherlands and were fully randomized and coded (blinded).
The biocrystallisation method seems to be a promising complementary outcome measure for plant bioassays investigating effects of homeopathic preparations.
Baumgartner S, Doesburg P, Scherr C, Andersen J.-O.(2012) Development of a Biocrystallisation Assay for Examining Effects of Homeopathic Preparations Using Cress Seedlings. Evidence-Based Complementary and Alternative Medicine, Article ID 125945, doi:10.1155/2012/125945 [PubMed]
All European countries with a minimum of 5 million habitants were initially included for which any data about CAM use in children were published in the last 10 years (29 countries), then expanded to include 2 smaller countries. Corresponding authors from these publications were contacted in each country, and they were asked to provide information about paediatric CAM use in their countries.
Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated.
Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. The authors extrapolated that 56% (range: 10—90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5—90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions.
Conclusion: This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.
Zuzak TJ, et al. Use of complementary and alternative medicine by children in Europe: Published data and expert perspectives. Complementary Therapies in Medicine (2012), doi:10.1016/j.ctim.2012.01.001