Complementary and Alternative Medicine Use and Initiatives in Europe

Abstract

Alternative and Complementary TherapiesVol. 24, No. 1 Free AccessComplementary and Alternative Medicine Use and Initiatives in EuropeJane HartJane HartSearch for more papers by this authorPublished Online:1 Feb 2018https://doi.org/10.1089/act.2017.29149.jhaAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail When it comes to complementary and alternative medicine (CAM), European clinicians and researchers are working hard to ensure high standards for CAM in clinical practice and research settings in order to inform clinicians' practice and patients' safety. Widespread use of CAM throughout Europe is common, and there are estimates that 145,000 physicians and 160,000 nonmedical practitioners provide CAM therapies throughout the European Union (EU)1 and that more than 100 million Europeans use CAM regularly.2 Acupuncture and homeopathy are among the most common therapies provided by both medical and nonmedical providers, and herbal medicine and reflexology are often provided by nonmedical providers, according to Von Ammon et al.1 While some areas of Europe are quite progressive in their offerings of CAM, still, in other areas, challenges and obstacles exist in terms of communication about CAM to providers and patients, standardization and regulation of therapies, assuring cost-effectiveness and accessibility to therapies, collaborative research networks, and obtaining funding for research.Research on CAM Use and NeedsAn analysis of the 2014 European Social Survey by Kemppainen et al. explored determinants of CAM use in Europe, and found that within the past year, 26% of survey participants had used one or more complementary therapies.3 Other results showed that massage therapy was the most frequently used CAM therapy, followed by homeopathy, osteopathy, herbal treatments, and acupuncture, and when CAM therapies were used as an alternative to seeking medical help, the most commonly used modalities were spiritual healing and acupressure. The most common conditions for which people used CAM treatments included skin conditions, pain, allergies, and digestive problems. CAM use also varied by country, according to the authors' findings, with approximately 10% use in Hungary and 40% in Germany and Switzerland. Research by Fischer et al. suggested that CAM is “very heterogeneous in terms of definitions and legal regulations between the European countries. In addition, citizens' needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries.”4A literature review by Nissen et al. explored trends in Europeans' attitudes, preferences, and needs regarding CAM.5 The review included 189 articles from 18 European countries, with the majority being from the United Kingdom, along with Germany, Turkey, Israel, Switzerland, Italy, and others. Results showed that many Europeans have positive attitudes about CAM and desire increased access to such approaches/modalities. They also desire “impartial, reliable and trustworthy information to support informed decision-making.”5 Interesting findings from this review included the fact that in both Switzerland and Germany, CAM is often provided by general practitioners, and treatments are often reimbursed through health insurance. On the flip side, lack of insurance coverage, cost, and lack of information by healthcare professionals may serve as barriers to CAM access in some areas of Europe.Integrative medicine has been and is being implemented in hospitals and outpatient settings throughout Europe. Anthroposophic and homeopathic hospitals are common and exist throughout Europe, especially in the United Kingdom, Switzerland, and Germany, and an Integrative Medicine Center was recently established in a hospital in Tuscany, Italy.1 Anthroposophic medicine—an “integrative multimodal treatment system based on a holistic understanding of man and nature and of disease and treatment”—originated in Europe, according to an article by Kienle et al.6 According to these authors, there are approximately 24 anthroposophic medical institutions, including hospitals, hospital departments, rehabilitation centers, and inpatient healthcare centers in Europe, including Germany, Switzerland, Sweden, Italy, The Netherlands, and also the United States.In regards to teaching of CAM and training medical professionals, homeopathic training in medical education is common throughout Europe, and a number of universities offer training in CAM therapies. According to Von Ammon et al., “The General Medical Council in the UK recommends that all UK medical schools offer an optional CAM familiarization course for all medical undergraduates.”1European Initiatives in CAMCertain countries in Europe have well-entrenched and established CAM policies and practice. Yet, in other countries, a lack of communication about CAM to the European public and providers in general may pose challenges when it comes to access and the need for credible information, according to research. For example, a 2012 survey of 20 organizations/stakeholders in the healthcare field in Europe revealed significant gaps in communication about CAM to the European public and providers, according to Reiter et al.7 Survey results included: 80% found the European citizens' access to reliable information about CAM poor or very poor; 95% found it important or very important to meet the European citizens' need for more information on CAM in the future; 54% found the level of CAM information provided by European health authorities poor or very poor; 60% of the participating organizations found their own access to information regarding the CAM situation in the European countries difficult or very difficult. Reiter et al. concluded: “The most important informational needs regarding CAM in Europe concern evaluation of treatments (77%), guidelines for CAM users (46%), [and] access to research data (46%).”7Initiatives are underway, however, to improve communication, research, and clinical practice regarding CAM in the EU. CAMbrella was created to research CAM use and needs in Europe, and was conducted between 2010 and 2012. The results of this investigation are on the CAMbrella website (https://cambrella.eu/home), and several of their findings are cited in this article. One of the motivating factors for the project was the fact that Europe lacks proper funding for CAM research, and healthcare professionals in Europe have commented that a European Center similar to the National Center for Complementary and Integrative Medicine in the United States is urgently needed.EUROCAM is a “foundation uniting European organizations representing CAM patients and trained CAM health professionals” whose objective is to “promote and facilitate CAM's role in maintaining citizens' health, highlight the health promotion and illness prevention aspects of CAM for EU public health policy and programs, to advance the accessibility, affordability, and availability of CAM and generally promote CAM at the European level.”8 In October 2017, the Committee on the Environment, Public Health and Food Safety (ENVI) of the European Parliament held a workshop titled “Complementary and alternative therapies for patients today and tomorrow,” according to the EUROCAM website.9 The workshop reviewed CAM utilization, attitudes, and needs of European citizens, legal and other issues regarding CAM, the CAMbrella report, and goals for future research.The European Society of Integrative Medicine is another organization whose mission is to “facilitate the advancement of science, research, education and further training to support best and evidence based medical care and to provide policy in the realm of Integrative Medicine.”10 One of the activities of the organization is hosting the annual European Congress for Integrative Medicine. The 2018 Congress will be held on September 21–23 in Ljubljana, Slovenia, and is titled “The Future of Comprehensive Patient Care.”11 The Congress website commented that “The aim of the Congress is to promote health and develop integrated and sustainable treatment for acute and chronic diseases.”11ConclusionAs the above research has suggested, European citizens are very interested in CAM use, and providers are interested in providing evidence-based information to their patients. In order to achieve this in a well-integrated manner, Von Ammon et al. suggested: “There is a huge variation in regional, national, European and international legal regulations, which make any comparison about CAM practice and provision almost impossible,” and they added, “Standardization of legal status, teaching and certification of different levels for CAM therapists as well as for CAM products and markets, through a central and independent body, would have enormous value and should be investigated and propagated by rigorous scientific methods.”1 Fischer et al. concluded, “Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative,” and they added, “A European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM … This center would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe's reality.”4▪References1 Von Ammon K, Cardini F, Daig U, et al. Health Technology Assessment (HTA) and a map of CAM provision in the EU. Online document at: https://phaidra.univie.ac.at/detail_object/o:300096 Accessed October 20, 2017. Google Scholar2 Eardley S, Bishop FL, Prescott P, et al. CAM use in Europe: The patients' perspective. Part I: A systematic literature review of CAM prevalence in the EU. Online document at: https://phaidra.univie.ac.at/view/o:292161 Accessed October 20, 2017. Google Scholar3 Kemppainen LM, Kemppainen TT, Reippainen JA, et al. Use of complementary and alternative medicine in Europe: Health-related and sociodemographic determinants. Scand J Public Health 2017 Oct 1 [Epub ahead of print]; DOI:10.1177/1403494817733869. Crossref, Medline, Google Scholar4 Fischer F, Lewith G, Witt CA, et al. A research roadmap for complementary and alternative medicine—What we need to know by 2020. BMC Complement Altern Med 2014;14:46. Medline, Google Scholar5 Nissen N, Schunder-Tatzber S, Weidenhammer W, et al. What attitudes and needs do citizens in Europe have in relation to complementary and alternative medicine? Forsch Komplementmed 2012;19:9–17. Crossref, Medline, Google Scholar6 Kienle GS, Albonico HU, Baars E, et al. Anthroposophic medicine: An integrative medial system originating in Europe. Glob Adv Health Med 2013;2:20–31. Crossref, Medline, Google Scholar7 Reiter B, Baumhöfenerb F, Dlaboha M, et al. Building a sustainable complementary and alternative medicine research network in Europe. Forsch Komplementmed 2012;19:61–68. Crossref, Medline, Google Scholar8 Complementary and Alternative Medicine CAM—for a healthier Europe. EUROCAM. Online document at: http://cam-europe.eu/index.php Accessed October 20, 2017. Google Scholar9 CAM workshop European Parliament 16 Oct 2017. EUROCAM. Online document at: http://cam-europe.eu/cam-workshop-european-parliament-16-oct-2017.php Accessed October 20, 2017. Google Scholar10 About the Society. European Society of Integrative Medicine. Online document at: www.european-society-integrative-medicine.org/ Accessed October 20, 2017. Google Scholar11 The Future of Comprehensive Patient Care. The European Congress for Integrative Medicine. Online document at: www.ecim2018-slovenia.org/ Accessed October 20, 2017. 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