Complementary and Alternative Medicine had a real growth in the last decades, in The European Union and in Romania as well. Having a controversed history, it is the one that successfully completes the treatments prescribed by the conventional phisicians. It is though necessary to clearly define C.A.M. and all the therapies that are included, and to prezent o short history of it, and a knowledge of the Romanian and European Legislation about C.A.M.. Our aim is: to offer these above mentioned informations, to prezent the problems of C.A.M. in Romania, and to offer some solutions and new perspectives to these problems.
Key words: C.A.M., complementary, therapies, alternative.
C.A.M. is defined in many ways, but the main ideea is that it will always remain an indispensable tool in helping and asisting Allopatic Medicine. The definition of CAM is recent. It has been developed at a 1997 conference of the United States Office for Alternative Medicine of the National Institutes of Health [now National Center for Complementary and Alternative Medicine, NCCAM and subsequently adopted by the Cochrane Collaboration and the Ministerial Advisory Committee on Complementary and Alternative Medicine. The definition states that ‘Complementary and alternative medicine (CAM) is a very large domain of healing resources that can accompaniate the health system,with all its healing modalities, practices and beliefs.’.(1) The World Health Organization, – in which Romania’s health system is also included – defines it as being a world wide spread practice which doesn’t necessarily include the traditional medicine and religious beliefs of a country (2). Other terms sometimes used for describing medical practices include ”natural medicine”, ”non-conventional medicine” and also “holistic medicine”. (1 , 2).
There are different ways to define C.A.M.. Another main issue is that C.A.M. is considered to be a non-conventional ansamble of therapies not integrated in the dominant health care system. It is formed of all the therapies and aiding techniques used to improve or maintain the population’s health (3). The Council of Europe states that all the 27 EU countries should affiliate to the same medical system, and so, on November the 4th 1999 the Council of Europe published the Resolution no. 1206 on non-conventional medicine. In it the Council stated that: various forms of medicine exist in Eu; it is possible for them to exist side by side and complement one another; alternative or complementary forms of medicine could be practiced by doctors of conventional medicine as well as by well-trained practitioners of non-conventional medicine; a patient could consult one or the other, either upon referral by family doctor or of his/her free will; ethical principals should prevail; Member States should model their approach of their neighbors’ experiments and, whenever possible, co-ordinate their position with regard to these medicines.1, and in the ‘Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities’ (2007-2013) among the provisional activities in the chapter ‘Optimizing the delivery of health care to European citizens’, CAM are included as follows: ‘Translating clinical outcome into clinical practice: to create the knowledge bases for clinical decision-making and to address the translation of outcomes of clinical research into clinical practice, especially addressing patient safety and the better use of medicines (including some aspects of scientifically tested complementary and alternative medicines) as well as the specificities of children, women and the elderly population.’ (1).
The historical background of C.A.M.
‘Traditional Medicine has a long history. It is the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences which are specific to different cultures, used to promote health, as well as in the prevention, diagnosis, improvement or treatment of both physical and mental diseases. The terms complementary/alternative/non-conventional medicine are used interchangeable in some countries.’ (1 , 3). It is hard to identify which is the exact moment when a culture or a traditional medical system has been born. Recalling World Health Assembly resolutions promoting traditional medicine, including WHA 56.31 on Traditional Medicine of May 2003, we can assume that the term “traditional medicine” historical covers a wide variety of terapies and practices which may vary greatly from a country to another and from a region to another region, and that traditional medicine may also be referred to as alternative or complementary medicine (1 , 4).
Recognizing traditional medicine as one of the resources of primary health care services to increase availability and to contribute to improve health outcomes including those mentioned in the Millennium Development Goals (1).
As Healthcare practices, the history of CAM finds her references in the global history of Medicine. Historically, there were first different ways of Healthcare practices around the world. In the east of world, the healthcares find her sources in philosophy (Traditional Chinese Medicine for example). In West countries, there was Folk Medicine (Herbal Medicine for example), and the knowledge was orally transmitted. The first separation appears in occident comes with the importance of religions in prevention and cure (Greek Medicine, Arabic Medicine). As example Hygienic attitude is recognition of Arabic world and this was the same in Roman Empire with thermal baths. At this date of history, there was the “God’s Medicine” and Folk medicine. The second separation appears in the XVIIe century. A new model of human functioning appears. In France, with Descartes theory, Brain and body were definitively separated (but afterwards, he proved all wrong). He has been dubbed the “Father of Modern Philosophy”, and much of subsequent Western philosophy is a response to his writings, which continue to be studied closely to this day. Descartes was also one of the key figures in the Scientific Revolution. René Descartes (1596-1650) published his Discourse on the Method in 1637, which helped to establish the scientific method. (2)
THE EUROPEAN UNION LAWS REGARDING C.A.M.
There are some European Laws regarding C.A.M., laws that decide the statuss of C.A.M. all-over the EU. These laws are in the legislation of The European Parliament, which had the duty to launch a process of recognizing nonconventional medicine and, to this end, to take the necessary steps to encourage the establishment of appropriate committees. (3). The EU Parliament should also carry out a thorough study into the safety, effectiveness, area of application and the complementary or alternative nature of all the types of medicines and to draw up a comparative study of the various national legal models to which non-conventional medical practitioners are subject.
It is also indicated that after all these steps, The European Parliament has to draw a definite line to separate all the therapies and traditional medicines, in order to have a general view upon them, and, on the other hand, upon Allopatic Medicine.(4)
The Resolution 1206 (1999) – A European approach to non-conventional medicines, (Extract from the Official Gazette of the Council of Europe – November 1999) also comes with something new. The Assembly reaffirms the importance of conventional medicines whose effectiveness has been proved scientifically and which form the basis of European social protection systems. It notes, however, that alternative, complementary and nonconventional forms of medicine are growing in importance in Europe and throughout the
world. The well-established forms include acupuncture, homeopathy, osteopathy and
chiropractic. However, these are not alone among less conventional methods, some of
which have been in existence for a very long time. Patients themselves are increasingly calling for the use of different forms of treatment. This is a fact that cannot be ignored. The Assembly recognises the preeminence of conventional medicines (5); however, the various forms of medicine should not compete with one another: it is better for them and for human health to stay side-by-side and to complete each-other. In the health field, it is important to preserve the diversity of national legislation and practice that is one of Europe’s assets: people’s attachment to their own systems and traditions must be respected (5 , 6).
Laws in Romania regarding usage of CAM
Laws in Romania regarding CAM are dichotomous, being elaborated to specify the patients’ perspective on CAM, and also the providers’ perspectives and regulations. The above-named laws are: the law associated with rights and patient access to therapies and practices of complementary / alternative medicine, and the Law regarding professional organizations of medical practitioners complementary / alternative and exercise control activities. The first law states that:
All people have access to treatment and practice of complementary medicine / alternative, regulated by law.
People who are under practitioner of complementary and alternative medicine treatment must be told benefits of complementary medicine / alternative and should be expressed in writing the agreement will.
People who are under a practitioner of complementary medicine / alternative benefit the privacy of health.Persons under treatment must receive written information accessible and easy to understand, to know the benefits and risks they run.(8 , 9)
The second Law, (regarding professional organizations of medical practitioners complementary / alternative and exercise control activities), states the following regulations:
With the Medical Practitioners Order , complementary / alternative work specialized committees for each area of practice of complementary medicine / alternative, are bound to regulate professional practitioners in each specific area.
Order of Practitioners of Complementary Medicine / Alternative is required to develop code of ethics, supported by specialist committees.Code of ethics includes the rights to practice, disciplinary sanctions for professional incompetence, practice restrictions in case of incompatibility or damage to patient health.
Evidence of practitioners of complementary medicine / alternative is held in single register of practitioners of complementary medicine / alternative, which is kept at the headquarters of the Order of Practitioners of Complementary Medicine / Alternative necessarily communicate and National Centre for Training in Healthcare.
Ministry of Public Health, College of Physicians in Romania, Dental College and College of Pharmacists in Romania Romania shall, in consultation with the Order of Practitioners of Complementary Medicine / Alternative, studies curriculum for institutions that prepare practitioners of complementary medicine / alternative to ensure level qualification. (9)
Solutions for the Romanian laws regarding C.A.M.
As it has been seen before, the Romanian law is not very specific regarding C.A.M.
CAMbrella – the pan-European network for Complementary and Alternative Medicine in the EU in its newsletter spring 2011 writes: “In Romania the legislation regarding the practice of different therapies is very permissive, even though there are no accredited trainers and no official certification for many CAM therapies. (10) As proof for this, is the Romanian law: Ordin nr. 418/2005 “Certification of graduation in the programme of complementary studies implied obtaining a competence issued exclusively by the Ministry of Health through the National Center of Continuous Education Bucharest only for medical doctors, dentists and pharmacists”. (11)
The conclusion is that in Romania the Ministry of Health doesn’t specify clearly which therapies are only for MDs, and which ones can be practiced also by other categories, excepting Kinetotheraphy – which can be practiced by anyone who graduated the Competence Exam in this field.
Because the laws in Romania are unclear, non-specific and permissive, a non MD’s Association – ANATECOR (The National Association Regarding Complementary Therapies in Romania) has gained field in our country. This non-Governmental Association covers all the non-MD therapists and the MDs that share the same opinion with them. From their point of view, all CAM therapies should be provided also by other fields of activity, not only by MDs. (12). We don’t agree with these, because anyway the current statuss of CAM in Romania is already a derutating one, and now ANATECOR wants to develop a law-project for our Parliament to vote for liberalizing CAM in Romania. Adopting this law means a total chaos for alternative therapies, for patients, and of course, for MDs.
The solution against the law ANATECOR is prepairing would be a more specific legislation about CAM in Romania. This new legislation should be accordingly to the EU regulations, but should also agree with what MDs want for first, and then with what therapists from other categories want.