Forum sulle
Medicine non convenzionali
The
Social Demand for a Medicine Focused on the Person:
The
Contribution of CAM to Healthcare and Healthgenesis
Paolo
Roberti di Sarsina MD
Expert for Non Conventional Medicines, Italian National Council for Health,
Ministry of Health, Rome.
Coordinator
Committee for CAM in Italy. Department of Mental Health, Health Local Unit,
Bologna, Italy
(da eCAM
2007;4(S1)45–51 doi:10.1093/ecam/nem094)
ABSTRACT:
The Non Conventional Medicines have a greater social impact and the
demand for such treatments of more than 10 million Italian citizens
(male and female) of all ages and social classes and of thousands of
Italian families reveals an interest proving that there is a trend
reversal, involving also other sectors of the medical and scientific
world, which shifts the focus from the symptom to an idea of more
general and comprehensive well-being of the person. Over the last few
years the scientific debate on Non Conventional Medicines and their
integration with the academic or dominant medicine in our western
society has favored and legitimated an increase in the demand and has
activated a cultural transformation process involving the life styles.
The focus is therefore shifted to the self-healing capacities, to the
reawakening of the individual potentialities, which support and amplify
the benefits of the treatments and the citizens start pretending to be
accurately informed in order to choose freely their own health program.
Introduction
The
definition of CAM, relative to statements of NCCAM and WHO, points out that
‘unconventional’, although the most common expression used in Italy, would
seem to place these treatment methods in contrast with academic medicine,
considered as conventional. In the English-speaking world the term CAM
(Complementary and Alternative Medicine) is used, and it is crucial to
underline the complementary nature of different possible diagnostic and
therapeutic approaches that fit here in order to emphasize the integration
which is currently in the health system and the possibility of the practical
use of all the information provided by the patient. Concepts like healthcare
strictly connected with that of healthgenesis are introduced together with
data concerning CAM in the western world thus focusing on the present
situation of Non Conventional Medicines/Introduction The definition of CAM,
relative to statements of NCCAM and WHO, points out that ‘unconventional’,
although the most common expression used in Italy, would seem to place these
treatment methods in contrast with academic medicine, considered as
conventional. In the English-speaking world the term CAM (Complementary and
Alternative Medicine) is used, and it is crucial to underline the
complementary nature of different possible diagnostic and therapeutic
approaches that fit here in order to emphasize the integration which is
currently in the health system and the possibility of the practical use of
all the information provided by the patient. Concepts like healthcare
strictly connected with that of healthgenesis are introduced together with
data concerning CAM in the western world thus focusing on the present
situation of Non Conventional Medicines/ CAM in Italy. ‘Medicine Focused On
The Person’ results from the need of every patient and client. The
importance of being treated with dignity and respect is every person’s
right, improving patient’s experience of care, reducing inequalities, being
well aware of the ‘health social gradient’ with regards to sustainable
balance and pharmacoeconomy in order to encourage change in the thought
processes of Health Policy, particularly towards those developing national
health care strategies. The term ‘Medicine Focused On The Person’ in terms
of sustainability clearly includes, the sense of Integrative Medicine as a
synergistic and harmonious blend of conventional and complementary medicine,
within a safe environment but looks open to future developments. The results
of numerous surveys on health care quality carried out in the USA, in Europe
and more recently in Italy show that, if a patient is asked to assess the
quality of the medical treatments, his/her priorities are: humanization,
tailoring of the treatments, the need of attention from Public Institutions
and adequate information in a comfortable environment for a free choice of
the individual health individual health programs leads to a different social
view of the healthcare quality and of the attention given by the
Institutions to the social need for the humanization of the welfare system
starting from Medicine or better from the social demand for a Person-Focused
Medicine.
Person-focused Medicine
The
Person-focused Medicine provides a psychophysical balance to the individual,
and this is the stepping-stone of any sustainable social balance for current
and future societies. Non Conventional Medicines represent a development of
medical knowledge and practice. The evolution of the medical doctrine in the
end of the 19th century led to great undeniable medical progresses; on the
other hand the methodological and epistemological approaches of NCM/CAM are
useful to meet the 21st century requirements.
Complementary and Alternative Medicine
As
is known, CAM is a widely used term, but it has no commonly accepted
definition. 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 (appendix)] and subsequently adopted by the
Cochrane Collaboration and the Ministerial Advisory Committee on
Complementary and Alternative Medicine. The definition is: ‘Complementary
and alternative medicine (CAM) is a broad domain of healing resources that
encompasses all health systems, modalities, and practices and their
accompanying theories and beliefs, other than those intrinsic to the
politically dominant health system of a particular society or culture in a
given historical period. CAM includes all such practices and ideas
self-defined by their users as preventing or treating illness or promoting
health and well-being.’ The World Health Organization defines it as follows:
‘Complementary and alternative medicine (CAM) refers to a broad set of
health care practices that are not part of a country’s own tradition and not
integrated into the dominant health care system. Other terms sometimes used
to describe these health care practices include ‘‘natural medicine’’,
‘‘non-conventional medicine’’ and ‘‘holistic medicine’’.’ The World Health
Organization in ‘General Guidelines for Methodologies on Research and
Evaluation of Traditional Medicine (Geneva, 2000) states the following
definitions of Traditional Medicine ‘Traditional Medicine has a long
history. It is the sum total of the knowledge, skills and practices based on
the theories, beliefs and experiences indigenous to different cultures,
whether explicable or not, used in the maintenance of health, as well as in
the prevention, diagnosis, improvement or treatment of physical and mental
illnesses. The terms complementary/alternative/non-conventional medicine are
used interchangeably with traditional medicine in some countries.’
Traditional Medicine (TRM)
Traditional medicine is the sum total of the knowledge, skills and practices
based on the theories, beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the maintenance of health as
well as in the prevention, diagnosis, improvement or treatment of physical
and mental illness.
Complementary/Alternative Medicine
The
terms ‘complementary medicine’ or ‘alternative medicine’ are used
inter-changeably with traditional medicine in some countries. They refer to
a broad set of health care practices that are not part of that country’s own
tradition and are not integrated into the dominant health care system.
Herbal Medicines Include
(i)
Herbs including crude plant material such as leaves, flowers, fruit, seed,
stems, wood, bark, roots, rhizomes or other plant parts, which may be
entire, fragmented or powdered.
(ii)
(ii)
Herbal materials including, in addition to herbs, fresh juices, gums, fixed
oils, essential oils, resins and dry powders of herbs. In some countries,
these materials may be processed by various local procedures, such as
steaming, roasting or stir baking with honey, alcoholic beverages or other
materials.
(iii)
(iii) Herbal preparations are the basis for finished herbal products and may
include comminuted or powdered herbal materials, or extracts, tinctures and
fatty oils of herbal materials. Extraction, fractionation, purification,
concentration or other physical or biological processes produce them. They
also include preparations made by steeping or heating herbal materials in
alcoholic beverages and/or honey, or in other materials.
(iv)
(iv)
Finished herbal products consisting of herbal preparations made from one or
more herbs. If more than one herb is used, the term mixture herbal product
can also be used. Finished herbal products and mixture herbal products may
contain excipients in addition to the active ingredients. However, finished
products or mixture products to which chemically defined active substances
have been added, including synthetic compounds and/or isolated constituents
from herbal materials, are not considered to be herbal.
Traditional Use of Herbal Medicines
Herbal medicines include herbs, herbal materials, herbal preparations and
finished herbal products that contain as active ingredients parts of plants,
or other plant materials or combinations. Traditional use of herbal
medicines refers to the long historical use of these medicines. Their use is
well established and widely acknowledged to be safe and effective, and may
be accepted by national authorities.
Activity
Therapeutic activity refers to the successful prevention, diagnosis and
treatment of physical and mental illnesses; improvement of symptoms of
illnesses; as well as beneficial alteration or regulation of the physical
and mental status of the body.
Active Ingredients
Active ingredients refer to ingredients of herbal medicines with therapeutic
activity. In herbal medicines where the active ingredients have been
identified, the preparation of these medicines should be standardized to
contain a defined amount of the active ingredients, if adequate analytical
methods are available. In cases where it is not possible to identify the
active ingredients, the whole herbal medicine may be considered as one
active ingredient.
World Health Organization
WHO
made a number of policy recommendations concerning practitioners of TM/CAM.
Among these were that national governments should: establish registration
and licensing of providers; recognize the role of TM/CAM providers in
providing health care; optimize and upgrade the skills of TM/CAM providers;
develop training guidelines for the most commonly used TM/ CAM therapies;
strengthen and increase the organization of TM/CAM providers; strengthen
cooperation between TM/CAM providers and other health care providers. The
most widespread Non Conventional Medicines in Europe share a holistic view
of man and of the world, take into account the complexity of the natural
phenomena, the study of the man-environment relationships and of the
mind-body interactions, the meaning of man’s spiritual integrity and the
potential active role of the patient in his/her recovery and in the
preservation of good health. A modern professional ethics, which aims at
achieving a satisfying doctor–patient relationship, should develop from a
renewed listening capacity to a renewed understanding capacity. This implies
that the focus on the microscopic and tiniest aspects is to be shifted and
the view extended to the natural and social environment I which man lives
and falls ill. That is why an integrative medicine based on a true
confidence is required.
The Consortium of Academic Health Centers for Integrative Medicine
In
the year 2000 The Consortium of Academic Health Centers for Integrative
Medicine, (CAHCIM) was founded in the USA in order to promote CAM research
and training. It gathers more than 30 universities. The Consortium developed
and adopted on May 2004 and edited on May 2005 the following Definition of
Integrative Medicine: ‘Integrative Medicine is the practice of medicine that
reaffirms the importance of the relationship between practitioner and
patient, focuses on the whole person, is informed by evidence, and makes use
of all appropriate therapeutic approaches, healthcare professionals and
disciplines to achieve optimal health and healing.’ The World Health
Organization, with resolution no. WHA56 31 dated May 28, 2003, invites the
Member States to formulate and implement policies and national regulations
on NCM, and to give special attention to personnel training. The best
position statement on the practice of CAM at European level was produced by
the Council of Europe in a resolution in 1999 Resolution 1206.
The Council of Europe
The
membership of the Council of Europe embraces all European countries
including the EU 27. On November 4, 1999 the Council of Europe published the
Resolution no. 1206 on non-conventional medicine. In it the Council stated
that: various forms of medicine should not compete with one another; 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.
The European Union
The
free movement and establishment of persons within the EU is a cornerstone of
the Treaty of Rome, but the diversity of national policies on healthcare
severely limits its applicability to practitioners of CAM because Article
152 of the Amsterdam Treaty states: ‘Community action in the field of public
health shall fully respect the responsibilities of the Member States for the
organisation and delivery of health services and medical care.’ European
Parliament (1997), Council of Europe (1999) and World Health Organization
(2003) stated that policies and regulations on CAM should be formulated and
implemented. Directive 2005/36/EU (appendix) on the recognition of
professional qualifications: mutual recognition of qualifications after
completion of basic medical training or specialist medical training. No
mutual recognition of other medical qualifications. New medical specialties
can be included if common to at least two-fifths of the Member States. In EU
we have no legislation in CAM area also if CAM in medical practice is a
growing remarkably widespread phenomenon in the EU. This situation causes
self-regulation by establishing training standards and accrediting training
courses. National statutory/legal regulation is still patchy in spite of
resolutions by EP, Council of Europe and WHO.
The European Community and CAM
There is a growing demand among the European citizens CAM: the clinical
effectiveness of CAM is, in many cases, at least as high as the
effectiveness of conventional medicine, as showed by several long-term
studies involving many thousands of patients; CAM is not only effective but
also very safe, and that, therefore, CAM can help to reduce the enormous
burden of mortality and morbidity caused by the adverse effects of
conventional prescription drugs. In the ‘Seventh Framework Programme of the
European Community for Research, Technological Development and Demonstration
Activities’ (2007–13) 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 pharmacovigilance and scientifically tested
complementary and alternative medicines) as well as the specificities of
children, women and the elderly population.’ NCM/CAM empowers the patient
taking responsibility for its own health; it promotes the individual’s
health awareness making her/ him less dependent of the present health care
system (social security).
Analyses of Cost
Studies indicate that NCM/CAM is cost effective since it contributes to and
restores a sustainable health (certainly in the long run and taking into
consideration the positive social fringe effects). Integrated Health Care
offers the better of two worlds, i.e. conventional medicine and NCM/CAM. A
system of Integrated Health Care will contribute to a healthier health
economy, since NCM/ CAM deals with (potential) health problems in an earlier
stage and will thus prevent high-cost interventions in more advanced
pathology.
Italian Situation
In
2002 the Italian National Federation of MDs’ and Dentists’ Colleges (FNOMCeO)
with the so-called Terni Resolution, entitled ‘Guidelines on Non
Conventional Medicines and Practices’, assigned to nine disciplines the
medical status: Acupuncture, Traditional Chinese Medicine, Homeopathy,
Homotoxicology, Ayurvedic Medicine, Anthroposophic Medicine, Phytotherapy,
Osteopathy and Chiropractic. Government and Parliament had been invited to
pass a law that acknowledges and rules the practice of NCM. Such law has not
yet passed. Similar resolution has been issued on 2003 by the Italian
Federation of Veterinarians (FNOVI). On the other hand the Italian Supreme
Court of Justice [(Suprema Corte di Cassazione, Statement no. 1735/
21.05.2003 (appendix)] stated that those CAM must be practised only by MDs.
Perspective towards the Future
The
educational and therapeutic task of Complementary Medicines is to teach
modern medicine how to take advantage of their contribution in an integrated
way, including humanization of medical practices. The time has come now for
a deep reflection involving all the society levels as it is the society
itself, the patients’ and citizens’ associations, as well as the individual
citizens (male and female) who demand that the integrity and wholeness of
each human being is restored and respected with regards to the
diagnostic-therapeutic access. This is the first contribution of Non
Conventional Medicines to a medicine focusing on the human being in its
wholeness, integrity and full dignity for a suitable and free choice of the
individual health program. Health is no longer conceived as absence of
illness but it corresponds to the psychophysical well-being claimed by the
World Health Organization.
TORNA AL FORUM SULLE MEDICINE NON
CONVENZIONALI
