Wiesener Solveig, Salamonsen Anita, Fønnebø Vinjar
The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
BMC Complement Altern Med. 2018 Jan 10;18(1):11. doi: 10.1186/s12906-017-2073-9.
Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe.
The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions.
Twelve of 39 countries generally understand the included CAM treatments to represent "high risk", 20 countries "low risk", while the remaining 7 countries understand CAM treatments as carrying "very little or no risk". The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe.
The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality healthcare", and regulate CAM accordingly.
许多欧洲公民正在寻求补充和替代医学（CAM）。这些疗法在欧盟/欧洲自由贸易联盟国家的监管差异很大。这可能表明在如何看待与使用补充和替代医学相关的风险方面存在差异。由于大多数补充和替代医学疗法在欧洲各地的实践方式相当相似，不同的风险认知可能会影响欧洲补充和替代医学使用者的患者安全。因此，本文的总体目标是在欧洲的政策制定/结构层面上，促进对补充和替代医学领域可能存在的不同风险认知的概述和认识。
该研究是对在“CAMbrella欧盟第七框架计划”文件中收集的数据以及关于39个欧洲国家补充和替代医学监管的访谈研究进行的重新分析。根据限制其实践仅限于受监管职业的国家数量，对“CAMbrella研究”中包含的12种补充和替代医学模式的假定风险潜力进行了排名。39个国家根据它们限制受监管职业实践的补充和替代医学模式数量进行了排名。
39个国家中有12个国家普遍认为所包含的补充和替代医学疗法代表“高风险”，20个国家认为是“低风险”，而其余7个国家认为补充和替代医学疗法“风险很小或没有风险”。在最多国家中被视为风险高到足以需要专业监管的补充和替代医学模式是整脊疗法、针灸、按摩、顺势疗法和整骨疗法。将研究中的大多数补充和替代医学模式视为潜在高风险疗法的国家，除了两个例外（葡萄牙和比利时），都集中在欧洲东南部地区。
补充和替代医学监管的差异可能表明欧洲卫生政策制定者之间在共同风险认知方面存在严重不足。我们认为，监管差异在很大程度上也基于与患者风险无关的因素。我们认为，欧洲各地的政策制定者解决这种混乱局面对于患者安全很重要。这可以通过应用世界卫生组织的患者安全定义和欧盟的政策来促进获得“安全和高质量的医疗保健”，并相应地对补充和替代医学进行监管来实现。
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