Chapman-Smith D A
Med Law. 1997;16(3):437-49.
Traditional and complementary health care services have a growing and significant role in both developed and developing countries. In the United Kingdom the British Medical Association (BMA) has identified five complementary approaches to health care that should now be regarded as "discrete clinical disciplines" because they have "established foundations of training and have the potential for greatest use alongside orthodox medical care". These are acupuncture, chiropractic, herbalism, homeopathy and osteopathy. The BMA recommended that there should be legislation to regulate these disciplines and the Chiropractors' Act enacted in the U.K in 1994. The chiropractic profession was founded in the United States in 1895, and the practice of chiropractic has been regulated in the United States and Canada since the 1920s, in Australia since the late 1940s, in New Zealand and South Africa since the 1960s, and more recently in Asia, Europe, Latin America and elsewhere. Figure 1 lists the countries which currently recognize and regulate the chiropractic profession. Many countries, such as Japan with approximately 10,000 chiropractors with different levels of education, and Trinidad & Tobago with 5 chiropractors who are graduates of accredited chiropractic colleges in North America, are considering legislation. Croatia, with 3 chiropractors, is preparing legislation. Cyprus, with 6 chiropractors, has legislation. Even in countries such as these, where the profession is small, there are compelling public interest arguments for regulation. This is especially true in the 1990s. One reason is the growing incentive for lay healers and others without formal training to use the title "chiropractor" as chiropractic practice gains increasing acceptance. The majority of chiropractic practice involves patients with non- specific or mechanical back and neck pain. The chiropractic approach to management, which includes spinal adjustment or manipulation, other physical treatments, postural advice, rehabilitative exercises and early return to activities, formally only had empirical evidence of success. Now there is firm scientific support. Recent national, evidence- based, multi-disciplinary guidelines in Canada (neck pain), the United Kingdom (back pain), and the United States (back pain) support these methods as a first line of management for most patients. Another reason for regulation is that international standards of chiropractic education and scope of practice have been established by appropriate chiropractic organizations, including the World Federation of Chiropractic which represents national associations of chiropractors in 63 countries. This paper now reviews current legislation worldwide.
传统和补充性医疗保健服务在发达国家和发展中国家都发挥着越来越重要的作用。在英国，英国医学协会（BMA）确定了五种补充性医疗保健方法，现在应将其视为“独立的临床学科”，因为它们“有既定的培训基础，并且有潜力与正统医疗保健一起得到最大程度的应用”。这些方法是针灸、整脊疗法、草药疗法、顺势疗法和整骨疗法。BMA建议应制定立法来规范这些学科，英国于1994年颁布了《整脊疗法法案》。整脊疗法专业于1895年在美国创立，自20世纪20年代以来，美国和加拿大对整脊疗法的实践进行了规范，自20世纪40年代末以来在澳大利亚进行了规范，自20世纪60年代以来在新西兰和南非进行了规范，最近在亚洲、欧洲、拉丁美洲和其他地区也进行了规范。图1列出了目前认可并规范整脊疗法专业的国家。许多国家，如日本有大约10000名接受不同程度教育的整脊治疗师，特立尼达和多巴哥有5名毕业于北美认可的整脊疗法学院的整脊治疗师，正在考虑立法。克罗地亚有3名整脊治疗师，正在准备立法。塞浦路斯有6名整脊治疗师，已经有了立法。即使在这些专业规模较小的国家，也有令人信服的公共利益理由进行规范。在20世纪90年代尤其如此。一个原因是，随着整脊疗法实践越来越被接受，非专业治疗师和其他未经正规培训的人使用“整脊治疗师”头衔的动机越来越大。大多数整脊疗法治疗的患者患有非特异性或机械性的背部和颈部疼痛。整脊疗法的管理方法，包括脊柱调整或手法治疗、其他物理治疗、姿势建议、康复锻炼以及尽早恢复活动，以前只有成功的经验证据。现在有了确凿的科学支持。加拿大（颈部疼痛）、英国（背部疼痛）和美国（背部疼痛）最近基于证据的多学科指南支持将这些方法作为大多数患者的一线管理方法。进行规范的另一个原因是，包括代表63个国家整脊治疗师全国协会的世界整脊疗法联合会在内的适当整脊疗法组织已经确立了整脊疗法教育和实践范围的国际标准。本文现在回顾全球范围内的现行立法。
