MD, PhD, FMedSci, FSB, FRCP, FRCPEd

All across the world we see initiatives to regulate alternative medicine. The most recent news in this sphere comes from Switzerland. The ‘Swissinfo’ website reported that the training of alternative medicine practitioners is to be regulated by creating a ‘COMPLEMENTARY MEDICINE DIPLOMA’.

The decision was welcomed by the Organisation of Swiss Alternative Medicine Professionals (OdA KT), which will conduct the exams for the diploma in question. The five therapies selected by the government for the complementary medicine diploma are yoga, ayurveda, shiatsu, craniosacral therapy and eutony. The first exams are expected to be held in 2016.

“Recognition by the state provides an important political basis for these therapies,” Christoph Q Meier, secretary general of OdA KT told swissinfo.ch. “The diploma will also improve the quality of therapy offered in Switzerland, as until now anybody could call themselves a therapist.” Meier estimates that there are between 12-15,000 practitioners of complementary therapies in Switzerland. Applicants for the national diploma will first have to pass a series of pre-exams. However, those with recognised qualifications and at least five years of experience could be exempt from the pre-exams. The exam is open to foreign nationals but will only be offered in German, French and Italian. In April this year, ayurveda was also included for a separate national diploma in naturopathy medicine along with Chinese and European traditional medicine, as well as homeopathy. Switzerland has around 3,000 naturopaths.

Whenever issues like this come up, I ask myself: IS REGULATION OF ALTERNATIVE MEDICINE A GOOD OR A BAD THING?

On the one hand, one might be pleased to hear that therapists receive some training and that not everyone who feels like it can do this job. On the other hand, it has to be said that regulation of nonsense will inevitably result in nonsense. What is more, regulation will also be misused by the practitioners to claim that their treatment is now well-established and supported by the government. This phenomenon can already be seen in the comments above and it misleads the public who understandably believe that, once a form of health care is regulated officially, it must be evidence-based.

So, what is the solution? I wish I knew the answer.

Any suggestion is welcomed.

25 Responses to The regulation of alternative medicine – a good or a bad thing?

  • It all depends who the regulators are!
    We can probably expect them to be ‘industry professionals’ in which case we are doomed!

  • One regulator for all with standardized rules applicable to all!
    https://www.ahpra.gov.au/
    This should be extended further!

  • Health care practice is already regulated.
    In the UK – by the GMC, GDC, GNC, HPC etc.

    Folks who do not want to, or cannot, secure registration with existing bodies are excluded.
    That’s how reputable health professions are regulated.
    Any attempt to water down the existing systems will harm important provisions for patient protection – which is why the regulatory systems were established in the first place.
    Patients can still see quacks if they wish, but can at least judge their professional status.

    As all right thinking commentators have said (including Professor Ernst): “It is a nonsense to regulate nonsense.”
    What next? Palmistry, spirit mediums, astrology, faith healers?
    Just because a CAM envelops itself in a Cloak Of Confusion and gives out that its treatments are based on ‘evidence’, are rational and provide ‘benefit’ does not make it so.

    Please will camists (who practice CAM) and who want to be in a regulated profession, take the trouble to join one.
    A few doctors have done so and still practice homeopathy (admittedly in the face of criticism that they have failed to provide any plausible evidence that the remedies they prescribe have any benefit greater than placebos. In otherwords – they are placebos). The GMC has yet to assess whether these doctors are fit to practice, but a regulatory mechanism does exist and can be called upon if there are complaints that ethics have been breached. For example, that fully informed consent to treatment has not been obtained.

    If CAM is ‘regulated’ it will cease to be an alternative and patients who do want an alternative will be deprived of the benefits of their faith. They will have to turn to crystals and unidentified flying energies.

    Let us stop the infighting and join together for the common good.
    First step (of many) is for camists to join a regulated profession.

  • Alt-med is religion, masquerading as medicine, perpetrating fraud. The only regulation is requires is a court of law.

    • This is truly a cynical and hateful website. Was just reading an article with a title that suggested a positive story about fish oil. Instead it was a smoke screen that hid another negative attack on something non-pharma. And then of course the article was accompanied by spiteful comments from the membership.

  • I have just graduated from a 4 year Integrated Masters in Ayurveda. In my opinion it is the basic right of the patient that they are protected when receiving treatment from a qualified practitioner. It is also right that the practitioner is protected too. The comment whether CAM should be regulated is too generalised. It is seen in systematic research on the definition of CAM that the majority of those in Europe do not know what CAM means. Therefore it is not likely to be regulated under these conditions. I value Ayurveda and the positive effects it can bring in both acute and chronic conditions. It is a medical system in it’s own right and shouldn’t be presented under the CAM banner.

    • What’s CAM then and where’s the evidence for ayurveda?

      • What’s CAM? That is exactly the point; it is undefinable. Read the paper by Wieland et al.,2011. Altern. Ther. Health Med. As for where is the evidence on Ayurveda. Evidence that it is a medical system in its own right, you are not clear? Or scientific evidence. There is evidence of both and the body of research is growing slowly. Without regulation funding for more rigorous studies is hindered further.

        • more often than not, regulation is misused by proponents to masquerade as evidence. in this way, regulation often hinders research into the effectiveness of alt med.

  • I still can’t believe that there is just course and diploma in non-sense. We are in the 21 century, and still, the belief is strong.

    Think about the money wasted on regulation Regulation… Of fantasy and pure delirium. How we came to this ?

  • I am all for watchdogs and whisteblowers. But you guys attacking every system of healthcare on the planet except the one that kills the most, harms the most, is the most corrupt, and in many respects the most fraudulent and quack-laden… it is funny and also terribly tragic.

    The worship of MDs and their toxic plastic pills. Knocking down symptoms while ignoring root cause. The patient feels better now but pays the price later. The appearance of scientific rigor, but when deconstructed it’s a lot of smoke and mirrors and unsound methods.

    Behind the facade of technology and machines and white coats and the aura of omniscience lurks a crudeness and ignorance and superficiality. Most docs for example lack basic understanding of the role of diet/nutrition in health and disease. Is that not quackery?

    Natural medicines are powerful and beautiful. Give it a try. Plants are our friends.

    • where did you see me worship MDs and their toxic pills?
      if directed at me, your recommendation to ‘give it a try’ is very funny – I have researched this area for >20 years.
      are you sure you know what you are on about?

  • Any system of regulation for any kind of CAM is not just a waste of our (taxpayers’) money, but positively dangerous, as it encourages people to think the therapy they are being offered must be OK – it has a government approval attached. In the UK, for instance, people associate any ‘approved’CAM as being automatically equivalent to real medicine. This must kill a lot of people – but we don’t know how many.

  • L. Barton: What you have described is almost exactly the situation here in the US with mainstream medicine and the quasi-regulation of the FDA.

    One difference — we DO have a good idea now many are being killed.

  • Well I am not even 1/4th as educated as most of you esteemed academicians and physicians. But I do have a question, if Ayurveda was indeed from the dark ages, why is it that the west is so desperate to stake their claim over traditional ayurvedic remedies like turmeric, neem,holy basil etc and in a race to steal them by way of patent claims? They have been used since thousands of years in India. I find certain comments from such educated people as blatantly racist and offensive.

    • Manu obviously knows very little about patents and how they work. You cannot “steal” something by applying for a patent for it.
      That someone applies for a patent does not mean that it does or will work. It only means that the applicant hopes to obtain time limited monopoly rights to an invention. The invention will have to be original and patentable. That someone is applying for patents concerning Turmeric says nothing more than it has become fashionable in the food supplement business. One cannot take a plant and claim patent for it. But one can claim patent rights within a certain state to have the exclusive rights for a limited time to for example extract something from the plant in a certain manner.
      Anyway, beware of anything called Ayurveda. There are several incidents on record of heavy metal poisoning from so called Ayurvedic nostrums. It might be because they happen to have been produced using the original old recipes.
      Of course the peddlers of archaic potions desperately try to explain away these facts but history (try Googling “Rasa Shastra) and recorded facts prevail. Ayurveda is archaic witchcraft.

      • Björn Geir: You’re obfuscating. The “stealing” is not explicit or direct; it happens through the systematic propagandizing and distorting that the pharma biz undertakes as part of their effort to (a) marginalize the substance in its original whole form, (b) discredit whatever medical systems use the substance in its whole form, and (c) claim the superiority of their synthesized version.

        As for your wholesale panning of Ayurveda… you are making a fool of yourself.

        • @Adam
          Your post makes no sense at all. What do you mean by marginalizing/discrediting the substance ‘in its whole form’ versus ‘their synthesized version’. A chemical is a chemical. It doesn’t matter a hoot whether it’s made synthetically or extracted from something. A molecule is a molecule; its structure is no different wherever it comes from.
           
          Perhaps what you’re objecting to is the use of a single molecule (synthetic or otherwise) as a drug, versus using a whole plant, as in herbalism. Suppose you have discovered a plant that clearly works to treat one or other definable disease. If you’re keen to make the most of your discovery, wouldn’t it seem natural to figure out which part of the plant really contains the most/best medicine? The leaf, the stem, the flower, whatever? Then wouldn’t you want to find which conditions of growth give you the active part of the plant with the strongest medicinal effect?
           
          Once you’ve got there, then maybe you can get your medicine even more effective by fractionating the active part of the plant till you have effectively isolated the molecule that really has the medicinal effect. Once you know what it is, you may even find it’s simpler to synthesize it than to grow a lot of plants and extract it (not always, but quite often). Oh, no! You can’t do that, because people like Adam prefer to use the substance in its original whole form: it can’t possibly ever be improved upon. Yep, the horse and cart clearly represent the best possible use of the wheel.
           
          By the way, what I’ve written also addresses your later post about artemisinin and TCM. It was science like what I described above that won Youyou Tu her Nobel Prize, not TCM. For over a century scientists have been looking at traditional medicines (and previously untested ‘natural’ sources) to discover which ones truly have a pharmacological effect, and finding exactly what it is that gives the medicinal property. The process is called pharmacognosy, and it leads to progress in medicine, instead of staying stupidly fixed on the achievements of the past, as if they can’t be improved upon.
           
          The internal combustion engine was an advance over the horse and cart; the jet turbine was an advance over the internal combustion engine. Science and technology constantly make advances to deliver you the most effective possible product. People like you would presumably reject matches, preferring to get your fire by rubbing sticks together.

          • Frank Odds: My point has simply been to counter the the notion that plants are of no value in their whole form, and must be “improved” by modern science before they are useful medicinally.

            This is NOT the same as saying that using the whole plant is the only way. Did I assert that somewhere, or are you putting words in my mouth?

            As for isolating the molecule with the medicinal effect, hasn’t it already been documented that there are problems with resistance to Artemisnin in the treatment of Malaraia? And that whole plant Artemisia does not have this problem?

            The wisdom of herbalism seems to be in understanding the synergy that exists between different compounds of a plant (sum is greater than the parts), as well as between different whole plants when used in concert.

          • @Adam
            “This is NOT the same as saying that using the whole plant is the only way.” I’m not putting words in your mouth. You’re the one who thinks that plants are best in their ‘whole form’ (what’s that? seeds, stem, leaf, flower, roots, just rip the whole darn thing out of the ground regardless whether it’s germinating, flowering, forming seeds, whatever. Do you really not comprehend the complexity of plant biology and the need to narrow down?)
             
            Yep, resistance is developing to artemisinin, as it does in most microbes for most antimicrobial agents. Please point to the data where the whole plant Artemisia does not have this problem. Since the ‘whole plant’ (see above) has not been tested in any kind of credible clinical trial it’s difficult to picture the evidence that resistant Plasmodium strains suddenly react differently to artemisinin when the stuff’s administered in the form of seeds, stems, leaves, flowers, whatever.
             
            “The wisdom of herbalism seems to be in understanding the synergy that exists between different compounds of a plant”. This is fair; the possibility is real that a given plant contains two or more compounds required to act synergistically to produce a medical effect. Chinese legislation on phamaceutical licensing actually favours this idea, though the evidence is support of the notion is slim. Please don’t keep assuming that those who seek to discover medicinally valuable compounds are more stupid than you are. I can guarantee there are large numbers of drug discovery projects that seek to take advantage of synergistic interactions. The difficulty is that they very seldom show up when serious testing is substituted for anecdote.
             
            The bottom line remains that, if a plant (you seem to be restricted to herbalism as the basis for pharmacology) can be reliably shown to treat a (properly defined) medical condition, tons of research scientists will descend on the phenomenon and seek to make their reputations and fortunes out of the effect. The approach has been historically successful in a number of instances. Sadly, the law of diminishing returns seems to be taking over, so the rate at which herbal sources provide genuinely valuable remedies — alone or synergistically — has sunk to deep parts of the barrel.
             
            Alan, please do keep eating your plants and remaining ignorant of what science actually involves. Keep rubbing the sticks together.

          • Frank Odds: Isn’t the vast majority of research driven by the search for isolated, patentable compounds and so whole plant remedies are not even on the radar of commercial science? In fact, whole plant medicine like cannabis would seem to be the antithesis of modern medicine.

            A link to an article on a whole plant artemisia study:
            https://www.umass.edu/newsoffice/article/whole-plant-therapy-shows-promise-beat

          • @Adam
            “Isn’t the vast majority of research driven by the search for isolated, patentable compounds and so whole plant remedies are not even on the radar of commercial science?” Not necessarily. The reason why it’s desirable to isolate active molecules rather than use whole plants is because it’s far simpler to standardize the medicine. Whole herbal products often show considerable variation in potency and toxicity, even from batch to batch. It’s simpler and safer to know exactly what’s being given to a patient rather than loading them with a complex mix of mostly unknown molecules.
             
            The story of the lower resistance induction of whole leaves of Artemisia vs. isolated artemisinin is a fascinating one. (The actual paper is Elfawal et al, PNAS 2015;112 (3): 821-826. The study was done in rodents, not in any clinical trial.) The authors point to synergistic effects between artemisinin and another substance in the whole plant, or to superior bioavailability of artemisinin by eating dried plant leaves. Both possibilities are amenable to scientific follow-up and could lead to patentable products.
             
            You mention cannabis. Surely that’s a supreme example where a whole field of knowledge has been generated by investigating why the plants have the pharmacological effects they do. Didn’t I read somewhere recently that the non-standardization of whole cannabis was leading to people exposing themselves to less safe, higher concentrations of the ingredients than in the forms of plants produced in the past?

        • @Adam

          It has been clearly explained here in this blog, with reference to reliable facts why and how medical substances of herbal origin are neither practical, efficacious nor safe when used as “whole plant”. If it were that simple, we would be growing wintergreen in our window sills and chewing chinchona bark on travels in the tropics. Just because some people like you believe otherwise and want to sell herbal homebrews from whole plants does not make them safe, effective or reliable.

          I do not mind being corrected if mistaken.
          Please explain in what way I am making a fool of myself by warning of a well documented risk and presenting a few of the abundant references to facts about heavy metal content of some[sic] so called Ayurvedic “medicine”. It is well known that heavy metal containing substances are part of many old recipes for “ayurvedic” and chinese herbal concoctions. One of the best known is cinnabar, which is a poisonous mercury containing ore. The onus is on you to convince us that I am mistaken. Calling me fool without substantiating the judgement only serves to reinforce your own emerging status as a simple troll

    • Manu: Could not agree more. The recent article here asserting that the discovery of artemesinin owes everything to modern science and nothing to TCM was similarly offensive. Not to mention arrogant and deluded.

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