Summary: Welcome to this Integrator travelogue, linking you to international policy developments in traditional medicine and complementary and alternative medicine practices ... A citizen's referendum in Switzerland forces inclusion of CAM practices in healthcare planning ... In England, a report from the King's Fund concludes that we need both new methodologies and new attitudes, thank you, to optimally research complementary medicine and health ... A report on non-conventional medicine (the preferred term) in Italy calls for an end to 20 years of procrastination, and shares what's already covered in Tuscany and parts north ... Actuary Heather McCloud, a CAM leader in the International Association of Actuaries, is setting up a similar group in a new African health economics organization ...

In recent months, the Integrator has received articles from various sources offering insight into developments in complementary, alternative and integrative medicine, or "non-conventional medicine" (NCM) as is used in Italy. These range from a call for government action to "stop 20 years of procrastination and pass a full-scale national law" (Italy) to a significant breakthrough toward inclusion (Switzerland), identifying methodological needs (England) and getting CAM-interested actuaries together (Africa). Enjoy the travels!

1.  Notes on CAM and the European Union: Petitions in Brussels push for better integration

A report on Italy by Paolo Roberti di Sarsina, MD and Iseppato Ilaria, discussed below, includes a brief review of action to push the European Union (EU) to incorporate complementary and alternative medicine into policies and actions. The authors note petitions and action from the late 1990s through 2005 which led to an October 2007 European Union health program that, in the EU report's words, "should reflect the importance of a holistic approach to public health and, where appropriate and supported by scientific and clinical evidence of effectiveness, consider complementary and alternative medicines within its scope.’’ A year later, complementary medicine advocates were back in the EU capitol of Brussels delivering a 9-point "manifesto" which ends with: "For the benefit of all Europeans, we strongly recommend that the European Union promote the integration of valid CAM and effective Medicinal Traditions in its health policy!" In a separate article published in E-CAM in June 2009, Roberti offers data on use of a category called HAMP (Homeopathic and Anthroposophical Medicinal Products), used by 49% of the French, 46% of Germans and 35% of British.
 

Joerg Fritschi, MD - leading the successful referendum drive

2.  Swiss pass referendum to place CAM inclusion in the constitution

Earlier this year, the Swiss people voted via national referendum in favor of a constitutional article to include complementary medicine in national health policies. Of those voting, 67 percent of voters supported the new constitutional article. By the act, according to advocates, Switzerland became "the first country in Europe to set out in the constitution, authority for the state (cantons) and constituent states to take complementary medicine into consideration in the public health service." The language is as follows:

Federal constitution Art. 118a BV:

"The Federal government and cantons shall ensure that, within the scope of their jurisdiction, complementary medicine is taken into consideration."

• "Admission of doctors of complementary medicine in the fields of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM) into obligatory health insurance;
  
• "Creation of national diplomas for non-medical therapists;
  
• "Integration of complementary medicine into teaching and research, and
• "safeguarding of proven remedies."
  

Comment:  Living as I do in a state in which I am able to have many services of licensed complementary healthcare practitioners covered via a state legislated requirement that was forced on them by our then Insurance Commissioner Deborah Senn (thank-you, Deborah), I particularly celebrate the organizing these citizens apparently engaged to push this referendum by reluctant lawmakers. It will be interesting to see what is in, and what out, once the evidence battle is engaged. (Thank you Clem Bezold, for the heads-up on the story - last June!)

Paolo Roberti di Sarsina, MD - pushing Italian government to action

3.  To the Italian Government: End procrastination and develop a "full-scale national law" on non-conventional medicines

Non-Conventional Medicine in Italy: The present situation is an 8-page

Comment:  Looking abroad helps us reflect on what is here at home. Some parallels are interesting: coverage and inclusion of "NCMs" is a regional phenomenon in the US as well, also with something of a north-south split. And while we have, in the U.S., an organized, national commitment to funding research, we do not have significant national legislation, other than for chiropractic medicine, that requires inclusion. Professional organizations representing licensed acupuncturists, naturopathic doctors and certified professional midwives are knocking at these doors this year. Yet when all is said after the current health reform push in Congress, we could conclude that "there is still much work to be done and, maybe, time is not ripe yet." (Thank you Paolo for sending the files to the Integrator.)

Professor Dame Carol Black - report on CAM assessment focuses on health creation

4.  England: Report from King's Fund recommends new directions in assessing CAM

A special committee of the King's Fund, chaired by Dame Carol Black, published a report in August 2009 entitled Assessing Complementary Practice: Building Consensus on Appropriate Research Methods. The report comes smack down on the side of needing some new approaches to research: "It is our belief that the specific difficulties we grappled with (relative to complementary practices) reflect a more generic challenge: the challenge to use a scientific approach to understand and test those things that we, as members of the public, do to manage our health." The conclusions take on those conservative voices in the research community that hold that current methodologies are up to the task. Here, again, Black's report:

"We need to match our resources and develop our methods to fit the task of testing and understanding the ways in which we sustain as well as damage our health. Part of that task is to understand more fully the therapies and complementary practices that are so commonly used. This may require new methods. It will certainly require much collaborative effort."

Comment: The framing of this work is perfect, focusing on "testing and understanding the ways in which we sustain as well as damage our health." In short, they recognize that the core dialogue is about health creation. And they acknowledge the dimensions of this work, that it is new ground, and will require a striking open-mindedness. I am shocked often by how most NIH-funded CAM researchers defend present methodologies, or, at best, their need to shape their work to reductive methodologies if they want their projects scored well by reviewers whose attitudes would likely need a serious adjustment to meet the directions this group from the Kings Fund is laying out. Credit Black and her assembled team for looking the bull in the eye and, well, in a very civil way, screaming "Bull!" Can we get this kind of thinking to guide the next NCCAM strategic plan? (Thanks to Professor Heather McCloud, see below, for linking me to the the King's Fund report.)

African health org to have CAM group

5.  Africa: Actuary organizes CAM group in the

Comment: A general comment, on the work of all of these individuals: Given the challenges of culture change and of resource scarcity all of us in the integrative practice arena face from time to time, the pleasure is particularly special in seeing how there are souls similarly committed to promoting the uptake of natural health approaches across the globe. I hope you've enjoyed your tour. (And by the way, Heather, thanks for staying in touch!)

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