A serious alternative

The use of complementary and alternative medicine (CAM) has grown at a phenomenal rate in Catalunya over the last 20 years and the practice continues to gain medical, economic and sociological importance.

Reports from the federation known as TENCAT* state that the popularity of treatments such as homeopathy, reflexology, hypnotherapy, acupuncture, shiatsu massage and traditional Chinese medicine is continuing to rise. However, what is also on the increase is the controversy over their use, regarding both efficacy and regulation.

Whereas conventional medicine is led by a diagnosis from a patient’s symptoms followed by a treatment, complementary and alternative medicine aims to treat the patient as a whole. In alternative medicine, an illness can mean a breakdown of physical and mental wellbeing. Treatment is not necessarily a cure, but aims to stimulate the body’s natural resources and self-healing abilities. A return to natural health methods has seen a rise in people seeking nutritional advice, practising yoga and using massage. Chinese herbal medicines are commonly used as dietary supplements whilst homeopathic remedies are increasingly used to treat the likes of insomnia or stress. Zoe Holden, who practices homeopathy in Barcelona says many people are choosing alternative therapies over conventional medicine in order to treat the cause of their illness. “Patients realise conventional medicine often only offers treatments that suppress symptoms and they are looking for something that works on a deeper level”.

According to Spain’s first credible study on the use of complementary and alternative medicine conducted in 2007 by Cofenat (Profesionales de las Terapias Naturales), it was found that proportionally, CAM is more prevalent in Catalunya than in any other region of Spain, with reflexology, acupuncture and homeopathy topping the list of the most popular treatments. The study also found that women are more likely to use alternative therapies than men, especially within the 35-45 age bracket, and that it is most popular among people financially better off.

Currently the Catalan CAM industry finds its status clouded in uncertainty resulting in growing pressure from certain quarters to increase regulation within the industry. The situation is further complicated by some practices such as acupuncture, naturopathy and osteopathy being regulated (here by the Instituto de Estudios de la Salud de Catalunya), whilst other practices are not.

In 1997, the Código Internacional de Ética para los Profesionales de la Salud was adopted and stipulated that doctors using CAM must inform patients of the importance of continuing their conventional treatment and telling them of the non-conventional nature of the complementary/alternative therapy. It also prevented doctors from using methods that have not been scientifically proven to treat a patient.

Move forward 10 years and, after pressure from a number of CAM practitioners, the Generalitat introduced a pioneering bill aimed at regulating the sector, only for it to be stopped in its tracks by the Tribunal Superior de Justicia de Catalunya (TSJC) two years later. The main opponent to the legislation was Barcelona’s official medical college, (Col·legi Oficial de Metges de Barcelona or COMB) whose current President Dr Miquel Vilardell said this of their resistance: “We were against it as it was trying to regulate an ‘assistance activity’ that would mean non-healthcare professionals were in a position to practice…(only) medical practitioners are responsible for the indication and implementation of activities aimed at promoting and maintaining health, disease prevention, diagnosis and treatment of patients”.

Their main objection is that to regulate the alternative medicine industry means medicines and treatments need to have been scientifically validated and that in itself is a problem. Hard evidence supporting alternative treatments is weak and well-conducted clinical trials, which could support or dismiss them, have been few and far between.

According to Barcelona-based nutritionist Carolina Harboe, CAM simply does not generate enough money to get together sizeable study groups in order to get results published in scientific journals. “There have been small-scale studies, necessary to be able to commercialise a product, which have produced promising results. But when there is no product to sell behind the treatment, such as acupuncture, kinesiology or reiki, or the product is inexpensive like homeopathy or Bath flower remedies for example, it is impossible to find a study to prove their effectiveness. This does not mean however that it doesn’t work.” Additionally, in most countries alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of their efficacy—a further disincentive for manufacturers to fund scientific research.

Barcelona-based reflexologist Benedicte Taillard says until there are more scientific findings available, alternative practices will always attract scepticism. “Although reflexology has proved to be very efficient in a wide array of conditions­—the patient’s improved health or healing being the prime indicator—it does not escape the need in our society to scientifically prove the ‘hows and whys?’ of its efficiency. A growing amount of scientific research is now being carried out on reflexology, applied to various pathologies, and as more data becomes available a greater number of people turn to it as a serious alternative. Reflexology is officially recognised to be a safe and non-invasive natural therapy. It is also increasingly used as a complementary therapy by many physicians and medical staff in all countries, including Spain.”

Most alternative therapists will tell you that the future of alternative therapies lies in a more integrated approach. Barcelona-based acupuncturist Uby Muñoz, who works at the city’s Wellwoman Clinic, believes that in her field the combination of conventional and alternative medicine works well. “I often work with patients being treated by fertility clinics; the combination of acupuncture with assisted reproduction increases the success rate. This is supported by many scientific studies.” Muñoz stresses however the importance of making her work supportive to actual medical practices. “I ask my patients about all of their treatments to ensure that my plans support and facilitate the healthcare decisions they are making with other providers. This integrated approach means you don’t have to constantly juggle methodologies, educating yourself in two (or more) medical systems so that patients get what they need from each practitioner. We help them understand how our care will work in and around other medical care, so that they can put these different puzzle pieces together to the best effect”.

A working group of the Ministries of Health and Education is currently entrusted with the task of working out regulatory rules for complementary and alternative therapies. The group has already made an initial report and is working on its proposed regulation. Given the obvious complexities involved in deciding who can and who cannot practice certain therapies, the process is expected to be a slow one.

A number of conventional doctors in Catalunya privately say they are keen to use more alternative methods alongside conventional practice, but it seems they are less keen to admit it publicly, due, in part, to the fact that bad practice within the alternative field still exists. So until there is a reciprocity of open-mindedness between the two methodologies and better regulation, it may be the patient who misses out in the long run.

*Federacíon de asociaciones profesionales de terapias naturales y de la cultura de la salud