Swedish alternative medicine sector in danger of fragmentation

Consumers of complementary and alternative medicine (CAM) are getting a rough deal in Sweden compared to other Europeans, argues Lysanne Sizoo.

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Through government disinterest, the Swedish CAM sector is in danger of being split between a mainstream medical sector that creams off the more acceptable therapies and a diverse and disorganized alternative sector reluctant to be held accountable to western medical standards.

This leaves consumers with no way of judging whether their acupuncturist, herbalist, or homeopath is a well trained professional, or whether their forward thinking physician actually has more than a passing knowledge of a complementary approach.

Alternative in Sweden is 'mainstream' elsewhere

A Swedish government report from 2006 identified 200 or so CAM approaches ranging from crystal therapy to acupuncture, making it impossible to talk about this sector as a homogenous entity. What connects them is the lack of ‘evidence based’ efficacy.

“This means an Ayurvedic doctor practices her country’s mainstream approach at home in India, but becomes ‘alternative’ the moment she wants to practice in Sweden”, says Susanne Nordling, Chairwoman of the Nordic Cooperation Council for non-conventional medicine and board member of KAM, the Committee for Alternative Medicine.

This view is echoed by Phil Austin, who worked as an osteopath in various GP surgeries in the UK.

“Before I came to Sweden I never even considered myself an alternative therapist”. Phil Austin now runs Osteopati & Pilatus in Stockholm and explains that in Sweden osteopathy is neither regulated nor banned. However, as with all CAM therapies, the law does forbid its practitioners to treat cancer patients, people suffering from epilepsy and young children.

Other European countries began embedding CAM approaches into national health legislation many years ago. The Swedish government, influenced by a health care sector that is obsessed with evidence-based research, allows only those remedies and practices to be used that are proven – in research labs – to work.

So while German and English patients have the freedom to choose CAM care from government regulated practitioners that are well educated, covered by insurance and follow ethical guidelines, Swedish consumers are discouraged from seeking CAM treatment by relegating the sector to the shadow lands of health care. And despite expensive studies, the new conservative government dropped plans for a CAM register when they came into office two years ago.

Seeking good research evidence

It is only in the last 50 years that the massive market in medical research and evidence based trials has begun to dominate. Before that even the forerunners of today’s mainstream doctors had to cope with the process of gaining acceptance for their methods. Bloodletting may have given way to new ideas and techniques, but these methods were often practiced by enlightened ‘charlatans’ until their efficacy was shown to hold.

“I do believe the government could be more active”, says Prof. Martin Ingvar, Professor in Integrative Medicine at Karolinska Institutet and head of research at the Osher Centre for Integrative Medicine.

“As well as looking at who should regulate CAM practitioners there is tremendous confusion around the regulation of herbal medicines.”

Swedish CAM practitioners were delighted when, two years ago, KI received a grant of 50 million kronor ($7.25 million) from Mrs. Barbro Osher, Consul General of Sweden in San Francisco and Chairwoman of the Osher Foundation. After all, the two existing Osher Centres at the University of California and Harvard University both feature research, education, and clinical care in CAM.

But the Swedes were to be disappointed: “The Osher Centre at KI is not a centre for alternative medicine, it is a centre for integrative medicine,” says Prof. Ingvar. The main focus of their research is on the so-called generalized sickness response and the placebo effect.

CAM therapists treat the person not the illness, and this holistic approach has often been given as an explanation for the placebo effect. According to Prof. Ingvar, before the efficacy of any therapy can be researched and proven, this riddle needs to be understood, putting the research ball firmly back into the CAM sector’s court.

The World Health Organisation (WHO) has expressed a great interest in seeing better research applied to CAM and supports the many initiatives around the world, but despite that, there are still many alternative practitioners who resist playing by ‘western rules’.

Is self-regulation the way forward?

In the end, self regulation may be the best way forward for CAM practitioners.
“I believe that (self) regulation is about accountability, and I am working very hard with the Swedish Association for Osteopathy, as well as the two training centres in Sweden to get osteopathy regulated”, says Phil Austin.

But how about approaching the regulatory bodies as one homogenous group, like the Committee for Alternative Medicine, KAM, tried to do? It was set up in 1985 and took eight years to devise its current system of self-regulation. but to date only some 137 therapists have signed up.

KAM’s Susanne Nordling agrees that the sector is increasingly diverse, and that not everyone wants to be under the same umbrella. In addition, there are some practitioners who prefer to remain unregulated.

“It has also been difficult to be taken seriously as one small independent body. But we are currently working with the WHO to establish international rules for accreditation; covering education, ethics, and insurance.”

So far only the guidelines for chiropractors and acupuncturists have been published by the WHO committee, but at least another eight disciplines are being explored.
“I would welcome government regulation, and would hope that some of the work that we are currently doing will benefit a process of government led regulation for the CAM sector,” adds Nordling.

But until then Swedes will have to rely on personal recommendations when it comes to finding reliable alternative therapists. And while the growing interest from within the existing mainstream medical sector is welcome, there is a danger is that the very essence of holistic complementary treatment is lost.

Furthermore, it could lead to inverted quackery, where a few weeks of homeopathy, acupuncture, or herbal training is bolted onto a medical degree, leaving a totally inadequate knowledge base.

September’s inaugural meeting of the Network for Integrative Medicine only welcomed doctors with an accreditation from the National Board of Health and Welfare, thus excluding 90 percent of current CAM practitioners.

While the organizers have every right to invite whom they want, it is a development that should concern anyone who wants the CAM sector in Sweden to come out of the shadows and into greater transparency. If not, they may find their ‘sector’ will be plucked of its finest feathers. And without government regulation, Swedes will be denied a broad and inclusive health care system and end up receiving the worst of both worlds.