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1. 'Then I went to a hospital abroad': acknowledging implications of stakeholders’ differing risk understandings related to use of complementary and alternative medicine in European health care contexts

Author

Anita Salamonsen and Solveig Wiesener

Subjects
Complementary and alternative medicine, Traditional and complementary medicine, Refusal of conventional treatment, Risk definitions, Risk perceptions, Risk understandings: risk behaviors, Other systems of medicine, RZ201-999
Abstract

Abstract Background Complementary and alternative medicine (CAM) is a rather novel issue within public healthcare and health policy-making. CAM use in Europe is widespread, patient-initiated, and patient-evaluated, and the regulation across countries has been evaluated as disharmonized. CAM users are left in an uncertain position, and patient safety may be threatened. How “risk” is understood by individuals in health policy-making and clinical encounters involving the use of CAM has not yet been much debated. The aim of this article is to explore and discuss the existence and possible consequences of differing risk understandings among stakeholders maneuvering in the complex landscape of CAM practice and CAM regulation contextualized by European public healthcare systems. Methods Qualitative data were derived from two studies on CAM in European healthcare contexts. Findings from the EU project CAMbrella on legislation and regulation of CAM were mixed with data from an interview study exploring risk understandings, communication, and decision-making among Scandinavian CAM users and their doctors. In a secondary content analysis, we constructed the case Sara as a typology to demonstrate important findings with regard to risk understandings and patient safety involving European citizens’ use of CAM in differing contexts. Results By combining and comparing individual and structural perspectives on risk and CAM use, we revealed underexplored gaps in risk understandings among individuals involved in European CAM regulation and legislation, and between CAM users and their medical doctors. This may cause health risks and uncertainties associated with CAM use and regulation. It may also negatively influence doctor-CAM user communication and CAM users’ trust in and use of public healthcare. Conclusion Acknowledging implications of stakeholders’ differing risk understandings related to CAM use and regulation may positively influence patient safety in European healthcare. Definitions of the concept of risk should include the factors uncertainty and subjectivity to grasp the full picture of possible risks associated with the use of CAM. To transform the findings of this study into practical settings, we introduce sets of questions relevant to operationalize the important question “What is risk?” in health policy-making, clinical encounters and risk research involving European patients’ use of CAM.

Published
2019
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2. Which risk understandings can be derived from the current disharmonized regulation of complementary and alternative medicine in Europe?

Author

Solveig Wiesener, Anita Salamonsen, and Vinjar Fønnebø

Subjects
Risk understanding, Regulation, Risk governance, Risk perception, Health governance, Complementary therapies, Other systems of medicine, RZ201-999
Abstract

Abstract Background Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. Methods The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. Results Twelve of 39 countries generally understand the included CAM treatments to represent “high risk”, 20 countries “low risk”, while the remaining 7 countries understand CAM treatments as carrying “very little or no risk”. The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. Conclusion The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU’s policy to facilitate access to “safe and high-quality healthcare”, and regulate CAM accordingly.

Published
2018
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3. World Congress Integrative Medicine & Health 2017: part three

Author

Miriam Ortiz, Katharina Schnabel, Michael Teut, Gabriele Rotter, Sylvia Binting, Margit Cree, Fabian Lotz, Ralf Suhr, Benno Brinkhaus, Mohammad M. Parvizi, Farhad Handjani, Mohammad M. Zarshenas, Mahmood R. Moein, Majid Nimrouzi, Gholamreza Hatam, Jafar Hasanzadeh, Nasrin Hamidizadeh, Mojtaba Heydari, Mohammad R. Namazi, Zahra Parvizi, Mehdi Pasalar, Maryam Mosaffa-Jahromi, Kamran Bagheri-Lankarani, Suleiman Afsharypuor, Ali M. Tamaddon, Mohadeseh Ostovar, Giuseppe Peloni, Ingo Bolliger, Rui M. Da Cunha Faria, Pierluigi Quadri, Wilma Sanzeni, Damiano Zemp, Hilde Risvoll, Trude Giverhaug, Kjell H. Halvorsen, Marit Waaseth, Frauke Musial, Elio Rossi, Sonia Baccetti, Marco Picchi, Tommaso Conti, Fabio Firenzuoli, Carmelo Guido, Filippo Bosco, Marialessandra Panozzo, Chiara Cervino, Linda Nurra, Antonella Traversi, Katia Vuono, Federica Sabatini, Tommaso Bellandi, Britta Rutert, Angelika Eggert, Georg Seifert, Wiebke Stritter, Christine Holmberg, Alfred Längler, Anita Salamonsen, Solveig Wiesener, Friedemann Schad, Megan Steele, Matthias Kröz, Harald Matthes, Cornelia Herbstreit, Anja Thronicke, Irene Schlingensiepen, Tido von Schoen-Angerer, Romy Schneider, Livia Waeber, Jan Vagedes, Gregor Kaczala, Cosette Pharisa, Johannes Wildhaber, Benedikt Huber, Pavel Sidorov, Evgeniya Sovershaeva, Ana P. Simões-Wüst, Anna Nietlispach, Mónica Mennet, Martin Schnelle, Ursula von Mandach, Xia Wang, Hye L. Woo, Jin M. Lee, Yuhao Wu, Yumin Cho, Younghee Yun, Hyunho Kim, Wonmo Jung, Bo-Hyung Jang, Eric Ziea, Henny Hui, Mia Li, Dora Tsui, Christine Lam, Joyce Hsieh, Edith Chan, Lynda Balneaves, Sandra Burnside, Ethel Doyle, Shelley Dorazio, Pak K. Chan, Anjali Bhagra, Po-Hsu Chen, Vincent C. H. Chung, Justin C. Y. Wu, Zhi X. Lin, Wendy Wong, Xin Y. Wu, Robin S. T. Ho, Charlene H. L. Wong, Lily Chan, Eric T. C. Ziea, William Elder, Roberto Cardarelli, Cornelia Kaspar, Robert Kempenich, Jacques Kopferschmitt, Zulj Marinko, Sebo Damir, Aleksandar Vcev, Ricardo Monezi, Eny Márcia Ruggerini, Ivna M. Fuchigami, Ana C. Moreno Mazini, Maria Waldenez Oliveira, Petar Papuga, Janet Schloss, Amie Steel, Márcia da Silva Jacobsen, Miranda Rodrigo Jacobsen, Maria T. Mangini, Gianfranco Trapani, Tiziana Di Giampietro, Luisella Zanino, Luigi Ciullo, Diego Lanaro, Francesco Cerritelli, Francesco Macrì, Andre Tsai, Chin Lin, Tu-Hsing Wu, Eduardo D’Alessandro, Sam Watts, Ying Zhang, Xufang Wu, Xun Li, Yutong Fei, Jianping Liu, Nanqi Zhao, Liyan Jia, Xiaoyi Yan, Fei Zhen, Zhaolan Liu, Jinhyang Ahn, Sulaiman AlEidi, Ashry Gad Mohamed, Abdullah M. Al-Beda, Raid A. Abutalib, Mohemmed K. M. Khalil, Hakima Amri, Sathyanarayana Badekila, Elham Behmanesh, Seyyedali Mozaffarpour, Pantea Shirooye, Razie N. Meybodi, Roshanak Mokaberinejad, Mojgan Tansaz, Babak Daneshfard, Ayda Hosseinkhani, Vahid Tafazoli, Amir M. Jaladat, Hasan Sadeghi, Li Zhou, Meng Zhao, Weiwei Li, Anette L. Larsen, Agnete E. Kristoffersen, Torunn Hamran, Bjørg Evjen, Trine Stub, Meiling Li, Jianxiong Cai, Taoying Lu, Lingjia Yin, Darong Wu, Lixin Wang, Siaw M. Liew, Tiegang Liu, Chen Bai, Zian Zheng, Yuxiang Wan, Jingnan Xu, Xuan Wang, He Yu, Xiaohong Gu, Guoyan Yang, Deja Ostrowski, Kealoha Fox, Fatemeh Tabatabei, Fatemeh Amini, Saravanan Sathasivampillai, Pholtan Rajamanoharan, Michael Munday, Michael Heinrich, Yvonne M. Scherrer, Carolyn Szuter, Fatemeh Tabatabaei, Ali Tavakoli, Fatemeh Tavakoli, Mahsa rostami, Maria C. Torri, Harald Walach, Faith Warner, Anne Majumdar, Palitha Serasingh, Annemarie Abbing, Anne Ponstein, Erik Baars, Sarah Croke, Suzanne Hanser, Viola Heckel, Daniel Krüerke, Sebastian Weiss, Susanne Metzner, Jang W. Lee, Min K. Hyun, Morgana Masetti, Renate Oepen, Harald Gruber, Peter Heusser, Holger Pelz, Volker Perlitz, Nicola Robinson, Patricia Ronan, Awais Mian, Su Madge, Ava Lorenc, Penny Agent, Siobhan Carr, Monica E. Winnubst, Jafar Abolghasemi, Paolo Fedi, Mariella Di Stefano, Katia Belvedere, Katherine Beaven, Anita Rose, Gerhard Florschutz, Nicola Brough Phil, Helen Parsons, Sarah Stewart-Brown, Katherine Burke, Martine Busch, Fenna Heyning, Jan Smit, Hans Jeekel, Hans de Goeij, Paulo Caceres Guido, Norma Barraza, Ziomara Balbarrey, Alejandra Ribas, Beatriz Jimenez, Claudia Iachino, Fabiana Quattrone, Marisa Gaioli, Marta Dell’Orso, Silvia Villanueva, Carmen Rocha, Adriana Macchi, Lina Chen, Sicheng Wang, Eunji Choi, Namgyeong Go, Yongho Lee, Gokarna Dahal, Xaver Frauenknecht, Heike Gerhardt, Mónica Galanti, Carmen J. Cerda, Daniela Navarrete Heckersdorf, Héctor Jorquera, María L. Alcázar Saldivia, Daiva Jakubonienė, Bradley McEwen, Francislete Melo, Fernanda Mulinari Fontana, Ana C. Viana Valle, Maria T. Borges Neres, Abolali Mohagheghzadeh, Mohammad E. Zohalinezhad, Olja Njaradi, Momir Dunjic, Jitka Pokladnikova, Iva Selke-Krulichova, Jinsoon Seo, Hyunchul Jang, Carolina Moltó-Puigmartí, Martien van Dongen, Pieter Dagnelie, Carel Thijs, Eva Tihanyi, Gabriella Hegyi, and Xiaolin Tong

Subjects
Other systems of medicine, RZ201-999
Published
2017
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4. World Congress Integrative Medicine & Health 2017: Part one

Author

Benno Brinkhaus, Torkel Falkenberg, Aviad Haramati, Stefan N. Willich, Josephine P. Briggs, Merlin Willcox, Klaus Linde, Töres Theorell, Lisa M. Wong, Jeffrey Dusek, Darong Wu, David Eisenberg, Bettina Berger, Kathi Kemper, Beate Stock-Schröer, Hedda Sützl-Klein, Rosaria Ferreri, Gary Kaplan, Harald Matthes, Gabriele Rotter, Elad Schiff, Zahi Arnon, Eckhard Hahn, Christina M. Luberto, David Martin, Silke Schwarz, Diethard Tauschel, Andrew Flower, Harsha Gramminger, Hedwig H. Gupta, S. N. Gupta, Annette Kerckhoff, Christian S. Kessler, Andreas Michalsen, Eun S. Kim, Eun H. Jang, Rana Kim, Sae B. Jan, Martin Mittwede, Wiebke Mohme, Eran Ben-Arye, Massimo Bonucci, Bashar Saad, Thomas Breitkreuz, Elio Rossi, Rejin Kebudi, Michel Daher, Samaher Razaq, Nahla Gafer, Omar Nimri, Mohamed Hablas, Gunver Sophia Kienle, Noah Samuels, Michael Silbermann, Lena Bandelin, Anna-Lena Lang, Eva Wartner, Christoph Holtermann, Maxwell Binstock, Robert Riebau, Edin Mujkanovic, Holger Cramer, Romy Lauche, Andres Michalsen, Lesley Ward, Dominik Irnich, Wolfram Stör, Geoffrey Burnstock, Hans-Georg Schaible, Thomas Ots, Jost Langhorst, Tobias Sundberg, Catherina Amarell, Melanie Anheyer, Marion Eckert, Mercedes Ogal, Annette Schönauer, Birgit Reisenberger, Bernhard Brand, Dennis Anheyer, Gustav Dobos, Matthias Kroez, Aldo Ammendola, Jun J. Mao, Claudia Witt, Yufei Yang, Miriam Oritz, Markus Horneber, Petra Voiß, Alexandra von Rosenstiel, Catharina Amarell, Friedemann Schad, Marc Schläppi, Matthias Kröz, Arndt Büssing, Gil Bar-Sela, David Avshalomov, Samuel Attias, Sian Cotton, Miek Jong, Mats Jong, Christian Scheffer, Friedrich Edelhäuser, Abdullah AlBedah, Myeong Soo Lee, Mohamed Khalil, Keiko Ogawa, Yoshiharu Motoo, Junsuke Arimitsu, Masao Ogawa, Genki Shimizu, Rainer Stange, Karin Kraft, Kenny Kuchta, Kenji Watanabe, D Bonin, Harald Gruber, Sabine Koch, Urs Pohlmann, Christine Caldwell, Barbara Krantz, Ria Kortum, Lily Martin, Lisa S. Wieland, Ben Kligler, Susan Gould-Fogerite, Yuqing Zhang, John J. Riva, Michael Lumpkin, Emily Ratner, Liu Ping, Pei Jian, Gesa-Meyer Hamme, Xiaosong Mao, Han Chouping, Sven Schröder, Josef Hummelsberger, Michael Wullinger, Marc Brodzky, Christoff Zalpour, Julia Langley, Wendy Weber, Lanay M. Mudd, Peter Wayne, Clauda Witt, Wolfgang Weidenhammer, Vinjar Fønnebø, Heather Boon, Amie Steel, Andrea Bugarcic, Melisa Rangitakatu, Jon Adams, David Sibbritt, Jon Wardle, Matthew Leach, Janet Schloss, Helene Dieze, Nadine Ijaz, Michael Heinrich, George Lewith, Bertrand Graz, Daniela Adam, Linus Grabenhenrich, Miriam Ortiz, Sylvia Binting, Thomas Reinhold, Susanne Andermo, Johanna Hök Nordberg, Maria Arman, Manoj Bhasin, Xueyi Fan, Towia Libermann, Gregory Fricchione, John Denninger, Herbert Benson, David D. Martin, Inge Boers, Arine Vlieger, Michael Teut, Alexander Ullmann, Fabian Lotz, Stephanie Roll, Claudia Canella, Michael Mikolasek, Matthias Rostock, Jörg Beyer, Matthias Guckenberger, Josef Jenewein, Esther Linka, Claudia Six, Sarah Stoll, Roger Stupp, Claudia M. Witt, Elisabeth Chuang, Melissa D. McKee, Petra Klose, Silke Lange, Vincent C. H. Chung, Hoi L. C. Wong, Xin Y. Wu, Grace Y. G. Wen, Robin S. T. Ho, Jessica Y. L. Ching, Justin C. Y. Wu, Amanda Coakley, Jane Flanagan, Christine Annese, Joanne Empoliti, Zishan Gao, Xugang Liu, Shuguang Yu, Xianzhong Yan, Fanrong Liang, Christoph D. Hohmann, Nico Steckhan, Thomas Ostermann, Arion Paetow, Evelyn Hoff, Xiao-Yang Hu, Ruo-Han Wu, Martin Logue, Clara Blonde, Lily Y. Lai, Beth Stuart, Yu-Tong Fei, Michael Moore, Jian-Ping Liu, Michael Jeitler, Hannah Zillgen, Manuel Högl, Barbara Stöckigt, Georg Seifert, Christian Kessler, Talat Khadivzadeh, Maryam Hassanzadeh Bashtian, Shapour Badiee Aval, Habibollah Esmaily, Jihye Kim, Keun H. Kim, Carina Klocke, Stefanie Joos, Abdulrahman Koshak, Li Wie, Emad Koshak, Siraj Wali, Omer Alamoudi, Abdulrahman Demerdash, Majdy Qutub, Peter Pushparaj, Sigrid Kruse, Isabell Fischer, Nadine Tremel, Joseph Rosenecker, Brenda Leung, Wendy Takeda, Ning Liang, Xue Feng, Jian-ping Liu, Hui-juan Cao, Nina Shinday, Lisa Philpotts, Elyse Park, Gregory L. Fricchione, Gloria Yeh, Niki Munk, Arash Zakeresfahani, Trevor R. Foote, Rick Ralston, Karen Boulanger, Dominik Özbe, Elmar Gräßel, Katharina Luttenberger, Anna Pendergrass, Daniel Pach, Judit Bellmann-Strobl, Yinhui Chang, Laura Pasura, Bin Liu, Sven F. Jäger, Ronny Loerch, Li Jin, Katja Icke, Xuemin Shi, Friedemann Paul, Michaela Rütz, Andreas Lynen, Meike Schömitz, Maik Vahle, Nir Salomon, Alon Lang, Adi Lahat, Uri Kopylov, Shomron Ben-Horin, Ofir Har-Noi, Benjamin Avidan, Rami Elyakim, Dorit Gamus, Siew NG, Jessica Chang, Justin Wu, John Kaimiklotis, Dania Schumann, Ludovica Buttó, Dirk Haller, Caroline Smith, Sheryl de Lacey, Michael Chapman, Julie Ratcliffe, Neil Johnson, Jane Lyttleton, Clare Boothroyd, Paul Fahey, Bram Tjaden, Marja van Vliet, Herman van Wietmarschen, Wilfried Tröger, Pia Vuolanto, Paulina Aarva, Minna Sorsa, Kaija Helin, Claudia Wenzel, Iris Zoderer, Patricia Pammer, Patrick Simon, Gerhard Tucek, Kathrin Wode, Roger Henriksson, Lena Sharp, Anna Stoltenberg, Yang Xiao-ying, Li-qiong Wang, Jin-gen Li, Ying Wang, Lynda Balneaves, Rielle Capler, Chiara Bocci, Marta Guffi, Marina Paolini, Ilaria Meaglia, Patrizia Porcu, Giovanni B. Ivaldi, Simona Dragan, Petru Bucuras, Ana M. Pah, Marius Badalica-Petrescu, Florina Buleu, Gheorghe Hogea-Stoichescu, Ruxandra Christodorescu, Lan Kao, Yumin Cho, Nadja Klafke, Cornelia Mahler, Cornelia von Hagens, Lorenz Uhlmann, Martina Bentner, Andreas Schneeweiss, Andreas Mueller, Joachim Szecsenyi, Isabella Neri, Katharina Schnabel, Margit Cree, Ralf Suhr, Sonia Baccetti, Fabio Firenzuoli, Maria V. Monechi, Mariella Di Stefano, Gianni Amunni, Wendy Wong, Bingzhong Chen, Hakima Amri, Lucy Kotlyanskaya, Belinda Anderson, Roni Evans, Paul Marantz, Ryan Bradley, Cathryn Booth-LaForce, Heather Zwickey, Benjamin Kligler, Audrey Brooks, Mary J. Kreitzer, Patricia Lebensohn, Elisabeth Goldblatt, Neus Esmel-Esmel, Maria Jiménez-Herrera, Alexandra Jocham, Pascal O. Berberat, Antonius Schneider, Morgana Masetti, Henriette Murakozy, Marja Van Vliet, Rita Agdal, Fatemeh Atarzadeh, Amir M. Jaladat, Leila Hoseini, Fatemeh Amini, Chen Bai, Tiegang Liu, Zian Zheng, Yuxiang Wan, Jingnan Xu, Xuan Wang, He Yu, Xiaohong Gu, Babak Daneshfard, Majid Nimrouzi, Vahid Tafazoli, Seyed M. Emami Alorizi, Seyed A. Saghebi, Mohammad R. Fattahi, Alireza Salehi, Hossein Rezaeizadeh, Mohammad M. Zarshenas, Kealoha Fox, John Hughes, Nenad Kostanjsek, Stéphane Espinosa, Peter Fisher, Abdul Latif, Donald Lefeber, William Paske, Ali Ö. Öztürk, Gizemnur Öztürk, Wim Tissing, Marianne Naafs, Martine Busch, Mohammad R. Sanaye, Kilian Dräger, Brent Leininger, Kate Shafto, Jenny Breen, Ana P. Simões-Wüst, Carolina Moltó-Puigmartí, Martien van Dongen, Pieter Dagnelie, Carel Thijs, Shelley White, Solveig Wiesener, Anita Salamonsen, Trine Stub, Sergio Abanades, Mar Blanco, Laia Masllorens, Roser Sala, Shafekah Al-Ahnoumy, Dongwoon Han, Luzhu He, Ha Yun Kim, Da In Choi, Terje Alræk, Agnete Kristoffersen, Christel von Sceidt, Stig Bruset, Frauke Musial, Felix J. Saha, Heidemarie Haller, Hoda Azizi, Nayereh Khadem, Malihe Hassanzadeh, Nazanin Estiri, Hamideh Azizi, Fatemeh Tavassoli, Marzieh Lotfalizadeh, Reza Zabihi, Mahmoud Mohammadzadeh Shabestari, Reza Paeizi, Masoumeh Alvandi Azari, Hamidreza Bahrami-Taghanaki, Erik Baars, Anja De Bruin, Anne Ponstein, Sergio Segantini, Maria Valeria Monechi, Fabio Voller, Jürgen Barth, Alexandra Kern, Sebastian Lüthi, Anja Zieger, Fabius Otto, Ariel Beccia, Corina Dunlap, Brendan Courneene, Paula Bedregal, Alvaro Passi, Alfredo Rodríguez, Mayling Chang, Soledad Gutiérrez, Florian Beissner, Christine Preibisch, Annemarie Schweizer-Arau, Roxana Popovici, Karin Meissner, Sylvie Beljanski, Laura Belland, Laura Rivera-Reyes, Ula Hwang, Dominik Sethe, Dörte Hilgard, Peter Heusser, Felicity Bishop, Miznah Al-Abbadey, Katherine Bradbury, Dawn Carnes, Borislav Dimitrov, Carol Fawkes, Jo Foster, Hugh MacPherson, Lisa Roberts, Lucy Yardley, Michelle Holmes, Paul Little, Cyrus Cooper, Patrizia Bogani, Valentina Maggini, Eugenia Gallo, Elisangela Miceli, Sauro Biffi, Alessio Mengoni, Renato Fani, Nadine Brands-Guendling, Peter W. Guendling, Gert Bronfort, Mitch Haas, Craig Schulz, Xiangwei Bu, J. Wang, T. Fang, Z. Shen, Y. He, X. Zhang, Zhengju Zhang, Dali Wang, Fengxian Meng, Klaus Baumann, Eckhard Frick, Christoph Jacobs, Ralph-Achim Grünther, Désirée Lötzke, Sonny Jung, Daniela R. Recchia, Sibylle Robens, Josephin Stankewitz, Mika Jeitler, Chunhoo Cheon, Bo H. Jang, Seong G. Ko, Ching W. Huang, Yui Sasaki, Youme Ko, Anna Cheshire, Damien Ridge, David Peters, Maria Panagioti, Chantal Simon, Hyun J. Cho, Soo J. Choi, Young S. Jung, Hyea B Im, Kieran Cooley, Laura Tummon-Simmons, Rachel Wasson, Kristen Kraemer, Richard Sears, Carly Hueber, Gwendolyn Derk, JR Lill, Ruopeng An, Lois Steinberg, Lourdes Diaz Rodriguez, Francisca García-de la Fuente, Miguel De la Vega, Keyla Vargas-Román, Jonatan Fernández-Ruiz, Irene Cantarero-Villanueva, Francisca García-De la Fuente, Fanny Jiménez-Guerrero, Noelia Galiano-Castillo, Gualberto Diaz-Saez, José I. Torres-Jimenez, Olga Garcia-Gomez, Luis Hortal-Muñoz, Camino Diaz-Diez, Demijon Dicen, Helene Diezel, Jane Frawley, Alex Broom, Fei Dong, Xueyan Ma, Liyi Yan, Liqun Wu, Jiaju Ma, Jianhua Zhen, Julie Dubois, Pierre-Yves Rodondi, Sophia Schwartze, Barbara Trapp, and Dirk Cysarz

Subjects
Other systems of medicine, RZ201-999
Published
2017
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5. 'Then I went to a hospital abroad': acknowledging implications of stakeholders’ differing risk understandings related to use of complementary and alternative medicine in European health care contexts

Author

Solveig Wiesener and Anita Salamonsen

Subjects
Typology, Complementary Therapies, Risk, medicine.medical_specialty, Traditional and complementary medicine, Doctor-patient communication, Health Knowledge, Attitudes, Practice, animal structures, Risk perceptions, Person-centeredness, Alternative medicine, Legislation, Qualitative property, Refusal of conventional treatment, Regulation, risk governance, Norway, Europe, Risk communication, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Health policy-making, Health care, medicine, Risk ontology, Humans, Policy Making, Risk definitions, Quality of Health Care, VDP::Medical disciplines: 700::Health sciences: 800::Other health science disciplines: 829, Operationalization, business.industry, Health Policy, lcsh:Other systems of medicine, General Medicine, Public relations, lcsh:RZ201-999, 3. Good health, 030205 complementary & alternative medicine, Europe, Complementary and alternative medicine, VDP::Medisinske Fag: 700::Helsefag: 800::Andre helsefag: 829, Content analysis, 030220 oncology & carcinogenesis, Quality in health care, Risk understandings: risk behaviors, business, Psychology, Decision making, Research Article
Abstract

Published version, available at: https://doi.org/10.1186/s12906-019-2499-3 Background Complementary and alternative medicine (CAM) is a rather novel issue within public healthcare and health policy-making. CAM use in Europe is widespread, patient-initiated, and patient-evaluated, and the regulation across countries has been evaluated as disharmonized. CAM users are left in an uncertain position, and patient safety may be threatened. How “risk” is understood by individuals in health policy-making and clinical encounters involving the use of CAM has not yet been much debated. The aim of this article is to explore and discuss the existence and possible consequences of differing risk understandings among stakeholders maneuvering in the complex landscape of CAM practice and CAM regulation contextualized by European public healthcare systems. Methods Qualitative data were derived from two studies on CAM in European healthcare contexts. Findings from the EU project CAMbrella on legislation and regulation of CAM were mixed with data from an interview study exploring risk understandings, communication, and decision-making among Scandinavian CAM users and their doctors. In a secondary content analysis, we constructed the case Sara as a typology to demonstrate important findings with regard to risk understandings and patient safety involving European citizens’ use of CAM in differing contexts. ResultsBy combining and comparing individual and structural perspectives on risk and CAM use, we revealed underexplored gaps in risk understandings among individuals involved in European CAM regulation and legislation, and between CAM users and their medical doctors. This may cause health risks and uncertainties associated with CAM use and regulation. It may also negatively influence doctor-CAM user communication and CAM users’ trust in and use of public healthcare. Conclusion Acknowledging implications of stakeholders’ differing risk understandings related to CAM use and regulation may positively influence patient safety in European healthcare. Definitions of the concept of risk should include the factors uncertainty and subjectivity to grasp the full picture of possible risks associated with the use of CAM. To transform the findings of this study into practical settings, we introduce sets of questions relevant to operationalize the important question “What is risk?” in health policy-making, clinical encounters and risk research involving European patients’ use of CAM.

Published
2019

6. Which risk understandings can be derived from the current disharmonized regulation of complementary and alternative medicine in Europe?

Author

Vinjar Fønnebø, Solveig Wiesener, and Anita Salamonsen

Subjects
Risk, medicine.medical_specialty, Risk perception, Alternative medicine, Health Personnel, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Political science, Health care, medicine, Humans, Modalities, Public economics, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, business.industry, Risk governance, Health governance, Traditional medicine, lcsh:Other systems of medicine, General Medicine, lcsh:RZ201-999, Chiropractic, Complementary therapies, 030205 complementary & alternative medicine, 3. Good health, Risk understanding, Europe, Complementary and alternative medicine, 030220 oncology & carcinogenesis, business, Research Article, Regulation
Abstract

Source at https://doi.org/10.1186/s12906-017-2073-9 . Background: Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. Methods: The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. Results: Twelve of 39 countries generally understand the included CAM treatments to represent “high risk”, 20 countries “low risk”, while the remaining 7 countries understand CAM treatments as carrying “very little or no risk”. The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. Conclusion: The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU’s policy to facilitate access to “safe and high-quality healthcare”, and regulate CAM accordingly.

Published
2018

7. International Development of Traditional Medicine/Complementary and Alternative Medicine Research - What Can Europe Learn?

Author

Vinjar Fønnebø, George Lewith, Johanna Hök, Wolfgang Weidenhammer, Torkel Falkenberg, Solveig Wiesener, and Koldo Santos-Rey

Subjects
Complementary Therapies, Cross-Cultural Comparison, medicine.medical_specialty, Biomedical Research, National Health Programs, Research methodology, Acupuncture Therapy, Alternative medicine, 03 medical and health sciences, 0302 clinical medicine, Complementary medicine, Qualitative study, Humans, Medicine, 030212 general & internal medicine, Health Services Needs and Demand, Traditional medicine, business.industry, Research, Homeopathy, ddc, 030205 complementary & alternative medicine, 3. Good health, Europe, Complementary and alternative medicine, Utilization Review, business, International development, Delivery of Health Care, Qualitative research
Abstract

Background: The aim of this study was to analyse global research and development (RD) strategies for traditional medicine (TM) and complementary and alternative medicine (CAM) across the world to learn from previous and on-going activities. Methods: 52 representatives within CAMbrella nominated 43 key international stakeholders (individuals and organisations) and 15 of these were prioritised. Information from policy documents including mission statements, RD strategies and RD activities were collected in combination with personal interviews. Data were analysed using the principles of content analysis. Results: Key stakeholders vary greatly in terms of capacity, mission and funding source (private/public). They ranged from only providing research funding to having a comprehensive RD and communication agenda. A common shift in RD strategy was noted; whereas 10 years ago research focused mainly on exploring efficacy and mechanisms, today the majority of stakeholders emphasise the importance of a broad spectrum of research, including methodologies exploring context, safety and comparative effectiveness. Conclusion: The scarce public investment in this field in Europe stands in stark contrast to the large investments found in Australia, Asia and North America. There is an emerging global trend supporting a broad research repertoire, including qualitative and comparative effectiveness research. This trend should be considered by the EU given the experience and the substantial research funding committed by the included stakeholders. To facilitate international collaborative efforts and minimise the risk of investment failure, we recommend the formation of a centralised EU CAM research centre fostering a broad CAM RD agenda with the responsibility for implementing the relevant findings of CAMbrella.

Published
2012
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8. Legal Status and Regulation of Complementary and Alternative Medicine in Europe

Author

Vinjar Fønnebø, Solveig Wiesener, Gabriella Hegyi, Torkel Falkenberg, Johanna Hök, and Paolo Roberti di Sarsina

Subjects
Complementary Therapies, Cross-Cultural Comparison, medicine.medical_specialty, National Health Programs, Quality Assurance, Health Care, media_common.quotation_subject, Alternative medicine, Legislation, Harmonization, Public administration, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Documentation, Health care, Device Approval, Medicine, media_common.cataloged_instance, Humans, 030212 general & internal medicine, European union, Practice Patterns, Physicians', media_common, VDP::Medical disciplines: 700::Health sciences: 800::Other health science disciplines: 829, business.industry, Cross-cultural studies, 3. Good health, Europe, Complementary and alternative medicine, VDP::Medisinske Fag: 700::Helsefag: 800::Andre helsefag: 829, 030220 oncology & carcinogenesis, Family medicine, business, Diversity (politics)
Abstract

This is the peer-reviewed but unedited manuscript version of the following article: Wiesener, S., Falkenberg, T., Hegyi, G., Hök, J., Roberti di Sarsina, P. & Fønnebø, V. (2012). Legal status and regulation of complementary and alternative medicine in Europe. Forschende Komplementärmedizin / Research in Complementary Medicine, 19(suppl 2), 29-36. https://doi.org/10.1159/000343125. The final, published version is available at https://doi.org/10.1159/000343125. Objective: The study aims to review the legal and regulatory status of complementary and alternative medicine (CAM) in the 27 European Union (EU) member states and 12 associated states, and at the EU/European Economic Association (EEA) level. Methods: Contact was established with national Ministries of Health, Law or Education, members of national and European CAM associations, and CAMbrella partners. A literature search was performed in governmental and scientific/non-scientific websites as well as the EUROPA and EUR-lex websites/ databases to identify documents describing national CAM regulation and official EU law documents. Results: The 39 nations have all structured legislation and regulation differently: 17 have a general CAM legislation, 11 of these have a specific CAM law, and 6 have sections on CAM included in their general healthcare laws. Some countries only regulate specific CAM treatments. CAM medicinal products are subject to the same market authorization procedures as other medicinal products with the possible exception of documentation of efficacy. The directives, regulations and resolutions in the EU that may influence the professional practice of CAM will also affect the conditions under which patients are receiving CAM treatment(s) in Europe. Conclusion: There is an extraordinary diversity with regard to the regulation of CAM practice, but not CAM medicinal products. This will influence patients, practitioners and researchers when crossing European borders. Voluntary harmonization is possible within current legislation. Individual states within culturally similar regions should harmonize their CAM legislation and regulation. This can probably safeguard against inadequately justified over- or underregulation at the national level. Ziel: Ziel der Studie war es, den rechtlichen und regulatorischen Status der Komplementärmedizin (CAM) in den 27 EU-Mitgliedsstaaten und 12 assoziierten Staaten auf EU-/ EWR-Ebene zu erfassen. Methoden: Zunächst wurden Kontakte zu den nationalen Ministerien für Gesundheit, Recht, oder Bildung, sowie zu nationalen und europäischen Verbänden im CAM Bereich und den CAMbrella Partnern geknüpft und etabliert. Um Dokumente zu identifizieren, die die nationale CAM Regulierung sowie die offizielle EU-Gesetzgebung reflektieren, wurden Literaturrecherchen in staatlichen, wissenschaftlichen / nichtwissenschaftlichen Websites, sowie den Web-Sites / Datenbanken EUROPA und EUR-Lex durchgeführt. Ergebnisse: Alle 39 Staaten verfügen über eine strukturierte Gesetzgebung zu CAM, die aber jeweils unterschiedlich ist. 17 verfügen über eine allgemeine Gesetzgebung zu CAM, bei 11 von diesen liegt ein spezifisches CAM-Gesetz vor, während 6 Staaten CAM spezifische Abschnitte im Rahmen ihrer allgemeinen Gesetzgebung zur Gesundheitsversorgung aufweisen. Einige Länder regeln nur bestimmte CAM-Therapien. CAM-Arzneimittel unterliegen den gleichen Zulassungsverfahren wie andere Arzneimittel, mit der möglichen Ausnahme der Dokumentation der Wirksamkeit. Die Richtlinien, Verordnungen und Beschlüsse in der Europäischen Union (EU), die die berufliche Praxis der CAM Anwendung beeinflussen, wirken sich auch auf die rechtlichen Bedingungen aus, unter denen Patienten in Europa eine CAM-Behandlung erhalten. Fazit: Die Vielfalt im Hinblick auf die Regulierung der CAM-Praxis ist außerordentlich hoch, dasselbe gilt jedoch nicht für CAM-Arzneimittel. Diese Tatsache beeinflusst Patienten, Anwender und Wissenschaftler beim Überschreiten europäischen Grenzen. Eine freiwillige Harmonisierung ist jedoch im Rahmen der derzeitigen Gesetzgebung möglich. Staaten in kulturell ähnlichen Regionen sollten daher ihre CAM-Gesetzgebung und Regulierung harmonisieren. Ein solches Vorgehen kann möglicherweise einer unangemessenen Über- oder Unterregulation auf nationaler Ebene vorbeugen.

Published
2012
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9. Title Pages / Table of Contents

Author

Klaus von Ammon, Johanna Hök, H. Felix Fischer, Koldo Santos-Rey, Nina Nissen, Helle Johannessen, Harald Walach, Florian Junne, Susanne Schunder-Tatzber, Bettina Reiter, Bernhard Uehleke, Philip Prescott, Francesco Cardini, Franziska Baumhöfener, Simona Dragan, Gabriella Hegyi, Susan Eardley, Ute Daig, Solveig Wiesener, Torkel Falkenberg, Stephanie Regenfelder, Felicity L. Bishop, Paolo Roberti di Sarsina, Wolfgang Weidenhammer, Reinhard Saller, Jan Sørensen, Bernard Uehleke, Meike Dlaboha, Benno Brinkhaus, George Lewith, Martin Frei-Erb, Vinjar Fønnebø, Claudia M. Witt, Jorge Vas, and Jesper Odde Madsen

Subjects
Complementary and alternative medicine, Traditional medicine, business.industry, Medicine, Library science, Table of contents, business
Published
2012

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