ENTE MORALE

ENTE MORALE
Traditional and Non-Conventional Medicine:
a Multi Contextual Approach


Paolo Roberti di Sarsina, MD

Expert for Non Conventional Medicine,
High Council of Health, Ministry of Health, Italy

Observatory and Methods for Health, University of Milano-Bicocca, Italy





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HOME MISSION ISTITUZIONI EVENTI RETI SOCIALI CONVENZIONI PUBBLICAZIONI CONTATTI
SOCI ONORARI

CHGYAL NAMKHAI NORBU (2010)
HARALD WALACH (2011)
PETER ZIMMERMANN (2012)
THOMAS BREITKREUZ (2012)
PAUL U. UNSCHULD (2013)
SCIENTIFIC ADVISOR

HARALD WALACH
Associazione per la Medicina Centrata sulla Persona
in collaborazione con
Istituto Internazionale Shang Shung per gli Studi Tibetani
Lezione Magistrale del Prof. Namkhai Norbu:
La Medicina Tibetana: patrimonio dellUmanit
Bologna, sabato 11 settembre 2010, ore 9
Aula Magna, Istituto di Anatomia Umana Normale,
Universit di Bologna, via Irnerio 48
Patrocinii:
Segreteria Scientifica: Paolo Roberti di Sarsina, Luigi Ottaviani, Alfredo Vannacci
Segreteria Organizzativa: Paolo Roberti di Sarsina, Nadia Gaggioli, Luigi Ottaviani, Cesare Pilati
Associazione per la Medicina Centrata sulla Persona
www.medicinacentratasullapersona.org
info@medicinacentratasullapersona.org
Sua Santit il XIV Dalai Lama
Presidenza del Consiglio dei Ministri
Ministero degli Affari Esteri
Regione Emilia-Romagna
Provincia di Bologna
Comune di Bologna
Facolt di Medicina e Chirurgia, Universit di Firenze
Istituto Italiano per lAfrica e lOriente, Roma
European Medical Association
European Association for Predictive, Preventive and Personalised Medicine
Ordine Provinciale dei Medici-Chirurghi e degli Odontoiatri di Bologna
Osservatorio e Metodi per la Salute, Universit degli Studi di Milano - Bicocca
Azienda Unit Sanitaria Locale di Bologna
Fondazione di Noopolis, Roma
LASSOCIAZIONE PER LA MEDICINA CENTRATA SULLA PERSONA
Fondata nel 2007, lAssociazione per la Medicina Centrata sulla Persona ha come fine la tutela della
salute della popolazione, lumanizzazione, la personalizzazione e la sostenibilit dei trattamenti basan-
dosi sulla centralit del paziente nella scelta delle cure.
LAssociazione tutela, salvaguarda, promuove, studia, tramanda e applica il patrimonio culturale dei
saperi e dei sistemi medici antropologici sia occidentali sia orientali, nel rispetto dellintegrit originaria
e tradizionale dei singoli paradigmi e lignaggi.
LAssociazione intende promuovere e sostenere iniziative finalizzate al progresso degli studi e delle
ricerche nei vari campi di intervento della medicina centrata sulla persona.
Chgyal Namkhai Norbu Rinpoche
Chgyal Namkhai Norbu nasce a Derge, nel Tibet orientale,
nel 1938.
Da bambino viene riconosciuto come reincarnazione (tulku)
del grande Maestro di Dzogchen Adzom Drugpa (1842-1924) e
successivamente S.S. il XVI Karmapa, lo riconosce come la
reincarnazione (tulku) di Shabdrung Ngawang Namgyal
(1594-1651), primo Dharmaraja del Bhutan. Ancora adoles-
cente completa il rigoroso percorso di studi tradizionale,
ricevendo insegnamenti da alcuni dei pi grandi maestri
dellepoca.
Nel 1955 incontra Changchub Dorje (1826-1961), il suo princi-
pale maestro (Maestro Radice) di Dzogchen, il cui stile di vita e modo di insegnare lo ispireranno
profondamente.
Nel 1960, in seguito alla drammatica situazione sociale e politica in Tibet, riesce a trasferirsi in Italia
accettando linvito del prof. Giuseppe Tucci, fondatore dellOrientalistica in Italia, fondatore
dellIstituto Italiano per il Medio ed Estremo Oriente (IsMEO), ora Istituto per lAfrica e lOriente
(IsIAO), contribuendo cos a dare un impulso concreto alla diffusione della cultura tibetana in
Occidente.
Nei primi anni sessanta lavora a Roma allIsMEO, e, in seguito, fino al 1992, insegna Lingua e Lettera-
tura Tibetana e Mongola allIstituto Universitario Orientale di Napoli.
I suoi lavori accademici denotano una profonda conoscenza della civilt tibetana, e una tenace volont
di mantenere vivo e facilmente accessibile lo straordinario patrimonio culturale del Tibet. Alla met
degli anni settanta, dopo avere insegnato per alcuni anni Yantra Yoga a Napoli, Chgyal Namkhai Norbu
incomincia a dare insegnamenti Dzogchen, incontrando un crescente interesse dapprima in Italia e poi
in tutto lOccidente.
Nel 1981 fonda la prima sede della Comunit Dzogchen di Merigar ad Arcidosso, in Toscana. Nel corso
degli anni migliaia di persone diventano membri della Comunit Dzogchen in tutto il mondo. Sorgono
centri negli Stati Uniti, in varie parti dEuropa, in America Latina, in Russia e in Australia. Nel 1988
Chgyal Namkhai Norbu fonda ASIA (Associazione per la Solidariet Internazionale in Asia),
unorganizzazione non governativa impegnata soprattutto in progetti educativi e medico-sanitari rivolti
alla popolazione tibetana.
Nel 1989 Chgyal Namkhai Norbu fonda lIstituto Shang Shung con il compito di salvaguardare la
cultura tibetana promuovendone la conoscenza e la diffusione e ASIA Onlus.
Ancora oggi Chgyal Namkhai Norbu viaggia costantemente in tutto il mondo tenendo conferenze e
ritiri cui partecipano migliaia di persone.
Glottologo, ricercatore di fama mondiale della Civilt dello Shang Shung e della Tradizione Tibetana,
profondo conoscitore della Medicina Tibetana, il prof. Namkhai Norbu ha scritto centinaia di testi.
LIstituto Internazionale Shang Shung per gli Studi Tibetani
LIstituto Internazionale Shang Shung stato fondato nel 1989 da Chgyal Namkhai Norbu Rinpoche
e inaugurato nel 1990 a Merigar da Sua Santit il XIV Dalai Lama.
un ente culturale senza fini politici o di lucro, la cui missione quella di preservare la cultura tibetana
nella sua purezza ed integrit.
Prende il nome dallantico regno dello Shang Shung, che prosperava in quelle vaste regioni pi di 4.000 anni fa
ed considerato l'origine della cultura del Tibet.
La straordinaria cultura tibetana, sopravvissuta per migliaia di anni pura e incontaminata, trasmessa di generazi-
one in generazione, rappresenta uno dei tesori del nostro pianeta.
Oggi esiste il concreto pericolo che questo tesoro unico possa andare perduto.
Pertanto, lIstituto Shang Shung promuove la conoscenza della cultura tibetana in tutti i suoi aspetti religiosi,
filosofici, artistici, storici, sociali al fine di salvaguardarla e contribuire alla sua conservazione.
LIstituto organizza corsi, seminari di studio, conferenze, mostre; cura la traduzione pubblicazione di numerosi
libri e testi; vanta un moderno centro di documentazione multimediale; offre borse di studio a giovani tibetani
meritevoli. La sede centrale dellIstituto Shang Shung a Merigar (Arcidosso, Grosseto); altre sedi sono presenti
in Austria e negli USA. Negli anni lIstituto ha collaborato con diverse Universit, Fondazioni e Musei,
contribuendo ad accrescere linteresse per la cultura tibetana in tutto il mondo.
Nel 2005 LIstituto ha istituito il primo corso tradizionale di Medicina Tibetana in occidente, riconosciuto
dall'Universita' di Xining (il piu' importante centro di Medicina Tradizionale Tibetana al mondo) e da ATMA
(American Tibetan Medicine Association)
ASIA Onlus, Associazione per la Solidariet in Asia
Organizzazione Non Governativa di Cooperazione Internazionale (Decreto Ministero degli
Esteri)
ASIA nata in seguito ad una serie di missioni condotte in India e Nepal (nel 1978) e in Tibet (nel
1981 e nel 1988) dal prof. Namkhai Norbu insieme ad un gruppo di studenti, che rimasero
fortemente colpiti dalle difficili condizioni in cui vivevano i tibetani e dal forte declino della lingua
e della cultura tradizionale conseguente alla rivoluzione culturale cinese.
Con lo scopo di salvaguardare la Cultura Tibetana e di sostenere lo sviluppo economico, sociale e culturale sia dei
Tibetani rimasti in Cina che di quelli profughi in India e Nepal, nel 1988 il professore e suoi studenti fondarono
ASIA Associazione per la Solidariet Internazionale in Asia.
Fino al 1992 il lavoro di ASIA si focalizzato sugli insediamenti tibetani in India allo scopo di migliorare le
condizioni di vita dei rifugiati; in seguito lattenzione si rivolta sempre di pi verso il Tibet etnico, nelle aree
della Cina abitate dalla minoranza tibetana (Qinghai, Sichuan, TAR, Gansu).
Nel 1993 stato presentato al Ministero degli Affari Esteri un primo progetto di intervento multisettoriale volto
a promuovere leducazione, la salute, lautosufficienza economica dei nomadi e la protezione artistico culturale
nel villaggio di Gamthog, nella Prefettura di Chamdo (Regione Autonoma Tibetana).
Nel 1997 stata inaugurata la prima scuola costruita da ASIA: una scuola tibetana elementare e media nel
villaggio di Dongche nella provincia del Qinghai, nellAmdo.
Nel 1999 arrivato il riconoscimento di idoneit da parte del Ministero degli Affari Esteri come ONG di Cooper-
azione Internazionale.
Nel 2001 ASIA ha firmato il partnership agreeement con ECHO (lUfficio per gli Aiuti Umanitari della Comu-
nit Europea) per i progetti di emergenza e dal 2005 presente con progetti di post-emergenza anche in altri
paese del continente asiatico.
Casa Editrice Shang Shung
La Shang Shung Edizioni, fondata in Italia nel 1983, cura la stampa dei testi degli insegnamenti di Chgyal
Namkhai Norbu e di altri Maestri rappresentativi della spiritualit e della cultura buddhista tibetana. Nel
2006 la casa editrice e' stata assorbita dallIstituto Shang Shung. Lattivit editoriale prevede la
trascrizione, traduzione e pubblicazione degli insegnamenti orali dati da Chgyal Namkhai Norbu nei centri della
Comunit Dzogchen Internazionale o in altre sedi, e la traduzione di testi tibetani originali per opera di traduttori
qualificati. Nel corso degli anni la Shang Shung Edizioni ha pubblicato pi di duecentocinquanta testi.

7
>> continued on the following page
Shang Shung Institute Italy
Localit Merigar
58031 Arcidosso (GR, Italy)
Tel & fax: +39-0564-966940
info@shangshunginstitute.org
www.shangshunginstitute.org
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Shang Shung Institute Austria
Gschmaier 139
8265 Gr. Steinbach, Austria
Cell phone: 0043 676 3221365
Ofce: 0043 3386 83218
Fax: 0043 3386 83219
www.shangshunginstitute.org
www.ssi-austria.at
Shang Shung Institute of America
18 Schoolhouse Rd
P.O. Box 278
Conway, MA 01341, USA
Phone (main-Anna) 413 369 4928
Fax/Bookstore 413 369 4473
www.shangshung.org
Shang Shung Institute of Tibetan
Studies
The London Centre for the Study
of Traditional Tibetan Culture and
Knowledge
Kathy Cullen Administrator
++44 79 5086 2270
kathycullen@gmail.com
www.shangshunguk.org
Shang Shung Institute
T
he ancient Tibetan medi-
cal system was the core of
the Keynote Address given
by Chgyal Namkhai Norbu on
September 11 in the auditorium
of the Institute of Anatomy of Bo-
logna University.
Bologna, capital of Traditional
Tibetan Medicine for a day. On
Saturday September 11 at 9 am,
Prof. Namkhai Norbu, one of the
most important living Masters
of the Tibetan tradition, gave a
keynote address entitled Tibet-
an Medicine, Patrimony of Man-
kind in the Auditorium of the
Institute of Anatomy of the Uni-
versity.
This was the rst time that the
Auditorium of the Institute of
Anatomy at Bologna University
has been open for a public ad-
dress.
The event which was organized
by the Associazione per la Me-
dicina Centrata sulla Persona
(Association for Centered Per-
son Medicine, Onlus a Charity
established according to the Ital-
ian Law) in collaboration with
the International Shang Shung
Institute for Tibetan Studies, in
acknowledgement of its overall
signicance, has been granted of
the following endorsements:
His Holiness the 14th Dalai
Lama
The Presidency of the Council of
Ministers
The Minister of Foreign Affairs
The Government of Emilia-
Romagna Region
The Government of the Province
of Bologna
The Municipality of Bologna
The Faculty of Medicine, Univer-
sity of Florence
The Italian Institute for Africa
and the East, Rome
The European Medical Associa-
tion
The European Association for
Predictive, Preventive and Per-
sonalised Medicine
The College and Council of MDs
and Dentists of the Province of
Bologna
The Observatory and Methods
for Health, University of Milano-
Bicocca)
Bologna Local Health Authority
Noopolis Foundation, Rome
The Keynote Address given by
Professor Norbu was the rst
public initiative at the interna-
tional level by the Associazione
per la Medicine Centrata sulla
Persona Onlus, (Onlus is the Ital-
ian acronym for a charity recog-
nized by the Italian Law) a not-
for-prot association founded in
2007 in Bologna by psychiatrist
Paolo Roberti di Sarsina, MD, one
of the leading experts in Europe
for the advancement of Tradi-
tional, Complementary, Alterna-
tive and Unconventional Medi-
cine and member of the research
consortium nanced by the Eu-
ropean Commission. Roberti
di Sarsina explained, Tibetan
medicine is an ancient science in
which some of its fundamental
principles are listening carefully
to the patient, a close global ex-
amination (body, mind, energy,
but also surrounding circum-
stances) and personalized medi-
cal care.
Therefore it is a therapeutic
system that really has a lot to give
to a West that has not come to
terms with its own approach to
the problem of suffering. It is an
integral part of the Tibetan Tra-
dition that is the patrimony of
Mankind. In Italy, 18.5% of the
population, more than 11 million
people, have chosen to use non-
conventional medicine (source:
Eurispes); there were 8 million
in 2005 (ISTAT data). The trend is
even more impressive at the Eu-
ropean level with more than 130
million citizens in the EU who
regularly make use of non-con-
ventional medicine.
This is a phenomenon of great
importance which, however, ac-
cording to Roberti di Sarsina,
the Italian establishment is not
responding to adequately. Our
Parliament has not yet under-
stood or wanted to set up that
series of laws to regulate non
conventional medicine that we
have been waiting 20 years for.
Yet, by now everyone is aware of
the need to move from a type of
unpersonalised medicine to one
that is humanistic and promotes
the health of the person taking
into consideration his/her glo-
bality and uniqueness. Our As-
sociazione was created in order
to contribute actively to this pro-
cess.
Emilia-Romagna is one of the
regions that is focusing atten-
tion on the change that is taking
place as evidenced by the creation
by the Regional Government, in
2004, of the Observatory for Non
Conventional Medicine, of which
Roberti di Sarsina is founding
member, with the aim of giving
rise to some experimental proj-
ects within the Local Health Au-
thority. The integrated bill pre-
sented to the Health Commission
of the Senate by proposer Sen.
Daniele Bosone also includes the
national bill sent to the Cham-
bers, during the last legislature,
by the Emilia-Romagna Region.
Strongly desidered by Paolo
Roberti di Sarsina, the arrival
in Bologna of Chogyal Nam-
khai Norbu Rinpoche, one of
the highest level representatives
of the Tibetan Tradition, shows
the authority and commitment of
the Associazione per la Medicina
Centrata sulla Persona Onlus, as
far asin promotingon and safe-
guarding of suchthis Knowledg-
es of Health are concerned.
www.medicinacentratasullaper
sona.org
Chgyal Namkhai Norbu
at Bologna University
More than 400 people attended Rinpoches lecture. The Main Hall was completely full and another
lecture hall was equipped with a sound systemto receive those who could not nd a place.
Update on Ka Ter
Translation Project
W
ith great pleasure I
send you the latest in-
formation about the
Ka-Ter Translation Project and
the translation project Complete
Works of Chgyal Namkhai Nor-
bu.
Many of you have already experi-
enced the value of being able to
read the unique Dzogchen Teach-
ings written by our Master, Ch-
gyal Namkhai Norbu, in English,
which, until recently, were avail-
able only in Tibetan. Due to the
tireless work of the translators
and the editor, people do not
have to learn Tibetan in order to
read these texts, but can simply
acquire them and thus have the
marvelous opportunity to read
them. Just think of wonderful
books like The Light of Kailash,
Birth, Life and Death, Longchenpas
Advice from the Heart, or The Rain-
bow Body, and the great range
of books and booklets that help
each practitioner to apply the
Teachings of our incomparable
Master Chgyal Namkhai Norbu
already made available by Shang
Shung Edition.
Rinpoche has pointed out so
many times, that a translator
from Tibetan not only needs the
capacity to translate the Tibetan
words into English, but that one
must have the capacity to trans-
late the MEANING of these mar-
velous texts. For many Tibetan
words describing a certain state
or understanding there does not
exist an English term. For that
reasona qualied translator must
knowthe meaning of the text and
must also have experienced the
state that is explained.
The Shang Shung Institute Aus-
tria is in charge of raising suf-
cient funds, so that the transla-
tors and the editor can focus on
their work and not have to earn
their living throughactivities oth-
er than translating or editing the
precious texts, which Rinpoche
offers us. All translators and the
editor receive payment for their
wonderful work. The funds for
their income come exclusively
from donors to the Internation-
al Dzogchen Community this
means from YOU.
To raise funds for translation
projects is not at all easy.
Though many donors have been
very generous, the fact is that in
2010 we could not cover all the
costs for the translation staff.
For that reasonwe ask you to sup-
port our activities this year with
special generosity.
Please read the detailed Report of
Activities and please support our
efforts, so that we can continue
with our benecial work. Please
donate directly with your cred-
it card on our web safe site or
get one of our Donation Pack-
ages.
Thank you so much for all your
support and dedication.
Tashi Delegs andvery best wishes,
Oliver Leick
Coordinator of the Ka-ter Trans-
lation Project and
Complete Works of Chgyal
Namkhai Norbu
www.ssi-austria.at
Report of
Activities of the
International
Shang Shung
Institute
We welcome you to read the de-
tailed Report of Activities and to
support our efforts so that we can
continue with our work also for
the benet of future generations.
Adriano Clemente
In 2010 Adriano Clemente
worked on the following books:
Rainbow Body: The Life and Realiza-
tion of Togden Ugyen Tendzin
Translated from Tibetan, edited
and annotated by Adriano. Pub-
lished in August 2010.
THE MIRROR No. 106 September, October 2010
06/09/10 22.42 "Tibetan Medicine:Heritage of Mankind"
Pagina 1 di 2 http://www.dzogchen.it/lp/conferenza_2010-09-11/index.php?lang=en
Association for Centred Person Medicine
Keynote Lecture by Prof.
Chgyal Namkhai Norbu Rinpoche
"Tibetan Medicine:
Heritage of Mankind"
Bologna, Saturday 11th September 2010, 9 AM
Main Hall, Institute of Human Anatomy,
University of Bologna 48 Irnerio Street, Bologna
Endorsements:
His Holiness the 14th Dalai Lama
The Presidency of the Council of Ministers
Ministry of Foreign Affairs
Regional Government of Emilia-Romagna
Provincial Government of Bologna
Municipality of Bologna
Faculty of Medicine, University of Florence
Italian Institute for Africa and the East, Rome
European Medical Association
European Association for Predictive, Preventive and Personalised Medicine
Observatory and Methods for Health, University of Milan-Bicocca
Province of Bologna College of MDs and Dentists
Bologna Local Health Authority
Noopolis Foundation, Rome
Scientific Secretariat: Paolo Roberti di Sarsina, Luigi Ottaviani, Alfredo Vannacci
Organizing Secretary: Paolo Roberti di Sarsina, Nadia Gaggioli, Luigi Ottaviani, Cesare Pilati
10/09/10 08.16 Unione Buddhista Italiana - UBI
Pagina 1 di 3 http://www.buddhismo.it/
UBI - Unione Buddhista Italiana
Ente Religioso riconosciuto con D.P.R. 3-1-1991
Associata allUnione Buddhista Europea
N e w s
Comunicati Stampa
ubi.italia@tiscali.it
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Lezione Magistrale
del Prof. Namkhai Norbu
"La Medicina Tibetana: patrimonio dell'Umanit"
Bologna, sabato 11 settembre 2010, ore 9:00
Aula Magna, Istituto di Anatomia Umana Normale,
Universit di Bologna, via Irnerio 48
Locandina (pdf 581 kb)
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1LkMINCLCG IN 8ICMLDICAL LI1LkA1UkL IN LNGLISn LANGUAGL

ll Lermlne !"#$%&'(#) +,$%-%(," fa la sua prlma comparsa su una rlvlsLa dl blomedlclna ln llngua lnglese su ubMed nel 1932.
ll Lermlne .,"/'( 0,(1",$ +,$%-%(," appare per la prlma volLa nel 1974.
l Lermlnl +,$%-%(# 2)1,"(#&3#", +,$%-%(# 0'45),4,(1#"," e +,$%-%(# 6(1,7"#&3#" hanno un'orlglne recenLe nella leueraLura
blomedlca.
lacendo rlferlmenLo a Medllne e ubMed ll Lermlne 2)1,"(#&3, +,$%-%(," apparve per la prlma volLa ln una rlvlsLa dl blomedlclna nel
1973 allorquando nurslng 1lmes" lnlzl a pubbllcare una serle dl arucoll sulla MedlLazlone 1rascendenLale, la Cuarlglone SplrlLuale e la
Medlclna Cmeopauca.
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quando ll LanceL pubbllc l'arucolo dal uLolo: ComplemenLary Medlclne ln Lhe unlLed klngdom".
lnvece ll Lermlne 6(1,7"#&3, +,$%-%(," vlene lnLrodouo ln una rlvlsLa dl blomedlclna ln llngua lnglese nel 1993.
2)1,"(#&3, #($ 0'45),4,(1#"9 +,$%-%(," rlsale su ubMed al 1991.
MenLre ll Lermlne 0'45),4,(1#"9 #($ 2)1,"(#&3, +,$%-%(," compare per la prlma volLa su ubMed ln un arucolo del 1996.
lnvece l prlml due arucoll lndlclzzau su ubMed nel cul uLolo sl rlLrova ll Lermlne 1radluonal Aslan Medlclne e Aslan 1radluonal Medlclne
sono rlspemvamenLe dell'anno 1988 e dell'anno 2000. 1radluonal LasL Aslan Medlclne appare nel 2012. ComplemenLary, AlLernauve and
lnLegrauve Medlclne nel 2013.

k|assumendo: pr|ma comparsa ne||a |eueratura b|omed|ca d| ||ngua |ng|ese su ubMed:

1. 1rad|nona| Med|c|ne (1M) 19S2
2. erson Centred Med|c|ne (CM) 1974
3. A|ternanve Med|c|ne (AM) 197S
4. Unconvennona| Med|c|ne (UM) 1983
S. Comp|ementary Med|c|ne (CM) 198S
6. A|ternanve and Comp|ementary Med|c|ne (ACM) 1991
7. Integranve Med|c|ne (IM) 199S
8. Comp|ementary and A|ternanve Med|c|ne (CAM) 1996
9. 1rad|nona| As|an Med|c|ne (1AM) 1988
10.As|an 1rad|nona| Med|c|ne (A1M) 2000
11.1rad|nona| Last As|an Med|c|ne (1LAM) 2012
12.Comp|ementary, A|ternanve and Integranve Med|c|ne (CAIM) 2013
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

CAM (Complementary and Alternative Medicine) acronimo ampiamente
diffuso nella letteratura internazionale ma non completamente accettato.

Tale definizione stata coniata nel 1997 alla Conferenza del United States
Office for Alternative Medicine of the National Institutes of Health
(successivamente eretto dal Governo Federale a National Center for
Complementary and Alternative Medicine, NCCAM) e successivamente
adottato dal Cochrane Collaboration e dal Ministerial Advisory Committee
on Complementary and Alternative Medicine:

Complementary and alternative medicine (CAM) is a broad domain
of healing resources that encompasses all health systems,
modalities and practices and their accompanying theories and
beliefs, other than those intrinsic to the politically dominant health
system of a particular society or culture in a given historical period.
CAM includes all such practices and ideas self-defined by their
users as preventing or treating illness or promoting health and well-
being. Boundaries within CAM and between the CAM domain and
that of the dominant system are not always sharp or fixed.
Differences between
Western Medicine and TM/CAM

The main philosophy of Western Medicine is that if the human body is
struck by diseases, the causative agent must be identified and dealt with
in order to return patients to a state of good health.

A common feature of most systems of Traditional Medicine is that they
take a holistic approach towards the sick individual and treat
disturbances on the physical, emotional, mental and living environment
levels simultaneously.


Dr Xiaorui Zhang, former Coordinator Traditional Medicine, Department of Health System
Governance and Service Delivery, World Health Organization

Perspectives on Complementary
and Alternative Medicine Research
For thelast 2decades, thephrasecomplementaryand
alternative medicine has been usedto describe a wide
array of treatments, health practices, and practitioner
disciplines with historical roots outside conventional
medicine. Examples include ancient practices such as
acupuncture; herbal remedies; visits to complemen-
tary clinicians includingnaturopaths, homeopaths, and
chiropractors; and meditative practices such as mind-
fulness, yoga, and tai chi. Data fromthe 2007 National
HealthInterviewSurveyshowthat about 40%of USresi-
dents integrate1 or moreof theseunconventional health
practicesintotheir personal healthcare,
1
spendingabout
$34 billion per year out of pocket.
2
The widespread use of these practices perplexes
many physicians. Concerns include scientific implausi-
bility, unjustified claims of benefit, possible adverse ef-
fects, interactions withprescribedtreatments, adulter-
ated products, and the possibility that vulnerable
patients with serious diseases may be misled.
TheNational Institutes of Healths (NIHs) efforts to
address theseconcerns beganinearnest in1999, driven
toward 2 ends: filling gaps in scientific evidence about
efficacy and safety and exploring the possibility of real
benefit in some practices of interest to the public. The
effortshaveincludedbothlarge, multicenter clinical trials
andawide-rangingportfolioof exploratory, investigator-
initiated, basic and clinical research projects.
That this publicsector investment has beenthesub-
ject of intense debate
3
is not surprising. If well-
informed, suchdebateis welcome. However, somecriti-
cismsbetrayalackof understandingof scientificprogress
inthis fieldandhowit has shapeda compelling, sharply
focused research agenda. In this Viewpoint, we de-
scribe the 2013 NIH perspective on investment in re-
search on these interventions and call for a more nu-
anced conversation about them.
What Have We Learned?
National surveys suggest that approximately half of
US residents use of these complementary and alterna-
tivetherapies is totreat symptoms, particularly chronic
pain.
1
The other half is used to promote physical health
or psychological well-being.
1
Althoughmuchof this use
is self-administered, it is most oftencombinedwithcon-
ventional care. Usetoreplaceprovenconventional treat-
mentalthoughof substantial concernis uncommon.
1
Moreover, many mainstream institutions, both ci-
vilian and military, are integrating some of these ap-
proaches intothecaretheyprovide.
2
Marketingtocon-
sumer demandintheUShealthcaresystemundoubtedly
is driving some of this integration, ahead of evidence
about safety and efficacy.
For some mind-body approaches, however, there
is mounting evidence of usefulness and safety, par-
ticularly in relieving chronic pain. A few examples
include acupuncture for osteoarthritis pain; tai chi for
fibromyalgia pain; and massage, spinal manipulation,
and yoga for chronic back pain.
4
Increasing comfort
with this emerging evidence is reflected in practice
guidelines from the American College of Physicians,
the American Pain Society, and the Department of
Defense.
5,6
Translational research is also elucidating effects of
interventions like meditation and acupuncture on cen-
tral mechanismsof painperceptionandprocessing, regu-
lation of emotion and attention, and placebo re-
sponses. Althoughnot yet fullyunderstood, theseeffects
point toward scientifically plausible
mechanismsoftenunrelatedtothetra-
ditional mechanistic explanationsby
which these interventions might exert
benefit.
Another major focus of past NIHin-
vestments has beenonrigorous, appro-
priately powered, placebo-controlled
trials of widely used dietary supple-
ments. These include St Johns wort for major depres-
sion, glucosamine and chondroitin sulfate for knee os-
teoarthritis, silymarin for chronic liver disease, saw
palmetto for benign prostatic hyperplasia, ginkgo for
early cognitive decline, and vitamin E and selenium to
prevent prostatecancer.
7
Theresults of theselargestud-
ies failed to confirmbenefits seen in earlier preliminary
studies. Althoughmanyweredisappointed, this bodyof
work has had well-documented influences on con-
sumer use and spending
8
and has contributed evi-
dence to systematic reviews. In addition, high-quality
data sets fromthese studies are being used to examine
other important health research questions.
Other research on natural products has yielded
important information about safety concerns, includ-
ing toxicities of specific products, herb-drug interac-
tions, and instances of product contamination or adul-
teration. This work has contributed to regulatory
actions aimed at consumer protection and has argu-
ably heightened awareness that natural does not
mean safe.
For some mind-body approaches,
however, there is mounting evidence of
usefulness and safety, particularly in
relieving chronic pain
VIEWPOINT
Josephine P. Briggs,
MD
National Center for
Complementary and
Alternative Medicine,
National Institutes of
Health, Bethesda,
Maryland.
Jack Killen, MD
National Center for
Complementary and
Alternative Medicine,
National Institutes of
Health, Bethesda,
Maryland.
Corresponding
Author: Josephine P.
Briggs, MD, National
Center for Complemen-
tary andAlternative
Medicine, 31 Center Dr,
Bldg 31, Ste 2B11,
Bethesda, MD20814
(briggsj@mail.nih.gov).
jama.com JAMA August 21, 2013 Volume 310, Number 7 691
Downloaded From: http://jama.jamanetwork.com/ by a BIBLIOSAN remote cilea clas User on 08/21/2013
8r|ggs I, k|||en Ik. erspecnves on
Comp|ementary and A|ternanve Med|c|ne
kesearch. IAMA 2013,310(7):691-692.
Perspectives on Current Research
and Future Directions
These investments of a small fraction of public sector health re-
searchdollarshavebeguntomeet theneedfor better evidenceabout
thesewidelyusedinterventions andclarifythepotential of somefor
integration into patient care. A new set of priorities has evolved,
shaped around emerging evidence of efficacy and safety, amena-
bility to rigorous investigation, and practical but important public
health needs.
One research priority is focused on symptom management
specificallytheroleof mind-bodyinterventionsinmanagingpainand
other symptoms common to many chronic diseases. All physicians
understandthelimits of current treatments for chronic painandthe
potential value of nonpharmacological interventions. This priority
alsoencompasses researchtobetter understandthemechanisms
includingplaceboresponsesthat couldbeexploitedtomediateor
modulate these symptoms.
Similarly, research on natural productsdietary supplements,
herbal medicines, and probioticshas also been focused consider-
ably. Priorities nowinclude translational research to elucidate bio-
logical actions and provide a sound mechanistic foundation for po-
tential clinical studies and include the development of a strong
technological platformfor systematic study of herb-drugandherb-
herbinteractions using state-of-the-art methods of pharmacology,
pharmacognosy, genomics, and proteomics.
Debateabout NIHeffortsinthisareaisvital toensuringthat valu-
able research resources are wisely invested. However, the debate
requires amorenuancedconversationthanhas oftenbeenthecase
in the past.
First andforemost, theconversationshouldreflect current reali-
ties, includingtheevolutionofresearchprioritiesandtheshiftsinfund-
ingtoprojectsthat addressthem, rather thanareasthat havelesssci-
entificpromiseor lessamenabilitytoscientificinvestigation. Second,
although discussions about complementary and alternative medi-
cine often imply a clear demarcation distinguishing a monolithic al-
ternativedomainfromconventional medicine, thisdistinctionbreaks
downintherealitiesofthepluralisticUShealthcaresystem. Thebound-
aries also shiftin both directionsas evidence changes. Third, the
conversationshouldrecognizethestateof current evidenceindicat-
ing that some of these practices are useful and can appropriately be
integratedintocare, someshouldnot, somearedangerousandmerit
regulatory attention, and many are somewhere in between.
A more nuanced conversation about this field and its research
canimprovethedialoguebetweenhealthcareprofessionals andpa-
tients, foster better researchpartnerships, andfacilitatepatient ac-
cess to interventions that may be helpful.
ARTICLE INFORMATION
Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Formfor
Disclosure of Potential Conflicts of Interest and
none were reported.
REFERENCES
1. Barnes PM, BloomB, Nahin RL. Complementary
and alternative medicine use among adults and
children: United States, 2007. Natl Health Stat Rep.
2008;(12):1-23.
2. Schultz AM, Chao SM, McGinnis JM. Integrative
Medicine and the Health of the Public: A Summary of
the February 2009 Summit. Washington, DC:
National Academies Press; 2009.
3. Offit PA. Studying complementary and
alternative therapies. JAMA. 2012;307(17):1803-
1804.
4. Spotlighted research resultschronic pain.
National Center for Complementary and Alternative
Medicine, NIHwebsite. http://nccam.nih.gov
/health/556/research. Accessed April 24, 2013.
5. Chou R, QaseemA, SnowV, et al; Clinical Efficacy
Assessment Subcommittee of the American College
of Physicians; American College of Physicians;
American Pain Society LowBack Pain Guidelines
Panel. Diagnosis and treatment of lowback pain: a
joint clinical practice guideline fromthe American
College of Physicians and the American Pain
Society. Ann Intern Med. 2007;147(7):478-491.
6. Pain Management Task Force Report: providing
a standardized DoDand VHA vision and approach
to pain management to optimize the care for
warriors and their families. Office of The Army
Surgeon General. http://www.armymedicine.army
.mil/reports/Pain_Management_Task_Force.pdf.
May 2010. Accessed April 24, 2013.
7. Spotlighted research resultsdietary
supplements. National Center for Complementary
and Alternative Medicine, NIHwebsite.
http://nccam.nih.gov/health/13/research. Accessed
April 24, 2013.
8. NBJs Supplement Business Report 2012. New
York, NY: Penton Media; 2012.
Opinion Viewpoint
692 JAMA August 21, 2013 Volume 310, Number 7 jama.com
Downloaded From: http://jama.jamanetwork.com/ by a BIBLIOSAN remote cilea clas User on 08/21/2013
8r|ggs I, k|||en Ik.
erspecnves on Comp|ementary and A|ternanve Med|c|ne kesearch.
IAMA 2013,310(7):691-692.
Barnes et al., CDC NHS # 12 2008
:
Definition of Integrative Medicine
Integrative Medicine is the practice of medicine that
reaffirms the importance of the relationship between
practitioner and patient, focuses on the whole person,
is informed by evidence, and makes use of all
appropriate therapeutic approaches, healthcare
professionals and disciplines to achieve optimal
health and healing.
Developed and Adopted by The Consortium, May 2004
Edited May 2005
http://www.imconsortium.org
University of California,
San Francisco
Duke University
University of Maryland
University of Massachusetts
University of Arizona
Harvard University
1999: 8 Institutions
Stanford University
University of Minnesota
Albert Einstein/Yeshiva University
Boston University
Columbia University
Duke University
Georgetown University
George Washington University
Harvard Medical School
Johns Hopkins University
Laval University, Quebec
Mayo Clinic
McMaster University, Ontario
Northwestern University
Ohio State University
Oregon Health & Science University
Stanford University
Thomas Jefferson University
University of Alberta
University of Arizona
University of Calgary

University of Maryland
University of Massachusetts
University of Medicine &
Dentistry of New Jersey
University of Michigan
University of Minnesota
University of New Mexico
University of North Carolina,
Chapel Hill
University of Cincinnati
University of Pennsylvania
University of Pittsburgh
University of Texas
University of Vermont
University of Washington
University of Wisconsin
Vanderbilt University
Wake Forest University
Yale University
University of Connecticut
University of Hawaii
University of Illinois
University of Kansas
University of California, Irvine
University of California, Los Angeles
University of California, San Francisco
University of Colorado
2009: 44 Members
*
*
*
*
National Efforts Addressing
CAM Integration in Education
NI H- Funded I nst i t ut i ons ( R25 Gr ant s)
Undertaking Curricular Initiatives (15)
Consortium of Academic Health Centers for
Integrative Medicine (30) (est. 2002)
Policy Initiatives:
White House Commission on CAM Policy (2002)
National Policy Dialogue Report (2002)
Institute of Medicine (IOM) Committee on CAM (Jan
2005)
National Education Dialogue (June 2005)
Institute of Medicine (IOM)
Study on CAM
Recommendation on Education

The committee recommends that
health profession schools (e.g.
schools of medicine, nursing,
pharmacy, and al l i ed heal th)
incorporate sufficient information
about CAM into the standard
curriculum!to enable licensed
prof essi onal s t o compet ent l y
advise their patients about CAM.
Report Issued: January 12, 2005
USA number of postgraduate CAM qualifications
1995-2010
Differences between the biomedical and holistic model
Model

Biopsychosocial

Biomedical



Body/mind as a system interlinked
with other systems

Mind/body separation; body as an
object

Emphasis

Health

Disease

Priority

Prevention

Curative

Diagnostic focus

Whole person in his/her social &
psychological environment

Localised tissue disruption &
specific pathogen

Treatment approach

Support vis medicatrix naturae;
restoring balance to the whole
psychosomatic system

Intervention in disease pathway;
symptomatic

Individualization/standardization

Individualization of care

Standardization of care

Long-term/short-term

A long-term focus on creating and
maintaining health and well-being

Aggressi ve i nt ervent i on wi t h
emphasis on short-term results

Military metaphor for therapy

Stimulate the home forces

Search and destroy the invader

Patient/physician relationship

Aut hori t y and responsi bi l i t y
inherent in each individual;
c o - o p e r a t i v e p a r t n e r s h i p ;
empowering
Authority and responsibility inherent
i n pr act i t i oner, not pat i ent ;
paternalistic; disempowering
[Comparison of the Biopsychosocial and Biomedical model; adapted from Millenson and Davis-Floyd]
!"# %&'"()& *+',-
.("/0" 1(("2&,'3("
4"'2&3&(,'5 602&7&,0
!08'"3/0,3

WHO and Traditional Medicine
WHO HQ
Geneva,
26.04.06
Traditional and Complementary Medicine
Traditional Medicine is the sum total of the knowledge,
skills, and practices based on the theories, beliefs, and
experiences indigenous to different cultures, whether
explicable or not, used in the maintenance of health as
well as in the prevention, diagnosis, improvement or treatment of
physical and mental illness.
More information
NEW! WHO Traditional Medicine Strategy: 2014-2023
Denitions of Traditional medicine terms
WHO Collaborating Centres for Traditional medicine
Executive Board and World Health Assembly Resolutions
Publications
WHO's Support for Regulation of Herbal Medicines
International Regulatory Cooperation for Herbal Medicines (IRCH)
Informations sources supported by WHO Regional Ofces
SEARO - South East Asia
HerbalNet - Digital Repository in Herbal Medicines
WPRO - Western Pacic Region
GHL WPRO Country Focus
Highlights of the rst WHO Congress on Traditional Medicine
"Beijing Declaration"
For further enquiries please contact:
E-mail: trm@who.int
Dr Zhang Qi
HSS/HPW/TRM
WHO/Geneva
Fax: +41 22 791 4153
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Traditional medicine (TM) refers to the knowledge, skills and practices
based on the theories, beliefs and experiences indigenous to different
cultures, used in the maintenance of health and in the prevention,
diagnosis, improvement or treatment of physical and mental illness.
Traditional medicine covers a wide variety of therapies and practices which
vary from country to country and region to region. In some countries, it is
referred to as "alternative" or "complementary" medicine (CAM).
Traditional medicine has been used for thousands of years with great
contributions made by practitioners to human health, particularly as primary
health care providers at the community level. TM/CAM has maintained its
popularity worldwide. Since the 1990s its use has surged in many
developed and developing countries.

General information
Fact sheet: traditional medicine
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medicine?
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and Pharmaceutical Policies (EMP)
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regions
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General Guidelines for Methodologies on Research and
Evaluation of Traditional Medicine (Geneva, 2000)
Traditional medicine Definitions
Traditional medicine has a long history. It is the sum total
of the knowledge, skills and practices based on the
theories, beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the
maintenance of health, as well as in the prevention,
diagnosis, improvement or treatment of physical and
mental illnesses.
The terms complementary/alternative/non-conventional
medicine are used interchangeably with traditional
medicine in some countries.
The World Health Organisation defines it as
follows:

Complementary and Alternative Medicine
(CAM) refers to a broad set of health care
practices that are not part of a country's
own tradition and not integrated into the
dominant health care system.

Other terms sometimes used to describe
these health care practices include natural
medicine, non-conventional medicine
and holistic medicine.
WHO Traditional Medicine Strategy 2002-2005
integrate TM/CAM with
national health care systems
provide evaluation, guidance and
support for effective regulation
ensure avai l abi l i t y and
affordability of TM/CAM, including
essential herbal medicines
P r o m o t e
therapeutically-sound use of TM/CAM
by providers and consumers
1
2
3
4
Policy:
Safety, efficacy and quality:
Access:
Rational use:
WHO Traditional Medicine Strategy 20022005 objectives, components and expected outcomes

Objectives

Components

Expected outcomes
POLICY: Integrate TM/CAM with national
health care systems, as appropriate, by
developing and implementing national TM/
CAM policies and programs
1. Recognition of TM/CAM
Help countries to develop national policies and programmes on TM/
CAM
1.1 Increased government support for TM/CAM, through
comprehensive national policies on TM/CAM
1.2 Relevant TM/CAM integrated into national health care system
services
2. Protection and preservation of indigenous TM knowledge
relating to health
Help countries to develop strategies to protect their indigenous TM
knowledge
2.1 Increased recording and preservation of indigenous knowledge of
TM, including development of digital TM libraries
SAFETY, EFFICACY AND QUALITY:
Promote the safety, efficacy and quality of
TM/CAM by expanding the knowledge-base
on TM/CAM, and by providing guidance on
regulatory and quality assurance standards
3. Evidence-base for TM/CAM
Increase access to and extent of knowledge of the safety, efficacy and
quality of TM/CAM, with an emphasis on priority health problems
such as malaria and HIV/AIDS
3.1 Increased access to and extent of knowledge of TM/CAM through
networking and exchange of accurate information
3.2 Technical reviews of research on use of TM/CAM for prevention,
treatment and management of common diseases and conditions
3.3 Selective support for clinical research into use of TM/CAM for
priority health problems such as malaria and HIV/AIDS, and common
diseases
4. Regulation of herbal medicines
Support countries to establish effective regulatory systems for
registration and quality assurance of herbal medicines
4.1 National regulation of herbal medicines, including registration,
established and implemented
4.2 Safety monitoring of herbal medicines and other TM/CAM
products and therapies
5. Guidelines on safety, efficacy and quality
Develop and support implementation of technical guidelines for
ensuring the safety, efficacy and quality control of herbal medicines
and other TM/CAM products and therapies
5.1 Technical guidelines and methodology for evaluating safety,
efficacy and quality of TM/CAM
5.2 Criteria for evidence-based data on safety, efficacy and quality of
TM/CAM therapies
ACCESS: Increase the availability and
affordability of TM/CAM, as appropriate,
with an emphasis on access for poor
populations
6. Recognition of role of TM/CAM practitioners in health care
Promote recognition of role of TM/CAM practitioners in health care
by encouraging interaction and dialogue between TM/CAM
practitioners and allopathic practitioners
6.1 Criteria and indicators, where possible, to measure cost-
effectiveness and equitable access to TM/CAM
6.2 Increased provision of appropriate TM/CAM through national
health services
6.3 Increased number of national organizations of TM/CAM providers
7. Protection of medicinal plants
Promote sustainable use and cultivation of medicinal plants
7.1 Guidelines for good agriculture practice in relation to medicinal
plants
7.2. Sustainable use of medicinal plant resources
RATIONAL USE: Promote therapeutically
sound use of appropriate TM/CAM by
providers and consumers
8. Proper use of TM/CAM by providers
Increase capacity of TM/CAM providers to make proper use of TM/
CAM products and therapies
8.1 Basic training in commonly used TM/CAM therapies for allopathic
practitioners
8.2 Basic training in primary health care for TM practitioners
9. Proper use of TM/CAM by consumers
Increase capacity of consumers to make informed decisions about use
of TM/CAM products and therapies
9.1 Reliable information for consumers on proper use of TM/CAM
therapies
9.2 Improved communication between allopathic practitioners and their
patients concerning use of TM/CAM
LINEE GUIDA PER LO SVILUPPO DI INFORMAZIONI PER IL CONSUMATORE PER UN
USO APPROPRIATO DI MEDICINA TRADIZIONALE, COMPLEMENTARE E ALTERNATIVA
World Health Organization: Global Atlas of Traditional, Complementary and Alternative Medicine.
Centre for Health Development, Kobe, Japan, 2005
Beijing Declaration

Adopted by the WHO Congress on Traditional Medicine, Beijing, China, 8 November 2008

Participants at the World Health Organization Congress on Traditional Medicine, meeting
in Beijing this eighth day of November in the year two thousand and eight;

Recalling the International Conference on Primary Health Care at Alma Ata thirty years
ago and noting that people have the right and duty to participate individually and
collectively in the planning and implementation of their health care, which may include
access to traditional medicine;

Recalling World Health Assembly resolutions promoting Traditional Medicine, including
WHA56.31 on Traditional Medicine of May 2003;

Noting that the term Traditional Medicine" covers a wide variety of therapies and
practices which may vary greatly from country to country and from region to region, and
that Traditional Medicine may also be referred to as alternative or complementary
medicine;
Recognizing Traditional Medicine as one of the resources of primary health
care services to increase availability and affordability and to contribute to
improve health outcomes including those mentioned in the Millennium
Development Goals;

Recognizing that Member States have different domestic legislation,
approaches, regulatory responsibilities and delivery models;

Noting that progress in the field of Traditional Medicine has been obtained
in a number of Member States through implementation of the WHO
Traditional Medicine Strategy 20022005;

Expressing the need for action and cooperation by the international
community, governments, and health professionals and workers, to ensure
proper use of Traditional Medicine as an important component
contributing to the health of all people, in accordance with national
capacity, priorities and relevant legislation;

In accordance with national capacities, priorities, relevant legislation and
circumstances, hereby make the following Declaration:
1. The knowledge of Traditional Medicine, treatments and practices
should be respected, preserved, promoted and communicated widely
and appropriately based on the circumstances in each country.

2. Governments have a responsibility for the health of their people and
should formulate national policies, regulations and standards, as part
of comprehensive national health systems to ensure appropriate, safe
and effective use of Traditional Medicine.

3. Recognizing the progress of many governments to date in
integrating Traditional Medicine into their national health systems, we
call on those who have not yet done so to take action.
4. Traditional Medicine should be further developed based on research
and innovation in line with the "Global strategy and plan of action on
public health, innovation and intellectual property" adopted at the
Sixtyfirst World Health Assembly in Resolution WHA61.21 in 2008.
Governments, international organizations and other stakeholders
should collaborate in implementing the global strategy and plan of
action.

5. Governments should establish systems for the qualification,
accreditation or licensing of Traditional Medicine practitioners.
Traditional Medicine practitioners should upgrade their knowledge and
skills based on national requirements.

6. The communication between conventional and Traditional Medicine
providers should be strengthened and appropriate training
programmes be established for health professionals, medical students
and relevant researchers.
Integration of TM/CAM
into National Health Systems
The two systems of traditional and western
medicine need not clash. Within the context of
primary health care, they can blend together in a
beneficial harmony, using the best features of each
system, and compensating for certain weaknesses in
each
Dr Margaret Chan, Director-General of WHO at Opening ceremony of WHO
Congress 7
th
November 2008, Beijing
Countries Progress in the Field of
Traditional Medicine
Number of countries before 1990: 5
Number of countries in 2007: 48
0
10
20
30
40
50
5 7 11 17 25 34 41 44 48
Before
1990
1990 -
1991
1992 -
1993
1994 -
1995
1996 -
1997
1998 -
1999
2000 -
2001
2002 -
2003
2007
Number of
countries with
national policy
pending: 51
31% of
respondents
have national
policy
Number of Member States with
national policy on TM/CAM
WHO Global Survey on National Policy and
Regulation of Herbal Medicines 2005 and WHO
medicine strategy 2008-2014

Countries Progress in the Field of
Traditional Medicine
Number of countries before 1986: 14
Number of countries in 2007: 110
65% of
respondents have
established
herbal medicines
law or
regulations
42 (49%) declared
regulations were
in the process of
being developed.
Number of Member States with
herbal medicines law or regulations
WHO Global Survey on National Policy and
Regulation of Herbal Medicines 2005 and WHO
medicine strategy 2008-2014
62
12
15
21
25
31
36
41
43
58
0
10
20
30
40
50
60
70
1970 1975 1980 1985 1990 1995 2000 2003 2005 2007
Year
N
u
m
b
e
r

o
f

M
e
m
b
e
r

S
t
a
t
e
s
Countries Progress in the Field of
Traditional Medicine
Number of Member States with a national research
institute on TM/CAM or herbal medicines

New trend in integrating/including TM/CAM
practice into Health Services

! Hungary 1997
! Belgium 1999
! Ghana 1999
! Ukraine 1998
! Myanmar 2000
! Russian Federation 2001
! Singapore 2001 and 2002
! Tanzania 2002
! Indonesia 2002 and 2007
! Norway 2003
! Portugal 2003
! Brazil 2006
! UK 2008


The countries have established national law and regulation for
practice of TM/AM therapies
FIFTY-SIXTH WORLD HEALTH ASSEMBLY
Resolution 56.31
Traditional medicine

WHO New Resolution on Traditional Medicine
Resolution World Health Assembly 62.13 adopted on 26 May 2009
The WHA Resolution emphasizes:
" To preserve and communicate knowledge of Traditional
Medicine;
" To formulate national policies, regulations and standards of
Traditional Medicine;
" To integrate Traditional Medicine into national health
systems;
" To develop research and innovation;
" To establish qualifications and licensed practice;
" To strengthen communication between conventional and
Traditional Medicine providers.
WHA 62.12 on primary health care,
including health system strengthening
Request WHO
to foster alignment and coordination of global interventions
for health system strengthening, basing them on the primary
health care approach, in collaboration with Member States,
relevant international organizations, international health
initiatives, and other stakeholders in order to increase
synergies between international and national priorities;

WHO restructure
Traditional Medicine: Traditional Medicine Programme
is relocated in the Department of Health System
Governance and Service Delivery

Renewed priority areas of WHOs
Traditional Medicine
# Capitalizing on the potential contribution of Traditional
Medicine to self-care and to people-centred primary care

# Modality for integration of Traditional Medicine into
health systems

# Promoting agreement and consensus on criteria for
endorsement, integration, and evaluation of Traditional
Medicine as a subsystem of national health systems
# Strengthening research to promote the quality, safety
and efficacy of traditional medicines and products
Research for Integrative Medicine
Two priority areas

Technical research: the research related to further develop
Traditional Medicine and focus on safety, quality and
efficacy of products and practice etc

Social research: the research related to evaluation role of
Traditional Medicine in the healthy system, the models of
integration of TM into healthy system, evaluation of cost-
effectiveness etc

$ The characteristics and special theory of TM/CAM should not be ignored
in the research

$ Communication between TM/CAM practitioners and conventional
health professionals and researchers should be further strengthened

$ Multiple training/education of TM/CAM for conventional health
professionals and researchers as well medicinal students should be
considered

$ Standards and terminology standards of TM/CAM could be play as the
bridge to facilitate communication between TM/CAM practitioners and
conventional professionals

$ Appropriate research methodology and approaches is crucial related to
the results of the research. Need efforts to develop the appropriate
research methodology and approaches.

Appropriate research methodology and
approaches for Traditional Medicine
UNESCO

Acupuncture and Moxibustion of Traditional Chinese Medicine

Inscribed in 2010 on the Representative List of the Intangible Cultural Heritage of Humanity

Description
Acupuncture and Moxibustion are forms of Traditional Chinese Medicine widely practised in China and also found in regions of south-east Asia, Europe and the
Americas.
The theories of Acupuncture and Moxibustion hold that the human body acts as a small universe connected by channels, and that by physically stimulating these
channels the practitioner can promote the human bodys self-regulating functions and bring health to the patient.
This stimulation involves the burning of moxa (mugwort) or the insertion of needles into points on these channels, with the aim to restore the bodys balance and
prevent and treat disease.
In Acupuncture, needles are selected according to the individual condition and used to puncture and stimulate the chosen points. Moxibustion is usually divided into
direct and indirect moxibustion, in which either moxa cones are placed directly on points or moxa sticks are held and kept at some distance from the body surface to
warm the chosen area.
Moxa cones and sticks are made of dried mugwort leaves.
Acupuncture and moxibustion are taught through verbal instruction and demonstration, transmitted through master-disciple relations or through members of a clan.
Currently, Acupuncture and Moxibustion are also transmitted through formal academic education.

Decision 5.COM 6.6

The Committee () decides that [this element] satisfies the criteria for inscription on the Representative List, as follows:

R1: Acupuncture and moxibustion are a traditional knowledge and practice being transmitted from generation to generation and recognized by Chinese communities
worldwide as part of their intangible cultural heritage;

R2: Their inscription on the Representative List could contribute to raising awareness concerning traditional medicine worldwide, while promoting cultural exchange
between China and other countries;

R3: A set of present and future safeguarding measures aim at protecting and promoting the element, supported by the commitments of the State, the communities and
the skill-bearers to their implementation;

R4: The nomination demonstrates that practitioners have participated in the nomination process and have provided their free, prior and informed consent;

R5: Acupuncture and moxibustion are inscribed on the National List of Intangible Cultural Heritage administered by the Department of Intangible Cultural Heritage of the
Ministry of Culture.

http://www.unesco.org/culture/ich/index.php?lg=en&pg=00011&RL=00425
WHO to define information standards for Traditional Medicine

WHO will develop, for the first time, a classification of Traditional Medicine, paving the way for the
objective evaluation of its benefits.

Creating an evidence base for Traditional Medicine
The International Classification of Traditional Medicine project will assist in creating an evidence base for
Traditional Medicine - producing terminologies and classifications for diagnoses and interventions.
We recognize that the use of Traditional Medicine is widespread. For many people especially in the
Western Pacific, South-East Asia, Africa and Latin America Traditional Medicine is the primary source of
health care, said Dr Marie-Paule Kieny, Assistant Director-General of Innovation, Information, Evidence
and Research at WHO.
Throughout the rest of the world, particularly Europe and North America, use of herbal medicines,
acupuncture, and other traditional medicine practices is increasing. Global classification and terminology
tools, for Traditional Medicine, however, have been lacking.

International platform to harmonize data
The International Classification of Traditional Medicine will have an interactive web-based platform to
allow users from all countries to document the terms and concepts used in Traditional Medicine.
Several countries have created national standards for the classification of Traditional Medicine but there
is no international platform that allows the harmonization of data for clinical, epidemiological and
statistical use. There is a need for this information to allow clinicians, researchers and policy-makers to
comprehensively monitor safety, efficacy, use, spending and trends in health care," said Kieny.
The classification will initially focus on Traditional Medicine practices from China, Japan and the Republic
of Korea that have evolved and spread worldwide.

Tokyo 7 December 2010

http://www.who.int/mediacentre/news/notes/2010/trad_medicine_20101207/en/print.html
WHO Benchmarks for Training in Traditional Complementary and Alternative Medicine
http://www.who.int/medicines/areas/traditional/trm_benchmarks/en/index.html



SHS/EGC/IBC-19/12/3 Rev.
Paris, 8 February 2013
Original: English/French

REPORT OF THE IBC ON
TRADITIONAL MEDICINE SYSTEMS AND THEIR ETHICAL IMPLICATIONS
UNESCOs International Bioethics Committee included the subject of
traditional medicine in its work programme for 2010-2011. A working
group was set up and asked to consider the ethical implications of
these widespread and highly varied practices, avoiding any overlap
with the research being carried out by other United Nations bodies
and agencies. In addition, relations were established with internal and
external sources for consultative purposes.
Internally, exchanges took place with the Member States of the
Intergovernmental Bioethics Committee (IGBC) at the joint session of
IBC and IGBC, and the 7th Session of IGBC, held at UNESCO
Headquarters in October 2010 and September 2011 respectively. At
IBCs 17th Session, in October 2010, experts from UNESCOs Natural
Sciences Sector and Culture Sector were also invited to present their
points of view on the matter.
Externally, traditional medicine practitioners from different parts of the
world were invited by IBC to take part in its 18th Session, held in Baku
in May-June 2011, and they enriched the discussion by presenting
their own experiences and viewpoints.
A draft version of the report was discussed by IBC members in the first
months of 2012. The report was submitted at the 19th Session of IBC,
held at UNESCO Headquarters in Paris on 11 and 12 September
2012, so that the possible follow-up to it could be studied.
Consequently, based on the comments received during the 19th
Session, the Committee revised and finalized the report in January
2013.
This document, which is neither exhaustive nor prescriptive, does not
necessarily represent views of UNESCOs Member States.
UNESCO REPORT OF THE INTERNATIONAL BIOETHICS COMMITTEE
ON TRADITIONAL MEDICINE SYSTEMS AND THEIR ETHICAL IMPLICATIONS 2013
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Progress since WHO TM Strategy
2002-2005 (review of the indicators)
25
39
45
48
69
65
82
92
110
119
0
20
40
60
80
100
120
140
1999 2003 2005 2007 2012
Figure 1: Number of MS with TM policy and MS regulating herbal medicines
Number of MS with TM policy Number of MS regulating herbal medicines
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Progress since WHO TM Strategy
2002-2005 (review of the indicators)
19
56
58
73
0
10
20
30
40
50
60
70
80
1999 2003 2005 2012
Figure 2: Number of MS with national research institute in TM/CAM
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Current situation: regulation on providers
With regulations on
T&CM providers
With no regulations on
T&CM providers
Not answered
Regulations on T&CM providers
Source: country report

!"
!"#$%&'
!"
!"#$%&'
$%
!(#&'
$&'
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Current situation: education
No T&CM education at university
level
With T&CM at university level
Not answered
Member States that provide T&CM education at university level
Source: country report
!"
"#$%&

#$
&'()*

!$+
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Challenges
15
58
60
63
65
67
68
75
78
83
105
0 20 40 60 80 100 120
Other
Lack of education and training for TM/CAM providers
Lack of mechanisms to monitor safety of TM/CAM products, including herbal
medicines
Lack of cooperation channels between national health authorities to share
information about TM/CAM
Lack of mechanisms to monitor safety of TM/CAM practice
Lack of expertise within national health authorities and control agencies
Lack of financial support for research on TM/CAM
Lack of appropriate mechanisms to monitor and regulate TM/CAM providers
Lack of appropriate mechanisms to control and regulate herbal products
Lack of mechanisms to control and regulate TM/CAM advertising and claims
Lack of research data
Number of Member States
Difficulties faced by Member States with regard to regulatory issues
related to the practice of T&CM
Source: country report
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Requests
11
29
38
45
47
50
51
51
54
54
55
55
58
65
1
49
37
39
37
36
28
32
34
35
29
33
39
29
5
10
12
14
7
11
17
19
17
8
10
9
6
7
0 20 40 60 80 100 120
Other
Provision of guidance on self-care, information for the public in primary health care or at the
community level
Provision of cooperation channels between national health authorities
Provision of technical support to promote safe and effective use of indigenous traditional
medicine in Primary Health Care
Arrangement of global meetings
Provision of guidelines or minimum requirements for basic training of TM/CAM providers
Seminar/workshop about national capacity to establish regulations for herbal medicines
Seminar/workshop on developing national policy and programmes for TM/CAM
Seminar/workshop about national capacity to establish regulations on TM/CAM practice
Provision of research databases
Seminar/workshop about national capacity building on safety monitoring of herbal medicines
Seminar/workshop about integration of TM/CAM in the primary health care context
Information sharing on regulatory issues
General technical guidance for research and evaluation of TM/CAM related to safety, quality
and efficacy
Number of Member States
The type of support for T&CM issues
that Member States are interested in receiving from WHO
Source: country report
Great need
Some need
No need
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A strategy on T&CM for 2014-23:
from recognition to regulation and integration
Goals:
Harness the potential contribution of T&CM to health, wellness and person-
centred health care in MS
Promote safe and effective use of T&CM through regulation, evaluation
and integration of products, practitioners and practice
Objectives:
To build knowledge base to actively manage T&CM through appropriate
national policies
To strengthen the quality, safety and effectiveness of T&CM through
regulating products, practice and practitioners
To promote equitable access to health through appropriate integration of
T&CM services in healthcare delivery and self-health care

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A strategy on T&CM for 2014-23:
from recognition to regulation and integration

Support Member States on research of T&CM to build the
knowledge for management and policy development:
practice profile, modalities, resource preservation
Support Member States on regulation of T&CM:
benchmarks, guidelines, terminologies and networks
Support Member States on integration of T&CM into health
systems: access, service delivery models, classifications,
education manuals
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Regulation on T&CM

Regulation on T&CM products
Regulation on T&CM practice
Regulation on T&CM practitioners
Knowledge based, evaluation
International regulatory collaboration
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Timeline
2011:
preparation;
assemble
evidence
2012:
drafts and
consultations
2013:
finalize draft
and file
report to EB
2014:
discussed in
EB and WHA
Fourth WHO Working Group Meeting on Traditional Medicine Strategy held in Hong Kong April 2013

The World Health Organization (WHO) today (April 24) convened the Fourth Working Group Meeting on Traditional Medicine Strategy in Hong Kong to
further discuss and develop the next WHO Traditional Medicine Global Strategy.

The three-day meeting, jointly organised by the WHO and Hong Kong's Department of Health (DH), continues to devise the next global strategy in the light
of the latest global developments in Traditional Medicine and the challenges that have emerged in the past decade.

Addressing the opening ceremony today, the Director of Health, Dr Constance Chan, said, "Traditional Medicine has been, and will continue to be, a
precious resource and part of the cultural heritage in many parts of the world. It is our mission to maximise the potential contribution of traditional medicine to
the health care system to benefit our people, and our responsibility to ensure this resource is used in a safe, effective and cost-effective manner."

"Production of the global strategy at this point in time cannot be more pertinent," she added.

Dr Chan said that the Chinese Medicine Division of the DH, which is the designated WHO Collaborating Centre for Traditional Medicine, would continue to
support the WHO to advocate and implement the global strategy, and facilitate better collaboration and co-ordination among WHO member states and regions.

She also took the opportunity to share with participants some of the recent milestones that mark the Government's strong commitment to the development
of Chinese Medicine in Hong Kong. These include the setting up of the Chinese Medicine Development Committee (CMDC) by the Chief Executive early this
year to give recommendations to the Government concerning the direction and long-term strategy in the future development of Chinese Medicines in Hong
Kong, and the publication of the fifth volume of the Hong Kong Chinese Materia Medica Standards (HKCMMS) in December last year.

"The CMDC sets the scene for better integration of Traditional Medicine in the mainstream health care system, contributing to its modernisation and
internationalisation, while the HKCMMS with publications up to five volumes so far, covering standards for about 200 commonly used herbs in Hong Kong, is
an important step forward to ensure the quality of herbs on sale in the local market," Dr Chan said.

Dr Chan expressed her sincere gratitude to the WHO for its leadership in co-ordinating member states and regions in formulating the global strategy, which
would shape the future of health care and bring the whole world to new horizons.

About 20 international experts from the WHO's six regions, namely Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the
Western Pacific, as well as local experts attended the meeting.
hup:]]apps.who.|nt]|r|s]b|tstream]1066S]924SS]1]9789241S06090_eng.pdf
hup:]]www.who.|nt]med|c|nes]pub||canons]trad|nona|]trm_strategy14_23]
en]
The WHO Traditional Medicine Strategy 20142023 was developed and
launched in response to the World Health Assembly Resolution on
Traditional Medicine (WHA62.13).

The strategy aims to support Member States in developing proactive
policies and implementing action plans that will strengthen the role
Traditional Medicine plays in keeping populations healthy.

Addressing the challenges, responding to the needs identified by Member
States and building on the work done under the WHO Traditional Medicine
Strategy 20022005, the updated strategy for the period 20142023
devotes more attention than its predecessor to prioritizing health services
and systems, including Traditional and Complementary Medicine products,
practices and practitioners.
17
WHO Traditional Medicine Strategy
Evolution of the WHO TM Strategy 20142023
This document is intended to provide information, context, guidance and
support to policymakers, health service planners, public health specialists,
traditional and complementary medicine communities and other interested
parties about T&CM, including products, practices and practitioners. It
addresses issues in evaluating, regulating and integrating T&CM, as well as in
harnessing its potential to benet the health of individuals.

The WHO Traditional Medicine Strategy 20142023 updates and enhances
the framework for action laid out in:
the WHO Traditional Medicine Strategy 20022005 (2), the rst strategy
document ever prepared by WHO in this eld;
the traditional medicine sections of the WHO Medicines Strategy 2004
2007 (3);
and the traditional medicine components of the WHO Medicines Strategy
20082013 (4).
This new strategy reviews the potential contribution T&CM can make to
health, in particular health service delivery, and establishes priority actions
for the period to 2023. This strategy is an effective and proactive response
to the World Health Assembly Resolution on traditional medicine (1), which
encourages Member States to consider T&CM as an important part of the
health system and builds on the work introduced in the Beijing Declaration,
adopted by the WHO Congress on Traditional Medicine in 2008.
This new strategy is an important document for Member States, T&CM
stakeholders and WHO in positioning T&CM within countries health systems.
The strategy highlights advances in T&CM research and development
and recognizes the experience gained during implementation of the WHO
Traditional Medicine Strategy 20022005 and the WHO medicines strategies
mentioned above.
23
WHO Traditional Medicine Strategy
2.3 Education and research
In order to improve the safe and qualied practice of T&CM, Member
States have developed regulations on the quality, quantity, accreditation
and education structures for T&CM practitioners, including practitioners of
conventional medicine who use T&CM. Signicant progress has been made in
1
Communication with WHO from the Government of the Republic of Korea, Ministry of Health and Welfare, 2013.
Figure 3: T&CM education at university level
Source: Interim data from 2nd WHO TRM global survey as of 11 June 2012.
129
With T&CM
at university
level
Not
answered
No T&CM
education at
university level
72
(56%)
39
(30%)
18
(14%)
many. For example, the number of Member States providing high-level T&CM
education programmes including Bachelor, Master and Doctoral degrees at
university level has increased from only a few to 39, representing 30% of the
surveyed countries (Figure 3).
In the African Region, TM knowledge and practices have been passed on
orally among traditional health practitioners for many generations. In recent
years, some countries have strengthened training programmes to develop
the knowledge of traditional health practitioners. Furthermore, in some
countries TM is included in university curricula for health profession students.
For instance, various universities in the Economic Community of West African
States, Democratic Republic of Congo, South Africa and Tanzania include TM
in the curricula for pharmacy and medical students (8).
To support Member States in moving towards quality training, WHO has
published a series of training guidelines and benchmarks (http://apps.who.int/
medicinedocs/en/cl/CL10/; see also Annex C).
58
Table 1: Key performance indicators
Strategic objective Strategic direction Expected outcomes Critical indicator
4.1 To build the
knowledge
base for active
management of
T&CM through
appropriate
national policies
4.1.1 Understand
and recognize
the role and
potential of
T&CM
T&CM practices and practitioners
identied and analysed by Member State
and country prole devised for T&CM.
T&CM policies and programmes
established by government.
Number of Member States
reporting a national/
provincial/state T&CM
policy.
Number of Member
States reporting increased
governmental/public
research funding for T&CM;
4.1.2 Strengthen the
knowledge base,
build evidence
and sustain
resources
Strengthened knowledge generation,
collaboration and sustainable use of TM
resources.
4.2 To strengthen
quality assurance,
safety, proper use
and effectiveness
of T&CM by
regulating
products, practices
and practitioners.
4.2.1 Recognize
the role and
importance
of product
regulation
Established and implemented national
regulation for T&CM products including
registration.
Strengthened safety monitoring of T&CM
products and other T&CM therapies.
Technical guidelines and methodology
developed for evaluating safety, efcacy
and quality of T&CM.
Number of Member
States reporting national
regulation for T&CM
products
Number of Member
States reporting national/
provincial/state regulation
for T&CM practice
Number of Member
States reporting national/
provincial/state regulation/
registration for T&CM
practitioners
4.2.2 Recognize and
develop practice
and practitioner
regulation
for T&CM
education and
training, skills
development,
services and
therapies
Standards for T&CM products, practices
and practitioners developed by
government.
Established education/training
programme, benchmarks and
implementation capacities for T&CM
practitioners
Improved safe and effective use of T&CM
4.3 To promote
universal health
coverage by
integrating T&CM
services into
health care service
delivery and self-
health care
4.3.1 Capitalize on
the potential
contribution of
T&CM to improve
health services
and health
outcomes.
Integration of T&CM into the health
system.
Improved T&CM services and
accessibility.
Improved communication between
conventional medicine practitioners,
professional bodies and T&CM
practitioners concerning the use of
T&CM.
Number of Member States
reporting national plan/
programme/approaches for
integrating T&CM service
into the national health
service delivery

Number of Member
States reporting consumer
education project/
programme for self-health
care using T&CM
4.3.2 Ensure
consumers of
T&CM can make
informed choices
about self-health
care.
Better awareness of and access to
information about the proper use of
T&CM.
Improved communication between
conventional medicine practitioners and
their patients about T&CM use.
Implementing the Strategy
26/11/13 08:12 OMS: la strategia per le Medicine Tradizionali del futuro
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Home OMS: la strategia per le ...
OMS: la strategia per le Medicine Tradizionali del futuro OMS: la strategia per le Medicine Tradizionali del futuro
Pubblichiamo (vedi allegato) il "World Health Organization Traditional
Medicine Strategy 2014-2023", documento che riguarda la strategia
dell'Organizzazione Mondiale della Sanit per le Medicine Tradizionali per il
periodo 2014-2023.
A tal proposito, si ricorda che Paolo Roberti di Sarsina l'unico ricercatore
italiano citato nelle referenze bibliogra#che utilizzate dal gruppo di lavoro
dell'OMS per redigere il documento.
a cura di Redazione FNOMCeO Web
Articolo pubblicato in: News
Documenti allegati:
WHO Traditional Medicine Strategy 2014-2023
Ricerca nel sito
FNOMCeO FNOMCeO
Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri
HOME NOTIZIE CONTATTI
FEDERAZIONE COMUNICATI EVENTI PRIMO PIANO RICERCA ANAGRAFICA
EUROPEAN PARLIAMENT (1997)


Resolution n. 75

On the Status of Non-Conventional Medicine

Bruxelles, 29.05.1997
COUNCIL OF EUROPE (1999)


Resolution n. 1206

A European approach to Non-Conventional
Medicine

Bruxelles, 04.11.1999
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(aolo 8oberu dl Sarslna, denluon proposed Lo Lhe ?@"'5,#( FG.HI 02+B",))#
0'(/'"&@4= JKLJ)
Use of Traditional and Non-Conventional Medicine in Italy 1996-2012 (updated from Roberti
di Sarsina P, Iseppato I. (2011) EPMA Journal, 2(4):439-449.

ISTAT (1996-99) 9 million Italians use NCM (15.5%)
ABACUS (2003)
30% of Italians are familiar with the term Non-
Conventional Medicine
DOXA (2003) 23% of the population use NCM
ISPO (2003)
65% of the population are familiar with the term Non-
Conventional Medicine and know something about it
FORMAT (2003)
31.7% of Italians have used NCM at least once; 23.4%
use NCM regularly
CENSIS (2003)
50% think NCM useful; over 70% claim it should be
passed by the National Health Service; 65% would like
more monitoring by the national health authorities
Menniti-Ippolito et al. (2004)
3-year follow-up on 52,332 families (140,011 persons):
15.6% use NCM (homeopathy 8.2%, manual therapy 7%,
phytotherapy 4.8%, acupuncture 2.9%, other NCMs
1.3%)
ISTAT (2005) 8 million Italians use NCM (13.6% of the population)
EURISPES (Rapporto Italia 2006) 10.6% of the population choose NCM
Osservatorio Scienza Tecnologia e
Societ, Centro Ricerche Observa-
Science in Society, Nova Il Sole 24 Ore
24 07.12.2006
One Italian out of three adopted, at least occasionally,
homeopathic medicinal products to cure and treat
illnesses.
CENSIS (2008)
23.4% had adopted to TM/NCM medication therapies and
non-medication therapies in the previous year (especially
homeopathy and phytotherapy)
EURISPES (Rapporto Italia 2010)
more than 11 million opt for NCM medication therapies
and non-medication therapies, i.e. 18.5% of the
population
Health Monitor CompuGroup Medical-
Il Sole 24 Ore Sanit (2011)
about 52% of general practitioners suggests homeopathic
therapies to patients.
EURISPES (Rapporto Italia 2012) 14,5% of the population adopt NCM
Doxapharma (2012)
82,5% declare to have been informed about homeopathic
medicinal products; 16,2% adopted, at least once in the
year, homeopathic medicinal products.

LUkISLS kapporto Ita||a 2012

8lcorso alla medlclna convenzlonale (83,3)
8lcorso alla medlclna non convenzlonale (14,3)
8lspeuo alla rllevazlone dl due annl prlma quesL'ulumo daLo reglsLra
una conLrazlone (-4)

PomeopaLhy (70,6)
hyLoLherapy (39,2)
CsLeopaLhy (21,3)
AcupuncLure (21)
Chlropraucuc (17,2)
Ayurvedlc Medlclne (8,9)
PomoLoxlcology (6,4)
AnLroposophlc Medlclne (3,1)
1radluonal Chlnese Medlclne (3,8)
Widening the Paradigm in Medicine and Health:
Person-Centred Medicine as the Common
Ground of Traditional, Complementary,
Alternative and Non-Conventional Medicine
Paolo Roberti di Sarsina, Mauro Alivia, and Paola Guadagni
Contents
1 The Need for Person-Centred Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
2 The Need for Salutogenesis in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
3 TCAM Systems as Person-Centred and Salutogenetic Medical Systems . . . . . . . . . . . . . . . . . . . 338
4 The Current Situation of TCAM in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
4.1 The CAMbrella Consortium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
4.2 Prevalence of TCAM in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
5 Widening the Paradigm in Health and Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
5.1 Implications for Healthcare Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
5.2 Implications for Patients and Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
5.3 Implications for Society and Healthcare Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
6 Steps Towards Widening the Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Abstract This chapter outlines the paradigm of person-centred medicine and its
contribution to the growing pluralism of medical science. It adds to the paradigm of
personalised medicine. It is characterised by a holistic approach, which stems from
the demands of patients for a greater humanisation of medicine, individualisation
of treatments and autonomy in the choice of therapeutic processes. It nds fertile
P. Roberti di Sarsina ()
Ministry of Health, Rome, Italy
Charity Association for Person-Centred Medicine, Bologna, Italy
Observatory and Methods for Health, University of Milano-Bicocca, Via Siepelunga, 36/12,
40141 Bologna, Italy
e-mail: medicinacentratasullapersona@medicinacentratasullapersona.org;
paolo.robertidisarsina@unimib.it
M. Alivia P. Guadagni
Charity Association for Person-Centred Medicine, Bologna, Italy
Italian Society of Anthroposophic Medicine (SIMA), Milano, Italy
e-mail: mauroalivia@tiscali.it; pavgua@gmail.it
V. Costigliola (ed.), Healthcare Overview: New Perspectives, Advances in Predictive,
Preventive and Personalised Medicine 1, DOI 10.1007/978-94-007-4602-2 18,
Springer ScienceCBusiness Media Dordrecht 2012
335
REVI EW Open Access
Traditional, complementary and alternative
medical systems and their contribution to
personalisation, prediction and prevention in
medicineperson-centred medicine
Paolo Roberti di Sarsina
1,2,3*
, Mauro Alivia
2,4
and Paola Guadagni
2,4
Abstract
Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred
medicine (PCM), an epistemological orientation for medical science which places the person as a physical,
psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to
broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people,
doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene.
The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which
unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not
be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be
broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a
fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's
self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the
appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical,
psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care
workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect
for individual autonomy, personal culture, religion and beliefs.
Keywords: Traditional, Complementary and alternative medicine, Biomedicine, Person-centred medicine,
Personalised medicine, Prediction, Prevention, Salutogenesis, Health-care reform, Health-care education, Therapeutic
relationship
Review
The need for person-centred medicine
Patients themselves demand an improvement in the
quality of medical interventions with greater humanisa-
tion, personalisation of treatments and adequate infor-
mation received in a safe environment to be able to
make choices about their therapeutic process freely [1].
They want a doctor who will talk to them, listen to what
they say and give them advice about how to get better
and protect their health in the future. They want to be
given the time and the space to express during the con-
sultation, and once a therapeutic relationship is estab-
lished, they wish to continue seeing the same person to
give continuity to the process of healing. In many cases,
the wish for a prescription is secondary to the wish of
being cared for [2].
Many doctors and caregivers already practise person-
centred medicine (PCM) with growing interest from col-
leagues and institutions. There is a perceived need to
create a more satisfying therapeutic relationship, indivi-
dualising treatments beyond clinical guidelines to suit
the whole person in the context of his or her bio-
psycho-spiritual biography [3]. PCM takes on the task to
* Correspondence: paolo.robertidisarsina@unimib.it
1
High Council of Health, Ministry of Health, Rome 00144, Italy
2
Charity Association for Person Centred Medicine, Via Siepelunga, 36/12,
Bologna 40141, Italy
Full list of author information is available at the end of the article
2012 Roberti di Sarsina et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Roberti di Sarsina et al. The EPMA Journal 2012, 3:15
http://www.epmajournal.com/content/3/1/15
19/05/13 20:43 EPMA Journal | All articles
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Abstract | Full text | PDF | PubMed | Cited on BioMed Central
Abstract | Full text | PDF | PubMed | Cited on BioMed Central
Niva Shapira
EPMA Journal 2013, 4:1 (12 January 2013)
Review
Retinitis pigmentosa and ocular blood flow
Katarzyna Konieczka, Andreas J Flammer, Margarita Todorova, Peter Meyer, Josef Flammer
EPMA Journal 2012, 3:17 (3 December 2012)
Review
Introduction into PPPM as a new paradigm of public health service: an integrative view
Tatiana A Bodrova, Dmitry S Kostyushev, Elena N Antonova, Shimon Slavin, Dmitry A Gnatenko, Maria O Bocharova, Michael Legg, Paolo Pozzilli, Mikhail A
Paltsev, Sergey V Suchkov
EPMA Journal 2012, 3:16 (9 November 2012)
Review
Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine
person-centred medicine
Paolo Roberti di Sarsina, Mauro Alivia, Paola Guadagni
EPMA Journal 2012, 3:15 (6 November 2012)
Report
General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association for
Predictive, Preventive and Personalised Medicine
Olga Golubnitschaja, Vincenzo Costigliola, EPMA
EPMA Journal 2012, 3:14 (1 November 2012)
Review
Evidence-based pain management: is the concept of integrative medicine applicable?
Rostyslav V Bubnov
EPMA Journal 2012, 3:13 (22 October 2012)
Review
Predictive and preventive strategies to advance the treatments of cardiovascular and cerebrovascular diseases: the Ukrainian context
Ulyana B Lushchyk, Viktor V Novytskyy, Igor P Babii, Nadiya G Lushchyk, Lyudmyla S Riabets
EPMA Journal 2012, 3:12 (19 October 2012)
Review
Opinion controversy to chromium picolinate therapys safety and efficacy: ignoring anecdotes of case reports or recognising individual risks and
new guidelines urgency to introduce innovation by predictive diagnostics?
Olga Golubnitschaja, Kristina Yeghiazaryan
EPMA Journal 2012, 3:11 (7 October 2012)
Review
Personalized approach of medication by indirect anticoagulants tailored to the patientRussian context: what are the prospects?
Liliya Belozerceva, Elena Voronina, Natalia Kokh, Galina Tsvetovskay, Andrei Momot, Galina Lifshits, Maxim Filipenko, Andrei Shevela, Valentin Vlasov
EPMA Journal 2012, 3:10 (27 September 2012)
Review
Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and
pregnancy
Nadja Borisow, Andrea Dring, Caspar F Pfueller, Friedemann Paul, Jan Drr, Kerstin Hellwig
EPMA Journal 2012, 3:9 (22 June 2012)
Review
Unlocking Pandora's box: personalising cancer cell death in non-small cell lung cancer
Dean A Fennell, Charles Swanton
EPMA Journal 2012, 3:6 (18 June 2012)
Editorial
Time for new guidelines in advanced healthcare: the mission of The EPMA Journal to promote an integrative view in predictive, preventive and
personalized medicine
Olga Golubnitschaja
EPMA Journal 2012, 3:5 (28 March 2012)
Review
Behavior, nutrition and lifestyle in a comprehensive health and disease paradigm: skills and knowledge for a predictive, preventive and
personalized medicine
Guglielmo M Trovato
EPMA Journal 2012, 3:8 (22 March 2012)
For articles published prior to volume 3 please visit SpringerLink
eCAM 2007;4(S1)4551
doi:10.1093/ecam/nem094
Original Article
The Social Demand for a Medicine Focused on the Person:
The Contribution of CAM to Healthcare and Healthgenesis
Paolo Roberti di Sarsina MD
Expert for Non Conventional Medicines, Italian National Council for Health, Ministry of Health, Rome. Coordinator
Committee for CAM in Italy. Department of Mental Health, Health Local Unit, Bologna, Italy
The Non Conventional Medicines have a greater social impact and the demand for such
treatments of more than 10 million Italian citizens (male and female) of all ages and social
classes and of thousands of Italian families reveals an interest proving that there is a trend
reversal, involving also other sectors of the medical and scientific world, which shifts the focus
from the symptom to an idea of more general and comprehensive well-being of the person.
Over the last few years the scientific debate on Non Conventional Medicines and their
integration with the academic or dominant medicine in our western society has favored and
legitimated an increase in the demand and has activated a cultural transformation process
involving the life styles. The focus is therefore shifted to the self-healing capacities, to the
reawakening of the individual potentialities, which support and amplify the benefits of the
treatments and the citizens start pretending to be accurately informed in order to choose freely
their own health program.
Keywords: healthgenesis medicine focused on the person non conventional medicines
Introduction
The definition of CAM, relative to statements of
NCCAM and WHO, points out that unconventional,
although the most common expression used in Italy,
would seem to place these treatment methods in contrast
with academic medicine, considered as conventional.
In the English-speaking world the term CAM
(Complementary and Alternative Medicine) is used, and
it is crucial to underline the complementary nature of
different possible diagnostic and therapeutic approaches
that fit here in order to emphasize the integration which
is currently in the health system and the possibility of the
practical use of all the information provided by the
patient. Concepts like healthcare strictly connected with
that of healthgenesis are introduced together with data
concerning CAM in the western world thus focusing on
the present situation of Non Conventional Medicines/
CAM in Italy. Medicine Focused On The Person results
from the need of every patient and client. The importance
of being treated with dignity and respect is every persons
right, improving patients experience of care, reducing
inequalities, being well aware of the health social
gradient with regards to sustainable balance and
pharmacoeconomy in order to encourage change in the
thought processes of Health Policy, particularly towards
those developing national health care strategies. The term
Medicine Focused On The Person in terms of sustain-
ability clearly includes, the sense of Integrative Medicine
as a synergistic and harmonious blend of conventional
and complementary medicine, within a safe environment
but looks open to future developments. The results of
numerous surveys on health care quality carried out in
the USA, in Europe and more recently in Italy show that,
if a patient is asked to assess the quality of the medical
treatments, his/her priorities are: humanization, tailoring
of the treatments, the need of attention from Public
Institutions and adequate information in a comfortable
environment for a free choice of the individual health
For reprints and all correspondence: Paolo Roberti di Sarsina, MD,
Via Siepelunga 36/12 40141 Bologna, Italy. Tel: +39-3358029638;
E-mail: p.roberti@fastwebnet.it
2007 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Review
Looking for a Person-centered Medicine: Non Conventional
Medicine in the Conventional European and Italian Setting
Paolo Roberti di Sarsina
1
and Ilaria Iseppato
2
1
Italian High Council of Health, Ministry of Health, Rome, Italy and
2
Department of Sociology, University of
Bologna, Bologna, Italy
In Italy, the use of non conventional medicines (NCMs) is spreading among people as in the
rest of Europe. Sales of alternative remedies are growing, and likewise the number of medical
doctors (MDs) who practise NCM/complementary and alternative medicine (CAM). However,
in Italy as in other countries of the European Union, at the present time the juridical/legal
status of NCM/CAM is not well established, mainly due to the lack of any national law
regulating NCM/CAM professional training, practice and public supply and the absence of
government-promoted scientific research in this field. This is an obstacle to safeguarding the
patients interests and freedom of choice, especially now that dissatisfaction with biomedicine is
inclining more and more people to look for a holistic and patient-centered form of medicine.
Keywords: Non conventional medicines (NCMs) complementary and alternative medicine
(CAM) person-centred medicine NCM/CAM legal status
Introduction
In western societies, people generally confuse the terms
medicine, biomedicine, evidence-based medicine and
allopathic, using them as synonyms. Though the neolo-
gism biomedicine appeared as early as 1923 in Dorlands
Medical Dictionary (1)defined as clinical medicine
based on the principles of physiology and biochemis-
tryneither this nor other specific hybrid meanings
were much heard of before the 1960s when the US
National Institutes of Health (NIH) introduced the
term to justify its diversion of funds into molecular
biology. Medicine proper is actually something more
comprehensive, a holistic concept that includes biomedi-
cine, but also all other philosophical/anthropological
approaches to managing health, illness and disease.
Amid the prevailing confusion, western biomedical cul-
ture tends in its turn to define alternative medicine in
a negative way, as something outside the mainstream,
unsupported by scientific explanation or academy
legitimization (2).
The National Center for Complementary and
Alternative Medicine
The National Center for Complementary and Alternative
Medicine (NCCAM) of the US NIH defines CAM as a
broad domain of healing resource that encompasses all
health systems, practices and beliefs, other than those
intrinsic to the politically dominant health system in a
particular society at a given historical period. The main
limitation of this definition is mixing alternative medicine
and complementary practices in one single category.
CAM has been defined as therapeutic intervention that
has neither been widely established for use in conven-
tional healthcare practice nor incorporated into the stan-
dard medical curriculum. The NCCAM characterizes
CAM therapies into five categories: biologically based
therapies, manipulative- and body-based therapies, energy
medicine, mindbody medicine and whole medical systems.
In contrast, we have the definition of traditional medicine
For reprints and all correspondence: Paolo Roberti di Sarsina, MD,
Italian High Council of Health, Ministry of Health, Rome, Italy.
Tel: +39-3358029638; E-mail: p.roberti@fastwebnet.it
eCAM 2009;Page 1 of 8
doi:10.1093/ecam/nep048
The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
eCAM Advance Access published June 8, 2009
European Journal of Integrative Medicine 1 (2009) 6571
Review article
Non-Conventional Medicine in Italy: The present situation
Paolo Roberti di Sarsina
a,
, Ilaria Iseppato
b
a
Italian High Council of Health, Ministry of Health, Rome, Italy
b
Department of Sociology, University of Bologna, Italy
Received 26 March 2009; received in revised form 19 April 2009; accepted 29 April 2009
Abstract
This article provides a brief overview of the current situation in Italy regarding the diffusion and regulation of Non-Conventional
Medicine (NCM). In Italy the use of NCM is spreading among the population as in the rest of Europe. Sales of alternative remedies are
growing, and likewise the number of MDs who practice NCM. However, in Italy, unlike in other countries of the European Union, at the
present time the juridical/legal status of NCM is not well established, mainly due to the lack of any national law regulating NCM
professional training, practice and public delivery, not to mention the absence of government-promoted scientic research in this eld.
After procrastinating for 20 years, the Italian Parliament is therefore urged to legislate without further delay and approve a full-scale
national law on Non-Conventional Medicine to protect citizens safety and freedom of choice.
r 2009 Elsevier GmbH. All rights reserved.
Keywords: Non-Conventional Medicine (NCM); Complementary and Alternative Medicine (CAM); NCM legal status; Italian healthcare system
Epistemological bearings: Why we prefer talking about Non-
Conventional Medicine
For years the World Health Organization has dened
Non-Conventional Medicine (NCM) as Traditional Med-
icine in deference to the nations and cultures where such
forms of medicine are an integral part of the cultural and
medical heritage (for instance, Chinas and Indias cultural
traditions) [1]. Traditional Medicine is the sum total of
indigenous knowledge used in the maintenance of health in
these countries; however, wrongly, in Western countries the
terms Traditional Medicine and Non-Conventional
Medicine are often used interchangeably. So, paradoxi-
cally, in Western countries indigenous biomedicine and
alternative medicine may come to coincide.
The term adopted by the Cochrane Collaboration and
by international literature is Complementary and Alter-
native Medicine (Consensus Conference, United States
Ofce for Alternative Medicine of the National Institutes
of Health, Bethesda, USA, 1997). The multi-dimensional
meaning of this denition is immediately obvious: it applies
at the same time to both exclusively rst-choice treatment
(alternative medicine) and second-choice or associated
therapy approaches (complementary medicine) [2]. More-
over, Western biomedical culture usually tends to identify
alternative medicine in a negative way, as something
outside the mainstream, unsupported by scientic explana-
tion or academic legitimization [3].
For the reasons stated above, we chose to keep the term
Non-Conventional Medicine, which is generally socially
more widespread, better known and understood in Italian
parlance, as well as already employed by the (FNOMCeO
(National Council of the Italian National Federation of
Colleges of MDs and Dentists) in the Terni Document
(2002)) [4], by the European Parliament (1997), by the
Council of Europe (1999) and in the Consensus Document
on NCM in Italy (2003).
The Italian sociologist of health Guido Giarelli claries
this epistemological point in unmistakable terms as regards
the Italian scene: Non Conventional Medicine is the
denition we prefer and have chosen to keep in the current
Italian situation, for at least three reasons: it seems as little
laden as possible with positive or negative ideological
ARTICLE IN PRESS
www.elsevier.com/eujim
1876-3820/$ - see front matter r 2009 Elsevier GmbH. All rights reserved.
doi:10.1016/j.eujim.2009.04.002

Corresponding author. MD, Expert for Non Conventional Medicine

Italian High Council of Health, Ministry of Health, Rome, Italy.
Tel.: +39 335 8029638; fax: +39 051 442039.
E-mail address: p.roberti@fastwebnet.it (P. Roberti di Sarsina).
Letter to the Editors Brief an die Herausgeber
Forsch Komplementmed 2010;17:277278 Published online: September 9, 2010
DOI: 10.1159/000320603
Paolo Roberti di Sarsina, MD
Via Siepelunga 36/12
40141 Bologna, Italy
Tel. +39 335 8029638, Fax +39051442039
p.roberti@fastwebnet.it
2010 S. Karger GmbH, Freiburg
Accessible online at:
www.karger.com/fok
Fax +49 761 4 52 07 14
Information@Karger.de
www.karger.com
Person-Centred Medicine: Towards a Definition
Paolo Roberti di Sarsina
a
Ilaria Iseppato
b
a
Italian High Council of Health, Ministry of Health, Rome,
b
University of Bologna, Italy
The history of the relationship between Complementary and
Alternative Medicine (CAM) and mainstream health care has
shifted from the early days of pluralism, through hostility and
exclusion, to one of grudging acceptance. The current situa-
tion is characterised by a tacit acknowledgement and in some
cases opens endorsement by biomedicine for a number of
forms of CAM practice, largely driven by the popularity of
CAM to consumers in our increasingly market-driven health
care system both on the practice of CAM and biomedicine,
and on the health care choices available to consumers [1].
Person-centred medicine lies at the interface of biomedi-
cine and traditional, complementary and alternative medicine
(TM/CAM) or non-conventional medicine (NCM). Concepts
like health care strictly connected with that of health genesis
are introduced together with data concerning CAM/NCM in
the Western world [2]. The term person-centred medicine in
terms of sustainability clearly includes the sense of NCM/
CAM as a synergistic and harmonious blend of conventional
and complementary medicine, but looks open to future devel-
opments. The results of numerous surveys on health care
quality carried out in the USA and in Europe show that, if a
patient is asked to assess the quality of the medical treat-
ments, his/her priorities are: humanization, tailoring of the
treatments, the need of attention from public institutions and
adequate information in a comfortable environment for a free
choice of the individual health programme. However, despite
WHOs definition of health, the attitudes and practice of
much of modern medicine have become profoundly disease
focused and organ specific with ever increasing specialization.
The limitations of disease-specific approaches in the context
of the growing prevalence of co-morbidity are becoming more
obvious. Humanistic behaviour is considered an essential
component of professional medical care. However, the evi-
dence shows that it is often neglected. Many barriers to the
expression of sensitivity to the patients concerns, empathy,
and compassion in the clinical encounter can be identified.
Time constraints, poor continuity of care, appearance of al-
ienating factors between patients and physicians, and the hid-
den curriculum are just a few in a long list [3].
Person-centred medicine is a humanistic and at the same
time evidence-based approach. For all human beings the es-
sence of diagnosis and therapy is that they be tailored to the
intrinsic unity of mans physical and mental nature. This is
fundamental to the healing process. Person-centred medicine
allows for that individual psycho-physical equilibrium which
is, and will be, the basis for any sustainable equilibrium in so-
ciety at present or in the future. Person-centred medicine calls
for wider medical knowledge and practice, not only of how to
treat pathology but how to generate health (health-genesis).
It is a systemic approach, not mechanistic or reductive. It typi-
cally adopts a unitary view of sentient being and the world; it
values the complexity of natural phenomena; it studies the
relations of man to his environment, how body and psyche
interact, what spiritual integrity means in a human being; and
stresses active patient responsibility for keeping healthy or
being healed.
In the middle of the doctor-patient relationship under this
person-centred approach lies the patients own narration.
This narration is part and parcel of how the patient makes
sense across the spectrum of his/her bio-psycho-spiritual exist-
ence. Person-centred medicine entails total a priori acknowl-
edgement of and respect for each individuals dignity hence
physical, psychological, and spiritual suffering. Person-centred
medicine at this point becomes anthropological medicine. The
development of appropriate and effective therapeutic strate-
gies entails a negotiated understanding between the culture of
biomedicine, within which health care providers work, and the
patients cultural experience of illness.
At a time of increasing emphasis on regulating health care
and restraining expenditures, this person-centred approach
would better equip patients to make informed decisions. For
discretionary tests and procedures, complete information
about expected benefits and risks may lead many individuals
to choose alternative strategies or to be more confident in the
277_278_06002_iseppato.indd 277 18.10.10 16:02
The
Journal
International Reviews in
Predictive, Preventive & Personalised Medicine
(PPPM)
The EPMA Journal
Volume 2 Number 4 2011
EDITORIAL
European strategies in predictive, preventive and
personalised medicine: highlights of the EPMA World
Congress 2011
0. Golubnitschaja V. Costigliola 315
REVI EW ARTICLES
Mobility of medical doctors in cross-border healthcare
V. Costigliola 333
Perpetual transitions in Romanian healthcare
l. Spiru R.I. I. Turcu M. Marzan 341
Recommendations for the prevention of breast cancer
in shift workers
K. Richter J. Acker N. Kamcev S. Bajraktarov A. Piehl
G. Niklewski 351
The need for higher education in the sociology of
traditional and non-conventional medicine in Italy:
towards a person-centered medicine
P. Roberti di Sarsina M. Tognetti Bordogna 357
Main effects of sleep disorders related to shift work-
opportunities for preventive programs
S. Bajraktarov A. Novotni N. Manusheva D.G. Nikovska
E. Miceva-Velickovska N. Zdraveska V.C. Samardjiska
K.S. Richter 365
Present and future of secondary prevention after an
acute coronary syndrome
P.-F. Keller S. Carballo D. Carballo 371
Towards salutogenesis in the development of personalised
and preventive healthcare
M. Alivia P. Guadagni P. Roberti di Sarsina 381
Tibetan medicine: a unique heritage of person-centered
medicine
P. Roberti di Sarsina L. Ottaviani J. Mella 385
Forms of antipsychotic therapy: improved individual
outcomes under personalised treatment of schizophrenia
focused on depression
Z. Babinkostova B. Stefanovski 391
Magnetic resonance imaging and spectroscopy: how
useful is it for prediction and prognosis?
B. Condon 403
Regional Health Systems and non-conventional medicine:
the situation in Italy
M.T. Bordogna 411
Prospective care of heart failure in Japan: lessons from
CHART studies
N. Shiba H. Shimokawa 425
Traditional and non-conventional medicines: the
socio-anthropological and bioethical paradigms for
person-centred medicine, the Italian context
P. Roberti di Sarsina I. lseppato 439
Idiopathic REMsleep behavior disorder as a long-term
predictor of neurodegenerative disorders
S. Fulda 451
Salutogenesis and Ayurveda: indications for public
health management
A. Morandi C. Tosto P. Roberti di Sarsina D. Dalla Li bera 459
Indexed in SCOPUS, EMBASE, Google Scholar, Academic Onefile,
OCLC, Summon by Serial Solutions
Instructions for Authors for EPMA are available at
http:/ /www.springer.com/biomed/journal/ 13167
REVIEW ARTICLE
The need for higher education in the sociology of traditional
and non-conventional medicine in Italy: towards
a person-centered medicine
Paolo Roberti di Sarsina & Mara Tognetti Bordogna
Received: 22 May 2011 / Accepted: 19 July 2011 / Published online: 12 August 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract Italy is being forced to re-think her health plan as the
national health service moves towards regional systems,
individuals take more active responsibility for their health, the
demand grows for traditional and non-conventional medicine
and immigrants join the user list. Person-centered medicine and
ever-wider skills attainable with the tools of analysis and
research have made a new professional update indispensable.
The proposed Master-Course on Health systems, traditional
and non-conventional medicine, first of its kind in Italy, fits
this bill. The newforms of treatment that state and international
bodies are prepared to recognize depend entirely on the
universities training our professionals with concrete skills in
planning, research and health management. Our paper performs
an epistemological critique of the new health requirements and
goes on to outline the reasons behind this training imperative.
Keywords National health system. Regional health
systems . Traditional medicine . Non-conventional
medicine . Person-centered medicine . Personalized
medicine
The worlds various health systems show two current
trends: a steady alignment as to practice and procedure,
with slow but constant regionalization and decentralization;
and increasing resort to traditional and non-conventional
medicine. These processes call for specific skills if they are
to be effectively adjusted to, especially on the part of top
management and decision-makers.
The need for constantly updated knowledge is due not just
to changing organizational and operative patterns within
health services, but to new chronic and crippling diseases
and pandemics calling for specific know-how on the part of
national health services and their welfare networks, plus
knowledge of how world health systems work and the health
and prevention measures currently being taken.
Another factor that challenges us to upgrade our
understanding is that the end-user is often new, and used
to different health systems (immigrants). Add to this that
people are increasingly insisting on choose their treatment
and style of health practice for themselves, beginning with
traditional and non-conventional medicines [13].
Acquisition of this know-how is also a challenge to
veterinary medicine and especially organic zootechnics. Con-
trols on commercially-bred animals and foodstuffs of animal
origin involve the public veterinary service and immediately
affect consumer health as well as eco-sustainable animal raising
in conditions that protect biodiversity.
We urgently need the tools to understand the changes
afoot in society and its health systems and agricultural
processes; and our knowledge must translate into healthcare
Both authors contributed equally: P. Roberti di Sarsina, Coordinator and
M. Tognetti Bordogna, Director of Master-course on Health Systems,
Traditional and Non Conventional Medicine, University of Milano-
Bicocca, Italy
P. Roberti di Sarsina
Expert for Non Conventional Medicine, High Council of Health,
Ministry of Health,
Rome, Italy
P. Roberti di Sarsina
:
M. Tognetti Bordogna
Observatory and Methods for Health, Department of Sociology
and Social Research, University of Milano-Bicocca,
Milano, Italy
P. Roberti di Sarsina
Charity Association for Person-Centered Medicine,
Bologna, Italy
P. Roberti di Sarsina (*)
Via Siepelunga, 36/12,
40141 Bologna, Italy
e-mail: paolo.robertidisarsina@unimib.it
EPMA Journal (2011) 2:357363
DOI 10.1007/s13167-011-0102-1
REVIEW ARTICLE
Towards salutogenesis in the development of personalised
and preventive healthcare
Mauro Alivia & Paola Guadagni &
Paolo Roberti di Sarsina
Received: 1 August 2011 / Accepted: 13 October 2011 / Published online: 8 November 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract The purpose of this review is to discuss how a
salutogenetic approach that takes into consideration the
human being as physical, psychological and spiritual entity
may provide some answers to the difficulties faced by
healthcare systems. The choice of medical intervention
needs to take into account the technological advances of
biomedicine but tailor them to the physical, psychological
and spiritual needs of the patient in the context of their
biography. Such person-centred medicine aims to strengthen
Antonovskys concepts of resilience and sense of coherence
with each therapeutic intervention so that overcoming illness
becomes the foundation for better future health. Appropriate
evaluation parameters need to be developed and included in
order to evaluate the success of interventions in a person-
centred, salutogenetic system.
Keywords Personalised medicine . Preventive medicine .
Person-centred medicine
.
Salutogenesis
.
Non-conventional
medicine
Salutogenetic healthcare
Illness is a challenge to our physical, psychological and
spiritual wellbeing that has repercussions on our identity
and our social context. In a pathogenetic approach,
diagnostic tests are used to look for the underlying disease
and treatments are aimed at removing it. A person is
considered cured when the disease is no longer detectable
and agreed parameters have normalised. However daily
clinical practice is characterised by people who suffer from
chronic illness where there is often a discrepancy between
their biochemical results and the way they feel. Good or
even normal parameters do not necessarily correlate with a
good perceived state of health, and vice versa. Health is
therefore a concept that goes beyond the absence of disease
to include physical, mental and social wellbeing [1].
Salutogenesis, developed by Antonovsky in the 1970s,
looks at what generates health by exploring the reasons
why some people stay healthy in the face of hazardous
influences whilst others, faced with the same hardship fall
ill. Antonovskys research shows how adverse events and
stress can become the opportunity to generate health if
certain personal characteristics are present. Resilience to
difficult situations depends on a persons Sense of
Coherence (SOC), a global orientation towards life that is
based on self-reliance in the face of challenges, self-
confidence in ones ability to deal with demanding events
and the trust that difficult events hold meaning for ones life
[2, 3]. There is a growing body of research on all age
groups [46], different socioeconomic backgrounds and
across cultures [7] that shows how a strong SOC is related
to better health, healthier ageing [812] and is a protective
factor against alcohol addiction despite similar rates of
recreational consumption in teenagers [13]. Conversely, a
weak SOC is related to poorer health and lower mood
M. Alivia
Past President Italian Society of Antroposophic Medicine (SIMA),
Milan, Italy
M. Alivia
:
P. Guadagni
:
P. Roberti di Sarsina
Charity Association for Person Centred Medicine,
Bologna, Italy
P. Roberti di Sarsina
Expert for non-conventional medicine, High Council of Health,
Ministry of Health,
Rome, Italy
M. Alivia (*)
Corso di Porta Romana 118,
20122 Milano, Italy
e-mail: mauroalivia@medicinaantroposofica.it
EPMA Journal (2011) 2:381384
DOI 10.1007/s13167-011-0131-9
REVIEW ARTICLE
Tibetan medicine: a unique heritage of person-centered medicine
Paolo Roberti di Sarsina & Luigi Ottaviani & Joey Mella
Received: 4 August 2011 / Accepted: 13 October 2011 / Published online: 12 November 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract With a history going back approximately
2,500 years, the Tibetan medicine, known as Sowa Rigpa in
the Tibetan language, is one of the worlds oldest known
traditional medicine. It originally developed during the pre-
Buddhist era in the kingdom known as Shang Shung. As a
traditional medicine, the future development of Tibetan
medicine in Western countries is linked to being recognized
as a popular and viable healthcare option providing an
alternative clinical reality. Its inherent ability to incorparate
predictive diagnostics, targeted prevention, and the creation of
individualized medical treatment give Tibetan medicine great
potential for assessing and treating patients.
Keywords Tibetan medicine
.
Sowa Rigpa
.
Chgyal
Namkhai Norbu
.
Predictive diagnosis
.
Targeted
prevention
.
Individualized treatment
Introduction
Tibetan medicine is an intricate medicine with a long
history of treatment effectiveness. As this medicine begins
to spread globally, as with Chinese, Indian Ayurvedic, and
other traditional healing modalities, it is important to
accurately inform as large an audience to its salient
features. Primarily through alliance and collaboration with
Western MDs, Tibetan medicine can express its principles
in a clear and beneficial way. This would develop through
dialogue, research, and ultimately the sharing of intellectual
resources. This article is intended as a brief survey of
Tibetan medicines ancient history, its development into the
present, and an exploration into future collaborations. Upon
review it can be seen that Tibetan medicine is an excellent
example of personalized and preventive medicine.
History of Tibetan medicine
Aspects of Tibetan medicine can be found in ancient cultures as
old as 2,500 years. It was in the Kingdom of Shang Shung that
practitioners of the Bn Shamanistic religion recorded formal
texts describing healing rituals, medical divination, and
astrology. Practices such as medical divination lead to much
the same nature of treatment. A divination would be made
indicating a particular elemental disturbance and a ritual
P. Roberti di Sarsina
Expert for Non-conventional medicine, High Council of Health,
Ministry of Health,
Rome, Italy
P. Roberti di Sarsina
Observatory and Methods for Health,
Universtity of Milano-Bicocca,
Milano, Italy
P. Roberti di Sarsina
Charity Association for Person Centred Medicine,
Bologna, Italy
P. Roberti di Sarsina (*)
Via Siepelunga 36/12,
40141 Bologna, Italy
e-mail: paolo.robertidisarsina@unimib.it
L. Ottaviani
International Shang Shung Institute for Tibetan Studies,
Arcidosso, Italy
J. Mella
Shang Shung Institute,
Conway, USA
EPMA Journal (2011) 2:385389
DOI 10.1007/s13167-011-0130-x
REVIEW ARTICLE
Tibetan medicine: a unique heritage of person-centered medicine
Paolo Roberti di Sarsina & Luigi Ottaviani & Joey Mella
Received: 4 August 2011 / Accepted: 13 October 2011 / Published online: 12 November 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract With a history going back approximately
2,500 years, the Tibetan medicine, known as Sowa Rigpa in
the Tibetan language, is one of the worlds oldest known
traditional medicine. It originally developed during the pre-
Buddhist era in the kingdom known as Shang Shung. As a
traditional medicine, the future development of Tibetan
medicine in Western countries is linked to being recognized
as a popular and viable healthcare option providing an
alternative clinical reality. Its inherent ability to incorparate
predictive diagnostics, targeted prevention, and the creation of
individualized medical treatment give Tibetan medicine great
potential for assessing and treating patients.
Keywords Tibetan medicine
.
Sowa Rigpa
.
Chgyal
Namkhai Norbu
.
Predictive diagnosis
.
Targeted
prevention
.
Individualized treatment
Introduction
Tibetan medicine is an intricate medicine with a long
history of treatment effectiveness. As this medicine begins
to spread globally, as with Chinese, Indian Ayurvedic, and
other traditional healing modalities, it is important to
accurately inform as large an audience to its salient
features. Primarily through alliance and collaboration with
Western MDs, Tibetan medicine can express its principles
in a clear and beneficial way. This would develop through
dialogue, research, and ultimately the sharing of intellectual
resources. This article is intended as a brief survey of
Tibetan medicines ancient history, its development into the
present, and an exploration into future collaborations. Upon
review it can be seen that Tibetan medicine is an excellent
example of personalized and preventive medicine.
History of Tibetan medicine
Aspects of Tibetan medicine can be found in ancient cultures as
old as 2,500 years. It was in the Kingdom of Shang Shung that
practitioners of the Bn Shamanistic religion recorded formal
texts describing healing rituals, medical divination, and
astrology. Practices such as medical divination lead to much
the same nature of treatment. A divination would be made
indicating a particular elemental disturbance and a ritual
P. Roberti di Sarsina
Expert for Non-conventional medicine, High Council of Health,
Ministry of Health,
Rome, Italy
P. Roberti di Sarsina
Observatory and Methods for Health,
Universtity of Milano-Bicocca,
Milano, Italy
P. Roberti di Sarsina
Charity Association for Person Centred Medicine,
Bologna, Italy
P. Roberti di Sarsina (*)
Via Siepelunga 36/12,
40141 Bologna, Italy
e-mail: paolo.robertidisarsina@unimib.it
L. Ottaviani
International Shang Shung Institute for Tibetan Studies,
Arcidosso, Italy
J. Mella
Shang Shung Institute,
Conway, USA
EPMA Journal (2011) 2:385389
DOI 10.1007/s13167-011-0130-x
REVIEW ARTICLE
Regional Health Systems and non-conventional medicine:
the situation in Italy
Mara Tognetti Bordogna
Received: 18 April 2011 / Accepted: 14 June 2011 / Published online: 20 July 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract In Italy the different regional healthcare models
are structured, in order to provide both a single theoretical
framework and to enable direct comparisons. In this paper
we examine whether and how the regional healthcare
systems include alternative medicines and, if so, whether
this can be specifically attributed to the different organisa-
tional models in place. This analysis will be preceded by a
framework to show how in Italy there is a constant and
continuous increase in non-conventional medicine (NCM),
determined from a research by citizens of a person-centred
medicine and preventive. We shall examine how NCM has
been incorporated in the National Health System (SSN) in
Italy, from the time the Regional Health Systems were set
up, and the factors that have contributed to their inclusion
or exclusion. After a brief synopsis of the process of
growth, distribution and recognition of NCM in Italy, we
shall describe how it has been incorporated and consolidat-
ed in the regional healthcare systems.
Keywords Personalised medicine . Complementary and
alternative medicine CAM
.
Preventive measures
.
Regional
health delivery. Dominant health system. Italy
Introduction
Complementary and alternative medicine (CAM) or non-
conventional medicine (NCM), as this broad domain is
defined in Italy considering that they are neither part of the
dominant health system nor included in the mandatory
curriculum for graduation as a Doctor of Medicine (MD) in
Italy, embraces a variety of healthcare cures which are more
and more consolidated worldwide, although varying from
continent to continent and country to country, as do the
levels of recognition and degree of regulatory legislation
throughout the world.
In Italy the debate on the effectiveness of cures and
validity of the various NCMs is still ongoing. Despite this,
some Servizi Sanitari Regionali (SSR)Regional Health
Systemsuse them to integrate biomedicine.
This assimilation ranges fromservices that recognise and
support them as forms and methods of care on a part with
biomedicine, which is the dominant health system in Italy, to
those that do not recognise evidence of their curative value.
The debate does not seem to consider the fact that the
public makes constant use of NCM to address their health
problems and that more and more doctors practise and
prescribe them.
In the literature in general [1], and in particular in the
field of sociology, there is a growing interest in what were
once described as alternative medicinesas opposed to
official medicinethen promoted to complementary, and
now defined as non-conventional. The definition of NCM is
clearly adopted both by the European Parliament (Reso-
lution on the status of non-conventional medicine, 1997)
and by the Council of Europe (A European approach to
non-conventional medicines, 1999).
There are many reasons for the appeal of NCM: the need
for a personal rapport with the physician, the special
attention given to the individual nature of the patient, the
consideration of the individual as a wholephysical,
psychological and social, the appreciation of an approach
that values a patients resources, involvement in the process
of diagnosis and cure [2, 3].
M. T. Bordogna (*)
Department of Sociology and Social Research,
University of Milano-Bicocca,
Via Bicocca degli Arcimboldi 8,
20126 Milano, Italy
e-mail: mara.tognetti@unimib.it
EPMA Journal (2011) 2:411423
DOI 10.1007/s13167-011-0098-6
REVIEW ARTICLE
Traditional and non-conventional medicines:
the socio-anthropological and bioethical paradigms
for person-centred medicine, the Italian context
Paolo Roberti di Sarsina & Ilaria Iseppato
Received: 2 May 2011 / Accepted: 19 July 2011 / Published online: 11 August 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract In Italy the use of non-conventional medicines
(NCM) is spreading among people as in the rest of Europe.
However, in Italy, unlike that in other countries of the
European Union, at the present time the juridical/legal status
of NCM is not well established, mainly due to the lack of any
national law regulating NCM professional training, practice
and public supply and to the absence of government-promoted
scientific research in this field. This is an obstacle to
safeguarding the patients interests and freedom of choice,
especially now that dissatisfaction with biomedicine is
inclining more and more people to look for a holistic, fairer
and person-centered form of medicine.
Keywords Non-conventional medicine legal status
.
Person-centered medicine
.
Mainstream medicine
.
Complementary and alternative medicine
.
Health-genesis
.
Pharmacoeconomy
Some points of terminology
The World Health Organization has long called non-conven-
tional medicine Traditional Medicine in deference to the
countries where such forms of healing are in the long-standing
cultural heritage: one thinks of China and India.
The term adopted by the Cochrane Collaboration and the
international literature is actually Complementary and
Alternative Medicine (Consensus Conference, United
States Office for Alternative Medicine of the National
Institutes of Health, Bethesda, USA, 1997); one immedi-
ately infers that this has a multiple sense, covering
treatments chosen exclusively, i.e. as first-choice therapy
(alternative medicine), or second-choice therapy, i.e. in
combination with others (complementary medicine). Tradi-
tional and non-conventional medicine is the commonest
term in Italian usage, which we shall be adopting for
various reasons: it is less charged with ideology, hence
more neutral scientifically; it is a dynamic and relative
description of medicines which should not be seen as
inferior to conventional medicine. These are the forms that
are currently excluded from the official line-up of the health
service and from teaching in the medical faculty. Non-
conventional is here synonymous with unorthodox,
different from biomedicine.
For these reasons we prefer to stick to non-conventional
medicine (NCM) for the Italian setting. It is socially more
widespread, better known, understood in common Italian
parlance, used by the FNOMCeO in its Terni Document
(2002), by the European Parliament (1997) and the Council
of Europe (1999), used again in the Consensus Document
on NCM in Italy (2003). Besides, the term NCM ties up
with the fact that such disciplines are not properly included
as obligatory subjects on an Italian degree course in
medicine or veterinary science, unlike the practice of
P. Roberti di Sarsina
Expert for Non Conventional Medicine, High Council of Health,
Ministry of Health,
Rome, Italy
P. Roberti di Sarsina
Observatory and Methods for Health,
Department of Sociology and Social Research,
University of Milan-Bicocca,
Milan, Italy
I. Iseppato
University of Bologna,
Bologna, Italy
e-mail: ilaria.iseppato@gmail.com
Present Address:
P. Roberti di Sarsina (*)
Via Siepelunga, 36/12,
40141 Bologna, Italy
e-mail: paolo.robertidisarsina@unimib.it
EPMA Journal (2011) 2:439449
DOI 10.1007/s13167-011-0104-z
REVIEW ARTICLE
Salutogenesis and Ayurveda: indications for public
health management
Antonio Morandi & Carmen Tosto &
Paolo Roberti di Sarsina & Dacia Dalla Libera
Received: 31 August 2011 / Accepted: 2 November 2011 / Published online: 1 December 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
Abstract Ayurveda, the ancient traditional medicine of
India, defines health as a state of complete physical,
mental and spiritual well-being. The focus of Ayurveda is
on a predictive, preventive and personalized medicine.
This is obtained through a low-cost personalized counsel-
ing about lifestyle measures (diet, activities, etc.), trying to
involve the patient directly in the process of healing,
increasing his self-awareness and good relationships with
other people and nature. The approach of Ayurveda toward
positive health shares its features with that of salutogenesis
as described by Antonovsky. Prevention strategies prag-
matically suggested by Ayurveda - including factors such
as promotion of health education, individual awareness,
integration of spirituality and ethics in healthcare system-
may be applied in public health management, in order to
improve perceived and objective life quality, promote
healthy aging, limit drugs use (avoiding expensive side-
effects) and reduce chronic diseases social costs. Ayurveda
has a universal-coverage, being person-centered and
consequently intercultural.
Keywords Ayurveda
.
CAM
.
Salutogenesis
.
Predictive
medicine . Preventive medicine . Personalized medicine
Ayurveda and the concept of health as personalized,
predictive medicine
Tradition whatever its nature or origin is the distillation
of experience and therefore memory itself. It is the only
path to finding mans true nature, recovering what has been
forgotten and understanding the meaning of life itself. As
one of the worlds most ancient traditions, Ayurveda
(translated rom sanskrit knowledge of duration of life),
the traditional medicine of India and first of all anthropo-
logical/traditional medical systems, emphasizes the neces-
sity of a more person-centered, personalized approach in
medicine [14]. The process of healing has to be based on
peoples whole bio-psycho-spiritual unity and equilibrium,
including their relation to the environment and the way they
perceive or narrate their own complex individual exis-
tence, both in sickness and health. In Ayurveda the
determinants of health are biological, ecological, medical,
psychological, sociocultural, spiritual and metaphysical
factors, all interdependent and wired together by the
common concept of relationship. The harmonization and
integration of these determinants in a complex system
allows the emergence of what is identified as health.
A. Morandi (*)
:
C. Tosto
:
D. Dalla Libera
Ayurvedic Point,
C.SO Sempione 63,
20149 Milan, Italy
e-mail: dr.morandi@ayurvedicpoint.it
URL: www.ayurvedicpoint.it
A. Morandi
:
P. Roberti di Sarsina
:
D. Dalla Libera
SSIMA, Italian Scientific Society for Ayurvedic Medicine,
C.SO Sempione 63,
20149 Milan, Italy
D. Dalla Libera
IRCCS San Raffaele, Department of Neurology,
Via Olgettina 48,
20132 Milan, Italy
P. Roberti di Sarsina
Expert for non-conventional medicine, High Council of Health,
Ministry of Health,
Rome, Italy
P. Roberti di Sarsina
Observatory and Methods for Health, Department of Sociology
and Social Research, University of Milan-Bicocca,
Milan, Italy
EPMA Journal (2011) 2:459465
DOI 10.1007/s13167-011-0132-8
Reflection process on EU health policy

Commissioner David Byrne
2004
Health & Consumer Protection Directorate-General
Finally, a number of respondents have taken the opportunity of the
reflection process to reiterate the importance of certain
complementary health interventions such as nature healing,
homeopathic medicine, alternative and complementary medicines,
anthroposophic medicine and nutritional approaches. They would
like to see national health systems and reimbursement arrangements
recognise the value of these approaches (page 5)
COMMISSIONER BYRNES REFLECTION PROCESS ENABLING GOOD
HEALTH FOR ALL PREPARING THE GROUND FOR THE FUTURE HEALTH
STRATEGY REPORT ON RESPONSES RECEIVED
Health & Consumer Protection Directorate-General



EU Open Health Forum for Stakeholders
Health Challenges and Future Strategy
Charlemagne Building of the European Commission
Bruxelles 07-08.11.05
MANIFESTO ON COMPLEMENTARY AND ALTERNATIVE MEDICINE
SIGNED AT
THE EUROPEAN OPEN FORUM CONFERENCE FOR STAKEHOLDERS, Bruxelles, 08.11.2005

This morning we have been talking about subjects such as putting patients concerns higher on the agenda and
protecting them from health threats.

If we realise that:

there is a growing demand among the European citizens for Complementary and Alternative Medicine
(CAM)
clinical effectiveness of CAM is, in many cases, at least as high as the effectiveness of conventional medicine,
as showed by several long-term studies involving many thousands of patients
CAM is not only effective but also very safe, and that, therefore, CAM can help to reduce the enormous
burden of mortality and morbidity caused by the adverse effects of conventional prescription drugs

it is high time that the European Union includes CAM in its policy.

This document was signed by:

Dr Ton Nicolai European Committee for Homeopathy
Dr Giancarlo Buccheri International Federation of Anthroposophical Medical Associations
Dr Wolfgang Schmitz-Harbauer European Council of Doctors for Plurality in Medicine
Dr Norbert Missel Zentralverband der rzte fr Naturheilverfahren und Regulationsmedizin
Dr Walburg Masic-Oehler Deutsche rztegesellschaft fr Akupunktur
Dr Madeleen Winkler International Federation of Anthroposophical Medical Associations
Mr Michel Pradelle European Federation of Patients Associations for Anthroposophical Medicine
Dr Paolo Roberti di Sarsina Comitato Permanente di Consenso e Coordinamento per le Medicine Non
Convenzionali In Italia
Mr Colette Pradelle European Federation of Patients Associations for Anthroposophical Medicine
Mrs Alexsandra Hodgson European Forum for Complemenatry and Alternative Medicine
Mr Rainhard Schbel Association of Natural Medicine in Europe
Dr Franois Beyens International Council for Medical Acupuncture and Related Techniques
Mr Stephen Gordon European Council for Classical Homeopathy
Mr Seamus Connolly European Shiatsu Federation


DECISIONI ADOTTATE CONGIUNTAMENTE DAL PARLAMENTO EUROPEO E
DAL CONSIGLIO

DECISIONE n.1350/2007/CE DEL PARLAMENTO EUROPEO E DEL CONSIGLIO
del 23 ottobre 2007 che istituisce un secondo programma dazione comunitaria in
materia di salute (2008-2013)

Il programma dovrebbe prendere atto dellimportanza di unimpostazione
olistica della sanit pubblica e tenere in considerazione nelle sue azioni, ove
appropriato e in presenza di prove scientifiche o cliniche di efficacia, la medicina
complementare e alternativa.

The Programme should recognise the importance of a holistic approach to public
health and take into account, where appropriate and where there is scientific or
clinical evidence about its efficacy, complementary and alternative medicine in its
actions.

20.11.2007 Gazzetta Ufficiale dellUnione Europea L 301/5
Health & Consumer Protection Directorate-General




EU Open Health Forum 2008
Developing and Implementing Health
in the European Union
Charlemagne Building of the European Commission
Bruxelles 10-11.12.08
In Brussels on 11th December 2008 at the European Open Health Forum 2008, organised by the European
Commission DG Health and Consumer Protection, the following manifesto on CAM was signed and presented to
the European Commission, identifying them as a top priority for EU Health Policy:

Complementary and Alternative Medicine (CAM) is in strong demand among
European citizens reflecting a need for more holistic patient-centred care.
About 70% of the European population report that they have used CAM
therapies.
Clinical effectiveness of CAM is, in many cases, at least as high as the
effectiveness of conventional medicine as shown by several long-term studies
involving many thousands of patients.
CAM has a positive safety profile and is effective, especially in individualised
medicine.
CAM manufacturing techniques help protect the environment.
Integration of CAM in general health care can help reduce costs and the
burden of mortality and morbidity caused by multiple adverse effects of many
conventional prescription medicines.
CAM is needed in fostering good health in Europe for the young and the old.
CAM is a strong contribution to health promotion.

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!
(CAM)




European CAM research funding

http://www.cambrella.eu
CAMbrella
A pan-European research network for
Complementary and Alternative Medicine
CAMbrella history
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Lobbying to bring
CAM into FP7











Paving the way
First ad-hoc meetings
Nov06/Jan07

Deadline proposal
Dec08

Result of review
process Apr09

Grant Agreement
Oct09



Preparation
From Kick-off to final
conference











Execution
FP7-Health-2009-single-stage
3. Optimising the delivery of healthcare to European citizens
3.1 Translating Clinical Research into practice
3.1-3 Complementary and alternative medicine
funding scheme: Coordination action, max 1,5 Mio ", max 1 project

In order to create the knowledge base concerning the demands for
Complementary and Alternative Medicine (CAM) and the prevalence of its use
in Europe, consensus on the terminology of CAM and the definition of
respective CAM methods needs to be established. The current state with
respect to the providers perspective as well as needs and demands of the
citizens should be explored; the different legal status of CAM in EU Member
States needs to be taken into account. A roadmap for future European
research in this area should be developed.
CAMbrella
CAMbrella A pan-European research network for Complementary and
Alternative Medicine (CAM)

Start of the project: 1 Jan 2010

Duration: 3 years

Consortium: 16 participants from 12 European countries

Coordinator: Wolfgang Weidenhammer, Klinikum rechts der Isar, Munich,
Centre for Complementary Medicine Research
CAMbre||a k|ck-o Meenng. S|emens Ioundanon, Mun|ch, Ianuary 21-22, 2010.
George Lewith Helle Johannessen Vinjar Fnneb Torkel Falkenberg Wolfgang Weidenhammer Bernhard Uehleke Benno Brinkhaus Klaus von Ammon Bettina Reiter
131
ECHAMP Symposium
Brussels, Nov 18, 2009





The CAMbrella consortium
132





CAMbrella Advisory Board
Organization Abbrev. Web-site
European Public Health Association EPHA www.epha.org
European Central Council of Homeopaths ECCH www.homeopathy-ecch.org
European Forum for Complementary and Alternative Medicine EFCAM www.efcam.eu
European Coalition on Homeopathic and Anthroposophic Medicinal
Products
ECHAMP www.echamp.org
Association of Natural Medicine in Europe ANME www.anme.info
European Information Centre for Complementary and Alternative
Medicine
EICCAM www.eiccam.eu
International Council of Medical Acupuncture and Related techniques ICMART www.icmart.org
European Committee for Homeopathy ECH www.homeopathyeurope.org
European Herbal & Traditional Medicine Practitioners' Association EHTPA www.ehpa.eu
International Federation of Anthroposophic Medical Associations IVAA www.ivaa.eu
Kneipp-Bund eV KB www.kneippbund.de
European Council of Doctors for Plurality in Medicine ECPM www.ecpm.org





CAMbrella Scientific Steering Board
Coord|nator of CAMbre||a Wo|fgang We|denhammer, kllnlkum 8echLs der lsar, Cermany
CoordlnaLor 8ernhard Ueh|eke, unlverslLy of Zurlch, SwlLzerland W1 1ermlnology and denluon of CAM meLhods
CoordlnaLor V|n[ar Inneb, unlverslLeLeL l 1romsoe, norway W2 Legal sLaLus and regulauons
CoordlnaLor ne||e Iohannessen, Syddansk unlverslLeL, uenmark W3 needs and amLudes of cluzens
CoordlnaLor George Lew|th, unlverslLy of SouLhampLon, uk W4 CAM use - Lhe pauenLs perspecuve
CoordlnaLor k|aus von Ammon, unlverslLy of 8erne, SwlLzerland W3 CAM use - Lhe provlders perspecuve
CoordlnaLor 1orke| Ia|kenberg, karollnska lnsuLuLeL, Sweden W6 1he global perspecuve
CoordlnaLor 8enno 8r|nkhaus, CharlLe unlverslLy, Cermany W7 8oadmap for fuLure CAM research
CoordlnaLor 8emna ke|ter, Camed, AusLrla W8 ulssemlnauon and communlcauon
CoordlnaLor Iranz|ska 8aumhfener, 8aylC8, Cermany W9 ManagemenL
CAMbrella
Objectives

To develop a proposal for consensus on a series of definitions for the
terminology used to describe the major CAM interventions used clinically in
Europe.

To create a knowledge base that allows us to accurately evaluate the patient
demands for CAM and its prevalence of use in Europe.

To review current legal status of CAM in Europe.

To explore the needs, beliefs and attitudes of the EU citizens with respect to
CAM.
continued
CAMbrella
Objectives

To explore the providers perspectives on CAM treatment in Europe.

To propose an appropriate research strategy that will develop our understanding
of CAM use and its effectiveness within an EU context in response to the needs
of healthcare funders, providers and patients. This will take account of the
issues of effectiveness, cost, safety and the legal requirements for the
production of medicinal substances. To develop a process for prioritizing future
EU research strategy the current policies within the EU have to be considered.

To facilitate and foster a sustainable, high quality collaboration of European
CAM researchers by actively supporting a regional interest group within an
international society for CAM research.
3. Cpnm|s|ng the de||very of hea|thcare to Luropean c|nzens
3.1 1ranslaung Cllnlcal 8esearch lnLo pracuce
3.1-3 ComplemenLary and alLernauve medlclne

ln order Lo creaLe Lhe knowledge base concernlng Lhe demands for ComplemenLary
and AlLernauve Medlclne (CAM) and Lhe prevalence of lLs use ln Lurope, consensus
on Lhe Lermlnology of CAM and Lhe denluon of respecuve CAM meLhods needs Lo
be esLabllshed. 1he currenL sLaLe wlLh respecL Lo Lhe provlders perspecuve as well
as needs and demands of Lhe cluzens should be explored, Lhe dlerenL legal sLaLus of
CAM ln Lu Member SLaLes needs Lo be Laken lnLo accounL. A roadmap for fuLure
Luropean research ln Lhls area should be developed. CompleLed by Lhe Clobal
erspecuve.

CAM topic the task
W1 W2 W3 W4 WS W6 W7
CAMbre||a
A pan-Luropean research network for Comp|ementary and A|ternanve Med|c|ne (CAM)
137
Structure of the Work Packages





Work
Packages

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138
CAMbrella in a nutshell
Title CAMbrella A pan-European research network for
Complementary and Alternative Medicine (CAM)
Start of the project Jan 1, 2010
Duration 3 years
Consortium 16 participants from 12 European countries plus one
adjunct partner from Netherlands
Coordinator Klinikum rechts der Isar, Techn. Univ., Munich
Competence Centre for Complementary Medicine
and Naturopathy (Head: D Melchart); contact:
W Weidenhammer
Funding max 1.5 m. " (FP7/2007-2013, GA No. 241951)
Funding scheme: Coordination action
Aims to review the status quo of CAM in the EU and
to provide a proposal (=roadmap) for CAM research
Impact Research roadmap and network to enable
sustainable and prioritised CAM research in the EU
Information www.cambrella.eu
CAMbre||a M|dterm Meenng, 8o|ogna 23-2S March 2011, C La Gh|ronda Ioundanon
CAMbre||a I|na| Conference, 8ruxe||es 29 November 2012.
141
23/11/09 21.59 European Commission: CORDIS: FP7 : Find project
Pagina 2 di 3 http://cordis.europa.eu/fetch?CALLER=FP7_PROJ_EN&ACTION=D&DOC=1&CAT=PROJ&QUERY=0124de4572a5:c2b4:4a799312&RCN=92501
generated will be disseminated through our website, peer review publications and a final conference,
with emphasis on current and future EU policies, addressing the different target audiences with an
interest in CAM.
Project details
Project Acronym: CAMBRELLA
Project Reference: 241951
Start Date: 2010-01-01
Duration: 36 months
Project Cost: 1.67 million euro
Contract Type: Coordination (or networking) actions
End Date: 2012-12-31
Project Status: Accepted
Project Funding: 1.5 million euro
Participants
COMITATO PERMANENTE DI CONSENSO E COORDINAMENTO PER LE
MEDICINE NON CONVENZIONALI IN ITALIA
ITALY
UNIVERSITETET I TROMSOE NORWAY
WIENER INTERNATIONALE AKADEMIE FR GANZHEITSMEDIZIN AUSTRIA
BAYERISCHE FORSCHUNGSALLIANZ GEMEINNUTZIGE GMBH GERMANY
UNIVERSITATEA DE MEDICINA SI FARMACE VICTOR BABES
TIMISOARA
ROMANIA
AGENZIA SANITARIA E SOCIALE REGIONALE - REGIONE EMILIA-
ROMAGNA
ITALY
SERVICIO ANDALUZ DE SALUD SPAIN
UNIVERSITE PARIS 13 FRANCE
SYDDANSK UNIVERSITET DENMARK
UNIVERSITY OF SOUTHAMPTON
UNITED
KINGDOM
PECSI TUDOMANYEGYETEM - UNIVERSITY OF PECS HUNGARY
UNIVERSITAET BERN SWITZERLAND
UNIVERSITAET ZUERICH SWITZERLAND
KAROLINSKA INSTITUTET SWEDEN
CHARITE - UNIVERSITAETSMEDIZIN BERLIN GERMANY
Record Control Number: 92501
Update Date: 2009-10-30 13:18:51.0
23/11/09 21.59 European Commission: CORDIS: FP7 : Find project
Pagina 1 di 3 http://cordis.europa.eu/fetch?CALLER=FP7_PROJ_EN&ACTION=D&DOC=1&CAT=PROJ&QUERY=0124de4572a5:c2b4:4a799312&RCN=92501
Community Research and Development Information Service - CORDIS
European Commission > CORDIS > FP7 > Find project
Seventh Framework Programme (FP7)
FIND A PROJECT
Cambrella: a pan-European research network for complementary and alternative medicine (CAM) (CAMBRELLA)
Funded under 7th FWP (Seventh Framework Programme)
Research area: HEALTH-2009-3.1-3 Complementary and Alternative Medicine
Coordinator
Contact Person: Name: WEIDENHAMMER, Wolfgang (Dr)
Tel: +49-89-72669720
Fax: +49-89-72669721
Email: Contact
Organisation: KLINIKUM RECHTS DER ISAR
ISMANINGER STR.
GERMANY
Project description
The goal of this collaboration is to develop a roadmap for future European research in CAM that is
appropriate for the health care needs of EU citizens, and acceptable to the EU parliament as well as
their national research funders and healthcare providers. We will enable meaningful reliable
comparative research and communication within Europe and create a sustainable structure and policy.
CAMbrella is focussed on academic research groups which do not advocate specific treatments. The
Advisory Board represents the main CAM stakeholders including consumers, practitioners, clinical
providers, and manufacturers of CAM medicinal products. The specific objectives are to develop an
EU network involving centres of research excellence for collaborative research, to develop consensus-
based terminology widely accepted in Europe to describe CAM interventions, to create a knowledge
base that facilities our understanding of patient demand for CAM and its prevalence, to review the
current legal status and policies governing CAM provision in the EU and, to explore the needs, beliefs
and attitudes of the EU citizens with respect to CAM. Based on this information we will create a
roadmap that will enable a sustainable and prioritised EU research roadmap for CAM. We will
achieve this in 3 years by creating dialogue between researchers from 12 EU member and associated
states. We will set up a mechanism that will allow fruitful and thoughtful discussion throughout the
EU. To facilitate this coordinating action the project will be delivered in 9 independent but interrelated
work packages whose members meet regularly. It will be coordinated by a Management Board and
directed by a Scientific Steering Committee with support of an Advisory Board. The outcomes
CAMbrellas results of three years work
Luropean Consornum CAMbre||a (I7)
CAMbre||a Work ackage 2 - Lega| status and regu|anon of CAM |n Lurope - I|na| keport (314 pages)

Ioreword

1hls reporL ls developed by W2 ln Lhe CAMbrella consoruum ln Lhe perlod !anuary 1, 2010 Lo Aprll 30, 2012, and
has been updaLed ln Lhe perlod from May Lo CcLober 2012.
1he presenL reporL represenLs Lhe updaLed verslon from november 3, 2012.
1he a|m of Lhls work package was Lo revlew and descrlbe ln all 27 Lu member sLaLes as well as 10 assoclaLed sLaLes
(laLer expanded wlLh Lwo addluonal counLrles):

- 1he |ega| status of CAM
- 1he regu|atory status of CAM pracnces
- 1he governmenta| superv|s|on of CAM pracnces
- 1he re|mbursement status of CAM pracnces and med|c|na| products
- 1he regu|anon of CAM med|c|na| products

An addluonal alm was Lo revlew aL Lhe Lu level:
- 1he status of LU-w|de regu|anon of CAM pracnces and med|c|na| products
- 1he potenna| obstac|es for LU-w|de regu|anon of CAM pracnces and med|c|na| products

1he counLry-speclc sLaLus has been descrlbed on Lhe basls of publlcly avallable legal and regulaLory documenLs
supplemenLed by personal vlslLs Lo a purposlve sample of counLrles.
1he sLaLus wlLh regard Lo regulauon of CAM medlclnal producLs and Lhe Lu-wlde regulauon of CAM has been
descrlbed on Lhe basls of publlcly avallable legal and regulaLory documenLs only.

1he work of W2 Lega| status and regu|anon of CAM |n Lurope |s presented |n three separate reports:
1. art I - CAM regu|anons |n the Luropean countr|es (1-243)
2. art II - nerba| and homeopath|c med|c|na| products (244-273)
3. art III - CAM regu|anons |n LU]LI1A]LLA (274-314)

17/04/13 13:55 CAMbrella: la relazione finale su status giuridico e regolamentazione delle MNC in Europa
Pagina 1 di 2 http://www.fnomceo.it/fnomceo/showArticolo.2puntOT?id=97801
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Home CAMbrella: la relazione f...
CAMbrella: la relazione finale su status giuridico e CAMbrella: la relazione finale su status giuridico e
regolamentazione delle MNC in Europa regolamentazione delle MNC in Europa
Riceviamo e volentieri pubblichiamo (vedi allegato) la relazione finale del Gruppo Gruppo
di Lavoro 2 di Lavoro 2 del Consorzio CAMbrella (finanziato sotto il Settimo Programma
Quadro per la Ricerca e lo Sviluppo - FP7) concernente "Lo Status Giuridico e la
Regolamentazione delle Medicine Non Convenzionali in Europa".
Il Consorzio CAMbrella, rappresentato in Italia dal dottor Paolo Roberti di
Sarsina, la prima rete di eccellenza sulle Medicine Non Convenzionali costituita
sotto l'egida di un programma pluriennale di finanziamento per la ricerca nella
storia dell'Unione Europea.
a cura di Redazione FNOMCeO Web
Articolo pubblicato in: News
Documenti allegati:
CAMbrella Work Package 2 - Legal status and regulation of CAM in Europe - Final Report
Ricerca nel sito
FNOMCeO FNOMCeO
Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri
HOME NOTIZIE CONTATTI
FEDERAZIONE COMUNICATI EVENTI PRIMO PIANO RICERCA ANAGRAFICA
Luropean Consornum CAMbre||a (I7)
CAMbre||a Work ackage 2 - Lega| status and regu|anon of CAM |n Lurope - I|na| keport (314 pages)

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1hls reporL ls parL of a collecLlon of reporLs creaLed as dellverables of Lhe pro[ecL CAMbrella funded by Lhe 7
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lramework rogramme of Lhe Luropean Commlsslon (l7-PLAL1P-2009-3.1-3, CoordlnaLlon and supporL
acLlon, CranL-AgreemenL no. 241931, !an 1, 2010 - uec 31, 2012), CoordlnaLor: Wolfgang Weldenhammer,
CompeLence CenLre for ComplemenLary Medlclne and naLuropaLhy (head: uleLer MelcharL), kllnlkum rechLs
der lsar, 1echn. unlv. Munlch, Cermany




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1hls reporL ls parL of a collecLlon of reporLs creaLed as dellverables of Lhe pro[ecL CAMbrella funded by Lhe 7
Lh

lramework rogramme of Lhe Luropean Commlsslon (l7-PLAL1P-2009-3.1-3, CoordlnaLlon and supporL
acLlon, CranL-AgreemenL no. 241931, !an 1, 2010 - uec 31, 2012), CoordlnaLor: Wolfgang Weldenhammer,
CompeLence CenLre for ComplemenLary Medlclne and naLuropaLhy (head: uleLer MelcharL), kllnlkum rechLs
der lsar, 1echn. unlv. Munlch, Cermany




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1hls reporL ls parL of a collecLlon of reporLs creaLed as dellverables of Lhe pro[ecL CAMbrella funded by Lhe 7
Lh

lramework rogramme of Lhe Luropean Commlsslon (l7-PLAL1P-2009-3.1-3, CoordlnaLlon and supporL
acLlon, CranL-AgreemenL no. 241931, !an 1, 2010 - uec 31, 2012), CoordlnaLor: Wolfgang Weldenhammer,
CompeLence CenLre for ComplemenLary Medlclne and naLuropaLhy (head: uleLer MelcharL), kllnlkum rechLs
der lsar, 1echn. unlv. Munlch, Cermany



keferences for Ita|y (W2 I|na| keport, art 1, 229-230)

168. 8oberu dl Sarslna , lseppaLo l, edlLors. Non Convennona| Med|c|ne w|th|n the Ita||an Med|ca| rofess|on. LClM
2011, 2011, 8erlln.
169. 8oberu dl Sarslna , lseppaLo l. 1rad|nona| and Non Convennona| Med|c|nes: the Soc|oanthropo|og|ca| and
8|oeth|ca| arad|gm for erson-Centred med|c|ne. 1he Ita||an context. LMA. 2011,2:439-49.
170. 8oberu dl Sarslna , lseppaLo l. State of Art of the kegu|anve S|tuanon of Non Convennona| Med|c|nes |n Ita|y. 1he
!ournal of AlLernauve and ComplemenLary Medlclne 2010,16(2):141-2.
171. 8oberu dl Sarslna , lseppaLo l. Look|ng for a erson-Centered Med|c|ne: Non Convennona| Med|c|ne |n the
Convennona| Luropean and Ita||an Semng. Lvldence-8ased ComplemenLary and AlLernauve Medlclne 2011,2011.
172. 8oberu dl Sarslna , lseppaLo l. Non-Convennona| Med|c|ne |n Ita|y: 1he present s|tuanon. Luropean !ournal of
lnLegrauve Medlclne. 2009,1(2):63-71.
173. lrauarl L, khanchandanl 8, . 8oberu dl Sarslna, Wllllams !. 1he Lvo|unon of Ch|ropracnc kegu|anon |n Ita|y.
Assoclauon of lLallan ChlropracLors submlsslon Lo CAMbrella, 31 uecember 2011.
Original Article
Forsch Komplementmed 2012;19(suppl 2):2936 Published online: November, 2012
DOI: 10.1159/000343125
Solveig Wiesener
National Research Center in Complementary and Alternative Medicine (NAFKAM)
Department of Community Medicine, University of Troms
9037 Troms, Norway
Solveig.wiesener@uit.no
2012 S. Karger GmbH, Freiburg
1661-4119/12/0198-0029$38.00/0
Accessible online at:
www.karger.com/fok
Fax +49 761 4 52 07 14
Information@Karger.de
www.karger.com
Legal Status and Regulation of Complementary and
Alternative Medicine in Europe
Solveig Wiesener
a
Torkel Falkenberg
b,c
Gabriella Hegyi
d
Johanna Hk
b,c

Paolo Roberti di Sarsina
e
Vinjar Fnneb
a
a
National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine,
University of Troms, Norway
b
Research Group Integrative Care, Divison of Nursing, Department of Neurobiology, Caring Sciences and Society,
Karolinska Institutet, Huddinge,
c
IC The Integrative Care Science Center, Sweden
d
Health Science Faculty, Pcs University, Hungary
e
Expert for Non-Conventional Medicine, High Council of Health, Ministry of Health, Bologna, Italy
Keywords
Alternative medicine Complementary medicine
Regulation Government regulation Legislation
European Union Europe
Summary
Objective: The study aims to review the legal and regula-
tory status of complementary and alternative medicine
(CAM) in the 27 European Union (EU) member states
and 12 associated states, and at the EU/European Eco-
nomic Association (EEA) level. Methods: Contact was es-
tablished with national Ministries of Health, Law or Edu-
cation, members of national and European CAM associa-
tions, 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 regula-
tion 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 au-
thorization 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 safe-
guard against inadequately justified over- or underregu-
lation at the national level.
Introduction
The European Parliament [1] and the Parliamentary Assem-
bly of the Council of Europe [2] have both passed resolutions
recommending a stronger harmonization of, what they call,
non-conventional medicine in Europe.
The European Union (EU) has, however, repeatedly con-
firmed that it is up to each member state to organize and
regulate their healthcare system, and this will, of course, also
apply to complementary and alternative medicine (CAM).
Despite this confirmation, the recent Patients Rights in
Cross-Border Healthcare Directive 2011/24/EU [3] and other
directives indirectly encourage some degree of harmoniza-
tion. CAM professions can be registered in the European
Commission (EC) database of regulated professions, and
patients will probably have certain rights according to the
Cross-Border Healthcare Directive. The EU has also passed
directives regulating medicinal products that also cover CAM
medicinal products [46].
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CAMbrella - Work ackage 2 8eporL arL l age 13


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for Lhe member sLaLes. 1hls ls ad[usLed and conflrmed ln Lhe Llsbon 1reaLy ln 1l1LL xlv ubllc
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1hls sLaLemenL ls lmporLanL Lo keep ln mlnd when descrlblng naLlonal leglslaLlon and
regulaLlon of CAM. uesplLe Lhe sLaLemenL, Lhe followlng Lu ulrecLlves and 8egulaLlons can
poLenLlally lnfluence naLlonal leglslaLlon regardlng CAM pracLlces, LreaLmenLs and paLlenLs'
rlghLs and safeLy:
!"#$%&''( * +,%- .(/-(0& 1 2&3,%4 .(%4 5 .(0& 16


I|gure S.1.1 Genera| CAM |eg|s|at|on map

1ab|e S.1.1 Genera| CAM |eg|s|at|on - countr|es
7&8&%(' !"# '&09:'(49,8
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S.2 Acupuncture


I|gure S.2.1 Acupuncture map

1ab|e S.2.1 Acupuncture regu|at|ons - countr|es
2&06'(4&7 3%,8&99:,;
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CAMbrella - Work ackage 2 8eporL arL l age 24

S.3 Anthroposoph|c med|c|ne


I|gure S.3.1 Antroposoph|c med|c|ne map


1ab|e S.3.1 Anthroposoph|c med|c|ne regu|at|ons - countr|es
8egulaLed professlon and
Lu reglsLered (0)
8egulaLed professlon
noL Lu reglsLered (0)
8egulaLed LreaLmenL
noL regulaLed professlon (7)
no regulaLlon (32)
AusLrla
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SwlLzerland

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anLhroposophlc medlclne ls statutory reg|stered as an addlLlonal educaLlon for medlcal
docLors. ln Austr|a dlplomas awarded by Lhe AusLrlan Medlcal 8oard spec|a||se phys|c|ans ln
anLhroposophlc medlclne. ln Germany anLhroposophlc medlclne ls regulaLed by |aw as "a
CAMbrella - Work ackage 2 8eporL arL l age 26

S.4 Ayurveda



I|gure S.4.1 Ayurveda map

1ab|e S.4.1 Ayurveda regu|at|ons - countr|es
8egulaLed professlon
and Lu reglsLered (0)
8egulaLed professlon
noL Lu reglsLered (0)
8egulaLed LreaLmenL
noL regulaLed professlon (3)
no regulaLlon (34)
Pungary
LaLvla
8omanla
Serbla
Slovenla

We have found LhaL ayurvedlc medlclne ls dlrecLly menLloned ln regu|at|ons |n S out of 39
countr|es. ln some of Lhe oLher 34 counLrles ayurvedlc medlclne ls recognlzed as a
LherapeuLlc sysLem LhaL may be provlded by regulaLed healLh personnel (ofLen docLors), buL
noL dlrecLly menLloned ln Lhe regulaLlons.
!"#$%&''( * +,%- .(/-(0& 1 2&3,%4 .(%4 5 .(0& 16

S.S Ch|ropract|c


I|gure S.S.1 Ch|ropract|c map

1ab|e S.S.1 Ch|ropract|c regu|at|ons - countr|es
2&07'(4&8 3%,9&::;,<
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S.6 nerba| med|c|ne]hytotherapy


I|gure S.6.1 nerba| med|c|ne]hytotherapy map

1ab|e S.6.1 nerba| med|c|ne ] hytotherapy regu|at|ons - countr|es
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S.7 nomeopathy


I|gure S.7.1 nomeopathy map

1ab|e S.7.1 nomeopathy regu|at|ons - countr|es
2&07'(4&8 3%,9&::;,<
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S.8 Massage


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1ab|e S.8.1 Massage regu|at|ons - countr|es
2&08'(4&9 3%,:&;;<,= (=9 >?
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5;%(&' ?V
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CAMbrella - Work ackage 2 8eporL arL l age 37

S.9 Naprapathy


I|gure S.9.1 Naprapathy map
1ab|e S.9.1 Naprapathy regu|at|ons - countr|es
8egulaLed professlon and
Lu reglsLered (2)
8egulaLed professlon
noL Lu reglsLered (0)
8egulaLed LreaLmenL
noL regulaLed professlon(0)
no regulaLlon (37)
llnland
Sweden

naprapaLhy ls a regulaLed and proLecLed professlon ln llnland and Sweden. llnland has
reglsLered Lhelr naprapaLh professlon ln Lhe Lu regulaLed professlons daLabase as phys|ca|
therap|st wlLh Lhe LlLle "Naprapaat|]Naprapat". Sweden has reglsLered Lhelr naprapaLh
professlon ln Lhe Lu daLabase as ch|ropractor wlLh Lhe LlLle "naprapat".
We have noL found LhaL naprapaLhy ls recognlzed or pracLlsed ln Lhe oLher 37 counLrles. ln
some counLrles "manua| therapy" or "phys|ca| therapy" ls a common Lermlnology for
slmllar LreaLmenLs.

!"#$%&''( * +,%- .(/-(0& 1 2&3,%4 .(%4 5 .(0& 67

S.10 Naturopathy


I|gure S.10.1 Naturopathy map

1ab|e S.10.1 Naturopathy regu|at|ons - countr|es
2&08'(4&9 3%,:&;;<,= (=9
>? %&0<;4&%&9 @AB
2&08'(4&9 3%,:&;;<,=
C,4 >? %&0<;4&%&9 @AB
2&08'(4&9 4%&(4D&=4
C,4 %&08'(4&9 3%,:&;;<,= @EB
C, %&08'(4<,= @6AB
FG<4H&%'(=9 I<&/J4&=;4&<= "'$(=<(
!K3%8;
L%(=/&
M&%D(=K
.,%480('
2,D(=<(

C(48%,3(4JK <; ( regu|ated profess|on <= 2 countr|es (Sw|tzer|and, L|echtenste|n).
Sw|tzer|and J(; %&08'(4&9 4J& 3%,:&;;<,= "natura| hea|th pract|t|oner" (=9 J(; %&0<;4&%&9
4G, 9<::&%&=4 3%,:&;;<,=; <= 4J& >? %&08'(4&9 3%,:&;;<,=; 9(4($(;&N naturopathe]
homopathe(IkB (=9 naturopathe (de trad|t|on Luropenne)(Ik). L|echtenste|n J(; =,4
CAMbrella - Work ackage 2 8eporL arL l age 40

S.11 Neura| therapy


I|gure S.11.1 Neura| therapy map

1ab|e S.11.1 Neura| therapy regu|at|ons - countr|es
8egulaLed professlon and
Lu reglsLered (0)
8egulaLed professlon
noL Lu reglsLered (0)
8egulaLed LreaLmenL
noL regulaLed professlon (3)
no regulaLlon (36)
AusLrla
Pungary
SwlLzerland

3 countr|es (Austr|a, nungary, Sw|tzer|and) have speclflc regulaLlon on neural Lherapy. ln
Austr|a dlplomas awarded by Lhe medlcal assoclaLlon speclallse physlclans ln neural Lherapy.
ln nungary CAM leglslaLlon regulaLes neural Lherapy. ln Sw|tzer|and neural Lherapy ls
lncluded ln federal laws.
36 counLrles have no speclflc regulaLlon on neural Lherapy. Ceneral CAM and healLh
regulaLlons may lnfluence neural Lherapy pracLlces.
CAMbrella - Work ackage 2 8eporL arL l age 41

S.12 Csteopathy


I|gure S.12.1 Csteopathy map

1ab|e S.12.1 Csteopathy regu|at|ons - countr|es
8egulaLed professlon and
Lu reglsLered (6)
8egulaLed professlon
noL Lu reglsLered (3)
8egulaLed LreaLmenL
noL regulaLed professlon (6)
no regulaLlon (24)
llnland lrance 8elglum
lceland Pungary 8ulgarla
LlechLensLeln LaLvla lLaly
MalLa orLugal
SwlLzerland 8omanla
uk Slovenla

ln 9 countr|es osLeopaLh ls a regu|ated profess|on. 6 counLrles have reglsLered Lhe
professlon ln Lhe Lu regulaLed professlons daLabase. (I|n|and, Ice|and, L|echtenste|n, Ma|ta,
Sw|tzer|and, Uk). I|n|and, Ice|and, L|echtenste|n, Ma|ta requlre a quallflcaLlon level S3 -
dlploma of posL-secondary level (3-4 years). ln Sw|tzer|and Lhe quallflcaLlon level ls 3 years
!"#$%&''( * +,%- .(/-(0& 1 2&3,%4 .(%4 5 .(0& 67

S.13 1rad|t|ona| Ch|nese Med|c|ne (1CM)


I|gure S.13.1 1CM map

1ab|e S.13.1 1CM regu|at|ons - countr|es
2&08'(4&9 3%,:&;;<,= (=9
>? %&0<;4&%&9 @AB
2&08'(4&9 3%,:&;;<,=
C,4 >? %&0<;4&%&9 @AB
2&08'(4&9 4%&(4D&=4
C,4 %&08'(4&9 3%,:&;;<,= @EAB
C, %&08'(4<,= @1FB
"8;4%<(
G8'0(%<(
>;4,=<(
H8=0(%I
J<&/K4&=;4&<=
2,D(=<(
L&%$<(
L',M&=<(
LN<4O&%'(=9
?P

Original Article
Forsch Komplementmed 2012;19(suppl 2):3743 Published online: November, 2012
DOI: 10.1159/000343129
Klaus von Ammon, MD
Institute of Complementary Medicine KIKOM
University of Bern, Imhoof-Pavillon, Inselspital
3010 Bern, Switzerland
klaus.vonammon@kikom.unibe.ch
2012 S. Karger GmbH, Freiburg
1661-4119/12/0198-0037$38.00/0
Accessible online at:
www.karger.com/fok
Fax +49 761 4 52 07 14
Information@Karger.de
www.karger.com
Complementary and Alternative Medicine Provision
in Europe First Results Approaching Reality in an
Unclear Field of Practices
Klaus von Ammon
a
Martin Frei-Erb
a
Francesco Cardini
b
Ute Daig
a
Simona Dragan
c

Gabriella Hegyi
d
Paolo Roberti di Sarsina
e,f
Jan Srensen
g
George Lewith
h
a
Institute of Complementary Medicine KIKOM, University of Bern, Switzerland
b
Health and Social Regional Agency (ASSR) Emilia Romagna, Bologna, Italy
c
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
d
PTE Pecs University Medical School, CAM Department, Pecs, Hungary
e
High Council of Health, Ministry of Health, Rome,
f
Committee for CAM in Italy, Bologna, Italy
g
Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark
h
Aldermoor Health Centre, University of Southampton, UK
Keywords
Complementary medicine Economics Effectiveness
Physician Practitioner Provision Training
Summary
Background: The demand for complementary and alter-
native medicine (CAM) treatment in the European Union
(EU) has led to an increase in the various CAM interven-
tions available to the public. Our aim was to describe the
CAM services available from both registered medical
practitioners and registered non-medical practitioners.
Methods: Our literature search comprised a PubMed
search of any scientific publications, secondary refer-
ences and so-called grey literature, a search of govern-
ment websites and websites of CAM organisations to
collect data in a systematic manner, and personal com-
munications, e.g., via e-mail contact. Due to the different
reliability of data sources, a classification was developed
and implemented. This weighted database was con-
densed into tables and maps to display the provision of
CAM disciplines by country, showing the distribution of
CAM providers across countries. Results: Approximately
305,000 registered CAM providers can be identified in
the EU (~160,000 non-medical and ~145,000 medical
practitioners). Acupuncture (n = 96,380) is the most avail-
able therapeutic method for both medical (80,000) and
non-medical (16,380) practitioners, followed by home-
opathy (45,000 medical and 5,800 non-medical practi-
tioners). Herbal medicine (29,000 practitioners) and re-
flexology (24,600 practitioners) are mainly provided by
non-medical practitioners. Naturopathy (22,300) is domi-
nated by 15,000 (mostly German) doctors. Anthropo-
sophic medicine (4,500) and neural therapy (1,500) are
practised by doctors only. Conclusion: CAM provision in
the EU is maintained by approximately 305,000 regis-
tered medical doctors and non-medical practitioners,
with a huge variability in its national regulatory manage-
ment, which makes any direct comparison across the EU
almost impossible. Harmonisation of legal status, teach-
ing and certification of expertise for therapists would be
of enormous value and should be developed.
Introduction
Complementary and alternative medicine (CAM) is a develop-
ing area associated with much conflicting debate. It appears
that CAM services are in great demand by patients. Life-time
CAM use prevalence rates of between 3 and 25% are reported
internationally [1, 2]. CAM use has been documented across
Europe for the UK, Germany and Italy and is used by between
10 and 70% of the population [38]. However, in practice,
there is a varying provision of CAM within the European
Union (EU). This review covers the providers perspective and
Acupuncture (all countries)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Antihomotoxicology Provision by MD and Non-Medical Practitioners per
100'000 Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Herbal Medicine Provision by MD and Non-Medical Practitioners per
100'000 Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Homeopathy Provision by MD and Non-Medical Practitioners per
100'000 Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Homeopathy Provision by MD and Non-Medical Practitioners per
100'000 Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Humoral Drain off Therapy Provision by MD and Non-Medical Practitioners
per 100'000 Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Kinesiology Provision by MD and Non-Medical Practitioners per 100'000
Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Naturopathy Provision by MD and Non-Medical Practitioners per 100'000
Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Orthomol Med Provision by MD and Non-Medical Practitioners per 100'000
Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Reflexology Provision by MD and Non-Medical Practitioners per 100'000
Inhabitants (EU 27+12)

no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
Shiatsu Provision by MD and Non-Medical Practitioners per 100'000
Inhabitants (EU 27+12)
no provision: white | no data: off-white |< 1: light gray |< 5: gray |< 10: dark grey | > 10: black
177



CAMbrella In-depth Reports
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Sistemi Sanitari, Medicine
Tradizionali e Non
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Terza Edizione

III Edizione
Universit di Milano-Bicocca
Dipartimento di Sociologia e Ricerca Sociale
Via Bicocca degli Arcimboldi, 8
20126 Milano, Italia
Docenti
ALIVIA M. Societ Italiana di Medicina Antroposofica
BOFFI M. Universit Milano-Bicocca
BOMBARDI S. AO Universitaria di Ferrara
BRONZINI M. Universit Politecnica delle Marche
CASTAGNINI G. AO San Gerardo, Monza
CATINO M. Universit di Milano-Bicocca
CERRI C. Universit di Milano-Bicocca
COLOMBO E. Universit di Milano
DECATALDO A. Universit di Milano-Bicocca
DEMETRIO D. Universit di Milano-Bicocca
DELLE FAVE A. Universit di Milano
FIRENZUOLI F Universit di Firenze
FULLIN G. Universit di Milano-Bicocca
GENOVA A. Universit di Urbino
GOSTINELLI M. Centro Oncologico Fiorentino Casa di
Cura Villanova
GUARISCO E. Istituto Internazionale Shang Shung per gli
Studi Tibetani
INGROSSO M. Universit di Ferrara
ISEPPATO I. Fondazione ANT Italia ONLUS
LONGO F. Universit Bocconi
LUCCHINI M. Universit di Milano-Bicocca
LUSARDI R. Universit di Parma
MINELLI E. Centro Collaborante OMS per la
Medicina Tradizionale
MISSONI E. Universit Bocconi
MORANDI A. Societ Scientifica Italiana di Medicina
Ayurvedica
NEGRELLI S. Universit di Milano-Bicocca
NERI S. Universit di Milano
NUVOLATI G. Universit di Milano-Bicocca
ORNAGHI A. Universit di Milano-Bicocca
PASCIUTO A.M. Associazione Italiana Medicina Ambiente
Salute
POMA L. Giornalista, esperto in comunicazione nel
settore sanitario
QUARANTA I. Universit di Bologna
ROBERTI di SARSINA P. Associazione per la Medicina Centrata
sulla Persona ONLUS
RONCHI A. Federazione Italiana Associazioni e Medici
Omeopati
ROSSI E. Registro degli Osteopati d'Italia
ROSSI P. Universit di Milano-Bicocca
SIRONI V Universit di Milano-Bicocca
STREPPARAVA M. G. Universit di Milano-Bicocca
TOGNETTI M. Universit di Milano-Bicocca
TOMELLERI S. Universit di Bergamo
TOSTO C. Scuola Ayurvedic Point Milano
VINTANI P. FederFarma
WILLIAMS J.G. Associazione Italiana Chiropratici
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Comitato Scientifico
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Cardano Mario Universit di Torino
Costa Giuseppe Universit di Torino
Facchini Carla Universit di Milano-Bicocca
Gensini Gian Franco Universit di Firenze
Giasanti Alberto Universit di Milano-Bicocca
Ingrosso Marco Universit di Ferrara
Maciocco Gavino Universit di Firenze
Manghi Sergio Universit di Parma
Mingione Enzo Universit di Milano-Bicocca
Missoni Eduardo Universit Bocconi
Niero Mauro Universit di Verona
Roberti di Sarsina Paolo Associazione per la Medicina Centrata
sulla Persona ONLUS
Silvestrini Bruno Fondazione di Noopolis
Stella Andrea Universit di Milano-Bicocca
Tognetti Mara Universit di Milano-Bicocca
Vicarelli Giovanna Universit Politecnica delle Marche
Direttore del Master: Mara Tognetti
Coordinatore: Paolo Roberti di Sarsina

Referenti di area
Cesare Cerri Medicina
Paolo Roberti di Sarsina Medicine Tradizionali e Non
Convenzionali
Mara Tognetti Sociologia della Salute, Sociologia delle
MT/MNC





Il Master conferisce 60 CFU (art.7 comma 4 del DM 270/2004)
Lezioni 240 ore (30 CFU)
Laboratorio 48 ore (3 CFU)
Esercitazioni 48 ore (4 CFU)




Stage pratico e/o di ricerca 400 ore (16 CFU)
Prova finale (6 CFU)
Sono previste inoltre attivit relative a : studio guidato e studio autogestito.
Dedico questo mio contributo al mio Maestro,
il Dharmaraja, Chgyal Namkhai Norbu Rinpoche.
Che la Adamantina Dottrina si propaghi come il vento