Scope of Homeopathy in European Countries

Dr K R Mansoor Ali
Over the past 30-40 years homeopathy has benefited from growing demand both from doctors and from the public in the majority of the European countries. According to a survey by European Commission order three Europeans out of four know about homeopathy and of these about 30 % use it for their health care. In the European Union there are approximately 30,000 physicians who have taken a training course in homeopathy. Manymore doctors in Europe prescribe homeopathic medicines without any homeopathic training: approximately 25-40 % of the GPs from time to time, 6-8 % of them on a more regular basis.

Among the different forms of Complementary and Alternative Medicine (CAM), in particular homeopathy has a form of legal recognition in certain European countries, an organisational structure at European level, self-regulatory mechanisms, and a certain level of scientific credibility.Homeopathy is being increasingly recognised as a potential asset to European health care. Resolutions on CAM (or non-conventional medicine) have been adopted by the European Parliament and the Council of Europe, EU Directives oblige the Member States to register homeopathic medicinal products, and homeopathic medicinal products are being included in the European Pharmacopoeia.

Legal Status
The current legal situation varies from country to country. The result is a situation where citizens within the individual countries of the European Union and greater Europe do not share equal rights and opportunities.

In most Member States of the European Union the practice of homeopathy is exclusively restricted to medical doctors -doctors with a conventional medical degree like MBBS,MD. In some other Member States, however, also non-medically qualified practitioners can practise homeopathy.

A rather tolerant system can be seen in Denmark, Estonia, Finland, Germany, Ireland, the Netherlands, Sweden and the United Kingdom. These countries stipulate that only specific medical acts (e.g. treating people for infectious diseases, performing surgery, administering anaesthetics, prescribing drugs that require a prescription, giving injections, using X-ray) are restricted to medical practitioners with a university degree, although the range of these medical acts may differ from country to country. This implies that the practice of homeopathy by non-medically qualified practitioners is tolerated.

The monopolistic system exists in Austria, Belgium, Cyprus, Czech Republic, France, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Slovakia and Spain, constituting 60% of the whole EU population. Medical practice by other people is illegal, which implies that in these countries also the practice of homeopathy is explicitly restricted to medical doctors.

Germany is the only EU Member State where non-medically qualified practitioners or Heilpraktikers, have to qualify for a licence. Health authorities subject the candidates to an examination in order to assess that they have sufficient public health knowledge as well as some basic knowledge of anatomy, physiology and pathology to prevent them from constituting a public health risk. The purpose of the examination is not to determine the level of knowledge and skills required for their professional competence

Total of 42 countries:
Albania, Austria, Belarus, Belgium, Bosnia Herzegovina, Bulgaria, Croatia, Cyprus, Czech ,Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Macedonia, Malta, Moldova, Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom, Yugoslavia.

Homeopathy is practiced in  39 countries

It is legal to practice as a professional homeopath in 25 out of 39 countries: Albania, Bosnia Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, Germany, Greece, Iceland, Ireland, Italy, Latvia, Liechtenstein, Macedonia, Malta, Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, Switzerland and United Kingdom.

This includes the majority of the EU member countries (11 out of 15).

For most of the remaining 14 countries it is only legal to practice if you are a medical doctor.

In Germany professional homeopaths may practise, but only if they are registered health care practitioners (Heilpraktiker) or medical doctors.

Although only medical doctors are allowed to treat patients in Poland, irrespective of the therapy being used, some professional homeopaths do practise, and it appears that this is tolerated by the authorities.

In Switzerland legislation varies, and it is legal to practise in some cantons and not in others.

It is illegal in five out of 26 countries

In Belarus a medical doctor must have 3 years clinical experience in general medicine, and follow a 2 month course with 312 hours of lectures and clinical training in homeopathy, before she or he can become
a homeopath.

In Latvia medical doctors may practise when they have been certified by the Latvian Homeopathic Association, after passing an exam.

According to Portuguese law a medical doctor may practise any therapy, but must register with the Portuguese Order of Medical Doctors. This order does not permit the practice of alternative and complementary therapies like homeopathy. Doctors who do practise homeopathy are reprimanded when they openly admit they do so. Other statutorily regulated health care practitioners are not allowed to practise homeopathy.

Homeopathy is considered a medical speciality in Russia, and a medical doctor must obtain a licence from the Ministry of Health. To gain this speciality a doctor must complete a 216 hour course including lectures and clinical practice. A medical doctor cannot treat the following conditions with homeopathy: cancer, tuberculosis, acute infectious diseases, schizophrenia and affective insanity.

Medical doctors in Slovakia are not allowed to only practise homeopathy.

Medical doctors in Croatia and Slovenia are prohibited from practising homeopathy.

In France dentists and midwives may also practise homeopathy in addition to medical doctors.

In Germany only homeopaths who are registered health care practitioners (Heilpraktiker) or medical doctors are allowed to treat patients irrespective of the therapy being used. Heilpraktiker is a medical profession recognised by the German government, based on the Heilpraktikergesetz law of 1939. The requirement for earning the distinction Heilpraktiker is the successful passage of an exam set by the Public  Health Department. A Heilpraktiker is allowed to practise any unconventional therapy, e.g. homeopathy.

Medical doctors who have followed a specific training programme may use the title homeopath. The official title is regulated by the Deutsche Ärztekammer (German Medical Association).

In the Netherlands insurance companies will refund homeopathic treatment from both professional homeopaths and medical homeopaths provided the homeopath is a member of one of the two national member associations for homeopaths (NVKH or VHAN).

In Norway there are no restrictions for homeopathy specifically, but there are some minor restrictions under the 1936 Act of Quackery (10)

In the United Kingdom some treatment is available and funded by the National Health Service (NHS), and some health insurance companies will recognise treatment by homeopaths. Common law allows anyone to practise any therapy as long as they do not claim to be a medical doctor (MD).

Medical doctors are not allowed to practise homeopathy in Croatia and Slovenia

Funding for research
Money has been granted for the funding of research in 16 out of the 39 countries. In seven countries funding has been granted from the Government (Denmark, France, Germany, Netherlands, Norway, Spain and Switzerland). In 12 countries research has been conducted with funding from other sources (Finland, France, Israel, Italy, Norway, Poland, Romania, Russia, Spain, Sweden, Ukraine and the United Kingdom).

Homeopathy and the European Union Member States
In certain Member States the practice of homeopathy is officially recognised by the government. As early as from 1950 the Faculty of Homeopathy in the United Kingdom is officially acknowledged, by Act of Parliament, as a postgraduate training establishment for doctors, with the objective of ‘advancing and extending the principles and practice of homeopathy’. Its remit has subsequently been extended to other recognised health professions, including veterinary surgeons, dentists, pharmacists and midwives. Homeopathy is the only form of CAM available under the National Health Service. The UK House of Lords Select Committee on Science and Technology in their 2000 report on CAM note that public satisfaction with CAM is high and use of CAM is increasing, and that in the interests of public safety the complementary medicine sector should be properly regulated. That training for CAM professionals should be standardized and independently accredited, and that registered conventional health professionals should become more familiar with CAM. The report made some recommendations as to how research could be encouraged, including pump-priming by the National Health Service and Medical Research Council.

In Hungary (1997) and Lithuania (1999) homeopathy is officially recognized as a regular medical method by the government. In 1999 the Belgian Parliament adopted a law with the aim to recognise some CAM modalities, including homeopathy. According to this law homeopathy is considered as an additional qualification (GP with homeopathy, paediatrician with homeopathy etc.).

The Portuguese Parliament in 2003 and the Bulgarian Parliament in 2005 adopted similar laws, providing a framework for recognition of individual branches of CAM including homeopathy. The Italian Parliament is currently discussing legislation that will eventually lead to the recognition of medical qualifications in homeopathy and other branches of CAM.

The European Pharmacopoeia (EP), which belongs to the jurisdiction of the Council of Europe, is including specific homeopathic monographs on several homeopathic starting materials – from botanical, chemical, mineral, or zoological origin – and this process will proceed over the next years. It is intended that the official homeopathic pharmacopoeias currently used in the Member States, i.e. the French and German one, will eventually merge into the European Pharmacopoeia.

Homeopathy and the national medical associations
Several National Medical Associations have recognised homeopathy as a therapeutic medical method. In Germany doctors can obtain, after passing an examination, an additional qualification ‘Homöopathischer Arzt’ recognised by the Bundesärztekammer. A similar situation exists in Austria where the additional qualification ‘Homöopathie’ is recognized  by the Österreichische Ärztekammer.

The Latvian Medical Association (Latvijas Arstu Biedriba), which regulates and supervises all medical specialties, conferred homeopathy the official status of a clinical specialty in 1995.

In 1997 the French Medical Association (Ordre National des Médecins) recognised homeopathy as an existing therapeutic medical method and stated that homeopathic education should be installed at Universities, leading to a diploma authorised by the Ordre, and that systematic information on homeopathy should be given within the undergraduate medical curriculum.

A subspecialty under the term of “certificate of capacity in homeopathy” has been in place in Switzerland since 1998 in collaboration with the Swiss Medical Association FMH, for doctors holding a title of a current specialty such as General Medicine, Internal Medicine or Paediatrics.

In 2002 the Italian Medical Association (Federazione Nazionali degli Ordini dei Medici Chirughi e degli Odontoiatri or FNOMCeO) recognized homeopathy as a medical method and insisted on legislation in this field.

Both the British Medical Association and the British Medical Council have recommended to incorporate familiarisation courses on CAM into the medical undergraduate curriculum and set up accredited postgraduate training.

Homeopathy at universities and hospitals
In some countries, such as France, Germany, Poland and Spain, homeopathic education is provided at universities as well as at other training institutes. In France at 8 universities (Aix-Marseille, Besançon, Lille, Paris-Bobigny, Bordeaux II, Limoges, Poitiers, and Lyon), in Germany at five (Berlin, Düsseldorf, Hannover, Heidelberg, and Freiburg), in Poland at seven (Warsaw, Poznan, Krakow, Katowice, Lublin, Gdansk, and Wroclaw), and in Spain at four (Barcelona, Murcia, Sevilla and Valladolid). In all other European countries homeopathy is taught in private training institutes.

There are five chairs in Complementary and Alternative Medicine (CAM) in Germany: University of Witten/Herdecke, University of Duisburg/Essen, University of Rostock, Charité University of Berlin, Centre for Complementary Medicine Research (ZNF) at the Technical University of Munich. In the United Kingdom there are chairs in Complementary and Alternative Medicine (CAM) at the University of Exeter, University of Southampton and Thames Valley University. At two Swiss universities (Bern, Zürich) a chair in Complementary and Alternative Medicine (CAM) has been established providing familiarisation courses on homeopathy and other CAM modalities in the undergraduate medical curriculum. At an increasing number of universities in other countries familiarisation courses in homeopathy and other CAM methods have been introduced or are about to be introduced into the undergraduate medical curriculum. These courses are compulsory in Germany and the United Kingdom and optional at many universities all over Europe. A recent review by the University of Debrecen, Hungary revealed that 40% of the responding medical faculties at European universities provide teaching courses involving CAM, although there is a wide variation between medical schools in students’ level of exposure to these therapies.

Several hospitals in Europe, in their out-patient departments, currently provide homeopathic treatment by physicians, i.e. in Austria (seven), France (two), Germany (five), Spain (two), Italy (some). There are five dedicated public sector homeopathic hospitals in the United Kingdom.

European Committee for Homeopathy – ECH
The European Committee for Homeopathy or ECH is the European association for all statutorily regulated health professionals – doctors with a conventional medical degree like MBBS, MD plus homeopathy, as well as other professionals who can contribute to the development of homeopathy (such as researchers, documentalists and patients’ organisations).

Its aims are:

– To promote and defend the quality of the science of homeopathy;

– To defend, by all legal means, the practice of homeopathy;

– To promote research in homeopathy;

– To assist all the people it represents in their local activities;

– To promote the harmonisation of the practice of homeopathic medicine in Europe;

– To represent both individuals, as well as local, regional and national organisations throughout Europe which share the same aims.

To date 37 homeopathic doctors’ associations in 22 European countries are affiliated to the ECH. In addition, many homeopathic veterinarians, dentists and pharmacists in Europe are affiliated. The ECH closely collaborates with the IAVH, the International Association for Veterinary Homeopathy.

The ECH’s aim is the full integration of homeopathy within the European health care system, which will meet the growing demand among European citizens for homeopathic care within a safe medical context.The ECH comprises various subcommittees working in different fields, such as education, politics, pharmacology, documentation, research, provings, patients/users etc. Several ECH publications as well as other information on the work of the various subcommittees are available.

According to ECH none of the EU Member States are diplomas in homeopathy for non-medically qualified practitioners recognised by the national authorities. Because of the limited amount of medical training, the practice of homeopathy by non-medically qualified practitioners can be considered as a paramedical profession and is, therefore, to be regulated in the same way as for other paramedical professions. Guidelines describing and delineating their functions and responsibilities are to be submitted to and approved by the Medical Councils of the Member States.

ECH implies that the regulation and co-ordination of training criteria imposed on the practitioners providing homeopathy should, in the interests of both patients and practitioners, be harmonised at the same high level as in conventional medicine. Since in conventional medicine only a full medical qualification entitles to practice these disciplines, each within the bounds of competence of their own specific discipline, it is self-evident that the same requirements apply for homeopathy to be practised within these disciplines.

The ECH has established the Medical Homeopathic Education standard, being a consensus framework of training requirements for a safe and effective practice of medical homeopathy (the practice of homeopathy by medically qualified practitioners), and outlines the syllabus for examinations. This level corresponds to the current requirements for doctors with the qualification ‘Homöopathischer Arzt’ in Germany, ‘Homöopathie’ in Austria, the subspecialty in homeopathy in Switzerland, and with the level of DIU (Diplome Inter-Universitaire) in France.

ECH-secretariat:
Chaussée de Bruxelles 132, box 1
1190 Brussels
Belgium
Telephone: +32-2-3453597
Fax: +32-2-3461826
Website: www.homeopathyeurope.org
E-mail: info@homeopathyeurope.org

ECH AFFILIATED ASSOCIATIONS
http://www.homeopathyeurope.org/associations/index.html
Contact them for the legal status and regulations in your local area

The European Council for Classical Homeopathy –ECCH
Is an international council whose membership is made up of established associations of professional classical homeopaths existing within individual countries. Established in 1990 the European Council for Classical Homeopathy (ECCH) focuses its representational activities within the boundaries of Europe and often specifically within the European Union. The Council is non profit-making unincorporated association registered in the United Kingdom.

ECCH has NGO Consultative Status with the Council of Europe and is an associate member of the European Public Health Alliance (EPHA). ECCH is an active member of the Brussels-based European Public Health Alliance (EPHA), a Corresponding Member of the European Coalition for Homeopathic and Anthroposophic Medical Products(ECHAMP)  and has NGO Participatory Status with the Council of Europe.

According to ECCH – A  professional  homeopath  is  a  practitioner  who  has  had  a  substantial  education  and  training  in

homeopathy, and who is not a medical doctor. It means that it is not  illegal for professional homeopaths to practise and the practice ofhomeopathy is not restricted to medical doctors or other statutorily recognised healthcare practitioners only.

Membership of the Council

Professional Membership of the Council is open to an established association of professional homeopaths in any country which:

· Maintains for the use of the public a register of trained and regulated homeopaths

· Sets stringent educational and training standards for entry to their registers

· Maintains a code of ethics and practice to which their members are accountable

· Agrees to support the aims, objectives and activities of the Councils

There are at present 24 professional association members in the Council from the 20 countries of Armenia, Belgium, Bosnia & Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, Ireland, Israel, Italy, Netherlands, Norway, Sweden, Switzerland, Portugal, Serbia & Montenegro, United Kingdom, . The are applications for membership pending from Macedonia, Poland and Spain. The Council is also represented in Austria, France, Iceland, Liechtenstein, and Luxembourg.

Activities of the Council
ECCH recommends all European authorities and European national authorities act to ensure that legislation establishes the effective voluntary self-regulation of homeopaths. ECCH has agreed and recommends the following criteria for voluntary self-regulation as a required minimum

1. A single national professional body, where appropriate, established according to common high standards of education, registration and practice agreed across Europe

2. Patient representation on all standard setting committees – particularly for complaints and professional conduct procedures

3. An accreditation process for institutions providing homeopathic education

4. Continuing Professional Development

5. Professional Indemnity Insurance for all practitioners

6. Code of Ethics and Practice

7. Complaints and Disciplinary Procedures

As well as publishing a number of policy documents on subjects such as education, provings, and public health. One important role of ECCH is to act as an advisory body on homeopathic matters to national and international governmental institutions.

For further information contact the General Secretary at the Secretariat:
School House, Market Place
Kenninghall, Norfolk NR16 2AH
Tel & Fax: (+44) 1953 888 163
Email: ecch@gn.apc.org
Website of ECCH : http://www.homeopathy-ecch.org/

National Member Professional Associations of ECCH
http://www.homeopathy-ecch.org/content/view/15/32/
Contact them for the legal status and regulations in your local area

As per the ECCH Report 2009 March : It is legal to practise in Belgium, Bosnia and Herzegovina, Croatia, Denmark, Estonia, Finland, Greece, Iceland, Ireland, Israel, Italy, Liechtenstein, Malta, Netherlands, Norway, Poland, Portugal, Republic of Macedonia, Slovakia, Slovenia, Spain, Sweden and the United Kingdom. It is legal to practise in the majority of  all Swiss cantons (24 out of 26).

It is illegal for someone who is not a medical doctor to practise in Armenia, Austria, Belarus, Bulgaria, Czech Republic, France, Germany, Hungary, Latvia, Lithuania, Luxembourg, Romania, Russia, Serbia and Ukraine. It is illegal to practise in two out of 20 Swiss cantons (Jura and Waadt).

In Germany homeopathy may only be practised by medical doctors or Heilpraktikers. A Heilpraktiker is a CAM practitioner who has passed a local health authority exam. Heilpraktikers must use the title ‘Heilpraktiker’ and may also inform which therapies they offer, such as homeopathy.

Countries where only legally recognised healthcare practitioners are allowed to practise
These categories of healthcare practitioners may practise in the following countries:

Medical doctors and dentists: Armenia, Austria, Belarus, Bulgaria, Czech Republic, Hungary, Italy,
Lithuania, Romania, Russia, Ukraine
Medical doctors, dentists and nurses: France
Medical doctors, dentists and physiotherapists: Latvia
Medical doctors and Heilpraktikers: Germany
Medical doctors and Naturheilpraktikers: Liechtenstein
Statutorily regulated healthcare practitioners: Luxembourg, Serbia (medical doctors, dentists, nurses,
midwives, physiotherapists, pharmacists)

Countries where legally recognised healthcare practitioners are prohibited from practising homeopathy
In Slovenia medical doctors are prohibited from practising homeopathy and must sign a statement saying they  will not practise homeopathy or any other CAM therapy. Anyone except medical doctors may practise.

In Sweden statutorily regulated healthcare practitioners are prohibited from practising homeopathy and any other CAM therapy that has not been scientifically proved. The exception is if a patient asks for it, if there is no risk involved, if there is no parallel to conventional treatment and if all possible conventional treatments have been tried without relief. Anyone except statutorily regulated healthcare practitioners may practise.

Government regulation exists in Belgium, Bulgaria, Cyprus, Denmark, France, Germany, Hungary, Iceland, Latvia, Liechtenstein, Lithuania, Norway, Romania, Russia and Switzerland.

Homeopathy available within the public healthcare system
Homeopathy is available within the public healthcare system in 10 countries (Armenia, France, Germany, Israel, Lithuania, Luxembourg, Netherlands, Poland, Romania, United Kingdom). In Israel homeopathy is offered within the setting of the national healthcare system, but it is not subsidised. Although homeopathy is not available within the public healthcare system in Austria, homeopathic remedies are being prescribed in acute cases in some hospitals. We have been unable to obtain information on the situation in five countries (Belarus, Moldova, Montenegro, Turkey, Ukraine).

Reference :
WHO Report on Complementary & Alternative Medicine 2001
ECCH Report 2009 – Legal status of Homeopathy in Europe
ECH Report 2007 – Position of Homeopathy in Europe