Regulation of Complementary Therapy in the UK: An Overview of Current Practices

Introduction

Complementary therapy are methods and procedures of non-conventional treatment which, unlike conventional medication deals with several traditional, herbal, remedial, natural as well as body movement based therapeutic interventions to trigger internal healing process of the body. These therapies include acupuncture, aroma therapy, herbal medicine, homeopathy, naturopathy, reiki and yoga. According to Khanna et al. have discussed the importance of yoga therapies in the light of philosophical perspective of Buddhism and it’s clinical implication for treatment of addiction (Khanna, et al, 2013). The complementarity is adjudged with respect to conventional medication and then it is termed as complementary. On the other hand when a nonmainstream intervention is applied then it becomes alternative. Since last few decades complementary practice in UK has emerged as an important methodology for parallel intervention. Posadzky et al. have discussed the popularity of complementary medicine among the patients in UK (Posadzky, et al, 2013). In spite of popularity and positive outcome complementary therapy, if not applied with proper procedure and ethical guidelines may cause severe problems and therefore, in UK there are statutory and voluntary self-regulation systems for delivery of effective complementary therapies. The types of therapy have four streams, BIOLOGICALLY BASED PRACTICES - the substances used for the therapy have biological origin, such as natural herbs, vitamins and foods which encourage the strengthening of body as well as enhance the healing power. Dietary supplements like probiotics, fatty acids, amino acids are also used; MANIPULATIVE AND BODY-BASED THERAPIES – in this procedure the therapeutic interventions are done by moving body parts of the body to heal stress, pain, anxiety and depression. Chiropractic treatment, massage and physiotherapy along with full body technique (FMT) are used to reduce problems related to joint, shoulder, neck and skeletal system; MIND-BODY INTERVENTIONS – this is used to connect body and mind through relaxing and spiritual upliftment. The procedure includes yoga, meditation and several relaxing procedures; ENERGY THERAPIES – this is based on a belief that body has it’s own invisible field of energy and when it is blocked an unbalance happens. Reiki, touching and some energy harvesting therapies are done to enhance the positive energy. (Micozzi, 2014; Kelner, et al, 2014) In this essay the current regulation of complementary therapy will be discussed in the light of UK based complementary therapeutic practices.

Current systems utilized for regulating complementary alternative therapies

In spite of popularity the complementary and alternative therapies cannot be remained unregulated on the ground of safety and ethical perspectives. In UK there are several measures have taken to regulate the practice. These bodies are General Regulation Council for Complementary Therapies (GRCC), Complementary Natural Health Care Council (NHC), General Osteopath Council (GOC), General Chiropractic Council (GCC) and many other health regulating bodies. International organisation like World Health Organization (WHO) also provide updated guideline for the practice. This trusts as a whole provide proper training and education for competent application of therapies, moreover they provide the facility of licencing and legislation of practitioners. These bodies also promote and raise awareness on the therapy.

Legislative actions

The practitioners involved in complementary and alternative practice have to maintain a few rules and regulations to provide successful intervention. This regulations include statutory legislation voluntary self-regulation and a few unregulated practices which are involved in providing complementary alternative therapy.

Statutory regulation: Osteopathy and chiropractic practitioners should be properly qualified and should have proper knowledge of safety as well as ethics. Moreover, by understanding standard code and regulation norms they need to get recommended for registration. However, the body is not supposed to “ recommend” any practitioner. (McHale, 2015)

Osteopaths must have a registration from General Osteopathic Council and should not claim themselves osteopath without proper training. The training include communication and patient partnership for effective treatment, knowledge, skill and performance of a primary healthcare professional, aptitude to develop, proper safety and ethical knowledges, honesty and integrity to achieve highest level of professional quality. (Council, G. O., 2016)

Similarly chiropractors must have registration under General Chiropractic Council. Without proper training nobody can claim to be a chiropractor. Chiropractors deals with neck and back pain injuries and they need physically demanding qualities. In most cases they are self employed and have flexibility regarding terms of working. They should have proper knowledge about code of practice like, principles of practice, consent seeking, communication skills and professionalism for successful practice. Moreover, they should promote the standard and work collaboratively to ensure safety and quality of treatment. (Ljaz, et al, 2019)

These regulations confirm the safety of the patient but do not emphasize on the scientific proof or effectiveness of the treatment, for that proper evidence is needed like, placebo effect, pain relaxation due to spinal manipulation and many other factors. Without proper safety measures several hazards can happen like aches, muscle pain, stiffness, tiredness and some other adverse conditions such as stroke. The regulating councils mainly stress on the safety associated with the treatment.

Voluntary self-regulation: Professional association or person can voluntarily get registered as a complementary practitioner. They can join by fulfilling some basic standard and by agreeing to adhere with few standards of practice. Legal issues are also considered for registration because the practitioners are generally do not get associated with a particular organization. In this case however, they do nor need to maintain certain regulations mentioned in statutory legislation. The codes and regulation are conglomerated with several other health regulation practice like integral healthcare, home care model as well as integrated psychological interventions. Various regulation seminars are hosted in regular basis to update the policies regarding aroma therapy, herbal medicine, and many others. Multidisciplinary therapies can get associated for training and skill development and Nursing and Midwifery Council. (O’Regan, et al, 2010)

The both types of legislation, rules discussed above are basically two parts of an integral body, different in terms of expertise related to therapeutic intervention. Statutory legislation is applicable for osteopaths and chiropractors. On the other hand voluntary practitioners are related to homeopathy, hydropathy, healing by touch and many other non-conventional medication. Therefore, volunteer are not obliged to fulfil the statutory rules and regulations. However, to ensure systematic knowledge, training courses from recognised body is necessary for a voluntary practitioner (Wardle, et al, 2014). Ries et al. have discussed the inadequacy of regulatory model for complementary alternative therapist and evaluated the associated risk factors. Tyreman has recognised the position of the regulations with respect to conventional orthodox medicine and concluded that the different practice associated with complementary therapies are incongruous in nature. However, the common values should be identical across different fields. Subjectivity and experienced behaviour is necessary to encourage the wellbeing of patient (Tyreman, 2011). However, it is worth to mention that voluntary self-regulation lacks rigid legal binding like, statutory legislation services.

Points of ethics

As stated earlier unlike conventional medical approaches, complementary therapy is supported by a little amount of scientific knowledge. However, to confirm safety and the security of patient, several regulating bodies in England have defined code of conduct for delivery of safe therapeutic interventions. Though there are different types of ethical conditions have been settled by different organization, but the common features are mostly same. (Adams, et al, 2012) Before going into discussions following points should be considered:

• CAM is often a part of private practice, hence cannot be regulated by official healthcare bodies.
• All CAM practitioners do not have proper medical training. Therefore, stress should be given on training.
• Some of the non-medical complementary therapy using bodies have their own legislative clauses.
• Effectiveness as well as safety issues of the therapy is under investigation and research funds are low.
• This therapy is a part of traditional belief.
• Also it is holistic in nature.

General Data Protection Regulation (GDPR): Personal data is a matter which should be kept confidential. According to the rules of GDPR the data collection is emphasised on the basis of the interaction between person and health service, which can be used purposefully, sometimes without explicit consent. (Addis, et al, 2018) In NHS bodies these data are used for research, however, it should be done carefully otherwise some controversy may arise. Therefore data protection laws deals with restriction of ‘personal data’. Personal data is stored as name of individual, address, date of birth as well as IP addresses of users computer. Therefore, the data is pseudonymised in order to prevent leakage of personal information.

No harm: During the therapeutic intervention some harmful effect can be encountered. These should be avoided and rules and regulations should be strict enough for complementary medicine in this regard. Many therapeutic interventions include food supplements which may have toxic outcome with respect to the physical condition of the patient like, cancer (Anderson, et al, 2012).

Consent and confidentiality: As stated earlier consent is necessary for data protection and usage. However, following point should be considered:

• Fairness
• Transparency
• Lawful standard
• Legitimacy

All the information should be coded with proper care to confirm the reidentification. A code name is used with proper care to prevent reidentification. Still the data is a personal data and therefore some regulations and guidance is given from Information Commissioner’s Office (ICO). (Carter, 2015)

Educational standards: The no harm should also be an agenda during the training of practitioner. They should know the dangers related to the treatments. The education should be creative and should aware of scientific understanding. (Neiberg, et al, 2011) NHS deals with the training of graduates of complementary medicine through different professional organisation and at the same time they emphasise on some basic educational qualities of the student.

Benefit and limitations of the legislation

Regulations of complementary research are rather inconsistent in some cases. The lack of research based evidence may be the reason behind the inaccuracy related to guidelines. Proper investigation is needed to :

• The mechanism of therapeutic effect.
• Safety related to practice.
• Interaction with conventional medicine.
• Relation between the claim and the real effects.
• Improvement that is necessary.
• True cost of treatment.

Research is needed to elucidate the placebo effect connected to homeopathy (Howick, et al, 2013) and other medicinal interventions and should be done systematically to avoid chance of coincidence, effect of conventional medicine and should be tested in laboratory scale. (Lewith, et al, 2010) However, funding is a big problem in this regard and current legislation cannot expand without proper scientific investigation. Funding agencies also lack a robust framework of research idea regarding this matter. (Vos, et, al, 2010) Fischer et al. discussed that, the lack of research has limited the scope of regulation in complementary and alternative medicine (Fischer, et al, 2014).

The range of statutory legislation and voluntary self-regulation spans from clinical bodies to the patient’s under consideration. These organizations are in a way of imposing homogeneity in the practices. However, some inhomogeneous nature is observed. Some unregulated bodies are there who uses massage, yoga and Reiki including some physically manipulating practice is difficult to bring under the umbrella of legislation. Moreover, in spite of public popularity aroma therapy is associated with some sort of risk factors specially for the vulnerable patients. (Khiewkherm, et al, 2013) Therefore, current legislation is not adequate to cover these interventions. Non accredited training should not be consider with alternative practice and legislation do not give them permission. This ensures safety of the patients.

In USA complementary medicine is treated as an alternative of conventional medicine which deals with treatments using chiropractic, osteopathy, acupuncture, aroma therapy and many other means of treatment. National Centre for Complementary and Integrative Health (NCCIH) regulates their use. (Menard, et al, 2015) On the other hand, in UK more emphasise is given on safety, quality and proficiency. The products are verified in laboratory to confirm the safety and then marketized for personal usage. According to NHS guideline before going to alternative therapist, one must visit the General practitioner (GP). (Sharp, et al, 2018)

Practical application

The statutory legislation and voluntary self-regulation provides proper knowledge of practice and promote awareness about the complementary, alternative therapies. The duty of legislative bodies is to verify professionality of a traditional as well as innovative medicine based therapy. Therefore, they basically provide the practitioner proper guidelines of practice. Many practitioners have ability to deliver multiple types of therapy, but they need to get endorsement from legislative body, whether they can practice in multiple domain or a single domain. Osteopaths and chiropracts are separate in terms of profession, these types of variation is not clear cut for acupuncture, herbal medicine as well as traditional medicine. Only legislative rules can separate the ambiguity among different therapeutic interventions and therefore legislative systems try to resolve the problems by providing different licensing status with laws of renewal. The eligibility and qualification emphasise on safe practice. In some countries accredited licence is provided after exam. This makes the involvement of voluntary self-regulation based practitioner, streamline in nature. Increasing relicensing procedures confirms quality control as well as safety. (Steel, et al, 2012)

The key requirement of osteopathic practitioner needs good communication skills, effective patient, partnership and should not violate the limitations of dignity of a person. Empathetic care with sensitive approach is needed, consent seeking is another important legal term which should be verified from time to time during license renewal. Knowledge, skill and performance should be up to date with proper reflection to ensure quality and safety. (Council, G. O., 2016)

In case of chiropractors along with quality and safety professional degree is necessary for legal practice in UK. In UK chiropractic act define the code of practice and list of competence that are needed like:

• Priority of patients interest
• Honesty and integrity
• Professionalism
• Informative practice with updated knowledge
• Protection of patient’s information

Legislative rules emphasise on training purpose as well for the promotion of skills and patient’s safety. The practitioners involved in traditional practices like, tai-chi, yoga, acupuncture can have varied extent of training and expertise (Kaley-Isley, et al, 2010). Some of them learn in a apprentice type of framework and very less evidence are found regarding their training of hygiene. Therefore, short courses are delivered and time to time seminars are arranged to convey updated knowledge about most recent findings in the field.

The duty of legislative body to confirm the safety of the patient’s treated with alternative medicines. The rules and regulations therefore, enforce the practitioners as well as medicine manufacturing agents to follow the no harm policy of practice as well as check the security of the product marketized for treatment. (Khiewkherm, et al, 2013)

Conclusion

Complementary therapy is endowed with traditional and placebo based treatment of the patient and lacks rigid scientific evidences about pharmacology of clinical practice. The legislation and regulating bodies are therefore constantly involved in refinement of practicing laws and licensing strategies. The main focus of the rules, laws and course is safety and security of the patient and they promote this by regular training sessions.

Recommendation

Like all other conventional medical streams complementary alternative therapy and medicine needs constant research. If placebo is only a psychological condition, then analysis of the particular psychological state should be determined in order to refine the legislative system. Unregistered bodies should also be taken under the big umbrella by proper scientific investigation of the skills. In this regard it is worth to mention that, more strict rules and inspecting bodies are needed to stop illegal therapeutic practices.

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