Shanghai RMC 2010

Current situation of Chinese medicine in Spain: legislation, health care and educational issues

The International Seminar on Traditional Chinese The International Seminar on Traditional Chinese Medicine StandardizationMedicine StandardizationShanghai, China, 25-26 January 2010Shanghai, China, 25-26 January 2010

Dr. Ramon Mª CalduchDr. Ramon Mª Calduch

Economist, lawyer, auditor and Economist, lawyer, auditor and anthropologist specialised in medicine. anthropologist specialised in medicine.

Vice-president of the European Foundation Vice-president of the European Foundation of TCM (FEMTC)of TCM (FEMTC)Vice-president of the Pan-European Vice-president of the Pan-European Federation of TCM Societies (PEFOTS)Federation of TCM Societies (PEFOTS)President of the European Chamber of President of the European Chamber of Commerce for TCM (ECCTCM)Commerce for TCM (ECCTCM)Chairman of the Supervision Board of the Chairman of the Supervision Board of the World Federation of Chinese Medicine World Federation of Chinese Medicine Societies (WFCMS)Societies (WFCMS)Vice-president of the World Federation of Vice-president of the World Federation of Acupuncture Societies (WFAS)Acupuncture Societies (WFAS)

In Spain there exist 35.000 practitioners in the field In Spain there exist 35.000 practitioners in the field of Complementary and Alternative Medicines of Complementary and Alternative Medicines (CAM). From them, approximately 15.000 practice (CAM). From them, approximately 15.000 practice any of the techniques of the Chinese medicine, any of the techniques of the Chinese medicine, mostly acupuncture.mostly acupuncture.

From the total number of Chinese medicine From the total number of Chinese medicine practitioners, 2.800 are Western doctors and the practitioners, 2.800 are Western doctors and the rest of them are non medical therapists (including rest of them are non medical therapists (including physiotherapists and nurses).physiotherapists and nurses).

At the associational level, Western doctors that At the associational level, Western doctors that practice acupuncture are integrated in the sections practice acupuncture are integrated in the sections of acupuncture doctors of the different Regional of acupuncture doctors of the different Regional Medical Associations, summing up a total of 1.200.Medical Associations, summing up a total of 1.200.Nowadays huge efforts are made on the promotion Nowadays huge efforts are made on the promotion for the association of all these Acupuncture for the association of all these Acupuncture doctors and for the coordination of the different doctors and for the coordination of the different regional sections in order to obtain more strength regional sections in order to obtain more strength to defend their interests.to defend their interests.

The International Seminar on Traditional The International Seminar on Traditional Chinese Medicine StandardizationChinese Medicine StandardizationShanghai, China, 25-26 January 2010Shanghai, China, 25-26 January 2010

Current situation of Chinese medicine in Spain: legislation, health care and educational issuesCurrent situation of Chinese medicine in Spain: legislation, health care and educational issues

Regarding the practitioners (therapists and other Regarding the practitioners (therapists and other health practitioners) that represent up to the 80% of health practitioners) that represent up to the 80% of the total number of Chinese medicine practitioners. the total number of Chinese medicine practitioners. Health care practitioners are associated at a very low Health care practitioners are associated at a very low level in the sections of Acupuncture of their level in the sections of Acupuncture of their Professional Associations and most of them are Professional Associations and most of them are integrated in other associations that include other integrated in other associations that include other health care practitioners, therapists and Western health care practitioners, therapists and Western doctors as well.doctors as well.

These associations sum up a total of 2.000 members, These associations sum up a total of 2.000 members, being the most important the Practitioner’s Register being the most important the Practitioner’s Register of the European Foundation of TCM (with about 1.000 of the European Foundation of TCM (with about 1.000 members) and the SAC (with about 300 members). members) and the SAC (with about 300 members). The rest of the practitioners are integrated in other The rest of the practitioners are integrated in other small associations.small associations.

Other acupuncturists are members of organizations Other acupuncturists are members of organizations that integrate all CAM but the exact number of these that integrate all CAM but the exact number of these is unknown because there are no statistics that set is unknown because there are no statistics that set aside acupuncturists from the rest of the aside acupuncturists from the rest of the practitioners, as they use to combine different practitioners, as they use to combine different therapies in their treatments.therapies in their treatments.


Current situation of Chinese medicine in Spain: legislation, health care and educational issues.Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

In Spain, as it happens in other countries of the South of In Spain, as it happens in other countries of the South of Europe, Phytotherapy is used less than the other Europe, Phytotherapy is used less than the other techniques due to the fact that herbs are considered techniques due to the fact that herbs are considered drugs and consequently its sale is illegal.drugs and consequently its sale is illegal.

In Spain, herbs can not be registered as “food In Spain, herbs can not be registered as “food supplement”, so Chinese herbs consumed in Spain supplement”, so Chinese herbs consumed in Spain come from other countries of the European Union, come from other countries of the European Union, bought directly by each particular patient that has to pay bought directly by each particular patient that has to pay very expensive prices due basically to the individual very expensive prices due basically to the individual shipment costs. shipment costs. There are therapists that buy them personally in order to There are therapists that buy them personally in order to provide the product to their patients, although they provide the product to their patients, although they assume the risk of an important penalty and the assume the risk of an important penalty and the confiscation of the product in the inspection from the confiscation of the product in the inspection from the Spanish health authorities.Spanish health authorities.



From May 2009 in Spain there is a rule of mutual From May 2009 in Spain there is a rule of mutual recognition between the different countries of the recognition between the different countries of the European Union, consequence of a Community European Union, consequence of a Community Directive of the EU that establishes the mechanism Directive of the EU that establishes the mechanism and formalities that do not allow a country to oppose and formalities that do not allow a country to oppose to the registration of the products that are already to the registration of the products that are already registered in any other European country, without an registered in any other European country, without an accredited justification based on public health accredited justification based on public health reasons.reasons.

However there is not any experience and it is not However there is not any experience and it is not clear what will happen in those countries of the EU clear what will happen in those countries of the EU where Chinese herbs are freely sold, after April 2011 where Chinese herbs are freely sold, after April 2011 when the term for its register established by Directive when the term for its register established by Directive 24/2004 EC will be finished, due to the existing 24/2004 EC will be finished, due to the existing difficulties for the register.difficulties for the register.



On the other hand, there is a tax and labour ruling that On the other hand, there is a tax and labour ruling that allows non Conventional Medicine doctors to be registered allows non Conventional Medicine doctors to be registered and work as “other parahealth practitioners”.and work as “other parahealth practitioners”.

As a result, the inspections of the Health Ministry (under As a result, the inspections of the Health Ministry (under the control of Conventional Medicine doctors) produce the the control of Conventional Medicine doctors) produce the closure of many therapists offices putting forward that they closure of many therapists offices putting forward that they are practicing a health care activity without being doctors are practicing a health care activity without being doctors and this is happening although these therapists are and this is happening although these therapists are legalized and registered both under the tax and the labour legalized and registered both under the tax and the labour laws.laws.

In these cases the only possible way out is to go to court, In these cases the only possible way out is to go to court, but the proceeding in Spain can take some years and in the but the proceeding in Spain can take some years and in the meanwhile the office of the therapist will have to remain meanwhile the office of the therapist will have to remain closed.closed.



Taking into account the existing rules on the Taking into account the existing rules on the acknowledgement of the profession, the acknowledgement of the profession, the professional activity and the academic professional activity and the academic acknowledgement of the education, the acknowledgement of the education, the situation is quaint mainly because now there situation is quaint mainly because now there is no regulation in force:is no regulation in force:

On one hand, Western doctors claim that On one hand, Western doctors claim that Chinese medicine (acupuncture) should be Chinese medicine (acupuncture) should be considered as a medical specialty reserved considered as a medical specialty reserved just for them.just for them.



As I have already mentioned, in Spain As I have already mentioned, in Spain there are about 12.000 therapists (non there are about 12.000 therapists (non Conventional Medicine doctors) that Conventional Medicine doctors) that practice Chinese medicine. practice Chinese medicine.

We, in order to be able to sleep We, in order to be able to sleep soundly at night, have decided to soundly at night, have decided to declare our clinics as Health Care declare our clinics as Health Care Centres with a leading Medical Centres with a leading Medical Director, who is a Conventional Director, who is a Conventional medicine doctor, but most of the medicine doctor, but most of the offices of this sector are quite small offices of this sector are quite small and they cannot afford it due to all and they cannot afford it due to all costs entailed.costs entailed.



With the advising of a committee of With the advising of a committee of experts (4 of them were from the experts (4 of them were from the European Foundation of TCM) the European Foundation of TCM) the regional government of Catalonia regional government of Catalonia approved a Decree that regulated the approved a Decree that regulated the Natural Therapies.Natural Therapies.

This decree, among other therapies, This decree, among other therapies, regulated Acupuncture and Chinese regulated Acupuncture and Chinese medicine, establishing the minimal medicine, establishing the minimal curricula and qualification, a curricula and qualification, a professional statute, a professional professional statute, a professional register, the rules that all schools should register, the rules that all schools should respect and the rules for the professional respect and the rules for the professional exercise.exercise.



These rules, in which we invested lots of These rules, in which we invested lots of efforts and time, were the first to be created efforts and time, were the first to be created in Spain after claiming for them for many in Spain after claiming for them for many years.years.

But the Spanish government appealed these But the Spanish government appealed these rules as it considers they are ruling a basic rules as it considers they are ruling a basic national materia and that the national national materia and that the national government should regulate it and not the government should regulate it and not the regional governments.regional governments.

Furthermore the Spanish government Furthermore the Spanish government manifested its engagement to regulate CAM, manifested its engagement to regulate CAM, because it agrees that the regulation is because it agrees that the regulation is necessary.necessary.



The result was that the Superior Court of Justice The result was that the Superior Court of Justice of Catalonia agreed with the Spanish government of Catalonia agreed with the Spanish government and the Decree was cancelled, but the and the Decree was cancelled, but the government of Catalonia has alleged this government of Catalonia has alleged this decision to the Spanish Superior Court, as it decision to the Spanish Superior Court, as it considers that if these rules should be a national considers that if these rules should be a national basic materia, while there is no regulation at a basic materia, while there is no regulation at a national level, the government of Catalonia national level, the government of Catalonia should be able to regulate the sector in order to should be able to regulate the sector in order to guarantee the safety and the quality of the guarantee the safety and the quality of the treatments that their citizens may receive.treatments that their citizens may receive.

We will have to wait to see how the story ends, We will have to wait to see how the story ends, but almost surely the effect of this Decree, but almost surely the effect of this Decree, currently cancelled, of the Catalan government currently cancelled, of the Catalan government will be the definitive regulation of the sector in will be the definitive regulation of the sector in Spain which is highly positive.Spain which is highly positive.



I would also like to talk about the current situation of the I would also like to talk about the current situation of the education of Chinese medicine in Spain.education of Chinese medicine in Spain.

As we have mentioned there is no official regulation of As we have mentioned there is no official regulation of these studies, so they are all included in the category of these studies, so they are all included in the category of “non regulated education” and each School has its own “non regulated education” and each School has its own qualifications, all of them without any official validity.qualifications, all of them without any official validity.

So the students register in one or another school, So the students register in one or another school, according to its prestige, price, professors, subjects, according to its prestige, price, professors, subjects, methodology…methodology…

This lack of regulation means a problem for those This lack of regulation means a problem for those schools that take the education more seriously as we schools that take the education more seriously as we do, because on our opinion the future of Chinese do, because on our opinion the future of Chinese medicine is conditioned by the quality of the education medicine is conditioned by the quality of the education received by practitioners, as there are many small received by practitioners, as there are many small schools with inappropriate teachers and subjects, there schools with inappropriate teachers and subjects, there are also many courses provided that are very short in are also many courses provided that are very short in time and they provide a qualification, sometimes a time and they provide a qualification, sometimes a university certificate, that has the same official value as university certificate, that has the same official value as our certificate, that is, none.our certificate, that is, none.



The biggest school of Chinese medicine in Spain is the The biggest school of Chinese medicine in Spain is the Higher School of TCM (with approximately 700 students), Higher School of TCM (with approximately 700 students), it belongs to the European Foundation of TCM, it offers it belongs to the European Foundation of TCM, it offers education on Chinese medicine lasting a total of 4 years education on Chinese medicine lasting a total of 4 years and also clinical training in TCM hospitals of China.and also clinical training in TCM hospitals of China.

There is also another school with approximately 300 There is also another school with approximately 300 students and different small centres with about 100 students and different small centres with about 100 students each one.students each one.

Western doctors and other health care practitioners Western doctors and other health care practitioners organize periodically courses on acupuncture, organize periodically courses on acupuncture, sometimes through universities, with non official sometimes through universities, with non official certifications and very short in time, lasting 1 year or 2 certifications and very short in time, lasting 1 year or 2 as a maximum, as in the small schools.as a maximum, as in the small schools.

In this sense, I consider of higher importance all efforts In this sense, I consider of higher importance all efforts in order to introduce at an international level the minimal in order to introduce at an international level the minimal standards of quality.standards of quality.



Thank youThank you

Shanghai RMC 2010

Health & Medicine

Transcript of Shanghai RMC 2010