Etat des lieux de l'homéopathie en Belgique - KCE

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74 Homeopathy KCE Reports 154 5.1.7.2 Proof of clinical effectiveness In its report of 6 March 1997 on the status of non-conventional medicine, the European parliament deemed that it would be advisable to distinguish between the different nonconventional medicines. Clinical studies, an assessment of the results of treatments and other scientific or academic studies are required to analyse the facts and how they interrelate. According to the European parliament, this assessment should use methodologies suitable for the different medicines. However this approach tends to fall apart when their therapeutic effect cannot be certified by commonly accepted scientific methods. This is a somewhat controversial issue. It is therefore important to choose recognised methodologies and to define suitable validity criteria. Moreover, the European parliament is aware that it would be advisable to use a ‘fluctuating range’ of proofs and acceptability rather than a strict divide between scientific and non-scientific proof. Another element that needs to be considered is the fact that several nonconventional medicines already benefit from some form of official recognition in certain Member States and sometimes have a representative professional organisation at European level. Their effectiveness has been certified by various studies (limited scope), the results of which are generally convincing (for example chiropractic and homeopathy). Key messages: the exercise of non-conventional medicine in the European context • Two concepts of healthcare coexist within the European Union. • According to the first principle, only doctors are authorised to practice medicine. • According to the second principle, any person who so desires can practice medicine, with the exception of certain acts, which are reserved for doctors. • Proof of clinical effectiveness is important in order to distinguish between non-conventional practices. 5.1.8 Conclusion concerning the Belgian and European legal framework 5.1.8.1 The practice of conventional medicine in Belgium The practice of conventional medicine in Belgium is governed by Royal Decree no. 78. By the ‘practice of medicine’ the law means the medical art, medicine, physiotherapy, nursing, the paramedical professions and midwifery. Each of these professions is governed by specific criteria. 5.1.8.2 The practice of non-conventional medicine in Belgium The law of 29 April 1999 concerning non-conventional practices in the field of medicine, pharmaceuticals, physiotherapy, nursing and the paramedical professions defines a framework for recognition of the practice of (certain forms) of non-conventional medicine. The Colla law considers the practice of homeopathy, chiropractic, osteopathy and acupuncture to be non-conventional practices. This list is not restrictive and other non-conventional practices could be added. The purpose of the Colla law is to guarantee quality care for patients. This guarantee is provided by a dual registration system. Firstly, each of the non-conventional practices must be registered (which is only possible if certain criteria are satisfied) and secondly, each practitioner of these disciplines must also be registered (satisfying various conditions). The joint committee instigated by the Colla law is called on to play a key role in this field, notably by giving an advice concerning the general conditions applicable to the exercise of non-conventional practices. Since this joint committee has not yet been formed, it is not in a position to play this key role, so the law cannot be executed and is therefore not yet in force.
KCE Reports 154 Homeopathy 75 5.1.8.3 The relationship between the Colla law and Royal Decree no. 78 Royal Decree no. 78 provides such a broad description of the practice of medicine that it covers the exercise of non-conventional practices. Practitioners of non-conventional practices who are also doctors have the choice of exercising a non-conventional practice or a conventional practice. In the former case, they must comply with the Colla law, and in the latter with the provisions of Royal Decree no. 78. However, practitioners of non-conventional practices who are not doctors can only perform these practices after having received a recent written diagnosis from a doctor concerning the complaint. 5.1.8.4 The consequences of the (non-)conventional exercise of healthcare Only the holders of a medical diploma or a dentistry licence are authorised to perform a diagnosis and prescribe a treatment. The provisions of the law of patients’ rights of 22 August 2002 and the law on healthcare compensation of 31 March 2010 can only be applied to practitioners of nonconventional practices when the Colla law has come fully into force. As long as the Colla law is not fully applied, the practice of non-conventional medicine, by a non-doctor therapist is qualified as the illegal practice of medicine. Several practitioners of non-conventional practices who are not doctors have already been sentenced for this reason. It should however be noted that jurisprudence is tending increasingly towards acquittal, provided that certain conditions are satisfied (such as adequate training) and in the light of the failure to execute the Colla law. In addition, certain medical treatments that can also be practiced as alternative therapies can also be practiced legally by certain professionals such as physiotherapists. 5.1.8.5 The exercise of non-conventional medicine in the European context Two concepts of healthcare coexist within the European Union. According to the first principle, only doctors are authorised to practice medicine. According to the second principle, any person who so desires can practice medicine, with the exception of certain acts which are reserved for doctors. 5.2 THE SITUATION IN THE NETHERLANDS, FRANCE AND THE UNITED KINGDOM This chapter is common to the three reports on alternative medicines, as most of the issues are common to all non-conventional practices. 5.2.1 Structure of the chapter This chapter contains a brief presentation of the legal situation in the Netherlands, France and the United Kingdom. 5.2.2 Netherlands 5.2.2.1 The legal situation In 1865 the Netherlands promulgated the Wet op de Uitoefening der Geneeskunst (law on the practice of medicine, hereafter referred to as ‘WUG’), which introduced an examination prior to becoming a doctor. This law makes a distinction between conventional medicine and non-conventional medicine, making the practice of conventional medicine by unauthorised persons punishable. The Dutch legislation tolerates alternative therapists. In the Netherlands, ‘alternative’ medicine is the opposite of ‘conventional’ medicine. This monopoly of doctors was amended in November 1993 by the Wet Beroepen in de Individuele Gezondheidszorg (law concerning the individual healthcare professions, hereafter referred to as ’BIG’). In principle this law authorises anyone to provide medical care, with the exception of certain acts that can only be performed by practitioners specially authorised for this purpose by the BIG law.
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