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

1. Current situation of Chinese medicine in Spain: legislation, health care and educational issues The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Dr. Ramon Mª Calduch Economist, lawyer, auditor and anthropologist specialised in medicine. Vice-president of the European Foundation of TCM (FEMTC) Vice-president of the Pan-European Federation of TCM Societies (PEFOTS) President of the European Chamber of Commerce for TCM (ECCTCM) Chairman of the Supervision Board of the World Federation of Chinese Medicine Societies (WFCMS) Vice-president of the World Federation of Acupuncture Societies (WFAS)

2. In Spain there exist 35.000 practitioners in the field of Complementary and Alternative Medicines (CAM). From them, approximately 15.000 practice any of the techniques of the Chinese medicine, mostly acupuncture. From the total number of Chinese medicine practitioners, 2.800 are Western doctors and the rest of them are non medical therapists (including physiotherapists and nurses). At the associational level, Western doctors that practice acupuncture are integrated in the sections of acupuncture doctors of the different Regional Medical Associations, summing up a total of 1.200. Nowadays huge efforts are made on the promotion for the association of all these Acupuncture doctors and for the coordination of the different regional sections in order to obtain more strength to defend their interests. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues

3. Regarding the practitioners (therapists and other health practitioners) that represent up to the 80% of the total number of Chinese medicine practitioners. Health care practitioners are associated at a very low level in the sections of Acupuncture of their Professional Associations and most of them are integrated in other associations that include other health care practitioners, therapists and Western doctors as well. These associations sum up a total of 2.000 members, being the most important the Practitioner’s Register of the European Foundation of TCM (with about 1.000 members) and the SAC (with about 300 members). The rest of the practitioners are integrated in other small associations. Other acupuncturists are members of organizations that integrate all CAM but the exact number of these is unknown because there are no statistics that set aside acupuncturists from the rest of the practitioners, as they use to combine different therapies in their treatments. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

4. In Spain, as it happens in other countries of the South of Europe, Phytotherapy is used less than the other techniques due to the fact that herbs are considered drugs and consequently its sale is illegal. In Spain, herbs can not be registered as “food supplement”, so Chinese herbs consumed in Spain come from other countries of the European Union, bought directly by each particular patient that has to pay very expensive prices due basically to the individual shipment costs. There are therapists that buy them personally in order to provide the product to their patients, although they assume the risk of an important penalty and the confiscation of the product in the inspection from the Spanish health authorities. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

5. From May 2009 in Spain there is a rule of mutual recognition between the different countries of the European Union, consequence of a Community Directive of the EU that establishes the mechanism and formalities that do not allow a country to oppose to the registration of the products that are already registered in any other European country, without an accredited justification based on public health reasons. However there is not any experience and it is not clear what will happen in those countries of the EU where Chinese herbs are freely sold, after April 2011 when the term for its register established by Directive 24/2004 EC will be finished, due to the existing difficulties for the register. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

6. On the other hand, there is a tax and labour ruling that allows non Conventional Medicine doctors to be registered and work as “other parahealth practitioners”. As a result, the inspections of the Health Ministry (under the control of Conventional Medicine doctors) produce the closure of many therapists offices putting forward that they are practicing a health care activity without being doctors and this is happening although these therapists are legalized and registered both under the tax and the labour laws. 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 meanwhile the office of the therapist will have to remain closed. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

7. Taking into account the existing rules on the acknowledgement of the profession, the professional activity and the academic acknowledgement of the education, the situation is quaint mainly because now there is no regulation in force: On one hand, Western doctors claim that Chinese medicine (acupuncture) should be considered as a medical specialty reserved just for them. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

8. As I have already mentioned, in Spain there are about 12.000 therapists (non Conventional Medicine doctors) that practice Chinese medicine. We, in order to be able to sleep soundly at night, have decided to declare our clinics as Health Care Centres with a leading Medical Director, who is a Conventional medicine doctor, but most of the offices of this sector are quite small and they cannot afford it due to all costs entailed. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

9. With the advising of a committee of experts (4 of them were from the European Foundation of TCM) the regional government of Catalonia approved a Decree that regulated the Natural Therapies. This decree, among other therapies, regulated Acupuncture and Chinese medicine, establishing the minimal curricula and qualification, a professional statute, a professional register, the rules that all schools should respect and the rules for the professional exercise. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

10. These rules, in which we invested lots of efforts and time, were the first to be created in Spain after claiming for them for many years. But the Spanish government appealed these rules as it considers they are ruling a basic national materia and that the national government should regulate it and not the regional governments. Furthermore the Spanish government manifested its engagement to regulate CAM, because it agrees that the regulation is necessary. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

11. The result was that the Superior Court of Justice of Catalonia agreed with the Spanish government and the Decree was cancelled, but the government of Catalonia has alleged this decision to the Spanish Superior Court, as it considers that if these rules should be a national basic materia, while there is no regulation at a national level, the government of Catalonia should be able to regulate the sector in order to guarantee the safety and the quality of the treatments that their citizens may receive. We will have to wait to see how the story ends, but almost surely the effect of this Decree, currently cancelled, of the Catalan government will be the definitive regulation of the sector in Spain which is highly positive. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

12. I would also like to talk about the current situation of the education of Chinese medicine in Spain. As we have mentioned there is no official regulation of these studies, so they are all included in the category of “non regulated education” and each School has its own qualifications, all of them without any official validity. So the students register in one or another school, according to its prestige, price, professors, subjects, methodology… This lack of regulation means a problem for those schools that take the education more seriously as we do, because on our opinion the future of Chinese medicine is conditioned by the quality of the education received by practitioners, as there are many small schools with inappropriate teachers and subjects, there are also many courses provided that are very short in time and they provide a qualification, sometimes a university certificate, that has the same official value as our certificate, that is, none. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

13. The biggest school of Chinese medicine in Spain is the Higher School of TCM (with approximately 700 students), it belongs to the European Foundation of TCM, it offers education on Chinese medicine lasting a total of 4 years and also clinical training in TCM hospitals of China. There is also another school with approximately 300 students and different small centres with about 100 students each one. Western doctors and other health care practitioners organize periodically courses on acupuncture, sometimes through universities, with non official certifications and very short in time, lasting 1 year or 2 as a maximum, as in the small schools. In this sense, I consider of higher importance all efforts in order to introduce at an international level the minimal standards of quality. The International Seminar on Traditional Chinese Medicine Standardization Shanghai, China, 25-26 January 2010 Current situation of Chinese medicine in Spain: legislation, health care and educational issues.

14. Thank you