eCAM 2005 2(2):233-235; doi:10.1093/ecam/neh098
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43rd National Congress of the Italian Psychiatric Association—Consensus Conference: ‘Non-Conventional Medicines’
October 19–24, 2003, Palazzo della Cultura e dei Congressi, Bologna, Italy
Paolo Roberti, MD
Department of Mental Health, Health Local Unit Bologna, Italy
For reprints and all correspondence: Paolo Roberti, Via Siepelunga 36/12, 40141 Bologna, Italy. Tel: +39-3358029638; E-mail: p.roberti{at}fastwebnet.it
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Foreword
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The Italian Republic protects health as a fundamental right
of the individual, safeguards the principle of scientific pluralism
and ensures the freedom of choice of treatments by individuals
and the professional qualification of health operators, with
special focus on the independence of doctors as regards the
choice of treatments (Supreme Court, 4th Section, Sentence no.
301, February 8, 2001).
The right of choice that every person is acknowledged as having as a focal point of every modern consideration of the respect of the will of individuals for their own state of health and sickness has already been explicitly expressed and has taken on concrete shape through increasingly larger sections of the population resorting to a number of treatments and therapeutic practices known under the common overall name of ‘medicine non convenzionali—non-conventional medicines’ (MNC–NCM): acupuncture, homeopathy, phytotherapy, traditional Chinese medicine, anthroposophical medicine, homotoxicology, ayurvedic medicine, chiropractic and osteopathy (‘Guidelines for non-conventional medicines’, FNOMCeO, Terni, May 18, 2002).
It is generally agreed that no therapeutic and health-restoring methods can disregard the need for a preliminary clinical diagnosis, the responsibility for which appertains only to a doctor with specific competence, who is entitled to use such methods as an integral part of medicine according to science, conscience, competence and skill.
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Definitions
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The attribute ‘non-conventional’, despite its being
currently the commonest expression used in Italy, would seem
to place these treatment methods in contrast with academic medicine,
which is considered to be conventional. It should be remembered
in this respect that in the English-speaking world the term
CAM (complementary and alternative medicine) is used, and it
is crucial to underline the complementary nature of the different
possible diagnostic and therapeutic approaches that fall within
this field in order to emphasize the integration under way in
the health system and the possibility of the practical use of
all the information provided by the patient.
Also of crucial importance is the search for, finding and adoption of a common language that, by defining single methodological characteristics in a clear-cut way, favors the exchange of as much information as possible between health operators and researchers, above all in academic spheres. The goal is to appreciate the advantages and limits of each method and to better identify, among a broad range of therapies and treatments and on the basis of the available evidence, which is the most appropriate for the sick patient.
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Scientific Research
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The ethics of the therapeutic integration provided by these
methods of treatment having been acknowledged, it is a good
idea and necessary to envisage the possibility of accrediting
and establishing study and scientific research programs that,
while respecting the particular nature of each method, permit
the evaluation of their efficacy and the enhancement of their
effective therapeutic medical role.
For this purpose, alongside institutional public research, the need is felt for targeted and productive co-operation between industries, companies and medical-scientific societies in the sector to set up suitable research programs through special forms of credit and funding. We might also hope for a greater contribution from public health institutes and departments of medicine to the process of scientific validation of non-conventional medicines currently under way.
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Legal Recognition
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The legislative procedure under way to adapt Italian legislation
to the directives of the European Union (European Directives
nos 92/73 and 92/74; Resolution no. 75 of the European Parliament
dated May 29, 1997: ‘Status of non-conventional medicines’;
Resolution no. 1206 of the Council of Europe dated November
4, 1999) must allow doctors suitably trained in the individual
methods to promote their qualifications, skill and professional
training.
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Information and Media
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Health information must be centered on educating the population
to acquire healthy habits and behaviors useful for preserving
health considered not only as the absence of sickness but also
as psychophysical well-being (as laid down by the WHO), as well
as the prevention of illnesses and their cure and treatment
in case of need.
For non-conventional medicines, the establishment of special regional observatories is suggested, both for the ongoing verification of useful information necessary for the broadcasting of correct and complete information to the public and for documentation and research concerning each individual method, mainly through co-ordination among scientific companies in the sector. The aim is to place at the disposal of the public and health operators independent and qualified surveys of the situation of non-conventional medicine in their area. The results of such surveys can be collected up by a national observatory as a point of reference and co-ordination to generate an overall evaluation that avoids duplicating interventions and ensures cost-effective research.
To protect users, and during the course of the legislative reorganization of the sector, the adoption, on the mandatory basis of criteria agreed with the most authoritative schools and scientific associations for each type of medicine, by all Provincial Colleges of Physicians and Dentists of suitable procedures for recognizing the specific training of their members is acknowledged and expected, representing a guarantee for patients.
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Informed Consent
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In compliance with the regulations of the Code of Medical Ethics,
it is only right to recall the duty concretely to apply, within
a free, consensual and informed relationship, the principles
of the freedom of choice of treatment by patients and of the
freedom of cure by the doctor. The need is therefore confirmed
to completely, correctly and clearly inform people in order
to develop a relationship between a patient and a doctor, who
is thus able to use medicine in a broader sense, considered
as a profession exercised in total freedom, and is permitted
to use every means considered useful and ethically valid in
the interest of the patient and with the patient's approval.
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Training and Skill
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Although it is acknowledged that universities play a historical
role in training, there is no doubt that Italian universities
lack the academic staff and the resources required for teaching
and researching non-conventional medicine. The training programs
currently available are provided mainly by private institutes
that have been operating in the sector for years. It can only
be hoped, therefore, that universities, in the effort to make
up for this training deficiency, help pinpoint and realize co-operation
conventions and agreements with the associations and the schools
already engaged in research, teaching and verifying the learning
of these alternative methods, as a useful contribution toward
valorizing the experience acquired. It is to be hoped that such
a training integration process will gradually achieve a situation
of free competition between private institutes and universities,
envisaging, in the initial stages, the inclusion of general
informative concepts in the degree courses of departments of
medicine and, whenever possible, the organization of elective
introductory courses able to foster a better knowledge of non-conventional
medicine.
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Lower Expenditure for Medicines and Area Integration
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The fact that a large number of patients turn to non-conventional
medicine, with total freedom of treatment and without representing
a burden for the National Health System, points to a phenomenon
that involves all those in this health sector. It follows, then,
that the need exists in one way or another to foster co-operation
and/or agreements between the various figures involved in this
area (GPs, hospital specialists, local health units, paramedic
staff, and so on) in order to disseminate a correct, integrated
course and adequate information relating to the advantages and
limits of such fields of medicine.
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Relations with Institutions
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Doctors who are experts in the different types of medicine (suitably
indicated by the most representative scientific associations
for each type of medicine) must be present and take part on
a completely equal standing in terms of roles and functions
in the consultative commissions and bodies of the profession,
of the Ministry of Health, of the Ministry of Universities and
Scientific Research, of patient and consumer associations, toward
numerous ends: recognition of qualifications obtained abroad,
allocation of resources to research projects, adaptation and
integration with already existing organizations and orders,
and so on.
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Prescription and Treatment Instruments
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In order to avoid requests of a limitative type, which are often
made without any real knowledge of the problem, quality, safety
and efficacy criteria must be established once and for all relating
to the authorization for marketing of the medicines and treatment
instruments used for the various branches of therapy. The pinpointing
of such criteria, specific to each branch of therapy, must be
done on the basis of indications by the most representative
and authoritative scientific societies and professional associations
for each field.
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Conclusions
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We should like to thank the Italian Psychiatric Association,
which, as part of its 43rd National Congress in Bologna, organized
the first Consensus Conference on Non-Conventional Medicines
to be staged in Italy in an academic setting. This Consensus
Document is the result of the work of its promoter and of all
the signatory associations and schools. Let us hope this event
will stimulate the complete integration of similar initiatives
in the field of so-called basic medicine and in other fields
of medical specialization.
The Consensus Document, shared by the authoritative representatives of non-conventional medicine in Italy convened here today and by doctors and researchers who are experts on the subject, is intended to represent the basis for ongoing unitary action in this sector of medicine, open to all health components, and in the representative seats of the medical profession (FNOMCeO and the Provincial Colleges of Physicians and Dentists), in the Institutions of the Republic (national, regional and territorial), as well as with respect to citizens' associations.
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Signatory Associations, Bodies, Institutes, Schools and Scientific Societies
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- Ambulatorio di Omeopatia, Centro di riferimento per l'Omeopatia della Regione Toscana, Ospedale Campo di Marte, ASL 2 Lucca, Dott. Elio Rossi
- Anthropos e Iatria, Associazione Scientifica Internazionale per la Ricerca, lo Studio e lo Sviluppo delle Medicine Antropologiche e Accademia Europea per le Discipline di Frontiera, Genova, Prof. Paolo Aldo Rossi
- Associazione Atah Ayurveda, Bologna, Dott. Guido Sartori
- Associazione Italiana di Omeopatia di Risonanza, AIOR, Piacenza, Dott.ssa Giuliana Rapacioli
- Associazione Italiana Pazienti della Medicina Antroposofica, AIPMA, Milano, Adelina Ansante
- Associazione Medica Italiana di Omotossicologia, AIOT, Milano, Dott. Ivo Bianchi
- Associazione Lycopodium-Homeopathia Europea, Scuola di Omeopatia Classica ‘Mario Garlasco’, Firenze, Dott.ssa Pia Barilli
- Associazione per le Medicine Non Convenzionali in Odontoiatria, AMNCO, Roma, Dott. Salvatore Bardaro
- Associazione Nazionale Medici Fitoterapeuti, ANMFIT, Empoli, Dott. Fabio Firenzuoli
- Associazione Pazienti Omeopatici, APO, Napoli, Vega Palombi Martorano
- Associazione per l'Universalità della Medicina, ASSUM, Roma, Prof. Francesco Macrì
- Associazione di Ricerche e Studi per la Medicina Antroposofica, ARESMA, Milano, Dott. Angelo Franzini
- Centro Clinico di Medicina Naturale, Centro di riferimento per la Fitoterapia della Regione Toscana, Ospedale S. Giuseppe, ASL 11 Empoli, Dott. Fabio Firenzuoli
- Centro Italiano di Studi e Documentazione in Omeopatia, CISDO, Milano, Dott. Ennio Masciello
- Centro di Medicina Tradizionale Cinese ‘Fior di Prugna’, Centro di riferimento per le Medicine Non Convenzionali e la Medicina Tradizionale Cinese della Regione Toscana, ASL 10 Firenze, Dott.ssa Sonia Baccetti
- Federazione Italiana delle Associazioni e dei Medici Omeopati, FIAMO, Terni, Dott.ssa Antonella Ronchi
- Federazione Italiana dei Medici Omeopati, FIMO, Roma, Dott. Marco Lombardozzi
- Federazione Italiana delle Società di Agopuntura, FISA, Bologna, Dott. Carlo Maria Giovanardi
- Gruppo Medico Antroposofico Italiano, GMAI, Milano, Dott. Giuseppe Leonelli
- Homoeopathia Europea-Internationalis, HEI, Bruxelles, Dott. Carlo Cenerelli
- Istituto delle Scienze Bioenergetiche onlus, ISBE, Roma, Dott.ssa Maria Teresa Elia
- Istituto di Studi di Medicina Omeopatica, ISMO, Roma, Dott. Gino Santini
- Istituto di Studi di Medicina Omeopatica, ISMO, Reggio Calabria, Dott.ssa Rosa Femia
- Istituto Superiore di Medicina Olistica e di Ecologia, ISMOE, Urbino, Prof. Corrado Bornoroni
- Liga Medicorum Homoeopathica Internationalis, LMHI, Berna, Dott. Renzo Galassi
- Nobile Collegio Omeopatico, NCO, Roma, Dott.ssa Anna Maria Rigacci
- Società Italiana di Ecologia, Psichiatria e Salute Mentale, SIEPSM, Imperia, Dott. Giuseppe Spinetti
- Società Italiana di Farmacoterapia Cinese e Tradizionale, SIFCeT, Roma, Dott. Giulio Picozzi
- Società Italiana di Floriterapia, SIF, Bologna, Dott. Ermanno Paolelli
- Società Italiana di Medicina Omeopatica, SIMO, Palermo, Dott. Ciro D'Arpa
- Società Italiana di Omeopatia e Medicina Integrata, SIOMI, Milano, Dott.ssa Simonetta Bernardini
- Società Italiana di Omotossicologia e Omeopatia, SIOOM, Carsoli (Aq), Dott. Luigi Minonzio
- Società Italiana di Psichiatria Olistica, SIPOl, Bologna, Dott. Ermanno Paolelli
- Società Scientifica Italiana di Medicina Ayurvedica onlus, SSIMA, Milano, Dott. Antonio Morandi
- Unione di Floriterapia, UF, Milano, Dott.ssa Maria Antonietta Balzola
- Unione di Medicina Non Convenzionale Veterinaria, UMNCV, Bologna, Dott. Francesco Longo, Dott.ssa Antonella Carteri, Dott. Andrea Malgeri
- World Psychiatric Association, Section on ‘Ecology, Psychiatry and Mental Health’, Imperia, Dott. Giuseppe Spinetti
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Foreword
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