Traditional and complementary medicine (T&CM) – information to consumers July 2017

The market for traditional and complementary medicine (T&CM) is big in Norway. According to a survey conducted by the National Research Center in Complementary and Alternative Medicine (NAFKAM), about one in four Norwegians saw a T&CM provider in 2016, and Norwegians spent more than NOK 4 billion on such treatment.
The range of T&CM treatment available is vast and varied, with more than 200 different modalities. In the Consumer Authority’s experience, the providers of T&CM are a complex group, and how serious they are, their knowledge about rules and regulations and their willingness to comply with them vary greatly.
Below you will find some information that may be helpful if you are considering T&CM treatment in Norway.

What is T&CM?

The term ‘traditional and complementary medicine’ is wide-ranging. It covers activities intended to alleviate or treat diseases or injuries, at the same time as these activities (normally) take place outside the ordinary public or private health services. Common forms of  T&CM include acupuncture, naprapathy, healing and reflexology, among many others. Read more about laws and regulations in the section ‘Regulation of traditional and complementary medicine’.

Why is a form of modality considered T&CM?

A modality is considered T&CM because it mainly takes place outside the Norwegian health and care services, without any requirements for documentation of the effect, medical knowledge or authorisation on the part of the person providing such treatment.

The effect of T&CM modalities usually lacks scientific evidence.

Who can provide T&CM?

The Norwegian authorities have not defined any general educational requirements for providers of T&CM.

In principle, anyone can start up such a business. Nor is there an authorisation system for providers of T&CM that ensures the quality of the services they provide.

Many who offer T&CM are members of providers’ organisations. Most such organisations set some professional requirements for their members, but they vary greatly. You should therefore check whether the provider you are planning to see has an education, and, in such case, what kind of education he or she has. Some practitioners of T&CM are also authorised health professionals, while others have only taken sporadic courses.

What patient rights apply to the use of T&CM?

In general, you have fewer rights when you use T&CM than treatment provided by the health and care services:

Most who use T&CM treatment receive it outside the health services, from non-authorised health personnel. In such cases, the patient is neither covered by the patient rights legislation nor by the Patient Injury Act.

This means that you are not entitled to patient compensation in the event of injuries.

In order to help to safeguard patients, the authorities require T&CM providers registered with the Brønnøysund Register Centre to have insurance that covers any liability in damages resulting from their treatment. You should therefore check whether your T&CM provider is registered in Altbas – the official voluntary register of T&CM providers. If not, you should ask whether they nonetheless have such insurance.

It is important to note that being registered in Altbas entails neither a professional nor a quality assessment of the individual T&CM provider and the treatment he or she provides. Nor does it entail that the effect and safety of the modality is scientifically documented.

T&CM provided by authorised health care professionals is subject to the Health Personnel Act. In such cases, the provider has a duty to keep patient records, for example. Few T&CM providers in Norway are authorised health care professionals. You should therefore check whether this applies to the provider you are considering. If not, check whether he or she nonetheless keeps patient records.

Note that, even if the modality is provided by authorised health care professionals, the legislation relating to patient rights and the Patient Injury Act only apply in some cases.

Consumers involved in a dispute concerning T&CM treatment not provided by authorised health care professionals, for example a claim for damages, can contact the Consumer Council  for mediation in the case.

As a rule, the costs of T&CM treatment are not covered by the National Insurance reimbursement scheme.

Can you trust the marketing?

The marketing of traditional and complementary medicine (T&CM) is strictly regulated by special regulations. The main rule is that persons offering such treatment must give ‘an objective and factual description of the nature of that activity’. In practice, this means that they are not allowed to define what type of diseases/conditions their treatment is claimed to be effective against.

Despite the stringent requirements that apply, the Consumer Authority has observed a lot of creative marketing by T&CM providers in connection with its supervisory activities. Consumers are advised to be critical of the marketing. What seems too good to be true usually is.

Many T&CM providers base their explanation of the modalities they offer on undocumented, alternative theories about what illness is and what causes it, and how the modality might help with the patients’ problems. The information is often unclear about the distinction between facts and theory, and is usually not a sufficient basis for making informed choices concerning your own health. Objective factual information about common forms of T&CM is available on the governmental website http://www.nifab.no/om_nifab_no/information_in_english.

Regulation of traditional and complementary medicine

The Act relating to the such treatment of disease, illness etc. (the ‘Alternative Treatment Act’) applies to anyone offering or practising T&CM in Norway. The Act aims to improve the safety of patients who seek or use such treatment, and to improve the regulation of such practice. The regulations attempt to strike a balance between consumers’ freedom of choice, on the one hand, and their need for protection, on the other.

The legal point of departure is that anyone is free to examine and treat people who are ill, but there are nonetheless certain legal limitations. Among other things, only authorised health care professionals may perform medical procedures or provide treatment that can entail a serious health risk, and treat serious and/or communicable diseases hazardous to public health.

T&CM treatment of children is currently legal in Norway, and there is no lower age limit for this. At www.nifab.no, you can read arguments both for and against a prohibition (in Norwegian).

Who supervises T&CM providers?

In the official health care system, the quality of the services are ensured through a number of measures such as organisation and management, internal control requirements, education systems and authorisation schemes for practitioners, and, not least, the Norwegian Board of Health Supervision (Statens helsetilsyn).

Only T&CM provided by authorised health care professionals is subject to state supervision. In reality, T&CM providers are free to practise as they want, without risking sanctions from the supervisory authorities, on the condition that they do not violate criminal law provisions.

The marketing of T&CM treatment, on the other hand, is subject to supervision by the Consumer Authority. This includes ensuring that they do not use claims that the treatment is effective against specific diseases. Such claims can lead consumers to develop unrealistic expectations that a form of treatment will help them. We also oversee that T&CM providers do not market treatment for serious diseases and disorders that they are not allowed to treat, such as cancer and HIV. The Consumer Authority can impose financial sanctions in the event of breach of the regulations, depending on the circumstances. You can report relevant marketing to the Consumer Authority.

The Consumer Authority has prepared guidelines for the marketing of traditional and complementary medicine.

Are you considering T&CM treatment in Norway?

  • It is wise to check whether the T&CM provider is registered in the voluntary Altbas registry, within the official Brønnøysund Register Centre. Registered T&CM providers are required to have liability insurance.
  • If the T&CM provider is not registered, you should ask whether he or she nonetheless has liability insurance, and whether he or she is a member of an approved T&CM providers’ organisation. These organisations have a dedicated complaints body that deals with complaints against their members.
  • Ask whether the provider has taken an education, and if so, what type of education, and whether he or she holds a health care professional’s authorisation/ licence.
  • If not, check whether he or she nonetheless keeps patient records.
  • Be critical of claims used in marketing – what seems too good to be true usually is. You can also check the website http://nifab.no/om_nifab_no/information_in_english, or ask NAFKAM about the effect and safety of T&CM modalities, on tel. (+47) 77 64 66 50 or email nafkam@helsefak.uit.no.

Read more about traditional and complementary medicine

  • Objective facts about T&CM treatment in general and common modalities in particular are available on the NAFKAM information page http://nifab.no/om_nifab_no/information_in_english.
  • The ‘Alternative Treatment Act’, the Regulations regarding the marketing of such treatment and the Regulations relating to the voluntary registration scheme for providers of T&CM are available at lovdata.no
  • Information about the criteria for the approval of T&CM providers’ organisations and registration of such providers: https://helsedirektoratet.no/English.
  • Overview of approved providers’ organisations: https://www.brreg.no/home/. You can search the official Altbas registry for registered T&CM providers
  • More information about Norwegian research on traditional and complementary medicine is available at nafkam.no (in Norwegian)
  • SABORG (An umbrella association of T&CM providers’ organisations) saborg.no (in Norwegian).

 

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