Now, I expect you have already made your mind up and I do not have any expectation that issues around quackery will sway your vote on the EU. However, I thought it would be interesting to look at what consequences might unfold if the UK were to leave the EU for alternative medicines. What would happen to the prevalence, regulation and availability of CAM? What would it mean for the training and registration of practitioners? How much does the EU influence what we see on the High Street, how consumers are protected and how public money is spent on such treatments?
As always, let’s start of with homeopathy and look at how this is viewed across Europe. The first thing to note is that there is a wide degree of variation on the prevalence and practices of homeopathy. The nearest continental neighbour to the UK, France, has very different attitudes and laws to us and this affects greatly how consumers access treatments.
In the UK, access to homeopathy is almost exclusively self purchased through a pharmacy or mediated by a medically unqualified homeopath – a lay homeopath. A few medically trained homeopaths do exist and practice within the the NHS but it is probable that we are in the last few years of this as funding has almost completely dried up. In France, the reverse is true. French pharmacies heavily sell homeopathic products whereas they are at best tolerated in the UK. In order to practice homeopathy you must be medically qualified. There is no legal lay homeopathy. The French state still pay for large numbers of homeopathic prescriptions although is no more than 5% of the total. The corresponding total in the UK is, well, homeopathic.
There are a large number of historical, cultural and regulatory reasons for these stark differences. If the EU was supposed to harmonise such things then it has failed miserably. The EU does influence some aspects of homeopathy but it is clear that it makes little difference to how it is seen and used on the street.
There are some areas where the EU has directly influence how homeopathy can be marketed and sold. This is to be expected as the EU is a project about ensuring trade barriers do not exist across member states. Two of the founding members of the EU, France and Germany, have major pharmaceutical companies that make homeopathic sugar pills and their interests are protected by a small number of EU rules. The most controversial of these are directives that ensure homeopathic remedies are recognised separately from other pharmaceuticals and given special privileges. Directive 2001/83/EC panders to the homeopathic canard that their remedies need to be treated differently due to the “difficulty of applying to them the conventional statistical methods relating to clinical trials”. This is, of course, utter nonsense. But the directive allows homeopathic remedies to be marketed without the clinic trials that a real drug would need. But it is not all stupid. It does so on the condition that homeopathic remedies that use the special provisions in this directive do not have ‘indications’ on the packet – that is they are not allowed to make claims that they can treat particular illnesses. Further restrictions are place on remedies including the need to ensure they are diluted enough not to propose a risk.
In the UK, the MHRA are tasked with regulating the sales of homeopathic remedies. They have a great deal of latitude over how they do so and it is clear that the EU rule are a minimum that needs to be applied. Enforcement of the rules appears to be very lax in the UK – a situation that the Nightingale Collaboration has looked into in some detail. If we left the EU would homeopaths and the manufacturers of such remedies be freed up in the UK? I doubt it very much. Firstly, the regulations would need to be reviewed and re-written. This would take decades with the vast amount of trade law that would need to be reviewed. There is no indication that the UK would want to adopt lower standards than already exist. Secondly, the UK would still exist within international markets and exporters of homeopathic products would be subject to their rules. The US FDA have the right to inspect manufacturers in the UK where products are exported. They did so with UK based laboratory Nelsons – who sell through Boots in the UK. They found many problems and risks to consumers. Issues that our own regulators had failed to uncover. Nelsons allowed glass fragments to get into the products, had a lack of procedures to ensure consistency and serious quality issues in manufacturing.
With respect to homeopathy, leaving the EU is unlikely to make a great deal of difference. Practices are largely cultural and historical, and determined by our own medicines and health laws and agencies with little direct influence from the EU. Even if homeopathic manufacturers were freed from the EU, globalisation will ensure that standards and rules will be imposed on them from other large economies that they wish to export to. At least in the EU, homeopaths have bodies they can lobby to give them favourable conditions. And they do do that.
The EU has been far more effective and influential in protecting consumers from the dangers of herbal medicines. Directive 2004/24/EC introduced rules as to how herbal products could be marketed. Before that each country looked after its own rules. But it was clear that this was posing a real threat to consumers with products being imported that had no standards of labeling, manufacturing or requirements to show efficacy. Products routinely were contaminated or were mislabelled. Wild claims were being made. Now, manufacturing practices are enforced and marketing authorisation is only allowed for products that have been ‘traditionally’ used within the EU. Herbalists can still practice as long as they provide their products after a consultation and are registered. The UK has done a good job of fudging these rules. Many herbal products are sold as food supplements and fail to meet quality standards.
Again, would being out of the EU make any difference? UK herbal trade bodies are lobbying hard but not getting anywhere. It is difficult to imagine any priority being given to such legislation post Brexit or that any future UK government would be more lenient over an issue where serious public health issues are at stake.
It would be possible to write a lot more about this. But a picture is emerging. EU laws about alternative medicine are not that great in number. The UK is free to choose who it licenses as a medical practitioner. It can allow chiropractors and osteopaths to have statutory regulation and does so. It can fund any such treatment publicly if it so wished without EU interference. It can police the sale of products on the High Street by funding Trading Standards and training them (but it chooses not to.) The UK government can come up with its own schemes to register herbalists and homeopaths and in doing so misleads the public about them. In short, it is possible to suggest that the UK governments do indeed exercise sovereignty over how alternative medicine manifests itself, how well the public is protected and how much public money is spent on it. Leaving the EU is not going to make much difference that way. Although I do suspect that staying might indeed over the years steadily increase the level of regulation around the matter. Successive UK governments have not done a lot. The EU just a little more.
I hope you have found more substantive issues over which to make your choice. Although I do suspect that this story has parallels in many aspects of our lives and relationship with Europe.