(2001; 200 pages)
Homeopathy was introduced into Spain in the beginning of the 19th century (172). The first Spanish homeopathic hospital, the Fundacion Instituto Homeopatico y Hospital de San Jose in Madrid, was founded in 1878. The Academia Medico Homeopatica de Barcelona was founded in 1890. There is an outpatient homeopathic clinic at the Hospital del Nen Deu of Barcelona (53). The Spanish Society of Homeopathic Medicine was founded in 1996. It represents all homeopathic associations (172).
In addition to homeopathy, popular complementary/alternative therapies include acupuncture, auriculotherapy, neuraltherapy, and biological medicine. However, until 1987, complementary/alternative medicine (with the exception of homeopathy) had only a minor role in the Spanish health care system (172).
There are several associations linked to complementary/alternative medicine in Spain. Since 1996, the Spanish Medical Council has supported complementary/alternative medicine, provided it is practised by licensed physicians (172).
There are 50 chiropractors practising in Spain (45).
In Spain, the practice of medicine is the exclusive right of allopathic doctors (172). In order to obtain the right to practise medicine, a candidate must hold an academic degree in medicine, have authorization from a medical college, pledge professional secrecy, be current in his or her taxes, and as outlined in the Statutes of the Collegial Medical Organization, respect the Spanish Code of Professional Ethics of 1990. Natural medicine, by the Royal Decree of 27 March 1926, may only be practised by licensed allopathic physicians.
On 16 June 1997, the Code of Medical Professional Ethics (172) was adopted in Catalonia. Article 44 of this code stipulates that doctors using complementary/alternative medicine must inform their patients of the importance of continuing necessary allopathic treatments and of the non-conventional character of the complementary/alternative therapy. Furthermore, doctors must coordinate their supplementary therapy with the allopathic physician in charge of the patient's basic treatment. Article 44 forbids using methods that have not been scientifically validated to make a diagnosis or treat a patient.
Royal Decree 127/1984 does not include branches of complementary/alternative medicine as medical specialities (172). Opposing this, professional associations registered with the Ministry of the Interior are seeking recognition from the Spanish Government for graduate practitioners using complementary/alternative medical techniques. The Council of Medical Colleges of Catalonia wants to make homeopathy, acupuncture, and natural medicine official.
Under Article 62 of Royal Decree 3166/1966 of 23 December 1966, licensed paramedics are allowed to perform medical acts only under the supervision of an allopathic physician (172). The three categories of paramedic professions are practitioners of odontology, psychologists, and university graduates in nursing, which include, for example, physiotherapists. Some paramedics illegally practice complementary/alternative medicine.
The illegal practice of medicine is regulated by Article 403 of the Penal Code, approved on 23 November 1995 (172). This article states that if persons without relevant academic certificates practise acts specific to a profession, they risk imprisonment for a period of up to 12 months. This includes all intrusions made by non-allopathic physicians in the field of medicine.
State authorities are relatively tolerant with private allopathic doctors and non-allopathic practitioners using complementary/alternative medicine. On 23 January 1984, in response to a case regarding acupuncture and reflexology, the Spanish Supreme Court declared that it is not necessary to have a degree in medicine in order to practise medicine (172). However, only approved medical professionals may make a diagnosis, give a clinical or medical examination, or decide to apply a specific therapy.
On 19 June 1989, in a Supreme Court decision, a non-allopathic practitioner of acupuncture-moxibustion was found not guilty of intrusion into the field of medicine on the basis of two points (172): first, the practitioner had several foreign certificates and was a member of the Latin American Association of Research on Acupuncture-Moxibustion; second, as complementary/alternative medicine is not taught within Spanish medical faculties and as there is no official certificate authorizing and legitimizing complementary/alternative medical practice, it does not legally exist. Consequently, it does not correspond to any legally determined profession and therefore its practice cannot be the object of intrusion.
In January 1993, the Supreme Court released a non-physician acupuncturist (172). The argument was the same: complementary/alternative medicine is not included within the official list of medical specialities and therefore practising complementary/alternative medicine is not an intrusion into the field of medicine.
Similarly, the Spanish Association of Physiotherapists denounced certain chiropractors for intrusion into the field of medicine. However, in an 18 March 1997 decision, the regional Court of Valencia stated that chiropractors and other practitioners using complementary/alternative medicine are not committing intrusion.
Article 54 of the Law on Medicaments 25/1990 of 20 December 1990 and Royal Decree 2208/1994 of 16 November 1994 regulate homeopathic remedies and the commercialization of homeopathic products (53).
Education and training
The medical universities of Madrid, Sevilla, Murcia, Zaragoza, Valladolid, Barcelona, and Santiago offer certificate courses in homeopathy, naturist medicine, and acupuncture to allopathic physicians. The universities of Barcelona, Sevilla, Valladolid, and Murcia offer postgraduate training in homeopathy for physicians (53). For pharmacists and veterinarians, some universities offer basic and advanced homeopathic training programmes as well as other courses and certificates.
Sociedad Española Acupunctura and Sociedad Española de Medicos Acupunctores in Madrid offer two-week introductory courses, three 90-day training courses, and a complete three-year training programme. With the sponsorship of the Council of Europe and the World Health Organization, the Teaching Centre of Traditional Chinese Medicine in Spain provides comprehensive training for both physicians and non-physicians in acupuncture with the intention of gaining professional status for acupuncture. Other professional organizations also provide courses in complementary/alternative medicine (172).
Two public hospitals, Hospital del Nen Deu in Barcelona and Fundacion Instituto Homeopatico y Hospital de San Jose in Madrid, provide homeopathic care to outpatients on a fee-for-service basis. Under Article 94 of Law 26/1990 of 20 December 1990, there is no justification for homeopathic products to be financed through the State insurance system, INSALUD. Efforts by the Homeopathic Physicians Charter of the State of Spain to gain social security coverage for homeopathic medications have been unsuccessful (172).
In Spain, only a few private insurance companies provide coverage for any complementary/alternative medicines (172).