In a 1989 survey (172), 20% of adults reported having received complementary/alternative medical treatment. Forty per cent of patients of complementary/alternative medicine stated they had chosen these treatments because they were not satisfied with the National Health Service. Seventy per cent stated that through their complementary/alternative treatment their health had improved or they had been cured of their illness; 1% stated their health had deteriorated.
Chiropractic is the most commonly consulted complementary/alternative medicine in Sweden. Thirteen per cent of the population has consulted one of the 130 practising chiropractors at least once (45). The next most popular form of complementary/alternative medicine is homeopathy, accounting for 4% of consultations, followed by acupuncture, naturopathy, and herbal medicine.
In Sweden, the National Board of Health and Welfare (172) maintains a registry of public health and medical personnel. Practitioners who are not included in the Supervision of Health and Medical Personnel list of medical practitioners (which includes only allopathic doctors, dentists, nurses, midwives, and physiotherapists) may not be registered. Thus, officially only recognized medical practitioners are under public scrutiny.
The requirements for practising medicine are included in the Act on Competence 542 of 1984 and the Medical Care Act 786 of 1996 (172). Although non-registered persons may treat patients, specific medical acts are restricted to allopathic physicians. The specific treatments reserved for physicians are outlined in the Quackery Act - Law 409 of 1960 (172), modified in 1982. Only a physician is allowed to act as a doctor in medicine; practise general or local anaesthesia; provide care with radiological methods; practise in an itinerant way; treat specific contagious diseases; treat cancer, diabetes, epilepsy, or pathological conditions associated with pregnancy or childbirth; treat a child who is younger than eight years old; issue written recommendations or instructions for the treatment of patients who are not personally examined by them; provide acupuncture; and test or supply contact lenses. The violation of these restrictions is an offence and may be prosecuted.
Non-allopathic practitioners who damage a person's health by using inappropriate therapies may be charged with charlatanism constituting a danger to health. Practitioners found guilty of this charge are punishable under the penal law and may be prohibited from working in the health care field.
In 1989, Sweden granted recognition to chiropractors satisfying the standards of the Council of Chiropractic Education. By Government Bill 1988/89:96 (172), those chiropractors completing studies as doctors of chiropractic have the right to obtain a licence and to be registered under the National Health Service. However, no Swedish training programme has so far been certified as meeting the appropriate standards. Currently, all registered practitioners have been trained abroad. Chiropractors trained at the Scandinavian College of Chiropractic in Stockholm are working to be included among the recognized practitioners.
Homeopathic remedies are legal and are manufactured according to good manufacturing practices (53).
In 1994, official recognition was extended to naturopaths. The Swedish Commission on Competence (172) does not intend to amend the rules of authorization for them. Osteopaths remain unrecognised and the Swedish Commission on Competence does not have any proposals regarding osteopathy.
The Swedish Commission on Competence was delegated to undertake a comprehensive review of the principles governing authorization and competence and, in the light of this review, to put forward proposals concerning, for example, rules of authorization and competence for various categories of professional medical care, including the Quackery Act.
The Swedish Parliament mandated the Commission on Alternative Medicine (172) to examine issues concerning the position of complementary/alternative medicine in Swedish society. The recommendations of the Commission on Alternative Medicine (1989) and the proposals of the Swedish Commission on Competence (1996) can be summarized as follows:
• create an association of non-allopathic practitioners who have had at least one year of training and are registered by the National Board of Health and Welfare;
• create a State register of all non-allopathic practitioners who have passed their exams;
• create professional titles;
• uphold the law reserving specific medical acts for allopathic physicians;
• introduce some types of complementary/alternative medicine into the National Health Service and incorporate complementary/alternative practitioners into the National Health Service, provided specific conditions are fulfilled;
• strictly control the advertising of natural remedies;
• plan scientific studies on the effectiveness of complementary/alternative medicine.
Education and training
Most of the increasing numbers of homeopaths working in Sweden today have been educated at private institutions. This education corresponds to that of allopathic physicians in many ways. There are three private schools providing homeopathic training. There is also a four-year basic medicine course taught by professors from the University of Upssala (53). No Swedish chiropractic training programme is officially recognized.
While non-allopathic practitioners may treat patients in Sweden, their care is not reimbursed by the health care system (172). Only acupuncture provided by an allopathic physician is reimbursed by social insurance, and then only partially. The Commission on Complementary/Alternative Medicine did not propose the reimbursement of treatments obtained from practitioners of complementary/alternative medicine.