LebanonWith thanks to The Daily Star 10.10.13:

From  http://www.dailystar.com.lb/News/Lebanon-News/2013/Oct-10/234128-alternative-medicine-lacks-regulation.ashx#axzz2hGjKdgpm  BEIRUT: Alternative medical treatments are becoming ever more popular in Lebanon. Holistic treatments such as reiki, acupuncture, homeopathy and Chinese herbal medicine are catching on with the public, thanks to word-of-mouth recommendations and increased international exposure via celebrities including Gwyneth Paltrow, Angelina Jolie and David Beckham, practitioners say. These treatments are currently exempt from state regulation and in the absence of self-regulatory bodies, which often govern non-mainstream medical practices in countries such as the U.S. and the U.K., qualified practitioners say there is little to prevent charlatans from passing themselves off as experts.

In addition, there is an ongoing problem, which started several years ago and has yet to be resolved, with television ads for supposed herbal cures that may expose the public to danger, says Professor Antoine Boustany, president of the Lebanese Order of Physicians.

Many of those practitioners in Lebanon who are properly qualified say that they would welcome a system of regulation.

Dr. Edmond Ibrahim, who is qualified in both Western medicine and traditional Chinese medicine, which he spent four years studying in China, runs his own practice in Beirut.

He says that the formation of a Lebanese syndicate for TCM – which includes acupuncture, Chinese herbal medicine and tuina acupressure massage – would solve many of the problems facing practitioners and the public alike, helping to prevent quacks from offering potentially dangerous services and engendering greater confidence in alternative medicine among the public and mainstream medical professionals.

“We don’t have rules here,” he says. “We don’t have a syndicate. It’s a governmental problem. … There are too many people who say they’re acupuncturists but probably they are not.”

Eva Zaatari, who studied acupuncture in the U.K., completing a three-year bachelor’s degree in Chinese medicine and acupuncture at the University of Westminster, stresses that acupuncture is a complementary – rather than an alternative – treatment, as it supplements Western medicine instead of competing with it.

In spite of this, she says, local doctors are often distrustful of non-mainstream medicine.

“In Lebanon it’s really not the same as in the U.K.,” she elaborates. “In the U.K. they rely on acupuncture now. Even general practitioners refer patients to acupuncture, for example for migraines or insomnia, because they tend to not want to give so many medications anymore.”

Unlike in the U.S., where most states require that acupuncturists have a national board certification in order to practice, in the U.K. acupuncturists don’t have to register with the state, she explains.

However, most qualified acupuncturists register with the self-regulatory British Acupuncture Council.

“It’s not compulsory,” she explains, “but it’s preferable and no patient will go to anyone else.”

But in Lebanon, there is no way for alternative practitioners to become officially recognized as professionals.

“When I came back to Lebanon the first thing I did is to go to the Health Ministry and ask them what status I have,” Zaatari recalls, “because I’m already a dietician … For acupuncturists it’s still a vague area. They told me ‘As long as you don’t [prescribe] ‘medicine’ it should be fine.’

“If there was a syndicate that would really help things,” she adds, “because acupuncture is invasive. You are putting needles in somebody’s body, so it has to be very clean. We should follow very rigid guidelines … If they’re not sterile then you can really cause damage – infections from needles can be very serious.”

Ibrahim says herbal medications can also be dangerous in the wrong hands, despite the widely held misconception that anything herbal must be harmless.

“Chinese medicine is a system,” he stresses, “it’s not only giving herbs. There is theory, there is a diagnosis and there is a treatment – it’s like Western medicine.”

When it comes to prescribing herbal remedies, however, there is widespread confusion as to the laws. Ibrahim, who believes he is currently the only Lebanese practitioner qualified in traditional Chinese medicine, says that due to the complicated process of registering medications with the Health Ministry, he does not currently import the medicine himself. Instead, he recommends patients bring them from abroad.

When it comes to the current regulations, ministry officials, the LOP and practitioners all provide differing information, suggesting a chaotic and poorly regulated system.

Boustany explains that herbal medications are not considered medicine by the Health Ministry and are therefore not subject to the same regulations and registration procedure as pharmaceutical drugs.

“A specialized committee is needed to look into the case,” he said. “We believe that all items related to the healing or treatment of people should be supervised and checked by the Health Ministry before hitting the market or even authorized to be imported.”

Dr. Armouni, head of the department of food supplements at the Health Ministry, says that all imported foodstuffs and drugs are subject to strict safety checks and regulations, but adds that she knows nothing about the status of Chinese herbal medicine or homeopathic herbal remedies.

“I can’t answer with regard to how homeopathy or acupuncture or Chinese medicine works,” she said.

While Chinese herbal medicine must be imported, homeopathic remedies are prepared at one or two homeopathic pharmacies in Lebanon, says homeopath Yvonne Siblini.

“Homeopathy is not legalized in Lebanon as yet, though we still have pharmacies – you can explain to me how that goes,” she told The Daily Star.

Lebanon is not alone in failing to come up with a system to regulate herbal medication. Many countries allow herbal medicines to be prescribed and sold without subjecting them to quality checks, including Germany and the U.K.

However, increased awareness of the dangers associated with this lack of regulation in recent years has pushed many countries to begin monitoring alternative practitioners.

A 1968 U.K. law, known as the “herbal exemption” allows unlicensed remedies to be made and supplied by practitioners following a one-to-one consultation, but a 2011 Department of Health announcement called for this law to be changed in favor of implementing strengthened medicines legislation, including a statutory register for practitioners.

As the popularity of alternative treatments in Lebanon increases a similar need is making itself felt.