New regulation found after the CAMbrella deliveries:
The Turkish government has on October 27, 2014 passed a new law on Regulation of Traditional and Complementary Medicine Practice. Official Gazette of the Republic of Turkey, Issue: 29158, 27th October 2014, Regulation of Traditional and Complementary Medicine Practice, by Ministry of Health. (321). The CAM treatments specified in the regulation are:
- Acupuncture: Who can provide: a certified Medical Doctor (A Dentist can only provide acupuncture for dentistry related disorders).
- Apitherapy, Maggot Theraphy, Mesotherapy, Prolotheraphy: Who can provide: A certified Medical Doctor.
- Homeopathy, Ozone Theraphy, Phytotheraphy: Who can provide: a Certified Medical Doctor or Dentist.
- Hypnosis: Who can provide: A certified Medical Doctor and Dentist (a psycologist can apply under the supervision of a medical doctor).
- Cupping, Chiropractic, Hirudo therapy, Osteopathy, Reflexology: Who can provide: A certified Medical Doctor (Other medical personel can only provide under the supervision of a medical doctor).
- Musicotheraphy: Who can provide: A certified Medical Doctor and Dentist (Other medical personel and a person who holds music education at a licence level can provide under the supervision of a medical doctor).
Go directly to legislation of specific CAM therapies in Turkey:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) - Other treatments
Turkey is a candidate country for European Union (EU) membership. On 18 February 2008 the Council adopted a revised Accession Partnership with Turkey (11). The EU established a Customs Union with Turkey in 1995 (11). Turkey became member of the Council of Europe on 9 August 1949 (12).
The legal and regulatory status of CAM and CAM practices
There is no general legislation or regulations on Traditional, Complementary and Alternative Medicine (CAM) in Turkey (289). Physicians preserve the right to treat their patients with all approaches, including the use of CAM (289). Consequently CAM therapy is recognized in Turkey as approved directly by the Ministry of Health (MOH)(290). In 1991 and 2002 by-laws on acupuncture were approved by the MOH (290, 291, 292).
Laws and regulations on Herbal Medical Products were issued in 1985 in the “Permanent Notice concerning Shops, Spice Shops and Similar Stores”, at the same time as the Expert committee for Licensing Herbal Medicinal Products was established (59)
Turkey has a long cultural tradition of self-medication and common folk medicine uses herbal medicines and CAM treatments. However, among physicians the knowledge and provision of CAM treatment is low (293). In 2002 WHO reported that the regulation of the pharmaceutical and herbal medicine sector needed improvements (294).
Since Turkey is a candidate country and not a member state of the EU, no CAM professions are registered in the EU regulated professionals’ database. In Turkey CAM training has not been mandatory in the medical curriculums, but recently some universities, medical schools and hospitals have started to offer lectures or training courses in CAM (291, 293).
The governmental supervision of CAM Practices
On 2 November 2011, the Ministry of Health used the term ’CAM’ for the first time and stated that Traditional, Alternative and Complementary Medicine regulations, treatment approvals and inspection tasks belongs to the General of Health Services Directorate (295).
In the ninth development plan (2007-2013) Turkey has developed a patient-oriented health system with legal regulations set up to prevent malpractice in medicine and the regulatory and supervisory role of the Ministry of Health (MOH) has been strengthened (296, 297). The Communication report from The European Commission on enlargement challenges 2011- 2012 concludes that Turkey has not yet completed the improvement process on health legislation and safety status of the population (298).
Due to the strong tradition of self-medication and use of herbal medicine in Turkey, health personnel (physicians) must be aware of possible harmful side-effects and possible negative drug-herb interactions (293).
The Ministry of Health of Turkey, General directorate of pharmaceuticals and pharmacy, has aimed at harmonizing their new legislation on medicinal products with the EU Directives. http://www.iegm.gov.tr/Default.aspx?sayfa=regulations&lang=en&thelawtype=11
The reimbursement status of CAM practices and medicinal products
CAM therapy treatment or CAM medicinal products are not covered by any insurance in
Turkey (291). Some CAM therapies are available through physiotherapy and pain clinics, but the vast majority of CAM provision in Turkey is within the private sector.
None of the private health insurance companies cover CAM treatments in their policies. Even if acupuncture is regulated it is not covered by the private insurance companies in Turkey.
11. EUROPA. Gateway to the European Union; member countries. Brussels EUROPA
Communication department of the European Commission; 2011 [cited 2011 November 3]; Available from: http://europa.eu/about-eu/countries/index_en.htm.
12. Council of Europe. Council of Europe. Strasbourg: Council of Europe; 2011 [cited 2011
November 7]; Available from: http://www.coe.int/lportal/web/coe-portal.
289. Dr. Altunay Söylemez Ağaoğlu. Turkish Classical Homeopathy Association. Izmir: Liga Medicorum Homoeopathica Internationalis (LMHI); 2012 [cited 2012 February 23]; Available from: http://liga.iwmh.net/index.php?menuid=1&reporeid=162.
290. Ministry of Health Turkey. Acupuncture Regulation;Turkish Ministry of Health, bearing the date of 29 May 1991, Offical Gazette 29.05.1991, Issue: 20885, (pp.3-5): AKUPUNKTUR TEDAVİ YÖNETMELİĞİ Resmi Gazete Tarih: 29.5.1991; Sayı: 20885. 1991 [cited 2012 February 25]; Available from: www.burdur.saglik.gov.tr/mevzuatlar/tipmeslek/29051991_20885.pdf.
291. Yusuf Ozgur Cakmak MD Phd; Acupuncture Program for Physicians; Department of Anatomy: School of Medicine; University of Yeditepe. Email: CAM in Turkey – CAmbrella project. 2012.
292. Ministry of Health Turkey. Acupuncture Regulation of the Ministry of Health, bearing the date of 17 September 2002. Regulation concerning the Application of Treatment and Private Health Institutions in Which Acupuncture is Applied. Official Gazette Date: 17.09.2002; Issue: 24879.: AKUPUNKTUR TEDAVİSİ UYGULANAN ÖZEL SAĞLIK KURULUŞLARI İLE BU TEDAVİNİN UYGULANMASI HAKKINDA YÖNETMELİK 17 Eylül 2002 – Sayı : 24879. Turkish Physicians Society; 2002 [cited 2012 February 24]; Available from: www.ttb.org.tr/mevzuat/index.php?option=com_content&view=article&id=206:akupunkturtedavuygulanan-el-saik-kuruluari-e-bu-tedav-uygulanmasi-hakkindayetmel&catid=2:ymelik&Itemid=33
293. ALIS OZCAKIR MD, GANIME SADIKOGLU MD, NURAN BAYRAM PD, M. MUMTAZ MAZICIOGLU MD, NAZAN BILGEL MD, ISIK BEYHAN MD. Turkish General Practitioners and Complementary/Alternative Medicine. The Journal of Alternative and Complementary medicine. 2007;13(9):1007-10.
294. Savas BS, Karahan Ö, Saka RÖ. Health Care Systems in Transition:Turkey. In: Thomson S, Mossialos E, editors. Copenhagen: WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies; 2002. p. 1-118.
295. Ministry of Health Turkey. 2 Kasım 2011 ÇARŞAMBA Resmî Gazete Sayı : 28103 (Mükerrer) Kanun Hükmünde Kararname: SAĞLIK BAKANLIĞI VE BAĞLI KURULUŞLARININ TEŞKİLAT VE GÖREVLERİ HAKKINDA KANUN HÜKMÜNDE KARARNAME 2011 [cited 2012 February 24]; Available from: www.resmigazete.gov.tr/eskiler/2011/11/20111102M1-3.htm.
296. Dundar M, Uzak A, Karabulut Y. Healthcare in overview of Turkey. The EPMA Journal. 2010;1(4):587-94.
297. Grand National Assembly of Turkey. Official Gazette, Decision of Turkish grand national assembly; Decision on the approval of Ninth Development Plan (2007-2013) Decision No: 877 Decision Date: 28.06.2006: approved in the 121st plenary session (section 605/609). Istanbul 2006.
298. The European Commission. extract from the Communication from the Commission to the European Parliament and the Council “Enlargement Strategy and Main Challenges 2011-2012″, COM (2011)666 final. EUROPA 2011.