THE AMBIVALENT INTEGRATION. THE ROLE OF NON-CONVENTIONAL MEDICINES IN THE ITALIAN NHS

Abstract

The problem of integration of alternative and complementary medicine (CAM) with biomedicine in contemporary health care systems has been quite debated during the last few years. We can identify two main models of strategic integration: the market-driven integration typical of the American health care system and the state-driven integration proper of the European, Canadian, and Australian health care systems. Whereas in the first model the medical-industrial complex (health insurances, private health care facilities, pharmaceuticals and health technologies industry) is the leading actor playing a substantive role in a demand-led process of integration where the market rationale is affecting all the other social actors involved (professions, citizens, researchers and the state), in the second case it is the state which plays a fundamental role in advancing the process that some scholars call of ‘mainstreaming’ of alternative medicine, with some contradictions.

In the Italian case, in fact, this role appear somewhat unclear, since it is strongly conditioned by the medical profession and its vested interests: since many years, a bill on regulation of alternative medicines is still on discussion in the Parliamentary Health Commission and its approval appears quite far away. In this national regulatory vacuum, some Regional Health Authorities (Piedmont,  Lombardy, Campania, Emilia-Romagna, Umbria and Tuscany) within the National Health Service (NHS) have started taking different measures in order to integrate some non-conventional medicines (in particular, homeopathy, herbal therapy and acupuncture) within their regional health systems, sometimes conflicting with the central government. Finally, the situation appears further complicated by the fact that, even though medical pluralism is not formally implemented in the Italian National Health Service yet, according to more recent surveys a growing number of citizens choose to treat themselves using some kind of non-conventional medicine. On the whole, the Italian case show a high degree of ambivalence between chances of an actual pluralistic integration and risks of co-optation of weakened forms of non-conventional medicines within the formal health care system.

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• The article is available in full versio in Russian