What helps to define alternative treatment?
The purpose of the Norwegian Act on Alternative Treatment of Disease (The Alternative Treatment Act) is to contribute to patient safety and to regulate the right to practise such treatment. The Act defines alternative treatment as follows: 'Alternative treatment is understood to mean health-related treatment which is practised outside the established health services and which is not practised by authorised health personnel. However, treatment practised within the scope of the established health services or by authorised health personnel is also covered by the term alternative treatment when the methods used are essentially methods that are used outside the established health services.' (2) .
The health authorities have expressed to NAFKAM that it is difficult to make a general statement on what alternative treatment is, and that it must be assessed on a case-by-case basis. The individual practitioner's view on whether the Act applies to their activity is not the deciding factor.
The Norwegian Consumer Authority oversees compliance with the marketing regulations for alternative treatment. The definition it gives for alternative treatment is wide and also includes alternative treatment and services without physical contact between the practitioner and patient, for example, remote healing. Similarly, it also considers the use of alternative medical tests, devices and other tools to be alternative treatment (3) .
Both in its own role and as a dialogue partner for the authorities, NAFKAM meets parties wishing to define themselves outside the scope of the Alternative Treatment Act and thus be exempt from the responsibilities and duties that the Act imposes on practitioners.
Approximately 80 % of the known alternative practitioner associations participate in the registration scheme, the Norwegian Register of Complementary Practitioners (4) . Although listing in the practitioner register is voluntary, many practitioners have chosen to register themselves and their business.
Until recently, an advantage of being listed in the register was exemption from VAT on services offered. Since the exemption from VAT ended in 2021, the number of registered practitioners has fallen by as much as 34 % in one year (1) . The mass deregistration has made the register less useful in defining what can be considered to be alternative treatment in Norway.
In the scientific literature, alternative treatment is divided into categories (5, 6) (Table 1), which can assist in clarifying what activities can be considered to be alternative treatment.
Table 1 Categorisation of alternative treatment in the scientific literature.
Category
Description
Examples
Alternative medical systems
Medical systems with their own theories about what disease is, causes of disease and treatment
Anthroposophic medicine, Ayurveda, homeopathy, naturopathy, traditional Chinese medicine
Body-based and physical therapies
Therapies that treat various conditions through physical contact, stimulation and touch or manipulation of the body
Atlas therapy, reflexology, cupping, massage, medical (western) acupuncture
Mind-body therapies
Forms of therapy based on the belief that our thoughts and mind can affect the body, bodily function and physical health
Relaxation techniques, prayer, hypnosis, art therapy, meditation, music therapy, mindfulness, visualisation, yoga
Biologically based therapies
Substances that are intended to have an effect on the body and bodily functions to achieve better health
Aromatherapy, dietary supplements, minerals, natural remedies, natural products, herbs, vitamins
Energy therapies
Based on the belief that the body has an energy system, and treatments consist of opening blockages and strengthening energy where it is weak
Healing, Chinese (eastern) acupuncture, tai chi, qigong
The categories illustrate different fundamental approaches to disease within alternative treatment. Some techniques are not too far removed from a medical framework of understanding. Medical (western) acupuncture is one example of an alternative treatment where the effect can be explained by western medical knowledge. Other forms of alternative treatment, for example Chinese (eastern) acupuncture, are based on energy pathways and meridians, for which western medicine has no frame of reference.
The boundaries between alternative treatment and activities that often have aims other than health-related treatment are indistinct. There is a relatively large difference between yoga practised at home for one's own well-being and yoga practised with an instructor for health-related purposes in return for payment. These boundaries can be challenging for both patients and practitioners to assess (Figure 1).
Figure 1 Alternative treatment has grey areas at the boundaries with several services and offerings. Contact with the health service takes place when healthcare professionals within the primary care service, specialist health service or dental service use alternative treatment as part of the service provision within integrative treatment . Adjunctive medical treatment , for example vitamins, dietary supplements and dietary/lifestyle advice, could cross over to become alternative treatment when it is not used on a doctor's advice or not in accordance with the package leaflet. Self-help and self-treatment would be considered alternative treatment when offered for health-related purposes outside the health service. When practitioners of folk medicine offer health-promoting services with a clear patient-practitioner relationship, this would be considered to be alternative treatment. Service offerings involving well-being, beauty care, education and religious activities have not traditionally been regarded as health-related and, therefore, not considered to be treatment, but recently this interpretation has been challenged, including through 'aesthetic medicine'. Source: NAFKAM.no (1 ).