Representation of complementary and alternative medicine (CAM) in German treatment guidelines — An appraisal

Background

In the German medical care system CAM still seems to be more or less ignored.

Objective

To evaluate the occurrence of CAM in German treatment guidelines and in the 4 national health care guidelines (NHCG).

Design

The treatment guidelines and NHCG published by the Working Groups of the Scientific Medical Societies (www.AWMF.de) between 2004 and 2009 were searched for CAM with respect to occurrence and rating (recommendations: positive, negative, still unclear) in August 2009.

Results

Eighty-eight scientific medical societies have published altogether 728 treatment guidelines. Only 75 guidelines and the NHCGs list any CAM; of these, 9 guidelines and 2 NHCGs mention kinesitherapy, dietetic treatment, relaxation techniques, physical therapy and physiotherapy mainly without supplying further details. In the guidelines and NHCGs altogether 168 CAM measures are validated as positive, 48 as negative and 88 as unclear. Main reasons for the rating “unclear” are low quality or missing clinical trials.

In Germany, CAM methods are subsumed under the generic terms physical medicine and balneotherapy/climate therapy (measures of physical therapy, physiotherapy, balneotherapy and climate therapy) or naturopathy (which includes measures of physical medicine, balneotherapy and climate therapy and several other methods). From the measures of physical therapy, etc., mentioned in the guidelines, 95 are validated as positive, 12 as negative and 22 as unclear. If measures of physical medicine, etc. are excluded, of the remaining naturopathic methods 67 are rated as positive, 40 as negative and 43 as unclear. Alternative methods are rated as positive (n=9), negative (n=6) and unclear (n=13).

Conclusion

The notification of CAM in German medical guidelines increased in the last few years. Also, some naturopathic methods beyond physical medicine are rated as positive. However, CAM is still far from being a substantial part of medical care in Germany.