Thursday, 18 May 2017

Malta and Homeopathy

One of the reasons for writing this post is that there will be a homeopathic conference there in June 2017.  

Malta is part of the EU and publishes its laws in English as well as Maltese. Malta has a legal system that has many influences because of its complex history. It's a history that can be read about but it is best understood by actually visiting Malta.

Homeopathy is not popular in Malta. There is a Malta Association of Homeopaths (MAH) but it reveals very few members. Nor does it reveal a long standing tradition of homeopathy. Google searches reveal more lay homeopaths in Malta but, again, this does not reveal a long tradition of CAM in Malta.

Practice of Medicine
The legislation covering who can practice medicine is unclear in a few places. The Medical and Kindred Professions Ordinance 1901 (amended) has for the most part been superceded by more recent legislation. It makes no mention of homeopathy. However, it does state -
90A. (1) No person shall advertise or permit or suffer to be advertised in any manner whatsoever, any medical or health service or treatment, not being a service provided by Government, or any other service or treatment which is or is described as being of a medical, therapeutic or curative value or effect, or in any other way beneficial to health, without the approval of the Council of Health.(2) For the purposes of subarticle (1), "treatment" shall include any form of advice relating to the treatment or cure of maladies or ailments, or any advice relating to health.
It later goes on to state -
98. (1) No person shall use any premises as a hospital, clinic, maternity home, nursing home, home for the aged, medical diagnostic laboratory, X-ray department, or any other similarestablishment or institution, by whatever name called, unless there is in respect of such premises a valid licence for the purpose issued by the Minister responsible for public health, and no person may open or carry on any establishment or institution for any of the purposes aforesaid unless he is in possession of a valid licence for the purpose issued by the said Minister.
 The Healthcare Professions Act 2003 (amended) does make mention of "professions complementary to medicine". However, that does not mean "complementary medicine" in the usual meaning of the word. Rather -


Conditions to practise a Profession Complementary to Medicine.25.(1) No  person  shall  practise  any  of  the  professions complementary to medicine unless his name is entered in the respective register kept by the Council for Professions Complementary to Medicine, in accordance with the provisions of this Act.(2) No person shall qualify to be so registered unless -(a) he is a citizen of Malta or of a Member State or isotherwise  legally  entitled  or  authorised  to  work  in Malta;(b) he is of good conduct; and(c) his  name  is  entered  in  one  of  the  registers  for  the professions complimentary to medicine referred to in article 28.

Article 28 refers onwards to Schedule 3 which lists - 
  • Accupuncture
  • Audiologists
  • Dietetics
  • Physiotherapy
  • Dental Hygiene
  • Chiropractic 
  • Nutrition
  • Optometry
  • Orthoptics
  • Osteopathy
  • Speech Language Pathology
  • Clinical Perfusion
  • Podiatry
  • Psychotherapy
  • Radiography
  • Environmental Health
  • Dental Technology
  • Occupational Therapy
  • Medical Laboratory Science
  • Medical Physicists
  • Nutritional Therapists
No mention of homeopathy although it is an odd mix.

So what does this actually mean? There's nothing that explicitly forbids the practice of homeopathy although the law could be read in such a way that the advertising of homeopathic services by the non-medically qualified is illegal. Where they can practice is a moot point. 

Medicines Regulation
As Malta is a member of the EU, its medicines regulation has a lot in common with that for the UK, Ireland and Norway as previously discussed.

As far as can be determined, although Malta does have a scheme to register homeopathic medicines, none have been. It is unknown where lay homeopaths are obtaining their remedies from - whether they are personally importing products, obtaining them from a wholesaler in Malta or some other route. Anecdotally, homeopathic medicines are not found in pharmacies. Whilst some herbal products are found in healthfood stores, homeopathic medicines are not it would seem. It is not unreasonable to suspect that Maltese homeopaths are importing homeopathic medicines from elsewhere. 

The Maltese medicines regulator is the Malta Medicines Authority (MA). If has the same powers and functions that other EU member states. Reading Maltese regulations is a bit tricky as it is not one continuous document. The legislation that covers important of medicines is tricky to read but...

There is some very clear guidance on the importation of unlicensed medicines into Malta, which would seem to confine it prescriptions issued by doctors and dentists and that MA approval is required. It is difficult to find a direct source, but it is known that importation for personal use is largely legal although customs may seize products. But supplying personally imported homeopathic medicines is a no-no.

Advertising of Homeopathic Medicines
As no homeopathic medicines are registered in Malta, they are classed as unlicensed medicines and marketing is forbidden. Medicinal Products (Advertising) Regulations states this pretty clearly (cutting and pasting from the document is problematic). The question of whether, as the per UK and Ireland it would be understood that advertising homeopathic services is restricted in terms of what is indications have been approved for registered products is moot as Maltese law seems to indicate that lay homeopaths should not advertise.

Consumer Protection
Malta does not seem to have self-regulation of advertising. It is a relatively small market in EU terms. Effectively, the Malta Competition and Consumer Affairs Agency (MCCAA) regulates advertising in general where not covered by specific legislation and another government agency.

The most import piece of legislation is the Consumer Affairs Act which can be found alongside other legislation here. Again, this is difficult to read but the First Schedule -"Commercial Practices which are ipso jure unfair" contains the following relevant items.
....9. Stating or otherwise creating the impression that a product can legally be sold when it cannot.....12. Making a materially inaccurate claim concerning the nature and extent of the risk to the personal safety or security of the consumer or his family if the consumer does not purchase the product.....17. Falsely claiming that a product is able to cure illnesses, dysfunction or malformations.....
Oh dear
Oh dear indeed. The irony of a homeopathy conference being held in a country where lay homeopathy is so constrained will be lost on the attendees almost certainly.

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