The panic about government's intention to exert greater control over complementary medicines is the latest in a series of responses by civil society to ten years of social engineering in health. In that same ten years, the IFP warned of the faults in the Constitution of the Republic of South Africa, opposed health legislation derived from it and predicted the failure of government's approach to HIV/AIDS.

Health services continue to plunge on a downward spiral that began with the creation of a politically influenced Health Professions Council and Medicine Control Council (MCC). Shortly before the end of its second term in government, the ANC scrapped the MCC and its head Prof. Folb, (who opposed the Minister on virodene), urgently summoned a Task Team of overseas experts and set up the South African Medicine and Medical Devices Regulatory Authority (SAMMDRA). This body was to hasten transformation and to deal, post haste, with complementary medicines that had been embargoed due to alleged lack of clarity about their safety. That Act was an unworkable mess and could only be withdrawn when the courts decreed that Pres. Mandela had not applied his mind to its consequences.

Until that was done, medicines in this country were unregulated for at least a month. Scrapped Act 101, intended only for conventional medicines, had to be hauled out of the embers. It does not define "complementary medicine".

The next disaster was the establishment of the Allied Health Professions Council. Instead of that Council dealing only with allied health professions such as homeopathy chiropractic, acupuncture, ayurveda, herbalism and Chinese medicine, it was enlarged to include a host of fashionable complementary therapies based on as little as six week courses, and claims about holism and energy , whether from colours, fingers, odours or minds.

Even beauticians were included on the Council and one had to wonder why sex therapists were not. Henceforth all those professions that have established treatises and can be regulated in terms of scopes of practice, levels of education and accountability were diluted by a horde of holistic therapies with varying degrees of value and genuineness. But the holistic therapists clamoured to be included, hoping for the same medical scheme benefits, status and access to government services as members of the Health Professions Council, with its 74 sub groups, most of which are less related to medicine than are homeopathy or Chinese medicine.

All this achieved was swollen coffers for the Council and greater confusion. A professional who spins magnets to decide treatment and one who has 6 years of training, are differentiated by the title of therapist as against practitioner.

Accountability and standards have fallen by the wayside. As for ethical treatment where does one begin? The Allied Health Professions Council is a jumble. Many therapies that clamoured for inclusion now long to be released.

The latest healers to be included in this regulatory array are traditional healers, who will demand the same from government as all the rest. Nobody paid much attention to the fact that the legislation as written, puts the vast majority beyond regulation in terms of scope of practice and levels of accountability.

The easiest way to keep control of this extended and entangled mess, while scooping up some of the industry's huge profits, is to slap the same controls on whatever this panoply of therapists and healers sell, as on conventional medicines. Not to do so, would result in a host of legal challenges based on equality before the law. Why should Western herbs be regulated and traditional herbs not? Why should conventional medicines have fixed service fees added on, and supplements or herbs have a hefty mark up?

Start with a vision that government must control everyone everywhere, make the first irrational mistake and a domino effect sends everything into a downward spiral.

The solution proposed by the IFP is as simple as it is sound. It is based in the principle that regulations must ensure minimum standards and not seek total control. Pricing transparency as regards medicines must be required, not price fixing. Bureaucratic controls should be minimised and laws that can be effectively policed enforced. Where health services are needed, they must be drawn with incentives. All health products should be subjected to requirements of safety, quality and efficacy, but to establish these in a reasonable and workable fashion, representative specialists of the varying healing disciplines must be consulted separately and collectively. There can be no "One size fits all" approach.

Health professions should be regulated according to three tiers. The first Council should be an independent body comprising all professionals who can examine, diagnose and treat patients for diseases according to the scope of each practice. This would include conventional doctors, dentists, homeopaths and chiropractors. All such doctors should require a lengthy course of study at an accredited institution and be encouraged to work in partnerships.

The second Council should be an independent body comprising allied health professionals who treat patients based on doctor's diagnoses or the scope of whose practises can be clearly set. This would include the likes of physiotherapists, acupuncturists, occupational therapists, herbalists, ayurvedic and Chinese practitioners. The same tier should include Traditional Health Practitioners who practise within the limits of definitions, in terms of approved implements, medicines and practises. Any allusion to practitioners who use "things", as in the current bill, or who practise according to ideologies, should not be regulated, merely prevented from doing harm.

The third tier should be complementary therapists who employ a host of so called holistic measures ranging from massage, colour and reflexology, to exercise and breathing techniques and who make no more pretence or claim to being health professionals than sex workers, or the remedial gymnastic therapists currently regulated by the Health Professions Council.

It has been five years since the SAMMDRA debacle, ten years of talking, consulting and controlling. Medical devices remain unregulated, petitions and legal challenges abound, doctors and nurses flee the country and the health department is without a Director General or managers for AIDS and TB.