Moves are afoot to tighten regulation of the complementary health sector. University of Queensland researcher Jon Wardle examines why this is particularly important for the many Australians who attend naturopaths:
This week the Steering Committee for the Australian Register of Naturopaths and Herbalists has formally called for submissions as part of its process to set up an independent register for Australia’s largest complementary medicine professional group.
Chinese Medicine practitioners have recently been announced as one of the three new professions to be part of the National Registration and Accreditation Scheme for Health Professionals, joining Chiropractors and Osteopaths as registered complementary medicine professions.
However naturopaths are by far the largest complementary medicine profession in Australia and at this stage don’t look to be considered for this process until 2012 when currently unregistered practitioners are considered.
A report commissioned by the Victorian government in 2003 and published in 2005 strongly urged that these practitioners be statutorily regulated and moves were even made towards this goal before being delayed indefinitely due to the current National Registration and Accreditation Scheme.
Whilst the aim of this register is to eventually be subsumed by this process, it is being initiated now to ensure minimum standards and afford public safety in the interim.
Many may ask why this is even a health issue? It‚s easy to dismiss the registration of complementary medicine practitioners as a trivial pursuit and this attitude could possibly be a reason that the issue has failed to gain any traction for so long. But, like it or not, complementary medicine practitioners now form a very real part of the Australian healthcare landscape and look set to remain so for the foreseeable future.
Australians now spend more out of pocket on complementary medicine practitioner consultations than they do on conventional practitioners, and nearly half – more than half in some areas – of all health consultations are with complementary therapists.
Less than half of those who do consult with complementary therapists discuss this use with their conventional medicine practitioners, and an astounding 1 in 6 Australians now rely on complementary therapists as their primary care practitioner.
Setting benchmarks and standards in these professions has moved from an issue of minor consequence even a decade or two ago to one of major public health importance. However, whilst most of the attention on improving standards in complementary medicine has focused on product issues, practitioner issues have very much fallen off the radar.
Naturopaths are now chosen by patients with a broad range of health conditions and need appropriate levels of health knowledge not just to treat but also to be aware of the limitations of their treatments.
A case report in the Australian Family Physician highlighted this perfectly – a man with a head wound was unsuccessfully treated by his naturopath for so long that by the time he eventually consulted with a medical professional the infection had reached the meninges of his brain.
The matter here was not an issue of inefficacy of the naturopath’s treatments, but rather the opportunity costs borne by the naturopath not referring for more appropriate treatment sooner, and it could have been easily averted through adequate training.
The education situation has undoubtedly improved since the days when Australian Skeptics members’ dogs could get a government accredited complementary training organisation registered but complementary medicine qualifications are still extremely variable.
Anyone can currently call themselves a naturopath, and practise as one, without any qualifications, and whilst four-year Bachelor degrees do exist in naturopathy there also exists a cacophony of other courses of varying quality, and numerous professional associations that are more than willing to accredit their graduates.
The board of at least one professional association that accredits practitioners is composed of representatives of various private training colleges and therefore exhibits clear conflict of interest in setting educational benchmarks. This situation has left little incentive for improving standards and earlier this year Australia’s largest complementary medicine provider cut assessment of its students by between a third and one half to better compete financially with other providers.
Accreditation of naturopaths and herbalists is currently carried out through professional associations. However the standard to which this is done is variable due to the large number of associations in Australia. Qualifications for entry, continuing professional education requirements and practice standards all vary considerably, as do complaints handling processes. Sometimes this can have drastic consequences.
One naturopath was allowed to remain a member of his professional association due to fear of legal action even after it had become apparent that he had falsified qualifications and had a history of fraud and violent crime. And even when removed from professional associations unethical practitioners may continue to practice as naturopaths.
Another naturopath was allowed to continue practising whilst under investigation for sexual crimes – eventually being found guilty of 34 counts – as there was no mechanism to bar him from practise.
Notwithstanding these examples it is patently obvious an organisation can’t promote the public’s interest and the interests of the profession it represents without clear conflict of interest. Whilst this arrangement hasn’t been legally tested in Australian it has in other jurisdictions, and is part of the reason that naturopaths are now statutorily registered in South Africa.
It should be acknowledged that the vast majority of practitioners are well qualified, behave ethically and support the initiatives to clean up the industry more generally.
However, given the emerging role that the public is choosing for naturopaths to play in healthcare it is essential that minimum benchmarks and standards are put in place by a body independent of the profession. The health and safety of a large swathe of the population is dependent on it.
• The Steering Committee for the establishment of the Australian Register of Naturopaths and Herbalists is calling for submissions on the registration of these professions. Submissions are due in by close of business Monday, 31 August 2009. More details are here.
If Naturopaths are to be registered & accredited (who will do that?) then self-christened ‘Integrative Medical Practitioners'(IMP) should also come onto the radar. These are medical practitioners who encourage hair, sputum, nail & blood tests to arrive at a so-called ‘diagnosis’ of what your body lacks or has too much of and then ‘prescribe’ an array of dietary supplements which the practitioners sell to the patient.Most patients appear to receive the same advice/results from the expensive tests. Whereas Integrative Medicine is well established in the USA it is still in its infancy in Australia. There is no oversight in Australia of what happens in this sector from how doctors qualify in the first place and then something of a void as far as continuing education is concerned. Each IMP has a vested interest in ‘selling’ product which can lock a patient into a monthly bill of around $120 with usually no refunds. Much of this market caters for ‘the worried well’ many of whom have sufficient disposable income not to worry. And the Government isn’t too worried whilst most complementary therapies and products remain outside Medicare.Patients of IMPs can of course claim a Medicare benefit for a consultation.
Quite apart from the important question of whether there is any credible evidence that any of this “alternative” stuff works (until this is resolved the use of the term “complementary” is premature), there is the current problem that in the desperate drive to sign up waverers to private healthcare insurance many benefits are offered for all kinds of “alternative” therapies but comparable support for such potentially useful things as exercise and dietary management programs is not.
Since there are clear public health implications for any significant expansion of the “alternative” therapies sector (eg. reduced immunisation rates), my feeling is that this whole area could be lumped with gambling and smoking as issues of personal choice, but with a persistent and pervasive government funded advertising campaign to point out the many perils for us all of individuals continuing to make such unrealistic choices.