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Regulation of complementary/alternative medicine: A Canadian perspective

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Abstract

Increased use of complementary/alternative medicine (CAM) therapies by Canadians combined with increasingly forceful lobbying from both practitioner groups and the public have made the regulation of CAM practitioners an important issue for Canadian policy makers. A variety of challenges (including regulatory structures that are difficult to change, fear of adding costs to an already under-funded healthcare system and the lack of internal cohesion of some CAM practitioner groups) are currently hindering attempts to implement new policy. However, an environment of health regulation review and renewal as well as public support for regulation may have created a window of opportunity for investigating policy options. Currently in Canada, health care providers are regulated by individual provinces. This means that although some CAM practitioners are either regulated (e.g. chiropractors) or not regulated (e.g. herbalists, homeopaths) in all provinces; others (e.g. naturopathic practitioners, acupuncture/TCM practitioners) are regulated in some provinces, but not others. Harmonization of regulations and scopes of practice for CAM practitioners across Canada is one of the biggest future challenges.
Regulation of
complementary/alternative
medicine: a Canadian perspective
H. Boon
University of Toronto, Toronto, Canada
SUMMARY. Increased use of complementary/alternative medicine (CAM) therapies
by Canadians combined with increasingly forceful lobbying from both practitioner
groups and the public have made the regulation of CAM practitioners an important
issue for Canadian policy makers. A variety of challenges (including regulatory
structures that are difficult to change, fear of adding costs to an already under-funded
healthcare system and the lack of internal cohesion of some CAM practitioner groups)
are currently hindering attempts to implement new policy. However, an environment of
health regulation review and renewal as well as public support for regulation may have
created a window of opportunity for investigating policy options. Currently in Canada,
health care providers are regulated by individual provinces. This means that although
some CAM practitioners are either regulated (e.g. chiropractors) or not regulated (e.g.
herbalists, homeopaths) in all provinces; others (e.g. naturopathic practitioners,
acupuncture/TCM practitioners) are regulated in some provinces, but not others.
Harmonization of regulations and scopes of practice for CAM practitioners across
Canada is one of the biggest future challenges. C°2002 Elsevier Science Ltd. All rights
reserved.
INTRODUCTION
Complementary and alternative medicine (CAM)
has become an important Canadian health care
issue driven primarily by the large numbers of
patients who seek CAM products and therapies
and the corresponding increase in the number
of practitioners in the field. These developments
have led to increasing discussion about the need
for regulation of complementary medicine prac-
tices. This paper will begin with a discussion
of the challenges and opportunities associated
with regulating the practice of CAM in Canada
followed by a review of the current regula-
tory status of practitioners of some common
CAM therapies (acupuncture/traditional Chinese
medicine, chiropractic, herbal medicine, mas-
sage therapy, and naturopathic medicine). This
will lead to an exploration of CAM practition-
ers’ perceptions of statutory regulation as de-
scribed by practitioners in one Canadian province
(Ontario). Future challenges will be identified in
the conclusion.
Heather Boon BScPhm,
PhD University of Toronto,
19 Russell Street,
Toronto, Ontario M5S
2S2, Canada. E-mail:
heather.boon@utoronto.ca
CHALLENGES AND
OPPORTUNITIES ASSOCIATED
WITH REGULATING CAM
The regulatory environment in Canada presents
several unique challenges and opportunities for
the regulation of CAM practices. The challenges
are associated with the current regulatory struc-
ture and environment as well as the lack of cohe-
sion among many CAM practitioner groups. The
opportunities arise primarily because of the ex-
isting climate of legislative review and the public
demand for CAM health care services.
One challenge associated with the regulation
of CAM is the diversity of the current health pro-
fessional regulatory frameworks across the coun-
try. In Canada, natural health products are regu-
lated by the Federal government, while all health
care practitioners, including CAM practitioners,
are regulated by individual Provincial and Terri-
torial governments. The result is that, although
the regulation of CAM products is standardized
across Canada, regulation of CAM practitioners
Complementary Therapies in Medicine (2002) 10, 14–19 C
°2002 Elsevier Science Ltd. All rights reserved. 14
doi:10.1054/ctim.2002.0499, available online http://www.idealibrary.com on
A Canadian perspective of CAM regulation 15
varies widely from province to province. Thus,
a group of practitioners may be regulated in one
province, but not in others. In addition, the scope
of practice of a given practitioner group (e.g.
naturopathicpractitioners)canvaryfrom province
to province. This situation makes it difficult for
some health care practitioners to move between
provinces and causes confusion among members
of the public who seek health care services in dif-
ferent provinces.
Otherchallenges are associatedwiththe current
health care funding crisis. Health care costs are
escalating and Provincial governments are look-
ing for ways to provide efficient, cost-effective
care to Canadians. Regulation of ‘new’ groups of
health care providers may have a variety of cost-
implications for the system. There are costs asso-
ciatedwith drafting newregulations, initiating and
maintaining regulatory bodies, such as Colleges,1
and there is come concern that newly regulated
health care providers and/or the public may lobby
for coverage of their services within Provincially-
funded health care plans. Given the current fiscal
constraints, the costs associated with regulating
CAM providers is a challenge which cannot be
ignored.
Additional challenges are associated with the
lack of cohesion among some CAM groups. A
recent study identified lack of cohesive organiza-
tion as a major barrier to the professionalization of
CAM practitioner groups in Ontario. Only groups
that were unified and had good internal communi-
cation and organization have been able to achieve
thestatutoryself-regulationthat most groups iden-
tified as their ultimate goal.2
One final challenge appears to be associated
with the fact that many CAM therapies are prac-
tised by a variety of different CAM providers,
and sometimes regulated health care providers as
well. For example, one of the challenges associ-
ated with the regulation of acupuncture is whether
acupuncture should be regulated as a separate
practice or whether it should be regulated as a
modality that is part of a larger CAM system –
traditional Chinese medicine. Two Canadian
Provinces (British Columbia and Ontario) have
taken the view that traditional Chinese medicine
and acupuncture should be regulated under a sin-
gle piece of legislation. However, both have sug-
gested that different categories of practitioners
may need to exist within the regulatory struc-
ture. In contrast, two other Provinces (Alberta
and Quebec) regulate acupuncturists only and cur-
rently do not regulate the practice of traditional
Chinese medicine (see below for more detail.)
One issue that has not yet been adequately re-
solved is the use of CAM treatment modalities
by regulated health care providers, such as physi-
cians, nurses, and physiotherapists, whether or
not CAM providers are regulated to provide these
modalities.
The biggest opportunity for the regulation of
CAM practices is provided by the move toward
health care reform, restructuring and legislative
review. ManyCanadian provincesare currentlyen-
gaged in reviews of the regulation of health care
professionals.3,4Such reviews provide the oppor-
tunityforproposingchanges. For example, the last
revision of the Ontario Regulated Health Profes-
sions Act resulted in several ‘outsiders’ who had
previously been excluded (midwives among oth-
ers) ‘getting in’ to the Act.5O’Reilly suggests two
explanations for this: 1) ‘it may signal the begin-
ning of a process of assimilation into the domi-
nant paradigm or embedded ideational climate of
the sector’ (p. 308) or 2) ‘it may signal the be-
ginning of a process of paradigm shift or redefin-
ing the embedded ideational climate of the sector’
(p.308).5
In another example, the Health Professions
Council’s recent report, ‘Safe Choices: A New
Modelfor RegulatingHealth ProfessionsinBritish
Columbia’4outlines the results of their review of
the scope of practice of the 15 recognized health
professions in British Columbia and a review of
the legislation currently governing their practices.
This review included an inquiry into whether cur-
rent definitions of the scope of practice of reg-
ulated CAM practitioners (chiropractors, naturo-
pathic physicians, and massage therapists) needed
to be updated or expanded, and facilitated the con-
solidation of several different pieces of legislation
regulating specific health care practitioners into a
single Act – The Health Professional Act. The re-
port also outlines an entirely new framework for
regulatinghealth careprofessionals in theprovince
of British Columbia, consisting of non-exclusive
scope of practice statements and reserved acts
(i.e., making a diagnosis). This re-organization
and review has solidified these three CAM prac-
titioner groups as regulated health care providers
in British Columbia that are treated exactly the
same as all other regulated health care providers
(e.g. physicians, nurses, pharmacists etc.). It could
be said that this legislative restructuring has ‘lev-
eled the playing field’ for chiropractors, natur-
opathic practitioners and massage therapists in
British Columbia.5
Legislative review and re-organization in sev-
eral provinces has also resulted in the establish-
ment of permanent mechanisms for new groups
of health care providers (including CAM practi-
tioners) to be reviewed for possible statutory self-
regulation as health care practitioners in the fu-
ture. In British Columbia, this is called the Health
Professions Council6and in Ontario it is referred
to as the Health Profession Regulatory Advisory
Council (HPRAC).7Both Councils are currently
reviewing submissions from a number of CAM
practitionergroups. For thefirsttime, a specific av-
enue exists for considering whether to approve the
regulation of ‘new’ health care provider groups.
16 Complementary Therapies in Medicine
This provides a real opportunity for CAM prac-
titioner groups that wish to be regulated to make
their case.
The other major opportunity for CAM prac-
titioner groups is the increased public awareness
and utilization of their services.8Growing public
demand for high quality, safe practitioners is pro-
viding public pressure on provincial governments
to review the regulatory status of CAM products
and services.
REGULATION OF CAM
PRACTITIONERS IN CANADA
Regulation of CAM practitioners differs in each
province; however, most CAM practitioners (e.g.
herbalists, homeopaths and many others) are not
regulated by the state in any manner. This means
that anyone, with any level of experience and
training may practise these modalities. This sit-
uation results in a ‘buyer beware’ atmosphere for
consumers. Other practices, such as acupuncture,
chiropractic, massage therapy, and naturopathic
medicine are regulated to some extent in some (or
all) provinces, but not in others. The provinces in
which each of these practices are regulated will
be identified and the regulations in one or two
provinces will be reviewed to provide examples of
the regulatory environment for CAM practitioners
across the country.
Acupuncture (and traditional
Chinese medicine)
Regulation of traditional Chinese medicine and
acupuncture varies from province to province.
Acupuncture is currently regulated in British
Columbia, Alberta and Quebec. In Alberta,
acupuncturists are one of fourteen ‘designated
health disciplines and are regulated under the
Health Disciplines Act. For the purposes of this
Act, acupuncture is defined as, ‘the stimulation
of an acupuncture point on or near the surface of
the body by the insertion of needles to normalize
physiological functions or the flow of Chi for the
treatment of discomfort of the body and means
the techniques of needle acupuncture, electro-
acupuncture, acupressure and moxibustion.’ The
Act also stipulates that acupuncturists may not
treat a patient unless the person has already con-
sultedwitha physician (or dentist for dental condi-
tions). Acupuncturists in Alberta may not inform
patients that acupuncture ‘cures’ any disease nor
may they advise patients to discontinue any treat-
ment prescribed by a physician or dentist. Finally,
patients whose conditions do not improve after six
months of acupuncture treatment must be referred
to a physician (or dentist if appropriate).
The practice of acupuncture is currently reg-
ulated in British Columbia and in April 2001
the provincial government enacted legislation (the
TCM Practitioners and Acupuncturists Regula-
tions) to regulate traditional Chinese medicine
practitioners as well. The College of Traditional
Chinese Medicine and Acupuncture Practitioners
of British Columbia began accepting applications
for registration in May 2001 and plans to begin
issuing licenses in 2002.9In British Columbia, in-
dividuals may be registered as: acupuncturist, tra-
ditional Chinese herbologist, traditional Chinese
medical practitioner, or Doctor of traditional
Chinese medicine. Each category has a specific
scope of practice and its own set of educational
standards. Both TCM practitioners and acupunc-
turists are considered primary contact practition-
ers in British Columbia because patients do not
require a referral from any other health care prac-
titioners to access their services. The regulations
allow TCM practitioners to prescribe from a list
of specific Chinese formulae, paving the way for a
‘restricted’herbprescription system; although this
would require the involvement of the Federal gov-
ernmentwhichregulatesChinese medicinal herbs.
Chiropractors
Chiropractors are currently regulated in all
Canadian provinces. Each province has its own
Chiropractic Act; however, in all provinces, the
minimum licensure requirements include: grad-
uation from an accredited chiropractic college;
a minimum of three years pre-professional uni-
versity/college studies; passing scores on na-
tional examinations administered by the Canadian
Chiropractic Examining Board; and passing
scores in provincial licensing examinations. Some
provincesalso requireminimumage, period ofres-
idency within the province and evidence of good
moral character. There are currently two chiro-
practic training facilities in Canada: The Canadian
Memorial Chiropractic College in Toronto,
Ontario and the more recently founded chiroprac-
tic program at the Universit´eduQu´ebec `a Trois-
Rivi´eres (UQTR).
The actual legislation that governs chiroprac-
tic practice varies from province to province.
Ontario and Saskatchewan may be used as exam-
ples to explore the regulations in more detail. In
Ontario chiropractors are currently regulated un-
der the Regulated Health Professions Act (1991)
and the Chiropractic Act (1991) with a scope of
practice defined as the ‘diagnosis, treatment, and
prevention of disorders arising from the spine,
other joints, and related tissues.’ Chiropractors
in Ontario are authorized to use the title Doctor.
Chiropractic is considered a primary contact pro-
fession, thus patients may self-refer for chiroprac-
tic care. In Saskatchewan, chiropractic has been
a self-regulated profession since 1943 and is cur-
rentlyregulated underthe Chiropractic Act(1994).
Chiropractors have the right to: diagnose; refer
A Canadian perspective of CAM regulation 17
directly to medical specialists; to use, refer, and
request hospital privileges for access to diagnostic
X-ray services; and treat patients in hospital on the
request of the attending physician.
Reimbursement of chiropractic treatment also
variesfrom province to province. Currently,chiro-
practic services are included, and partially funded
by government, in the provincial health care plans
of Ontario, Manitoba, Saskatchewan, Alberta and
British Columbia. Patients must pay directly
for chiropractic services in the other Canadian
provinces, although many private insurance plans
include coverage for chiropractic care.
Herbal medicine
The practice of herbal medicine, like the practice
of a great many other CAM modalities, is not cur-
rently regulated in Canada. That means that any-
one, with any amount of training (or none at all)
can recommend herbs to Canadians. There are a
varietyofeducationalprograms thattrain individu-
alswhocallthemselves Chartered Herbalists (CH)
or Master Herbalists (MH); however, there are
no standard definitions for these designations and
the credentials of those who use these titles vary
widely. Given this lack of regulation, Canadians
have very little recourse if they suffer adverse ef-
fects or consequences as a result of following the
recommendations of self-labeled ‘herbalists.’ The
onlypartial exception tothis is in BritishColumbia
where the TCM herbalist is separately regulated
(seeacupuncture/TCMabove). However,this does
notrestrictothers from recommending TCM herbs
aslongas they do not use (or portray themselvesas
using) the TCM diagnostic technique (that would
be considered practising TCM herbalism).
Health care providers who are regulated (e.g.
physicians, chiropractors, naturopathic practition-
ers, pharmacists) may recommend herbs to pa-
tients as long as they remain within their regulated
scope of practice. In some provinces, the Colleges
that govern specific regulated health profession
groups have drafted guidelines or policies for reg-
ulated practitioners (e.g., pharmacists or physi-
cians) that wish to practise some form of CAM
(e.g. herbal medicine or acupuncture) or to refer
their patients to a CAM practitioner.
Massage therapists
Therapeutic massage is regulated only in Ontario
andBritish Columbia. Thepractice is notregulated
in other regions of Canada, thus the title ‘massage
therapist’ is only protected in Ontario and British
Columbia. The scope of practice of massage ther-
apists in Ontario is defined under the Regulated
Health Professions Act (1991) as ‘the assessment
of the soft tissue and joints of the body and the
treatment and prevention of physical dysfunction
and pain of the soft tissues and joints by manip-
ulation to develop, maintain, rehabilitate or aug-
ment physical function, or relieve pain.’ A similar
scope of practice exists in British Columbia. Nei-
ther province has granted massage therapists any
of the controlled or reserved Acts (such as diagno-
sis) available as part of their respective regulatory
structures.
Most massage therapists are self-employed al-
though they work in a variety of different settings
including: massage therapy clinics, chiropractic
offices, community health clinics, rehabilitation
centers, health spas, health and fitness clubs, nurs-
ing homes and hospitals. The majority of patients
self-refertomassagetherapists,thoughphysicians
and chiropractors may recommend that a patient
seek massage therapy. Massage therapy is not cur-
rently included in any provincial health insurance
plan.However,it is coveredby a variety ofpolicies
offered by private insurance companies including:
Sun Life, Blue Cross, and Liberty Health. In ad-
dition, the Workplace Safety and Insurance Board
will pay for massage therapy for workers injured
on the worksite. Some third party payers require
a written ‘referral’ from a physician in order for
a patient to be reimbursed for the cost of massage
therapy treatment. (Leach E, for Ontario Massage
Therapist Association, personal communication,
2000).
Naturopathic practitioners
Naturopathic practitioners are currently reg-
ulated in four provinces (British Columbia,
Saskatchewan, Manitoba and Ontario). Practition-
ers in regulated provinces must attend four years
of full-time education at an approved training in-
stitutionand then complete provincialandnational
licensing examinations. The national licensing ex-
amination(Naturopathic PhysiciansLicensingEx-
amination or NPLEX) is used by all licensed ju-
risdictions in North America and is managed by
the North American Board of Naturopathic Ex-
aminations (NABNE). The only approved train-
ing institution in Canada is the Canadian College
of Naturopathic Medicine (in Toronto, Ontario).
InOntario, naturopathicpractitioners havebeen
regulated under the Drugless Practitioners Act
since1925. Theyarecurrentlyunderreviewby the
Health Professions Regulatory Advisory Coun-
cil for possible inclusion under the Regulated
Health Professions Act, the umbrella legislation
under which all health care professions in Ontario
must eventually be regulated. The Drugless Prac-
titioners Act will be abolished once this review
is completed. Neither naturopathic medicine vis-
its nor products are currently reimbursed by the
provincial government under the Ontario Health
Insurance Plan (OHIP). However, many private
insurance companies offer plans to employers or
individuals that include coverage of naturopathic
consultations.
18 Complementary Therapies in Medicine
In British Columbia, the Naturopathic Physi-
cians Act was passed in 1936, giving naturopathic
practitioners their own unique act in that province.
However, the Health Professions Act is currently
being reviewed and the Health Professions Coun-
cil has recommended that naturopathic physicians
be included in that Act with the following scope of
practice, ‘The practice of naturopathy is the pre-
vention and treatment of disease, disorder or con-
ditionof an individualthrough the use ofeducation
and natural therapies or therapeutics to support
and stimulate inherent self-healing processes’.10
The same Council recommends that naturopathic
physicians be allowed to perform two reserved
acts:
1. making a diagnosis using naturopathic
methods;
2. performing physically invasive or physically
manipulative acts:
procedures below the dermis but only for
the purposes of venipuncture and skin
pricking for the collection of blood
samples, needle insertion acupuncture,
removal of foreign bodies from superficial
structures and first aid treatment of minor
cuts, abrasions and contusions,
moving the joints of the thoracic or lumbar
spine beyond the limits the body can
voluntarily achieve but within the
anatomical range of motion using a high
velocity, low amplitude thrust,
administering a substance, other than a
drug, by injection or inhalation.
The Council has recommended that naturo-
pathic physicians should not be granted hospi-
tal privileges nor should they be given the right
to prescribe drugs. These remain recommenda-
tions, but are expected (with modifications still
possible) to be enacted as law in the province
of British Columbia sometime in 2001. In British
Columbia, naturopathic consultations are partially
reimbursed by the provincial government under
the Medical Services Plan (MSP).
CAM PRACTITIONERS’
PERCEPTIONS OF REGULATION
Recently our research team interviewed the lead-
ers of five different Ontario CAM groups (chi-
ropractors,naturopathic practitioners, acupunctur-
ists/TCM practitioners, homeopathic practitioners
and Reiki practitioners) to explore each group’s
efforts to professionalize. We completed in-depth
personal interviews with 39 CAM practitioner
leaders, discussing topics such as: current regu-
latory status, hopes for the future and plans for
moving forward. With the exception of chiroprac-
tors and Reiki practitioners, a primary goal for
these CAM groups was to achieve statutory self-
regulation under the Regulated Health Professions
Act of Ontario. For chiropractors who are already
regulated under this Act, primary goals included
full (rather then partial) coverage by the Ontario
Provincial Health Insurance Plan, and university
affiliation for their education programs as well as
government support for research initiatives. Reiki
practitioners were not interested in statutory reg-
ulation or in professionalization and instead were
focused on personal growth for practitioners and
the maintenance of their traditions.2
Those CAM groups that considered statutory
regulation an important goal had very specific
ideas about what it would mean for their practi-
tioners if they were successful.
First, it was clear from the interviews that most
felt that the only way to become more profes-
sional was to become regulated. Regulation was
seen as legitimizing their practices, and providing
protection for their practitioners. In addition, all
stressed that regulation would allow quality stan-
dards to be identified and enforced, thus providing
a safer environment for patients who wished to
access their services. Finally, statutory regulation
was seen as a necessary step to gaining access to
governmental funding for research and provincial
funding for their services. Few of the individuals
interviewed identified any disadvantages associ-
atedwithachievingstatutory regulation. However,
several voiced the concern that their ‘identity’ as
a CAM group or the individualistic nature of their
practice may be compromised if they were regu-
lated under the Health Professions Act. Generally,
regulation was seen as a desirable goal that would
allow the group to set and maintain standards of
education and practice and that would enhance the
health of the public.
CONCLUSION
The current era of regulatory reform has re-
sulted in an opportunity to review the regula-
tory status of many health care professions across
Canadaincluding CAMproviders.Although many
CAM practices remain completely unregulated
(e.g. herbal medicine, homeopathy, Reiki), there
appearstobeincreasingrecognitionthatthesafety
of the public may be best served by some form of
regulation for CAM practitioners. Current regula-
tion of CAM practitioners varies widely across the
country:
Acupuncturists/traditionalmedicine practition-
ers are regulated British Columbia, Alberta and
Quebec and under review in Ontario; chiroprac-
tors are regulated in all Canadian provinces;
herbal medicine practitioners or herbalists are
not regulated in any jurisdiction in Canada; mas-
sage therapists are regulated in British Columbia
and Ontario; and naturopathic practitioners are
regulated in British Columbia, Saskatchewan,
A Canadian perspective of CAM regulation 19
Manitoba and Ontario, with legislation pending in
Alberta.
One of the key challenges currently facing
Canada is the need to harmonize provincial reg-
ulations and regulatory structures with respect to
all health care providers including CAM practi-
tioners. If regulation is deemed necessary to pro-
tect the public in one jurisdiction, it is unclear
why Canadians living in another jurisdiction do
not also deserve the same protection. In addition,
the ‘Status Report and Analysis of Health Pro-
fessional Regulations in Canada’ prepared for the
Federal/Provincial/Territorial Advisory Commit-
tee on Health Human Resources clearly identifies
that diverse regulatory structures impede the flex-
ible use of health human resources.1
Finally,it willbeimportant for the international
community to share experiences with respect to
regulatingCAM practitioners. Itwouldappear that
some international consensus with respect to edu-
cation and practice standards would enhance pub-
lic safety and facilitate collaborative research on
the safety and efficacy of CAM practices.
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... 15 The drive from large numbers of patients who seek traditional medicines and therapies and the corresponding increase in the number of practitioners in the field has immensely contributed in assuring that discussions on TM become an important health care issue. 16,17 Gqaleni et al. attest the latter by arguing that TM has sustained the health of millions of Africans over hundreds of years. 18 These systems have been used for centuries, where plants were used for the treatment and prevention of various illnesses and the revolution of science has further popularised this usage, ensuring capacity within their primary healthcare. ...
... 30 This comes on the back-drop of the realization that international organizations, such as the WHO, suggest the success of the primary healthcare delivery in developing countries depends on TM. 31 It would therefore appear that some international consensus with respect to education and practice standards would enhance What is the nature of research conducted on regulating traditional health practitioners? A scoping review 16 This is important to regulators of THPs because already European institutions are starting to influence the development of TM. Therefore, to ensure success in proper regulation, the international community will have to share experiences with respect to regulating the THPs. ...
... Therefore, to ensure success in proper regulation, the international community will have to share experiences with respect to regulating the THPs. 16 However, harmonisation of training and regulation of practitioners continues to a challenge for the future. More so, it is believed that the interests of patients will best be served by a process of education, investigation, and regulation involving various stakeholders such as the public, doctors and health professionals, other practitioners, and national authorities. ...
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... 10 There are approximately 2,400 NDs in Canada. 13 In provinces where naturopathic medicine is unregulated, practitioners with various levels of experience or training may use similar titles (for example "naturopath" or "naturopathic practitioner") 12 ; however, these unlicensed practitioners are not the focus of the present publication. In recent years, there has been increasing attention paid to the way in which the foundational principles of naturopathic medicine interface with modern scientific evidence and how these different types of evidence might be incorporated into clinical decision-making. ...
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Aim: In Canada, osteopathic medicine, a well-known branch of complementary/alternative medicine, has received minimal attention for pain management within oncology. Purpose: This review reports both the existing literature and patient experience surrounding the application of osteopathy as an effective treatment for pain in breast cancer patients. Results: Both the literature and this case study support, to some degree, the benefits of osteopathy as pain management for breast cancer patients. Conclusion: Due to contradictory reported findings, more studies would be required to make firm conclusions, especially within a Canadian context. However, a lack of standardization of osteopathic procedures and collaboration between osteopaths and traditional healthcare professionals are challenges in including osteopathy as a standard service offered to breast cancer patients.
... Naturopathic education and regulation have been examined primarily in single country studies. These studies have examined the challenges of implementing accreditation and regulation [12], descriptive studies of accreditation standards and training competencies [13,14], descriptive studies on the scope of naturopathic regulation in individual countries [15][16][17] and comparison of regulation between one country and another [18,19] as well as comparisons between naturopathic regulation and regulation of other professions in single countries [20]. There have also been studies of the various limitations of existing regulatory models in South Africa [21] and Australia [22], as well as examination of the impact of disharmonious regulation across the European Union [23,24]. ...
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Background This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined. Methods This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 – Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate. Results Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous. Conclusion Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.
... En otros casos, se habla de productos contaminados con metales pesados, plaguicidas, toxinas microbianas (41) que se comercializan sin ningún control de seguridad para uso humano. Falta mayor regulación para disminuir la inseguridad por el uso de una determinada práctica (17,20,36,41,67,68,69), incluso en materia aspectos de protección de la propiedad intelectual cuando se refiere a �rácticas a�tóctonas�� c���o �so se masifica (41). Aunque las terapias enfatizan en el poder de proceso de curación, aspectos saludables, la prevención más que en la patogénesis de la enfermedad (42), existen vacíos metodológicos a la hora de comparar las alternativas, contra placebos o tan solo con el hecho de no hacer nada (19,55). ...
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Recibido 12 diciembre 2011 Aceptado 23 diciembre 2011 Therapies, practices and actions in the search for better health RESUMEN Alrededor del mundo y a lo largo de la historia, las personas han realizad y seguirán realizando actividades, acciones, prácticas y terapias, en su afán de contar con un mejor estado de salud enfermedad. Materiales y Métodos: Se ��scaron artíc�los científicos principalmente en las bases de datos disponibles en el Sistema de Bibliotecas y Documentación de la Universidad de Costa Rica, además de otras fuentes de información, luego del análisis correspondiente se estructuró una comunicación que contempló tres grandes secciones: aspectos conceptuales, categorías terapéuticas y otros aspectos relacionados. Resultados: Se destaca que no existe un único concepto que englobe la diversidad de opciones existentes utilizadas. A disposición de la población existen más de 160 categorías terapéuticas, las cuales varían según el contexto social, c�lt�ral�� geográfico�� �olítico�� económico e ideológico en el que se desarrollan. Conclusión: Se necesita mayor consenso y participación de los entes involucrados en el tema, con miras a desarrollar sistemáticamente ma��or evidencia científica q�e dem�estre el �otencial de todo el arsenal tera�é�tico q�e sea eficaz�� efectivo, seguro y de calidad. Es necesaria una mayor regulación, educación formal e información dirigida a los diferentes actores involucrados en el uso de las distintas o�ciones tera�é�ticas con la finalidad de resg�ardar el �ien común. ABSTRACT Around the world and throughout history, people have done, and will continue doing activities, actions, practices and therapies, in their eagerness to have a better health condition. Materials and Methods: Scientific articles �ere so�g�t mainly in the databases available in the University Library System at the University of Costa Rica, and other sources of information, and then the analysis was structured for a communication which includes three main sections: conceptual, categories therapeutic and other related aspects. Results: Of the most important highlights that no single concept that encompasses the diversity of options used by people, available to the population there are more than 160 therapeutic categories, which vary according to the social, cultural, geographic, political, economic and ideological context in which they develop. Conclusion: Greater consensus is needed for and participation of the entities involved in the issue, in order to s��stematicall�� develo� ���rt�er scientific evidence t�at demonstrates the potential of all therapeutic arsenal is e��ficient�� e����ective�� sa��e and q�alit��. We need more reg�lation�� formal education and information to different stakeholders in the use of different therapeutic options in order to safeguard the common good.
... See Table 1 were repeated by four interviewees (57.1%saturation)- Px4, 7,9,10,13,15,17,20,24,25,28,38. Px13 represents a key point in the role of NM within an integrated model to treat certain disease/conditions, with three sub-points having been suggested 1) 4 participants said the role of NM is to treat patients that BM does not do a good job with 2) 3 experts felt the NM role is to treat chronic disease, and 3) 2 responses suggested treatment resistant cases. ...
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Background: Naturopathic Doctors (NDs) are licensed complementary and alternative (CAM) health professionals in 5 provinces in Canada and 16 U.S. States (American Association of Naturopathic Physicians [AANP], 2010). The Canadian Association of Naturopathic Doctors (CAND) reports 1550 licensed NDs currently practicing, and over 4 million Canadians having seen an ND at least once (CAND, 2010). Naturopathic Doctors practice in a variety of settings (Boon, 2004). The World Health Organization recommends the integration of Traditional Medicine and CAM into national health care systems (WHO, 2001). Originally based on the German Nature Cure system, Naturopathic Medicine strives to practice traditional and scientific health care. It employs significant levels of patient counselling and education on diet and lifestyle issues. (Boon et al, 2006). There is a need for evidence-based information and organizational support on the presence and scope of Naturopathic Doctors in the public health care system. The ability of NDs to integrate into the Ontario public health system will be explored, as initiated by a baseline look at the scientific worldview compared to that of Epidemiologist counter-parts. The goal is to provide information that is useful to policy makers for responsible, innovative and informed decision-making on CAM integration, in Ontario and elsewhere, in the near future. Methods: The setting for this investigation were established integrative health clinics in downtown Toronto Ontario Canada, including Community Health Centres, with ND presence. 5 NDs and 2 PhD Epidemiologists were interviewed using an eight-question, semi-structured open-ended, qualitative questionnaire. Grounded theory method (GTM) was used to collect and analyse data from these seven CAM experts (n=7). Theories were generated from Key Points and Concepts. Results: Seven semi-structured, open-ended expert interview questions resulted in thirtyeight Key Points and eleven sub-points. Three theories emerged that have practical implication for the potential presence of NDs in publicly funded health care system. At 7 the macro level is System preparedness, at the meso level is NM preparedness and at the micro level is the Role of Naturopathic Medicine in CHCs. These are the theories that emerged, grounded in the data of this qualitative study. Discussion: These results contribute to the research needed in order for systematic policy changes to follow through on WHO recommendations for member-state integration of CAM. Given the presence of NM preparedness, a scientific worldview and an understanding of their role within a publicly funded system, there is a potential function for naturopathic medicine within provincially funded Primary Care Teams. The traditional philosophy and scientific practice of naturopathic medicine is currently active, and striving to become evidence-based in order to fill a gap in health care. These results may be of interest to stakeholders in the regulation process of NM currently in Ontario Canada, but also may provide information to other international researchers looking to investigate national CAM or local integration potential and involvement in public health efforts.
... Particularly, many previous studies also have demonstrated dramatic increases in the understanding and application of TCM in China, the United States, Canada, Australia, and European countries. [5][6][7][8] However, most prevalent studies on TCM understanding and application issue were based primarily on common questionnaire surveys, simple telephone interviews or collecting few data from insurance claims, comprehensive and systematic survey has rarely been conducted. For example, no survey has been reported focusing on community residents, using a well development questionnaire that includes TCM non-drug therapy (acupuncture, massage, cupping, auricular acupuncture, TCM healthcare knowledge and treatment technique, such as medicated diet, medicinal tea, Tai Chi and Qi Gong). ...
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Objective: To investigate how community residents in Beijing understood and used Traditional Chinese Medicine (TCM) in their medical practice. Methods: This was a cross-sectional study conducted on 3410 community residents from four large communities of Tongzhou district in Beijng, China. A validated, self-administered questionnaire comprised of three sections was used to gather the data. A systematic sampling procedure was applied to recruit the community residents. Results: A total of 3410 participants completed the questionnaire survey. It showed that in highly educated residents, 33.4% (170) knew of the names of 3-10 Chinese herbals, 35.8% (182) knew of names of 3-10 traditional Chinese patent drug. Among all the respondent residents, 80.7% (2753) believed that TCM herbal therapy and TCM non-drug treatments were effective in disease treatment, health enhancement, 85.7% (2923) had taken traditional Chinese patent drug in their life, 56.8% (1937) of residents had used herbal decoction, 40.0% (1365) had received non-drug treatment of TCM, such as acupuncture, massage, cupping, auricular acupuncture. Among the elderly residents, 11.4% (98) often used Chinese patent drug and 9.8% (85) often used herbal decoction. In addition, 70.8% (2415) of residents were willing to accept knowledge and information on TCM for health enhancement and disease prevention, such as medicated diet, medicinal tea, Tai Chi and Qi Gong, although 82.8% (2825) of residents had never used them. Conclusion: Chinese patent drug and herbal decoction are widely used in the communities in Beijing, and there existed a possible close correlation between high educational level and better understanding of TCM. Age and occupation also correlated with the attitude to TCM therapies. The characteristics of the residents should be considered seriously in the course of promoting the understanding and application of TCM.
... Further, many so-called conventional practitioners in North America such as nurses, pharmacists, physicians, physiotherapists and psychiatrists have integrated CAM therapies like acupuncture, acupressure, massage, mind-body therapies into their regular practices (Achilles et al., 1999;De Bruyn, 2001;Hirschkorn and Bourgeault, 2005;Tataryn and Verhoef, 2001). In Canada for example, there has been some acceptance of CAM practitioners per se as part of the health care system, given that acupuncture, chiropractic care, midwifery, and naturopathy are regulated health professions in some provinces, and some extended health benefit plans cover them (Achilles et al., 1999;Boon, 2002;De Bruyn, 2001;Tataryn and Verhoef, 2001). However, steps in this direction have been slow for the majority of CAM modalities. ...
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Complementary and Alternative Medicine (CAM), particularly naturopathy, has increased in popularity among the Quebec population. Simultaneously, vaccine hesitancy is gaining momentum worldwide. If this trend persists, vaccination rates could decrease and there could be a resurgence of many deadly illnesses. Scientific literature suggests that CAM practitioners and their users have generally negative attitudes towards vaccination. It is therefore of the utmost importance to study the links between vaccine hesitancy and naturopathy in Quebec. Within the scope of my Master’s, I studied the influence of knowledge and trust on naturopaths’ ways of reasoning about risks associated with vaccination and I investigated how they manage these risks. To achieve this goal, I conducted 15 semi-structured interviews with Quebec naturopaths. The results of my research suggest that Quebec naturopaths believe that health can be achieved through a study of the causes of diseases in a holistic perspective and through the stimulation of the body’s vitality. Diseases, in this perspective, come from the imbalances of what naturopaths call the “field”. Through their practice, primarily based on nutrition, they encourage their clients to autonomously take responsibility for their health so they can restore the balance of their fields themselves, and therefore, return to health. This notion of health and care, paired with the trust naturopaths have toward their experiential knowledge, play a key role in how they think about risks inherent to vaccination and infectious diseases. Concerns about the risks that vaccination might break the homeostasis of the field are far greater than those associated with the risk of infectious diseases. Therefore, to manage these risks, naturopaths adopt many strategies that target the upholding of the field’s balance.
Chapter
Complementary and alternative medicine (CAM) is commonly used to prevent and treat various medical conditions worldwide. The chapter begins with a description of the epidemiology of CAM use among individuals with renal conditions, and discusses the legal and ethical considerations of CAM use. This is followed by a review of the scientific evidence regarding the efficacy and safety of CAM therapies (including natural health products, traditional Chinese medicine and massage) used to prevent and treat symptoms associated with various renal conditions (including urinary tract infections, nephrotic syndrome, chronic renal failure) with a special focus on pediatric populations. Some CAM therapies (e.g. cranberry, omega-3 fatty acids) considered have been researched more widely among pediatric populations than others; pediatric data are preferentially discussed when available. Some CAM therapies may be effective and relatively safe for use among pediatric populations (e.g. acupressure or acupuncture for uremic pruritus), while other CAM therapies have limited evidence and warrant further investigation (e.g. many traditional Chinese medicine herbal remedies).
Alternative Medicine in Canada: Use and Public Attitudes Vancouver: The Fraser Institute
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Ramsay C, Walker M, Alexander J. Alternative Medicine in Canada: Use and Public Attitudes. Public Policy Sources Number 21. Vancouver: The Fraser Institute; 1999
Alternative Medicine in Canada: Use and Public Attitudes. Public Policy Sources Number 21. Vancouver: The Fraser Institute
  • Ramsay C M Walker
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Ramsay C, Walker M, Alexander J. Alternative Medicine in Canada: Use and Public Attitudes. Public Policy Sources Number 21. Vancouver: The Fraser Institute; 1999.
Health Professions Council Post-hearing Update of Preliminary report: Naturopathic Physicians
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Epstein IE, Kazanjian A, MacAulay D. Health Professions Council Post-hearing Update of Preliminary report: Naturopathic Physicians. Vancouver: Government of British Columbia; 2001 March.
Complementary and Alternative Leaders Address the Professionalization Process
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Wellman B, Boon H, Kelner M, Welsh S. Complementary and Alternative Leaders Address the Professionalization Process. In: International Scientific Conference on Complementary, Alternative & Integrative Medicine Research; 2001;
Status Report and Analysis of Health Professional Regulations in Canada Prepared for the Federal/Provincial/Territorial Advisory Committee on Health Human Resources
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Casey JT. Status Report and Analysis of Health Professional Regulations in Canada. Edmonton, Alberta: Prepared for the Federal/Provincial/Territorial Advisory Committee on Health Human Resources; 1999 March.
Prepared for the Federal/Provincial/Territorial Advisory Committee on Health Human Resources
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Casey JT. Status Report and Analysis of Health Professional Regulations in Canada. Edmonton, Alberta: Prepared for the Federal/Provincial/Territorial Advisory Committee on Health Human Resources; 1999 March.
Public Policy Sources Number 21. Vancouver: The Fraser Institute
  • C Ramsay
  • M Walker
Ramsay C, Walker M, Alexander J. Alternative Medicine in Canada: Use and Public Attitudes. Public Policy Sources Number 21. Vancouver: The Fraser Institute; 1999.