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The Naturopathic Industry
Georgette de GrootDevon PoznanskiGarth Vatkin
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History
First began with Hippocrates over 2400 years ago with his concept of “The healing power of nature”
Began in North America by Dr. Benedict Lust who designed a clinical practice that integrated natural methods such as botanical medicine, homeopathy, nutritional therapy, acupuncture and lifestyle counseling
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History Continued…
In 1902 the American School of Naturopathy (founded by Dr. Lust) graduated its first class
Graduates from this school formed the Naturopathic Society of America and began institutions throughout North America
By 1920, naturopathic medicine was widely used in Canada
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History Continued…
Medical advances (examples: new surgical techniques, introduction of antibiotics) during and after WWII placed the naturopathic industry on the backburner
However over the past two decades, as people are becoming more proactive in their health, naturopathy has had a resurgence in popularity
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Regulation
In British Columbia, from 1921-1936, naturopathic doctors were regulated by the College of Physicians and Surgeons
In 1936, the Naturopathic Physicians Act was established separating naturopathy from homeopathy, osteopathy, and most importantly the College of Physicians and Surgeons
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Regulation Continued…
The act ultimately empowered NDs to self-regulate and they did this by creating the Association of Naturopathic Physicians of BC (ANPBC)
Initially the ANPBC was the provincial association and the regulatory body
Numerous amendments were made to the act between 1938-1993
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Regulation Continued…
In 1993 the ANPBC split into the regulatory board (BC Naturopathic Association) and the provincial association (ANPBC)
In 2000 the ANPBC -> College of Naturopathic Physicians of BC (CNPBC)
2009, NDs finally recognized as primary health providers by BC Ministry of Health
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Regulation Continued…
Elsewhere, Ontario, Saskatchewan, Manitoba, and Nova Scotia developed similar regulatory bodies
No other province or territory has regulation standards; however, Alberta is in the process of developing a regulatory body
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Where Regulation is Established
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Regulation Continued… Professional Associations and Regulatory Boards:
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Regulation Continued…
In 1978 the first naturopathic institution was created in Toronto called the Ontario College of Naturopathic Medicine (OCNM)
In 1983 the first ND program was established
In 1992, it became the Canadian College of Naturopathic Medicine (CCNM)
In 2000, a second school called the Boucher Institute opened in New Westminster, BC
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Regulation Continued…
One way that the industry is regulated is through its accredited schools (2 in Canada, 4 in the US and 1 in the process of accreditation)
The Council on Naturopathic Medical Education (CNME) is responsible for setting the criteria used in the accreditation process
CNME was established in 1978 and was designated by national naturopathic associations in the US and Canada in conjunction with the North American Board of Naturopathic Examiners (NABNE)
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Soooo…..How do you become a Naturopathic Doctor?
Complete undergraduate degree Attend accredited naturopathic institution
and complete 4 years of ND training Sit for NPLEX (2 written tests and 1 oral
exam with further elective testing in acupuncture and minor surgery)
Apply for registration with regulatory body in regulated province or state
Maintain continuing education competencies
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How to Become a Naturopathic Doctor OR???? Take an online program and work in an
unregulated state or province under the self proclaimed title of “Doctor or Physician”
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Naturopathic Normative Analysis
What the government “should“ do
• Economic efficiency • Other social objectives• Fairness
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Economic Efficiency
Imperfect competition Traditional medical
domination in primary care In effect, a monopoly
Informational market failure Public payment suggests
government preference Self-regulation signals
“quality” and legitimacy
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Fairness - access
Distribution of net benefits among interested parties
Primary care not equitable or sustainable across province
Access to providers = better health Increased primary care providers =
increased access =better population health
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Fairness - compensation
Public funded primary care versus private
Naturopaths report spending up to 90 min on assessment: mostly private pay. money= more time spent with provider Paying privately and through taxation
may lead to double cost for certain patients
Naturopaths set their rate independently
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Fairness -compensation
BCMA negotiates the contract Negotiation may not pass the “veil of
ignorance” test
Less advantaged may consume more healthcare resources because of the “free” service while affluent may use less and pay more
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Positive Analysis
What are the reasons the regulation takes the form that it does?
Objective of the regulation▪ Standardize and promote self-regulation of
naturopaths
Interactions between stakeholder groups▪ Government▪ Public ▪ Naturopaths▪ BCMA
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Stakeholders“Or what is in it for me”
Government ▪ Increased primary care providers▪ Maximize votes▪ Transfer public funds – spend money to regulate
today and gain the money back from physician visits
Public Improved access to new types of primary
care providers Choice
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Stakeholders Continued…
Naturopathic Doctors Improved professional standards Public protection Proof their standards are high Creates a commodity
BCMA Medical dominance Concern for public safety Issues regarding use of “Physician” and “Doctor” Loss of market dominance
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Stakeholder Interactions
Government, public and naturopathic physicians collaborative
BCMA adversarial
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Regulatory Reforms
Three current reforms:
1) Regulation for all provinces and territories
2) Prescription and lab rights 3) Internal reform
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Reform We Suggest
A) Education institutions B) Foreign trained NDs C) Pharmaceutical manipulation
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Winners and Losers
NDs Public Medical
Doctors Government
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Naturopathic Doctors
Self-regulation offers credibility to their therapeutic modalities
Increased legitimacy in the eyes of outsiders
Obtain research funding and government funds for services This will all lead to a greater market
share of the health care sector
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Naturopathic Doctors
New prescribing privileges in BC Over time, certain naturopathic
remedies have become scheduled Scope of practice was shrinking Can now fully attend to patients’ needs
and keep track of patients medications
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Naturopathic Doctors
Drawbacks Arguments among naturopaths: types of
research, older practitioners Cost: time and money
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Public
Increased standards of care and education
Better health outcomes through increased exposure?
Patient empowerment
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Conventional Medical Doctors
BCMA voiced concern over ND’s increased scope of practice Proper training/education Patients at risk
Motivated by concern for patients or concern for themselves?
Benefit: potential for lighter patient load
Drawback: economic loss?
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Government
Better health outcomes = reduced strain on health care system
Legislation of regulations took time and money
Increased demand = increased expenditures
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References
The Canadian Association of Naturopathic Doctors [Online]. No date [cited 2009 Oct 1]; Available from: http://www.cand.ca The College of Naturopathic Physicians of British Columbia [Online]. No date [cited 2009 Oct 1]; Available from: http://www.cnpbc.bc.ca British Columbia Naturopathic Association [Online]. No date [cited 2009 Oct 1]; Available from: http://www.bcna.ca/ Council on Naturopathic Education Council [Online]. No date [cited 2009 Oct 2]; Available from: http://www.cnme.org/ North American Board of Naturopathic Examiners [Online]. No date [cited 2009 Oct 2]; Available from: http://www.nabne.org/ Association of Accredited Naturopathic Accredited Colleges [Online]. No date [cited 2009 Oct 1]; Available from: http://www.aanmc.org/ BC Naturopathic Association Applauds Provincial Government’s Realization of Commitment to Improve Patient Care in BC [Online]. 2009
[cited 2009 Oct 2]; Available from: http://www.bcna.ca/documents/BCNAapprovalreleaseFINAL.pdf Roles Expand for midwives, naturopaths, and nurses [Online]. 2009 [cited 2009 Oct 2]; Available from:
http://www.binm.org/docs/binmprescription.pdf Alberta Association of Naturopathic Practitioners [Online]. No date [cited 2009 Oct 1]; Available from: http://www.naturopathic-alberta.com/ Welsh S, Kelner M, Wellman B, Boon H. Moving forward? Complementary and alternative practitioners seeking self-practice. Sociol Health
Ill. 2004; 26(2): 216-241 Arentz, S. (2003). Interview with a Canadian naturopath. J Aust Traditional – Medicine Society. Sep 2003; 9(3): 137-140. Brander, JA. Government Policy toward Business. 4th ed. Ontario, Canada: John Wiley & Sons Canada, Ltd.; 2006. Exploring a Federal Approach to Voluntary Self Regulation of Complementary Healthcare. The Prince’s Foundation for Integrated Health
[Online]. 2006 [cited 2009 Oct 3]; Available from: www.fihealth.org.uk CBC News: B.C. gives naturopaths right to prescribe drugs [Online]. 2009 Apr 10 [cited 2009 Oct 6]; Available from:
http://www.cbc.ca/canada/britishcolumbia/story/2009/04/10/bc-naturopaths.html Bubela T, Caulfield T, Boon H. Trends in Evidence Based Medicine for Herbal Remedies and Media Coverage. Health Law Review. 2006 Sep
22; 15(1): 3-8 Rosack J. Residency Program Addresses Drug Company Influences. Psychiatric News. 2001; 36(13): 5
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References Continued…
Primary Health Care Charter: A Collaborative Approach [Online]. 2007 [cited 2009 Oct 3]; Available from: http://www.primaryhealthcarebc.ca/library/publications/year/2007/phc_charter.pdf
The Quebec Association of Naturopathic Medicine [Online]. No date [cited 2009 Oct 3]; Available from:
http://www.qanm.org/safety_regulation.html NLM Gateway. Abstract: The Scope of Primary Care Practices in British Columbia, Canada [Online]. 2000 [cited 2009 Oct 4];
Available from: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102272797.html Lin V, McCabe P, Bensoussan A, Myers S, Cohen M, Hill S et al. The practice and regulatory requirements of naturopathy and
western herbal medicine in Australia. Risk Management and Health Care Policy. 2009; 2: 21-33 Sibbald B. New federal office will spend millions to regulate herbal remedies, vitamins. CMAJ. 1999 May 4; 160(9): 1355-
1357. Facebook [Online]. No date [cited 2009 Oct 4]; Available from:
http://www.facebook.com/topic.php?uid=34585339566&topic=6434&ref=mf Freidson, E. Professional Dominance: the Social Structure of Medical Care. 1st Edition Atherton, New York Shahjahan R. Standards of Education, Regulation, and Market Control: perspectives on complementary and alternative
medicine in Ontario, Canada. J Alternative and Complementary Medicine. 2004; 10(2): 409-412 British Columbia Medical Association [Online]. No date [cited 2009 Oct 4]; Available from:
https://www.bcma.org/files/BCMA_Submission_NP_Regulation.pdf CBC News: Canadian doctors overworked, unable to meet patients’ needs: survey [Online]. 2008 Jan 9 [cited 2009 15 Oct];
Available from: http://www.cbc.ca/health/story/2008/01/09/doctors-survey.html Boon H. Regulation of complimentary/alternative medicine: a Canadian perspective. Complimentary Therapies in Medicine.
2002; 10: 14-19