The Naturopathic Industry

1. Georgette de Groot Devon Poznanski Garth Vatkin The Naturopathic Industry

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Where Regulation is Established

10. Regulation Continued… • Professional Associations and Regulatory Boards:

11. 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

12. 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)

13. 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

14. 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”

15. Naturopathic Normative Analysis • What the government “should“ do • Economic efficiency • Other social objectives • Fairness

16. 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

17. 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

18. 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

19. 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

20. 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

22. 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

23. 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

24. Stakeholder Interactions • Government, public and naturopathic physicians collaborative • BCMA adversarial

25. Regulatory Reforms Three current reforms: • 1) Regulation for all provinces and territories • 2) Prescription and lab rights • 3) Internal reform

26. Reform We Suggest • A) Education institutions • B) Foreign trained NDs • C) Pharmaceutical manipulation

27. Winners and Losers • NDs • Public • Medical Doctors • Government

28. 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

29. 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

30. Naturopathic Doctors • Drawbacks • Arguments among naturopaths: types of research, older practitioners • Cost: time and money

31. Public • Increased standards of care and education • Better health outcomes through increased exposure? • Patient empowerment

32. 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?

33. Government • Better health outcomes = reduced strain on health care system • Legislation of regulations took time and money • Increased demand = increased expenditures

34. 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

35. 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