David Stelfox, Grad Dip(WesternHerbMed) BachNat DipRemMass
National Head of Naturopathy, Clinical Studies, Research
Australian College of Natural Medicine Melbourne Australia
Like most colonized countries in the Western world, Australia has a history of natural medicine use that dates back to the first settlement (by the British in 1788). The Government physician on the first fleet was quick to cultivate a physick or medicinal plant garden to provide medicines for all manner of ailments experienced by the government authorities as well as the convicts who established the first settlement. Of course, the original inhabitants of the country, the aborigines, had their own unique natural healing methods that included herbal treatments, food therapy and shamanic practice.
Over the first one hundred years of settlement in Australia, herbal medicine, homeopathy and traditional Chinese medicine formed the greater part of early health care for the inhabitants. “Naturopathy” as such, didn’t really become an entity until the late 1960s to early 1970s, although nature cure practitioners did exist during the early part of the 20th century.
Today, naturopathic medicine is second only to chiropractic as the most popular form of natural medicine health care in Australia. It is estimated that around 64% of Australians currently use natural medicine health care, 1 whether that is through consultations with natural medicine practitioners or self-medication. They spend over AUS$2 billion annually on natural medicine treatments 2 . This is more than the amount spent on over-the-counter pharmaceutical drugs in Australia each year. Growth of natural medicine usage has been quite significant, increasing from around 22% in 1986 to 50% in 1995, through to more than 60% in 1998. A study conducted in 1997 suggested that there were three main reasons why Australians were turning to natural medicine health care. These were:
- Dissatisfaction with the service received from conventional medical practitioners
- Desire for a better understanding of one’s own health condition and participation in the process of improving that condition of well being and health
- An increasing distrust in science and technology and a desire to return to a way of life (including treatment of illness) that is more simple, natural and safe. 3
Unlike North America, naturopathic practitioners are not registered or licensed by State legislation. Statutory regulation exists for chiropractic and osteopathy and, in one state of Australia, for Chinese medicine. The naturopathic profession is self-regulated, meaning that professional associations monitor the practice and training of practitioners. In reality this means that anyone, regardless of their level of education or training can use the title “naturopath” and practice as a naturopathic physician. As more Australians use natural medicine treatments for the maintenance and improvement of their health (often in conjunction with prescribed or over-the-counter pharmaceutical drugs), there is an increasing level of concern by the medical profession and Government about drug interactions and safety of natural therapies. This has raised the question about the need for closer monitoring and regulation by Government, of natural medicine. Currently an enquiry is underway, in one Australian state (Victoria), into the safety of naturopathy and Western herbal Medicine, and the need for statutory legislation to regulate these practices.
It is felt by some that regulation via statutory legislation promotes a higher level of professional conduct and greater credibility of the profession by the public, and also by other health professionals. However, in the case of statutory registration of acupuncture and Chinese herbal medicine (in the State of Victoria) there are those who feel that the process has been largely unsuccessful, and that enhanced validity, higher educational standards, and a more equal standing with conventional medical practice have not been achieved. Additionally, registration of traditional Chinese medicine in the State of Victoria has been by title, rather than by scope of practice. This tends to be the norm in Australia. While it does offer some degree of regulation, it does not prevent inadequately trained individuals from practicing acupuncture, Chinese herbal prescribing, or traditional Chinese medicine. It only stops them from using the titles Acupuncturist, Chinese herbalist, or Chinese medicine practitioner.
Most admit however, that closer regulation of naturopathic practice is both necessary and positive if the profession is to progress further in Australia. Whether this occurs via statutory regulation or by a co-regulatory model that involves both Government and professional associations is a matter for further debate.
Naturopathic education in Australia developed from an apprenticeship system whereby those who showed an interest found themselves a willing practitioner who was prepared to mentor them via on-the-job training. This process existed up until the mid 1970’s when the first of the naturopathy and other natural medicine schools became established. These privately run schools were founded generally by successful practitioners (many whom had formerly taken on apprentices) who were responding to an increased interest in natural medicine treatment by the public, as well as interest in naturopathy as a career by many who had personally experienced its benefits. For around twenty years naturopathic education was provided entirely by private colleges that received no funding from Governments, but which relied solely on student fees to operate.
Government accreditation of naturopathic courses first took place in 1993, when the Australian College of Natural Medicine and the Gold Coast Academy of Natural Therapies were both successful in having their courses accredited. These were accredited as Advanced Diploma qualifications in the vocational education and training sector. In 1995, the first Bachelor’s degree qualification was granted for naturopathic education. This was at the Southern Cross University in New South Wales and was the first university-based naturopathy program in Australia. A year later, in 1996, the Australian College of Natural Medicine and the Southern School of Natural Therapies (both private providers of natural medicine education) were successful in gaining accreditation of their four-year naturopathy degree programs. This set the benchmark for naturopathic medical training in Australia as four-years full-time at degree level or equivalent.
In 2002, the Australian Government introduced national training packages for natural medicine, including Naturopathy and Western Herbal Medicine, which aimed at establishing a standard curriculum via a competency-based training model. This has at least introduced some consistency in naturopathy training courses, although some argue that the standard could have been higher. One of the challenges faced by private providers of naturopathy courses is the lack of understanding or expertise in naturopathic medicine of some members of Government course accreditation panels. A comparison of naturopathy programs offered by both Government-funded universities and by private providers reveals that there is little difference in the structure of the courses.
Nutritional and Botanical medicine are without exception the core therapeutic modalities in naturopathic programs throughout Australia. Most, but not all courses incorporate some physical therapy (but not spinal manipulation), and some (but not all) include homoeopathy. The Western health sciences are core components (Chemistry, Biochemistry, Anatomy, Physiology, Pathophysiology) of all courses, but there is some level of inconsistency with other therapeutic modalities represented in the various programs. These may include flower essence therapy, colloidal mineral therapy, aromatherapy, ayurveda or traditional Chinese medicine foundations. This tends to reflect the somewhat eclectic nature of naturopathic medical practice. Clinic practicum can vary in duration from curriculum to curriculum, with some institutions requiring as few as 500 hours and others more than 1200.
Unlike their colleagues in North America, Australian naturopathic practitioners cannot perform minor surgery, chelation therapy, midwifery, nor administer intravenous injections, or prescribe pharmaceutical drugs due to legislative constraints. These are therefore not incorporated in the curriculums. While Australian naturopaths study pathology lab tests and procedures, they cannot carry these out themselves and must refer patients to pathology labs or general medical practitioners for this purpose.
Concern about safety and efficacy of naturopathic medicine has resulted in more evidence-based education. The university-based naturopathy curriculums tend to place more emphasis on evidence-based information, while the private colleges generally try to maintain the traditional and philosophical focus of naturopathy as well as accommodating an evidence-based approach. Introduction of critical appraisal skills and foundations of research training are further indications of a trend towards a more sophisticated and scientifically sound approach to naturopathic education in Australia. Herbal medicine training in particular has taken a more scientific approach to providing an understanding of the pharmacology and pharmacognosy of plant medicines.
Universities such as Southern Cross are leading the way with research into naturopathy. Southern Cross University, in conjunction with the University of Queensland, is represented by Stephen Myers on the Naturopathic Medical Research Agenda (NMRA) Core Research Team. Of the private colleges, Australian College of Natural Medicine has developed a research agenda based on similar principles to that of the NMRA and are currently embarking on research in various areas of natural medicine practice.
An interesting observation of the nature of students who undertake naturopathy courses for the purpose of pursuing a career in this profession, is that the age at time of enrolment in the programs has decreased significantly over the last ten years. In 1995, the typical enrolling student was between the age of 25 and 40, more often than not had previous tertiary education experience, and was seeking a change in career. In 2004, the typical student has only recently left school, and naturopathy is their first career choice. This is at least partly explained by the fact that these younger students have been raised by parents who themselves have been users of natural medicine. Natural living, healthy diet, use of herbal medicines and nutritional supplements have been part and parcel of their upbringing and naturopathic medicine is a legitimate and even “mainstream” career path (rather than an alternative one) for these individuals.
In Australia, the naturopathic practitioner is generally seen to be something of a general practitioner of natural therapies, and is more commonly consulted by members of the public ahead of practitioners of other natural medicine modalities (e.g. homoeopathy, herbal medicine, nutritional medicine). The majority of private health insurance companies provide rebates for naturopathic consultations. Some also provide some rebate for medications prescribed by naturopaths. Perhaps one of the greatest challenges facing the naturopathic profession in Australia, in the 21st century is the ability to embrace evidence-based practice while remaining true to the philosophy and principles of naturopathy. However, this is not unique to Australia, It is the challenge that naturopathy faces as a profession everywhere. And by all indications, things appear to be moving in the right direction.
References
1. Kermode S, Ramsey L, Myer S. Natural and complementary therapy utilization on the north coast of New South Wales, Journal of Holistic Nursing 1998; Vol 5, No 2: 7-13
2. MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Preventive Medicine 2002; 35: 166-173
3. Siahpush M. Postmodern values, dissatisfaction with conventional medicine and popularity of alternatives. Journal of Sociology 1998; Vol 34, No 1: 58-70