Regulation of Herbalists and Naturopaths in Australia

 

The issue of regulation of the Western herbal medicine and naturopathy professions has been around for some time. Within Australia, there is a National registration system for full and partially registered health professionals - The Australian Health Practitioner Regulation Authority (AHPRA).

AHPRA's operations are governed by the Health Practitioner Regulation National Law, and are in force in each state and territory (the National Law). This Law came into effect on 1 July 2010 and has enabled that for the first time in Australia, 14 health professions have been able to be regulated by nationally consistent legislation under the National Registration and Accreditation Scheme. AHPRA supports the 14 National Boards that are responsible for regulating the health professions. The primary role of the National Boards is to protect the public and they set standards and policies that all registered health practitioners must meet. In 2011, this was followed by partially registered professions such as Traditional Chinese Medicine. The objective of this standardised registration scheme is to remove barriers to practice and to enable the workforce to have the ability to practice between states.

In the third and final round, the working party was asked to consider the need to regulate any unregulated health professions, including herbalists and naturopaths. This process seems to have been delayed indefinitely despite continued lobbying by complementary and alternative medicine (CAM) associations, practitioners, academics, and researchers to proceed with this process. There is the belief amongst those connected to political activities that there is some momentum with the hope that herbalists and naturopaths will be reconsidered at the next review within the next few years.

In 2011 an independent register - The Australian Register of Naturopaths and Herbalists (ARONAH), was formed to mirror the government statutory regulated boards of AHPRA. ARONAH hopes to be fully functioning by mid 2013. While the main stated purpose of ARONAH is the provision of minimum education standards for herbalists and naturopaths in Australia, it will also provide an easily transferable model of statutory registration should herbalists and naturopaths achieve registration with AHPRA.

The criteria for regulation 

Whether a profession is regulated depends on it meeting six criteria adopted by the Australian Health Ministers Advisory Council (AHMAC), which stipulates that regulation is not about recognition of a profession. It is primarily about protecting the public from poorly or untrained, unscrupulous or fraudulent practitioners.

The six AHMAC criteria are:

  • Is it appropriate for Health Ministers to exercise responsibility for regulating the occupation in question, or does the occupation more appropriately fall within the domain of another ministry?
  • Do the activities of the occupation pose a significant risk of harm to the health and safety of the public?
  • Do existing regulatory or other mechanisms fail to address health and safety issues?
  • Is regulation possible to implement for the occupation in question?
  • Is regulation practical to implement for the occupation in question?
  • Do the benefits to the public of regulation clearly outweigh the potential negative impact of such regulation? 

Do our professions meet these criteria?

Most practitioners and associations agree that as a profession we meet most of the criteria outlined above. The one area where there is some disagreement is in criterion 2, ‘Do the activities of the occupation pose a significant risk of harm to the health and safety of the public?’

Those arguing against regulating the professions are implying that the practice of herbal medicine and naturopathy is inherently safe and therefore regulation is unnecessary and only an extra cost burden to practitioners.

A workforce study commissioned by the National Herbalists Association of Australia (NHAA) and the Federation of Natural and Traditional Therapies (FNTT), highlighted a significant number of adverse reactions from the ingestion of herbal medicine prescribed by Western herbal medicine practitioners and naturopaths. The number of adverse reactions was similar to that reported for traditional Chinese medicine (TCM) as reported in ‘Towards a Safer Choice’. In addition to the risk of adverse reactions, there is also a risk of ingested herbs reacting with prescription pharmaceutical medications by either enhancing or diminishing their actions.

In our role as primary care practitioners there is a danger to patients/clients through acts of omission or commission, (things that practitioners do or do not do). This includes misdiagnosis and failing to refer to other health professions (i.e. Medical Practitioners) when appropriate.

The current situation is such that any person, with or without training, can practice as either an herbalist or naturopath. This situation has led to two deaths linked to naturopathic practice being investigated by the coroner in recent years. In both of these cases, the practitioners concerned were not members of any of the associations and neither was suitably qualified to practice as a naturopath or herbalist. Despite the obvious lack of training, these people were described as naturopaths in the press with the subsequent backlash to well trained and ethical practitioners.

The case for regulation 

The NHAA therefore believes regulation is warranted based on: 

  • adverse events associated with herbal and nutritional medicines
  • potential toxicity of some herbal medicines
  • potential for interactions between herbal medicines and pharmaceutical drugs
  • acts in practice that can be injurious to the public
  • acts of omission or misdiagnosis causing delay of appropriate treatment
  • acts of malpractice and fraud resulting in complaints 

The options for regulation 

The options for regulation are: 

  • Maintain self-regulation
  • Co-regulation
  • Statutory regulation 

Maintaining a self-regulatory model will leave both the public and practitioners vulnerable. By not regulating the professions, the public is at risk from bogus and poorly trained practitioners and practitioners are in the situation where their expertise remains unrecognised and undervalued. The NHAA does not see this as a viable option.

The co-regulatory model poses other concerns. For this regulatory option to be successful, it will be contingent upon a single national controlling body for the professions. Several associations, including the NHAA, have engaged in dialogue attempting to create such a body. The association that instigated this working group believes there is a profession called a ‘Natural Therapist’, which includes all modalities practiced under this banner. The NHAA disagrees with this approach and believes it is too simplistic, as there are a large range of modalities and associations, and a desire by practitioners to be recognised by their own modality. In addition, this has proved difficult as there is a desire by some associations to maintain absolute control over the modality practiced by their members. To be effective and have ‘clout’ any national body will need to be the arbitrator of educational, ethical and practice standards as well as maintaining independent registers of qualified practitioners. Given the history of the associations, there is much work to be done to build trust before agreement could be reached on this model.

The last option is statutory regulation. This involves the creation of a national registration board which sets standards for education and ethics and recognises qualified practitioners. This form of regulation limits the use of specific titles such as Western Herbalist or Naturopath to those people who meet the standards set by the registration board, but does not interfere with the way in which practice is conducted. Given the experience of TCM practitioners in Victoria, this is an easy way to protect the public and for suitably qualified practitioners to be readily identified. What this form of regulation will not do is guarantee access to Medicare funding for visits to herbalists or naturopaths.

Advantages and disadvantages 

The NHAA perceives the advantages of regulation, regardless of the form it takes as: 

  • Improved and consistent standards of education for practitioners
  • Protection of the public from fraudulent, untrained and unscrupulous practitioners
  • Better access to  information for consumers
  • Increased community confidence in the professions and enhanced status of practitioners
  • Professional associations able to have a greater focus on improving professional development and benefits for members
  • Incorporation of complementary medicines into the mainstream health system
  • Improve quality and safety in healthcare as a result of better communication and referrals among practitioners
  • Better access to tools of trade for the profession with improved therapeutic outcomes for the public
  • Decrease in administration costs for health funds and insurers
  • Compulsory professional indemnity insurance to protect clients
  • Access to a fair, equitable and transparent complaints mechanism for the public 

The perceived negatives of regulation are generally limited to the professions: 

  • Potential increase in fees for practitioners (regardless of the model)
  • Increase in restrictions to entry to the professions due to higher standards
  • Loss of livelihood to some practitioners who may be refused registration
  • Increase in costs to educational institutions to upgrade courses to comply with new standards. These costs may be passed on to students.
  • Loss of GST free status if registration is refused to a practitioner
  • Need for some practitioners to upgrade their qualifications incurring extra costs 

On balance, the NHAA believes the advantages of being regulated far outweigh the alternate options that perpetuate unregulated professions. The benefits afforded to the public and practitioners alike must sway the debate and auger well for the future of public health in Australia.