School of Public Health The Practice and Regulatory Requirements of Naturopathy and Western Herbal Medicine Vivian Lin Alan Bensoussan Stephen P. Myers Pauline McCabe Marc Cohen Sophie Hill Genevieve Howse November, 2005 Funded by the Department of Human Services, Victoria Copyright State of Victoria, Department of Human Services, 2006 This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968 (Cth). Authorised by the State Government of Victoria, 50 Lonsdale Street Melbourne. This document may be downloaded from the following website: www.health.vic.gov.au/pracreg/naturopathy.htm ISBN-13: 978-0-9775864-0-0 ISBN-10: 0-9775864-0-5 Published by School of Public Health, La Trobe University Bundoora Victoria, 3086 Australia THE PRACTICE AND REGULATORY REQUIREMENTS OF NATUROPATHY AND WESTERN HERBAL MEDICINE CONTENTS VOLUME ONE Summary Report..........................................................................................................1 1. Introduction.......................................................................................................1 2. Methodology.....................................................................................................1 3. Key findings and recommendations..................................................................2 3.1 Definition of practice and scope of study ........................................................2 3.2 Growing use of naturopathy and WHM...........................................................3 3.3 Growing recognition of naturopathy and WHM..............................................4 3.4 Benefits of naturopathy and WHM..................................................................5 3.5 Risks of naturopathy and WHM ......................................................................5 3.6 Characteristics of the naturopathy and WHM workforce................................7 3.7 Training of practitioners ..................................................................................8 3.8 Organisation of the professions .......................................................................9 3.9 Occupational regulation.................................................................................10 3.10 Consumers’ expectations .............................................................................11 3.11 Regulation of naturopathy and WHM in Victoria .......................................11 3.12 Recommendations for regulatory requirements...........................................14 3.13 Additional recommendations.......................................................................16 1. Introduction to the Project....................................................................................21 1.1 Introduction...................................................................................................21 1.2 National and international context................................................................22 1.3 Scope and organisation of the project...........................................................23 1.4 Evolution of the practice of naturopathy and Western herbal medicine.......24 1.5 Definitions used in this report.......................................................................26 1.6 Organisation of the report .............................................................................27 2. Risks Associated with the Practice of Naturopathy and Western Herbal Medicine.............................................................................................................32 2.1 Introduction...................................................................................................32 2.2 Methodology.................................................................................................32 2.3 Categories of risk ..........................................................................................33 2.4 Risks associated with the clinical judgment of the practitioner....................33 2.5 Risks associated with the consumption of nutritional and herbal medicines37 2.6 Practitioner-reported adverse events in herbal medicine and naturopathy ...48 2.7 Summary of results .......................................................................................53 2.8 Discussion.....................................................................................................54 2.9 Recommendations.........................................................................................55 - i - 3. A Review of Reviews of the Benefits of Naturopathy and Western Herbal Medicine.............................................................................................................68 3.1 Introduction...................................................................................................68 3.2 General citation review.................................................................................69 3.3 Evaluation of pharmacological research in herbal medicine ........................71 3.4 Evaluation of the literature on nutritional supplements and herbal medicine .................................................................................................................75 3.5 Evaluation of the literature on homeopathy..................................................91 3.6 Summary of results .......................................................................................93 3.7 Synthesis of review findings.........................................................................93 3.8 Recommendations.........................................................................................94 4. A Workforce Study of Naturopathy and Western Herbal Medicine Practitioners in Australia.................................................................................97 4.1 Introduction...................................................................................................97 4.2 Methodology.................................................................................................98 4.3 Demographics ...............................................................................................99 4.4 Nature of practice........................................................................................102 4.5 Safety in practice.........................................................................................108 4.6 Education ....................................................................................................111 4.7 Professional context....................................................................................113 4.8 Summary of results .....................................................................................115 4.9 Discussion...................................................................................................116 4.10 Recommendations.....................................................................................117 5. Tertiary Education in Naturopathy and Western Herbal Medicine...............118 5.1 Introduction.................................................................................................118 5.2 Methodology...............................................................................................118 5.3 Overview of education providers and awards identified in Australia (participant and non-participant)...........................................................119 5.4 Courses offered by participating education providers ................................122 5.5 Educational approaches ..............................................................................129 5.6 Student body ...............................................................................................130 5.7 Graduate completions and educational trends ............................................133 5.8 Economic value of naturopathy and WHM education................................135 5.9 Academic workforce in naturopathy and WHM.........................................136 5.10 Quality assurance in naturopathy and WHM education ...........................140 5.11 Views and opinions of naturopathy and WHM education providers........141 5.12 Summary of results ...................................................................................144 5.13 Discussion.................................................................................................147 5.14 Conclusion ................................................................................................154 5.15 Recommendations.....................................................................................154 6. Representation of Practitioners of Naturopathy and Western Herbal Medicine by Professional Associations ..........................................................................157 6.1 Introduction.................................................................................................157 6.2 Methodology...............................................................................................157 6.3 Associations ................................................................................................158 6.4 Membership ................................................................................................165 6.5 Practice standards........................................................................................169 - ii - 6.6 Current concerns of associations ................................................................173