Ontario Legislative Progress
In what amounts to be an historic and significant change within the Ontario homeopathic community, eight influential members reached consensus and expressed their concerns and suggested improvements to the Health Professions Regulatory Advisory Council (HPRAC) report: Critical Links : Transforming and Supporting Patient Care: A Report to the Minister of Health and Long-Term Care on Mechanisms to Facilitate and Support Interprofessional Collaboration and a New Framework for the Prescribing and Use of Drugs by Non-Physician Regulated Health Professions.
The eight members requested that the Minister set aside recommendations by HPRAC in respect to regulations for the Naturopathy Act 2007 on the practice of homeopathy by the naturopaths with respect to the practice of homeopathy by the naturopaths until the Transitional Council for homeopathy has provided the Minister with advice on standards of education and practice for homeopathy (designed to protect the public) as is its role as set out in the Homeopathy Act, 2007.
This action by the community demonstrated a willingness to dialogue and to act for a common purpose and to work to preserve the profession of homeopathy and to make it flourish.
In Ontario, since June 2007, Bill C-171 has added five new professions to be regulated under The Regulated Health Professions Act (RHPA). There are now 28 health care professions including medical doctors, dentists, nurses, chiropractors, naturopaths and homeopaths. The stakeholders in Ontario who have been involved in discussions with the government regarding the regulation of homeopathy await the formation of the Transitional Council that will be responsible for establishing the Homeopathic College whose main purpose is Public Protection and Public Interest. Basil Ziv, NASH’s Bi-national Liaison, has been meeting with each of the stakeholders in order to help unify the homeopathic community and thereby assist in facilitating the process. All of the participants have now agreed that there are solid advantages to regulation and there appears to be a genuine willingness to work together for the common good of the profession. Basil continues to meet with all of the stakeholders with the objective of bringing Ontario homeopaths, schools and associations together to participate in a joint conference. Through cooperative effort, we will have the chance to establish homeopathy, in the 21st Century, as a powerful alternative to the current medical system.
In Ontario there are moves underway to regulate the practice of homeopathy. Proposals have been put forth by the Ontario Homeopathic Association (OHA) to widen the scope of practice of homeopathy so as to include homeopathy within the RHPA (Registered Health Practitioners Act) which also includes medical doctors. Under this Act, homeopaths would be able to conduct certain medical procedures including making medical diagnosis, penetrating the skin, etc. In addition, the proposal makes recommendations regarding the educational requirements in respect of the medical sciences that exceed those currently required by the CHC. The Ontario homeopathic community felt this scope of practice was not reflective of the practice of homeopathy. Our Canadian rep, Basil Ziv, has led a coalition of homeopathic organizations to object to this original proposal.
Subsequently, it now appears that HPRAC will indeed recommend to the Minister of Health in Ontario that homeopathy be regulated under the RHPA Act and that the homeopaths join the naturopaths under a common college. The details of this arrangement would be left to a joint committee. HPRAC must submit its proposal to the Minister by the end of March 2006.
As you may know, the Canadian government has been on the trail of the regulation and registration of homeopathy in Ontario. In order to study the question of statutory regulation of healthcare professions including alternative health professions, the Ministry of Health commissioned an organization called HPRAC to assess issues such as the risk of harm from the profession and the relative interest among professionals in statutory regulation. Various organizations had been called upon for comments and input for the government’s report. The results of this five-year project are detailed in the following link: www.hprac.org/downloads/newdirections/english.pdf.
Some of the conclusions drawn from this study are of service to the profession of homeopathy while others offer an incomplete or biased view. NASH has been sifting through the information and has developed a response to HPRAC. Concurrently, this same HPRAC document has been circulated within the Homeopathic Action Alliance. The CHC and CHE have also submitted responses. Please view our letter of response to Canada’s Ministry of Health.
NASH is working on a more elaborate response whereby we have surveyed our Canadian members for their input and are developing a task force to review the report with a fine toothed comb. We will then develop a legal response in line with the larger community of homeopaths in Ontario and Canada.
We have talked with representatives from the Ontario Homeopathic Association, The British Institute of Homeopathy, The Devon School of Homeopathy, The Ontario Society of Homeopaths, the West Coast Society of Homeopaths, NUPATH, and more.
We have developed a response to the Ministry of Health whereby we recommend a two-tiered system of regulation for (a) the homeopathic doctor (licensed provider with access to controlled medical acts), and (b) the self-regulated homeopathic professional. Here are the NASH response letters ( Appendix A, Appendix B, and Appendix C,).
The situation in Canada provides an opportunity to look at the many facets of moving homeopathy into a place of recognition in the medical world. It is clear that it won’t be a smooth transition, and NASH is working hard to prepare for changes both in Canada and the U.S.
We hope that we can impact some of the decisions HPRAC has made for Canadian homeopaths. While we keep abreast of the situation in Canada, we are working toward developing unity in the U.S. homeopathic community to prepare for the inevitably of the federal governments imposition of a similar recommendation. The work ahead requires a degree of cooperation and unity to build strength in our profession.
Correction to July Update
Just a clarification of terms – The regulation of homeopathy reported on in the July update is the Ontario PROVINCIAL legislation. It is not Canadian federal legislation. Health is a provincial matter in Canada. “Health Canada” is a FEDERAL body that is concerned specifically with the medication side. So, access to homeopathic medicines is a federal, not a provincial concern. If this legislation is passed, it only will apply to practitioners in the province of Ontario and it only directly affects them. Of course, it may become a future model for other provinces, hence the interest outside of Ontario. Also, we had reported that it was a five-year project when in fact it was only a one-year project. Thank you Pat Deacon of the British Columbia Society of Homeopaths for this clarification and Karen Werhstein of the Canadian Society of Homeopaths
Click here for response to HPRAC
NASH’s Proposal for Ontario
NASH was originally conceived to be a bi-national organization representing Canadian and American homeopaths. Initially, NASH had an active Canadian branch of the organization located on the west coast of Canada. Over the years, however, awareness of the needs of our Canadian members by NASH and participation of Canadian members had dwindled.
The NASH board is dedicated to revitalize NASH’s presence in Canada and to help develop ways, in cooperation with our Canadian members, to promote the practice and professionalism of homeopathy in Canada and to develop a unified body of practitioners with a strong presence in the face of governmental regulation.
Recent independent studies of regulatory structures for CAM modalities are in harmony with what the original founders of NASH have found: the key to the protection of the profession and the provision of safe practices is voluntary self-regulation. This system assures both self-determination and consumer protection, However, this system depends on a stronger role of professional societies working with governments. We recommend you read the two reports by the Prince of Wales Foundation for Integrated Health and the House of Lords Report for more details information in this regard:
The most significant step for homeopaths to exercise control over their profession is for practitioners to join an established professional organization like NASH that has a system of voluntary self-regulation in place including:
- educational and supervised clinical training requirements
- certification process
- standards and scope of practice
- code of ethics
- grievance procedures
- accountable electoral and fiscal structure
We invite all Canadian homeopaths to participate in shaping the homeopathic profession and to join NASH.
The first part of the NASH plan is creating an opportunity for all Canadian homeopaths to fast-track into the “registered homeopath” level of membership via an incentive program to become first an associate member and then benefit from a first-class prep-program to help pass the CHC exam. We will be working with the CHC to facilitate the process of certification and to improve access for Canadian applicants to exam facilities. We also encourage Canadian professional associations and educational institutions to work with us, the CHC and the CHE to create unified educational standards in Canada. NASH will be contacting directly as many Canadian homeopaths as possible to encourage them to join.
The second part of our plan is to negotiate on behalf of the Canadian homeopathic profession and to work proactively with the provincial governments in setting up a two-tiered system: recognition of self-regulation based on NASH, the Prince of Wales Foundation’s Report, etc., and a regulatory structure for statutory regulation of primary care homeopaths.
The Ontario government has introduced a bill that would impose statutory regulation on homeopathic practitioners and create a joint regulatory body for naturopaths and homeopaths. Many Ontario homeopaths feel that this legislation represents an undesirable shift in the status quo, that it will make it difficult or impossible for many homeopaths to continue serving their patients and clients. Some homeopaths have expressed reservations about being regulated along with the NDs and many have submitted their concerns to the Ontario government.
NASH President Manfred Mueller and Canadian Representative Basil Ziv have been in touch with the Ontario Ministry of Health and members of parliament to discuss the NASH model of voluntary self-regulation. In the past, lay homeopaths and professional homeopaths have greatly contributed to the advancement of homeopathy. NASH supports the preservation of a non-statutory practice model of classical homeopathy in Canada and the U.S. We feel that the NASH model of voluntary self-regulation will be preferable to government regulation in protecting consumers and in assuring continued access to homeopathic services.
We invite all Canadian homeopaths to join our efforts and become members of NASH. Please contact Basil Ziv or Manfred Mueller if you would like to help.
April, 23, 2007
Ontario Homeopaths Claim Their Profession Is Being Hijacked
The North American Society of Homeopaths (NASH) made a presentation to the Ontario Legislature’s Standing Committee on Social Policy today objecting strongly to Bill C-171 that would regulate the Homeopathic Profession through a joint professional college with the Ontario Association of Naturopathic Doctors.
NASH identified a number of critical errors made by the Health Practitioners Regulatory Advisory Council (HPRAC) in its recommendations to the Ontario Ministry of Health and Long-term care. In particular NASH claimed that HPRAC had not adequately consulted with the homeopathic community and was promoting a minority view that would significantly change the existing scope of practice. NASH pointed out areas of potential conflict of interest as supporters of the regulation proposal are poised to benefit significantly from an increase in students of homeopathy in their associated schools at the expense of other homeopathic schools in the Province.
NASH stressed that Homeopathy, if practiced by a qualified practitioner, can cure patients of a wide range of chronic diseases without substantial risk of harm. Homeopaths work in partnership with Doctors of Medicine and Naturopathy to ensure that patients are properly supervised by a regulated primary care practitioner. As well NASH pointed out that regulation of a profession is costly and the misapplication of regulation would provide no additional protection to the public while at the same time substantially increasing the cost of homeopathic care.
NASH advised the Committee Members that homeopaths in other jurisdictions in the United States, the United Kingdom and Australia were operating successfully under self-regulation regimes with the encouragement and support of government. NASH pointed out that since the government failed to present evidence that a majority of Ontario homeopaths support regulation and that their practice presents a substantial of harm to the public, Bill C-171 falls short of meeting two essential provisions of the Registered Health Professions Act.
NASH requested that the Standing Committee recommend to the Minster of Health that the proposal to regulate Homeopathy be dropped from the massive omnibus Bill and the matter referred back to HPRAC for further study.
Basil Ziv, RSHom (NA), CCH
Canadian Board Member
343 Carrville Road
Richmond Hill ON L4C 6E4
President, North American Society of Homeopaths
P.O. Box 450039
Sunrise, FL 33345-0039, USA
Phone: 206.720.7000, fax: 208.248.1942
NASH presentation to HPRAC Bill 171 – Canada
As you are aware, NASH made a presentation to HPRAC on April 23rd regarding governmental regulation of homeopaths under the naturopathic college. We will keep you posted on the response. Thank you to those members who have supported our work in Canada.
Over the years, NASH has had greater or lesser involvement in Canada, with or without a Canadian representative. Many thanks go to Basil for his dedication to representing the voice of the Canadian homeopaths. We look forward to helping bring greater unity in the multiple factions of homeopaths that work throughout Canada.
Bi-national liaison Basil Ziv and president Manfred Mueller have been working closely with various Canadian organizations regarding the Ontario Regulation bill. In mid-May, the Ontario government withdrew its original proposal to create a combined College of Naturopaths and Homeopaths and, in addition, the controlled acts have been removed. In its place the government proposed two separate colleges under similar conditions and this legislation, contained in the massive Bill 171, passed into law as of June 4, 2007. We at NASH are satisfied that our efforts and those of other members of our coalition succeeded in protecting the integrity of our profession. We have achieved this by obtaining our own College as distinct from the Naturopaths and we have protected the current level of practice of homeopaths by having the controlled acts removed. We see this development as a significant milestone for the promotion of homeopathy as a stand alone profession.
The new Homeopathy Act calls for the formation of a Transitional Council that will develop and implement regulations, by-laws and policies relating to the ethics and standards of practice of homeopathy in Ontario. As many as nine individuals from the homeopathic community will be appointed to this council and notice of these positions will be posted on the Public Appointments Secretariat website; www.pas.gov.on.ca/scripts/en/home.asp. NASH is looking to be appointed to this transitional council as we have an already internationally recognized standard of practice and ethical guidelines. We also share the concern of the Canadian Society of Homeopaths in that we want to make sure that the transitional council will reflect the needs of the entire homeopathic community in Ontario rather than specific interests.
While regulation is not health freedom we do believe this to be a significant success for the recognition of the practice of homeopathy. We will keep you posted on updates as they develop.
In response to the Ontario government’s attempt to regulate the homeopathic profession, NASH initiated a coalition of Ontario homeopathic organizations to consider and to respond individually and collectively to the government initiative. This culminated with NASH’s formal presentation to HPRAC which included our proposal to establish a two-tiered system thereby satisfying homeopaths who were in favor of statutory regulation including certain controlled acts and those who favored voluntary self-regulation without the controlled acts. Earlier this year, Bi-national Liaison Basil Ziv and homeopathic student Jim Roy testified at a committee hearing before the Ontario Legislature reiterating NASH’s proposals. Subsequently, the Ontario government passed Bill C-171 into law and homeopathy is now regulated under the RHPA. The government had proposed a joint college with the naturopaths and we believe that our stand helped ensure that the homeopathic profession would have its own college independent of the naturopaths. In addition, regulation of homeopathy will not include any of the controlled acts. Last week the government invited NASH to attend an information session regarding “The Regulation of Health Professionals in Ontario.” This first session was arranged to provide information to the stakeholders about the Transitional Councils and the Colleges. For a more detailed report on our efforts in Ontario, please see Basil Ziv’s article in this year’s issue of The American Homeopath.
Presentation to the Standing Committee on Social Affairs Ontario Legislative Assembly
On Schedule C of Bill C-171, the Health Improvement Act regarding the Naturopathy and Homeopathy Act.
April 23, 2007
We very much appreciate the opportunity of meeting with you today. We are here to convey some significant concerns that the homeopathic community has about Schedule C of Bill 171, the Health System Improvement Act regarding the proposed Naturopathy and Homeopathy Act. We also will propose solutions that you may wish to incorporate as amendments into this act.
Jim Roy and I are members of NASH, the North American Society of Homeopaths. I am a practicing homeopath here in Toronto and, like all NASH registered Homeopaths am board certified. Jim has an extensive consulting background in organizational development and is a student of homeopathy intending to practice after retirement. Since 1990 NASH has pioneered the concept of voluntary self-regulation and has advised a number of jurisdictions across North American on how best to work with the homeopathic community. Jim and I have been active in facilitating discussions among different groups in the Ontario homeopathic community regarding the regulation project and have met with HPRAC. As well NASH has conducted a survey of Ontario Homeopaths to get their feedback on the different options for improving the homeopathic profession in the Province.
We hope, in the short time available, to explain to you the errors that the Health Professions Regulatory Advisory Council (HPRAC) and the Ministry of Health and Long-term care have made, in respect to their documented process, in respect to their analysis and in respect to the solution they propose.
We take as our guiding principle that this Act is about improving the health system, reducing the risk of harm to the public and helping health care professions improve their professional standards, again for the protection of the public.
Regulation should not be an opportunity for one profession to come to dominate and transform another and yet, here in Bill C-171, such an unprecedented proposal is to be enshrined in law.
Unfortunately, in the case of Homeopathy and Naturopathy, HPRAC and the Ministry are effectively intervening in the marketplace and placing the practice of Homeopathy in jeopardy.
It is clear that this wasn’t the intention of the Ministry when it directed HPRAC to work with the homeopathic community to determine if Homeopathy should be regulated. So how did we get to this sad state of affairs?
We ask you to be somewhat sympathetic for the dilemma HPRAC was faced with:
- Homeopathy is one of the few healing modalities where no risk of harm has been demonstrated and the majority. Given this fact the majority of Homeopaths in the Province (as in other jurisdictions) do not agree that regulation by government edict is necessary or even desirable;
- While there are many excellent models of Homeopathic self-regulation in other jurisdictions, and the homeopathic organizations and schools operate in Ontario all draw upon these international best practices, we admit that the homeopathic community in Ontario still has significant work to do in coming to a consensus over standards and in consolidating under one umbrella organization;
- Homeopathy is difficult to master and its application requires patience and persistence on the part of both the homeopath and the patient. It is tempting therefore to take shortcuts, treating the symptoms rather than the whole person, at the risk of not effecting the fundamental cures possible when Homeopathy treatment is done properly. The Naturopaths, the Ontario Homeopathic Association (OHA) and a few other groups favour training their members more in these non-homeopathic healing modalities at the expense of developing the required skills in Homeopathy; and
- HPRAC was almost moribund when the Ministry decided to charge it with the review of a number of health professions. They had to gear up organizationally, were given inadequate consulting resources and were faced with impossibly short timeframes. As the saying goes, you get what you pay for, and in this case the flawed process produced an ill-advised and dangerous set of recommendations not supported by the majority of Homeopaths in the Province.
In initiating its consultative process with the homeopathic community, HPRAC clearly got off on the wrong foot. It solicited a proposal for regulation from the Ontario Homeopathic Association (OHA)which represents a minority of homeopaths in the Province. OHA proposes changes to the scope of practice which are not in sync with the way the majority of Ontario Homeopaths practice. They proposed the addition of controlled acts not required by Homeopaths and they made claims about the risk of harm not supported by rigorous scientific analysis in order to bolster their case for regulation
This was clearly an attempt by one small group to gain economic advantage over their competitors, as their homeopathic school would be well positioned to acquire the monopoly on homeopathic education at the expense of several other excellent schools.
When HPRAC published the OHA proposal on their website, both HPRAC and the Ministry were quickly bombarded with letters of objection from the other homeopathic organizations and schools asking why OHA had been asked to submit a proposal on behalf of the homeopathic community as it is non representative of the majority of Homeopaths and pointing out that OHA had not carried out the extensive consultations it claimed in its proposal.
Subsequently, HPRAC met with OHA and a coalition of those objecting to OHA’s proposal, but only separately, and made no significant attempts to help the homeopathic community reach a consensus on the regulation project.
HPRAC was faced with conflicting business interests and a lack of a solid and viable consensus upon which to base a regulation project.
So what did HPRAC do?
Most disturbingly, HPRAC seized upon a proposal submitted by the Ontario Association of Naturopathic Doctors who claimed that they had superior expertise in homeopathy and that, with their long experience as a regulated profession, were best positioned to take the homeopathic community under their wing (a form of stewardship) through a joint college. They made clear in their proposal that they wished to have the majority to ensure their dominance of the homeopathic profession. HPRAC recommended to the Ministry this proposal for a hostile takeover of one profession by another and the Ministry accepted this unprecedented recommendation.
Our survey of the Ontario Homeopathic Community has shown us that:
- The majority of Homeopaths are adamant that homeopathic remedies have no risk of harm and question the necessity of regulating the profession as well as the haste in which the regulation project is being pursued;
- The proposed controlled acts are not an essential part of homeopathic practice;
- The naturopathic and homeopathic professions are in competition with naturopaths practicing Homeopathy with a level of training below the acceptable level recognized by any homeopathic association or school. However the Naturopaths have a very strong organizational base and are, obviously politically savvy. Homeopaths are deeply concerned that their profession is being hijacked by the Naturopaths with the government’s blessing; and
- The Ontario Homeopathic Community is committed to making advances in the area of self-regulation but is hampered by the lack of government support. Government is other jurisdictions where self-regulation has proven to be successful have partnered with the homeopathic profession.
- Homeopaths are still hopeful that the Ministry of Health will see the error of its ways and partner with us to allow Ontario Homeopaths to develop a model of self-regulation that will be emulated across the country.
So what can be done to remedy the situation?
First, we are asking the Ministry of Health to abandon its interventionist proposal for a forced marriage between naturopaths and homeopaths; please give us back our own profession.
Secondly we are asking the Ministry to revisit HPRAC’s review of the scientific literature on the risk of harm (we have included as an annex to our presentation the literature search NASH submitted to HPRAC and the Ministry showing no documented risk of harm). The Ministry must seriously question the contentions of the OHA and the naturopaths on this issue and the also the contention that we need controlled acts. Both organizations are in clear conflict of interest and do not have the best interests of the wider homeopathic community at the core of their proposals.
The Ministry has already been warned by several homeopathic organizations that it risks legal challenges to these potentially damaging recommendations that have been produced by a flawed consultation process.
And thirdly, and we know most difficult for any government, to admit that the process was flawed, that more time is needed, and the option of self-regulation needs to be fully explored by the Ministry in partnership with the homeopathic community. There are excellent examples of self-regulation in other jurisdictions in the United States, the United Kingdom and Australia. We would welcome this demonstration of leadership and cooperation on the part of the Ministry of Health.
In Homeopathy what is unique in a patient is the key to cure. The government’s “one-size fits all” approach to improving health professions as embodied in Bill C-171 does not reflect the uniqueness and value of the homeopathic profession and risks seriously damaging it.
We look to the members of this committee to recognize that errors have been made and to recommend amendments to this Bill to ensure that Homeopathy is allowed to continue to improve and to fulfill its mission; better health for all.
NASH Response to HPRAC
Health Professions Regulatory Advisory Council
55 St. Clair West
Suite 806, Box 18
Toronto, Ontario M4V 2Y7
Dear Minister of Health and HPRAC Members,
NASH is a trans-national trade organization representing homeopaths in Canada, including Ontario, and the United States. We commend the Ontario Ministry of Health for commissioning the HPRAC to study whether regulation is appropriate for complementary and alternative medical professions. We welcome that in doing so the ministry expressly recognizes the existence of these professions and the profession of Canadian professional homeopaths in particular.
NASH has conducted a survey of our Canadian members in and outside of Ontario about their response to the HPRAC recommendation and conducted a fact-finding mission that assessed the position of the various homeopathic organizations in Ontario. We found that many homeopaths we contacted have concerns that if the homeopathic profession were to be organized in a college with naturopathy, the homeopathic profession may loose its integrity and come under the influence of the naturopathic profession if it were to come under the same college. In addition, over fifty percent of homeopaths do not agree with the assessment that homeopathy as currently practiced presents a risk of harm and some are considering legal action to challenge this and other allegations made by HPRAC in court.
In addition, many homeopaths we contacted have expressed concerns that if it were to come under the same college as HPRAC recommends, the homeopathic profession may loose its integrity and come under the influence of the naturopathic profession. This includes a concern that HPRAC did not make it clear if it views homeopathy as a distinct profession or merely a healing modality of naturopathy.
NASH is further concerned that under current HPRAC recommendation, homeopaths would not have access to all medicines and would not be allowed to compound medicines. Although HPRAC originally found that this would be desirable, the recommendation is that these controlled acts are not recommended. As mentioned in our other feedback forms, HPRAC failed to make a distinction for certified homeopaths that are already committed to self-regulation and have practiced safely.
NASH is concerned that the HPRAC recommendation may have taken a biased view of homeopathic practice with regard to its alleged risk of harm to the public, and may have misrepresented regulatory developments in Canada, the United Kingdom and the United States. What HPRAC has termed the “unacceptable” status quo completely ignores the sixteen-year-old history of voluntary self-regulation in Canada and the United States under NASH standards of competency and code of ethics. HPRAC never contacted NASH about it regulatory standards.
We are also contacting HPRAC through its ordinary response process and are informing them of our concerns with a detailed response to this effect, additionally showing that their assessment of harm is based on bias and on misinterpretation of data. We also present evidence that HPRAC has misrepresented the regulatory environment in the United States and in the United Kingdom, including that of the House of Lords Select Committee Report and the Prince of Wales’ Foundation of Integrated Health model, as well as the regulatory environment in the United States.
NASH pioneered the concept for voluntary self-regulation for homeopaths in Canada and the United States when it incorporated it in its by-laws in 1990. We support voluntary self-regulation of professional homeopaths, unless a risk of harm to the public can be established. So far this has not been done. Homeopathy has been safely practiced without statutory regulation in the United Kingdom as well as in the United States and in Canada. At least two separate reports (Minnesota Department of Health and Chantilly Report) have found CAM practices safe and free from risk of harm, and, specifically for homeopathy, no risks from professional homeopathic practice have been established even by the sources inappropriately quoted in the HPRAC recommendation.
Founded in 1990, NASH was the first professional organization in North America that instituted a certification process and a professional code of ethics for its members. These regulations were based on the standards of British Society of Homeopaths and the International Council on Classical Homeopathy. Since 2001, NASH adopted the Council on Homeopathic Certification, founded in 1993, as independent certification organization. Registered NASH members from Canada and the United States are required to meet rigorous written and oral exams in homeopathy and the human sciences developed by the CHC, and agree to abide by the organizations’ code of ethics and grievance process. HPRAC completely ignored these regulatory efforts and did not contact either NASH or CHC before completing its recommendation.
We understand that the recent HPRAC recommendations were made in response to an application of the Ontario Homeopathic Association, an organization that promotes statutory regulation of homeopathic practice that includes controlled acts. After conducting an investigation of the various homeopathic organizations and groups in Ontario, including the leaders of the OHA, NASH would like to suggest a compromise solution.
We feel that statutory regulation is appropriate for homeopathic professionals that operate within the conventional healthcare system including hospitals and perform controlled acts including diagnosis, prevention and treatment of diseases. In addition, we recognize a legitimate place for a continued safe practice of homeopathy without these controlled acts, and with voluntary self-regulation such as the certification standards and code of ethics established by NASH and CHC. To avoid duplication of efforts and to accommodate to the two main camps of homeopaths in Ontario, we propose a two-tier model of homeopathic practice, different from the one HPRAC examined and eventually rejected:
Homeopaths ought to be allowed to select from two types of practice:
- Homeopathic Doctor: Recognized homeopathic practice that will, after a transitional period involving additional training and education, as agreed upon by the Transitional Committee, include controlled acts as deemed appropriate, and, once they have met standards set up by the Committee, practitioners would be conferred the title Doctor of Homeopathy (HD) and be integrated into the formal healthcare system.
- Homeopathic Practitioners: Recognized homeopathic practice either independently or under the supervision of a homeopathic doctor, provided the practitioner accepts the code of ethics and certification that was voluntarily adopted by the profession through NASH and CHC (avoiding duplication of efforts), without engaging in controlled acts, and agrees to the continuing education requirements of the profession to maintain registration and certification.
We think that this compromise would solve all these concerns and be acceptable to most Ontario homeopaths and their patients. For further documentation of the concerns listed above please refer to the appendix section at the end of this letter.
Our Canadian representative and our Board would be happy to assist the Ministry of Health along with other homeopathic organizations in fine-tuning the process of regulation of homeopathic practice in Ontario.
Manfred Mueller RSHom(NA), CCH
North American Society of Homeopaths
NASH response to HPRAC assessment of risk of harm from homeopathic practice in the absence of statutory regulation
NASH is concerned that the April 2006 HPRAC report “New Directions” misinterpreted data and misrepresented the risk of harm from homeopathic practice in the absence of statutory regulation. NASH is also concerned that any recommendation to regulate professional homeopaths, who as members of NASH have already submitted to voluntary self-regulation, should be based on facts taking self-regulation into consideration. NASH is further concerned that the false impression that is created here about supposed risks may adversely affect and may lead to economic harm for the homeopathic profession. This could also lead to harm for patients because it may direct them away from safe and effective homeopathic treatments and towards riskier conventional treatments and procedures.
The HPRAC report risk of harm assessment from homeopathic practice fails to differentiate between practitioners that have submitted to voluntary self-regulation such as members of the North American Society of Homeopaths as compared with those groups who practice with little or no formal education and no professional oversight. The relative risk of harm is likely to differ between these groups. Furthermore, the HPRAC literature presented to support its conclusion of a significant risk of harm is of poor quality and often biased and unscientific. NASH concludes that the real risk of harm is minimal for the following reasons:
The HPRAC selected for its review of risks poor quality data not published in peer-reviewed scientific journals (numbers refer to New Directions (ND) foot notes in HPRAC report text: 21, 22, 23, 24, 27, 30, 31, 32, 33, 34, 36). The data selected represent individual commentaries, position statements, and personal opinions published in articles, books or articles in the press. This type of information should be reviewed with utmost skepticism when use to assess a highly politically charged subject matter such as the safety of an alternative from of medicine. The sources quoted in the text (ND footnotes 28, 29) that refer to articles published in peer-reviewed research journals are inappropriate for assessing the risk of homeopathic practice (see below). This leaves one audit of adverse events in homeopathic practice (ND foot notes 35) published by a homeopathic journal. It actually refers to data obtained on so-called “aggravations of symptoms” during homeopathic treatment. The aggravations listed are mostly uncomfortable “sensations”, not actual harmful effects. This hardly qualifies as a scientific assessment of real risks of harm. This could be compared to quoting the uncomfortable sensation of numbness from a local anesthetic during routine dental treatment as “risk of harm” from dental care. HPRAC also ignored multiple hard data available from high quality randomized, placebo-controlled, double-blind studies published in peer-review journals that found no adverse effects from homeopathy (see our references below 1-7).
Misinterpretation of Data
The division of risk in terms of “the homeopathic approach”, “practitioners” and “products” is very helpful, however the report does not differentiate between product risks and practice risk in its examples and is therefore misleading. Product risks are irrelevant for assessment of practice risk. Homeopathic products are already regulated in Canada, and a product risk exists whether homeopaths are regulated or not. Only the practitioner risks and the homeopathic approach would qualify for risk from homeopathic practice. Besides, under the Canadian Food and Drug Act potentially harmful products are unavailable to consumers and unregulated homeopaths.
In examining the content of the peer-reviewed articles quoted as evidence of harm, we discover that two of these articles actually report about the harm from abuse of products by consumers, not from homeopathic practice (28, 29). These products were used mistakenly by consumers in two foreign countries, not by prescription, and are not available in Canada or the United States. To draw inferences on homeopathic practice from the use (abuse) of a product that is not available in Canada because it is not considered safe by the regulatory agencies in order to build a case for harm from unregulated homeopathic practice is an inappropriate misuse or misinterpretation of data.
Other references quoted by HPRAC (36; Dantas, F, Fisher, P, 1998) include the practice of homeopathic provings as conducted worldwide prior to 1996, which in some cases, and especially in the distant past, and only in certain countries, may have included some possibly unsafe substances or levels of dilution, none of which are currently used by homeopaths in Canada. Current guidelines accepted in North America (see also Recommended Guidelines for Good Provings, European Council for Classical Homeopathy), make use of safe products only. To include these in an assessment of modern homeopathy is unfair and represents another misuse of data and a possible bias by HPRAC.
The HPRAC report expressed an anecdotal risk that unregulated homeopaths may prevent “other effective medical interventions, or discouraging immunizations.” The references for these allegations are from a private self-published report and from an article in the press (HPRAC foot notes 21, 22). Anecdotal data are unreliable and are often used by persons with a conflict of interest to promote an idea. The above allegations may not hold up to scrutiny in members of professional organizations like NASH, especially considering that NASH requires rigorous human sciences training to become certified. In any case, these data would not qualify as proof of a risk of harm because of their poor quality.
Alleged Indirect Risk
Indirect risks include, according to HPRAC harm from “misdiagnosis, missed diagnosis, disregarding contra-indications, discontinuation, prevention or delay of effective therapy, potentially hazardous diagnostic procedures, and interference of remedies with conventional treatments.”
HPRAC supports only two of these allegations with published data:
- Potentially hazardous diagnostic procedures. No potentially hazardous diagnostic procedures are used in homeopathic practice based on practice standards and scope of practice advocated by NASH, or on other widely accepted international practice standards of classical homeopathy. We were unable to find any rationale for these allegations taken from a book on CAM written by E. Ernst. This should be investigated for potential bias, as Dr. Ernst has made repeated negative and biased statements about CAM, and especially homeopathy, to newspapers and other media. In any case, should the allegation be supported by evidence the practice of such diagnostic procedures should by considered separately from homeopathy.
- Interference from homeopathy with conventional treatments. There is some evidence that this may occur though it has not been proven. The quote comes from a letter to the editor in a peer-review journal by the same author. The letter includes an anecdote about a homeopathic patient who died in spite of seeking conventional care after seeing a homeopath for months. No evidence was provided if the homeopath recommended she see a conventional doctor or about the duration, frequency of treatment or prescriptions. The letter also contains the claim quoted by HPRAC that homeopathic remedies interfere with conventional medications: many doctors also worry that CAM providers might interfere with their prescriptions, and preliminary evidence suggests that this does indeed happen with some regularity. The letter supports this claim with a reference to a study about inflammatory bowel syndrome (Moody GA, et al, Role of CAM in European and Asian patients with inflammatory bowel syndrome, and the role of European and Asian CAM patients. Public Health 1998; 7; 112(4): 269-71). Upon reviewing the study, we found that only 2 out of 192 of CAM patients reported that the practitioners “interfered with conventional prescriptions” by recommending that the patients discontinue their medication, and only about 10% of these practitioners were homeopaths. This amounts to about 0.1% of the homeopathic patients surveyed. If you give CAM practitioners the benefit of the doubt, they may have occasionally have legitimate reasons to recommend this to prevent harm from interaction of medicines. One wonders how HPRAC inferred from a statement by an individual in a letter to the editor “evidence of harm” for homeopathic practice. We doubt very much this “evidence” would hold up in a court of law.
HPRAC has not established any risk of harm from homeopathic practice that would hold up to scientific scrutiny. The evidence presented in the report is weak and relies on anecdotal reports, while ignoring hard data, which results in a biased and one-sided portrayal of the safety of homeopathic practice. Furthermore, those homeopaths who are well-trained in their profession and who are NASH members have been ignored. NASH, on behalf of its members, hereby requests that HPRAC revise, correct or qualify its statements about harm from homeopathic practice and any recommendation or regulation that rests on such an alleged risk.
Walach H, Hieber S, Ernst-Hieber E. Effects of Belladonna 12 CH and 30CH in healthy volunteers: a multiple, single-case experiment in randomization design. N: Bastide M, ed. Signs and Images: Selected Papers from the 7th and 8th GIRI Meeting [Montpelier, France, Nov 20-21, 1993, and Jerusalem, Israel, Dec 10-11th, 1994]. Dordrecht, Boston and London: Kluwer, 1997: 215-226;
Walach H. Does a Highly diluted homeopathic drug act as a placebo in healthy volunteers’ Experimental study of Belladonna 30C in double-blind crossover design- a pilot study. J Psychosom Res 1993; 37(8): 851-860;
Goodyear K, Lewith G, Lorraine Lowe J. Randomized double-blind, placebo-controlled trial of homeopathic “proving” for Belladonna C30. J R Soc Med 1998; 91: 579-582;
Walach H, Köster H, Hennig T, Haag G. The effects of homeopathic belladonna 30CH in healthy volunteers- a randomized, double-blind experiment. J Psychosom Res 2001; 50:155-150;
Vickers A, McCarne R, Fisher P, van Haselen R. Can homeopaths detect homeopathic medicines? A pilot study for a randomised, double blind, placebo controlled investigation of the proving hypothesis. Br Homeopathy J. 2001 Jul;90(3):115-6.;
Vickers AJ, van Haselen R, Heger M. Can homeopathically prepared mercury cause symptoms in Healthy volunteers? A randomized, double-blind placebo-controlled trial. J Alt Comp Med 2001;7(2):141-148;
Brien S, Lewith G, Byant T. Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of belladonna 30C. Br J Clin Pharmacol 2003;56:562-568
NASH response to HPRAC misrepresentation of the regulatory environment in the United States and Canada
The North American Society of Homeopaths (NASH) is concerned that the April 2006 HPRAC report “New Directions” misrepresented the regulatory environment of its members in the United States and Canada. The Recommendation chose to ignore the voluntary self-regulation of homeopaths under NASH. NASH is a trans-national trade organization representing homeopaths in Canada, including Ontario, and the United States.
Homeopaths in the United States practice legally either with or without statutory licenses of the healthcare professions. If the healthcare profession requires a statutory license in a state, homeopaths can legally practice under that license. To avoid the possibility of technical violations by complementary and alternative healthcare providers of various licensing laws, California, Minnesota, Rhode Island, Idaho, Oklahoma, and Louisiana, enacted health freedom laws after these states found no risk of harm from complementary and alternative health practices. Most unlicensed homeopaths in the United States are NASH registered members. Registered homeopaths have agreed to voluntary self-regulation under the NASH by-laws.
All professional organizations of licensed and non-licensed homeopaths have adopted voluntary standards of self-regulation. The American Institute of Homeopathy certifies licensed medical doctors under the American Board of Homeotherapeutics. The Homeopathic Academy of Naturopathic Physicians certifies licensed naturopathic physicians in homeopathy. The Homeopathic Nurses Association has adopted the standards of the Council for Homeopathic Certification (CHC), which certifies homeopaths from all licensed and unlicensed healthcare professions.
NASH pioneered the concept for voluntary self-regulation for unlicensed homeopaths in Canada and the United States when it incorporated it in its by-laws in 1990. We support voluntary self-regulation of professional homeopaths, in the absence of any risk of harm from homeopathic practice. Such as risk has never been established (please see also the NASH response to the alleged risk of harm from homeopathic practice in the HPRAC recommendation).
Founded in 1990, NASH was the first professional organization in North America that instituted a certification process, a grievance process, and a professional code of ethics for its members. These regulations were based on the standards of British Society of Homeopaths and the International Council on Classical Homeopathy. Since 2001, NASH adopted the Council on Homeopathic Certification, founded in 1993, as independent certification organization. Registered NASH members from Canada and the United States are required to meet rigorous written and oral exams in homeopathy and the human sciences developed by the CHC, and agree to abide by the organizations’ code of ethics and grievance process.
We are concerned that HPRAC completely ignored these regulatory efforts and did not contact either NASH before completing its recommendation, and has misrepresented the safety of homeopathic practice among Canadian NASH registered homeopaths.
NASH responds to HPRAC misrepresentation of the regulatory environment in the United Kingdom
NASH is concerned that April 2006 HPRAC report “New Directions” misrepresented the regulatory environment in the United Kingdom. The errors contained in this section of the report may have played a role in HPRAC’s decision in favor of regulation of homeopathy. NASH is not opposed to statutory regulation in principle, and supports statutory regulations for doctoral level homeopaths. Any recommendation in favor of statutory regulation of such professional homeopaths who as members of NASH have submitted to voluntary self-regulation should be based on facts rather than a misinterpretation or misrepresentation of regulatory trends in the United Kingdom.
On page 160, of its report, HPRAC states the following:
“The House of Lord Select Committee on Science and Technology issued a report calling for better regulation of homeopathy along with other complementary and alternative medicines including chiropractic, osteopathy, acupuncture and herbal medicine. On homeopathy in particular, the Select Committee commented that “statutory regulation may ultimately be appropriate.” The drive for regulation is being spearheaded by the Prince of Wales’ Foundation for Integrated Health. The Foundation supports the integration of complementary and conventional medicine in Britain, and is working on a statutory model for the regulation of homeopathy.”
Actually the House of Lords Select Committee report concluded that further statutory regulation in CAM was unnecessary save for those therapies which constituted a risk of harm in unskilled hands. It stated that for the vast majority of CAM therapies, which included homeopathy, that effective voluntary self-regulation provided an adequate means of protecting the public, a view that was supported by the government.
The Prince’s Foundation for Integrated Health issued a report titled “Exploring a Federal Approach to Voluntary Self Regulation of Complementary Medicine.” While it leaves the possibility for statutory regulation open, the report advocates “voluntary self-regulation”, not “a statutory model for the regulation of homeopathy”, as the HPRAC recommendation falsely claims. It supports a voluntary federal structure, providing “opportunities for the professional associations to expand their role in promoting and developing the profession.”
According to the report, the British Department of Health is “committed to the statutory regulation of acupuncture and herbal medicine, it is not currently considering statutory regulation of other complementary practitioners”, such as homeopaths. The Foundation report emphasizes that involvement by the professions in a voluntary federal structure will not automatically lead to statutory regulation (p. 7).
Department of Health Statutory Regulation of Herbal Medicine and Acupuncture. Report on the consultation.
Regulations of Health Professions in Ontario. New Directions. Health Professions Regulatory Advisory Council. April 2006.
House of Lords’ Select Committee on Science and Technology Complementary and Alternative Medicine. The Statutory Office 2000.
Stone, Prof. J Development of Proposals for a Future Voluntary Regulatory Structure for Complementary Health Care Professionals. The Prince of Wales’ Foundation for Integrated Health, 2005
Exploring a Federal Approach to Voluntary Self Regulation of Complementary Medicine. Consultation Document. May 2006