Your Health: Rules of engagement

By MARTIN JOHNSON

Medical students can spend 12 years training to register as a specialist; Bowen therapists' specialist training takes just 12 days. Practising doctors must by law sign up with the Medical Council; Bowen therapists have a voluntary registration body.

Errant doctors can be hauled before council re-education and complaints committees, the Health and Disability Commissioner, a court-like medical tribunal and ACC; Bowen therapists, too, can face the commissioner and Bowen Therapy Inc, but there is no independent prosecution body and patients harmed by the treatment have no medical misadventure recourse to ACC, which covers only those health workers who must be registered by law.

Admittedly, the scalpels and toxic drugs of Western medical science are capable of inflicting far greater harm than Bowen treatment, a form of gentle touch therapy. But the gulf between the two in training, registration and discipline illustrates the extremes of mainstream and alternative medicine.

The Bowen Therapy Inc chairwoman, Gay Jarvis, rejects the tag of fringe therapy for the treatment, which she delivers from a flat at the back of her Palmerston North Home. She prefers "complementary" therapy.

In addition to completing satisfactorily the 12 days' Bowen education, to become a professional member of the Bowen group, practitioners must have passed a basic anatomy and physiology course, hold a current first aid certificate and have the necessary business skills.

Like other representatives of the more than 70 alternative therapies practised in New Zealand - which range from spiritual healing to acupuncture - Jarvis wants to present her method and its practitioners as trustworthy and safe. "Bowen is safe to use on anyone. We are not ACC recognised, but we are striving towards that."

In the absence of statutory regulation of most alternative therapies, some see ACC recognition as a halfway measure. ACC will pay for accident victims to receive acupuncture, chiropractic and osteopathic treatment. But the providers must be registered with the Register of Acupuncturists, the Register of Osteopaths or the Chiropractic Board.

Of these three, only the chiropractic group is required by law to exist. Osteopaths and acupuncturists have been lobbying for a decade for similar status, and many other alternative therapies want it.

The Health Practitioners Competence Assurance Bill, likely to be enacted within weeks, will add osteopathy to chiropractic, medicine, nursing, podiatry, medical radiation technology and 13 other health professions that are now, or will be, regulated by statute.

The bill will be the first to regulate so many health professions under one law. It will also allow unregulated professions to be added if they can satisfy the Health Minister that their health services pose a risk of harming people - doubtless an easy hurdle for needle-based acupuncture at least - and that the practitioners agree on matters like qualifications and standards.

Register of Acupuncturists president Kevin Plaisted said his profession wanted statutory registration because of the risk of harm.

"Acupuncture is intrusive by nature. The public need to be protected, not only because of the risk of applying needles, but also because of the vulnerability of people who come to see people in the healthcare context.

"There's no form of formal discipline. If we suspend someone from the register we can stop their entitlement to claim under ACC, but they can still put a shingle out to say they're an acupuncturist and practise as usual." This has happened.

Also hoping for Government registration are homeopaths, at least one group representing naturopaths and medical herbalists, and the Charter of Health Practitioners, an umbrella group which has 9500 members in affiliate groups, which range from osteopaths and naturopaths to spiritual healers.

"The cost involved in becoming a statutory authority is humungous," said charter chief executive Patrick Fahy, whose organisation was set up a decade ago to protect the public and practitioners.

"A lot of our smaller groups can't do it. That's where the charter has the mass to become a single statutory authority and that's what we've applied for."

But it would seek to bring into this set-up only those signatory groups which wanted it. The rest would remain voluntary-registration bodies and would still enjoy the charter's other benefits.

Homeopathic Society president Bruce Barwell said his group wanted statutory registration partly to eliminate mavericks. Patients were not being harmed by homeopathic medicines, which were safe, but they were at risk of harm from practitioners who tried to treat beyond their competence or who failed to recognise medical conditions.

Health Minister Annette King said acupuncture was the only alternative therapy she knew of that was preparing to seek statutory registration, although the various groups representing Chinese- and Western-oriented practitioners needed to agree on their approach first. She was unsure which others would fit the legislation.

"The idea that you would register somebody who does your colours is something I can't see fitting the test of harm to the public, making a diagnosis, et cetera."

The Government promoted the health practitioners bill as an expansion of the Medical Practitioners Act 1995, which governs doctors. Discipline - now handled by the Medical Practitioners Disciplinary Tribunal, and by other bodies which also control registration, including the Nursing Council and the Medical Radiation Technologists Board - will shift to a new Health Practitioners Disciplinary Tribunal.

At least 19 types of health workers will be able to be charged with malpractice but the list contains just two alternative therapies, chiropractic and osteopathy, and excludes naturopathy, traditional Chinese medicine, colour therapy and the rest as they will not be statutorily regulated.

The prosecutor will be either the Health and Disability Commissioner's director of proceedings or a complaints assessment committee of the accused's registration body.

Alternative therapies not covered by the bill or subsequent Government regulations will escape the attention of the disciplinary tribunal, but not of the Health and Disability Commissioner's office.

Commissioner Ron Paterson said his office received a handful of complaints a year about alternative therapy practitioners. But they were a tiny fraction of the hundreds about mainstream health workers, mainly doctors.

This was partly because many consumers were unaware the commissioner could investigate alternative practitioners. Some who sought fringe healthcare might feel uncomfortable complaining about it because they felt embarrassed at their gullibility.

"Then there are people for whom it [alternative medicine] is a way of life. Even if they don't get the results they want, they aren't willing to lay a complaint. We don't investigate effectiveness of treatment. We investigate the standard we would expect of a reasonable practitioner. In osteopathy, acupuncture and chiropractic there are clear standards. In homeopathy there are some reasonably clear standards.

"Some of the truly fringe practitioners - how does one investigate the quality of care provided by a quantum booster operator [an alternative therapy given to child cancer patient Liam Williams-Holloway, who died in 2000]?"

But his office could investigate complaints on issues like practitioners' sexual misconduct and the adequacy of information they provided on their therapies.

"Reasonable people would want to know about the effectiveness of the treatment. Although practitioners may not able to give scientific evidence, I believe they need to say more than 'I've had a number of people who swear by this treatment'. They've got to be careful not to oversell their therapy."

While chiropractors are the only alternative therapists now liable to disciplinary prosecution by the commissioner's office - the maximum penalty, as for doctors, is to be de-registered - the office can take any accused practitioner, alternative or mainstream, to the Human Rights Review Tribunal, which can award damages.

The commissioner's investigations are limited to recommendations such as refunding a patient's fees, apologising and doing remedial education.

Consumers Institute chief executive David Russell said patients could sue alternative medicine practitioners if their therapies failed to live up to what was promised, but he was unaware of any cases.

"Most people believe they are getting better or that something is happening to them. I know of some desperate cases, one of a woman who died because she believed in a charlatan who was ripping her off for hundreds, if not thousands, of dollars."

Aged in her 40s or 50s, she had a large breast lump which would have been treatable early on, but she trusted in the "mumbo jumbo" of an alternative practitioner and his laying-on of hands.

One purpose of the registration bodies, whether statutory or voluntary, is to ensure registered practitioners' qualifications meet certain standards.

The more-mainstream therapies on the alternative side of the divide, including chiropractic, osteopathy, acupuncture, and homeopathy and others further out like naturopathy, herbal medicine and aromatherapy all have structured degree or diploma programmes.

Many are approved by the Qualifications Authority and in other cases, including naturopathy, acupuncture and chiropractic, the authority has registered trainers, such as the Wellpark College of Natural Therapies, that provide courses in these areas.

Authority spokesman Bill Lennox said, "We've never put ourselves in the position of judging whether something is worthwhile or not. The attitude NZQA has always taken is that if there are nationally recognised experts in their own field and standards can be defined and if we can be assured that there is a demand for a qualification then it's a legitimate thing to develop a qualification in that area."

The Government spends almost $2.2 million a year on alternative therapy training, providing hefty subsidies for many students, just as it does for medical and engineering students.

Auckland-based Wellpark's fees for New Zealanders in the naturopathy programme, its most popular, are $7600 a year, of which the state pays $4000.

It runs courses of between one and three years in aromatherapy, ayurvedic medicine, nutrition, herbal medicine, massage, yoga and a full-time three-year diploma in naturopathy.

Principal Phillip Cottingham said that in addition to tuition in natural therapies, the college's naturopathy and other students received extensive training in medical sciences, including anatomy, physiology, pathology and microbiology. The charter also emphasises anatomy and physiology. Fahy said the charter encouraged practitioners even of "non-tactile" methods such as spiritual channelling to learn at least the basics of these subjects. He accepts some of the practices the charter covers "may seem fringe-y" but asserts they do not weaken the organisation.

"I don't know the first thing about primal healing, but people get results from it and they have standards of how they train people. That's what we're about, making sure these people have standards in place so that they are accountable."

Entry to Wellpark's and other colleges' alternative therapy courses is generally open, without academic prerequisites, although some require sixth form certificate, university entrance, bursary or even more.

Before entering the College of Chiropractic's four-year bachelor of chiropractic course, students must pass eight university or polytech science papers.

To train as a doctor at the Auckland University Medical School, the academic entry requirement is a B+ average in the first year of the bachelor of health sciences course or the bachelor of science (biomedical science) course.

A medical degree requires a six-year course at university and hospitals. After qualifying and spending two more years working in hospitals, doctors can train for five or more further years to become a GP or a specialist, such as an emergency medicine physician or heart surgeon.

Colleges, such as the Royal Australasian College of Surgeons, oversee the hospital-based training and set the exams which culminate in the award of a fellowship. The Auckland and Otago University medical schools are accredited by the Australian Medical Council.

While the orthodox institutions continue to turn out their graduates, the public attraction to alternative medicine seems to be growing. Wellpark College reports rapidly increasing demand for its alternative therapy courses.

Consumer's David Russell urged the Government to give the Commerce Commission more money so it could toughen up on the "out-and-out charlatans" but he doubted new laws could help. "It's difficult to legislate against people's beliefs."

Health Options


The main alternative therapies practised in New Zealand.


Action potential stimulation therapy

Acupuncture

Alexander technique

Anthroposophical medicine

Applied Feng Shui

Applied iridology

Aromatherapy

Aura-soma colour therapy

Ayurveda

Bach flower remedies

Bio energy therapy

Biological medicine

Body electronics

Bowen therapy

Caeteris body/mind energy balancing

Chi Kung Chinese herbal medicine

Chiropractic

Colon hydrotherapy

Colour therapy

Craniosacral therapy

Crystal therapy

Dynamic phytotherapy

Educational kinesiology

Feldenkrais

Flower essence therapy

Gentle therapeutic manipulation therapy

Hellerwork

Herbal medicine

Holistic animal therapy

Holistic pulsing

Homoeobotanical therapy

Homoeopathy

Human potential

Hypnotherapy

Ifas

Intuitive healing Iridology

Isopathy

Jin Shin Jyutsu

Kinesiology

Maharishi's Vedic approach to health (Maharishi Ayur-Veda)

Massage (therapeutic and remedial)

Medical herbalism

Medium channel/intuitive healer/medium

Natural healing sciences

Naturopathy

Neurofeedback (LEG biofeedback)

Neuro-linguistic kinesiology

Neuro-linguistic programming (NLP)

Oriental massage

Ortho-bionomy

Osteopathy

Paramedical aesthetics and aesthetic medicine

Pacific traditional healing methods

Pilates-based body conditioning

Primal healing

Psychotherapy

Rebirthing

Reflexology

Reiki

Rife therapy

Rolfing (structural integration)

Sclerology

Shiatsu

Spiritual healing

Sports therapy

Touch for health test method


* Information from the Ministerial Advisory Committee on Complementary and Alternative Health.