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Guest Writer Steven Carter: The State of Integrative Medicine in Canada PDF Print E-mail
Written by John Weeks   

Guest Writer Steven Carter: The State of Integrative Medicine in Canada

Summary: Steven Carter, the long-time editor of the Journal of Orthomolecular Medicine. As such, he has been a fixture, organizer, writer and observer of the development on complementary, alternative and integrative medicine in Canada for over 2 decades. Carter was asked by the organizers of the 2011 Dr. Rogers Prize to delivery a 10 minute overview on the state of these developments in his country. He touches on recent controversies with complementary medicine and Ontario physicians, the IN-CAM national network, the coverage plan in British Columbia and what he sees as a threat to access to natural products. I thought Carter's review might be of interest to Integrator readers and asked him if I might publish it. He agreed.

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On September 23, 2011, Steven Carter delivered a 10-minute opening address to participants in an afternoon colloquium on integrative clinic models in Canada. Carter was selected for the job by the organizers of the Dr. Rogers' Prize for good reason. Since 1984, he has held a wide array of roles as organizer, publisher, writer and editor in the evolution of the complementary, alternative and integrative medicine fields. He is a co-founder of the International Society for Orthomolecular Medicine for which he produces the annual conference. He also serves as managing editor of the Journal of Orthomolecular Medicine. I asked Carter if I might share his overview with Integrator reader. He approved.
 

__________________________________

Integrative Medicine in Canada

A presentation at the Dr. Rogers Prize Colloquium
September 23, 2011


- Steven Carter



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Steven Carter
Introduction

For integrative medicine to grow in Canada, support is required from five areas: Research, Education, Medical Associations, Government, and Business. The ultimate goal for all these areas is to provide optimal health care for Canadians, and effective integrative medical clinics can play an important part in this provision.

While Canada is one of the world's leaders in integrating Complementary and Alternative medicine into the national health care system, CAM is clearly not yet a fully integrated option. However, the increasing acceptance of CAM is supported by a wide-ranging and well-articulated research base, and is also due to academic support in universities, the passing of more enlightened regulatory laws, and the support of health professional associations and corporate partners.

Canadians widely endorse the use of CAM. A recent study reports 54% of Canadians used CAM in the previous year and 74% have used CAM a least once in their lifetimes. In 2006 Canadians spent more than $5.6 billion on alternative therapy providers, and another $2.2 billion on herbs, vitamins, diet programs, books, classes and equipment. Clinical journals are evaluating the merits of CAM in letters, editorials and research at a level that would have been incomprehensible a few years ago.

Research

The Interdisciplinary Network for CAM Research (IN-CAM) was launched in January 2004. This unique Canadian initiative was founded by two leading researchers, Dr Heather Boon and Dr. Marja Verhoef. They believe that an interdisciplinary, collaborative effort is needed to address the many gaps that exist in CAM research. This network provides the opportunity to foster dialogue and communication among CAM researchers, to pool resources, create and transfer CAM knowledge and awareness, and build research capacity. Among many other activities, In-Cam has hosted six symposiums and maintained regular e-news updates since 2004.

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Key Canadian network
The University of Calgary recently established an Interest Group in Complementary Medicine to evaluate the use and effectiveness of CAM in the prevention and treatment of cancer, and the faculty of medicine has also instituted a research program conducting clinical trials of vitamin and mineral supplementation in bipolar disease. Dr Bud Rickhi, co-winner of the 2009 Dr Rogers Prize, is actively involved in CAM research in Calgary.


Naturopathic doctors including Dugald Seeley, Jonathan Prousky, Deborah Kennedy, Kieran Cooley, and Heidi Fritz are active leaders in CAM research, and have collaborated with MDs Raymond Wong and Stephen Sagar. The Journal of Orthomolecular Medicine, one of the leading CAM journals, publishes some of this research. This Canada-based Journal, published for over 40 years, has subscribers in over 30 countries.

Education

In Canada, as in other countries, attention to CAM in University Medical Education is limited; it varies across each of our 17 medical schools, and depends on several local factors such as the availability of faculty members who have the skills, interests, and credibility to 'champion' its inclusion. In many medical schools, the CAM curriculum is hidden, for example, 5 minutes on chiropractic in a lecture, and it is on an elective basis.

AIMS - Alternative and Integrative Medical Society - founded by UBC students in 1998, is a well-used resource for integrative medicine in BC.

The Mount Royal College in Calgary opened Canada's first post-secondary institute dedicated to advancing CAM health, together with a 24-hour phone line to dispense information about CAM options. (Andrew Weil, MD, is teaching there this week).

Public education is very important in order for us be aware of and knowledgeable about various therapeutic options available. Many national organizations such as HANS and Orthomolecular Health, and consumer health shows including The Wellness Show, Total Health, and Whole Life Expo have been dedicated to public education in CAM for decades

Medical Associations

There is a variance in CAM acceptance in medical associations and regulatory boards from province to province. As one very recent example, following submissions from the public and professional associations about its draft policy guidelines for physicians as to handling alternative medicine, the College of Physicians and Surgeons of Ontario (CPSO) released their proposed guidelines. In these, the college differentiates between allopathic medicine (conventional medicine taught in medical schools) and non-allopathic therapies (CAM).

The goal of the proposal "is to prevent unsafe or ineffective non-allopathic therapies from being provided by physicians". The guidelines, if approved, would prohibit doctors from misrepresenting the benefits of alternative medicine, but it stressed it had no intention of depriving patients of alternative medicine therapies "that are safe and effective."

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September 23, 2011 venue for Carter's talk
However, some medical organizations feel the proposed guidelines may give alternative medicine scientific legitimacy. The CMA said: "It is a matter of concern for us, that CPSO's draft policy appears to require of physicians a high level of knowledge regarding [alternative medicine], and a high level of acceptance for its routine incorporation into practice."


Response from the Board of Directors of Drugless Therapy-Naturopathy: "The Board supports the efforts of the CPSO to address the use of therapies outside of the conventional scope of allopathic medicine. We emphasize the importance of working collaboratively and improving communication with other regulated health professionals to facilitate the well-being of our patients."

By the way, Naturopathic medicine is regulated in six provinces: BC, Alberta, Saskatchewan, Manitoba, Ontario and Nova Scotia.

So there is still a considerable divide in opinion between CAM providers and Medical doctors, but there are examples of medical associations support for CAM; here are two: A comprehensive, practical, two-part course "Nutrition for Docs" given at U of Toronto by Aileen Burford-Mason and others, is accredited by the College of Family Physicians of Canada and has been presented four times over the last three years.

And a seminar to be presented in October by the Canadian Society for Orthomolecular Medicine on Integrative Medicine for the Treatment of Depression was also accredited by the College of Family Physicians of Canada.

Government

In Alberta, Bill 209, passed in 1997, allows Alberta doctors to perform any alternative therapy provided that it cannot be proven to do more harm than conventional drug and surgical treatments. Under this bill, chelation therapy, homeopathy, environmental medical therapies, vitamin, mineral and herb treatments provided by doctors are freely accessible to the public.
 
In 2000 the Province of Ontario passed Bill 2, with profound impact. The bill simply states: "A member (of the College of Physicians and Surgeons) shall not be found guilty of professional misconduct or of incompetence solely on the basis that the member practices a therapy that is non-traditional or that departs from the prevailing medical practice unless there is evidence that proves that the therapy poses a greater risk to a patient's health than the traditional or prevailing practice."

In 2006, in British Columbia, a similar bill was passed which frees doctors to practice complementary medicine. The bill is intended to "allow medical practitioners to use their own judgment to diagnose and treat patients." In the words of Dr Abram Hoffer, co-winner of the 2007 Dr Rogers Prize, this amendment to the medical act "will take away from the College of Physicians and Surgeons their power to harass doctors simply because they are practicing complementary medicine. It is a very powerful bill with teeth."

The Medical Services Plan of BC covers massage therapy, physiotherapy, naturopathy and midwifery.

According to the Canada Health Act, any medical service legally available in one province cannot be prohibited in other provinces, a caveat which means it's only a matter of time before someone challenges the state of affairs for health freedom in provinces like Quebec, which virtually ban the practice of CAM.

On the federal level, Health Canada has created the Natural Health Products Research Program, which is committed to supporting natural health product research and knowledge based activities both directly and in partnership with The Canadian Institutes of Health Research. Since its inception in 2003, this Office has provided financial support for product quality, clinical research, societal, cultural, environmental influences on health, as well as issues related to Natural Health Products regulations

Business

The Canadian Health Food Association, established in 1978 as the national non-profit trade association, launched the website "NHPsnot Drugs" in March 2010 - a consumer site for information on natural health products which are used by over 70% of Canadians. The availability of these products, which we all take for granted, may soon be in jeopardy - we must be vigilant.

The manufacturers, distributors and retailers of natural health products (NHPs) provide corporate support to many CAM educational organizations, including In-CAM, OSPCM and CSOM.

Conclusion

For all the efforts of Canadians to bring CAM into the mainstream we now have, thanks to the Lotte and John Hecht Memorial Foundation, the Dr. Rogers Prize for Excellence in Complementary and Alternative Medicine, to focus attention on the importance of integrative medicine.  And with support from all five of areas I've outlined, integrative medical clinics will have a better opportunity to flourish.

In researching possible panelists for this colloquium, I found well over 100 clinics across Canada who use the word "integrative" in their titles - lets' see how these four clinics assembled with us this afternoon exemplify the description and help us to experience integrative medicine at work.
 


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