Anybody can set themselves up as a herbalist, homeopath or massage therapist More and more people are turning to alternative medicine for help. But in an unregulated sector, Sylvia Thompson asks is this a safe option
The tragic case of a 49-year-old Mayo man, Paul Howie, who died of suffocation caused by a cancerous tumour in his throat has highlighted yet again the urgent need for regulation of complementary and alternative therapists in this country.
Howie's widow, Michelle, told the inquest into his death that Mulrany-based natural health therapist Mineke Kamper had repeatedly told them that if Paul got other medical treatment, he would die.
Kamper was also involved in another case when a patient she was treating died from an asthmatic attack in July 2001. It is understood that Kamper, a trained nurse, was practising as a homeopath although she is not a member of the Irish Society of Homeopaths (ISH), the professional register of homeopaths in Ireland.
"We are keen to regularise the situation so the public can know who they are going to," says Sally Quinlan, spokeswoman for the ISH. If someone is a member of a professional association, they are bound by a code of ethics and trained to a proper standard. They would also recognise when input from other professionals is needed," she says.
"It's a two-way responsibility that the lines of communication are open between the medical professional and complementary therapists," she says. "Statutory regulation would also ensure protection of title which would safeguard the public against such cases."
Many therapists such as acupuncturists, medical herbalists and homeopaths already have professional registers of practitioners who only register therapists who meet both their training requirements and experience in clinical practice. For instance, the ISH, which is the only professional register for practising homeopaths in Ireland, requires that members complete a four-year part-time course in homeopathy and be in clinical practice for one year before they can apply for registration.
The registration process itself examines all aspects of their professional practice and includes a visit to their practice. Continued professional development is also a requirement of registration. ISH members must also abide by a code of ethics which states that the patient's consent is required for all treatment and that homeopaths explain the nature of homeopathy to their patients.
The ISH also has a complaints procedure which allows them "strike off" members. However, since its foundation in 1990, no registered members have been struck off.
In an unregulated sector, unscrupulous or indeed well meaning but naïve individuals can set themselves up as homeopaths, herbalists, massage therapists or as natural health therapists without adequate professional training or clinical experience.
"Anybody can call themselves an acupuncturist or homeopath which creates as much difficulty for us as it does for members of the public. It doesn't help the cause of alternative medicine," says Dr Stephen Gascoigne, a medically trained doctor who practises acupuncture and Chinese herbal medicine in Clonakilty, Co Cork. "The Acupuncture and Chinese Medicine Organisation, which I belong to, has a helpline that people can ring up to check whether practitioners are members," he says.
Dr Gascoigne, who has been teaching orthodox medicine to complementary therapists for 20 years, says, "It is our responsibility to educate people about what our therapies can do, how they work and the limits of treatment. Practitioners should be aware of what's safe and what's not safe and this might sometimes involve referral to another practitioner.
"When people are sick and vulnerable, they often do go to people and follow their advice but I always suggest that they bring someone else with them so that person might remember what the practitioner said about certain issues and also what questions to ask. Even if people are on registers, the public still has to check them out," he says.
Helen McCormack, medical herbalist, believes statutory regulation of complementary and alternative health practitioners should have different layers or structures, depending on the treatment claims of the therapy. If someone is giving foot or back massage, the limitations of their therapy are usually clear and if they notice any irregularities, they can suggest patients have them checked out by a physiotherapist or doctor.
However, if someone is claiming to treat at a more intense level - such as acupuncturists, herbalists, homeopaths - McCormack is adamant that more rigorous training is required to ensure they are competent to diagnose and are not blind to the potential seriousness of a situation. "Every training course [that is accredited to professional registers of such practitioners] should stress both the capacity and limitations of its practice and have appropriate referral pathways to other healthcare professionals," she says.
"Medical doctors are rightly concerned about the training of complementary and alternative healthcare practitioners but they don't recognise that some training can be very good," she says. "The danger is when a therapist only sees the positive aspects of a therapeutic approach. It can be a case of 'a little knowledge is a dangerous thing' and certain therapies aren't always the most appropriate for certain conditions. Also, therapists have to be very careful not to turn their approach into a power trip. This can be very dangerous and unethical."
Dr Brian Kennedy, a medically trained doctor who practises homeopathy, suggests a seven-point charter on best practice in complementary medicine could help consumers be better informed and put the onus on therapists to respond to all queries openly and give their patients clear information about medicines prescribed, their side effects and possible interactions with any other medicines. Such a guide, he says, could be prominently displayed at the practice premises and a copy could be given to patients at the start of the first consultation.
"The charter might be administered by an independent consumer watchdog on behalf of a series of professional associations which were committed to this as a gold standard of consumer protection," he adds.