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Naturopathy: What is Co-Regulation? with Peter Berryman

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Registration, co-regulation, statutory registration… Bottom line, what do they all mean for naturopathy in Australia?

In today's podcast, Peter Berryman recounts the rich history of the Australian Traditional Medicine Society (ATMS), from it's beginnings with Dorothy Hall, through to becoming the largest Australian natural medicine association serving a plethora of clinical modalities that make up the greater complementary medicine industry.

Peter joins us today to fulfil an FX Medicine podcast request we received from our community asking us to explore the other side of the statutory registration debate, namely, co-regulation.

The co-regulatory model is the status quo and is supported by ATMS as the go-forward regulatory system for naturopaths in Australia. Peter covers off what this means, why they feel this is the best option and how this still supports patient and public safety. Peter and Andrew discuss the legal issues around scope of practice and protection of title as well as the powers the association holds to ensure members are trained to an agreed standard and committed to uphold the association's code of conduct. 


Covered in this episode:

[00:45] Welcoming Peter Berryman
[02:40] Why homeopathy and naturopathy?
[07:55] The history of ATMS
[11:13] The evolution of registration
[13:33] A question of safety?
[15:22] Protection of title
[16:05] The purpose of co-regulation?
[21:49] Benefits of co-regulation?
[24:10] Defining scope of practice
[31:15] What about award wage?
[44:50] Can associations work together?

With thanks to ATMS

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Peter Berryman. Peter has been continuously in private practice as a natural medicine practitioner since 1985, having graduated from five different universities and three different colleges during his ongoing training. Including his recent award with merit, the Master of Science from the University of Central Lancashire.  
Peter has continuously taught natural medicine students since 1990, most recently anatomy and physiology, pathology and clinical examination. As well as homeopathy, homeopathic pharmacy, homeopathic research, and supervised student homeopathic clinic. 
Peter has been a Director of the Board of the Australian Traditional Medicine Society since 2007, and has been the President and Chair of the ATMS Board, since February 2017. So today we're going to discuss a different offering to the highly charged registration debate in Australia, and that is Co-regulation. 

Welcome to FX Medicine, Peter, how are you? 
Peter: Excellent today, thank you, Andrew. 
Andrew: Now, Peter you've done a lot in your career. I'd like to investigate that a little bit. Tell us a little bit more about your history. 
Peter: I made a life changing decision when I was the ripe old age of 14 years. 
Andrew: Really? 
Peter: When one of my colleagues at school had a serious illness that affected her for 12 months. She took a year off school and no orthodox conventional medical doctor could help her at the time. She had glandular fever mononucleosis affected by the Epstein-Barr virus. And I made a life decision at 14 that I wanted to be the type of person who could help people who were not being helped by conventional medicine of the day. 

Andrew: Wow. 
Peter: And everything I've ever done since I started university at 16, has always been to that purpose. So all of my studies have all been towards being able to help those who've not been helped by anyone else. 
Andrew: So tell me why go down that homeopathic naturopathic field, what was it that drew you towards that? Were your parents of that mind or…? 
Peter: I was...of some fortune, you might say to be the youngest of four children, and all the siblings were in conventional medicine, and they were able to tell me about its limitations, and that its limitations were much higher than might have been publicly aware of. They were able to tell me in private and encouraged me to find a better way. 

Andrew: Right. 
Peter: And so in that era, we're talking about the 70s and 80s, there wasn't much awareness of natural medicine. And through a number of evolutionary steps I found my way towards science, natural therapies. I was very fortunate to do a naturopathic undergraduate course which is great because it's an eclectic base. In those days it was four major modalities and a good number of minors. So having been exposed to nutrition and herbal medicine and massage, and homeopathy, I was then able to make a personal decision about which one of those I wanted to master rather than be a jack of all trades. 

Andrew: Yep. 
Peter: I decided to commit myself to what in my opinion was the pick of the bunch, the hardest one to do and the one that had the least limitations and the greatest benefits. 

I had the opportunity in my training to go to student clinic and do my very best at all of those modalities. And it was obvious to me which one had the best outcome, which one had the least limitations, and which was relevant therefore to my life decision about wanting to be able to help those who were not helped by others. 
So that's been my niche for the last 30 odd years, is the most difficult clients. And I feel that's what therapy in Australia is about, because there is a wonderful marketplace of choice out there for the Australian public. 
Most of our parents and grandparents were socialised to going just to conventional western doctors, but now, you're spoilt for choice. There's so much choice out there and that's great. Because each person will find who they're looking for, and if they have not been helped by conventional medicine they can choose to go into the private sector and find out what does acupuncture offer? What does chiropractic offer? What does homeopathic offer? And eventually, one would hope, that they would find who they're looking for and get the outcome that they're looking for. 
So that's the respect I have of all the other modalities out there. They're there for everyone and people will find who they're looking for. The reputation of homeopathy, even if not as well known as the word naturopath, is that it has a reputation of being able to help those who are the most difficult clients. 
Now most practitioners can help simple uncomplicated problems and many of those are relatively straightforward and might be lifestyle advice, reasonably common sense things. But when it comes down to practicing medicine, I feel that homeopathy, in my personal opinion, is the most effective least limited modality out there. 
Andrew: We used to have home-stay students some years ago, and I was quite surprised with our South American students from Brazil, two of them. And they told me that over in Brazil it's homeopathy that is the medicine of choice, the medical system of choice for the people unless you've got oodles to money. Because it's the only one that's cheap. You know pharmaceuticals cost heaps and heaps of money. 

So the general populace actually chooses homeopathy as their preferred system of medicine. 
Peter: Yes, indeed. So Brazil is an excellent international case study, so is India. Where again, there's a large choice available to the public. But all are supported by the government. 

In India there's something like 275 homeopathic hospitals, something like 295,000 homeopaths, something like 14% of all hospital beds in India are homeopathic hospitals. So it's a modality that's capable of delivering outcomes to the point of running a hospital. We see that in South America as well, but I guess the dilemma with Brazil is its language isolation, speaking Portuguese, not such a common international language these days. So that's possibly why we don't know so much about the fabulous things going on in Brazil. 
Andrew: I was quite surprised about Louisa's... particularly Louisa's experience and what she told me about how their family took care of themselves. 
Peter: Indeed and something similar to that is what's going on in Cuba. Whatever your thoughts are about Cuba it has arguably the best public healthcare system in the world. And homeopathy is a significant choice amongst the modalities of intervention that the Cuban doctors use. 
Andrew: Peter, I want get back on to this registration issue, but first, I think we need to investigate and learn a little bit more about you with your experience with the Australian Traditional Medicine Society. 

Tell us about the history of the ATMS. Indeed, you know, like, I can't remember I've spoken to Denis Stewart about years ago, the sort of preregistration debate back in the...what was it? Late 60s early 70s. 

But how was the ATMS set up, and what was the dream of registration if you like, back then, and how has it changed, how has it evolved? 
Peter: ATMS was set up by the Grande old dame of Australian herbal medicine, a lady most people know called Dorothy Hall. And she set it up as a reaction to another professional association that set up shortly prior, who had standards of entry relatively limiting. There were a significant number of practitioners who could not join this other association and were left over. So Dorothy collected all of these people and formed ATMS. 
Andrew: Got you. 
Peter: So it has since been the underdog, and it's now Australia's largest multimodality natural medicine association, it has well over 10,000 accredited members practicing, we have 24 registered modalities that we look after. 

So we're big, we're bigger than all of the competition. We have...I think it's something like 65% of the industry are our members. 
Andrew: Part of that though would be obviously because you embrace more modalities than some of the others. Like for instance, one is a herbal registration. 
Peter: Yes, so there are single modalities associations out there, like, look after...just western herbal medicine or look after just acupuncture, or just look after just homeopathy. And by definition their numbers would be limited because the total number of practitioners just doing that modality would be relatively smaller than an eclectic association. 
So the value of the eclecticism in ATMS is when it comes to numbers, when numbers count, and when they count is politically and financially. 

So for example, ATMS has excellent financial assets to the envy of most other associations. We have excellent lobbying powers when it comes to our recent trips to Canberra for example, getting appointments to see ministers, and ombudsman and senators and so forth. They will listen to us because they say, "Well who do you represent?" And if we say we represent 10,000 plus members they go, "Oh okay. So you've got a few votes behind you, yes we'll have an appointment with you." 
Andrew: So this is the way that the political halls work. 
Peter: Yes, yes, if we've got the money to fund our strategic plan, and if we have the staff to be able to do it, we have the CEO, and the company secretary, and a board structure, and we can afford to do all of those things, we can make a difference. And we are. We are very proud of our achievements and we've been doing this for 32 years now. 
Andrew: And how has that dream of registration or as you put it the co-regulation, how is that changed and evolved over the years? 
Peter: Well, there's been some flip flops. And if statutory registration was seriously contemplated by parliamentarians, government, we would entertain it. But our position is that its neither justified nor achievable in the current environment. 

Now as the current environment changed? We are adaptable, we are adjustable, we're not absolutely stuck in a rut but this is our position for the moment and it serves us well. And that is that we support the current status quo. Where as a professional association we have a code of conduct, we have a complaints mechanism. We have the capacity within our constitution to expel members, and so we can look after our own. 

There's also currently, almost in all states and territories of Australia, negative licensing. So even without statutory registration there is a relatively informal scene of co-regulation, co-registration happening in Australia at the moment. Now, it's not being formalised but the status quo is effectively a co-registration situation. 
Andrew: The spectre if you like of registration/ co-regulation has raised its head in the last couple of years, because of an unlicensed as far as I'm aware, person posing as a naturopath. At least that's how the media purported her to be. They also purported her to be a midwife but she doesn't appear on AHPRA under the nurses and midwives list. But her conduct basically sent a child into hospital. 
What is the state of play with regards to a bona-fide practitioner being registered with an association, and therefore I guess the safety of the community with that? What are the issues surrounding this? 
Peter: Well, that's why I mentioned we have our own internal policies and procedures. We have our own code of conduct that's a living document. We've just updated ours recently to make it in tune with what's going on in all the Australian states and territories. We have a complaints committee. So we can action complaints that come from members, practitioners, the public, manufacturers, and so forth. And we can take some action upon that. 
We recommend remedial action. For example, if they need to attend some educational institution and learn about recordkeeping for example. Or if they've had a problem with not having adequate records or... So we have some internal resources to cope with our own. 

Andrew: Yep. 

Peter: And we can suspend and expel members as well. But with negative licensing from the states and territories, they can actually prohibit a practitioner from practicing for a finite or an indefinite period as well. 
So that situation is probably pretty good as far as what we can do internally and what governments can do state and federally, externally as well. So the most problematic people can actually be stopped from practicing, and stopped from practicing if they were to choose to move around Australia as well. 
Andrew: Right, okay. So if the practitioner was a member of another registration obviously, the complainant would have to find out who they're registered with, and complain to the appropriate association. 
Peter: That's right, so we have on our website publicly available, ‘find a practitioner’. So if they know the name of the person they can make a legitimate fill in the form make a complaint, and due process will take care of itself. And they'll be informed all the way through of what the process is and natural justice. 
Andrew: Gotcha. 
Peter: So we're fairly happy that we do what we can, for our own. Now you're alluding to, in a sense, protection of title. 

We don't have license to protect those titles. All the 24 titles that we look after, the modalities. So we can't stop someone calling themself a naturopath not being registered, not being a member of an association and doing unpleasant things. 
So we can't stop that, but if a complaint is made then the negative licensing by government can take care of that, if we can't take care of, because they're not ours, they're not one of ours. We can take care of ours, but those who do things who are not a member of an association that's when the government can take care of the public that way. 
Andrew: What exactly are we talking about here with health practitioner registration or co-regulation? Now that we're into the new millennium, the 2000s, what's it for, what's its purpose, what are we aiming for here? 
Peter: It's principally for the benefit of the public. To minimise the risk to the public of adverse drug reactions or fraud, or some other malevolent activities so that the public are protected. 

And so what then needs to be perceived is a significant or serious risk by any health modality. And there are a number of health modalities that do have statutory registration, that there is deemed to be sufficient risk. Osteopathy, chiropractic and recently, acupuncture. So for other natural medicine modalities needing to be registered there would need to be a significant risk. 

Now, yes there are occasionally mishaps and occasionally deaths related to work done by natural medicine practitioners, who may or may not be in an association. But if we compare this to the type of serious risk involved in conventional western medicine, or other allied health, the risk is very small. 

And therefore, the other implications in terms of cost-benefit of having set up registration boards, the red tape and bureaucratic involvement in maintaining those, the costs and so forth don't make it worthwhile. 
Andrew: I'm totally understanding that, you know, one of the reasons I love natural medicine is it's so forgiving. But I do also believe that you can get people who, either through no fault of their own, either an idiosyncratic reaction, or through this...I'm going to call it misadventure or malpractice. But what we're finding is that these people aren't really licensed to practice naturopathy. The people who have actually had the education seem not to pose that risk to the public.  
Peter: That's right. So that's one of the reasons for having a professional association is so that graduates from a good college, and ATMS can process those to say “this is an ATMS recognised education provider and these are recognised programs from them.” 

So students or the public can select a program that is known to be of high quality according to our own internal industry jurisdiction. And they can graduate and then they can become a member of our association, and therefore the public can have some confidence that the practitioners that are members of ATMS are safe and competent. They've been educated to a standard of excellence. And should there be a problem there are policies and procedures for natural justice to come about. 
Now, you know, no one's perfect and nothing is absolutely safe. So there will always be small problems, minor problems. And we have the policies and procedures to take care of those. And we don't feel that for the cost and time and bureaucratic red tape, that it's worthwhile these other natural therapies requiring statutory registration. 
Now co-registration is the current status quo. So what you're alluding to is something above and beyond. That acupuncture experienced five years ago and osteopathy and chiropractor experienced 30 or 40 years ago. 
So if we look at the example of what has happened to acupuncture as a consequence of being statutory registerated. It hasn't seemingly benefited them greatly. It's cost them more, they're more tied up in red tape, they have lots of issues for instance around English language competency skills for example. And the potential benefits haven't really flourished for acupuncturists. 
So if it perceived that acupuncture has that much risk associated with it that the public need greater protection by doing this to the industry of acupuncturists. It hasn't really gone well for the acupuncturists to have gone down this pathway. 
Andrew: Oh, okay. 
Peter: I don't really see it as being great benefit to the Western medical herbalists or the nutritionist or naturopaths, or the homeopaths and so forth. So it's not really worth it. 
Andrew: Right. What about chiropractic though? I mean, they seem to be well entrenched with AHPRA, they get attacked very so often by the Friends of Science in Medicine. But you know, they really do enjoy, as far as I'm aware... Forgive me I'm a registered nurse, I'm not a chiropractor, but, you know, they really seem to enjoy the protection of being under AHPRA. 
Peter: Yes, they do and chiropractic/ osteopathic education is thriving in Australian universities in spite of critics who would like to change all that. 
Andrew: Thank goodness. 
Peter: And the Australian Medical Association have been battling against the chiropractors forever. And things go up and down, better and worse, but they’re still surviving. Although I have met chiropractors who would like to suggest that this whole registration has not done their industry as much good as some would like to say.

Andrew: Ahh, ok. 

Peter: But there would be contrary opinions as well. 
Andrew: So let's talk about co-registration or co-regulation. What do you see is the benefits of that? And if we...we alluded to it at the beginning about the protection of title. Would you be able to get protection of title with a co-registration model? 
Peter: No, Co-registration is the model that is informally right now. 

So what you're alluding to I think is statutory registration which is where we would have protection of title, but the industry would be out of our hands. So at the moment with the status quo, we still have some capacity to make some difference on some things. And that's good. Because we haven't lost our industry to government who may have different agendas than our agendas for own industry. 
Andrew: But how would that differ from like acupuncture and chiropractic if you like? Are you saying that chiropractic aren't in control of their profession? 
Peter: They are answerable to their boards.

Andrew: Right. 

Peter: And if their boards are made up of bureaucrats then what happened to chiropractic? So we don't want to have that happen to these other modalities, these ones that are not statutory registered. So that we can maintain some control and address issues that we've outlined in our position statement. 
So that we can still suggest what the education standards are. We can suggest what continuing professional education looks like. We can dictate the costs involved in becoming a professional member. We can negotiate a suitable or relatively lower professional indemnity insurance premium. We can still encourage the art of medicine as well as the science of medicine in our traditional practices. 
We can advocate on our own behalf rather than having to be under the total control of government agencies. We can promote ourselves in the way we'd like to and take the industry in the direction that we want to, rather than be dictated to by bureaucrats. 

Andrew: Right.

Peter: We feel that we would rather be able to participate in our industry. And in a co-regulatory way because we are able to do that within the scope that we have as an association, and then government bureaucrats outside that through the negative licensing do what they can to those who don't belong to an association and do mischief. 
Andrew: What about the issue of scope of practice? Like I've said it before and I don't know whether I'm right. I've just said it. This is my ponderings, is that a herbalist knows that they're a herbalist. A nutritionist knows that they are a nutritionist, and there are boundaries around that. 
Naturopath seems to be, well I do this sort of naturopathy and whereas they can go, and shake hands with a naturopath who practices two doors down and they'll do a naturopathy but with a completely different set of skills or choices. 

So is that part of the issue of scope of practice range, and indeed, registration. 
Peter: Not so much. No, it's just an unfortunate consequence that Australia took this term, naturopath from North American Natural Medicine Practitioners. 

Andrew: Right. 

Peter: In Europe, the word naturopath is not so well known. I mean you might know in Germany the use the term heilpraktiker. But what you were saying in comparison to the word naturopath, these other modalities are quite specific. 
When you say Western herbal medicine we know somewhat precisely what you do. When you say nutrition we know somewhat precisely what you do, and homeopath etc, etc. 

So these are singular modalities whereas the term naturopath of all the terms that we could come up with is an eclectic term, it doesn't precisely say what you do. 

Andrew: Yeah. 
Peter: So when I trained as a naturopath in the 80s, there were four major modalities and about ten minor modalities under the umbrella. As I said in my early introduction, I was grateful for that because it gave me an early introduction to so many, so that I could choose which ones did I prefer and want to go on to excel and master in. And I still see that as a benefit, and I still welcome that eclectic base for being a naturopath. But when you're talking about scope of practice it is a bit of a problem. 
So currently, in some of the education institutions here in Australia, a naturopath could be more specifically a nutritionist and a herbalist, a western herbal medicine practitioner. 

Andrew: Yeah. 

Peter: They tend to not have as a major modality, anything else. Now they do some minors and this and that and the other thing, but those are their two major modalities. So the term naturopath might need to be addressed. 
Andrew: To me it might be one of those terms like antioxidant, we might need to evolve it. 
Peter: No, but if we understand that a naturopath is an eclectic term, someone who is a naturopath might have to say, "Well yes, I am a naturopath but that's based on my majors in herbal medicine and nutrition. So if I'm, you know, in terms of being in a list or a table of practitioners put me in a list of this and that rather than having a list of naturopaths." 

Because you could be... Well, the word naturopath, I think, came from a historical word called a hygienist. 

Andrew: Yeah. 

Peter: And hygienism was the roots of naturopathy and this was the idea of clean living. 
Andrew: Yeah, and exercise. 
Peter: Having fresh air, fresh food, those sorts of things. And that got divided up into all these different modalities today. 

So yes, there's an infinite number of modalities. So if people have skills and training in specific one or two or ten, I think that we could solve some of these scope of practice, and these naming issues. Not too bad, not too hard. 
Andrew: Yes. I'm just wondering whether it might be something akin to a GP has their scope of practice defined by medicine, orthodox medicine. 

But a GP can quite likely do dry needling because they might have done a certificate in that. Now it's not acupuncture and it's not defined as acupuncture, it tends to be putting needles in somebody for that sort of relief. But it I guess tends to, from a GP perspective, be, dare I say the word limited to more things like pain relief. 

Is that where you're going with this, is sort of like, you know, the base core definition would be the nutritionist, herbal medicine. And then you add on there a certain interest if you like that you practice? 
Peter: Well, again back to this risk to the public we want the public to have access to as many choices of medical care as they wish. And to have safe and competent practitioners. 

So if a member of the public went to see an ATMS member for some dry needling, we would want that person to have excellence in that and be recognised as a competent safe practitioner, rather than someone who wasn't. 

Because we want their experience to be as well as can be given the givens and this mostly happens. So perhaps the dilemma with the term naturopath is probably more comparable to the term government employee. If you are a public servant…
Andrew: Ahh, well done. 
Peter: If you're a public servant what... 
Andrew: What do you do? 
Peter: ...precisely do you do, and it's not precise. Because you could be a teacher, you could be a fireman, you could be doing... So if I said look, "I'm a homeopath and I've specialised in homeopathy and I'm a classical homeopath following Samuel Hahnemann, that's fairly precise. 
So this sort of thing could be sorted with a scope of practice, and the only word I can think of that would be...the greatest problem would be this word naturopath. Which is arguably the most common and used word in Australia. 

But in other parts of the world particularly in Europe or in India these other words are very common. We might not know them so we'll here like Ayurveda and Unani, as well as traditional Chinese medicine and homeopathy and Western medicine and so forth. 
So I think that the public would get used to that in time. Again, through these legislative pathways if necessary and these association pathways. Because, you know, if you looked at the 24 modalities that ATMS looks after, you might recognise half of them, but half of them you would say, "What's Bowen therapy? And what's Alexander Technique? And Buteyko?" 
Andrew: Feldenkrais? 
Peter: "What's that?" Yeah. So you might say, "Gee these are strange sounding names." But these are very specific modalities and people in the know, know precisely what they are. And for those who benefit from them they'd say, "I just love my therapist doing this for me." So we want there to be choice. We want all of these available, but we want them to be safe to the public so that the public are looked after. 
Andrew: Peter what about award wage and career path for naturopaths, this has been a bugbear for quite a while. Are there any plans in place, any hopes, dreams to be able to create an award wage that people can be promised? 
Peter: Well, natural medicine functions pretty much in the private sector and there aren't awards as far as I know to govern that. And the naive hope has been a link to Medicare, but Medicare is not particularly affordable. The Australian government is struggling with its budget deficit including the significant costs to the PBS and the over-the-counter drugs. And the other related health industries like optometry and dental which are ancillary along with natural therapies and the private health insurance coverage there. 
So with the cost of conventional medicine rising, any naive hope of natural medicine joining in on Medicare benefits is not likely. And we're having a current campaign addressing the government support for private health insurance rebates for natural medicine. They want to take the money that they're contributing out and put it into the budget deficit without truly considering the impact of what they're doing. 
Andrew: Now that I don't understand. 
Peter: Well, it's a short-term quick fix to the budget deficit, but the economic rationalisation is relatively small. The amount of money that would be saved is in talking in tens of millions of dollars, not billions of dollars. And the compromise to the 28,000 small business enterprises that happen in natural medicine won't like that. Because that it might make the difference between success and failure or opening or closing for a small business person to lose the income that that comes from. For say particularly body workers where they seem to be quite reliant on the small rebates that they get from people who have private health insurance and get those rebates. 
So we're campaigning on that at the moment. So we aren't allowed to do price fixing, we aren't allowed to make strong recommendations by an association for what a cost of consultation would be so the market dictates this. So an award wage is not particularly realistic at the current industry. 
There have being surveys of the industry to see what sort of money is being made by practitioners and it's very varied. Between, say a middle aged female who may have a family, and a partner who's working school friendly hours out of her front room, some days a week while her partner is the major breadwinner. And she might be earning 20,000 or 30,000 dollars a year. Through to men who are single and have multiple practices earning six figure incomes. 
So there's quite a dichotomy in the industry between well, what is possible from a relatively moderate second income for a family. Through to a significant income as a major interest. So there's lots of opportunities to work in natural medicine. From the obvious one of being in a private practice. Or you could go on and be an academic educator and higher research... Postgraduate research is a definite pathway there. There are a good number of Australian universities offering postgraduate programs in natural therapies, you know, highly respected Australian universities as well. There are opportunities in manufacturing and retail as well. So these are probably the most common career pathways. 
But like any one in small business there's a significant drop out rate of graduates, and one of the things that we try and do as an association is provide mentoring and support for new graduates in those early difficult years when they're struggling to get their competency in business skills, as well as their practitioner skills, and keep them in the industry so that they can have a long and successful career. 
Andrew: I know this changes each time we change government and that's exceedingly frequent over the past seven years in Australia, but what does the government want from naturopaths? 
Peter: Well, they want our tax dollars, and we contribute something like $4.1 billion into the government from being in the industry, and not being in the black market, a legitimate income. They want us to provide choice to the public. Because they are probably smart enough and savvy enough to know that there are good stories to be had around natural medicine. 
In our recent visits to Canberra doing some lobbying each of the politicians we spoke to had an aside, an anecdote about a good experience with natural therapies, every one of them. And so they would probably want that to continue. This idea of choice and access and good outcomes, and particularly good outcomes where previous experiences were not so good with other practitioners, with conventional doctors. 
So they would want that to continue because politicians are human and they've been touched by disease and ill health and tragedy and death as much as anyone else. So they would like that choice as well. And we were quite surprised how many politicians like their Pilates classes or the yoga classes or take homeopathic medicines, or take nutritional and herbal supplements and so forth. And are improved by that experience, and therefore have this private type of support to do so.  
So we are endeavoring to continue to make that difference to everyone including politicians so that our reputation stays excellent. So we're trying our hardest to provide the public with safe and competent practitioners. So the board of ATMS are well trained. I mean given my example of my biography, I'm recognised through both orthodox and unconventional training as someone who knows what they're talking about. And here I am addressing issues of education so that the people who follow behind me get as good as an education as possible, as rigorous and as safe as possible, and as competent as possible to do a good job. And if they have problems they need support or if they have adverse drug reaction or complaint made against them, then we take care of our own that way. 
And so we do an excellent job, dare I say, about what we're doing for our own industry. And we do recognise the role of government to make sure that the issues that we've touched on before with negative licensing are taken care of as well. 
So I think the Australian public are pretty lucky that they have a situation, a status quo, as it is. And we would like to support the status quo and including what you mentioned earlier about supporting the continuing government money in private health insurance rebates. Because in a sense that takes some of the pressure off the public system and diverts it into the private system, and that's where we thrive. And the government is doing a good thing there, or it has been. And we wish they would continue to do so. 

Andrew: Yeah, yeah. 

Peter: So Australia is pretty damn lucky, I know. 
Andrew: Well, this is the thing like we are the lucky country and it was actually a pharmacist that said this to me years ago, when I was perhaps a little bit overzealous in my support of natural medicines. And she didn't placate me, she admonished me. She admonished me and said, "Well hang on, obviously don't forget your orthodox medical training. She said it's not about favouring one or the other it's about choice." 
You know, and as I said before the Friends of Science and Medicine would say that we need to protect...we are the good ones and we need to protect the public from ‘you’, ‘the bad ones’, the natural health practices. 

I would gainsay in that, there was a very small study done at the Alfred Hospital. If we're talking about the Medicare and private medical fund rebates, I totally agree with you about Medicare, that is a separate issue. But private medical fund rebates for those people that have private medical funds, there was a very small study done at a cardiac centre and just doing a foot massage on people who had been through cardiac surgery. And they didn't want to touch the torso because of drips, drains, cracks, sternums, and things like that. But just massaging the foot, and they had dramatic decreases in the use of opioids which is a societal problem in Australia. So pain medications but also in other medications as well, the need for other medications. Which plays into the role of stress, obviously, and their outcomes from cardiac surgery. Just doing a foot massage. Now if people could continue to get private medical fund rebates for that, you've got a cost saving for Australian tax dollar haven't you? 
Peter: Well, this is a dilemma for the government. They are in between the lobbying power of conventional medicine including the Australian Medical Association and the pharmaceutical industries. And on the other hand, the Australian public who love what natural medicine practitioners do. We have the numbers to suggest that there are more consultations held per annum in Australia with natural medicine practitioners than there are with conventional GPs. 
That the Australian public are prepared to pay out of their own pocket after tax dollars for the natural medicine products. More money is spent on natural medicine products than money is spent on the Pharmaceutical Benefits Scheme and over-the-counter drugs. So the Australian public love what we do and they're prepared to support it in this way. 
So the politicians would know that and here they are between these two parties. Here, the associations like ATMS are trying to support this choice and the politicians are stuck in the middle. They have to seemingly please everyone and no one. 

So the battle...it's a bit of a turf war. It's about money and power and... 
Andrew: That's what it is. 
Peter: And the history of medicine over the long period there’ve been ups and downs as to who's dominant, and at the moment the dominant power is conventional Western medicine. I would dare say they are in decline and natural medicine is on the rise. We've been on the rise since 1970s, 80s, particularly the 1990s. In education we see these numbers getting big. What we've had in the last 10 years we've seen a doubling in the size of the industry. So we're truly a growth industry, we're on the way up, and that's why here in Brisbane recently, I've been surprised to see on the sides of buses, something I've never seen before, advertisements for GPs. Now why? GPs suddenly need to advertise. Because they are losing on the battleground, they're losing financially and economically, politically, and natural medicine is who they see is the opposition. And they don't like that.  
They once upon a time had a monopoly. They don't like losing that, they don't want to share the medical pie that is and natural medicine is on the rise. And so we're starting to utilise this political economic power and we're trying to improve the health of Australians for the sake of the sake of Australians. It's not just about our money and our power. We're much more, I would say, empathetic to the Australian public. We want to see the Australians improve and that's a global thing. We want to see the health of the world improve by the increase patronage to natural medicine. 
And this is why World Health Organization do recognise that traditional and indigenous medicines are the dominant medical paradigms around the world. And that the cost involved in orthodox conventional western medicine is just too high a price to pay for the general public. And so that’s way they would like to encourage the utilisation of natural medicines. We feel that we have a genuine option to provide that is effective. And as I've alluded to with what we've done in the association, we're making sure that the practitioners who are members are safe and competent and do an excellent job to the Australian public. 

So we're very grateful that we’re well tolerated by the Australian public, and we don't mind competing, so long as it was a relatively even playing field, which it's not. So conventional Western medicine do have an advantage of having Medicare support and all sorts of other support that we don't have. But even so I think we're fighting above our weight and we're doing quite well in this battle. So we expect to see natural medicine continue to rise and improve and do excellent things for Australian public. 
Andrew: One last question Peter. You've got within AHPRA...indeed let's just concentrate on GPs. You've got the Rural GP Association, you've got this association, that association. But you've got a major lobbying arm, the AMA, and you've got a major college the RACGP, the Royal Australian College of GPs. 

So you've got a college and a lobbying association if you like. Where do you think Australia needs to go with regards to all of the associations getting together, and having one lobbying group? 
Peter: Well, ATMS as the largest...has attempted over the last 10 years to get cooperation amongst all of the private natural medicine associations. But unfortunately it's been a ten year failure. 

The only times that the natural medicine associations do all come together is when there's a common external issue to be addressed. Like we did around say GST. Or now for example, with the rebates being pulled by governments. So where there is something relatively external we do, but it's again the unfortunate issues around dare I say egos that there's been this lack of unity amongst the natural medicine associations. And if we did, oh my God, would we have some...what Marcus Blackmore called ‘some political horsepower’.  
Marcus was critical at a speech he did, when we had a healthy breakfast in the Senate in May for a natural medicine weekend. He said, "It was really good to be see ATMS at last utilising its political horsepower." He's been watching for 50 years for us to get going and now we have. And given those numbers I was suggesting about how the Australian public is supporting us, I think the Australian public can look forward to an improved opportunity to utilise excellence in natural medicine education, natural medicine patronage, natural medicine products, for their improved health. So we are on the rise. Watch out Australia, here we come. 
Andrew: Words well, said. Peter Berryman, thanks for joining us on FX Medicine today. 
Peter: Welcome. Thank you, Andrew. 
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Additional Resources

Peter Berryman
Australian Traditional Medicine Society
ATMS: Board of Directors
ATMS Position Statement
ATMS: Code of Conduct
AHPRA: Australian Health Practitioner Regulation Agency
AMA: Australian Medical Association
RACGP: Royal Australian College of General Practitioners


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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.