The Case for Naturopathic Registration with Dr Amie Steel

FXMedicine's picture

The Case for Naturopathic Registration with Dr Amie Steel

Dr Amie Steel is a true leader in the Naturopathic profession and she wants to protect safe and qualified naturopaths from the actions of non-qualified persons which sometimes surface in the media. This podcast is highly contentious because "Naturopath" is not a protected title, allowing anyone to use the it.

Today Dr Steel takes us through the legalities facing practitioners of natural medicines, the myths sometimes propagated by those fearful of registration, and what organisations like Australian Register of Naturopaths and Herbalists (ARONAH) are doing to protect not just patients but also properly qualified, safe practicing practitioners from the damage caused by untrained and unethical providers.

What do you think of naturopathic registration? Take the survey.

Covered in this episode

[00:48] Welcoming Dr Amie Steel
[01:29] Challenges of attempting registration
[05:17] Overcoming these challenges
[06:18] What does statutory registration mean, and what might it accomplish?
[09:49] Protecting the title of naturopath
[12:42] The bureaucratic process of getting registration 
[16:12] Introducing ARONAH
[17:52] Will registration require naturopaths having to go for further training?
[21:01] What are the drawbacks of registration?
[23:45] Registration as a safety net
[27:28] The differences between lobbying and registration
[29:05] How can practitioners support registration?
[31:04] Will registration prevent harm to patients?
[34:47] Thanking Amie and closing remarks

Andrew: This is FX Medicine, and I'm Andrew Whitfield-Cook. And with me on the line today, all the way from Queensland, is Dr Amie Steel, who is a naturopath with over 15 years experience, with a PhD in health services research. Now, she was looking at the role of naturopathy within maternity care in the Australian healthcare system, a very important thing to investigate. 

Amie's been involved in naturopathy in a variety of capacities, including clinical practice, industry, policy development, and research and academic activities. Amie is currently the chair of ARONAH, supporting statutory registration of naturopathy in Australia. Welcome, Dr Amie Steele.

Amie: Thank you. Thank you, Andrew.

Andrew: So Amie, given your wide variety of activities within the naturopathy industry and profession, what would you say are the major challenges facing naturopathy in Australia at this point in time?

Amie: Well, there's a few different areas that I think potentially are causing problems for the development and advancement of naturopathic practice. One big area is an issue which I called “co-option and appropriation.” 

So, this is where what naturopathy actually is, is being picked up by really anyone who wants to practice what is loosely defined as “natural medicine.” So, naturopathy has had 100 years of practice in Australia and has core defined philosophies that underpin practice and the approach to practice. 

But what it has become in more recent years, particularly in the last 30 to 40 years, is an area where basically anyone who wants to practice anything within the vast field of natural medicine, irrelevant of whether they're following naturopathic philosophy or not, but is calling themselves a naturopath. Which is antithesis to the World Health Organization definition of naturopathy, and the World Naturopathic Federation's definition of naturopathy.

Andrew: So, there's good definitions out there of naturopathy, with the World Health Organization? I didn't know this.

Amie: Absolutely. So the World Health Organization actually worked on a core document around naturopathic medicine. That had its own history, which was not… and it's not the strongest document because at the time, we didn't have an international body. The World Naturopathic Federation has been formed, and they've just recently done a survey involving 18 different countries where naturopathy is practised, and there's 95% consensus about the definition of naturopathy across those 18 countries. 

So that strength of across the globe of what naturopathy is, is outside of just Australia. But unfortunately, the lack of definition within Australia, we don't have anyone who's clearly standing up and saying “This is what naturopathy is.” We don't have enough of that, particularly for those outside of the profession. 

So I often have asked the government representatives, we're not really sure what a naturopath is, so how do we know what they can do, or who we should send to them, or what we should do with them? 

Andrew: Yeah.

Amie: That lack of definition goes hand in hand with the co-option and the appropriation, and they're two areas that are causing major issues.

Andrew: Yeah. So my understanding of it was that… you know, you talk about naturopaths don't necessarily know what they are. My way of looking at it was that naturopaths don't know what they are not.

Amie: Well, potentially. I think that one of the problems actually is that natural medicine is...the definition of that broader catch-all group of natural medicine has become more of defining themselves by what they are not, and less of a focus on defining themselves by what they are. 

And so what we're really focused on with ARONAH is developing a core definition of what naturopathy is, what it means to be a naturopath, what you need to be competent in to be able to be calling yourself a naturopath. And we haven't had that documentation and that clear detail to be able to hand over to other health professions and to the government so that they are aware of... 

It's very hard to plot the role that we, as a health profession, have within a health system if we can't even tell people who we are and what we do.

Andrew: Yeah.

Amie: It becomes incredibly difficult. And so there's never any way to put us anywhere, and to understand how we could possibly work with other health professionals to do that.

Andrew: Okay. So, what needs to happen to overcome these challenges, then?

Amie: Well, I guess the one thing that… because then it is probably the third challenge as well, is we lack professional unity. And so we've got disagreement over standards across different associations.But ironically, if we can overcome those issues, we'll probably find that associations have got more in common than they actually hold different in a lot of areas. 

So I think the solution, really, there's going to be a lot of pieces that have to fit into the puzzle, but a key foundation is statutory registration. And it's not to say that statutory registration is a cure-all. It's certainly not intended to be so. There are a number of other issues that we face within our profession that we would also need to address. But it is a really good, strong start as it will clear away a lot of the outside issues, and allow us to address some remaining fundamental factors that will be a part of that as well.

Andrew: What does “statutory registration” mean, though, Amie?

Amie: Well, this is something that often causes a lot of confusion for practitioners because what it actually means in Australia is that the title of naturopath is protected and that only people who fulfil certain education and practice standards can use that title. And this is really quite important. And so in doing that, and once they are registered, then they are held accountable and held to certain standards, which apply to their main practice. 

Now, it is also important to realise that these standards, they shouldn't be confused with strict protocols for treatment. So it's not to say that you'll be told if some patient comes in with depression, you must prescribe them St. John's Wort, and you must do this, and you must do that. It's not about that. 

They're more standards that are defined by the profession, and they're more about how to approach care, that you'll provide individualised care that is safe and considerate of the patient’s place in life, and all of those kinds of things. They're the sort of standards that we're talking about. It's more defining and describing exactly how a naturopath approaches treatment, rather than what they specifically do for a patient.

Andrew: What does it not mean, though?

Amie: Well, from that point of view, I guess it doesn't mean a defined scope, as I said. But also, there's a lot of other things that statutory registration doesn't mean. 

It doesn't necessarily mean that it would give us guaranteed access to Medicare, and that in itself could be a double-edged sword, you know? It would be great to be able to provide public-funded care to lower-income communities, but the flip side, of course, is then you're tied into a lot of the restrictions that GPs and people like that act in under. But that's not to say that there'll be government-funded work for naturopathy, assuming there's registration. 

It also doesn't necessarily mean that you're going to start getting higher referral rates from general practitioners or other health professionals to naturopaths. Having said that, the other three CAM professions, osteopathy, chiropractic, and TCM in Australia that are registered, since registration has come in place, their referral rates have gone up. But I'd say what's happening there is that whilst there is going to always be a group of stalwart doctors who will insist that they would never refer to a naturopath, there are going to be a group in the middle who are probably a bit ambivalent, and don't really mind if their patient goes to a naturopath, but are uncertain about the ability to ensure safety and accountability for good care, should that happen. 

And if they refer to an unregistered practitioner, and something goes wrong, they can be made liable for providing inappropriate care by giving that referral. So by having a registration body in place, looking after naturopaths and those, that sort of releases the onus from them to make sure that the practitioner is safe to begin with. And so from that point of view, it is possible there's higher referrals, but it's not guaranteed. 

It also means that the… It may not mean that there's increased support from the medical community, necessarily. But as I said, it may actually provide that ability for the ambivalent practitioners, who don't necessarily support naturopathy but also aren't particularly against it, to be able to work with naturopaths more appropriately and effectively.

Andrew: So to me, it's like practitioners that do enjoy that protection of registration can know that naturopaths are both safe and accountable for their actions.

Amie: That's correct. Absolutely. And it's also true for the case of the naturopaths. It means that the majority of incidents, the vast majority, in fact, of incidents that have resulted in naturopaths, and I use that term carefully...

Andrew: In the current landscape, yeah.

Amie: the current situation, causing damage to the public in some way, affecting ill harm. Those practitioners have, without a doubt, almost every incidence has been related to a practitioner who would not have been accepted into a registration program…

Andrew: Yeah.

Amie: …whether they had a previous criminal background, or they weren't appropriately qualified, whether they'd already had an incident in the past that would have had them under restricted practice, all those sorts of things. 

If we had registration, then that would be less of a problem. And so one of the issues that we're having is that some of the bad reputation that naturopaths have in the community, it's not the naturopaths that are doing it. It's the people who aren't naturopaths...

Andrew: But are calling themselves naturopaths.

Amie: ...that are using the title of naturopath.

Andrew: That's right. And to me, this is the crux of the matter, is there seems to be this real argument as “Do we want registration or not?” And my...coming from a nursing background, my stance is why would you not want registration when you want protection of your title? It's the only way. 

Because right now, the people who are actually causing damage to your name are the people that aren't like, "you," but they're allowed to call yourself you, you know? So, it's kind of like an imposter sort of thing. How do you stop an imposter? Well, you take out the… You make them identifiable.

Amie: That's right. That's right. And so what we have at the moment, because as a brand, naturopath is quite a strong brand in Australia, compared to the United Kingdom, for example, where people know of a herbalist or a homeopath, but naturopath is not as well known as a profession. 

But people have heard of naturopaths in Australia, and so you have a lot of people who trade on that brand, who have done a couple of courses here and there, and picked up a few things, but haven't had the foundational core training that is expected of a naturopath. But they're able to hang out a shingle, call themselves a naturopath, and the public are not able to tell the difference.

Andrew: Yes.

Amie: And so they'll come in with high-risk cases, with vulnerable populations, complex situations, polypharmacy conditions, and the practitioners who are calling themselves a naturopath but don't have the training to provide high-level naturopathic care are making mistakes in amongst that, and putting the public at risk. And as a result, putting the profession at risk.

Andrew: Yeah, that's right. All right, so where are we up to in the landscape of Australia? Because I thought this has been going on for decades.

Amie: Well, it has been. Well, the history behind it is "frustrating." We actually had registration in the Northern Territory about 30 years ago, and then that got pulled. And that's really frustrating. And part of the issue was that there wasn't enough naturopaths to justify it in the Northern Territory, and that's really frustrating. 

Because then what happened is when the Victorian government, once they implemented the Chinese Medicine Board in Victoria, they then said, “Okay, we also need to look at naturopaths.” So they did a review against a criteria that had been established about 20 years ago. And this particular criterion was set by the government to say, “If we're going to have registration, then you need to justify it against the set criteria.” 

And this set criteria has actually been used for this report that was done in Victoria, and they evaluated naturopathy as a profession, to identify whether or not there was sufficient risk to the public for people to provide naturopathic care without being appropriately qualified and registered. And the outcome of this report was yes, that was the case. 

Now, the next step for the Victorian government would have been to set up something similar to the Chinese Medicine Registration Board that they had for naturopathy and herbal medicine. But unfortunately, the timing was just not quite right for us, because the National Registration scheme started to get set up. 

And so the Victorian government said, “You know what, we're not going to set up our own registration board because it's all been rolled into this National Registration scheme. So we're going to take this report, and give it to the Council of Australian Governments, where all the state governments come together, and let them roll it up into the National Registration scheme.” And it's been sitting there ever since.

Andrew: So, we've had no champion?

Amie: So, we don't have a champion. And that's what we need. And it's quite frustrating. I mean, if Northern Territory had retained its registration for naturopaths, we would have been wrapped up in the same way that the Chinese medicine profession was. They only had one state that they were registered in, but we would have been able to be pulled in. 

And so when they set up the National Registration there were three steps. The first was any profession that had National Registration were assimilated in, and the second was any profession that had at least one state reporting. And the third is to develop the pathway for new professions that were as yet unregistered but needed to be. And we're still there. So, part of the reason we haven't gone anywhere is just bureaucracy. The Health Practitioner Regulation Agency hasn't actually developed these pathways. 

So, but the flip side of that is that if you've got a strong enough champion, as you mentioned, you can overcome that bureaucracy. The paramedics had not been assessed against the criteria in the way that naturopaths had, they hadn't been sitting on the table for 10 years the way that naturopaths had. 

But one of the state health ministers discovered that paramedics were not registered, and identified that that was not okay. And so they pushed for it, and they've been pushed through the system themselves. So they actually have been bumped up ahead of naturopathic registration, and we've been told by certain government contacts that whilst naturopaths are still sitting on the table, it's not dismissed. We've not been told we're not being registered, but just not really being considered one way or the other. They've acknowledged that paramedics will be going through as soon as they can.

Andrew: So to me, this is where ARONAH sits perfectly. Because in my mind, you have your various associations, but you need a lobbying group. And this is where ARONAH is different. So I'm going to ask you, what's ARONAH?

Amie: Well, ARONAH is the Australian Register of Naturopaths and Herbalists. And in part, it was established in response to this gap, the fact that registration has been acknowledged as being needed, and it wasn't being enacted by the government. 

But what we've...instead, it's independent and voluntary, it is not government statutory registration. And the only people who are joining and who would join ARONAH are practitioners, who are voluntary members. But what people often miss, and you've picked up on it very well, is that that registration board is only a small part of what it is that ARONAH does, and is doing. 

So, lobbying is part of it, actively engaging with state ministers as often as we can, and in whatever channels that we have available to us to try and push forward for statutory registration. But we're also developing degree accreditation standards, and working with other accreditation and registration bodies internationally to support the transportability of practitioners, people who have trained in Australia being able to practice elsewhere, people practising elsewhere being able to come to Australia. 

We're also working on a trans-Tasman agreement at the moment with the New Zealand colleges and associations, to really shore that particular pathway up because we've got such close ties with New Zealand. And also working with the colleges to try and develop a group or a collaboration amongst the colleges, so that they are working more cohesively together to strengthen the education of naturopaths in Australia.

Andrew: Amie, one of the arguments I've heard is that if we go for registration, we'll have to give up so much. And furthermore, we'll have to do further study and we won't be appreciated for our prior expertise. 

Now in my mind, this sort of thing is a parallel to what happened with nurses who went through the hospital system having to upgrade to a degree, external to the hospital system. It was just something that was a natural evolution, and they were given a certain period of time, and it seemed to go hand in hand. Tell me what that fear is, and what do you think the reality will be?

Amie: Well, the reality is, the way it works in any profession and as nurses, midwives, TCM practitioners, this has all happened for all of these guys, is that when registration comes in, they'll have a grandparenting period in which they acknowledge that practitioners have trained when there's been different levels of qualifications available. And no one would ever suggest in nursing or midwifery that a practitioner who has been in practice for 40 years, and trained in the hospitals and has a certificate is less capable or competent as a practitioner than those who have just graduated with a degree. And that would be a completely inappropriate thing to say. 

And so, the registration board has acknowledged this. I mean, the registration boards are made up 80% by practitioners, so they know their professions. And so the registration board has acknowledged this, and they've set up grandparenting standards in which there are just pathways in for people with different levels of qualification, and all they need to show… People with degree training can show evidence of their degree, but people with other levels of training and, you know, particularly certificate or diploma qualified practitioners that have been around for 10 years or more and have been in practice, or you know, 20, 30, 40 years a lot of these practitioners have been around for a long time. As long as they can show that they've been in practice and maintained the recency of practice and continually attended CPD training and education opportunities, and they've kept themselves up to date, then they're grandparented in and they are kept within that system. 

There's not even an expectation that these practitioners upgrade their qualifications so long as they show that they've maintained recency of practice, and they haven't been out of it so long that they've forgotten or they've missed new developments that are actually really important to providing safe and effective care in modern times.

Andrew: So yeah, so it's really got to do with safety and currency.

Amie: Absolutely. Absolutely. And so in fact, the purpose of registration is not to place value judgments on currently trained practitioner's qualifications at all, it's actually to be as inclusive as possible. And the purpose of registration is to identify a profession that needs to be registered, and figure out a way of capturing all of those people who rightly and justifiably fit within that profession, and then providing a structure upon which to ensure that they are accountable for their practice. 

So it's not about trying to exclude practitioners who should be included, because by doing so, those practitioners aren't stopped from practising at all. In fact, they're continuing to practice under the regular design, but that's not what they want. They're trying to capture as many people as possible so that they're part of that group that are held accountable for what they do.

Andrew: Yeah. So do you think there would be any drawbacks to statutory registration for the profession?

Amie: Look, the main thing that I would say is really, there's an additional cost attached to it. And I mean, practitioners will complain about ARONAH's registration fees each year…

Andrew: We all do.

Amie: ...which is $150. But I tell you what, it does add more cost. Absolutely it does. It is a user-pay system in the sense that the government doesn't fund really, especially registration, the profession does. And so the viability of statutory registration boards and what they do, is funded by the members of the profession. And you know, they could be up to $800 a year. That's kind of what I think is averaging out for a lot of people. 

So I think that that would be the main drawback. The rest of it is defined by the profession, you know? What we're trained in is defined by profession. And so what our scope of practice is is defined by the profession, and the board is made up of the profession, and so people who are found to be practising outside of registration standards are being assessed based on the standards that have been developed by the profession. It's all about the profession, really. 

Andrew: Yeah.

Amie: And the main drawback is that there is an extra cost attached to it, but that's the trade-off for ensuring public safety.

Andrew: And along that line, I think, you know, one of the things that I hear in the nursing, or in the AHPRA circles, if you like, is those instances where practitioners are sanctioned. So for instance, unless it's a public menace, where that nurse caused a fire which caused the death of...I can't remember how many people, disgusting behaviour. 

But there are many cases where - I’m going to say nurses because I know about it - where nurses are sanctioned because of unsafe care or because of, more precisely, unsafe conduct or practice. And it may not be affecting somebody else, it may be things like addiction, they're using drugs of addiction, or stealing drugs of addiction, and so they're sanctioned. But that doesn't necessarily make the media. 

And so this is one of my arguments for registration is that... And I'm not saying it's a closed book, I'm just saying the things that aren't necessarily appropriate to be publicised in the media, because it really doesn't matter, it's something that's against that practitioner for unsafe conduct, the regulatory body can then take sanctions and not worry about backlash for the profession. This is my...

Amie: Absolutely. And look, I think the things that really kind of escalate, even if there were issues in people who have been picked up for doing the wrong thing, who are under the label of being a naturopath. 

Andrew: Yeah.

Amie: Another thing that we talk about with registration as well is that it's proactive and not reactive. So, and there's a starting point, you're screening practitioners as they're coming in to ensure that they have the appropriate trainings in ethical conduct and clinical care and that those kinds of things to know. And so they are aware of their boundaries, and they're not making silly mistakes that are inappropriate, but just through not knowing any better. 

And so you've got that screening process, but you also have this infringement approach that you're kind of working towards, where you can pick up minor indiscretions along the way, and minor transgressions I should say, along the way, where people maybe have done something that they shouldn't have done. It's not caused anyone's death or even major harm, but it has been identified maybe by another practitioner as, "Hang on, you shouldn't be doing that, that's not okay.” And so there's a disciplinary response, rather than a penalising response. 

Andrew: That’s right. That’s what I was getting at.

Amie: And so their response is, “Okay, there's obviously a gap here in what you understand as okay or not okay, in terms of ethical conduct or clinical care or whatever it may be. So we've identified that, and we're going to put you under a limited registration banner, make sure you're working with someone who can oversee that whilst you upskill in that particular area. And we're confident that you're going to be able to move forward again and practice safely and appropriately.” 

And so these minor transgressions wouldn't make the media, they're not particularly interesting, they're not sensational enough. But what you're doing in doing so is providing support to the profession in a way that doesn't completely disregard practitioners who have the capacity to provide good care, that might have just been missing a few points along the way that they needed just to brush up on.

Andrew: Yeah. And indeed, you know, conversely, I think, protecting the profession.

Amie: Absolutely. Absolutely. And you know, the rates of complaints… I mean, we get a lot of complaints coming into ARONAH about practitioners, but the thing is at the moment, we don't have anywhere for those complaints to go. 

Andrew: Yeah.

Amie: And the HCCC, the Health Complaints Consumer Commission, will only act on the more serious ones. And so the minor transgressions kind of get missed, which gives the opportunity...well, not, opportunity is the wrong word, but it creates a situation where practitioners who are undertaking these minor transgressions may extend those without realising that they're causing a problem until it becomes a major problem. 

Then it hits a headline, it ruins a practitioner's career, and it affects someone's health in an inappropriate way. And you know, it's a terrible tragedy that arises, that there was potentially opportunities before then to address and provide support to the practitioner, and keep them well trained in the profession.

Andrew: Yep. So to all intents and purposes, registration is really the safety net for the profession.

Amie: I believe so wholeheartedly, you know? And ARONAH is a volunteer-run board. There's no one on the board who gets anything out of it except for the opportunity to spend their own time doing something that they get nothing back for, other than seeing the advancement and the stabilisation, and the future of the profession being maintained. 

So from that point of view, I wouldn't be doing what I'm doing if I didn't feel wholeheartedly that it was a thing that needed to be done for my profession to be able to exist and grow and develop into all of the fullness of its potential and into the future. I wouldn't waste my time away from my family and other things.

Andrew: I hear you there. One of the questions that I get asked sometimes is how is a lobbying group different from a registration? So, I'll frame this up. How is ARONAH different from statutory registration?

Amie: Well, the main thing with us is that, as I said before, we're independent and voluntary. We also have a group of, as an extra set of activities that we're undertaking, that are slightly more than what the registration board would undertake, and one of those is lobbying. That's not something that a registration board does at all. 

And often, they will outsource things like degree accreditation. They will manage it, but they'll have another board or a body that kind of puts it together, and then they kind of support whatever that other body does. And so from that point of view, there are certain things that we're doing. 

But having said that, what we've done with ARONAH is actually, whilst we're not held to health practitioner registration, we've written into our constitution that we follow the Health Practitioner Registration legislation as if we were bound to it, and so we actually are really carefully making decisions. The decisions that we make, the guidelines that we write, the processes that we follow mirror everything that they do in AHPRA as the way that we can most closely align with that. 

And also in the hope that when statutory registration picks up, it's going to be a very seamless transition for the government, that all the guidelines and policies and processes will already be established, they'll just be able to pick them up and run with them

Andrew: Okay, so what can current practitioners, real practitioners do to support registration at the grassroots level, though?

Amie: Well, the main thing really is to advocate for and support registration in every opportunity that they come across. Write a letter to the State Health Minister. If you want some help with that, contact ARONAH. Support ARONAH as much as you feel you can. 

Of course, we're encouraging practitioners to join ARONAH, and part of the reason for that is because one of the criteria that the government looks at for whether a profession should be registered is, is it possible, and is it practical?

Andrew: Yeah.

Amie:  And so by setting up ARONAH, we're just kind of trying to show that it is possible, it is practical, it can work. And so supporting ARONAH definitely is a great opportunity. 

We're actually setting up another option, which is kind of a friends of ARONAH situation, where people who may not want to join the register might still want to be affiliated in some way. So, we're setting that up as well. 

But if there's anything even outside of that...we're happy to support people who aren't members of ARONAH, but if they want to get behind advocating for statutory registration. So if you want to write a letter to the State Health Minister or you've got an opportunity to meet with someone, get in contact with us. We’ll give you some reports you can take with you, we'll help you draft the letter that you can send through. We will work with you in whatever way we can. Because at the moment, it is all volunteer and every extra set of hands will always help.

Andrew: Amie, I wholeheartedly support what ARONAH, and indeed yourself are doing for the profession of naturopathy. Because it's a really important leap -  not a step, a leap - that the naturopathic profession has to take to protect both itself and the community in general. 

So, I really thank you for your hard work done to date, indeed your colleagues, Jon Wardle as well, and others. So I really thank you for what you're doing for other naturopaths around Australia. Well done.

Amie: Thank you.

Andrew: Amie, forgive me, one more question. Some practitioners around Australia feel that there's no reason to become registered because there is no harm from practitioners. So, can you comment about this? Because to me, there's been a bit of an argument, and I don't think it's been answered properly.

Amie: Absolutely. Look, really the harm from… I fully agree that the risk to the public from having appropriately qualified practitioners providing care to the public is minimal. 

However, no one could possibly say that… Yeah, if you're saying your health treatment options are effective, they also as a result have harm. I mean, people can overdose on Picrorhiza, they can overdose on vitamin A. They can provide dietary recommendations that aren't safe, if people have got kidney problems and they're put on high protein diets. There are risks associated with providing inappropriate advice and prescriptions. 

That's not to say that it's inherent that there is risk associated with appropriate advice or prescription however, and so this is exactly why registration is needed. The people who are often arguing that there is no risk are forgetting that that's the same reason they also want practitioner-only products, only available through practitioners. Because there's a perception of the quality and the strength of the product, and that that shouldn't be something that people should buy off the supermarket shelf. If there is no risk attached to our products, then why do they need to come to a naturopath at all?

Andrew: Who cares? Yes. Yes.

Amie: And really, that's what it's about. And I think it's just a slight misinterpretation, and practitioners forget, or I think they're scared or they're fearful that having a statement of risk will actually undermine the external perception of the profession. But that's not the case at all.

Andrew: No, I don't think that's the case at all. Look at what's happened in invasive therapies like acupuncture. They're actually afforded greater protection by being registered.

Amie: That's right, absolutely. And really, when it comes down to it, as I said, if our treatments do not contribute some risk if used inappropriately, then we have to question whether or not there's any effectiveness to them at all. 

And even without the treatments aside, there are other risks that we call indirect risks in the public health world, associated with poor practice. And that would be misdiagnosis, or late referral, or not supporting other treatment options that the patient is currently using, for example. 

Andrew: Right. Yes.

Amie: So there are things that, again, come down to the practitioner being appropriately trained in what the capacity is for their therapies to provide certain outcomes, but also what they're not really going to get outcomes from, to the point where you say, “You know what, you're better off going to a chiropractor for your back pain because if you keep coming to me, I can help you with your anti-inflammatories, but I don't know how to do the manipulative therapy, so you're better off going to them.” 

So, or whether or not it's a case of “You know what, actually you've lost a lot of weight, and you're eating and you're not feeling well, and I'm thinking to myself there's a potential for other major serious condition here, I need to refer you on to another GP, or someone who could check that out.” So there's direct risks associated with inappropriate use of the medicines, and then there's indirect risks associated with inappropriate referral practice and application of care.

Andrew: Dr Amie Steel, I thank you for taking us through these, such important aspects of hopefully, registering naturopathy in Australia, and being able to enjoy the protection to both industry and public that indeed some states in the U.S.A., for instance, have. 

So I really thank you for taking us through that, and also for dispelling some of the myths that seem to be propagated around certain social media circles. So, well done for that.

Amie: Thank you very much, Andrew. I appreciate the time, and the support of so many of the profession, for all the work that we've been doing at ARONAH.

Andrew: This is FX Medicine, and I'm Andrew Whitfield-Cook.

Other podcasts with Amie include


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

Amie Steel is a qualified naturopath who has been in clinical practice since 1999. Amie not only holds a Bachelor of Naturopathy but also has a Graduate Certificate in Education (specialising in Higher Education) and a Master of Public Health from the University of Queensland. More recently, Amie completed a PhD through the prestigious Australian Research Centre in Complementary and Integrative Medicine, at the University of Technology of Sydney. Amie is widely published both in text books and peer-reviewed journals, has given invited talks at international research conferences and is on the editorial board for multiple international peer-reviewed journals related to complementary and alternative medicine.

Amie holds a number of professional positions which ensures she is abreast of the most recent research evidence, and important professional practice issues relevant to her areas of specialisation and to naturopathy more generally. These include: Consumer representative on the Mater Mothers Hospitals’ Maternity Clinical Governance Advisory Committee; member of the Network of Researchers in the Public Health of Complementary and Alternative Medicine; Board Member of the ‘Evidence, Research and Policy in Complementary Medicine’ Special Interest Group at the Public Health Association of Australia; Chariperson and Board member for the Australian Register of Naturopaths and Herbalists; Collaborative researcher for the Australian Longitudinal Study on Women’s Health.

Share this post: 
FXMedicine's picture
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 Dr Adrian Lopresti, Dr Michelle Woolhouse, Dr Damian Kristof and Emma Sutherland, 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.