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Lobbying, Advocacy and Research for the Naturopathic Profession with Prof. Jon Wardle and Dr Amie Steel

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Lobbying, Advocacy and Research for the Naturopathic Profession with Prof. Jon Wardle and Dr Amie S

Today we're joined by Dr Amie Steel and Prof. Jon Wardle to explore the aspects of lobbying, advocacy and research specifically for the naturopathic profession in Australia. 

Have you ever wondered what lobbying and advocacy actually is and how these could be applied for the direct benefit of the naturopathic profession? 

In today's discussion Andrew, Amie and Jon take us through how there is an art to strategically shape conversations for political purpose when it comes to health policy and why it's crucial we're accumulating sound, tangible evidence that shows the value a naturopathic care model can bring to public health. We also discuss why naturopathic medicine is distinct from natural medicine and why there is a critical need for positive and proactive media to contribute to the narrative about naturopathy so our profession is not left to be defined poorly by critics. 

Covered in this episode

[00:06] Welcoming Jon Wardle and Dr Amie Steel
[00:57] Defining what is: Lobbying and Advocacy?
[02:50] How Jon and Amie became involved in lobbying and advocacy
[05:15] How to shape conversation for success in the political arena
[12:43] How clinical experience can impact research and public health policies
[16:09] Creating research that supports tangible evidence of the value of the naturopathic profession
[17:39] Documenting and validating traditional knowledge
[23:58] Naturopathic Medicine vs. Natural Medicine - why it's important to separate the two
[30:17] Using the title: "Naturopath"
[34:19] Lack of pro-active positive media about naturopathy
[42:15] Do we need to combine all the naturopathic associations into one to achieve registration?
[47:18] Responding to critics from both inside and outside the profession
[50:14] Diversity is the strength of the profession
[53:32] Proactively leading on behalf of the profession
[57:34] Thanking Amie and Jon and closing remarks

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us today is Dr Amie Steel and Professor Jon Wardle

Jon Wardle is Professor of Public Health and Director of the National Centre for Naturopathic Medicine at SCU, Southern Cross University, in Lismore, New South Wales. He leads several World Federation of Public Health Association and World Health Organization initiatives on integrative medicine. 

Dr Amie Steel is Senior Research Fellow at the Australian Research Centre in Complementary and Integrative Medicine at UTS, University of Technology Sydney. As part of her research role, she also leads numerous research projects for the World Naturopathic Federation

Welcome both of you to FX Medicine. How are you going?

Amie: Thanks, Andrew. Great to be here.

Jon: Thanks for having us, Andrew.

Andrew: So, today, we're going to be talking about advocacy and lobbying and all that is entailed within it, but I think firstly to start, some listeners may not be aware of a difference between lobbying and advocacy. So, can we go through the difference and what they entail, please? Amie, can I ask you first?

Amie: I think, from my perspective, advocacy is about providing a voice to a group that doesn't necessarily have one. So usually it's about taking a voice that's disempowered in a certain setting and giving voice to that group, making sure that everyone who needs to hear the voice of that group, hears it. 

Whereas lobbying is about targeting a particular audience and trying to convince them of a certain opinion or perspective, so that they're absolutely enmeshed with one another, but advocacy is more general and is about generally just capturing the voice of a disempowered group and giving them a voice in general. Whereas, lobbying is much more targeted and it has an outcome in mind, as well. That's my definition of that. I don't know if Jon's got a different version.

Andrew: Got you. Jon?

Jon: Yeah. Well, I guess what I'd add to that is advocacy is really about pushing the profession forward, or whatever you're pushing forward, and highlighting the role that is perhaps unfilled in what the profession should be doing and what they can add to society, patients, other communities more generally. 

Lobbying is then actually taking that implementation and translation step, so you know what you should be doing. Lobbying is about trying to make that happen.

So, you know, we like to think that evidence-based policy is a thing that actually happens but politicians don't follow the evidence. It's more about politics than policies. So I guess the advocacy is really that good policy and the lobbying is about good politics.

Andrew: Okay. So, to continue on from that, how did you first become involved in this? I'll continue with you, Jon.

Jon: Accidentally. I guess just by, probably, virtue of my nature. I'm a Territorian. I don't tend to hold back when I disagree or agree or want to push things forward. And what I did find is that when you actually put cases forward to people, if they are rational cases, if they are cases that actually do make sense to someone, politicians are generally open to hear them. You know, other members are generally open to hear them. 

But what really needs to happen is it needs to be strategic, and that's the thing that really passionately got me into this profession was about helping patients. And at the end of the day, everyone wants patients to be better. No one cares about the profession in politics or any other group, but if you can actually highlight the role of the profession as a vehicle to bring in better patient care, there's suddenly a lot of interest.

And I guess just as I moved along more and more, there was… a lot of the barriers that I thought were, or that I was taught were actually out there for naturopaths were actually quite fake barriers. They're the same barriers that every other profession has had to overcome. The biggest barrier was actually naturopaths getting out there and actually arguing for a bigger role and actually putting the, you know, wearing out the shoe leather as they call it…

Andrew: Right.

Jon: …in that wellbeing space.

Andrew: And Amie? How did you first become involved?

Amie: I think I have a background role in lobbying in that I do some actual active lobbying, but most of the work I do is about collecting the data that we need and the evidence that is useful for those lobbying efforts. So I guess I don't believe that I have the political mask to kind of spend heaps and heaps of time down in Canberra sitting across ministers and navigating all of that. Not that I can't do it, but it's not where my strength is.

And so I spend a lot more of my time identifying what the evidence is that we need, identifying policy directions that the health policymakers are taking us in Australia and elsewhere, and figuring out what evidence we need to collect to show what role we might be able to play there. And so that's where I've sort of put most of my energy.

Andrew: Okay. So, Jon, you said something a little bit earlier. I'll continue on with that one. And you said you ‘argue a case.' But when does lobbying or advocacy actually turn into an argument? And what are the strategies I guess that we need to refrain from becoming emotionally charged? This passion is one thing, but then you can be argumentative. So, how do you go... I guess I'm referring here to when you're presenting to politicians.

Jon: Yeah, and you know that's a really good example, Andrew, because I've presented from… I've met with everyone from, you know, Bob Katter to Pauline Hanson to Julia Gillard to Tanya Plibersek to Greg Hunt and Scott Morrison. And, look, I definitely don't agree with everyone on that spectrum but it's such a wide spectrum. So, you know, you have to be able to stick to what...

Andrew: Don't tell me they're on the spectrum.

Jon: Yeah. Well, politics is a spectrum, and I'm on that spectrum somewhere and so is everyone else. I won't tell people what party I guess I most align myself with. But quite often it's not the one that I often have to present an argument in front of. 

So when you're talking about argument, everyone has a passion about something and everyone disagrees about other issues, so it's really about focusing on that area of commonality. You're going to disagree. That's just a part of human nature. I guess acknowledging that it is okay to disagree on a number of things and focus on those areas of commonality where you actually do have a common voice that you can move forward.

So, you know, Labour, for example, is very passionate about health but it's also reasonably dispassionate about complementary medicine because it views it as middle-class medicine. So the argument you've got to take there is actually treating the underserved and opening up those services. 

If you're looking at the Liberal party, for example, you know, they're more about freedom of choice and your healthcare services. And they don't necessarily believe in public healthcare as much. So you can sort of use that enhancing the private healthcare argument and actually expanding freedom of choice for practitioners.

So, the same argument is not going to work with everyone, and you're not always going to have the same allies in the same lobbying or advocacy efforts you have. And in a naturopathic perspective, I've had really positive relationships in advocacy with groups like ATMS that most people think that I hate because they disagree with registration and degree minimum standards. And we do disagree very, very strongly on those things, but we have mutual interests where we've actually worked together quite a lot. 

So, I think it's about the profession knowing that it can disagree with other people or other elements of the profession, but also knowing that that's okay. And you can actually work with those people in the areas you do agree.

Andrew: Yeah, Amie, I'm going to ask you, who in your opinion are doing the bulk of the lobbying and the advocacy work for our professions?

Amie: Well, I mean, Jon is absolutely doing the bulk of that work. But I'm sure he would also acknowledge that there's a raft of people who are contributing as well. And I think the reason that he's doing the bulk of the work is because he was the first one in the room and he's been paving the way in that regard. 

But he's also been taking a lot of energy to bringing other people along. So, we're building up a lot of capacity within the profession for more people to be involved in that way, but he could probably speak more to what he's doing in that space.

Andrew: Okay. So, Jon, continue.

Jon: Yeah, there's actually quite a large group of people actually doing a lot of work in this space at the moment. So one professional association I think that is taking a lot of leadership in the space at the moment is the NHAA. They've certainly started budgeting for advocacy which I think is incredibly important for any professional organisation. If you can't pay for it, you can't do it. And even something like a Murrays bus to Canberra is $40. And if you don't have even something as simple as that, it's very difficult.

Look, there are a lot of... You know, you've taught me not to talk about industry but I will. They do a lot of the stuff in the background, but I guess there's an overlapping of interest but they don't have the full Venn diagram of interest. So there's a whole lot of professional issues that frankly no one but the profession actually cares about and no one's going to push forward unless the profession does.

So, you know, they've certainly got a very active role and John O'Doherty at Blackmores, for example, the government relations person, has been very active in the private health insurance issues. Other companies were very… you know, they've got a very active interest in the traditional medicine stuff at TGA and that kind of stuff as well. 

But there are a lot of professional issues that I think are underdeveloped because we kind of rely on other people to do it as a profession. And really there's not a lot of people out there doing that, and there are a lot of people out there I would say that probably are doing it very ineffectively. So there's a lot of action but not a lot of impact, if that makes sense.

I won't name names but there is one professional association who is always in Canberra for example, two actually. But they're always trying to argue... the private health insurance legislation is a really good example. They were arguing about the impact on the profession or this is going to decimate the profession. And the government just doesn't care about the profession. You need to present an argument they do care about, which is patients, cost-savings, something like that.

And I remember actually meeting with the minister's adviser when they gave a...you know, this is going to impact a $4 billion profession industry. If the changes go through, it's going to decimate our $4 billion industry. The government had done modelling. It had worked out the the profession would probably lose $200 million out of this change, and they actually thought quite positively about that, "$200 million out of a $4 billion industry doesn't sound too bad. Maybe we're on the right track."

So, the lobbying they're doing had completely the opposite effect. So, you do have to be strategic, and you do have to frame it in not the profession. No one cares about the profession apart from the profession. So you have to frame it in some other away. And unless you do that, you're not going to get very far.

Andrew: Right.

Amie: And I can add to that.

Andrew: Yes.

Amie: So I think one of the more recent developments as well has been the Australian Naturopathic Council, which has formed. And it's a collaboration really between the NHAA, Complementary Medicines Australia, ARONAH, and also the colleges who teach naturopathic degrees in Australia.

And where that's been really useful is one of the things that's been a challenge for the naturopathic profession in Australia in lobbying is that the few people with the skills and the expertise and experience to do that work have been separated out, involved in different organisations. What we've been able to do through the Naturopathic Council is consolidate a lot of that and share resources and energy and skills and expertise and put together...we've put more submissions together in the last probably two years for the naturopathic profession than any of those organisations have done individually, just because we've been able to collaborate where appropriate. And it's been such an effective way of consolidating the skills and the expertise that we have.

Andrew: Got you. Amie, I'll follow on with you. So, what role do you think your past clinical experience plays in your research activities today? How has it influenced them?

Amie: It's been very influential because I've worked in multiple clinical settings. I've worked in my own private clinic in a home environment, in a multimodality natural therapies clinic. I've worked in a rural setting as well as an urban setting. I've also done other industry-related work. I worked as a product representative, so I went and visited a lot of naturopaths in clinics and spoke to them about the issues. 

And because my focus of my research is less about, “Does what we do work?” and more about, “Who are we and what can we offer?” Having that really diverse exposure to different types of practice environments and practitioners has given me a lot of different insights to the challenges that the profession has faced and places where we can really strengthen ourselves.

And I've made that decision on purpose because… and it is kind of with that lobbying hat on, that if we don't have evidence that we even exist as a profession and that we can contribute something of value, then having evidence that we have clinical effects for a particular product, or treatment, or practice in a particular health condition in a particular population isn't going to help in the long run because we're going to just fall apart as a profession. 

So most of my research has been about identifying the diversity of our profession and making sure that we've got documentation, that we exist and have something valuable to contribute.

Andrew: Right. And Jon?

Jon: Yeah. Look, I think the... When we talk about clinical education and practice, I think we focus way too much on the therapies and the products that we might be using. But the real value in what you learn as a naturopath is how to think about health problems and how to think about problems more generally. 
Complexity, is not a stranger to you. You're not scared of it. You can deal with complex moving parts and actually find the interactions to actually uncover, what's really going on. 

And that doesn't leave you if you're in practice or in other settings. One of the reasons I really love public health is because public health actually lets you apply that naturopathic way of viewing things through another prism.

I've been at forums… so the National Centre for Naturopathic Medicine has just been invited onto the Australian Health Policy Consortium. And the reason that has happened is because when I was working on a panel for the self-care agenda for the government, run by the Mitchell Institute that are really intrigued at these innovative ways or solutions that were coming from me, which were very obvious to me as a naturopath but very, very strange to them as non-naturopaths, I guess. 

They would never have thought of thinking like that to actually find the underlying cause, or to look at complex systems and how it might work with each other, and trying to actually find a commonality that can actually help address the issue that fell out of that.

So, that never leaves you, and that's equally as applicable in a policy setting, a research setting, a public health setting, or a one-on-one individual case presentation in the clinic.

Andrew: Okay. So currently what sort of research are you involved in? I'll go both, I’ll go Jon first and then Amie again. But what sort of research are you involved in now and what are you trying to achieve with that research? 

I'm picking up already a sort of flavour which is really interesting because it's a little bit at odds from what I have felt myself, but I'm getting to understand why, I think. 

So, continue, Jon. So, the question is: what sort of research are you currently involved in? What do you hope to achieve from it?

Jon: Yeah. So, we have quite a few research streams. I'll try and think of a few that are I guess more narrowly focused. So we do have a big clinical research stream, and one of the things that I’m particularly passionate about is actually looking at the stuff that naturopaths are doing that hasn't been tested yet. 

So we have a number of programmes, looking at complex conditions. So we’ve got an integrative health programme for veterans that we're currently doing because that's a group that actually isn't treated well by conventional medicine, but is actually treated quite well by naturopaths and other integrative health practitioners. 

We're looking at a lot of traditional treatments. I'm very interested in things like hydrotherapy or those self-care modalities that I think are really undervalued by conventional healthcare, but I dare say probably undervalued by naturopaths themselves, too.

Andrew: Right.

Jon: The other thing that we're really doing a lot of at the moment is research on traditional knowledge and actually sort of capturing that in a little bit more of a complex way. 

We had one student, for example, who did work on adaptogens, and it was incredible. Because everyone knew what an adaptogen was, everyone was very consistent on how they would define them, but no one could actually tell us where that came from. So there was a complete disagreement on, you know, “Oh, it's a Russian thing,” or “No, it's a Chinese thing.” But there was nothing from Western herbal medicine even though it is actually traditional Western herbal medicine concept.

So trying to find back from I guess that innate wisdom of indigenous, or traditional, or previously untapped forms of knowledge is a very big part of what we do. And we run the gamut of everything from ethnobotanical surveys and work in that space. We sent a student to Russia last year to see if there were secret Soviet research in herbal medicines, which there is a lot of...

Andrew: Yeah.

Jon: ...which was quite interesting. And going back to those old texts to find really interesting research. 

So we're working with a naturopathic college in Phoenix at the moment on antiviral medications. And the way that we found one that might potentially work in… they've actually tested in Ebola in vitro, and it does seem to have some real... But in vitro doesn't necessarily go to in vivo.

Andrew: I know.

Jon: But the way they found it was from one case study in a book from the 1850s.

So we've got a programme that we're starting at SCU, which is trying to look at the use of Australian indigenous plants in the first 50 years of colonisation by settlers. The Chinese medicine community, because there was a lot of Chinese medicine use of Australian indigenous plants, and the indigenous community itself. Because there's so much work that's... 

A lot of people talk about tradition, but really they're surprisingly little scholarly research or attention on traditional knowledge in naturopathy, and I think that's just a real tragedy.

Andrew: Right. And Amie?

Amie: Well, I guess similar to Jon. Once you finish your PhD and become well and truly on the road in being a researcher. You end up with multiple streams. 

Again, I'll pick a few that give a bit of an example of the flavour but obviously a lot of the work I do is generally around the naturopathic profession as I had mentioned before. And, for me, it's really about...a lot of that focus or impetus for that has been identifying areas where I feel like the health system is looking for answers, and I believe we already have the answers. We've just never documented those answers.

Andrew: Right.

Amie: And so I've got a research student who's just now finishing her PhD. Her whole honours PhD on the role of naturopathy amongst other professions in patient-centred care, that actually came from when I very first started...after I finished my PhD, I wrote my submission on behalf of the NHAA to the government about the role that of...it was a submission that they put out for primary care and how we're going to address patient-centred care and chronic disease management. 

And so my submission was, in fact, that naturopaths actually have a role to play here, but I realise that despite the fact that we positioned ourselves in our principles and philosophies of having a strong patient-centred care approach, we didn't have any evidence of that.

And so she's now built up this lovely body of work that confirms that we actually, from the patient's experience, we do provide patient-centred care, and we actually provide a high level of patient-centred care that almost any other health profession providing care to people with chronic disease. 

So that's a really important argument for us to make to health policymakers when they're saying, “How are we going to fix this issue in the health system?" We can put our hands up and say, 'Well, we're a big part of that solution for you.' So there's that body of work.

I've always been very interested, in fact, my master's research that I did before I even did my PhD was around the use of evidence and information in practice. And it's in response to the argument of the call for evidence-based practice. But my view is that we haven’t, as a profession, given enough scope and emphasis and priority to our traditional knowledge. We haven't treated it with the same respect, in the sense that we don't have a good sense of what it is. 

What is the body of knowledge and its traditional naturopathic knowledge? And do we direct train our professional graduates in how to engage with it, make sense of something that was written 500 years ago and used today, and translating that knowledge across? We don't actually think about how to do that in a really meaningful way. 

And in doing that, we actually belittle the knowledge by doing that. Which we teach graduate students how to critically evaluate research papers but not how to critically evaluate traditional knowledge. And that means that we're treating it very superficially and not giving it the respect that it deserves.

And so that's a big part of what it is that I'm trying to do. So there's a survey at the moment that I'm preparing for the World Naturopathic Federation. They needed some evidence to show how much we were using research in practice. And my response to that was actually “I think that that's not the question we need to be asking, because evidence-based practice is more than just about research evidence. It's also about clinician experience. It's about patient experience. There's the traditional knowledge aspect of that.”

And so instead we built this survey that engages with the idea of all of these different types of knowledge and information having value, and potentially being used in helping to understand in what circumstances they're being used and exactly how they're valued by a naturopathic practitioner. So it de-emphasises the expectation that every piece of valuable knowledge is going to come from a research paper and allows for the fact that these other types of knowledge also have value.

So, beyond that, probably...I won't go into the details, but I have a whole stream of work that I do in women's health as well. Which allows me to advocate quietly for naturopathy in a bigger kind of Trojan horse of women's health, preconception care, pregnancy, that kind of stuff.

Jon: I’d just like to add to what Amie says because I think this is a really important point that a lot of people in the profession probably don't fully understand or recognise. But the naturopathic philosophy and traditions are actually very important from a public health, from a legal, from a legislative, and from an implementation perspective.

So, I remember when we first went to the WHO with the World Naturopathic Federation. It took a lot of convincing that we were naturopathic medicine and not just natural medicine. And I think there's a lot of confusion over what makes a naturopath naturopathic, beyond just the fact that we use natural medicine products. 

And it's that core underlying philosophical and principles-based system of treatment that actually is the real valuable thing. And it breaks my heart a little bit to be honest, when I do see on some of the forums the professions conflating natural medicine and naturopathic medicine. They are very, very different concepts.

Look, without naturopathic philosophy, you're just a profession who, you know...if you don't have a naturopathic philosophy, we might as well give the whole natural medicine movement to integrative medical doctors because they already got access to medical rebates. They've already got access to patients. And to be honest, if they're not applying naturopathic philosophy, they're just doing natural medicine. There's a real benefit over them versus the naturopathic profession. So this sort of critical examination of what being a naturopath actually means is incredibly important at a global and a national level.

Andrew: Okay. Just moving on from there to the relevance though. And I guess I'm slowly changing my viewpoint. Like, I've been in the past of the mind that, enough to do with sociology, enough to do with what we think we fit in as and all that sort of thing. And can we please have more clinical stuff? Does curcumin work for x amount of conditions? And more that sort of thing.

So where does each side fit? And I guess where is the relevance of doing your sort of research? Like, is it clinically relevant? Go on, Jon. Continue with you.

Jon: Look, I think it is incredibly relevant. So, when I was at the University of Washington in 2010 because I was a neutral naturopath I guess, I got invited on to a state committee. And I remember something that the committee chair actually said there. And they said, “We're tired of naturopaths coming up and telling us they're trained the same as medical doctors. They've got this degree. They've got this degree. We know. You already have the table, but what can you actually do?” And I think, you know, the importance of public health research is exactly that, showing what naturopaths can do, and why it should be a naturopath delivering nutritional information rather than a dietician, or a GP, or some other professional groups.

So when Stephen Myers did his critical review of naturopathic studies last year, one of the criticisms was, John Dwyer said, “Well, this isn't naturopathic medicine. This is saying that people, with lifestyle education and better diet and all these other practices get better.” You know, a no-brainer, of course it does. And so his suggestion was “We'll just get more dieticians, and more physiotherapists, and more conventional practitioners in these spaces.”

So, it's important to show why the naturopaths themselves are important in this space because we're answering, not just clinical questions, but political questions, and policy questions, and funding questions. And having all the clinical evidence in the world doesn't actually change politicians' minds. If they actually see an advantage or a group that's not served well by current needs, or something like that, there are all sorts of other social, political, and cultural considerations that go into building the healthcare system.

Andrew: I see your point. Amie, what have you got to add for that?

Amie: I think from my perspective as well, one of the things I've really emphasised is in the absence...and this kind of goes back to that very first question around advocacy. In the absence of naturopaths, all being involved in research, one of the things I really have been focusing on capturing is the clinician experience and the clinician observation of what works, right? 

Because what we don't have is we don't have a billion-dollar pharmaceutical budget for naturopathic care because naturopathic care is not about one treatment. We have multiple treatments that are highly individualised. So, what we need to test is naturopathic care with all of its philosophies and the range of treatments that have been individualised to the patient. 

And that type of research doesn't have a pharmaceutical budget attached to it. It has a professional budget, which our profession isn't rolling in cash and can't afford to just be researching every possible whimsy of treatment, and condition, and population that comes across everyone's mind.

And so one of the things I've been focusing on is, by capturing this perspective, we're getting a sense of what is the most common conditions that practitioners are treating, the most common mix of treatments that they might be employing, the most common populations that they're looking after, and the settings that they're working in, so that we can pinpoint and make sure that the limited research resources that we'll spend on clinical research is targeting the things that are going to give us the biggest bang for our buck. 

And the research outcomes that we evaluate are going to be reflective of grassroots, real-life clinical practice. And not just my experience of it, not just your experience of it, but the cumulative experience of the profession and trying to make sure that that's captured as much as possible. And that's the contribution that I really feel, as well as all the stuff about communicating to policy and those kinds of things as well. There's that aspect of, “If you're going to do clinical research, we need to make sure we make the most effective steps forward with it,” and that needs to be the stuff that represents what's happening in practice already.

Andrew: I have to ask the question though: doesn't research by academics run the risk of being relevant for academia and not necessarily being relevant for clinicians in clinic at the grassroots level. Amie, can I start with you?

Amie: Yes, I think the question I guess is, or what people don't often realise is that, to be honest, in universities, what works for the academic world would be for us to do no naturopathic research. We get no professional advancement. The academic world doesn't really acknowledge the value of what we contribute.

If I go to a conference, I could be an invited speaker on a topic, a non-naturopathic topic, and I could be having a conversation with someone over the lunch table. And then I mention that I'm a naturopath and the lights just go off. And they're completely disinterested and they no longer want to engage.

Now, that doesn't stop me from naming myself as a naturopath. My Twitter tag states that I'm a naturopath. I'm very explicit about it, because I make a point of going into these settings and being a naturopath in these environments to desensitise them almost. You know, I'm on the Health Promotion Australia Queensland Committee, and the Public Health Association Queensland Committee, and the Women's Health Special Interest Group, and I’m in these spaces being a naturopath in those spaces, and I think it's really important that we do that.

But by and large, me saying that I'm a naturopath, me being a naturopath, me doing that naturopathic work is actually counterproductive to my own professional career because it's undervalued and dismissed largely by the academic world. 

And part of the reason I take the research approach that I do, as I said before, of taking the… surveying and engaging with practitioners and understanding their perspectives and experiences to make sure that the decisions that we make and the next steps forward aren't about what I think is important; it's about what the profession actually is doing and needs. And I think that's the step around that for me.

Andrew: Jon, what have you got to add to that?

Jon: Yeah. Look, I think that's an easy thing for commissions to say because I think...I mean people like Amie, for example, are probably a little bit too prolific in their public health research. Some of their clinical research, which they are doing and actually are doing more than other people in terms of the actual trials, and the tests, and actual clinical treatments, is actually quite substantial.

But the other point is the profession doesn't exist in a vacuum. And whether you like it or not, other people outside the profession assess whether the profession is worthy of bringing into the fold or involving in this particular area or whatever. And the public health research that Amie is talking about that her and I have done along with all sorts of colleagues with ARCCIM, NICM, NCNM, and other universities is incredibly important in that decision-making capacity. And I can vouch because I was there in the room when that happened. 

The fact that we actually gave them research that showed that naturopaths weren't two-headed creatures that could actually deliver good public healthcare and actually have positive health outcomes was what changed their mind to re-examine the private health insurance reviews.

So these things actually do have direct impact, on that sort of level. I remember… you know, Amie's spoken about the ANC, which is a fantastic initiative. But a year and a half ago in Canberra, these groups actually met with the Department of Health. It's the first time the Department of Health ever met with representatives of the naturopathic profession and were, to be honest, quite blown away by the fact that the naturopaths weren't these crazy people that they see on social media or 'A Current Affair'.

So, these things are clinically relevant because they place the profession in a place that the profession should be placed. They might not tell you what treatment has the most evidence base but they certainly impact your practice on the ground.

Andrew: Is this indeed part of the problem that you'll get the media saying naturopath for those people who do dangerous practices, and indeed affect public health. Certainly, these patients that have been in the media, we all know Marilyn Bodnar. There's also the Chinese medicine practitioner involved in the smacking of the child. But they're called under this derogatory umbrella of naturopath. 

So, how do we change that? Do we start, indeed, with media? Jon? Amie?

Amie: I mean, it's an easy answer for me. It's an easy answer for me. I think the most important answer is registration, and that wouldn't be a surprise to anyone who's ever heard me talk on anything related to these professional issues. 

I think that what we need is to have some clear definition of what is required for someone to use that title and have that enforceable boundary. And part of the research work that I've been doing is to help better understand what the profession is already doing so that the definition and the boundaries are set as reflective of practice and the profession.

Andrew: And Jon?

Jon: Yeah. Look, I think registration is a very important issue. But the other issue, of course, is just... If people are only seeing those stories on 'A Current Affair' or, you know, in the newspaper and nothing else, of course, they're going to have a negative view of naturopaths. So they don't have other naturopaths standing in front of them and actually saying, you know...telling positive stories of naturopaths. Of course, people are going to have a negative view of naturopaths. And to be honest, you can't blame them.

So, I remember in our study of GPs. Most patients only tell their GP about their complementary medicine use when something goes wrong. So all the GP is hearing are the negative stories. And when the positive stories happen, the patient tells them nothing. So, you can't blame people for having a negative perception of naturopaths if there are no other naturopathic groups standing in front of them and making a positive case.

We've seen that with the Department of Health. I've seen that with government, non-government, and with MPs and senators because they're filling that vacuum with their own information or their own biases. And you've got a lot of people who are quite... You know, Friends of Science in Medicine is a good example. 

Friends of Science in Medicine is only powerful because there's no opposite message being given by the profession itself. So Friends of Science in Medicine are actually abysmally bad at communication. They just make up for it with just quantity over quality.

So, I think the advocacy thing that we're talking about before, getting involved in that space, and naturopaths actually making the case for naturopaths is incredibly important.

Andrew: You know, that raises a very interesting question, or point. And that is... I was podcasting with a lecturer at Griffith University Monique Lewis about how media can be framed up by certain groups. And indeed Friends of Science in Medicine have done this with regards to how naturopathy is viewed or presented by media.

So the question I guess to ask both of you is: how can we get more positive media coverage for the naturopathic profession given that we've got a long way to go to reach registration, or indeed acceptance by the orthodox healthcare system? Jon or Amie, one of you, speak.

Jon: Yeah. So, you know, I think...

Andrew: Amie.

Jon: ...developing a positive and proactive media strategy is really important because... Sorry, Amie. Do you want to go?

Amie: No, no. It's all you, mate. It's all you.

Jon: I think, when it comes to media, the two problems that the naturopathic community has is it always talks about itself and it's always reacting to something. There's no proactive media strategy. There's no sandwich technique of good story-good story. So when a bad story comes up, and we need to react to a Marilyn Bodnar, you can sort of hide that amongst a number of good stories.

And, yeah, naturopaths should be speaking out on dietary policy. They should be speaking out on alcohol policy. They should be speaking out on exercise policy. The health minister last year declared the sleep deprivation and national public health issue of consequence. And where were the naturopaths? They were nowhere. That was a perfect space for them to be involved in.

If you look at the AMA media strategy, they're not speaking out on medicine or on doctors for 9 out of 10 of their stories so that, when that one time they have to react or argue against, or complain about government policy or a practitioner or unfair treatment, they're not seen as being a one-trick pony basically. I think the profession probably needs to be a little bit more proactive, tell more of the good stories, and define when naturopathy is a little bit better.

When John Dwyer came out against it, the media allowed him to define what naturopathy was in his eyes, and it was...I've written a textbook. I'm a director of a centre now. I've been a naturopath for about 20 years. And as I said in my radio interviews, I think I trust my definition of naturopathy a little bit more than John Dwyer's. We need to be able to take that initiative and actually define who we are rather than let other people define us.

Andrew: Yeah.

Amie: Yeah. And I think there's a transition that the profession is currently making and just sort of taking almost back into the point about the Australian Naturopathic Council and lobbying. One of the issue of the diffusion of our resources amongst multiple organisations has limited our ability to engage on these multiple fronts because we've only got actually a small number of people in the profession doing a bulk of this professional advancement work. Most people are in the ground, running their clinics, just trying to get by on a daily basis. And that's where their primary energy are and they want to see this work happen but it's kind of, “Why isn't someone doing something about this?”

And so, you know, as I said, we've put in a lot of submissions just this last week. I helped the NHAA on a submission in regards to pregnancy guidelines. So, currently updating the national pregnancy guidelines and so they put out a call. And so we put it in their heads some specific statements in there about probiotics and herbal medicines. And so we have to step in. We have to submit to those things. We have to be a part of these conversations just like the Chronic Disease Management. There was nothing in there about complementary medicine, but naturopathy is not a complementary medicine. It's a health profession. And if we're providing health in the community and part of the health system, we have to be a part of that.

We're incrementally making this way at a policy and lobbying level, but we haven't been able to transition that energy into the media, general mass media communications. And I think that is the next step and it's not for the lack of wanting to do that within the people doing the work; it's just a complete lack of human resources. Just the time that's required to do all these things, to upskill, and to undertake that work, we need more people with those skills prepared to put the energy in.

I mean, most of the work that I do for the profession is volunteer. It's not paid work. A lot of the research I do with the World Naturopathic Federation and only one project I've ever done for them that I've received any funding for, I actually didn't get that funding. It went for publication costs and those sorts of things. 

So, most of this work is volunteer. It's not a paid gig, and we just need more people stepping forward who've got the skills and the capacity to put some time and energy to address media communications and lobbying and all of these things.

Andrew: You made a point just then about so many associations though. Does it really require the dissolution of all of those associations for one? Because can't people still have their, you know, their different memberships, if you like, in the various associations but we need one lobby group. Is that what you're saying? Is that what we need?

Amie: Well, yes. I mean, one of the things that the World Naturopathic Federation has been really important for is being able to distil down the organisations that actually represent naturopaths and naturopathy. And they've got a very clear definition, which Jon will be able to tell you the exact wording of. But that's informed by the World Health Organisation requirements of what a professional association that represents naturopathy, what its characteristics have to be. We've got two members of the WNF in Australia, two-member organisations that are association members.

And they are the ones... And so that's actually helping to distil that energy down because other organisations that don't have a majority membership of naturopaths and whose focus is not primarily on advancing naturopathy, actually aren't recognised by the World Naturopathic Federation or the World Health Organisation as appropriate for advocating for naturopathy. And so that just kind of clears things down.

Now, that doesn't stop people from being members of whatever they want to be a member of. They can be a member of integrative medicine associations and Allied Health Organisations. And, me, I'm a member of the Australian Health Promotion Association, the Public Health Association, the Society of Lifestyle Medicine, all those things. 

These are all organisations that are completely legitimate and naturopaths have every right to be a part of them, but don't expect those organisations to take the responsibility for advocating for naturopathy because they're not naturopathic organisations. And I think that's the difference.

Andrew: Right. Jon?

Jon: Yeah. Look, I think a lot of people, there's a lot of probably...misplaced loyalty is probably a harsh term, but it's certainly true in many cases. There's a lot of areas where multiple professions can and should work together. But I think what's happened primarily in Australia is you've had, I guess, traditional medicine, or natural medicine, or complementary medicine societies trying to represent this disparate group of practices with very, very different needs in an all or nothing kind of approach.

And I've certainly seen it on some associations have argued against registration unless it includes everyone. Never going to work. You know? It is very important for a profession to be able to have their own leadership as well as be able to work in junction with other areas. 

So Allied Health is an example I use. Physiotherapy or dieticians or whatever have their own individual groups, and they work with the Allied Health Association or the Allied Health Council and they have a set of unified needs. The problem in Australia is we've got the Allied Health Association sort of dictating everything and trying to be everything to everyone, and ultimately they're nothing to no one.

So I don't think that we should start waging more against each other, but I do think that each individual profession should be considering what its needs are unique to other professional needs, and actually advocating on that themselves.

Andrew: Do you think we require registration though, to set up such things as, let's say, a minimum wage for naturopaths? Because dieticians have a minimum wage, and they're outside of AHPRA. So, can it be facilitated outside of a national registration system for naturopaths, that there is career solidarity? No? Career advancement?

Jon: There's only one reason that the dieticians can do that, and that's because there's one association which the government recognises and actually legitimises essentially through accreditation requirements for Medicare rebates.

Andrew: Got you.

Jon: The issue with a profession like a naturopath is you have multiple associations with multiple viewpoints and the government can't sign a document with one organisation. And until it can sign document with every organisation, it won't sign any document. 

Andrew: Right.

Jon: So, you know, this has really been the issue, I guess, for the last 40 years of naturopathic development. It's been the number one reason why the naturopaths just haven't gotten as far as other professions have in pretty much in any way. Even though naturopaths are punching above their weight in terms of seeing the public, punching above their weight in terms of actually doing research and all the things that we're supposed to be doing as a profession. 

Naturopaths are doing everything in the right except for their professional organisation to be honest. You know, if they can get that sorted, they're going to be unstoppable.

Andrew: Amie?

Amie: What he said.

Andrew: Let's talk about some of the criticism that you guys have received. Now, Jon, you've mentioned John Dwyer twice, three times. So, let's talk about some of the criticism that you both have received for your work or about your work. 

What's happened? And how do you think we can move forward? How can we collaborate better to have a more unified profession moving forward into the future? What needs to change? Amie, I'm going to start with you.

Amie: Okay. I think just acknowledging, first off, the criticism is not just a Friends of Science in Medicine criticism. A large bulk of the criticisms that I deal with are actually coming from within the profession about people questioning what I'm doing, whether or not they can trust my motives, those sorts of...whether or not I truly understand naturopathic practice, all of those kinds of things.

And I think it's interesting for me because, when I was first starting out doing my PhD, I was doing a little work in maternity care research. I was around the midwifery profession, which similar to naturopathy actually started out with trainee-based education and transitioned into hospitals and what have you, and transitioned into very professionalisation of universities. They're kind of differentiating themselves as partially primary care but also working alongside doctors. And there's all this very similar factors, but what I really observed was that the work that was being done by the research community was seen as valuable by the profession in general.

And I think that one of the things I've realised is that a lot of the work that we do, we’re too busy doing the work to tell people about the work. And it feels a bit awkward, too. Like, I've just recently shared a few articles on some of the social media platforms, because I actually realised some of the work that's been produced is really relevant to practice, but it feels really odd sharing that stuff within the Facebook community. I'll share them on Twitter no problem, because I feel like I'm just making it available but it feels a bit difficult. So it's something that I think I personally and other researchers, we need to take responsibility for finding ways to getting information about the work we're doing out to the profession.

But I think the main thing we can do to respond to critics outside of the profession is what we've been doing so well up until this point, is making sure that the work that we do is just so rigorous and has such a as flawless research design, and principles, and the practice of the work that we do that they can't dismiss it. They would love to and you can tell sometimes how much some of these critics would love to be able to dismiss the work that we're doing but they can't because the work is sound. We're doing good research and they can't push it to the side.

So, in terms of actually making sure that that is addressed, but I think the bigger issue of consolidating the profession is for us, as a profession, to realise that there is going to be diverse views on a lot of topics and that we don't need to agree on everything. We can have varying perspectives on different issues and that that's okay. But there is also going to be a common element that we all do agree on. As long as that common element is something that we agree on, then we can proceed as a profession and move forward.

For me, that agreement is that naturopathy is of value and it has something that can really contribute to the society, if we continue to do what we do very well.

Andrew: Jon, what have you got to add there? Don't say, 'What she said.'

Jon: Yeah, look, I think... What Amie said. It's funny. There's always been that joke, but if you put, two naturopaths in a room, you get three different opinions. And I think that we all laugh at that as students, and we all laugh at that at conferences, but it certainly doesn't play out that way on Facebook or other forums.

So my personal viewpoint is the only person that's not a real naturopath is a naturopath that tells another naturopath they're not a real naturopath. You know, there is supposed to be a diversity of views. The profession from day dot has had a number of different approaches to do it. And to be honest, I think that's actually its strength, not its weakness. The fact that we can have people who are green allopaths and people who are nature cure purists are actually applying the principles and philosophies in getting patient results in different ways but still under that unified theoretical and philosophical framework is an incredible boon and strength of the profession. It's not a weakness. 

And we need to acknowledge that it's okay to have those differences. We don't all need to be the same. Like, most of us came to a naturopathic profession because we didn't want to be the same. And I think the fact that people are now, once we're in here, trying to put us into the same box, it doesn't compute with the naturopathic philosophy or principles.

Andrew: Yeah, this is the thing that I have trouble with. It's okay to disagree, but the problem is that I feel dissent within naturopathy. Whereas, if you take other professions, let's say pharmacy. You've got the industry lobbying group, the Pharmacy Guild of Australia, and you've got the professional guidelines or standards group, and that's the Pharmaceutical Society of Australia. So there's basically these two major lobbying groups, but they're all lobbying for the one cause. 

You can have, you know, the Rural Doctors Association, you can have whatever small association a doctor...no, I'm going to say club. I'm not meaning to be derogatory but, you know, whatever association they want to be a part of, but they have the RACGP, the Royal Australian College of General Practitioners, that looks after guidelines and the Australian Medical Association which looks after lobbying, or if you like, the industry part of medicine.

So, it just seems that we haven't yet gotten to where these professions have made it. And I get the feeling that people want to, or feel that they're going to have to lose a major part of being a clinician if they want this recognition to stand up. 

Do you feel that this is what has to happen? Do you think we're going to have to lose a major part of what it is to be a naturopath to be recognised by government, or on a national level? Amie, I'll start with you again.

Amie: I guess I will acknowledge that there is a risk of that, and that risk is actually founded on us not being part of it and leading it ourselves; people who actually understand naturopathy and what it means to be a naturopath and what naturopathic principles and philosophies look like and feel like and a practice like on the ground.

If we don't have that, the naturopaths progressing this, then people from outside will try to do it and they'll do... As I said, they'll be doing the sort of stuff that Jon's talked about. I mean we've got World Health Organization guidelines at the moment that define naturopathic philosophy or principles that not a single naturopath was involved in drafting. Not a single naturopath because there wasn't people active at that level that could actually be involved. 

Now, that's probably an overstatement. I think there were some involved in the periphery but the final decision-making around that, they didn't involve any naturopaths in that process.

So I think one of the things that we have to really realise, that for us to make sure the outcome is the outcome we need for our profession, it means we have to be making that outcome for ourselves. We have to be leading it. We have to be actively a part of it. 

And rather than sitting back and wondering why it's happening to us, we make it happen for ourselves in the way that it needs to happen. And that's the way we get what we need out of it.

Andrew: Jon, can you continue, please?

Jon: Yeah. First, I just want to assuage people's fears that that WHO document was the reason for the funding of the World Naturopathic Federation. That actually has changed a lot. That document hasn't been changed, but it's in the process of. And it's because the naturopaths are actually showing leadership in doing that. You know, people want naturopaths to be determining naturopathic leadership in these spaces. But if there is no one, they're going to put whoever is standing next to them in charge instead.

So, look, I agree with Amie. The only danger is the naturopaths themselves not being involved in this space. And you mentioned the AMA, the RACGP, and a Pharmacy Guild. These aren't unified professions. They walk out the door. They dress in their... They dust off their tie, put their tie, or straighten their skirts, or whatever, up. But, you know, if you open up the door and look into the meeting room, there's chairs flung everywhere. There's broken windows. There's all sorts of disunity that's gone on there. But, you know, they recognise what they can't move forward on, and they recognise what they can move forward on, and that's what they do to push their profession forward.

Andrew: Right.

Jon: The problem with the naturopathic profession generally, registration and degree of education are two perfect examples of this. They can't look past one issue. So if you're against registration and I’m for it, all of a sudden I can't work with you on anything. There's this all or nothing approach which is really detrimental to the profession and we need to… you know, clinically it's amazing when you think about that clinically we live in a world of grey but professionally we can't do anything but black and white. So, we need to I guess, treat our profession more like we treat our patients.

Andrew: Wise words and very responsible because I totally adhere to that. We need to treat ourselves as much as we treat our patients. And with that, not just humility but respect. 

So thank you both, Jon Wardle and Amie Steel, for joining us on FX Medicine today. This is obviously a huge topic. I would welcome you back to thrash out further issues at a later date if you'd love to be a part and join us again on FX Medicine.

Amie: Thanks. Happy to.

Jon: Yeah, we’d love to. Thanks for having us on today.

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


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