York University Centre for Health Studies Reports on State of Alternative Health Therapies in Canada, Calls for Rigorous Research

TORONTO, November 22, 1999 -- The Centre for Health Studies at York University has completed the first nation-wide, comprehensive study of the state of complementary and alternative health practices in Canada calling for rigorous and expanded research on alternative therapies, a national public education strategy, and collaboration rather than confrontation between conventional medicine and alternative practitioners.

The $100,000 study, funded by Health Canada, is entitled Complementary and Alternative Health Practices and Therapies -- A Canadian Overview. It concludes that many difficult questions must be answered about the relationship between alternative health practices and conventional health care, requiring everyone involved to keep an open but critical mind.

"The study shows it is time for us to move on from the mistrust that has characterized the relationship between conventional medicine and alternative practitioners in Canada, and start examining broader questions about alternative therapies, their place in the health care system, and how efficacy is determined. This work is sorely needed," said Joan Gilmour, Associate Director of the Centre for Health Studies at York, Professor of Law at Osgoode Hall Law School and a co-author of the study. "It will also be important to consider how best to regulate both the therapies and the providers," said Gilmour.

The report confirms that the public is highly interested in, and committed to, complementary and alternative therapies. Canadians spent an estimated $3.8 billion on alternative treatments in 1998. It notes that many Canadians have already integrated complementary and alternative health practices into their health care, and consumption is likely to grow.

The report points to the many misunderstandings about alternative therapies and the fact that little is known about their interactions with conventional medicines -- which can increase risks. And it found that national and provincial umbrella health-care organizations in the hospital, community-health, and public sectors knew surprisingly little about what alternative health-care practices are being provided at a grass-roots level.

"As a consumer-driven movement, clearly alternative health practices need to be researched at the local and institutional level," the report states. It calls on Health Canada to:

undertake a comprehensive survey of the use of alternative health practices by Canadians, paying particular attention to the reasons they are using them, for which conditions, and under what circumstances, as well as to differences associated with gender, age, ethnicity and class;

encourage the submission of proposals to the appropriate funding agencies on evaluation of complementary and alternative therapies and practices through randomized clinical trials and other methods suggested in the report where appropriate. Depending on the type of therapy, randomized clinical trials may not be an appropriate or even possible way to test;

undertake a public education strategy to educate Canadians about the types of therapies and products that are available, and what is known and unknown about their interaction with conventional medicine;

further explore the issue of appropriate evidence bases for complementary and alternative health practices and therapies. This would include identifying the questions that need to be answered before decisions can be made about whether an integrated model of health care should be adopted.

set up a web-site with a database of current research and an assessment of the credibility of that research, in conjunction with alternative and conventional practitioners, HIV/AIDS groups and disease-specific consumer organizations. This would help coordinate the current knowledge base on alternative health practices for those in urgent need of this information, such as Persons Living with HIV/AIDS and for individuals living with chronic diseases. It recognizes that randomized clinical trials and other evaluation of alternative health practices may take years to complete and may not be the appropriate methodology;

facilitate dialogue among conventional and alternative practitioners, through workshops, conferences, seminars, educational programs and other means;

identify the appropriate bodies to continue monitoring and collecting information on the status of alternative health practices in the health care delivery system, and set up a mechanism for collating this information to facilitate policy development in this area.

The report recommends further research on:

an ethnographic description (examining different healing systems, their language, theories and social organization) of some of the more widely accepted complementary and alternative health practices to provide a full understanding of the assumptions from which they operate;

the definition, key characteristics and framework for organizing the diverse range of complementary and alternative therapies and practices;

the coverage of complementary and alternative therapies by the private insurance industry;

the governance of providers of alternative and complementary health care, as well as consultation on this subject among the responsible bodies and with conventional and alternative practitioners, including consultation with those engaged in developing the framework for the regulation of natural health products;

that further research on the status of complementary and alternative health practices and therapies within the health-care delivery system be undertaken at the local and institutional level;

The purpose of the study was to provide an overview of knowledge, opinion and practices in Canada, and a useful basis for future research and policy development in the area. Data was collected from January to March 1999. Discussion of natural health products is not the mandate of this study since the federal government's Standing Committee on Health had recently undertaken extensive work on this subject.

Among the study's findings:

Canadians are increasingly using complementary and alternative health practices as both an adjunct to and replacement for conventional medicine. The absence of a research base leaves them without information and puts physicians, who know that many of their patients are using alternative therapies, in an ethical dilemma.

People in the health care system working with Persons Living with HIV/AIDS are experiencing constant requests for information and for alternative health practices from their clients.

Many Canadians do not inform their doctors about their use of alternative therapies, perhaps anticipating a negative response, and this can increase risks. "This practice results in the fragmentation of health care, which ideally should be coordinated," the report states.

The commonly held assumption that ënatural' is ësafe' is not always true and could, in some instances, increase risks. The study cites a recent warning issued by the American Society of Anaesthesiologists recommending that certain herbs and other supplements be discontinued two to three weeks before surgery, based on anecdotal evidence of changes in heart rate and blood pressure in some patients taking herbal medications.

Social and political factors have played a role in limiting scientific exploration of alternative therapies, although that situation is changing, with several medical journals in the past few years devoting entire issues to alternative health practices.

Use of both alternative therapies and practitioners tends to be higher among women, aged 50 or younger, and among those with higher educational levels and income. The majority of those surveyed tend to use alternative therapies for prevention of disease and maintenance of well-being.

There is an increasing awareness of the significance of alternative health practices to the education of nurses and physicians. This awareness varies across the country. The development of courses and course content in this area is often driven by the interests of students.

Health insurance coverage for alternative therapies is not consistent across Canada. There is no coverage for chiropractic in provinces east of Ontario or in the Yukon or Northwest Territories. Naturopathic medicine is partially covered only in British Columbia. Coverage by workers' compensation boards is also uneven across the country.

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For further information, please contact:

Joan Gilmour
Centre for Health Studies
York University
(416) 736-5941; (416) 736-2100, ext. 55561
email: jgilmour@yorku.ca

Susan Bigelow
Media Relations
York University
(416) 736-2100, ext. 22091
email: sbigelow@yorku.ca
YU/130/99