This excerpt reprinted with permission of Dr. Iva Lloyd, author of The History of Naturopathic Medicine: A Canadian Perspective. To order a copy, contact the CAND directly, toll-free, at 1 800 551 4381.
Provincial Formation and Regulation
The following is a history prepared by Dr. Arthur William Dennis, ND around 1940. Some sections have been shortened for the purpose of this book and subsequent entries have been added to bring the history up-to-date.
The history of naturopathic medicine in Canada started primarily in British Columbia in the early 1900s when a handful of practitioners, graduates from various schools of healing in the United States, England and Europe, began their professional careers in natural healing. These dedicated men were rugged individualists, practical idealists, who openly opposed the then-current doctrines of allopathic medicine.
In 1886, the practice of medicine and surgery became regulated in British Columbia under the Medical Act, creating a statutory monopoly of medicine by allopathic (and homeopathic) physicians. This marked the birth of the College of Physicians and Surgeons of British Columbia. As of this time, only allopathic (conventional) practitioners could be employed by any hospital or provincial public service.
This was the back-drop upon which these new naturopathic physicians decided to meet together for a common purpose, unite as an association and then fight for social, political and legal recognition.
The first meeting of naturopathic doctors was held in March of 1920 and comprised such early practitioners as naturopathic doctors Lee Holder, James Perrin, Frank Dorchester, (Mr. and Mrs.) Moore, W. Castes, Arno Kruger, Everly Rogers, Marshall and Arthur Dennis. It was at this meeting that the decision was made to form an association which was called the Association of Naturopathic Physicians of British Columbia (ANPBC).
Initially the difficulties that the association faced were “stool pigeons” from the conventional medical associations that claimed that naturopathic physicians were practicing medicine without a license. In one such incident, one member, refusing to pay the fine, served a month in prison. These activities serviced the purpose of alerting the members of the need to stick together and to have a common voice.
In 1921 the first approach to the provincial legislature for legal recognition was made. The association presented petitions bearing 36,000 signatures and in a short time spent around $25,000 - which was a lot of money in the 1920s. The bill was defeated on second reading by one vote. In 1923 the B.C. Medical Association put a bill through the house to legalize naturopathic physicians under a committee of their naming, with only one appointee from the naturopathic group. So in 1923, naturopathic doctors and chiropractors in B.C. became regulated under the Medical Act.
The profession battled on through the years until 1936 when the Naturopathic Physicians Act became law in B.C. It was clear that the legislative intent as to enhance the social status of naturopathy as a medical profession distinct from allopathy, homeopathy and osteopathy. In the Act, “Naturopathy” was defined broadly as “the art to healing by natural methods.” The passing of this act, which was piloted through largely by the untiring efforts and skill of Dr. Arthur Paskins, ND marks the end of the individual practitioner’s struggle for professional existence. From that time, it became the responsibility of the association and its executives to continue to press for wider recognition by raising the professional standards of the professions, by lobbying for better legislation, and by establishing legal precedents through the courts.
Two of the early influential naturopathic doctors were Ron Holtum and Arthur Hilton. Dr. Holtum, ND was exceptionally brilliant and had served on the B.C. board as chairman of education before becoming president. He was responsible for a tremendous amount of progress in B.C. Dr. Albert Russell, ND who came into the profession later on, had considerable external contacts. He’d been vice-president of the Vancouver Junior Board of Trade, and had established many political contacts. Another key member was Dr. Douglas Kirkbride, ND. He was a pharmacist, and his skills proved very helpful in getting the preparations straightened out. These three doctors worked on rebuilding the Act, making it more coherent, pushed to have it revised, and got a lot of amendments accepted. Dr. Kirkbride worked on the Act mainly in the areas of ethics while at the same time working toward bringing a feeling of fellowship amongst members. Another active member was Dr. Joseph Boucher, ND who contributed an enormous amount of time to the profession. Following the war, Dr. Boucher was instrumental in encouraging Dr. Robert (Bob) Fleming, ND to enter the profession. Dr. Boucher’s sister was Ann Fleming, Dr. Fleming’s wife. Although Ann was never a member, she dedicated herself to the profession and her administrative skills were invaluable.
The initial naturopathic doctors in B.C. were a close knit group. Annual meetings were like a family reunion and there was a real sense of unity and team work. The provincial and regulatory work was spear-headed by a few, but the profession was supported by the majority of its members. The initial struggles and challenges were instrumental in holding the professions together.
High educational standards have been part of the B.C. Act since its inception in 1936. The initial legislation stated “a recognized school or college of naturopathic medicine shall be deemed to be an institution which teaches a residence course of not less then four calendar years of eight months in each year and not less than four thousand school hours in the four years.” The initial colleges that were approved included: the National College in Chicago and the Western States College in Portland. The initial act also stated that all members must past board exams prior to be entitled to registration and to practice as a naturopathic physician within the province.
Amendments to the British Columbia Naturopathic Act
The original Act of 1936 contained a separate section covering physiotherapists and masseurs, who were regulated by the board of naturopathic physicians. This proved unsatisfactory to all groups and in 1947 the practitioners of physiotherapy and massage were placed under their own separate acts.
One of the provisions of the original Act was the inclusion of a board of supervision whose purpose was approving the schools. This board was comprised of three members: the provincial secretary, the dean of the Faculty of Arts of the University of B.C., and the registrar of the University. The original board proved very valuable and there was close co-operation between these three members and the board of naturopathic physicians.
In 1938 the regulations were changed to cover a more comprehensive examination schedule which included clinical and laboratory diagnosis, bacteriology, medical jurisprudence, dietetics and biochemistry, obstetrics and gynecology, endocrinology and remedial psychology. The schedule of the practice of naturopathic medicine was specified as including electrotherapy, light therapy (helio and photo), hydrotherapy, physio-therapy (mechanotherapy), orthopedics, phototherapy, anatomical manipulation, manipulative surgery and homeopathic materia medica.
In 1948 the regulations were further amended to include increased educational requirements for entrance into a naturopathic college. During this time it also became mandatory for all members of the B.C. Association to take post-graduate studies each year, or to attend an educational symposium conducted by the B.C. board of governors, and submit proof of such attendances to qualify for membership in the association for the ensuing year. Also, stipulations respecting control of advertising by members of the profession were added to the regulations.
In 1958 the Act was amended to improve scope of practice and to enhance legal protection for the members. At that time, a legislative mandate for a schedule of preparations was established and in 1979 the Naturopathic Materia Medica, which outlined the range of products, herbs and supplements used by naturopathic physicians was updated. This document became a component of many government submissions. In 1984, the ANPBC prepared and presented a brief to the Caucus of the Government of B.C. The aim of this brief was to further educate the government on naturopathic medicine and to highlight the benefits that would be achieved it there was greater cooperation between the various health care disciplines.
In the mid 1990s, the B.C. government began work on revising its health care system. Two initiatives were started. The first being the Canada Health Protection Act (CHPA) and the other being the Health Professions Council (HPC). The goal of the CHPA was to consolidate out-dated and disparate acts representing health issues including tobacco regulations, wearing of hockey helmets, food and water regulations and, of special interest to naturopathic community, regulations with regards to natural health products.
The Health Professions Council was devised to look at a number of different groups and determine if they required their own separate Acts and if so, what changes and revision were needed. The brief that the ANPBC submitted in 1995 included answers to over fifty questions. The main focus of the ANPBC was to address the issues of scope of practice with an emphasis on laboratory privileges, prescription rights, access to natural health products, referrals to specialists and enhancing the role of NDs with the provincial health care system. They could not visit or treat their patients in hospitals or other institutional settings – even if a patient specifically requests their care. They also did not have access to the diagnostics that they needed and had to send laboratory samples to Alberta or Washington State. These issues were addressed in all documentation to the government, members and to the public.
In 1995 the naturopathic profession was involved in consultations with the government concerning moving to the Health Professions Act, which was an umbrella Act that would regulate many different health professions under one Act. The members of the ANPBC and the BCNA were not in favor of such a move. Naturopathic physicians had been regulated under their own act for almost sixty years and in a letter written to the government it stated, “The BCNA is skeptical that there are tangible benefits for inclusion in the Act. We feel that inclusion under an umbrella Act is a slight on our individuality, uniqueness and historical right to self-regulation.”
The work which began under the Health Profession’s Council review process has continued for over 14 years, and is still ongoing. It has involved the dedicated efforts of many individuals including naturopathic physicians Eugene Pontius, Braven Rayne, David Wang, Christoph Kind, Brian Martin, Garrett Swetlikoff, Lorne Swetlikoff and others. Glenn Cassie, the Executive Director of the BCNA has been involved for over ten years. The BCNA and the ANPBC have hired public relations consultants, government affairs consultants, lobbyists, and have maintained a letter writing campaign for over ten years. There have been numerous meetings with government officials, letters, written submissions and attendance at government functions. The physicians in B.C. realized that no matter how dragged out the process and how much it monopolizes the focus of the ANPBC (now CNPBC) and the BCNA, they can never give up; both groups continue to ensure that they have a strong presence both publically and with the government.
In April of 2009 the B.C. Ministry of Health approved a new set of regulations which now recognizes naturopathic doctors as primary health-care providers. The new regulations bestow on naturopathic doctors sweeping changes to their authority with respect to compounding, prescription authority, dispensing, ordering of laboratory and diagnostic services, and other privledges.
Naturopathic physicians in B.C. had enjoyed access to provincial labs since the early 1920s. Yet, in April of 1995 they started to receive letters from the provincial laboratories indicating that their access had been cancelled as a result of a ruling by the College of Physicians and Surgeons of British Columbia (CPSBC). The president of the BCNA, Dr. Eugene Pontius, ND wrote to the health minister on many occasions requesting the reversal of the this restrictive and discriminatory practice. Eventually the issue was deferred to the HPC. Over the next several years, there were various written submissions, expert testimony, meetings, and phone calls with no resolution. Following the publication of the final HPC reports, the committee was disbanded and the issue was once again a government issue. In response to a request made by the deputy health minister a third party evaluation was completed and in 2004 a document titled, The Naturopathic Scope of Practice Gap Analysis was presented to the health ministry. This document addressed all facets of scope of practice, specifically re-affirming the integral nature of laboratory testing (and access) in respect to naturopathic medicine. As a result of the regulatory changes that occurred in April of 2009 the door for laboratory access for naturopathic physicians in B.C. has been opened.
Medical Services Plan
Up until the 1950s, Canadians paid for all health care services out-of-pocket; consequently much health care was done at home. After the Great Depression there was increased demand for publicly funded health care. Saskatchewan was the first province to adopt a medical services program (MSP) (also known as medicare) in 1946, followed by British Columbia in 1965. A national medicare program was instituted across Canada in 1968. This meant that the provincial programs currently in place would receive assistance from the federal government. As medicare was implemented, the expectation became that all medical services in Canada would be covered.
For years the provincial and national naturopathic associations, especially in the West, spent most of their energy and focus on having naturopathic services included under medicare. The results were mixed. Some provinces such as British Columbia were fairly successful, others not at all. Over time, the profession realized that inclusion under medicare was actually detrimental to their practice. The profession recognized that the compensation and restrictions of such programs were out-of-synch with the time-intensive, patient-focused premise of naturopathic medicine. By 1990, only B.C. maintained any MSP coverage. However, the patient visit fees were increased incrementally while government subsidies decreased. Most NDs opted-out of the plan entirely. By 2002, MSP subsidies were modified to include only certain individuals, such as those that were on premium assistance, refugees, and individuals with eligible First Nations status registered with Health Canada.