To regulate or not to regulate?
That is the question legislators must grapple with when trying to decide what to do about the proliferation of so-called complementary and alternative practices.
The dilemma lawmakers face is well-illustrated in a criminal case that ended last week in Montreal.
Mitra Javanmardi, a naturopath, was acquitted of manslaughter and criminal negligence in a case that dates back many years.
In 2008, Ms. Javanmardi injected Roger Matern, 84, with a magnesium compound to treat his breathing problems. He fell seriously ill within minutes and died 16 hours later.
The treatment was dubious in the first place but, to make matters much worse, the drug was contaminated with a bacterium, Pantoea agglomerans, which can be deadly for people with compromised immune systems like Mr. Matern (who had chronic heart and lung disease).
Ms. Javanmardi is not a medical doctor; the court said it is clear she administered the drug magnesium sulfate without proper training or qualifications.
However, Quebec Court judge Louise Villemure acquitted the naturopath of the charges, saying that, despite her lack of formal credentials, she acted in good faith and took the necessary precautions when administering the drug – the implication being that the contamination was mostly due to bad luck. The judge added that Mr. Matern and his family members were aware that he was being treated by someone who was not an M.D. and "accepted the inherent risks."
The case is a reminder that people can engage of all manner of stupid and irresponsible behaviour before their actions are deemed criminal.
Just as importantly, it helps explain why health professions have their own regulatory regime: To ensure that practitioners are held to a high standard and can be sanctioned even if their actions may not otherwise open them up to criminal prosecution or civil lawsuits.
But here's the rub. Ms. Javanmardi was not sanctioned by her professional body. That's because, in Quebec, naturopathy is not a recognized health profession, so there is no regulation.
Practically, that means it's the Wild West: Anyone can hang up a shingle and call themselves a naturopath. By some estimates, as many as 5,000 people have done so in the province; their credentials range from having taken an online course through to a four-year university-like program.
For consumers, it's caveat emptor.
The naturopathic philosophy, according to the Canadian Association of Naturopathic Doctors, is to "stimulate the healing power of the body and to treat the root cause of disease" with the "appropriate use of natural therapies." Much of what naturopaths preach and practice is quite sound, motherhood-and-apple-pie health advice, but they also tend to embrace some quackery as well, such as homeopathy.
Notwithstanding the discussion about the legitimacy and usefulness of naturopathy – and many swear by it – the challenge for legislators is how to protect consumers from harm. There are, according to the national association, about 1,875 qualified, practising naturopaths.
Five provinces have opted to regulate naturopathy and create formal regulatory bodies, similar to those that oversee more mainstream professions like medicine, nursing and pharmacy.
The philosophy in those jurisdictions – B.C., Alberta, Saskatchewan, Manitoba and Ontario – is that it is best to legislate and give consumers formal recourse if they are wronged.
For example, the College of Naturopathic Physicians of B.C. is supposed to ensure that naturopaths "practice safely, ethically and competently." It has a list of licensed practitioners, a formal complaints process, and it cracks down on the unlicensed.
In Quebec and the Atlantic, the approach has been the polar opposite, to not recognize naturopathy and other alternative practices for fear of giving them legitimacy. And the reality is that many people don't know the difference between a ND and MD and, if they do, may place them on a par in terms of training and ability.
The case of Ms. Javanmardi brings these issues to the fore. She has been practising naturopathy in Quebec since 1985 and, according to testimony during the trial, has seen upwards of 5,000 patients.
Because there is no provincial college of naturopathy, complaints have, by default, fallen to the Collège des médecins du Québec, which oversees the practice of medicine in the provinces.
Ms. Javanmardi has been convicted three times of practising medicine without a license – in 1987, 1990 and 2006 and, in 2010, was fined $15,000 for disobeying an injunction forbidding her from posing as a medical doctor. The college is now suing her.
There is no question Ms. Javanmardi is a special case; she has fought legal battles all the way up to the Supreme Court of Canada.
But the key question is: Would her patients get a better shake, and would the public be better served if Quebec had better regulation – if, for example, there was a formal complaints process and sanctions like there are provinces like B.C. with a College of Naturopathic Physicians?
There is no simple answer to that question.
But, as the popularity of complementary and alternative practices grows, policy-makers and legislators owe it to the public to have the discussion and figure out what works best.
It shouldn't take a death to spur reflection, or action.
André Picard is The Globe and Mail's health columnist.