What Insurance Records Say About Homeopathy in France

Map of FranceAn analysis of insurance records in the national system in France yielded the following: Of all that nation’s healthcare professionals, 43% prescribed at least one homeopathic as a covered service between July 2011 and June 2012. For general practitioners, dermatologist, and pediatricians, the finding was 95%. For midwives, 75% prescribed homeopathics. In more than half of all cases (55%), regular medicines were co-prescribed.

The target populations were typically children and women, although at least 10% of the entire population—6,705,420 patients—received at least one prescribed homeopathic. Of total “drug units” prescribed in France in that 12-month period, 5% reflected homeopathic preparations. The article, with Michel Piolota as lead author, is entitled “Homeopathy in France in 2011-2012 according to reimbursements in the French national health insurance database.”

Comment: These data are interesting in the midst of the furor over homeopathy in Australia following publication of a controversial governmental report lambasting the field as having zero scientific support— and also in the context of the current re-examination of homeopathic regulation in the United States. (See Homeopathy on Trial (Again): Australian Report and Now USFDA April 20-21 Hearings.) Notably, the use appeared to be bi-modal, with a third having received only one homeopathic prescription and more than 50% having received three or more. Interesting to see how many were co-prescribed regular pharma. Makes one wonder about how rigid the adherence was to what a practitioner might have urged as optimal compliance for taking either type of medication.

This usage data underscores how critically important “grandparenting” is in defining what products, practices, drugs, and procedures of all types are included in a given insurance scheme, whether public or private. While homeopathic medications won’t typically pass through the eye of an insurer’s evidence needle, routine conventional practices wouldn’t fare much better. For instance, a University of Pittsburgh Medical Center leader recently opined that “only about a quarter of what we do has strong evidence and we only do that half the time.” In lieu of evidence-based medicine (EBM) we have CBM (“culturally based medicine”) or perhaps HBM (“historically based medicine”). Once we have that, we have the real-world practice of IBM (“insurance-based medicine”): what is best is defined by what is covered by insurance.

US Agency Upholds Discrimination Against Licensed Integrative Health Professions

Discrimination symbolIn the United States, a critical part of the 2010 federal healthcare reform for many in the integrative health and medicine movement was Section 2706: Non-Discrimination in Health Care. Urged b y a coalition that included licensed naturopathic doctors, chiropractors, acupuncturists, massage therapists, and others, Section 2706 was included in the law through the work of a now-retired former US Senator, Tom Harkin. Since passage, the federal regulator agencies, principally the US Department of Health and Human Services (HHS) has been dragging its feet. The drama is captured in Beltway Battle over Patients’ Rights to Integrative Medicine and Health.

The outline of the battle is this: Congress intended that these new categories of licensed practitioners should be covered under the law. The language was somewhat ambiguous. HHS officials filed a perspective that let insurers off the hook. Congress told HHS to “correct the FAQ to reflect the law and congressional intent.” HHS did not respond. Congress told HHS to do so by October 2014. HHS has not done so. Senator Harkin retired January 1, 2015. HHS has still not replied. This spring, Mike Jawer of the American Association of Naturopathic Physicians (AANP) asked a representative of Centers for Medicare & Medicaid Services (CMS) to clarify current activity on the issue. A team from the AANP had met with HHS in October of 2014 on the issue. He also asked if a CMS representative might meet with naturopathic doctors and students at an early May 2015 DC-FLI “lobby day” for the profession in Washington, DC.

The response came from Jim Mayhew, Director, Division of Regulations and Policy, Office of Oversight, Center for Consumer Information and Insurance Oversight of the CMS. He wrote to Jawer, “Many thanks for reaching out to us. Unfortunately, no one is available on May 4th for a meeting. Furthermore, we have nothing new to report since October in terms of publically available information. We’re continuing to work on issues related to section 2706 with our colleagues at Labor and Treasury and also with State regulators. Best regards, Jim Mayhew.” In short, HHS effectively told those following “non-discrimination in health care” (Section 2706) that HHS will not, anytime soon, abide by the law.

Comment: The World Health Organization views appropriate relationships of traditional medicine with regular medicine as critical for universal health care. Ironically, as is noted in this US report, Meeting the Nation’s Primary Care Needs (pictured), these licensed practitioners are already “first contact” providers for many. As such, they are already relieving the burden on the regular primary care system in the US system, playing a role in allowing care to be extended to others.

The parallel globally to this shunting aside of these licensed “complementary and integrative health practitioners” is with the entreaties from traditional medicine organizations in Asia and Africa and elsewhere who seek recognition and participation in research and regulatory activity. These US disciplines, like traditional medicine practitioners elsewhere, are usually accessed under the radar of regular medicine. Their value to the system is either not noted or discounted. It is a shame that the US is not showing leadership by fostering linkages rather than cutting them off.

Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for April 2015

quick linksThis monthly Global Integrator features highlights on developments in traditional medicine and alternative and integrative health during a 1-month period. Here are 75 short selections. Some significant themes and stories: a Native American owned integrative cancer center in the Pacific Northwest; the first ever Chinese government 5-year plan for traditional medicines; a useful herbal tea concoction for malaria; new use of a 400 year old Materia Medica; and a SouthAfrican situation regarding whether corporations must respect sick leave when papers are signed by traditional healers. What a pot pourri!

  • This article in India Daily Mail looks at the challenges to boosting integrative approaches despite the new Department of AYUSH.
  • The British government is spending an estimated $214,000 on homeopathic treatments in the Bristol area.
  • A natural medicine of Papua named sarangsemut promoted by Victoria Op is featured. A public health officer states: “Flavonoids act as antioxidants that are believed to neutralize free radicals in the human body,” Fanny said. “In addition, this compound acts as an anti-viral agent that can be used to fight viruses, including the herpes virus and HIV/AIDS.”
  • The story looks at issues for traditional medicines in Malaysia’s implementation of a new Goods and Services Tax. Another article here contextualizes this in a broader outcry against the tax, which went into effect April 1.
  • In Thailand, the National Reform Council’s committee on public health reform has taken a strong position that traditional Thai medicine “has been playing an important role for both the modern medicine and the local society.” They call for a reform of the traditional medicines sector.
  • The discussed MOU between Mauritius and India on traditional medicine has been signed by PrimeMinister Shri Narendra Modi.
  • The London Daily Mail pictorial focuses on the medicinal trade in endangered species.
  • THE Muhimbili National Hospital (MNH) inTanzania and the government of China, via the China Academy of Chinese Medical Sciences, signed an accord on “traditional medicine treatment related to surgery-bound diseases.” The original partnership began in 1987. Another focus is HIV-AIDs where the co-signers say TCM has proveduseful.
  • David Reilly, MDThe Weill Cornell Medical College of Qatarhosted a session on integrative care with speakers from around the globe. Scotland-based integrative physician and homeopath David Reilly, MD (pictured) was among speakers at the daylong session with speakers from around the globe. The symposium, also covered here, was entitled “Integrative Medicine: A Refreshing Approach to OptimalHealth.”
  • The impact of the diminution of biodiversity in Asia on medical discovery is the focus of this piece in Asian Scientist.The article reports that “natural products account for more than one-third ofthe approved drugs in the market, making up 39 percent of the total drugs approved between 1983 and 1994 in 33 different disease areas.” Two networks devoted to preservation for medicinal and other purposes are noted.
  • This strong Al Jazeera report examines impact of deforestation on traditional medicines and traditional ways of the OrangAsli indigenous peoples of Malaysia.
  • Shanghai was the site of a “wellness summit” promoted by a business called Sprout Lifestyle.
  • The second World Homeopathy Summit was held April 11-12 in Mumbai. The first was inBarcelona in 2013. Promoters anticipated 1000 plus attendees
  • An “Expat Corner” in Turkey offers a sample of traditional remedies.
  • A skeptical view of the growing number of herbshops is offered in this Saudi Gazette article.
  • The University of Arizona Confucius Institute and the Mel and Enid Zuckerman College of Public Health presented Chinese Health Day 2015 on April 4 as a means of spreading the word about Chinese health methods.
  • Ayurveda advocates are lauding a report from India’s premier medical institution, AIIMS that found Ayurvedic formulations effective in treating rheumatoid arthritis. AIIMS department ofpharmacology director described AIIMS work thusly: “Interest intraditional medicines is renewed and growing exponentially due to the adverse drug reactions and economic burden associated with modern system of medicine.The central government is promoting them too.”
  • The place of traditional medicine, one of seven divisions in Myanmar’s Department of Health, is not specified in this article on a restructuring.
  • In Jaipur, India, a government agency ismulling the potential value of “electroherbal therapy.”
  • This link looks at research that purportedly shows an ancient Anglo-Saxon remedy as valuable against MRSA.
  • Article fromTanzania speaks to why locals are using traditional medicine.
  • This article from the newsletter of the National Resources Defense Council speaks to the challenges to vultures (pictured) and other wildlife from traditional African medicine practices.
  • At the 5th meeting of health ministers of the South Asian Association for Regional Cooperation a resolution was passed that affirmed the importance oftraditional medicine in addressing non-communicable diseases.
  • This article,the last in 6 from China Daily focuses on the success of Tang Ren Tang becoming a global TCM company. The firm has 2000 stores, 110 of them abroad.
  • This post celebrating World Health Day focuses on “19 Bizarrely Effective Home Remedies” from around the world.
  • A central Angolan traditional medicines association is seeking to register practitioners with an eye to standardizing consultation prices.
  • A 10-bed hospital is the first in this Indian state of Nagaland under the new AYUSH department. The article speaks to the challenges in spreading the AYUSH system. Another related article here.
  • The Puyallup tribe’s integrative cancer center, Salish Integrative Oncology Care Center,with its naturopathic and tribal care, is here.
  • Canada’s Ontario province has taken a step to regulate homeopaths.
  • A major modernization of a licensing law and expansion of practice rights for naturopathic doctors in Canada’s Saskatchewan province is the subject here.
  • This column both speaks to and promotes the growth of “integrative medicine” in Kerala, India.
  • This oralpiece documents the work of the Tibetan Medicine College to create a resource of all important Tibetan medical texts.
  • This article looks at the emerging supplement industry in Zimbabwe.
  • An Ndola, Zambia-based herbalist claims cervical cancer cures via his herbs and calls for government research.
  • A Nigerianpractitioner of herbalism with a company calls on the government to engage more research and provide lower-interestloans to promote business expansion.
  • Materia medicaA 400 year-old German Materia Medica (pictured) is the subject of exploration for potential modern medical value
  • The finding of an ancient Venetian remedy potentially having value for Ebola treatment stimulated this re-think of “historical medicine.”
  • In Thiruvananthapuram, Union Health and Family Welfare Minister J P Nadda says a new center will “take all initiatives to bring Ayurvedic medicines to the mainstream of medical treatment.”
  • The article describes how the Kerala State Industrial Development Corporation (KSIDC) “has initiated steps to forge acommon platform for promoting ayurveda worldwide.”
  • This report from a study in NewZealand finds herbalists and naturopaths in support of greater integrationwith regular practice.
  • A natural pharma company in Vietnam has opened a traditional medicine museum.
  • The Karnataka government in India has appointedan exclusive controller for AYUSH. The move separates AYUSH from conventional drug regulations.
  • A conference in Botswana involving 32 nations explored demand-sideways to stop the market for animal parts for medicine.
  • This is a look at the growth of an Indonesian pharma firm that includes traditional medicine.
  • The Chinese government has issued a plan forprotection and advancement of traditional medicine materials – a first such national initiative – for the 2015-2020 period. The short Xinhuanotice is here.
  • A new MOU in India between Jamia Millia Islamiaand the Central Council for Research in Unani Medicine (CCRUM) will establish the HakimAjmal Khan Institute to foster study of these methods.
  • Data on the numbers and locations of varioustypes of AYUSH practitioners in India are in this article. There are presently, for instance, “3,601 AYUSH hospitals,including 2,827 Ayurvedic, 252 Unani, 264 Siddha and 216 Homeopathic operating across the country.”
  • A new statement by the judge in the case of the Canadian aboriginal child appears to reverse his previous view. A perspective on the importance of integrative traditional and modern methods is in this GlobeMail commentary.
  • PaxherbalsThis article speaks to the growth of Paxherbals (pictured), a company begun by a Catholic clergyman, as a regulated herb company in Nigeria. A piece touching on the company’s example was written by this investigator from London’s Africa Research Institute.
  • The provider of a major US Integrative Healthcare Symposium, Diversified Communications, is beginning a similar event inCanada in October 2015.
  • Two traditional medicine hospitals were on the list of Vietnamese institutions that have poorwaste treatment.
  • The Hamad Medical Corporation in Qatar announcesa plan to slowly bring in “alternative” treatment in its announced expansion of pain treatment facilities.
  • This significant piece in The Hindu questions the evidence and whether India should be backing both homeopathy and Ayurveda in its AYUSH ministry.
  • A new proprietary report on medical tourism in South Korea includes a breakdown on the numbers that journeyed for Traditional Korean Medicine.
  • A newmuseum on Ayurvedic medicine is opening in Sri Lanka.
  • MedPageToday offers a somewhat balanced two-perspective view following the FDA hearings on homeopathy.
  • A conference on corporate social responsibility in China in establishing sustainable TCM practices is reported here.
  • In a training session in Ghana, the administrator of the Traditional Medicine Practice Control, said the council is intensifying education “to crack the whip severely on practitioners who flout the laws” with over claims.
  • A new Paraguayan law under consideration will set a National Office of Indigenous Health for the 2% of indigenous peoples and their traditional practices.
  • An herbal tea combination including cochlospermumplanchonii (pictured) has scientific basis for its use in Burkina Faso and perhaps elsewhere in West Africa as an anti-malarialagent.
  • This legal view from South Africa asked whether corporations must accept sick leave if diagnosed by a traditional healer – with an interesting and culturally sensitive twist.
  • Challenges of the national Nigerian FDA in gaining trust of traditional medicine companies are noted in this argument that the country could benefit from more use of traditional practices.
  • A new industry collaboration is anticipated to bring more TCM products to Europe.
  •  Kottakkal Arya Vaidya Sala may soon become a collaborating center of collaboration for the World Health Organizationaccording to this presentation.
  • The blog is a goodreview of testimony before the US FDA in two days of hearings on regulation of homeopathy. The CNN report is here.
  • This article focuses on the timeliness of a book on medicinal plants of Barbados.
  • In Ghana, the Institute of Industrial Research (IIR) of the Council for Scientific and Industrial Research (CSIR) have apublic private partnership with Bio Resources International Ghana Limited withfunding from the Export Development and Agricultural Investment Fund to explore ingredients in traditional medicines.
  • An Iranian delegation to Tajikistan is promoting exchange in modern and traditional medicine.
  • This NewStraights Times article speaks to the new Malaysian regulations oftraditional healers from an antagonistic perspective toward “charlatans and faith healers”.
  • This Jakarta Post article opens with notice that “the Mentawai Islands regency health agency in West Sumatrawill use traditional medicinal plants commonly used by sikerei (traditional healers) in the region to accompany modern medicines in Puskesmas“ (community health centers). Research in 2012 found 151 different medicinal plants and identified 135 plant taxonomy types used in 79 medicinal potions.“
  • Health minister Datuk Seri S. Subramaniam In this article, health minister Datuk Seri S.Subramaniam (pictured) suggests that the slow registration of long time traditional healers is holding up implementation of a 2013 registration act in Malaysia. This related piece says traditional practices are already in 17 hospitals and the registration could include 15,000 practitioners.
  • Medical leaders meeting April 16, 2015 inKarachi, Pakistan argued for some integrated/integrativemedicine curriculum in all medical education as a source of health reform.
  • This article is an exit interview from Warwick Anderson, MD, the past CEO for 10 years of the Australian National Health and Medical Research Council that released the recent report lambasting homeopathy. He focuses the last of his challenges on non-conventional practice.
  • The Korean population is spending over $2.2-billion a year on traditional medicine and at rates that are growing at 7.7% ayear. The writer speculates that widespread use of acupuncture may explain why Korean rates of opiate use are well below the WHO recommended levels. Still, such practices account for only 4% of spending.
  • ·Here is an interview with Ottawa naturopathic doctor Dugald Seely, ND who just received a $3-million grant to explore naturopathic integrative oncology.

Swiss Government Will Recognize Practitioners of TCM, European Traditional Medicine, Homeopathy, and Ayurveda

Controversy over the past decade in Switzerland over coverage of “alternative therapies” led to the widely publicized decision to provisionally include a handful of therapies under the nation’s basic health insurance package 2012 to 2017. There was a proviso: the five therapies—homeopathy, holistic, herbal and neural therapies and traditional Chinese medicine (TCM)—needed to be provided by medical doctors.

In moves reported this month, the Swiss government is opening up the integrative health playing field in multiple ways. Most significantly, a scheme is being created through which distinctly trained practitioners in four fields will be able to get a “federally recognized diploma.” Three of the professions gaining recognition are closely linked to the previously recognized therapies: homeopathy, TCM, and European Traditional Medicine. The fourth is Ayurvedic medicine. Rudolf Happle, Secretary General of the organization of Swiss alternative medicine professionals, fired a shot across the bow toward the medical doctors who were the only ones previously recognized to provide services: “Patients can soon go to a professional who has passed these exams instead of someone who has done a weekend course.” There are roughly 2500 providers who can be included.

The recognition of Ayurvedic practitioners, as described in this article at Swiss.info, follows a strategy of the Swiss Ayurvedic community following the exclusion of Ayurvedic therapies in the earlier insurance coverage theme. After being told to be patient while the provisional coverage played out, the Ayurvedic leaders went ahead and created standards that distanced more qualified practitioners from the spa-based Ayurveda performed by individuals with little or no training. According to the article, “their efforts paid off when Ayurveda was officially approved as one of four [practitioner types] … for the national diploma by the State Secretariat for Education Research and Innovation (SERI).” The practitioners believe the recognition will pave the way for recognition by the Swiss insurance industry.

Comment: This is big news on two fronts. The most important is the interprofessional democratization reflected in the decision to offer recognition to the four practitioner types. One of the gross injustices in the integration movement is when “alternatives” are recognized only if practiced by people who are not expert in them—regular medical professionals. The assumption is that care will be better from person typically-less thoroughly trained in the modality in whom the system has prior trust than in a well-trained professional who has before then been viewed as an untouchable. Experience shows that the first step often leads to the sort of broader opening that is happening here. Now we will see if the Swiss insurers will follow suit.

The recognition is particularly important for the global Ayurvedic movement. These practitioner have not typically gained licensed or regulated status in the West in the way that TCM practitioners have. The Swiss decision surely is being celebrated in India where the government, with its new Ministry of AYUSH, is increasingly speaking of exporting its native medical traditions and products in the way China has.

The Inspiring Tale of a Nigerian Monk, Sustainable Herbalism, and the African Research Institute

Photo of Father Anselm Abodo, MA, MSc, PhD(c) The story begins with Father Anselm Abodo, MA, MSc, PhD(c) (pictured), a Benedictine monk in the Edo state of Nigeria. In 1996, with $200 and colleagues among the Monks of Ewu and a commitment to their local community, he started an herbal company. They named it Paxherbals. Nearly 20 years later, the company has a product line based on 40 local traditional “drugs” as they call them. Paxherbals is a direct employer of nearly 170 local people with 5000 distributors serving some 200,000 throughout Nigeria. The approach to herbs is science based, and research partners are actively sought. Most uniquely, the firm remains deeply embedded in a sustainable business model benefitting the local community.

The company is featured in a new publication from the London-based African Research Institute (ARI) entitled Modern African Remedies: Herbal Medicine and Community Development in Nigeria.  On its website, ARI introduces the reasons for this 24-page policy briefing with this: “In Nigeria, but also globally, there is growing recognition of the need to integrate traditional medicine into mainstream health systems to bolster their ability to cope with an ever-increasing burden.” The authors argue that an  “integrative heath care model as endorsed by the WHO” is the best model for Nigeria and much of Africa and that the values and practices of this firm serve as an exemplar. The authors write: “Through patience, determination and good practice, [Paxherbals] has become an exemplar in its market and is exerting increasing influence where it ought to be heeded—in government, academia and among medical practitioners.”
Photo of African Research Institute (ARI)
Paxherbals’ self-introduction on its site is this: “Pax Herbal Clinic and Research Laboratories was established in 1996 as a centre for the promotion, development and proper utilization of African medicine.” The firm declares its mission: “We aim to promote human health and human dignity, not just the eradication of pain which in fact is an essential aspect of being human. That is what we are up to. That is our business.” The firm chooses the herbals it manufactures from local practices, accesses raw materials with local labor, engages Western medical practitioners, and cultivates community in its network of distributors.

Comment: There is much in this story that inspires and gives hope. Such hope is for a stable and well-functioning system of integrative health and medicine that respects traditional practices and links them well with NGO medicine. The story is also one of hope for Nigeria itself. In a section of the report written by Father Abodo, we see this additional evidence of mission: “We constantly remind the local community of the paramount importance of maintaining a connection to the soil. As a society, a nation, we are in danger of losing that connection in Nigeria.”

This language can stimulate a yearning in those for whom the best choice to connect to nature may be flower boxes or rooftop greenspaces.  Abodo goes on: “By reconnecting people with nature, Paxherbals strives to bring them back to health. This might seem very philosophical, but being clear about the purpose of a project gives it a greater chance of succeeding.” Remarkable and uplifting guidance in this. Good for ARI to highlight the work and, more importantly, for the vision and manifestation of those who founded the firm they profile. This model is not only worth a read; it is worth seeking to emulate and replicate.

Canadian College Offers Naturopathic Medical “Bridge” for International Medical Graduates

Logo for Canadian College of Naturopathic MedicineBeginning April 27, 2014, the Canadian College of Naturopathic Medicine in Toronto, Ontario, is offering an efficient means through which international medical graduates can practice medicine in those Canadian provinces and states of the United States that regulate naturopathic doctors. The CCNM “Bridge Delivery” program offers a “compressed” naturopathic medical program of six terms in 24 months to candidates who have met stringent standards in prior medical education abroad. The pre-requisites for enrollment, for instance, include attaining a passing grade on the Medical Council of Canada Evaluating Examination (MCCEE) or a passing grade for United States Medical Licensing Examination Step I (USMLEI).

The CCNM site asserts that “many foreign trained medical doctors feel that the nature of a naturopathic doctor’s practice is much closer to their experience as a medical doctor.” The education of the naturopathic doctor at CCNM includes training in acupuncture techniques. The International Medical Graduate (IMG) Bridge Delivery application is here.

Comment: The phenomenon of a Chinese-trained medical doctor who practices as a non-doctoral licensed practitioner in acupuncture and Oriental medicine (AOM) is familiar in North America. The MD (China) attached to the LAc (licensed acupuncturist) fairly begs for a broader scope of practice than the AOM practitioner has in North American jurisdictions. Typically, western diagnosis is not in the acupuncturist’s scope of practice.
Image of flags
The MD (Russia) or MD (China) or MD (elsewhere) who chooses the CCNM 2-year program embarks on an interesting re-entrance to practice. The IMG becomes a “doctor” or, in most US jurisdictions, a “physician” such as he or she was accustomed to being. Yet at the same time, the IMGs will discovered the rude reality that in the heated politics of US medicine they might be scorned by polarizing forces in regular medicine as frauds and quacks.

Yet the naturopathic practice can be familiar to the IMG’s general practitioner experience at home. The ND’s patient population arrives with health issues typically as broad as are seen in conventional family medicine. In some US jurisdictions such as Vermont, Washington, Oregon, and Arizona, naturopathic doctors have broad prescribing rights including pharmaceuticals that require registration via the US Drug Enforcement Administration (DEA). Yet mainly the tools used by a naturopathic doctor are closer to what the IMG may know as traditional medicine back home.

Will a naturopathic practice satisfy an average IMG? No doubt, the right to practice in this case is yet the right to practice as a second class citizen. The ND is only partially included in the medical system. Yet change is afoot. CCNM, for instance, is an increasingly fertile bed for whole practice research that supports the profession’s claims. The Canadian Medical Association Journal recently published positive CCNM findings on naturopathic care for back pain. Major research grants related to cancer and diabetes were received this spring. A new CCNM cancer center in Ottawa has assumed a high profile in the community. Meanwhile, south of the Canadian border in the state of Vermont, for instance, naturopathic doctors are part of the primary care matrix and approved to run primary care medical homes (PCMHs) at clinics like Mountain View Natural Medicine. Across the country in Oregon, the Center for Natural Medicine is similarly pioneering such a role for naturopathic physicians under that state’s health reform.

In short, the decision of an IMG to re-enter the healthcare work force through the CCNM Bridge is yet a bit of a crapshoot but with the dice increasingly loaded for success. The CCNM site invites enrollees with: “If you are an internationally trained medical professional, you have significant training that is valuable to the Canadian health care system and to the health of Canadians.” This would be reassuring to an IMG if such a banner were posted on the Health Canada website. One suspects that, while the power relationships might not yet be what one wants, the content of the naturopathic education at CCNM is likely closer to the IMG’s less than fully industrialized medical education at home. There is likely something to the CCNM assertion that “the nature of a naturopathic doctor’s practice is much closer to their experience as a medical doctor.”