There has been discussion recently on the possibility of statutory registration of naturopaths in Australia. Given that such registration would normally only be considered by government where a healthcare practice modality poses a significant and demonstrable risk to the public, it’s important to quantify the level of risk posed by Australian naturopaths.
What are the Risks Attributable to Naturopathy?
Mortality and morbidity data associated with the practice of naturopathy in Australia is difficult to acquire. A good effort on this was made by Professor Michael Weir of the Faculty of Law atBond University,in a 2016 submission to the Health Workforce Principal Committee on the registration of naturopathy, western herbal medicine and nutritional medicine,on behalf of the Australian Natural Therapists Association1. In Schedule A of this document, Weir identified the following instances of death and adverse reaction which were directly associated with treatment by a person who was identified solely as an Australian naturopath:
- 1999 1 death as a result of direct intervention by naturopath
- 2002 1 death as a result of direct intervention by naturopath
- 2004 1 adverse reaction as a result of direct intervention by naturopath
- 2008 1 adverse reaction as a result of direct intervention by naturopath
- 2016 1 adverse reaction as a result of direct intervention by naturopath
- 2016 1 adverse reaction as a result of direct intervention by naturopath
In summary, over the 17 year period from 1999, Weir identified 2 deaths and 4 adverse reactions occurring as a result of direct intervention by a naturopath. Weir also cited cases where death or adverse reactions had been associated with the use of complementary medicine products purchased online and in other places by members of the public, and where treatment was provided by formerly registered Australian healthcare practitioners as well as naturopaths working overseas. This data has not been included in this analysis because of the difficulties in using it for comparative purposes.
In assessing the risk posed by naturopathy it may be instructive to compare this with the risk inherent in something which may be thought of as relatively innocuous, such as falling out of bed. Data from the Australian Bureau of Statics for 2008 state that in that year, 29 people died from falling out of bed2.
Assuming that 2008 was an average year for such events, over the same 17 year period used by Weir, beds would have been responsible for 493 deaths, making a fall from a bed 246 times more likely to cause death than being treated by a naturopath, if compared with the data provide by Weir1. On this basis, if naturopaths were to be registered because of the risk that they posed to the public, then it would seem that the registration of the suppliers of beds is more urgently required.
Risks Associated with Orthodox Medicine Compared to Naturopathy
In looking at the risk associated with naturopathy, it may be of benefit to examine the risk associated with the provision of services by a healthcare modality that is already registered, such as orthodox medical practice, to determine if the risk posed by naturopaths is similar. This is also useful to look at because practitioners of orthodox medicine serve as a good example of the type of practitioner who, while providing great benefit to the public, should be registered, because of the risks that they pose to the public.
Deaths from orthodox medical treatments
Makary and Daniel, writing in the British Medical Journal in 20163,refer to a figure of 400,000 deaths per year from orthodox medical treatmentsprovided in US hospitals, and comparing the current population of the United States with that of Australia, the local figure here would be something in the order of 31,000 deaths per year, making death from orthodox medical treatments provided in hospitals 263,500 times more likely than death resulting from the treatment provided by naturopaths.
A 2006 Victorian study4 found that the adverse event risk from treatment in Victorian hospitals was 6.88%. In Australia in the financial year 2016/2017, there were 11 million hospital admissions5. At a rate of 6.88%, for 11 million hospital admissions nationally, 756,800 people would have suffered an adverse event from receiving orthodox medical treatment in hospital. By comparison, according to this data and data from Weir1 referred to above, an adverse event from orthodox medical treatment provided in an Australian hospital is 3,216,400 times more likely to occur thanan adverse event associated with the treatment provided by an Australian naturopath.In support of the figure referred to above, a 2017 study by Moutaouakkil, et al6,cited an estimated adverse drug reaction rate of 4% to 10% of hospital admissions.
Ducket and Jorm, writing for the Grattan Institute in February of this year7, state that around 900,000 people who are treated in Australian hospitals each year experience an adverse reaction. According to this data and again using the data from Weir1, orthodox medical treatment provided in Australian hospitals is associated with 3,825,000 times more adverse reactions than the treatment provided by Australian naturopaths. It is worth noting that this figure is similar to the one identified above.
Wilson, et al, in a paper published in the Medical Journal of Australia in 19958, which was a review of data from 28 NSW and South Australian hospitals, found an adverse reaction rate of 16.6% and of these, a mortality rate of 4.9%, occurring in these facilities over the data collection period. Using Australia hospital admission data from the financial year, 2016/20175, this would give an adverse reaction figure of 1,826,000 and 89,474 deaths per annum nationally, indicating that orthodox medical treatments provided in Australian hospitals is7,760,500 times more likely to cause an adverse reaction and 760,529 times more likely to cause death, than the treatment provided by an Australian naturopath.
It should be noted that the morbidity and mortality data provided for orthodox medicine only covers treatment provided in hospitals and does not include treatment provided by general medical practitioners or specialists working outside the hospital system. In an average year in Australia there are in excess of 99 million visits to GP’s alone9, and while the morbidity and mortality risk associated with these treatments is exceedingly difficult to quantify, it’s reasonable to assume that the morbidity and mortality risk posed by these practitioners is at least as high as that posed by hospitals.
From the evidence available it is abundantly clear that naturopaths working in Australia pose a negligible direct risk to the public. On this basis, it’s highly unlikely that any level of Australian government would have an appetite for the statutory registration of this profession, unless or until a much higher level of risk can be identified.
1.https://www.australiannaturaltherapistsassociation.com.au/Public/Resources/Statutory_Registration/Public/Resources/Statutory_Registration.aspx?hkey=8c990abf-14a0-4a1b-9665-ecb161912c00 (Viewed 5 November, 2018).
2.http://www.abs.gov.au/ausstats/abs@.nsf/0/C46FE0522F16B6FECA2576F600122B27?opendocument(Viewed 4 November, 2018).
3.Makary M, Daniel M. Medical error—the third leading cause of death in the US. BMJ, 2016;353:i2139 doi: 10.1136/bmj.i2139
- Ehsani P, et al, The incidence and cost of adverse events in Victorian hospitals 2003–04 MJA, 184, 11, 551-555.
- https://www.aihw.gov.au/reports/hospitals/ahs-2016-17-admitted-patient-care/contents/table-of-contents(Viewed 4 November, 2018).
- Moutaouakkil Y, et al. Drug Iatrogenesis: A Review.Toxicol Open Access 2017, 3:129 DOI: 10.4172/2476-2067.1000129.
- Duckett S, Jorm C. All complications should count- Using our data to make hospitals safer. Grattan Institute, February, 2018.
- Wilson RM, et al. The Quality in Australian Health Care Study, Med J of Australia, 1995, 163, 9, 458-71.
- https://www.aihw.gov.au/reports/australias-health/australias-health-2016-in-brief/contents/what-services-do-we-use (Viewed 5 November, 2018).