Which doctor

Peak flu season is supposedly waning, but your voice is scratchy, your back hurts and your nose is runny.

Are your symptoms related? Where should you go for help?

You know about Student Health Services on campus, which employs nurses and medically trained doctors. Getting to campus has been a struggle and you live really close to a naturopath. There are also massage therapists and acupuncturists around the corner. A family member offers you some herbal products — which they swear by — to cure your cold.

Healthcare is a daunting word and has a daunting regulatory framework. It’s important to understand this complexity in terms of personal, private decisions contributing to a collective, public system.

Let’s examine who you can trust with health-related questions, how BC’s healthcare regulations can help or mislead you, who might try to exploit you, what different healthcare professionals can offer you and which health products are effective and safe. This examination will not only help your personal decisions, but will also help you understand how those around you make healthcare choices.

The regulatory nightmare

Who is a healthcare professional? British Columbia’s list of regulated health professions is a good place to start. This list includes options like physicians, nurses, dentists, pharmacists, psychologists, naturopathic physicians and traditional Chinese medicine practitioners.

Each of the professions on this list are regulated by their own colleges. These colleges are not specific schools which different professionals attend. They are self-governed organizations which ensure the ethical practices of its members and respond to complaints from the public. Nurses run the College of Registered Nurses to make sure its members are qualified, competent and follow the clearly defined standards of practice. Doctors regulate doctors, masseuses regulate masseuses.

Dr. Bernie Garrett, an associate professor in UBC’s School of Nursing, worries that patients often trust the wrong people with their healthcare decisions. The regulatory colleges can be a source of confusion according to Garrett, whose research focuses on how consumers make healthcare decisions. He blogs humorously about critical scientific thinking in part to draw attention to health issues in BC.

Garrett received his research training in the UK. When he moved to Vancouver in 2003, he was surprised with the comparatively relaxed regulation of the regulatory colleges. In BC, both scientific and naturopathic training result in the title of “doctor,” leading consumers to believe naturopaths and medically trained physicians have the same depth of knowledge and qualifications.

In fact, naturopaths and medically trained physicians receive vastly different training.

“That is not something that would happen in the UK, where they use the titles in different ways,” said Garrett. Ideally, BC regulatory colleges would call naturopaths “naturopathic practitioners” with the term “doctor” reserved for medically trained physicians.

So what? A small element of confusion in the regulation of healthcare, especially in something so specific as the regulation of professional titles, seems like small potatoes. The problem is that some practitioners build on confusion to exploit the public such as naturopathic doctors in Yaletown who charge consumers $100 to inject vitamins directly into their bloodstream.

“Humans are very easily deceived and that’s what people sometimes forget. It’s quite easy and well-documented to fool the brain,” said Garrett.

Still, BC’s regulated colleges of healthcare professionals are the most trustworthy source for health-related information.

The unregulated practitioners

Regulatory systems can be frustrating. With different unregulated practitioners so readily available — a quick jaunt on Broadway takes you past crystal healers, therapeutic touch clinics and reflexology practitioners — alternatives outside of the regulated colleges of healthcare professionals are temptingly convenient.

But if you have not memorized the list of regulated healthcare professions in BC, it can be hard to remember who doesn’t make the cut, especially if science-y jargon is thrown around. Unregulated professions include practitioners of therapeutic touch, faith healing and homeopathic medicine, as well as those who use seemingly science-based terminology in their titles such as “neurotherapy” and “bio-energy.”

When these alternatives outside of the regulatory colleges present themselves as comparable to scientific medical treatment, Garrett believes healthcare worsens for the average person in BC. With more misinformation, the public forgets the fact that scientific and technical progress are painstakingly built on ideas that have been tested over time.

Scientifically based medicine tests therapies, new and old, before critiquing or endorsing them. Unregulated practitioners, however, often use only the negatives of modern medicine to justify the existence of their own practices. Many unregulated practitioners will mention that prescription pain medications are addictive, without mentioning how many lives they have saved to promote their practices — like crystal healing — and without having any evidence to show that their therapies work.

“Criticizing the problems in medicine is not a good way to justify that alternative medicine works. It would be like stating a plane crash justifies flying carpets,” said Garrett.

Regardless of the opinions of researchers like Garrett, consumers still utilize unregulated practices. The Ubyssey attempted to speak with various professionals who practice outside of the regulatory colleges, but none were willing to offer their perspective.

In response to a request for an interview, Dr. Linda Turner, an instructor of holistic health studies at Langara College responded in an email, “we do not conduct interviews with journalistic students related to complementary therapy. This is because we find that often student journalists do not understand the concepts well enough to write about the subject with a balanced perspective.”

Others who offer services like Christa Lynn’s crystal healing sessions are even less open to conversation. “Christa does not answer questions on crystals, crystal healing properties, nor gives advice on crystal healing. If you are interested in learning more about crystal healing, then consider registering in one of her crystal healing classes,” reads her website. (We attempted without success to contact her anyway.)

Steering clear of practitioners who are not transparent is probably your best bet. At the very least, research where you are spending your time and money. Numerous studies have disproved the effectiveness of homeopathy, therapeutic touch, crystal healing and faith healing.

Meeting the alternative

Within the regulated structure, different healthcare professions provide patients with opportunities to find practices with which they are most comfortable.

“I grew up with Chinese medicine more than Western medicine in Japan,” said licensed Shiatsu massage therapist and registered acupuncturist Masako Doi. “This is something I say to my patients: Western medicine is great. They can help you especially with acute problems. But what I do — Chinese medicine, alternative medicine — is for prevention.”

Doi’s practice stands in contrast with the unpleasant experience of modern medicine, with all its injections, foul-smelling hospitals and time-crunched doctors. For some ailments such as pain and anxiety, Doi is a great resource. Doi herself knows she cannot help all patients and often recommends they see a medical doctor. Similarly, she knows doctors who refer their patients to her massage clinic.

Research shows that acupuncture does help in the management of pain, but scientists have not yet adequately explored its efficacy in treating other conditions. Massage, for which there is a considerable amount of research, has consistently been shown to be effective for relaxation and the reduction of anxiety.

There are differences in how she consults with her patients when compared to scientifically trained doctors.

“Normally I do a little bit of counseling first — I take 15 to 20 minutes for the consultation. We talk about their emotions, stress levels and sleeping patterns to distinguish their mental conditions. There is physical health and there is mental health, and we treat both,” said Doi.

She places emphasis on talking with her patients, and helps people realize what could be going wrong. Massage, for example, is not all about relaxation.

“With massage, [patients] may feel more pain than they ever thought of and they realize, ‘Maybe I have to do more exercise. Maybe I have to do more stretches,’” she said.

With the inclusion of massage therapy and traditional Chinese medicine within the regulatory colleges, BC legislators acknowledge the diversity of the province’s residents. When friends and family choose a different healthcare provider than you might — a massage therapist over a doctor, for example — respect that decision, knowing that different providers offer different spaces to different communities.

Even “natural” products need regulation

Which healthcare products are safe and effective? Similar to understanding who to trust, regulations can help us understand what products are worthwhile. Prescriptions are strictly regulated with clinical trials before consumer use, while natural products — including vitamins, treatments like Echinacea and other herbal products — are given more leeway.

In comparison to the US, Canadians have a fairly progressive regulation in place around natural products. The Canadian regulatory system is more proactive than reactive, according to Lynda Eccott, a senior instructor in UBC’s faculty of pharmaceutical sciences. She teaches future pharmacists an evidence-based course about commonly used herbs and supplements, their safety, how effective they are and about existing resources with information about natural products.

Eccott thinks it’s critical to educate people about the misconceptions of natural products. The biggest misconception: a natural product is safe simply because it’s natural.

“What people need to know is that your body doesn’t know if something is derived in the lab or comes from a rainforest. Look at poison ivy — that’s natural, but it’s not safe,” said Eccott.

Health Canada regulates natural products to ensure safety. All natural products need a natural product number signifying approval by Health Canada before they make it to store shelves.

Importantly, these safety claims do not take into account interactions natural products may have with other products used by patients. Natural products can interact badly with prescriptions and interactions can be missed because natural products are often not listed in a patient’s medication history.

Eccott strongly recommends that all students at UBC access the freely available Natural Medicines database online before using any natural product. The database is curated by experts, with up-to-date information about drug interactions, adverse reactions, effectiveness and nutrient content. Another database, the Natural Standards, is provided for public use by the BC Cancer Agency.

We should also pay attention to safety alerts put out by Health Canada by either accessing the website regularly or subscribing to their email list. Do not automatically assume that a product is safe because it is natural.

When it comes to effectiveness, Eccott said regulations of claims for efficacy of natural products are limited. Currently, as long as manufacturers can cite any small studies or prove the product has been in use for a few generations, natural products receive approval. Health Canada is in the process of updating these regulations.

“One of the things I really talk to my students about is the ethics of selling these products,” said Eccott. “How ethical is it to sell products where there is no evidence?”

Some natural products have absolutely no evidence for effectiveness — like shark cartilage as a treatment for cancer — yet worryingly, they are still found on store shelves.

Another worry for Eccott is that people are self-treating serious conditions like dementia and depression — which should be treated by a medical doctor — with natural products like ginkgo and St. John’s wort.

Allowing the public to purchase natural products for their health boils down to respecting people’s autonomy. You, your peers and other members of your community all want the ability to make choices for their health. In choosing what natural products to use, you should make sure to consult an expert, by looking up these products in expert-curated databases or by talking to a licensed pharmacist.

Health: Whose choice is it?

Define health. Is it something you feel in your body or in your mind? Is it something you and your family, peers, cities and other communities feel collectively?

These are tough questions — which is why healthcare professionals and policymakers take it upon themselves to define health, what safe healthcare products look like, who can provide healthcare and how it should be regulated.

Still, the healthcare system and professionals do not exist in a vacuum. Everyone in the Metro Vancouver area is a participant. Whether you are trying to decide how to treat your flu-like symptoms or deciding how to vote on healthcare legislation, we all make health-related decisions.

Garrett advises that making health decisions on a personal level is different than making decisions when we vote at the public level.

“I’ve got no problem with people believing whatever beliefs they wish as individuals,” said Garrett. “But the difference is here, we’re talking about our public healthcare system. When you start legislating on the basis of inclusivity and diversity, it becomes problematic because people can’t make an informed decision.”

You might allow yourself to steal a cookie from your roommate’s stash, but would you approve of laws giving everyone the right to steal any cookie whenever they want? Probably not. This is the difference between personal decisions and public ones — should you make a decision about other people’s health? No. Should society regulate who can work as a healthcare worker and what they are allowed to do? Yes.

Preventing injustice is why legislation on valuable resources like healthcare is important. Visiting an unregulated, non-evidence-based practice like a crystal healer instead of a regulated, evidence-based physician is a personal decision, but legislation should be in place to inform the consumer which is more likely to cure their health concern.

At some point, even legislation and evidence can’t prevent people from making bad decisions. We know that faith-based healing doesn’t work, but people still use this practice to treat their illnesses. Those who are convinced by science-based approaches have already moved on. The remaining consumers may be loyal to non-evidence based techniques rather than ill-informed about scientific studies of healthcare.

“You can’t bash people over the head with science and hope they’ll change their mind,” said Garrett. “That doesn’t work. It becomes adversarial. It’s always a question of questioning evidence and beliefs. You have to point out that skepticism in all aspects of life is a very healthy thing.”

The key in making good healthcare decisions is learning how to evaluate evidence and allowing yourself to change your mind if new evidence shows that a practice does not work. Garrett adds to the widespread call for better science education in high schools, where people first form their opinions on how to take in and evaluate evidence.

He calls for more science education as a result of a research project his group conducted in the last year, where they surveyed magical beliefs in undergraduate students. According to unpublished research from Garrett, 15 percent of students reported that they believed in the existence of paranormal phenomena such as ghosts and werewolves.

“If that’s the level in undergraduate students, what’s the level like in the general population?” said Garrett.

To figure out what the general population believes regarding their healthcare, researchers and policy writers come together to survey the public. While these studies are important first steps for changing existing problems, survey your friends and family with your health questions. Dig in your medicine cabinets and ask if all those products are effective, safe, worth their costs and are recommended by trusted professionals.

Healthcare-related decisions will continue to be some of the most important choices you make on a personal level and for the public’s well-being. We will need to continually re-examine our options. As these conversations progress and differences in opinion arise, we should try our best to find accurate data, correct those who are not properly educated and vote with society’s well-being in mind.