New Ontario college for traditional Chinese medicine

Traditional Chinese medicine (TCM) and acupuncture are now officially recognized as a health profession in Ontario under new legislation that will allow practitioners of the ancient holistic therapy operate under their own regulatory college — and potentially earn the right to use the appellation “doctor.”

Bill 50, which received royal assent at Queen's Park Dec. 20, legally recognizes the 3000-year-old traditions and paved the way for the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, which is expected to be operating in 2 to 3 years. This is the second college of its kind in Canada. In 1999, BC became the first to set up a college for TCM and acupuncture (CMAJ 1999;161:1435-6), while Alberta and Quebec have since established regulatory colleges for acupuncture. An estimated 48 US states also boast some form of regulation of TCM and/or acupuncture.

TCM, a holistic method of health care commonly practiced in China, is predicated on the belief that illness and disease is caused by blockages in a person's qi, a life force found in all living things. Therapies to rebalance qi include acupuncture, exercise, herbal therapy, tui na massage, cupping (placing heated cups on the skin to draw out stagnant blood) and moxibustion (the burning of herbs above specific points on the body).

Ontario's Minister of Health, George Smitherman, hailed the move as a “milestone.” “Regulating traditional Chinese medicine will help ensure that Ontarians are receiving safe, quality care from practitioners who have achieved a certain level of skill and training,” he stated.

The government estimates there are between 3000 to 4000 practitioners of TCM and acupuncture in the province, yet no uniformly accepted standards of practice in what is believed to be a multi-million dollar industry. Currently, if a person has a complaint about a TCM practitioner they must file a civil suit, which is often costly and time consuming. In addition to a disciplinary process, the college will set qualifications for practitioners of TCM or acupuncture. Those who don't meet the standards will have to undergo training — likely a 2-year accreditation program. The college will also establish different classes of TCM practitioners, to allow for basic practitioners and those with more advanced education who would earn the title “Doctor of Chinese Medicine.”

The news was welcomed by Cedric Cheung, president of the Chinese Medicine and Acupuncture Association of Canada, who has lobbied for more than 2 decades for regulation.

“We are very, very pleased,” he said, from his office in London, Ont. The college, he says, is important “for the safety and protection of the general public.”

“Although it is a centuries-old medicine, it's just like any other medicine; the people who are practicing it have to be well trained and qualified.” Cheung, who has been using TCM for 40 years to treat everything from infertility to hypertension and prostate cancer, says the legislation also goes a long way to help validate his profession.

And that's exactly what Dr. Lloyd Oppel fears. An emergency department physician and a co-founder of Canadians for Rational Health Policy, the Vancouver doctor is concerned that the college will push what he calls “a baseless alternative medicine” into the mainstream.

“By bringing in these regulatory bodies you are essentially allowing them to run cover behind a smoke-and-mirrors show, or what appears to be quality control but is not.”

Oppel says that the general public interprets the news of Bill 60 as the government giving its “stamp of approval” for TCM, when “it's really more like an application for a business licence to make sure that your books are in order.”

He insists that TCM and other alternative medicines should have to provide scientific proof of efficacy and safety before being officially recognised.

“There should be some kind of quality check that goes on, in the same that you would check the consistency of concrete blocks if you were building a bridge, or light bulbs if you were hoping to light a building.”

While there is significant evidence supporting the use of acupuncture, particularly for pain relief (CMAJ 2006;176:179-83), the literature has little to offer regarding the efficacy of TCM as a system of medicine. To date studies have investigated only specific TCM herbs.

Cheung, meanwhile is not surprised by the lack of trust of some members of the medical community.

“There are always skeptics everywhere,” he says. “This medicine has around for at least 5000 years — and maybe longer. You have to accept that as a stamp of approval…. How long has Western medicine been around? Maybe 200 years? And don't forget, in its initial stages Western medicine was regarded as witchcraft.”