TCM in Canada: Health Care and the Importance of Alternative Medicines that Complement Medical Practice : Chinese Medicine and Culture

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TCM in Canada: Health Care and the Importance of Alternative Medicines that Complement Medical Practice

France, Honoré✉,

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Chinese Medicine and Culture 5(4):p 216-220, December 2022. | DOI: 10.1097/MC9.0000000000000033
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Abstract

1 Introduction

Medical practices before the Europeans migrated to the place that is now called Canada was different, but sophisticated for the time. Similar to many societies around the world, it would be called folk medicine because it is based on natural medicines and healing experiences of mind and bodies.1 Europeans came to the North America as traders, but the beauty of the land and abundance of natural resources made an impression to them. The settlers made themselves at home, instituted their colonial laws and practices, and eventually pushed the indigenous people into smaller and smaller areas. Conflicts between indigenous people soon developed as more Europeans arrived. Bringing with them were diseases from Europe that wiped out 3/4 of the indigenous population within a generation’s time. The settlers called the eastern portions that they first conquered as Canada. The settlers later further expanded to the areas in the western regions.

Immigrants from around the world flocked to North America in the 19th century including people from China. Not only that the Chinese immigrants helped build the transcontinental railway and started businesses and farms, they also brought their cultural practices and influenced other ethnicities. In this article, the impact of immigrants from China would be profiled. The article would examine how traditional Chinese medicine (TCM) evolved and integrated into the health-medical system in Canada, the growth of TCM programs in higher education, the regulation and practice of TCM in Canada, and patient’s perspective on why using TCM treatments.

2 Chinese immigration to Canada

To understand TCM in Canada, it is important to explore the immigration of Chinese people and the old culture that they brought with them. Chinese culture, science, philosophy, and practices such as TCM were brought to North America through Chinese immigrants. According to Wong,2 with over 52 million Chinese living outside of China, they are the most mobile people in the world “shaping economies, cultures, and politics throughout Asia, the Americas, and the South Pacific”. According to France and Sue3:

  1. The three largest ethnic groups living in Canada from Asia are from China, India, and the Philippines.
  2. Ethnicities from Asia make up 12% of the population of Canada. Therefore, approximately one in eight people in the Canadian population is Asian.
  3. Of which, 21.9% is a landed immigrant or permanent resident, and projections indicate that the number will increase to 30% by 2036.

According to Shen et al,4 “Canadians of Chinese origin are the largest non-European ethnic group in Canada, and therefore represent an increasingly important segment of the population.” TCM is an essential element of Chinese culture. According to Dr. Ben Baoqi Cao,5 a well known TCM practitioner, it has been practiced in Canada since the first Chinese immigrants arrived in the 19th century. TCM has grown exponentially in Canada with users from all walks of life. The effectiveness and benefits of TCM can be seen in the health of those who use it. A study of the Canadian province of Alberta’s population from 1995 to 2003 found that life expectancy at birth for ethnic Chinese residents was on average nearly 6 years longer than non-Chinese.6

3 Alternative medicine in Canada

The adoption of multiculturalism in Canada has led to the incorporation of TCM and acupuncture into the health care system. These medical services along with Western scientific-based medical practice have improved patient care. In the past, indigenous medicine was the norm until Western medicine as is known today became the dominant form of medical practice. Cultural historian Paul Craddock7 demonstrates how the understanding of human anatomy and medical procedures has influenced Western medicine:

“In the last 70 years or so, technology has enabled us to transplant organs, but transplants per se have been widespread for at least 500 years and are underpinned by 5,000 years of culture without which modern transplant …would be inconceivable....the story of transplants is about something closer to our hearts than pumps and valves; it’s about how we understand our bodies and about our relationships with one another and with our ourselves.”

In order to understand the popularity of alternative medicines, a number of themes that are prevalent in everyday life in Canada are discussed based on Craddock’s research about our past and present experiences. Factors such as the industrialization and factory-oriented food production has resulted in a backlash and a rise in all things natural, including an acceptance and demand for more medical choices that alternative medicines offer. Generally, alternative medicines rely on organic and natural products. They have holistic practices and include a different way of thinking. Another factor is the rising cost of medical expenses. The high cost of pharmaceutical products and the respect for Chinese cultural practices are some of the themes that affect the growth of alternative medicines in Canada.

3.1 Organic and nature-based approaches

The experts of the medicine industry have noted that, over the past few years, there has been a rise in the demand for the inexpensive traditional Chinese medicines in the several emerging economies of the regions of Asia Pacific and East Asian, due to the increase in sales of the local drug manufacturing industry.8 Thus, the interest in low-cost natural-based foods and medicines deriving from organic products is very strong in Canada and around the world.

Organic foods are in great demand especially in the developed world, with people from Asia and Europe interested in producing these products.9 To this end, the Mayo Foundation for Medical Education and Research in 2022 has suggested that organic grains contain less harmful ingredients than non-natural grains or grains that rely on herbicides and pesticides to grow.10 They also emphasize that natural foods and medicines create an emotional bond with the grower and consumer that is quite strong. According to Pétursson11:

“…providing healthy food for those who stand closest, this emotional labor is also performed for the sake of the environment and to support organic producers—love for the near and dear is extended to the earth and to one’s fellowman.”

Some of the most widely utilized alternative medicines in Canada are TCM and naturopathic medicine. Naturopathic medicine is the practice of using natural medicines, diet, nutrition, homeopath, physical manipulation, and stress reduction to treat illness and maintain health. Interestingly, in a study on the use of complementary and alternative medicine (CAM), Professor Matthew Leach12 found that:

“...close to twelve percent of Canadian adults, sixteen percent of US adults, twenty-six percent of English adults, and twenty-three to forty-four percent of Australians had consulted a CAM practitioner, with massage being the most commonly used service.”

3.2 Underfunding and expensive pharmaceutical

The Canadian health care system is more similar to the socialization of medical practice found in Europe, and is very different from medical practice in the United States. It is viewed as a human right and should be made available to all on an equal basis. The political left and right support socialized medicine and the right to use alternative medicines. However, one of the challenges is that there has been chronic underfunding of health care, and many people feel that family physicians are underpaid. For example, in 2022, there is currently a shortage of family doctors in Canada. According to Dr. Birinder Narang,13 there is a need to address British Columbia (B.C.)’s family doctor shortage. Almost a million B.C. residents have no family doctor (1 in 3 residents). There is also shortage of family doctors across Canada. Medical school graduates increasingly do not want the jobs in family medicine according to the Canadian Broadcasting Company (CBC) News.

In 2022, The Canadian federal government has put forth a bill in Parliament to fund pharmaceutical products for those who earn less. Citizens are also being asked to take out health insurance for medicines amid prices for prescribed medicines escalate. Everyone from all political parties agrees that the Canadian health care system is in crisis. More and more people in Canada are taking their health into their own hands and seeking help from alternative medicines such as TCM, Ayurveda, and naturopathic medicine.

3.3 Respect for Chinese cultural practices

In a personal conversation with Dr. Harris Fisher, a TCM practitioner in Victoria, B.C., he shared that he was drawn to TCM because of his interest in Chinese philosophy which he began to explore as a student of Asian martial arts. In exploring the appeal of TCM, Sciban6 states that “…this appeal also derives from the fundamental values that TCM offers. Three of these values are apparent at first glance: TCM is economical, encourages involvement in one’s own health care, and has an established record in providing pain relief.” From a philosophical perspective, the appeal of Chinese culture and TCM is described eloquently by Professor Li Qizhong14:

“Chinese medicine is rooted in the splendid traditional culture of China, and its theoretical exploration methods and explanations are based on the historical and colorful traditional Chinese culture. Chinese medicine is the towering tree that has lasted for thousands of years, is still flourishing, which expertly derives from the nourishment of traditional Chinese culture.”

4 Accreditation and licensing regulations in Canada

Canada is a country of approximately 37 million people in a confederation of 10 provinces and three territories stretched across the northern area of North America. The vast majority of its people (86%) live in the provinces of Ontario, Quebec, British Columbia, and Alberta. Canada has two official languages, English and French with the majority of French speakers living in Quebec. As a confederation, each province regulates its educational and health care systems with funding from the federal government based in the capital city of Ottawa. Each province regulates all services including medical care and alternative health practices such as TCM and acupuncture, despite a national organization called the Canadian Association of Traditional Chinese Medicine and Acupuncture (CATCMA) with members residing across Canada. This organization’s role is to:

  1. develop and support academic programs and research relating to TCM.
  2. facilitate international academic exchanges, technical co-operations, and other connections with international academic organizations and scholars.
  3. provide opportunities for the academic enrichment of CATCMA members by supporting TCM continuing education.
  4. promote the establishment of appropriate policies, regulations, and legislation governing TCM in Canada by ensuing that governments have access to information and input from TCM experts in an open consultative process.
  5. ensure that the benefits of CATCMA membership accrue to all, creating a cooperative, friendly, and convivial atmosphere for members, manage CATCMA democratically, promote a spirit of dedication, creativity and rigorous scientific principle; and work toward the overall prosperity and development of TCM and acupuncture.15

CATCMA has no power to regulate or accredit practitioners, but is influential in lobbying with federal agencies and supporting provincial bodies in its accreditation. However, there are no national rules in regards to the regulation of TCM and acupuncture in Canada. The five provinces which have regulations are British Columbia (B.C.) and Ontario regulating TCM and acupuncture, while Alberta, Quebec, and Newfoundland & Labrador regulate acupuncture only. Considering that provinces have difference in regulations, it is expected that practitioners have to go through a certified program and are registered to practice TCM and acupuncture in order to practice in these five provinces. In British Columbia, for example, the TCM regulatory association is called The College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (CTCMPABC). It should be noted that in B.C., the word “college” in Canadian English means not only an educational institutions, but also a regulatory body. The strategic plan of this regulatory body has three goals:

  1. To ensure registrants have achieved competence and have a patient relations practice that conforms to the provincial health regulations;
  2. To enhance and promote the college role in ensuring that the public is served and to foster collaborative relationships with local, national and international organizations;
  3. To enhance organizational effectiveness with oversight of policies, procedures, and processes that meets the standards of the health regulations.16

There is no national education policy in Canada since it is a provincial or territorial jurisdiction. However, provinces do try to coordinate their rules and ensure that there is a great deal of uniformity in the practice of TCM. To practice TCM, herbology and acupuncture in Canada, people must complete one of the three educational paths to be eligible for registration:

  1. Registered Acupuncturist after completing a 3-year educational program in acupuncture;
  2. Registered Traditional Chinese Medicine Practitioner after completing a 4-year program of acupuncture and herbology with restrictions; Doctor of TCM after completing a 5-year program of acupuncture and serology without restrictions;
  3. Pass the Pan-Canadian Written and Clinical Case Study Examinations that is organized in the five provinces through the Canadian Alliance of Regulatory Bodies of Traditional Chinese Medicine Practitioners and Acupuncturists (CARB-TCMPA).

5 TCM training in Canada

Two useful websites that describe information on TCM educational programs in Canada can be found on TB - TCM Colleges and Training Programs in Canada and the Canada Higher Education Career Guide.17,18 The literature on these early training programs is incomplete, because in the past, TCM was called Chinese medicine or Oriental medicine. The use of the term TCM was the result of trying to unify the name by the Chinese government which has been accepted by almost all educational institutions of higher learning in Canada. Some published articles cited that the first TCM training institution started in 1985 or later. However, a source was found to have cited the year 1970 with the Institute of Acupuncture and Oriental Medicine in Toronto, Ontario. The institute was established by Dr. David Lam, an immigrant from China, making it the rightful first school in Canada.19 With the plethora of TCM training facilities in Canada, it is not a surprise that 51.4% of people have trained in North America, while 44.1% have trained in East Asia.20 This reinforces the peoples’ demand for effective alternative and holistic approaches. In that regard, TCM is viewed positively because it has been thoroughly researched and has been practiced for centuries in China.

College and University TCM programs are based on the criteria of the CARB-TCMPA, which is the national forum and voice of provincial regulatory authorities. The CARB-TCMPA organizes exams that all programs accept and are supported by the five provinces with a regulatory college, while the other provinces and territories will found the lead of the Canadian Association of Traditional Chinese Medicine, which has chapters in every province and territory. Typically, a program at the various training institutes of higher education is similar to that offered by the Pacific Rim College of Traditional Chinese Medicine.21 The Doctor of Traditional Chinese Medicine at the Pacific Rim College of TCM is a 10-semester program that deeply explores areas of TCM such as psychology, oncology, gerontology, acupuncture detoxification, research, and the classic texts that first recorded the principles of this powerful and ancient system of medicine. The program provides winter, summer, and fall semesters with a total length of 10 semesters. Students could choose to take the courses online or on campus. The program includes 1065 hours of clinical training, and the total training length is expected to be 3840 hours.

6 TCM practice: Elements of Health Centre, Victoria, B.C., Canada

The best way to understand how TCM operates in Canada is to explore the practice and how it works on a day-to-day basis from a patient’s experience, and so below was the author’s personal experience. As a TCM patient at the Elements of Health Centre in Victoria, B.C., Canada, the atmosphere of the center was more conducive to releasing anxiety. When I was choosing my TCM practitioner, I was drawn to the idea expressed in the vision of health and the approach of TCM:

“At the Elements of Health Centre, our holistic approach integrates alternative therapies with western medicine, harmonizing the wisdom of traditional practices with the advances of modern science. Our work in this field is joyful and fulfilling; we are especially passionate about empowering our patients to become active participants in their health in order to achieve long-term vitality, balance, and well-being.”22

In my first consultation with Dr. Harris Fischer, he listened to my concerns and then let me know that we were going to work together to combat the issues I had. He asked me questions about my lifestyle including diet, exercise, sleep pattern, medication, and what my family doctor was doing to help me. He examined me thoroughly and proposed an approach to help me deal with the hypertension that I was concerned about. In that sense he was using methods that benefited what my family doctor proposed, except that the TCM approach was more proactive and based on what I could do rather than just take the medication that my family doctor had me doing. The TCM approach is to use acupuncture, herbal remedies, and so on in strengthening my heart and having a healthier blood flow. The atmosphere at the Elements of Health Centre was very relaxing. The acupuncture on each visit were relaxing and surprisingly invigorating. I began to make lifestyle changes in diet and exercise and take herbal remedies that felt empowering. This TCM regime complemented what my family doctor was doing, except with TCM I felt more empowered with a sense of partnership with Dr. Fisher, which was very different from my family doctor’s approach. I was doing more with TCM than just taking medication and monitoring my heart. With TCM I felt listened to, receiving concrete strategies that I could use on a regular basis and built a partnership with the lead of Dr. Fishers to live a healthier life. A posting on the Centre website also struck a chord with me: “I have never felt so heard and supported by any other health practitioners ever before.”

7 Conclusion

Knowing more about the history of modern medicine is an important factor in understanding how the modern health care system functions in Canada. The dual system for funding medical care and the appropriateness of having Western medicine and traditional Chinese medicine work hand-in-hand brings together what science tell us about medical effectiveness and what nature provides for best health practice. While TCM was imported to Canada by immigrants who brought it with them from China, it has found acceptance and its place in the Canadian health care system similar to Chinese immigrants making a home for themselves in Canada. With regulations in place that are supported by the federal and provincial governments, those who seek TCM services can be assured that they are getting quality and professional care for their health needs.

Canada has a mosaic of medical bodies, funding agencies, and regulatory systems that are provincially oriented. The larger populated provinces with high levels of immigrants from China have provincial regulations, indicating that there are no specific regulatory bodies in those provinces. The incorporation of TCM as a discipline that students can study in Canada can be found in most of the provinces at institutions of higher learning. The author’s impressive experiences as a TCM patient lie in the expertise of TCM practitioner and the setting of Elements of Health Centre. I have received high quality care and can be confident that my insurance company will pay for the services I received from my TCM practitioners as they are respected and considered an equal in their approaches to health and well-being.

Funding

None.

Ethical approval

This study does not contain any studies with human or animal subjects performed by the author.

Author contributions

Honoré France has done the research and writing of the paper.

Conflicts of interest

The author declares no financial or other conflicts of interest.

References

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Keywords:

Canada; Chinese immigration; Education; Patient’s perspective; Regulatory system; Theories of growth in non-Chinese patients

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