Regulating Traditional Medicine Professionals in the Public Interest: A Case Study of Chinese Medicine and Acupuncture Regulation in Ontario, Canad

Many complementary and alternative medicine (CAM) interventions, such as acupuncture and herbal medicines, are rooted in traditional medicine (TM) systems indigenous to particular cultures and lands. The World Health Organization has recommended that nations take steps to regulate both TM and CAM practitioners worldwide, with the aim of enhancing their 'safety, quality and effectiveness'. Several United Nations bodies have moreover recommended that nations take steps to protect TM knowledge, and prevent further misappropriation of TM practices. However, to date, very few studies have investigated or discussed how regulators may address the unique complexities of regulating TM practitioners and TM-rooted practices. This PhD dissertation -- a qualitative case study of traditional Chinese medicine and acupuncture regulation in the province of Ontario, Canada: a) explores the range of factors that distinguish the regulation of traditional medicine practices and professionals from biomedical professionals; and b) considers how the 'public interest' may be conceptualized to appropriately address these distinguishing factors in regulatory context. Data for the study was generated from several sources, including mixed methods survey, documentary review, and 32 key informant interviews. Analytic approaches included thematic and critical discourse analyses using the principle of 'regulatory equity' as a guiding concept. Postcolonial, multiculturalism, and boundary work theories, as well as legal principles of disparate impact discrimination and reasonable accommodation, were applied across the study. This body of work points to ways in which regulatory structures in Western liberal democracies may systemically privilege biomedical and non-immigrant practitioners by examining state risk discourses and the construction of regulatory boundaries for acupuncture; the issue of English-language fluency for immigrant practitioners; and the negotiation of safety, quality and epistemology in acupuncture standard-setting across professions. In this light, a series of strategies is proposed to assist regulators in negotiating equitable approaches to CAM and TM regulation. Emphasizing a broad conception of the 'public interest,' these strategies prioritize protection of traditional knowledge frameworks, while seeking to accommodate biomedical practitioners' safe and skilled adoption of TM-rooted health care approaches.