AUSTRALIAN NATUROPATHIC NETWORK
 Serving the community since 1998

Raymond Khoury has played a significant role in shaping the landscape of complementary therapies as we know them in Australia today.  As a clinician with some 20 years experience, and a seasoned campaigner of many political struggles with State and Federal governments, it makes sense to take heed of the wisdom he imparts regarding the profession, education, and regulation of naturopathy. 

The Lecturer

Raymond first studied at the Southern Cross Herbal School under Denis Stewart.  In 1981 he graduated in herbalism and naturopathy. 

 Four years after graduation he was invited to lecture in pharmacognosy at Southern Cross Herbal School.  Raymond recalls, “In those days this [pharmacognosy at herbal colleges] was simply unheard of”.  This was a sign that things were starting to change in the area of complementary medicine.

Raymond developed and delivered a six week course which was well received.  He was consequently invited to lecture in materia medica.  Raymond’s abilities as a lecturer evolved, and today it is almost impossible to believe that in his early years he suffered from a speech problem.  

As Raymond’s reputation grew he was invited to lecture at other colleges.  “There were no real programs in those days, the lecturer developed the course material.”  In 1989 Raymond put the herbal medicine program together for Nature Care College in Sydney.  It took hundreds of hours to produce.  All aspects of therapeutics taught in herbalism at Nature Care today remain true to his original work.  As a testament to his program, when VETAB (Vocational Education & Training Accreditation Board) competencies were introduced, the herbal therapeutics component was still based on his program. 

Currently Raymond is the head of Herbal Medicine at Endeavour College in Sydney and is also the head of Herbal Medicine for the Australian Traditional-Medicine Society.

A Teacher?

Raymond makes a clear distinction between teaching and lecturing.  For him lecturing is about imparting knowledge to those who are hungry to learn, and see healing as a vocation.  Teaching does not necessarily meet these criteria.  Raymond wants to impart knowledge to people who have “gone around the block with life a few times”, people who can relate to the stresses of career, family, and finance.  Any romantic notions about the profession are long gone for Raymond.  He is quick to point out that this vocation is not for the faint-hearted, and that it requires strength of spirit and character in order to survive.

Importantly, Raymond sees his profession as a vocation not a career.  Complementary health reaches into his life-style and is not simply left behind in the clinic at the end of the day.  For example, at home his children know herbs by botanical names.  Healing is more than comprehension of facts and figures, and it is definitely not simply a small business opportunity.  It requires empathy with the human condition.  An art that must be felt as much as thought.  Raymond finds it truly “disheartening and saddening” when he does not see this understanding in others.

Over the years Raymond has seen the average age of students drop.  Often, even as the lecturer, he was the youngest in the class.  It almost seems that a herbalist is becoming a satisfactory career path like accounting or engineering.  Times do indeed change.  Perhaps in response, Raymond has reduced his lecturing workload over the last four years. 

Burnout 

One thing that Raymond has seen plenty of in his time is burnout.  “Many good and dedicated healers have disappeared from my era.”  Healing is “heavy-duty work”, there is no other way to describe it.  Practitioners who do not understand the art of professional care inevitably drain themselves of physical and emotional energy.  “One must remember we see patients that have gone through the entire medical system and come to us as a last resort.” 

Raymond emphasises the importance of looking after one-self.  He counsels students who take on too much work.  He recommends that practitioners partition their public availability from their private life: the idea of giving the home telephone number to patients is not recommended, except in special circumstances.   Should you start a clinic at home then get a separate telephone number.  “It is very important to limit hours, and to make yourself available at set times.  The average patient will take advantage of you, especially if you accept telephone calls at all hours.” 

Fighting the good fight

Over his years of practice Raymond has been involved with most of the major industry bodies – NHAA, ATMS and the FNTT amongst others.  Often he has been a founding member, usually in the role of secretary or chairman.  Raymond has put a vast amount of energy and dedication into this industry.

 It seems that 1985 provided a catalysing moment.  The NSW Department of Health had scheduled  Symphytum officinale (comfrey) on very dubious evidence.  There was outrage and fear that this was the thin edge of the wedge.

 Raymond is quick to point out that 15 years ago there was no professional infrastructure to fight such situations.  There was no differentiation between industry and practitioners, no effective professional body until ATMS came into existence.  Organisations that did exist were more social groups than anything else,  “these were the days when herbs were still hocus pocus.”

In response to the Symphytum issue the Herbal Advisory Research Council was established in 1986.  It was the first attempt to get a unified voice to challenge the Symphytum issue.  In Raymond’s typical style he threw enormous energy into the cause and chaired the early meetings.  Several meetings were held at Nature Care and the now defunct NSW College of Natural Therapies.  The Council operated for a year, there were some politics, almost nil funding and ultimately it went nowhere: the Symphytum issue was lost.  It did, however, succeed in getting people talking.  It started a professional body of the kind not seen before and people got to know each other.  “It was an invaluable starter.”

 The next significant cause Raymond become involved with occurred in 1986.  The first draft of the Therapeutic Goods Bill was released and “it was horrendous!”  Essentially the implication of the first draft was the creation of an environment where complementary therapists could not practice.  Vitamins and minerals could potentially be taken off the market.  The fear and concern this generated brought people together again: “a crisis will always bring people together.”  Subsequently, a meeting was organised at which 100 people participated.  The Government representative at the meeting took the concerns of the meeting back to Canberra.  The second draft of the bill did show some changes, but it was “a bandaid on a leaking dam”.  There were major modifications required, and lobbying continued from 1986 to 1991.  After this protracted campaign Raymond and colleagues were able to have the Therapeutic Goods Bill modified to the point where it was not a threat to complementary medicine.  The Act was passed in 1989, but the Regulations did not pass until 1991. 

At the time there were only three representational bodies for practitioners ATMS, ANTA and NHAA. During the campaign all three developed a good rapport with the TGA, and dispelled the “ratbag” image that complementary medicine practitioners.  The government now regarded practitioners as “activists”; that is, they would cause trouble if they were not happy.  Respect and visibility had been established.

During this time Raymond reached a point of collapse.  The five long years, ninety hour weeks and constant drain on mental and emotional energy took their toll. 

The Future & Regulation

When asked about his views on the future of naturopathy, Raymond does not paint a rosy picture, but reveals his gift of pragmatism and rational thinking, combined with informed opinion.

Raymond does not believe naturopathy will take on a life of its own.  He cites nursing and especially midwifery as a case in point.  “Health sociologists call it incorporation”, says Raymond.  “In the academic community it is just a fact.  Midwifery today isn’t controlled by midwives it is the Obstetricians who call the shots.  A midwife practises under the control of an Obstetrician.  That is ridiculous!”

“The same thing is happening to Naturopaths, only this time it is Pharmacy that is the culprit.”

Some would call Raymond paranoid, but history is a good teacher.  Given that the process has happened to most other allied health professionals why could this not happen to naturopaths?  Look at the doctors who want to be naturopaths?  The Australian College of Nutritional and Environmental Medicine (ACNEM) and the Australian Integrated Medicine Association (AIMA), are both examples of orthodox medicine picking up on the trend to complementary medicine.  Market forces are obviously just as powerful in the field of medicine as in any other industry.

Raymond is completing a Masters degree in which he is looking at the process and concept of incorporation.  He will be publishing papers on the topic.  “Just plain facts”, says Raymond. 

In an environment of incorporation could we still practise?  The answer to this question is not easy to predict.

At a recent Health Care Complaints Commission inquiry into unregistered practitioners, one witness gave evidence that suggested that patients must go to a doctor first who can then refer them to a natural therapist.  This concept generated some interest within the committee.  According to Raymond, “This means annihilation!  Doctors will employ their own natural therapists as is happening in pharmacies today.  They will pay them a pittance, and typically there will be one position for a hundred graduates.  They will get $15 per hour and they will be totally devalued and controlled.  This is in line with history.”

Raymond continues, “Think about doctors looking after birth.  A man who has no idea what it is about.  A man delivering a baby?  It is totally wrong.  Why all the surgical stuff?  Because medicine created the myth that birth had to be a surgical procedure. 

Well what can we do about this: is there a defence?  Thankfully Raymond’s answer is yes.  Once again Raymond offers an answer from his study of health sociology. 

“We can’t see the forest for the trees, that is why academics are good to listen to.  Where we are going wrong is that we are trying to prove our herbs on chemical grounds.  Industry does in vitro studies to sell product and it is financed by commercial concerns to make profits: this is pure business.  In order to impress, companies are putting up these studies.  In vitro studies are not human studies.  There has been a great swing to the understanding of herbs chemically and this creates an environment of pseudo-doctors, not herbalists.”

“Medical Herbalist?”  Raymond scoffs,  “What does this image do?  It only serves to infringe on medical territory, pharmacist territory, this is stupid.  Do not go to war unless you can win.”

“The way around it is to practice traditional herbal medicine.  Go back to traditional medicine.  Of course use pharmacognosy, but let common sense prevail.”

“Take Traditional Chinese Medicine for example.  The Victorian Health Department  conducted a $150K inquiry into TCM.  The report says that practitioners must be registered because they pose a threat to the community.  NSW and Queensland may both follow.  TCM do not do any chemistry!  Yet they are on the verge of being registered!”  (Registered as of earlier this year 2000)

“I cannot hold a conversation with a TCM practitioner: they speak a different technical language.  For example, if I ask a TCM practitioner is the herb Angelica sinensis used in female infertility, the answer I get is that it is used in hot ying cold yang situations.  I do not speak this language, and certainly western doctors do not.” 

“Two different worlds! Without so called science they are getting registered!  We are facing annihilation through incorporation.  Do not use science as a defence!  In a clinical setting, chemistry is meaningless, we must understand the application of the herb.  What is the point of pursuing this approach to regulation?  Clinical legitimacy, not scientific legitimacy, is the best strategy to approach regulation.”

 “If there is a move to registration of western herbs, we must have a public risk proven.  Some are saying yes, let us show that herbs are dangerous to get registration.  If we do this, then pharmacy will take it over because the consumer will support that.” 

It should be noted that the consumer movement is a powerful movement.  At all the government sponsored meetings that Raymond attends there is always a consumer group representative.  Consumers want to know about adverse effects, and the TGA can only agree.  If the industry says, “yes it is dangerous”, then we are going to be in trouble. 

Raymond believes self-regulation is a sensible option, and it basically exists today. 

A few years ago at a seminar organised by ATMS, a doctor explained why she had dropped out of the medical system.  According to her the controls and restraints were to great to tolerate.  At the same seminar a chiropractor stated that registration did nothing for his business.  “A good chiro is a good chiro and a bad one is bad.”  What is the point here?  Registration does not magically create a queue of patients at the door, but a good practitioner getting good results and running a sound practice does. 

For Raymond people who are not busy practitioners promote statutory registration.  That is, they practice irregularly principally on family and friends.  He prefers to listen to people with six-week waiting lists.  According to him, they are not fussed by registration. 

“With statutory registration, we will lose control, simply because the political process gets outside our reach.  History tells us this.”

Raymond’s Desiderata 

“Just heal.  Get out there and heal.  Herbs will heal.  Detoxification is sometimes the main strategy in the conditions we see.  We almost always see chronic situations.  Go carefully, our medicines are powerful, gentle but powerful.  Know your herbs.  Do your monographs – they are useful in clinic.  If in doubt about a certain disease process, then commence with work on the liver – get the liver working.  The main problem will always be patient compliance.  (It’s the alcohol not the herbs.)  Our Materia Medica was based on water based preparations.  Make your own medicines – fresh plant is superior.” 

 “Remember the patient’s diet, and use foods as medicine.” 

 “Be respectful to your patient – you know nothing about them – they could be a far more accomplished person than you will ever be.  Be honest with people – people can see through bullshit.” 

 “Never be afraid to say ‘I don’t know’ – a wise person can easily say it.  Monitor the patient closely and change the treatment if necessary.

 “In the early days watch your finances – you can easily spend your money and have no patients.  It takes three years to achieve a healthy practice.  You must temper burning enthusiasm with reality.  If you go into a clinic with others then have a legal contract.  Get a legal framework done in the early days.  Monitor your bookkeeping.  The ATO expects you to be a professional person.”

 “You will experience many emotions – our work is heavy work.  Look after yourself, because if you don’t you cannot heal.  Follow your heart.  Do your best, and do what your heart tells you, not what the rest of world says.  Healing is a vocation, and it can be very rewarding and very sad if a patient dies.  You can leave at any time.  You are not stuck.  It is not a highly paid profession.  Look after yourself, do your best.”