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Dr Jon Wardle

Biography

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Dr Jon Wardle is a lecturer at the UTS Faculty of Health and holds visiting positions at the School of Medicine, University of Washington and the School of Medicine, Boston University. He has clinical backgrounds in naturopathy and nursing and postgraduate training in public health and law.

Jon is the head of the Regulatory, Policy and Legislative Stream of the Australian Research Centre in Complementary and Integrative Medicine. He is also a core committee member of the Public Health Association of Australia's Research Advisory Group, which promotes and advocates for public health research and development.

Jon has worked on complementary medicine and primary healthcare policy in Australia, the UK, Germany, the US, Latin America and India, and holds editorial positions on a number of journals, including editor-in-chief at the International Journal of Naturopathic Medicine and Advances in Integrative Medicine.


Professional

  • Director, Research Capacity Building, NORPHCAM
  • Public Health Research Advisory Group, Public Health Association of Australia
  • Evidence, Research and Policy in Complementary Medicine Special Interest Group Committee, Public Health Association of Australia
Senior Lecturer, Faculty of Health
Core Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Core Member, CHSP - Health Services and Practice
BH Sc (Nzt - ACNM), M Hlth & Med Law (Melb), MPH (UQ), PhD
 
Phone
+61 2 9514 4813

Research Interests

Research expertise

  • Primary health care
  • Health policy
  • Health law
  • Complementary medicine
Can supervise: Yes

Areas of research supervision

  • Health law, policy and regulation
  • Complementary medicine

Apply for a research degree

Chapters

Wardle, J., Adams, J., Broom, A. & Sibbritt, D. 2013, 'Examining the relationship between complementary and integrative medicine and rural general practice: A focus upon health services research' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 115-132.
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Recent research has revealled that complementary and integrative medicine (CIM) is particularly popular amongst rural populations, with a growing body of literature supporting this interpretation
Wardle, J. & Adams, J. 2012, 'Indirect risks of complementary and alternative medicine: Promises and problems' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 212-219.
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A discussion of issues of safety and risk around complementary and alternative medicine (CAM) has primarily revolved around issues of direct risk, including adverse events (such as the potential hepatotoxicity of CAM products or potential CAM-drug interactions) and the monitoring of these events (pharmacovigilance). Yet the development of a broader public health agenda for CAM (Adams, 2008) provides an opportunity for a new focus on the inherent indirect health risks associated with these medicines - representing a novel, innovative approach to the consideration of risk and safety in CAM.
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S., Steel, A.E. & Beck, S. 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
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The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Wardle, J. & Seely, D. 2012, 'The challenges of traditional, complementary and integrative medicine research: A practitioner perspective' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 266-274.
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Adams, J., Sibbritt, D., Broom, A., Wardle, J., Steel, A.E., Murthy, V. & Daley, J. 2012, 'Research capacity building in traditional, complementary and integrative medicine: Grass-roots action towards a broader vision' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, London, pp. 275-281.
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Developing capacity to undertake health research effectively is an integral component of national and global health research systems (Lansang and Dennis, 2004) and is essential to producing a sound evidence base for decision making in policy and practice (Cooke, 2005). Moreover, research capacity building (RCB) - nurturing and producing sustainable increased capacity for future research endeavours - is important fOr all health research fields and TCIM is no exception (Andrews, 2006; Adams, 2007). There is currently a great opportunity to embrace RCB in relation to TCIM in order to help develop an evidence base and a stronger and more robust research culture among scholars and practitioners alike.
Wardle, J. 2011, 'Communication' in Zetler, J. & Bonello, R. (eds), Essentials of Law, Ethics and Professional Issues for CAM, Churchill Livingstone, Sydney, pp. 121-136.
A pioneering local textbook covering curriculum requirements for Complementary and Alternative Medicine (CAM) students. Legal, ethical, and professional practice issues are essential curriculum components of all Complementary and Alternative Medicine courses. Statutory bodies, professional associations, educational institutions and accreditation authorities require the incorporation of such content into CAM study. This has created the need for a definitive guide written specifically for Australian students according to CAM curriculum requirements. Essentials of Law, Ethics and Professional Issues for CAM is the only local textbook which deals comprehensively with legal, ethical and professional practice issues for Complementary and Alternative Medicine (CAM) students. This timely medical text takes a multidisciplinary approach, and is written by authors who are both academics and practitioners, with contributing authors for individual CAM modalities. Essentials of Law, Ethics and Professional Issues for CAM is ideal for students, trainees and even practitioners in various modalities, including naturopathy, traditional Chinese medicine, massage, osteopathy, chiropractic and western herbal medicine.
Wardle, J. 2011, 'Regulation of Chinese Medicine Practitioners in Australia' in Scheid, V. & MacPherson, H. (eds), Integrating East Asian Medicine into Contemporary Healthcare, Churchill Livingstone, Edinburgh, pp. 182-184.
Traditional East Asian healthcare systems have moved rapidly from the fringes of healthcare systems in the West towards the centre over the past 50 years. This change of status for traditional medicines presents their practitioners with both opportunities and challenges as the focus shifts from one of opposition towards one of integration into biomedically dominated healthcare systems. Integrating East Asian Medicine into Contemporary Healthcare examines the opportunities and challenges of integrating East Asian medicine into Western healthcare systems from an interdisciplinary perspective. Volker Scheid and Hugh MacPherson bring together contributions from acknowledged experts from a number of different disciplines - including clinical researchers, Chinese Medicine practitioners, historians, medical anthropologists, experts in the social studies of science, technology and medicine - to examine and debate the impact of the evidence-based medicine movement on the ongoing modernization of East Asian medicines. The book considers the following questions: .What are the values, goals and ethics implicit within traditional East Asian medical practices? . What claims to effectiveness and safety are made by East Asian medical practices? .What is at stake in subjecting these medical practices to biomedical models of evaluation? . What constitutes best practice? How is it to be defined and measured? . What are the ideologies and politics behind the process of integration of East Asian medical practices into modern health care systems? . What can we learn from a variety of models of integration into contemporary healthcare?
Wardle, J. 2010, 'Menopause' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 401-419.
Wardle, J. 2010, 'Dysmenorrhoea and menstrual complaints' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 346-362.
Wardle, J. & Steel, A.E. 2010, 'Fertility, preconception care and pregnancy' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 622-652.
Wardle, J. 2010, 'Polycystic ovarian syndrome' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 383-400.
Wardle, J. 2010, 'Endometriosis' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 363-382.

Journal articles

Fogarty, S. & Wardle, J. 2016, 'Integrative medicine case series: A clinician's guide to publication', Advances in Integrative Medicine, vol. 2, pp. 147-151.
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© 2015 Elsevier Ltd. Case series, while considered low on the research hierarchy, have been a valuable method of informing medical practice for as long as medicine has been practised. Case reports can generate hypotheses, uncover original observations, novel diagnostic and therapeutic approaches, unusual, new or uncommon diseases and complications of medical treatment. Despite their importance, and contemporary trends supporting their further use, publishing case series can be a difficult task for many clinicians and researchers. Preparing a case series for publication can be both a professionally and personally rewarding endeavour for clinicians. This article describes practical and academic insights into writing a case series for publication.
Wardle, J.L., Sibbritt, D., Broom, A., Steel, A. & Adams, J. 2016, 'Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective.', Frontiers in public health, vol. 4, p. 91.
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Health-care delivery is undergoing significant evolution and change. Task substitution has resulted in some practitioner groups expanding their scope of practice by assuming more complex clinical roles, new practitioner groups have emerged, and consumer-driven demand has changed the way the public engage with health practitioners and the way many health-care services are delivered. Using Australia as a case study, this paper explores the issue of the hesitancy to include new professions in health professions regulation schemes. Despite the significant changes in the health-care delivery landscape, policy development in this area has remained relatively static, with active resistance to extending formal registration to new practitioner groups. Ignoring the issue of new practitioner groups in regulatory schemes is unacceptable from a public health perspective and runs against the key public protection objectives of health practitioner regulation. Development of pathways for the entry of new health practitioner groups into regulatory schemes must be developed as a matter of priority.
Reid, R., Steel, A., Wardle, J., Trubody, A. & Adams, J. 2016, 'Complementary medicine use by the Australian population: A critical mixed studies systematic review of utilisation, perceptions and factors associated with use', BMC Complementary and Alternative Medicine, vol. 16, no. 1.
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© 2016 The Author(s).Background: There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years. Methods: A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia. Results: The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government. Conclusions: This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.
Wardle, J., Frawley, J., Steel, A. & Sullivan, E. 2016, 'Complementary medicine and childhood immunisation: A critical review.', Vaccine, vol. 34, no. 38, pp. 4484-4500.
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Vaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products.A database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination.A total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly individualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships.Although anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.
Joyce, P., Wardle, J. & Zaslawski, C. 2016, 'Medical student attitudes towards complementary and alternative medicine (CAM) in medical education: a critical review.', Journal of complementary & integrative medicine.
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This paper aims to remedy a gap in the knowledge by presenting the first critical review of the literature on major themes relating to medical students perceptions and attitudes towards the exponentially growing field of complementary and alternative medicine (CAM).After a comprehensive database search of the literature, 21 papers were chosen as suitable for the review. The results from these papers were tabled and discussed.The results indicated that medical students lacked knowledge of CAM and are generally positive towards CAM education (especially in the preclinical years, if it provided evidence of efficacy and post-placement). Medical students thought that CAM should generally be incorporated into the medical curriculum mainly so they can confidently undertake referral to CAM practitioners. Being able to communicate with future patients about their CAM use was a major motivation for medical students to learn about CAM and a factor for medical student support of further incorporation of CAM content in the medical curricula. Educational exposure to CAM in many forms and in many papers was shown to significantly affect medical student attitudes to CAM. This may be reflective of the fact that, outside direct CAM training, there may be limited accessible opportunities for medical students and if integration is to occur, educational exposure is most important.The rise of CAM as a social and clinical phenomenon necessitates consideration of further inclusion of these topics in the medical curriculum, if future physicians are to be able to fully discharge their role as care providers in an increasingly medically pluralistic world. However, the inclusion of CAM needs to be done in an objective and critical manner, which is relevant to the learner.
Wardle, J. & Rossi, V. 2016, 'Medical hypotheses: A clinician's guide to publication', Advances in Integrative Medicine, vol. 3, no. 1, pp. 37-40.
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Wardle, J. 2016, 'The Australian government review of natural therapies for private health insurance rebates: What does it say and what does it mean?', Advances in Integrative Medicine.
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© 2016 Elsevier Ltd.The review of the Australian Government Rebate on Private Health Insurance for Natural Therapies was set up to examine the evidence of clinical efficacy, cost effectiveness, safety and quality of natural therapies in scope of the Review. The terms of reference of the Review are that this examination will inform the decision on which of the Review's in scope natural therapies should continue to receive the government rebate for private health insurance. However, the practical relevance of the review has been negatively affected by the dearth of evidence in natural therapies. This has resulted in evidence being inconclusive in situations where there is broad evidence for the intervention of therapies but not practitioners (e.g. herbal medicine and herbalists), or where sufficient evidence may exist but the evidence refers to international practice rather than Australian (e.g. naturopathy). Some medicines based on traditions outside the English-speaking world (e.g. Shiatsu) were disadvantaged by the paucity of research in the English language. In many instances there was no evidence of positive outcomes for some therapies, based not on negative trials, but the fact that no research articles had been published at all. This article examines in detail the scope and results of the Review and discusses what it may mean for integrative medicine in Australia.
Wardle, J. 2016, 'More integrative research is needed: But where will it come from?', Advances in Integrative Medicine, vol. 3, no. 1, pp. 1-1.
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Wardle, J. 2016, 'Defining deviation: The peer professional opinion defence and its relationship to scope expansion and emerging non-medical health professions.', Journal of Law and Medicine, vol. 23, no. 3, pp. 662-677.
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The law imposes a duty to exercise reasonable care and skill in the provision of professional advice and treatment on all health practitioners, which in Australia is assessed via a modified Bolam principle. In an era of medical dominance, this standard was clearly related to the standards of the medical profession. However, the evolving nature of the Australian health workforce has fuelled speculation as to how non-medical professions are assessed to be practising in accordance with established standards. This article explores the peer-professional defence in relation to new, emerging and established non-medical professions practising in areas that were not historically part of their remit, and finds that individual health professions--even those which do not possess traits historically defined by professionalism--have ultimate discretion in determining the standards by which they are assessed, though such standards may be rejected by courts if they are deemed irrational
Wardle, J. 2016, 'Being internationalist: The only way forward for developing the Australian naturopathic profession', Australian Journal of Herbal Medicine, vol. 28, no. 3, pp. 67-68.
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Steel, A., Adams, J., Frawley, J., Wardle, J., Broom, A., Sidebotham, M. & Sibbritt, D. 2016, 'Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?', Birth.
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Faux, M.A., Wardle, J.L. & Adams, J. 2015, 'No payments, copayments and faux payments: are medical practitioners adequately equipped to manage Medicare claiming and compliance?', INTERNAL MEDICINE JOURNAL, vol. 45, no. 2, pp. 221-227.
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Wardle, J.L. & Chang, S. 2015, 'Cross-promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?', Australian and New Zealand Journal of Public Health, vol. 39, no. 2, pp. 124-128.
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Wardle, J. 2015, 'Price-based promotions of alcohol: Legislative consistencies and inconsistencies across the Australian retail, entertainment and media sectors', International Journal of Drug Policy, vol. 26, no. 5, pp. 522-530.
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© 2015 Elsevier B.V. Background: Excessive alcohol consumption is a major public health issue internationally, with alcohol consumption being recognised as a leading cause of preventable illness and major social burden. To help ameliorate the risks and harms associated with alcohol consumption, all levels of governments have explored various legislative and regulatory provisions to support responsible alcohol consumption, service and promotion. Methods: In this article, using Australia as a case study, the legislative environment around responsible alcohol promotion and consumption across the Australian retail, entertainment and media sectors will be explored, with a focus on pricing and volume-based discounts. Results: Whilst the potential harm and effect of both the licensed and non-licensed sectors appears to be widely acknowledged as similar in both scope and size of effect, legislative protections overwhelmingly focus solely on reducing the risks associated with alcohol consumption in licensed premises. This article explores the legislative provisions around preventing excessive alcohol consumption through promotional and marketing activities, and notes that whilst the licensed premises sector is facing increasing legislative restrictions, the off-premises sector remains unregulated and in some cases has even had existing restrictions removed, despite forming an increasing part of the alcohol chain in Australia. Conclusion: There appear to be inconsistencies and regulatory gaps in relation to price-based and volume-based discount alcohol promotions. Regulatory loopholes allow the retail sector in particular to use discounted alcohol as a promotional tool, in a way that is inconsistent with the goals of public health alcohol legislation, and in a way which would be illegal in any other sector. There appears to be a compelling case for introducing new restrictions, or extending existing restrictions, on these forms of promotion across all sectors involved in a...
Charaf, S., Wardle, J.L., Sibbritt, D.W., Lal, S. & Callaway, L.K. 2015, 'Women's use of herbal and alternative medicines for preconception care.', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 55, no. 3, pp. 222-226.
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Use of complementary and alternative medicine (CAM), particularly herbal and alternative medicine supplements, for preconception care and fertility management is becoming increasingly common.To determine the factors associated with the use of CAMs by women for preconception care.412 women who had visited an antenatal 'first visit' clinic situated at a Brisbane obstetric hospital or had visited a private ultrasound clinic in the same city for the purposes of a routinely indicated ultrasound scan in the first trimester were recruited into the study. Data were collected via a cross-sectional questionnaire.Complementary and alternative medicines (not including multivitamins) were used during preconception by 8.3% of women attending for obstetric care. Approximately half (55.8%) of women taking herbal and alternative medicines ceased these medications on discovery of their pregnancy, though fewer (17.4%) ceased taking multivitamin supplements. Baseline characteristics (age, education and income) are not significantly different between CAM users and those who did not take CAMs preconception. The results of statistical analyses showed that only visiting a practitioner to check for health (OR = 2.00; 95% CI: 1.33, 3.00) and trying to lose weight prior to pregnancy (OR = 1.53; 95% CI: 1.00, 2.36) were the key predictors for women using CAM during preconception.Women do consume CAMs to enhance preconception care to a certain extent, though CAM users remain in the minority. CAM users also tend to cease use once pregnant.
Wardle, J.L., Barnett, R. & Adams, J. 2015, 'Practice and research in Australian massage therapy: a national workforce survey.', International journal of therapeutic massage & bodywork, vol. 8, no. 2, pp. 2-11.
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Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is being increasingly integrated into the Australian health care system. However, despite the increasing importance of massage therapists in Australian health care delivery, or the increased practice and education obligations this may entail, there has been little exploration of practice, research, and education characteristics of the Australian massage therapist workforce.To identify practice, research, and education characteristics among the Australian massage therapist workforce.The Australian massage therapy profession.301 randomly selected members of the Association of Massage Therapists (Australia).A 15-item, cross-sectional telephone survey.Massage therapists' demographic information, practice characteristics, and education and research characteristics.Most respondents (73.8%) worked 20 hours per week or less practising massage, nearly half of all respondents (46.8%) treated fewer than 10 massage clients per week, and over three-quarters (81.7%) of respondents were self-employed. Massage therapy was the sole source of income for just over half (55.0%) of the study respondents. Only 5.7% of respondents earned over the average wage ($50,000) through their massage activities. Nearly half of all respondents (43.3%) reported regularly exceeding their continuing professional education (CPE) quota mandated by their professional association. However, 21.1% reported struggling to achieve their CPE quota each year. Over one-third of respondents (35.6%) were not interested in acquiring further CPE points beyond minimum requirements. Respondents were significantly more likely to have an active approach to research if they had higher income (p = .015). Multivariate analysis showed factors associated with access to CPE to be the only significant predictors for increased CPE.The massage profession in Australia ...
Wardle, J. 2015, 'Tensions and risks in the blanket use of locked door policies in acute mental health inpatient facilities: Balancing human rights, clinical utility and public and patient protection', Psychiatry, Psychology and Law, vol. 22, no. 1, pp. 32-48.
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© 2015 The Australian and New Zealand Association of Psychiatry, Psychology and Law.Although there has been a consistent trend away from institutionalised mental health care over the past decades, this has occurred at the same time as increased coercive care measures are employed in mental health inpatient facilities, as these facilities become weighted to more serious cases. Locked wards, which regulate the ability of both voluntary and involuntary patients to leave psychiatric units, are increasingly common in acute mental health inpatient settings. This article focuses on the controversy surrounding a recent initiative to extend locked door policies across all public acute inpatient facilities in Queensland, explores the legal, ethical and clinical issues around the implementation of locked door policies in acute mental health inpatient facilities, and examines the tensions in balancing individual rights and public and personal protections in the treatment of acute mental health disorders.
Wardle, J. 2015, 'Respecting science, respecting tradition: Evidence-based care in the integrative medicine professions', Australian Journal of Herbal Medicine, vol. 27, no. 2, pp. 47-55.
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© NHAA 2015. Evidence-based medicine (EBM) is seen as integral to modern medical science and practice, yet perceptions persist that there is a direct conflict between evidence-based and complementary and integrative medicine (CIM) models of patient care. Many practitioners fear that application of evidence-based philosophies to clinical practice may encourage therapeutic approaches that are reductionist (rather than holistic) and allopathic (rather than e.g. naturopathic), as well as eroding clinical autonomy by promoting 'cookbook' medicine over individualised care. These fears may be unfounded, as scientific inquiry has always been a core part of CIM practice. Founders of CIM professions highly valued the development and dissemination of research, as well as the development of higher clinical and education standards that evolved the professions. Although this has led to increasing research into CIM, the development of an evidence base for CIM needs to be appropriate, and respectful of the philosophy in which CIM is practiced. Such research suggests it is the traditional elements of practice that demonstrate the most benefit to patients when critically evaluated. Whilst new therapies are not without value, and the incorporation of these remain critical to the development of CIM professions, CIM may work best in an EBM model of healthcare when practice is focused upon tradition and philosophy. This discussion paper draws from a large body of work to highlight that only by truly respecting, valuing and incorporating tradition and philosophy can CIM be EBM, and the full promise of CIM realised.
Wardle, J. & Steel, A. 2015, 'Systematic reviews in integrative medicine: A clinician's guide to publication', Advances in Integrative Medicine, vol. 2, no. 2, pp. 103-109.
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© 2015. The role of evidence-based medicine in integrative medicine is becoming increasingly important, and with this increasing comes a need for succinct summaries of research evidence. Systematic reviews are essential to summarise evidence relating to efficacy and safety of healthcare and to summarise health care trends and phenomena accurately and reliably. However, reviews can bring with them numerous biases and methodological issues, particularly related to the sourcing of information used, and therefore need to be conducted in a systematic and methodical process. Specialised fields such as integrative medicine bring with them their own unique challenges in conducting an accurate and reliable review. This article describes practical and academic insights into writing a systematic review for publication.
Wardle, J. 2015, 'Innovation and rigour in integrative medicine: Encouraging inclusive debate', Advances in Integrative Medicine, vol. 2, no. 3, pp. 121-122.
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Wardle, J. 2015, 'Building integrative medicine's research capacity', Advances in Integrative Medicine, vol. 1, no. 3, pp. 105-106.
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Wardle, J. 2015, 'Diving into the complexity of integrative medical practice', Advances in Integrative Medicine, vol. 1, no. 2, pp. 67-68.
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Wardle, J., Weir, M., Marshall, B. & Archer, E. 2014, 'Regulatory and legislative protections for consumers in complementary medicine: Lessons from Australian policy and legal developments', European Journal of Integrative Medicine, vol. 6, no. 4, pp. 423-433.
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Introduction: Complementary and alternative medicine (CAM) use historically has been high in Australia, with Australia often an early adopter of regulatory and policy developments related to CAM, with varying degrees of success at ensuring consumer safety and protection with respect to both CAM products and CAM practitioners. Methods: This article uses a policy analysis framework to explore some of the outcomes of these developments and their implementation, reviews the success of legislative and regulatory approaches to ensuring consumer protection in CAM Australia has enacted, and examines the lessons that can be learnt from the Australian experience. Results: The Australian experience highlights the importance of developing health-specific legislative and regulatory guidelines, ensuring that regulators are actively empowered to fulfil their functions, and avoiding a reliance on self-regulatory authorities to fulfil roles better performed by statutory authorities. Conclusions: These experiences may assist decision-makers and public authorities to develop regulatory and legislative protections that are practical, sustainable and appropriately fulfil their public protection role. This article belongs to the Special Issue: Ensuring and Improving Patients' Safety in Integrative Health Care.
Steel, A.E., Wardle, J., Diezel, H.M., Johnstone, K. & Adams, J. 2014, 'Educating for collaboration: The outcomes of an interprofessional education workshop for complementary and alternative maternity care providers', Advances in Integrative Medicine, vol. 1, no. 1, pp. 17-24.
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Objectives: Despite high community use of complementary and alternative medicine (CAM) poor collaboration between conventional and CAM practitioners have been identified in many health sectors including maternity care. This is in part associated with a deficit in the formal training of CAM practitioners which overlooks collaborative practice skills and guidelines. This study evaluates the outcomes of an interprofessional education workshop which endeavours to improve the collaborative practice of CAM practitioners providing care to pregnant women. Methods: A pre-workshop and post-workshop questionnaire which evaluated the participants' perception of self-proficiency and their interprofessional practice behaviours when providing maternity care. Descriptive and inferential statistical analysis of the data was undertaken. Results: CAM practitioners (n = 30) providing care to pregnant women participated in the project. Prior to taking part in the workshop a low level of confidence in pregnancy-specific physiology and psychology knowledge more broadly but also poor confidence in engaging with conventional maternity care providers and understanding conventional models of maternity care was identified amongst participants. Participants who felt more positive about their knowledge of pregnancy and birth physiology were more likely to enquire about women's conventional care and discuss safety issues with women in their care. Following workshop involvement the participant's awareness of the models of maternity care available to Australian women improved alongside participants' knowledge of the scope and role of obstetricians and midwives. There was a reduced need by participants to have their role acknowledged by conventional care providers as important to enable effective collaboration after workshop completion. Conclusions: Interprofessional education is argued to be a valuable tool to promote interprofessional collaboration and communication. It may be employed as a use...
Wardle, J., Adams, J. & Sibbritt, D. 2014, 'Referral to yoga therapists in rural primary health care: A survey of general practitioners in rural and regional New South Wales, Australia.', International Journal of Yoga, vol. 7, no. 1, pp. 9-16.
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Yoga is an increasingly accepted complementary treatment modality for referral in Australian general practice, yet this practitioner group has largely escaped research attention in Australia. Complementary medicine use is highest in rural and regional areas, where a number of primary health care challenges are also more pronounced. Despite the significant role of complementary therapists in rural and regional Australia, and the increasing acceptance of yoga therapy in general practice, there has been little exploration of the interface between yoga therapists and conventional primary health care practitioners in this area. A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. Completed questionnaires were returned by 585 GPs, with 49 returned as 'no longer at this address' (response rate 40.7%). One-in-eight GPs (12.1%) advised their patients of specific yoga therapies and protocols, and 7.2% advised specific meditation techniques. Three-quarters of GPs (76.6%) referred to a yoga therapist at least a few times per year, with 12.5% of GPs referring at least once per week. GPs being in a remote location (OR = 10.95; CI: 1.55, 77.31), being female (OR = 1.85; 95% CI: 1.16, 2.94), GPs graduating from an Australian medical school (OR = 4.52; 95% CI: 2.61, 7.80), perceiving lack of other treatment options (OR = 3.29; 95% CI: 1.61, 6.74), GPs reporting good or very good knowledge of yoga therapies (OR = 18.2; 95% CI: 9.19, 36.19), and GPs using CAM for their own personal health (OR = 4.53; 95% CI: 2.60, 7.87) were all independently predictive of increased referral to yoga therapists amongst the rural GPs in this study. There is a significant interface between yoga therapists in Australian rural and regional general practice. There is generally high support for yoga therapies among Australian GPs, with low levels of opposition to the incorporation of...
Wardle, J.L., Sibbritt, D.W. & Adams, J. 2014, 'The interface with naturopathy in rural primary health care: a survey of referral practices of general practitioners in rural and regional New South Wales, Australia.', BMC Complementary and Alternative Medicine, vol. 14, pp. 238-238.
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BACKGROUND: Naturopathy forms an increasingly significant part of the Australian healthcare setting, with high utilisation of naturopaths by the Australian public and a large therapeutic footprint in rural and regional Australia. However, despite these circumstances, there has been little exploration of the interface between naturopathy providers and conventional primary health care practitioners in rural and regional Australia. The study reported here examined the referral practices and factors that underlie referral to naturopaths amongst a sample of rural and regional Australian general practitioners (GPs). METHODS: A 27-item questionnaire was sent to all 1,486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. RESULTS: A total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as "no longer at this address" (response rate: 40.7%). One-quarter of GPs (25.8%) referred to a naturopath at least a few times per year while nearly half (48.8%) stated that they would not refer to a naturopath under any circumstances. GPs were more likely to refer to a naturopath if the GP: was not initially from a rural area (OR=1.78; 95% CI: 0.95, 3.33); believes in the efficacy of naturopathy (OR=5.62; 95% CI: 2.42, 11.36); has seen positive results from naturopathy previously (OR=2.61; 95% CI: 1.35, 5.05); perceives a lack of other treatment options for their patient (OR=5.25; 95% CI: 2.42; 11.36); uses peer-reviewed literature as their major source of CAM information (OR=3.03; 95% CI: 1.65, 5.55); uses CAM practitioners as a major source of CAM information (OR=6.09; 95% CI: 2.91, 12.72); and does not have an existing relationship with any CAM provider (OR=3.03; 95% CI: 1.53, 6.25). CONCLUSIONS: There is little interaction (both via referrals as well as the development of professional relationships) between the naturopathic and GP communities in rural and regional Australia, with significant levels of...
Wardle, J.J.L. & Adams, J. 2014, 'Indirect and non-health risks associated with complementary and alternative medicine use: An integrative review', European Journal of Integrative Medicine, vol. 6, no. 4, pp. 409-422.
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Introduction: Complementary and alternative medicine (CAM) is being increasingly used across the general population, with much attention drawn to the direct health risks associated with rising CAM use - particularly in respect to efficacy and drug-herb interaction. However, the potential for other forms of risk associated with increased CAM use has received far less attention. This review article provides the first broad overview and appraisal of potential non-health and indirect health risks associated with CAM use. Methods: A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and EMBASE was conducted. The search was confi{ligature}ned to peer-reviewed articles published in English reporting non-health and indirect health risks associated with CAM. Results: The review identifies a number of non-health risks associated with CAM use. These can be broadly categorised as risks due to variability; risks due to assumption; risks due to opportunity costs; economic risks, and risks due to unorthodoxy. Indirect and non-health risks may also compound or exacerbate existing direct risks associated with CAM treatment. Conclusion: In order to fully appreciate and appraise the relative merits of CAM practice and provision, researchers need to be mindful that a range of potential risks (beyond direct health risks) may be associated with CAM use. Adequate regulatory and policy frameworks need to be put in place to ensure that these risks are minimised. This article belongs to the Special Issue: "Ensuring and Improving Patients' Safety in Integrative Health Care". © 2014 Elsevier GmbH. All rights reserved.
Wardle, J. & Roseen, E. 2014, 'Integrative medicine case reports: A clinicians' guide to publication', Advances in Integrative Medicine, vol. 1, no. 3, pp. 144-147.
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Case reports have been a valuable method of informing medical practice for as long as medicine has been practised. Many original observations, novel diagnostic and therapeutic approaches, unusual, new or uncommon diseases and complications of medical treatment were first identified and published as case reports. Despite their importance, and contemporary trends supporting their further use, publishing case reports can be a difficult task for many clinicians and researchers. Preparing a case report for publication can be both a professionally and personally rewarding endeavour for clinicians. This article describes practical and academic insights into writing a case report for publication.
Wardle, J.L. & Sarris, J. 2014, 'Student attitudes towards clinical teaching resources in complementary medicine: A focus group examination of Australian naturopathic medicine students', Health Information and Libraries Journal, vol. 31, no. 2, pp. 123-132.
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Background: Complementary medicine is forming an increasingly large part of health care in developed countries and is increasingly being formally taught in tertiary academic settings. Objectives: An exploratory study of naturopathic student perceptions of, use of and attitudes towards teaching resources in naturopathic clinical training and education. Methods: Focus groups were conducted with current and recent students of 4-year naturopathic degree programmes in Brisbane and Sydney to ascertain how they interact with clinical teaching materials, and their perceptions and attitudes towards teaching materials in naturopathic education. Results: Naturopathic students have a complex and critical relationship with their learning materials. Although naturopathic practice is often defined by traditional evidence, students want information that both supports and is critical of traditional naturopathic practices, and focuses heavily on evidence-based medicine. Students remain largely ambivalent about new teaching technologies and would prefer that these develop organically as an evolution from printed materials, rather than depart from dramatically and radically from these previously established materials. Conclusions: Findings from this study will assist publishers, librarians and academics develop clinical information sources that appropriately meet student expectations and support their learning requirements. © 2014 Health Libraries Group.
Wardle, J. 2014, 'Holding unregistered health practitioners to account: an analysis of current regulatory and legislative approaches.', Journal of law and medicine, vol. 22, no. 2, pp. 350-375.
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An increasingly large part of health care delivery in Australia is provided by unregistered health practitioners, who have not been historically subject to formal regulatory arrangements and instead have been held to account via a milieu of non-specific regulatory and legislative obligations. This article explores current trends in the regulation of unregistered practitioners in civil law, criminal law and in the development of new regulatory tools such as "negative licensing". In addition, this article conducts an empirical analysis of the favoured model for extending accountability to unregistered health practitioners (negative licensing) by examining its application in New South Wales. Based on this analysis, it is argued that although negative licensing offers greater protections than previous models, it should not be viewed as a replacement for extension of statutory registration to new health disciplines, and instead should be viewed as a complementary measure to existing and new statutory registration arrangements.
Wardle, J., Adams, J., Lui, C. & Steel, A.E. 2013, 'Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice', BMC Pregnancy Childbirth, vol. 13, no. 15, pp. 1-10.
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Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession.
Wardle, J., Stewart, C. & Parker, M. 2013, 'Jabs and Barbs: ways to address misleading vaccination information using currently available strategies', Journal of Law and Medicine, vol. 21, no. 1, pp. 159-178.
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Misleading vaccination information undermines confidence in vaccination and may lead to reductions in the effectiveness of vaccination programs. A number of regulatory techniques can be employed to challenge the spread of false information, including health care complaints, therapeutic goods laws, consumer protection laws and professional discipline. This article examines three case studies involving the publication of anti-vaccination information by non-professionally aligned organisations, by non-registered health professionals, and by registered health professionals under the National Law. The article examines the effectiveness of different regulatory responses and makes suggestions for future strategies to deal with the publication of demonstrably false information regarding vaccination.
Wardle, J. 2013, 'Hydrotherapy: A forgotten Australian therapeutic modality', Australian Journal of Medical Herbalism, vol. 25, no. 1, pp. 12-17.
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Put simply, hydrotherapy, also called hydrothermal therapy or medical hydrology, is the use of water, in any of its forms, for the maintenance of health or the treatment of disease. Balneotherapy is a branch of this therapy that specifically studies baths and their medical uses, with a large focus on the healing aspects of various mineral contents (though this itself used to be a subbranch called crenology, which was limited to the science and use of mineral spring waters). Thalassotherapy is another branch which refers to the use of seawater and seascapes for healing.
Diezel, H.M., Steel, A.E., Wardle, J. & Johnstone, K. 2013, 'Patterns and influences of interprofessional communication between midwives and CAM practitioners: A preliminary examination of the perceptions of midwives', Australian Journal of Medical Herbalism, vol. 25, no. 1, pp. 4-10.
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Women are increasingly using complementary and alternative medicine (CAM) such as naturopathy and Western herbal medicine during their pregnancy and midwives have described an affinity for CAM. However, the reality of the midwife-CAM practitioner interfa
Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referrals to chiropractors and osteopaths: a survey of general practitioners in rural and regional New South Wales, Australia', Chiropractic and Manual Therapies, vol. 21, pp. 5-5.
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Chiropractic and osteopathy form a significant part of the healthcare setting in rural and regional Australia, with national registration of practitioners, public subsidies for services and high utilisation by the Australian public. However, despite their significant role in rural and regional Australia, there has been little exploration of the interface between chiropractic and osteopathy and conventional primary health care practitioners in this area. The study aim was to examine the referral practices and factors that underlie referral to chiropractors and osteopaths by rural and regional Australian general practitioners (GPs), by drawing on a sample of GPs in rural and regional New South Wales.
Adams, J., Sibbritt, D., Broom, A., Loxton, D., Wardle, J., Pirotta, M. & Lui, C. 2013, 'Complementary And Alternative Medicine Consultations In Urban And Nonurban Areas: A National Survey Of 1427 Australian Women', Journal Of Manipulative And Physiological Therapeutics, vol. 36, no. 1, pp. 12-19.
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Objectives: The purpose of this study was to evaluate survey data from a national cross-sectional sample of 1427 urban and nonurban Australian women focusing on the relationship between the use of specific complementary and alternative medicine (CAM) pra
Wardle, J., Adams, J. & Sibbritt, D. 2013, 'Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia', Homeopathy, vol. 102, no. 3, pp. 199-206.
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Introduction: Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs).
Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Acupuncture referrals in rural primary healthcare: a survey of general practitioners in rural and regional New South Wales, Australia', Acupuncture in medicine, vol. 31, no. 4, pp. 375-382.
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Background Acupuncture services form a significant part of the Australian healthcare setting, with national registration of acupuncture practitioners, public subsidies for acupuncture services and high use of acupuncture by the Australian public. Despite
Wardle, J. & Adams, J. 2013, 'Are the CAM professions engaging in high-level health and medical research? Trends in publicly funded complementary medicine research grants in Australia', Complementary Therapies In Medicine, vol. 21, no. 6, pp. 746-749.
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Introduction: Developing research capacity is an essential part of professional development in the health professions, as well as essential to improving health care delivery. CAM is one area in which the importance of research capacity has been previousl
Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referral To Massage Therapy In Primary Health Care: A Survey Of Medical General Practitioners In Rural And Regional New South Wales, Australia', Journal of Manipulative and Physiological Therapeutics, vol. 36, no. 9, pp. 595-603.
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Objectives: Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this st
Wardle, J., Adams, J. & Sibbritt, D. 2013, 'Acupuncture in Australian general practice: trends in reimbursed acupuncture services from 1995 to 2011', Acupuncture in Medicine, vol. 31, no. 1, pp. 45-50.
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Objectives: To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Design: Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Main outcome measures: Use of acupuncture by GPs, patients sex and age and the socioeconomic disadvantage index of GPs practice. Results: There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Conclusions: Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specificf actors affecting reimbursement for non-vocationally registered GPs.
Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referral to Chinese medicine practitioners in Australian primary care: a survey of New South Wales rural and regional general practitioners', Chinese Medicine, vol. 8, pp. 8-8.
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Background: Chinese medicine practitioners (CMPs) play an important part in rural and regional Australian healthcare. A survey was conducted to investigate referral practices between Chinese medicine (CM) and conventional primary health care practitioners in this region. Methods: A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. This survey explored GP opinions, perceptions and practices in relation to complementary and alternative medicine or Chinese medicine specifically. Results: A total of 585 GPs completed the questionnaire. Forty-nine were returned as 'no longer at this address', resulting in an adjusted response rate of 40.7%. One in ten GPs (9.9%) had referred their patients to CMPs at least a few times over the past 12 months, one in five GPs (17.4%) could not locate a CMP to refer to in their local area, and over one-third of GPs (37.7%) stated they would not refer to a CMP under any circumstances. GPs that had graduated from an Australian medical college (OR = 3.71; CI: 1.22, 11.23), GPs observing positive responses previously in patients using CM (OR = 2.53; 95% CI: 1.12, 8.58), GPs perceiving a lack of other options for patients (OR = 3.10; 95% CI: 1.12, 8.58), GPs reporting satisfactory or higher levels of CM knowledge (OR = 15.62; 95% CI: 5.47, 44.56), and GPs interested in increasing their complementary and alternative medicine knowledge (OR = 3.28; 95% CI: 1.17, 9.21) referred to CMPs more frequently than did other groups of GPs amongst the rural GPs included in this study. Conclusion: There has been little interaction between CMPs and Australian rural and regional GPs.
Wardle, J. 2013, 'Plagiarism and registered health professionals: navigating the borderlands between scholarly and professional misconduct', Journal of Law and Medicine, vol. 21, no. 1, pp. 399-414.
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As access to published materials becomes more readily available, the ability to plagiarise material, deliberately or unwittingly has become easier than ever. This article explores important recent decisions in Australia and the United Kingdom regarding registered health practitioners who have engaged in plagiarism, both related and unrelated to their clinical practice, and explores the ways in which regulatory authorities in these countries have viewed scholarly misconduct committed by registered health professionals. This article also examines the implications of plagiarism for the registered health professions, and makes suggestions for strategies to reduce its influence and incidence in modern clinical practice
Wardle, J.L., Steel, A.E. & Adams, J. 2013, 'Tensions in Naturopathic Education Response', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 19, no. 12, pp. 979-980.
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Adams, J., Sibbritt, D., Lui, C.-.W., Broom, A. & Wardle, J. 2013, 'Omega-3 fatty acid supplement use in the 45 and Up Study Cohort', BMJ Open, vol. 3, no. 4, pp. e002292-e002292.
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Archer, E., Marshall, B., Weir, M. & Wardle, J. 2013, 'Regulation of complementary and alternative medicine: interplay of therapeutic goods legislation consumer law', Bond Law Review, vol. 25, no. 1, pp. 13-34.
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The Therapeutic Goods Act 1989 (Cth) constitutes an important segment of the consumer law regulatory regime applying to complementary and alternative medicine ('CAM'). This article critically evaluates that regime, concentrating on the level of evidence required to justify health claims for registration or listing of CAM products and in relation to the advertising of such products. It identifies the anomalies that arise from the application of the current regulatory structure, and offers conclusions and recommendations intended to improve the present position.
Wardle, J., Steel, A. & McIntyre, E. 2013, 'Independent registration for naturopaths and herbalists in Australia: The coming of age of an ancient profession in contemporary healthcare', Australian Journal of Herbal Medicine, vol. 25, no. 3, pp. 101-107+158+159.
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Recent changes in the healthcare landscape in Australia have prompted renewed debate regarding the most appropriate regulatory model for naturopaths and herbalists. Numerous government reports have recommended independent statutory regulation yet naturopaths and Western herbalists are yet to be included in the National Registration and Accreditation Scheme. This has left professional associations to carry the administrative burden and manage the conflicting interests of practitioner regulation and professional advocacy. The outcome of this self-regulatory model has damaged advancement of these professions through limiting the scope of professional associations to promote the value of practitioners within contemporary healthcare. It has also left naturopaths and Western herbalists vulnerable to health policy reform which impact on unregistered practitioners. In response, an independent registration body, the Australian Register of Naturopaths and Herbalists (ARONAH) has been established which mirrors the NRAS process and offers legitimacy to the professions whilst also safeguarding the public. This paper outlines: the history of the registration debate in Australia; the scope and role of ARONAH; the relationship between ARONAH and the existing professional associations and the rationale underpinning important standards and guidelines developed by ARONAH for its members. © National Herbalists Association of Australia 2013.
Wardle, J. 2013, 'Conference report: 2013 New Zealand association of medical herbalists conference', Australian Journal of Herbal Medicine, vol. 25, no. 3, pp. 146-147.
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Wardle, J. 2013, 'Are there really monsters under the bed? Conspiracies and the complementary and alternative medicine professions', Australian Journal of Herbal Medicine, vol. 25, no. 3, pp. 108-111.
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Weir, M., Wardle, J., Marshall, B. & Archer, E. 2013, 'Complementary and alternative medicine and consumer law', CCLJ - Competition and Consumer Law Journal, vol. 21, no. 2, pp. 85-110.
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The application of consumer Law has become significant in the health sector including the provision of complementary and alternative medicine. Many legal authorities in this area deal with extreme examples of breaches of consumer law which provides a problematic image for the evidence base for this form of health care especially when high quality scientific is sought in regard to representations made. The article discusses the fact that in some contexts traditional use evidence is applied in regard to the determination of appropriate indications of use for the registration and listing of complementary and alternative medicine but this does not appear to be applied in consumer law decisions. The capacity to provide high quality scientific evidence is limited for many form of complementary and alternative medicine based upon their historical background and approach to healing. Based upon an analysis of the value obtained from scientific evidence for complementary and alternative medicine this article argues for a broader use of traditional evidence and other forms of evidence to support compliance with consumer legislation in a context of where public safety is preserved.
Steel, A., Diezel, H., Wardle, J. & Johnstone, K. 2013, 'Patterns of inter-professional communication between complementary and conventional practitioners providing maternity care services: A preliminary examination of the perceptions of CAM practitioner', Australian Journal of Herbal Medicine, vol. 25, no. 2, pp. 57-61.
© National Herbalists Association of Australia 2013. Inter-professional communication is well acknowledged as a vital piece in the practice of multi-disciplinary health care.Yet, even in health sectors such as maternity care where high rates of complementary and alternative medicine (CAM) use are well documented, there is little examination of the inter-professional communication patterns between CAM and conventional care providers. This study reports preliminary findings from a survey of CAM practitioners (n=31) which examines their perceived interprofessional communication patterns with conventional maternity care providers. The results indicate CAM practitioners may provide care to women from preconception care through to the postnatal period. The practitioners were most likely to receive referrals from other women or previous clients (sometimes: 41%; often 27%), rather than from health professionals. Formal communication was most likely to be directed to other CAM practitioners (sometimes: 18%; often: 4%) and least likely to be directed to obstetricians (sometimes: 0%; often: 4%). No participants reported receiving formal communications from obstetricians but a small number indicated receiving formal communication from midwives (sometimes: 7%; often: 4%) and other CAM practitioners (sometimes: 17%; often: 4%). These low rates of communication may be impacting on patient safety through overtreatment or therapeutic interactions. There are concerns that policy and legislative barriers may be limiting the inter-professional communication practices of conventional care providers. Similarly, educational and regulatory weaknesses in CAM may be contributing to poor inter-professional communication practices for CAM practitioners. Further substantive research is needed to contextualise and verify these findings.
Sibbritt, D., Adams, J., Lui, C., Broom, A. & Wardle, J. 2012, 'Who uses glucosamine and why? A study of 266,848 Australians aged 45 years and older', PLoS One, vol. 7, no. 7, pp. e41540-e41540.
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Objectives: There has been a dramatic increase in the use of complementary medicines over recent decades. Glucosamine is one of the most commonly used complementary medicines in Western societies. An understanding of glucosamine consumption is of significance for public health and future health promotion. This paper, drawing upon the largest dataset to date with regards to glucosamine use (n = 266,844), examines the use and users of glucosamine amongst a sample of older Australians.
Wardle, J., Steel, A. & Adams, J. 2012, 'A Review Of Tensions And Risks In Naturopathic Education And Training In Australia: A Need For Regulation', Journal Of Alternative And Complementary Medicine, vol. 18, no. 4, pp. 363-370.
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In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners.
Wardle, J., Lui, C. & Adams, J. 2012, 'Complementary and Alternative Medicine in Rural Communities: Current Research and Future Directions', Journal of Rural Health, vol. 28, no. 1, pp. 101-112.
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The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings. Research findings are grouped and examined according to 3 key themes: "prevalence of CAM use and practice," "user profile and trends of CAM consumption," and "potential drivers and barriers to CAM use and practice." Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J. & Homer, C.S. 2011, 'Attitudes And Referral Practices Of Maternity Care Professionals With Regard To Complementary And Alternative Medicine: An Integrative Review', Journal of Advanced Nursing, vol. 67, no. 3, pp. 472-483.
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Aim. This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women. Background.
Wardle, J., Adams, J., Magalhães, R.J. & Sibbritt, D. 2011, 'Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: A step towards explaining high CAM use in rural health?', Australian Journal of Rural Health, vol. 19, pp. 197-204.
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Objective: Complementary and alternative medicine (CAM) use is high in rural health and an agenda for research in the geography of CAM has been outlined. Unfortunately, no studies to date have mapped the geographic distribution of CAM practitioners in rural areas. For the first time we investigate CAM practitioner distributions across a large district/region in rural Australia.
Wardle, J. & Oberg, E. 2011, 'The intersecting paradigms of naturopathic medicine and public health: opportunities for naturopathic medicine', Journal of Alternative & Complementary Medicine, vol. 17, no. 11, pp. 1079-1084.
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Complementary medicine research, including naturopathic medicine research, is plagued with many methodological challenges. Many of these challenges have also been experienced in public health research. Public health research has met these challenges with a long history of multidisciplinary, multimethod, and whole systems approaches to research that may better resonate with the ?real world? clinical settings of naturopathic medicine. Additionally, many of the underlying principles of naturopathic medicine are analogous to the underlying principles and activities of public health, specifically in such areas as health promotion, prevention, patient education, and proactive rather than reactive approaches to disease management and treatment. Future research in the field of naturopathic medicine may benefit from adopting public health research models rather than focusing exclusively on biomedical models. A complementary and collaborative relationship between these fields may provide an opportunity to deliver research that more accurately reflects naturopathic medicine practice, as well as providing the opportunity to improve health outcomes more generally.
Parker, M., Wardle, J., Weir, M. & Stewart, C. 2011, 'Medical merchants: conflicts of interest, office product sales and notifiable conduct', Medical Journal of Australia, vol. 194, no. 1, pp. 34-37.
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Professional ethical codes identify the issue of conflict of interest, which can distort doctors' objective judgements concerning the best interests of patients. Legal fiduciary duties may be owed by doctors to patients in situations of potential conflict of interest. Prescribing and dispensing functions have been largely legally separated to prevent conflicts of interest arising. The advent of integrative medicine has been accompanied by an apparent growth of in-house selling of therapeutic products. Medical merchandising constitutes a prima-facie conflict of interest and may amount to notifiable conduct under the Health Practitioner Regulation National Law provisions. We believe that doctors who sell therapeutic products should adhere to strict conditions to avoid significantly departing from accepted professional standards. Doctors who have a reasonable belief that a colleague is failing to comply with these conditions could consider notifying the Medical Board of Australia.
Wardle, J. 2011, 'The National Registration and Accreditation Scheme: What Would Inclusion Mean for Naturopaths and Western Herbalists? Part 2: Implications for Clinical Practice', Australian Journal of Medical Herbalism, vol. 23, no. 1, pp. 18-26.
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The development of national registration may be extended to include naturopaths and herbalists. This article highlights areas that are likely to impact these professions, and what registration would mean for practice.
Wardle, J. 2011, 'The national registration and accreditation scheme: What would inclusion mean for naturopathy and western herbal medicine? Part II: Practice implications', Australian Journal of Medical Herbalism, vol. 23, no. 1, pp. 18-26.
Wardle, J. 2011, 'No case to answer', Australian Doctor, no. 16-SEPTEMBER, p. 25.
Wardle, J., Adams, J. & Lui, C. 2010, 'A Qualitative Study Of Naturopathy In Rural Practice: A Focus Upon Naturopaths Experiences And Perceptions Of Rural Patients And Demands For Their Services', BMC Health Services Research, vol. 10, no. 1, pp. 1-8.
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Background: Complementary and alternative medicine (CAM) use - of which naturopathy constitutes a significant proportion - accounts for approximately half of all health consultations and half of out-of-pocket expenditure in Australia. Data also suggest C
Pirotta, M., Kotsirilos, V., Brown, J., Adams, J., Morgan, T. & Williamson, M. 2010, 'Complementary Medicine In General Practice A National Survey Of Gp Attitudes And Knowledge', Australian Family Physician, vol. 39, no. 12, pp. 946-950.
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Background Integrative medicine is a holistic approach to patient care that utilises both conventional and complementary therapy. This article compares the demographics of Australian general practitioners who do, and those who do not, practise integrativ
Wardle, J. 2010, 'The National Registration and Accreditation Scheme: what would inclusion mean for naturopaths and Western herbalists? Part 1: The legislation', Australian Journal of Medical Herbalism, vol. 22, no. 4, pp. 113-118.
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The development of national registration may be extended to include naturopaths and herbalists. This article highlights areas that are likely to impact these professions, and what registration would mean for practice.
Wardle, J. 2010, 'Homeopathy: what does the "best" evidence tell us? Comment', Medical Journal of Australia, vol. 191, no. 3, pp. 191-192.
Wardle, J.L. 2010, 'Homeopathy: what does the "best" evidence tell us? Comment.', The Medical journal of Australia, vol. 193, no. 3, pp. 191-192.
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S. & Beck, S. 2009, 'Women's Use of Complementary and Alternative Medicine During Pregnancy: : A Critical Review Of The Literature', Birth: issues in perinatal care, vol. 36, no. 3, pp. 237-245.
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Background: The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile,""motivation and condition of use,""perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Adams, J. & Wardle, J. 2009, 'Engaging practitioners in research', Journal of Complementary Medicine, vol. Sept/Oct, pp. 5-5.
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The CM field needs to further enhance a positive role for practitioners in research Public-health and health-services research in CM is needed to supplement and contextualise clinical trials and related designs A new research network will help address such challenges
Sarris, J., Adams, J. & Wardle, J. 2009, 'Time for a reassessment of the use of Kava in anxiety?', Complementary Therapies In Medicine, vol. 17, no. 3, pp. 121-122.
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Seven years after the ongoing ban of Piper methysticum (Kava) by the EU, UK and Canada: Where are we at? In December 2008, articles by the Fiji Times reported that the Kava ban was over-turned. This statement was subsequently revealed to be erroneous and is indicative of the controversy and confusion sometimes surrounding regulatory, safety and efficacy issues associated with Kava. Cases of hepatotoxicity purportedly caused by European Kava products may have been due to a commercial costmotivated preference for injudicious Kava cultivars or plant parts, and the use of non-traditional solvents (ethanol and acetone).1 Conversely, traditional use of Kava (<100 g per week) is associated with remarkably few adverse effects in Pacific Island communities,2 and public health concerns instead centre on issues of abuse by heavy users.2 5
Wardle, J. & Baranovic, M. 2009, 'Is lack of competition in the retail grocery sector a public health issue?', Australian & New Zealand Journal of Public Health, vol. 33, no. 5, pp. 477-481.
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The economic implications of a lack of competition in the grocery retail sector are hotly contested. However, there are also significant health implications of such anti-competitive practices that seldom receive attention. This paper hopes to draw attention to the potential public health issues that arise as a result of lack of competition in the grocery retail sector. Relevant supporting literature was reviewed to explore the possible effects of market concentration on various health outcomes. High retailer concentration may adversely affect affordability, accessibility, quality, and choice of healthy food options to consumers. In turn this has significant implications for public health. Unless these upstream factors are addressed through the development of healthy competition, policy public health programs aimed purely at encouraging the public to consume higher quantities of healthful foods may be rendered ineffective.
Wardle, J. 2008, 'Why run a risk agenda for CAM regulation?', Australian Journal of Medical Herbalism, vol. 20, no. 4, pp. 136-141.
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Practitioners are often concerned at the mention of complementary medicine's inherent risk. Industry groups certainly refuse to acknowledge that any risk can be associated with complementary medicines. Various industry spokespersons have made comments refuting the need for regulation because the lower risk profile of complementary medicines mean that [any] tougher line is unwarranted (Creswell 2008) or natural therapies are actually safer than eating meat from a delicatessen (Birnbauer 2008). Considering Australia has approximately 11,500 cases of food poisoning every day (resulting annually in 18,000 hospitalisations and 120 deaths) and the preparation and sale of food is highly regulated this is hardly an appropriate analogy (Food Standards Australia New Zealand 2008). Although the direct risks of complementary medicine are often relatively low when compared to other health practices, pharmaceuticals for example, they still pose sufficient risk to warrant regulation. This article will explore in depth that acknowledging this risk isn't necessarily detrimental to the profession and may actually benefit qualified practitioners.
Wardle, J. 2008, 'Greater regulation of complementary medicine therapists needed.', The New Zealand Medical Journal, vol. 121, no. 1287, pp. 92-93.
Wardle, J. 2008, 'Involve complementary medicine practitioners in research.', British Medical Journal, vol. 337, no. a2389, pp. 1069-1070.
Wardle, J.L. 2008, 'Involve complementary medicine practitioners in research.', BMJ (Clinical research ed.), vol. 337, p. a2389.
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Reports

Wardle, J. Metro North Brisbane Medicare Local 2012, Metro North Brisbane Medicare Local Population Health Indicator Maps, pp. 1-63, Brisbane.
Wardle, J. Metro North Brisbane Medicare Local 2012, Population Planning for Metro North Brisbane Medicare Local, pp. 1-147, Brisbane.
Wardle, J. NORPHCAM 2008, Regulation of complementary medicines: a brief report on the regulation and role of complementary medicines in Australia. Report for the Parliamentary Secretary for Health, pp. 1-73, Brisbane.
Report on complementary medicine regulation commissioned by the Commonwealth Parliamentary Secretary for Health and Ageing