this post is an expanded version of this post that appeared on the Huffington Post
A new petition has surfaced concerning the scope of practice of Naturopaths in Ontario. The Ontario Association of Naturopathic Doctors (OAND) is collecting signatures to support a rather vague demand that the Ontario health minister Deb Mathews ensure that naturopathic doctors (NDs) are allowed to “maintain effective continuous care” of their patients and while insisting that naturopathic therapies are “scientifically proven”. This is a continuation of the controversy over prescribing rights that were added as a last minute amendment to The Naturopathy Act (2007) after lobbying by Ontario’s naturopaths. It seems that some ND’s think it is not good enough that they will be allowed to prescribe their own (largely unproven) “natural” remedies, they also want to take over as your main family doctor, wanting the ability to also prescribe mainstream drugs, like antibiotics and NSAIDs.
Naturopaths are alternative medicine providers who present themselves publicly as science-based health professionals. However, naturopathy is actually a belief system based on the pre-scientific belief in“vitalism”, which proposes that there is a “life force” or “vital force” that can be shaped by “naturopathic” treatments. Naturopaths offer a variety of treatments can range from reasonable health advice (diet and exercise) to treatments that may be useless (homeopathy or acupuncture) to questionable (intravenous vitamins, supplements, and herbalism) to the dangerous or inappropriate (chelation and various forms of “detoxification”).
In 2007, the Ontario government, in response to 2 government reports in 1996 and 2001 passed the The Naturopathy Act, establishing a new regulatory framework for naturopathic doctors in Ontario. This is meant to replace the current regulator for ND’s, the Board of Directors of Drugless Therapy – Naturopathy (BDDT-N), originally established in 1925 as part of the Drugless Practitioner’s Act. Despite previous warnings from investigators that the profession was not only unscientific but due to its great swath of treatment choices rather devoid of any standards of care, the newly established Health Profession’s Regulatory Advisory Council recommended an update to the current legislation based on a growing interest in the public for alternatives to conventional medical care.
Originally, this was going to solidify the scope of practice, or more specifically, the controlled acts that a ND could perform in Ontario. It did not contain the right to prescribe controlled substances, and naturopathic associations, as well as the BDDT-N, were worried that this would restrict the current scope of practice. At the time, bill C-51 was being considered by the Canadian parliament. It sought to put further restrictions on the sale of therapeutic goods in Canada and ensure that sellers of natural products did not make claims that were not evidence based, with the threat of seizure and legal action if they did. This was worrisome to the natural health community as it would add to the new restrictions the use of some products, like amino acids and the more dangerous herbal drugs, that were formerly over the counter but now were available only by prescription. This also gave the NDs the chance to argue for further prescribing rights for mainstream prescription meds, and this is where it starts to get sticky.
The complementary and alternative (CAM) medical community exists largely outside of the mainstream medical establishment. Despite some clinics in Ontario offering “integrative” medical care, with CAM practitioners on site with medical doctors, they are still not covered by medicare insurance*. The establishment of naturopaths as primary care physicians, the new term for family doctors, is one step toward public funding of their mandate. Indeed, one of the worries expressed by opponents to the expansion of the scope of NDs to include primary care medicine prescription was that it would establish a dual-care system, where naturopaths outside of medicare compete with physicians inside of it, which is not the intent of current Ontario Medicare legislation. The larger question is do naturopaths have what it takes to be primary care doctors in Ontario? The evidence suggests quite strongly that they do not.
One of the greatest achievements in medical care in the past 20 years is the establishment of evidence-based medicine (EBM) as the standard of modern health care. The claim by the OAND that naturopathy offers “scientifically proven” treatments is very dubious. Beyond the mainstream disease prevention techniques of lifestyle counselling that ND’s unjustly claim as their own, therapeutics like homeopathy, colonic irrigation, and acupuncture do not have any significant scientific evidence behind them. Canadian health law researcher Timothy Caulfield did an analysis of these interventions, and looked at the websites of Albertan and BC naturopaths making the most popular claims: they found a lack of any good evidence to support any of them. Quoting Caulfield in his 2011 analysis in Allergy, Asthma, and Clinical Immunology, Caulfield and co-author Christen Rachul:
“Even the most generous interpretation of this literature would not support a characterization of “science based,” if this phrase is meant to imply the therapies have been shown to be efficacious using traditional scientific methodologies. These services are, at best, on the margins of scientific legitimacy”
It is no wonder that they want to start using mainstream drugs. These types of rights have already been given to BC naturopaths and the Ontario ND’s want similar rights, claiming they have the same education as mainstream physicians and that they are fully capable of prescribing them safely. Dr. Rob Tarzwell did an analysis of these claims back in 2010 for Skeptic North and found that the claims of equality between ND’s and mainstream doctors to be completely without merit. Caulfield as well did an analysis of the expansion of scope in BC and Ontario, and found that in 2001 BC’s own health professions council stated that, “Naturopaths were found unqualified to: perform cervical manipulations, administer allergy test procedures, prescribe Schedule 1 drugs (28 proposed), and be granted hospital treatment privileges. “ Caulfield’s continued that “despite the council’s conclusions, the province decided to grant naturopaths (in the April 9, 2009 amendment) some of the very same reserved acts (e.g., allergy testing) found in the report to be beyond the scope of the profession.”
Even more worrisome is that due to the myriad of conflicting therapeutic theories** there is no standard of care in naturopathy. Is it a derangement of Qi that is causing the rash or a sensitivity to wheat? Will homeopathic pills based on the “like cures like” help manage heart failure, or do we need to use an herb like digitalis to counter it? There is no standard treatment for conditions like diabetes or angina, it is up to the individual ND to decide which treatment to offer – or all of them.
Given the absence of a standard of care, the lack of sufficient training in pharmaceuticals, and a philosophy that runs counter to using any mainstream drug, prescribing rights should not be expanded to include any prescription medication. We have already gone too far in what therapeutics we allow naturopathic doctors to use; Ontario should not give them any more rope with which to hang their patients.
* There is a clinic partially supported by the Brampton Civic Hospital (BCH) just outside of Toronto that operates on site and provides care from Naturopathic Doctors in the context of a teaching clinic that is run in conjunction with the Canadian College of Naturopathic Medicine (CCNM). It has yet to be established what the funding model is, but unless the CCNM is picking up the entire bill for rental of the space from BCH, this constitutes de facto subsidization of not only naturopathic care but the training of new ND’s in Ontario by the government health care system: publicly funded CAM.