Naturopaths are allowed to call themselves doctors in Ontario, placing them alongside Physicians, Dentists, Psychologists, Optometrists, and (regrettably) Chiropractors as a statutorily-legitimized and protected class of healthcare provider.
When someone is given the right to call themselves a doctor, we expect a very high level of medical training and expertise. So it’s fair to ask just what Naturopaths learn during their education. About 2.5 years ago, John did just that, looking at the curriculum of the Boucher Institute in Westminster, BC and finding it riddled with pseudoscience. This article is intended to update John’s work by breaking down the curriculum of the country’s largest naturopathic college, the Canadian College of Naturopathic Medicine (CCNM) in Toronto.
Admission & Program Reqirements
Entry into the CCNM requires at least a 3-year bachelor’s degree in any field of study, a minimum GPA of 2.7 (B-), at least one full year course (6 credits) in each of Biology, Physiology, and Humanities, as well as one half year course (3 credits) in each of Chemistry and Psychology. But for the lack of MCAT scores, this is not dissimilar to the minimum requirements for entry into an MD program, though due to competition, pre-med does tend to be much more rigorous than those minimum requirements. Still, it sets a bar grounded in science, and that’s a good thing.
The program itself is also clearly modelled after Canadian MD programs — two years of academic study, two years of clinical practice, and a two-part certifying exam. The main difference seems to be the lack of a residency requirement, but it’s nonetheless hard to fault ND’s for not putting in the time.
The question, then, is what they’re putting in that time learning. There are three primary areas of study: Biomedical Sciences, Clinical Sciences, and the Art and Practice of Naturopathic Medicine. I won’t cover Clinical Sciences, as it’s mostly about application of the other two, but here’s a breakdown of the rest of the curriculum.
Coursework in anatomy, physiology, biochemistry, immunology and clinical pathology seems promising. While we can’t be certain of what’s taught in these courses, let’s give CCNM the benefit of the doubt and assume they’re the same as they would be in an MD program, and that they provide a firm grounding in life sciences.
I’m less inclined to grant such leeway to the courses in environmental & public health, given that so many ND’s come out of these programs anti-vaccination, and that alternative medicine has been found to be significantly associated with reduced adherence to vaccine schedules. Yes, there could be self-selection confounding both of these findings, but if this were the case, a science-based curriculum should disabuse students of these biases, and it clearly isn’t. Something seems to be going on in these courses; for further proof, just look at the top titles available in the school’s library. (h/t Scott).
Similarly, the decoupling of courses in pharmacology from those in pharmacognosy (study of natural medicines) is perhaps not surprising, but nonetheless troubling. If a natural medicine works, it does so by pharmacological means, rendering the distinction meaningless — except, that is, to provide ground for the naturalistic fallacy (“natural = safe”) and arguments from antiquity (“old practices = trusted wisdom”) to take root.
Take-away: while there’s likely much science being taught in the biomedical portion of the CCNM program, there are also areas that are likely laced with pseudoscience. When it’s all presented as if it’s “of a piece”, it’s reasonable to be concerned about ND’s ability to tell fact from fiction.
Art and Practice of Naturopathic Medicine
And it only gets worse from there, as the coursework covers the six major modalities of naturopathic medicine:
- Homeopathic Medicine – Homeopathy is an elaborate placebo system with no basis in science. That it forms a fundamental part of the naturopath’s curriculum is shameful, and further indication of the casual way in which science is blended with pseudoscience in the curriculum.
- Asian Medicine/Acupuncture – covers “Yin and Yang theory, the meridians and channels system, the five-element theory and the symptoms and signs involving the 12 master meridians.” This is pure vitalism, the belief that living things possess an animating energy or life force, and that such energy can be manipulated for therapeutic benefit. In other words, bollocks. Acupuncture in particular has been extremely well studied, and consistently shows no benefit beyond a placebo in the highest quality trials.
- Botanical Medicine – as discussed above, treating botanical medicines as different from other medicines is an artificial distinction that only serves the naturalistic fallacy. Nature of course produces many useful compounds, but unfortunately they’re only occasionally safe enough and effective enough to be useful in their native form.
- Clinical Nutrition – includes “prescriptive therapeutic strategies” like detoxification (bollocks), supplementation (bollocks), and orthomolecular therapy (bollocks).
- Physical Medicine – includes hydrotherapy (bollocks) and naturopathic manipulation (almost certainly bollocks)
- Health Psychology and Lifestyle Counselling – not much to say here, other than presumably the counseling includes guidance in applying the other 5 modalities.
Take Away: any good done by the science courses in the biomedical track is completely undone by training in naturopathic modalities. If there’s a pseudoscientific treatment out there, it’s probably taught at the CCNM.
The Statutory Whitewash
Even if we accept the basic notion that natural treatments are somehow better than other medical treatments, the presence of homeopathy, detoxification, and energy therapies in the Canadian College of Naturopathic Medicine’s curriculum is a healthcare travesty. Though CCNM’s ND program is structurally modeled after Canadian MD programs, its substance is so divorced from reality as to render its graduates incapable of science-based practice. That they’re allowed to call themselves doctors is a testament to a flawed regulatory structure, not the training standards of the profession.