Photo: The Canadian Press
Medical equipment sits in an exam room at a clinic in Calgary, Friday, July 14, 2023. British Columbia, along with the Northwest Territories, boasts the most extensive scope of practice for naturopathic doctors in Canada, including the ability to prescribe medicines and administer vaccinations. The Canadian Press/Jeff McIntosh
Vancouver naturopathic doctor Vanessa Lindsay has been treating high blood pressure for many years through nutrition and exercise.
“She’s lost weight, she’s got more strength, she’s eating right, she’s drinking more water, she’s sleeping better,” Lindsay said.
However, the patient is still taking two blood pressure medications, and naturopathic doctors in British Columbia are allowed to prescribe them, so Lindsay is working with the patient on those as well.
“I’m able to monitor her and support her in safely weaning her off the medication when the time is right,” said Lindsay, who is also president of the BC Naturopathic Doctors’ Association.
“So we use complementary care when appropriate, but we also integrate traditional tools when necessary.”
British Columbia, along with the Northwest Territories, has the most extensive scope of practice for naturopathic doctors in Canada, including certification to prescribe medicines and administer vaccines.
The Canadian Association of Naturopathic Physicians would like to see similarly trained doctors across the country allowed to practice the same scope of practice, said executive director Sean O’Reilly.
She touted a four-year training program that incorporated science and distinguished “naturopathic doctors” from unregulated practitioners who call themselves naturopaths without undergoing standardized training.
There is a shortage of family doctors in Canada, and many naturopaths are positioning themselves as the solution, claiming they are trained to be patients’ primary care physicians.
There is growing concern among doctors and medical professionals that they are ill-equipped to be the primary care providers for their patients.
“We really have to be careful,” said Dr. Michelle Cohen, a physician at Lakeview Family Health Team in Brighton, Ontario, and an assistant professor in the Queen’s University School of Medicine.
“When it comes to naturopathic physicians, there is a concern that many of them, and some of their organizations, will refer them as if they were just another form of family medicine,” Cohen said.
“No, it’s not,” she said.
They’re learning anatomy and physiology, but there’s a lot they’re not doing.”
To become a naturopathic doctor in Canada, students must complete an undergraduate degree followed by four years of training at the Canadian College of Naturopathic Medicine, which includes “biomedical and clinical sciences,” including studying pharmacology and vaccinations, O’Reilly said.
“The philosophy and approach that naturopathic doctors take with their patients is what sets them apart from other medical professionals,” O’Reilly said.
“Their approach is to look at the whole person, so not just the physical aspect, but also the mental, emotional, social and environmental (factors),” she said.
“They also focus on educating patients about lifestyle, diet, and so on.”
O’Reilly said naturopathic doctors are regulated in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and the Northwest Territories, and will soon be regulated in Nova Scotia.
O’Reilly said many people calling themselves “naturopaths” in some states are unlicensed and unregulated. These practitioners give the profession a bad name and are the ones most likely to be opposed to vaccines, she said.
But Cohen took issue with the idea that naturopaths, even university-trained physicians, are considered a type of family physician.
“They have a completely different type of training and are on a different path.”
Cohen said he looked “fairly thoroughly” at naturopathic doctor training and found that neither the curriculum nor the clinical training requirements equipped doctors to diagnose and treat serious illnesses.
Naturopaths claim to follow the same four-year program as medical doctors, but “the way they describe it is misleading,” she said.
After four years of medical school, doctors must complete at least two more years of training before practicing, she said.
Naturopathic doctors also need to complete at least 1,200 hours of clinical training, while family doctors need closer to 10,000 hours, Cohen said.
The type of clinical training is also different, with family medicine residents seeing a wide variety of patients, many of whom are seriously ill, through hospital rotations, she said.
Without that experience, doctors could miss “red flags” that could indicate serious illness in patients with certain symptoms, leading to misdiagnosis, she said.
Still, Cohen sees a role for naturopaths to work alongside family doctors and nurses as “part of a team providing care within our own specialties,” which could include providing lifestyle and dietary advice and evidence-based information about interactions with supplements and other medications.
Cohen noted that naturopathic doctors are taking part in Ontario’s COVID-19 vaccination campaign and said some may be specially qualified to provide evidence-based counselling about the vaccine to people who are hesitant to get vaccinated and don’t trust the health-care system.
Dr. Tamina Ali, president of BC Family Doctors, agreed that naturopathic doctors can play a special role as part of a patient’s primary care team and said she welcomes their contributions.
“They are often more educated about the preventative and holistic dietary and lifestyle aspects of health promotion, prevention and healing. And I believe we need both, not one or the other,” Ali said.
She stressed that communication and coordination among health care providers is essential for patients’ health and to avoid ordering duplicate diagnostic tests and treatments.
But other medical experts are more skeptical.
“For naturopaths to be selling themselves as the solution to the current crisis is misleading at the very least. From a family physician’s perspective, it’s extremely frightening,” said Dr. Sarah Bates, acting president of the family medicine section of the Alberta Medical Association.
“I fundamentally believe that primary care is a team sport – 100 per cent. We should work collaboratively with nurse practitioners, nurse practitioners, pharmacists, psychologists, and complement each other’s practice, not compete. But there’s no place for naturopaths in that,” Bates said.
“Much of it is pseudoscientific in nature and rhetoric,” she said. “It also has the potential to do harm.”
Dr. Bates still remembers a patient from about 15 years ago who had rectal bleeding and recommended that he undergo diagnostic testing, including a colonoscopy.
But her patient did not undergo the procedure.
“She went to a naturopath instead and came back to me a year and a half later with even more bleeding, had lost weight and was extremely unwell,” Bates said.
The naturopathic doctor was treating patients with candida yeast infections, a fungal infection, she said.
“She died of colon cancer six months later.”
Bates said he realizes it may sound like he is trying to protect his “turf,” but he is simply trying to protect his patients.
“There are enough jobs here,” she said, “but the solution is not to bring in doctors who aren’t properly trained to provide a certain level of care.”
Blake Murdoch, a senior research fellow at the University of Alberta’s Health Law Institute, agreed.
“Much of naturopathic medicine is based on the principle that modern medicine only treats symptoms and not underlying causes, which is demonstrably false except in cases where there is no known scientifically effective treatment,” Murdoch said in an email.
“Alternative medicines are thought to ‘fill the gap’ with things that are ineffective, untested and potentially unsafe.”
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