A recent survey by the New Brunswick Medical Association found that 41 per cent of naturopathic doctors in the province were using prohibited terms such as “physician” and “practitioner”, in violation of New Brunswick’s medical law.
While these numbers may be surprising, Canadian doctors will tell you they have noticed an increase in misrepresentations by health care providers over the past few years. These are private practitioners without medical degrees who refer to themselves as “family doctors” or experts in the field of oncology, and some even imply in their marketing materials that they graduated from medical school. These types of representations also violate regulations in other provinces.
“I was trained in medicine. I have a natural way of focusing.”
But it’s hard to blame individual naturopaths for spreading misinformation when the associations that represent them model the same behavior: In 2016, the Canadian Association of Naturopathic Doctors adopted the tagline “Medically Trained. Nature Focused.”
The Ontario Naturopathic Doctors Association confidently states on its website that naturopathic school, like most medical schools, is four years long and students learn the basic sciences and complete 1,200 hours of supervised clinical work. This supports claims such as those made by one Ontario naturopath on his own website, who states that naturopathic doctors (NDs) and MDs “receive similar levels of training” that are “almost identical.”
However, a medical student conservatively completes approximately 4,000 hours of supervised clinical research, most of which takes place in a hospital, not a naturopathic clinic. More importantly, all physicians undergo years of residency training after earning their MD. Between graduating from medical school and becoming a family physician, I accumulated at least 6,000 hours of supervised clinical research, and many of my colleagues have trained for much longer than that. If the comparison is to a new MD graduate, it is very misleading to ignore the fact that an MD alone does not make a physician.
Certainly, naturopathic education includes basic science and clinical skills, but claiming this is “medical training” is arguably false advertising. Many medical professionals complete multi-year programs in which students memorize anatomy, see patients under supervision, and take tests on clinical skills. This is not “medical” training; it is essential background for nearly anyone who works in healthcare. And just as “dentistry” or “nursing” are clear and unambiguous ways to describe one’s background, “naturopathic” should be a sufficient description as well. The only reason people would start overusing the word “medical” is to intentionally try to create confusion about their education.
Five provinces (British Columbia, Manitoba, Alberta, Saskatchewan, and Ontario) have schools of naturopathic medicine that are tasked with regulating the profession and protecting the public. This summer, Alberta surgeon Dr. Cary Kollias contacted the Alberta School of Naturopathic Medicine about a naturopath claiming to be a “recent medical school graduate.” The school responded that the claim was “not misleading in any way” because the doctor’s website lists the naturopathic school he attended. However, patients should not have to fact-check a doctor’s background. Using the words “naturopathic” and “medical” as if they were interchangeable is a confusing bait-and-switch tactic. To tolerate this behavior as a regulator is a dereliction of duty.
Providing informed consent
Patients need honest information about their health care providers. The spread of misinformation targeting people interested in alternative medicines demands the attention of health care regulators. If you are misinformed about your health care provider’s education, they did not obtain your fully informed consent. This is not only a patient safety issue, but also a patient autonomy issue, since informed consent is a fundamental health care right.
Two doctors in Ontario and New Brunswick, Dr. Quynh Nguyen Giang and Dr. Linda LeBlanc, have written letters to state medical colleges and the Ministry of Health urging them to address the issue. They’re also considering creating an online registry where anyone could report misrepresentations by health-care providers, which would speed up complaints, provide a more coordinated response, and track the scope of the problem. It’s a commendable grassroots effort, given that health-care regulators have been largely lackluster in their response.
Lack of organizational interest
While New Brunswick’s medical school has filed lawsuits against several naturopaths for false advertising, other regulators appear completely uninterested in the allegations made by at least Nguyen-Giang and LeBlanc. Just as regulations regarding naturopathic medicine vary from province to province, the apparent concerns expressed by medical schools also vary, with some refusing to even address the issue.
So if we can’t expect medical and naturopathic colleges to take this issue seriously, governments must step in. Patient safety issues are too important to ignore, especially when the law is blatantly being ignored. Ministries of Health need to combat misrepresentation, challenge naturopathic organisations that spread misinformation, and enforce rules on false health advertising. It is irresponsible to expect this to be solved by professional turf wars. Governments have a duty to the public to make real, concrete efforts to protect the accuracy of health care provider information.
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