Naturopathic doctors are not the solution to the primary care crisis: doctors and health experts

Vancouver naturopathic doctor Vanessa Lindsay has been treating a patient’s high blood pressure for a long time through nutrition and exercise.

“She’s lost weight. She’s stronger. She’s eating well. She’s hydrated. She’s sleeping better,” Lindsay said.

But the patient is still on two blood pressure medications, and since British Columbia naturopaths can prescribe medications, Lindsay works with her patient on those medications as well.

“I can support her in following up and safely removing one when appropriate,” said Lindsay, who is also president of BC Naturopathic Doctors.

“So, use complementary care when appropriate, but also integrate those conventional tools when necessary.”

British Columbia, along with the Northwest Territories, has the broadest scope of practice for naturopathic doctors in Canada, including the ability to prescribe medications and be certified to administer vaccines.

The Canadian Association of Naturopathic Physicians wants the same scope of practice to be allowed for similarly trained professionals across the country, said executive director Shawn O’Reilly.

She touted a four-year training program that she said includes science and distinguishes “naturopathic doctors” from unregulated professionals who call themselves naturopaths without any standardized training.

Amid the shortage of family doctors in Canada, many naturopathic doctors are positioning themselves as a solution, arguing that they have the training to be a patient’s primary care provider.

This is raising alarm among doctors and health experts who say they are not prepared to be a patient’s primary source of medical care.

“We have to be very careful,” said Dr. Michelle Cohen, an assistant professor of medicine at Queen’s University and a physician with the Lakeview Family Health Team in Brighton, Ont.

“When it comes to naturopathic doctors, my concern is that many of them, and also some of their organizations, present them as if they are just a different form of family doctor,” Cohen said.

“They’re not,” he said.

“They’re learning some anatomy and some physiology, but there’s a lot they don’t do.”

To become a naturopathic doctor in Canada, students must have a bachelor’s degree and then complete four years of training at the Canadian College of Naturopathic Medicine. That training involves “biomedical and clinical sciences,” including pharmacology and immunization learning, O’Reilly said.

“It’s really the philosophy and approach that naturopathic doctors take with their patients that sets them apart from other health care professionals,” O’Reilly said.

“Their approach is to look at the whole person. So not just their physical aspects, but mental, emotional, social and environmental (factors),” he said.

“They also focus a lot on educating their patients about things like lifestyle and diet.”

Naturopathic doctors are regulated in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and the Northwest Territories, O’Reilly said, and are in the process of being regulated in Nova Scotia.

O’Reilly said that in some provinces, many people who call themselves “naturopaths” are not qualified or regulated. Those professionals give the profession a bad name and are the most likely to be against vaccines, he said.

But Cohen disputed any notion that naturopathic doctors, even those who go through college, can be considered a type of family doctor.

“They have a completely different type of training and follow a different path.”

Cohen said he has examined the training of naturopathic doctors “pretty thoroughly” and found that neither the curriculum nor the clinical practice requirements prepare them to diagnose and treat serious illnesses.

Although naturopaths argue that they do a four-year program like a doctor does, “it’s misleading the way they present it,” he said.

Doctors must complete at least two more years of residency after their four years of medical school before they can practice, he said.

And while naturopathic doctors must have at least 1,200 hours of clinical training, family doctors have about 10,000 hours, Cohen said.

The type of clinical training also differs, he said, as those training to be family doctors care for a wide variety of patients, many of them very sick, through hospital rotations.

Without that kind of experience, a doctor may miss a “red flag” that could indicate a serious illness in a patient with certain symptoms, leading to a misdiagnosis, he said.

Still, Cohen sees a role for naturopathic doctors to work cooperatively with family physicians and nurse practitioners, as “part of a team providing care according to their line of expertise.” That could include lifestyle and diet consultations and providing evidence-based information about supplements and how they might interact with other medications.

Some may also be uniquely qualified to provide science-based vaccine advice to people who are hesitant and untrusting of the medical system, Cohen said, noting that naturopathic doctors have been involved in COVID-19 vaccination campaigns in Ontario.

Dr. Tahmeena Ali, president of BC Family Doctors, agreed that naturopathic doctors can play a specific role as part of a patient’s primary care team and said she welcomes their contributions.

“They often have more education about the preventative and more holistic aspects of diet and lifestyle for health promotion, prevention and healing. And I don’t think there has to be an ‘either or’, but rather an ‘ both,'” Ali said. .

He emphasized that communication and coordination between providers is essential for the well-being of the patient and to avoid requesting duplicate diagnostic tests or treatments.

But other health care experts are much more skeptical.

“For naturopaths to present themselves as a solution to our current crisis is misleading, to say the least. And from a family doctor’s perspective, it’s pretty horrifying,” said Dr. Sarah Bates, interim chair of the section of family medicine. of the Alberta Medical Association.

“Now, I fundamentally believe that primary care is a team sport. One hundred percent. We should work collectively with nurses, nurse practitioners, pharmacists and psychologists and complement each other’s practice, not compete with it. But there is no place there for naturopathic doctors,” Bates said.

“A lot of this is essentially pseudoscientific rhetoric,” he said. “You can do harm.”

Bates still remembers a patient from about 15 years ago who had rectal bleeding, so he referred her for diagnostic testing, including a colonoscopy.

But his patient did not undergo the procedure.

“Instead, she went to her naturopathic doctor and, a year and a half later, she came back with more bleeding and weight loss. She seemed terribly ill,” Bates said.

The naturopath had been treating the patient for Candida yeast, a fungal infection, he said.

“He died about six months later from colon cancer.”

Bates realizes it might seem like he’s trying to protect his “turf,” but he said he’s just trying to protect the patients.

“There is enough work here for everyone,” he said. “But the solution is not to present a doctor without adequate training to provide a certain level of care.”

Blake Murdoch, senior research associate at the University of Alberta Health Law Institute, agreed.

“Much of naturopathy is based on the principle that modern medicine only treats the symptoms rather than (the) underlying cause, which is patently false except when there is no effective treatment known to science,” Murdoch said in an email.

“This is where alternative medicine supposedly ‘fills in the gaps,’ with things that don’t work or are unproven and potentially unsafe.”

This report by The Canadian Press was first published March 25, 2024.

The Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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