Respectful Insolence

I’ve mentioned before how Detroit is my hometown. What that means is that I live very near to Canada. In fact, I can go into Windsor pretty much any time I want to, although I don’t do it very often. Lots of Canadians work at the cancer center I work at because it’s only a few miles from the tunnel to Windsor. That’s why I was so disturbed when Ontario proposed letting naturopaths have prescribing privileges. Ultimately, the bill was passed, allowing naturopaths to prescribe actual prescription drugs, although it took three years to hammer out regulations based on the law. Of course, naturopaths continued to lobby for more prescribing rights under the law, thinking that somehow they are capable of prescribing real medications—as opposed to their quack medications—and of being primary care providers.

It’s laughable, of course. Naturopathy, as I’ve described many times before, is a veritable cornucopia of quackery that mixes and matches homeopathy (which is a required part of naturopathy school), traditional Chinese medicine, and a mixture of all sorts of other quackery ranging from applied kinesiology, reflexology, and more. Naturopaths are no more qualified to prescribe real medications used by real doctors than my dog, and at least my dog knows his limitations. Even naturopaths seem to recognize this to some extent. I say this because I’ve seen an e-mail that’s making its rounds among pharmacists in Ontario, one of whom forwarded it to me:

To: Hospital Pharmacists practicing in Ontario

Subject: Recruiting Pharmacists to be Assessors for Naturopathic Doctor Therapeutics Certification Course Oral Exam

The Transitional Council of the College of Naturopaths of Ontario has recommended that Naturopathic Doctors (NDs) need to take a certification course to become more knowledgeable about the evidence-based use of common prescription medications. This course was developed by Drs. Adil Virani and James McCormack from the Faculty of Pharmaceutical Sciences at UBC and has been given over the last three years to all NDs in BC as part of a certification process for NDs to prescribe certain medications.

The Transitional Council of the College of Naturopaths of Ontario has asked that all NDs practicing in Ontario take this course and pass both a 2.5 hour written exam and complete 3 oral assessments to be certified to practice in Ontario.

For the oral assessment, NDs will be given three cases and the NDs will have to derive and defend a treatment plan, utilizing prescription medications. We are recruiting pharmacists to be assessors of the oral exam process. Pharmacists who were assessors in the BC course found the process to be enjoyable and also that it helped them learn more about the disease states they were examining.

If you agree to be an assessor, you will be provided with a template to follow and any training you need. Your role will be to listen to the NDs rationale for the treatment they have selected, make notes and score the relevant responses to specific questions (which we will provide you with) on the template provided. If you agree, I will put your name on a list and contact you when we have an oral assessment planned and invite you to attend. Easy right???

Here are some more details:

Honorarium: $350/day

Dates: Toronto: Not yet identified. Likely late May 2014and/or Sept 2014 (Location TBD) and every 3-4 months after that.

We require approximately 18 assessors for each oral exam.

Time: 8:30 am – 5 pm (approximately – depends on how many NDs sign up for the exam).

If you are interested and available to participate, please email Adil Virani (adil.virani@ubc.ca) by March 30, 2014?

If you have any questions, feel free to call Adil at 604-613-2549.

Thanks,

Adil Virani and James McCormack

Dr. Adil Virani

Director, Lower Mainland Pharmacy Services Professional Practice, Education & Burnaby Hospital Fraser Health | Providence Health Care | Provincial Health Services | Vancouver Coastal Health

Associate Professor

Faculty of Pharmaceutical Sciences, UBC

Yes, you read that right. Ontario naturopaths are looking for pharmacists to administer oral examinations to naturopaths who wish to prescribe real drugs. It turns out that part of the law allowing naturopathic prescribing mandates this, which is what is required in British Columbia:

Under BC’s legislation and accompanying regulations, naturopaths will not prescribe certain restricted classes of medications, such as antipsychotics and chemotherapy drugs. The regulatory board that governs naturopathic doctors is now finalizing the standards and list of substances that naturopaths will be allowed to prescribe.

But they will first have to meet educational requirements and pass a qualifying examination, says Christoff Kind, president of the British Columbia Naturopathic Association. “The whole thing really is just based on providing for a shared scope of practice model here in BC, which I think is coming across the country,” he says. “Professions that have the training should be allowed to practise to their level of education and expertise.”

So, in other words, naturopaths don’t have the requisite level of education, contrary to their frequent claims, to prescribe real medications. So they have to get it by taking courses and then passing a qualifying examination, which pharmacists in Ontario are being dragooned into service doing the qualifying examinations on all these naturopaths who want to expand their scope of practice beyond what their education supports. Yeah, that’ll work.

I’ve written a lot about “integrative medicine,” whose proponents like to represent it as being the “best of both worlds,” in which science-based medicine is “integrated” with “complementary and alternative medicine” (CAM). At least, that’s the direction that it usually happens. Unfortunately, “integrating” pseudoscience with real medicine doesn’t make the real medicine better. It contaminates it with quackery. Who knew that the “integration” could go the other way around, with quacks like naturopaths wanting to “integrate” real medicine into their quackery. I can understand why they want to do it. Their modalities don’t work, by and large; so of course they want to have some real medicine to add to their armamentarium. However, the same problems apply.
integrating real medicine into the quackery seems as though it would make the quackery less quacky, but it won’t. All it will do is to unleash hundreds, if not thousands, of incompetents incompetently trying to administer real medicines to real patients, medicines with real therapeutic effects but also real side effects and adverse events.

No, “integrating” quackery with real medicine never works, regardless of which is being “integrated” with what. It’s far better to stick with one science-based standard.

Comments

  1. #1 Agashem
    Soaking up the cold cold rays of the sun
    March 4, 2014

    Weirdly this same legislation was supposed to give us Physical Therapists the right to order Xrays but this part of the bill was stayed and yet this drek is being allowed to go through. My sister is a pharmacist here in Ontario but I don’t think most of them realize what all this means.
    When this legislation passed, I wrote the ‘college’ of naturopaths asking why they needed this privelege when they supposedly already have all sorts of nostrums to treat clients. I got a zero response. Quel surprise. The Ontario government continues to look for cost cutting measures for health care and I believe this is one of their ‘solutions’ as I am sure naturopaths are cheaper than primary health physicians. It stinks.

  2. #2 Todd W.
    http://www.harpocratesspeaks.com
    March 4, 2014

    My question is: why don’t naturopaths have to take the same courses that real doctors take in order to learn about prescription drugs? Why don’t they have to take the same tests as real doctors? After all, those courses already exist, and the tests are already in place. Creating a new naturopath-centered system is duplication of effort, not to mention it introduces potential substandard training.

  3. #3 daedalus2u
    http://daedalus2u.blogspot.com/
    March 4, 2014

    What “standard of care” is the test being graded to? If the ND says to use magic water, is that a fail?

  4. #4 Eric
    Pickering, ON
    March 4, 2014

    I’m sure this is a cost cutting measure. Naturopaths aren’t covered by our publicly funded healthcare (which is a good thing). They are hoping to ease the financial strain on the system by directing people to services that are paid for out of pocket instead of with government dime.

  5. #5 Denice Walter
    March 4, 2014

    This is comedy gold:
    for years, natural health advocates- which count naturopaths amongst their ranks- constantly harp on how meds used by SBM are too toxic, strong or unnatural and their own solutions ( homepathy, herbalism, energy medicine, reflexology, TCM, orthomolecular et al) are just what the doctor should order. So why in flaming h3ll are they trying to get rights to prescribe meds?

    If your own therapies are superior to whatever ‘western’ medicine has to offer why would you want to be able to prescribe ‘western’ medicine? Do you suppose that your more spiritual attitude or humanistic rapport with your clients will somehow automatically turn the tide and transmute the poisonous pharma alchemically into golden panacaea- despite its humble and obnoxious origins?Or do you coax the Xi to its proper level and mode of circulation?

    It is an inadvertent admission that their own naturalism doesn’t really work.

    And, sillly me, I always held on to the naive belief that somehow Canadians had a tad more common sense** than other English-speakers***.

    ** perhaps you need a measure of common sense/ realism to survive in the tundra, forests, frozen islands and sub-arctic population centres that exist there.
    *** and yes, I know that some of them are Francophone.

  6. #6 Denice Walter
    March 4, 2014

    After prescribing meds will they then have to prescribe altie nostrums to counteract their damaging effects?
    Ooo! New business model.

  7. #7 Gary
    March 4, 2014

    I wonder how many ND’s in BC “passed” the certification exam?

    Scary

  8. #8 lurker
    March 4, 2014

    I’m with Denise @ 5: a comedy of contradictions.

    Anyone here care to place bets on how long it will take before some naturopath has the intellectual honesty to step up and say, in public, that s/he found, in her/his own practice, that ‘Western’ medicines worked better than guru water and ‘energy’? And further, that s/he is now applying to med schools and/or nursing schools to learn to practice real medicine?

    That would spell the beginning of the end of naturopathy, and possibly the beginning of the end of quack ‘healing’ modalities altogether.

    I’ll bet we see the first defector from naturopathy in three years. That would be March 2017. And in the subsequent 12 months, we will see scores of others following suit.

  9. #9 Todd W.
    http://www.harpocratesspeaks.com
    March 4, 2014

    @Denice

    I think you may be on to something. I see a new market opening up for Lord Draconis.

  10. #10 Calli Arcale
    March 4, 2014

    So they’ll be restricted from prescribing antipsychotics and chemo? Fine. What I’m sure many are already thinking is whether or not they’ll be prohibited from prescribing narcotics. Seems that if they’re allowed to prescribe those, naturopathy would be a very profitable career path for a drug dealer wanting to avoid unpleasant police entanglements.

    And yeah, the dripping irony of practitioners who explicitly say their nostrums are “better” wanting prescribing privileges.

  11. #11 Daniel Corcos
    France
    March 4, 2014

    Naturopaths save government money, not only for healthcare, but also for pensions.

  12. #12 NH Primary Care Doctor
    March 4, 2014

    Why are they having pharmacists administer the exam. If there is a clinical scenario, why not have MDs do it?

    I live in NH. Unfortunately, naturopaths have full prescribing privileges. https://www.nh.gov/pharmacy/documents/naturo-form.pdf

    Read it and weep. I’ve had the pleasure of treating many cases of C. diff as a result of their unwarranted antibiotic use for “Lyme’s disease.”

    * “Lyme’s disease” as opposed to “Lyme disease.” Lyme disease is a real thing. “Lyme’s disease” is made up by quacks.

  13. #13 Eric Lund
    March 4, 2014

    Creating a new naturopath-centered system is duplication of effort, not to mention it introduces potential substandard training.

    Feature, not bug.

    If your own therapies are superior to whatever ‘western’ medicine has to offer why would you want to be able to prescribe ‘western’ medicine?

    I suppose that some patients may demand it. I don’t know if medicines can be advertised in Canada the way they are in the US–but since most Canadians live within 100 km of the US border, it may not make that much of a difference, since over-the-air broadcasts don’t care about national borders.

  14. #14 Todd W.
    http://www.harpocratesspeaks.com
    March 4, 2014

    @Eric Lund

    since over-the-air broadcasts don’t care about national borders

    What are you talking about? There are totally anti-radio fences erected at our borders.

  15. #15 Mephistopheles O'Brien
    March 4, 2014

    Why are they having pharmacists administer the exam. If there is a clinical scenario, why not have MDs do it

    At a guess, MDs would be assumed to be prejudiced against NDs and therefore would grade lower. Pharmacists, on the other hand, would see NDs as another potential source of orders and revenue, and would only be concerned about making sure that they did a reasonable job in prescribing medicines.

    But that’s just a guess.

  16. #16 JerryA
    March 4, 2014

    Do the ND pharm exams take into account all of the herbal crap the NDs “prescribe” and/or their patients take? Even when the herbs don’t work, they may still interfere with real medication, possibly causing or strengthening side effects. (And, of course, the woo-folk will blame the meds, not the natural herbs.)

  17. #17 Mephistopheles O'Brien
    March 4, 2014

    Doesn’t the ND’s oath begin, “First, do no pharm”?

  18. #18 herr doktor bimler
    March 4, 2014

    Lyme disease is a real thing. “Lyme’s disease” is made up by quacks.

    Much as discussion in the Crankosphere now centres on “Morgellon’s disease”, following the theory that a fictitious disease becomes more real if you pretend that it was named after a discoverer.

  19. #19 Dorothy
    Oz
    March 4, 2014

    Do the people who pass these laws bother to seek (or recognize) expert opinion before putting this junk through the legislative process?

    It’s not going to save anybody any money when people get sick(er) from the drugs these yokels will end up “prescribing”. You are totally right that your dog knows as much as an ND about the whole business. I know a few ND’s and they would never make the cut for medical school.

  20. #20 palindrom
    March 4, 2014

    Of course you can’t have allopathic doctors examining naturopaths. They would be mean! Mellows would be harshed, and that is to be avoided.

  21. #21 Eric Lund
    March 4, 2014

    Do the people who pass these laws bother to seek (or recognize) expert opinion before putting this junk through the legislative process?

    In this context, the word “expert” means whatever the speaker wants it to mean. You and I would not consider an ND to be a medical expert, but if the ND can convincingly portray himself as such to a sufficiently influential and gullible legislator, that legislator can claim that the ND is an expert. Lots of dubious laws and legislative hearings, and not just on biomedical subjects, involve similar stretching of the definition of “expert”. The Texas board which decides what textbooks schools in that state use is a notorious example–but that’s a separate rant.

    In this case, it looks like the law in Ontario was modeled on a law on the same subject in British Columbia, which accounts for why somebody at UBC (the Vancouver phone number was the first thing I noticed) is helping the Ontario provincial government set this up. Sometimes, it can be a good thing to look at what other states/provinces have done and copy what works. But all too frequently dubious ideas like this law spread in exactly this fashion. In some cases a national lobbying group will come up with a model law which gets introduced in several state/provincial legislatures simultaneously (there has been rather a lot of that in the US lately).

  22. #22 TwistBarbie
    March 4, 2014

    I’m a pharmacy tech. working in B.C. and I’ve seen some worrying things from NDs. Often it seems like they are experimenting on their patients, in fact, some patients even proudly proclaim themselves to be experiments. Odd uses of products with no studies to be found for whatever condition they are attempting to treat. Patients on combinations of 4 or 5 antiparasitics for YEARS to treat some mythical tapeworm. Many, many compounded high-strength vitamin injections. Some of these patients spend thousands of dollars and sink their families into debt to treat their “adrenal fatigue” and whatnot (medical-related debt is not a common thing here because of our medical system, these people are essentially choosing to do this)

  23. #23 Nick K
    Chengdu
    March 4, 2014

    #5 Denice: Comedy gold indeed, though the altie community can’t see the contradiction. By definition, the set of people ascribing to woo, and the set of people capable of clear, logical reasoning, are disjoint.

  24. #24 Denice Walter
    March 4, 2014

    @ TwistBarbie:

    Because NDs often disparage the use of phamaceuticals, it would be interesting ( to me, at least) to know which meds they DO accept. Anti-parasitics are one- I’ll venture that they despise and avoid antidepressants, antipsychotics, antianxiotics- why they’ve got herbs and supplements for those conditions.
    Probably any hormonals or steroids are verboten and antibiotics only for extreme conditions.
    So what do they prescribe?

  25. #25 Denice Walter
    March 4, 2014

    @ Nick K:

    Sure. I often traipse across fields of irony whilst surveying woo. It is awe inspiring- but not in a good way.

    e.g. just now, an accomplished woo-meister publishes a piece that describes most establishment leaders ( of government, academia, corporations, media etc) as psychopaths who are unaware of their own illness/ incompetence, unconcerned about how their actions affect other people, primarily obsessed with earning money and acquiring power etc. ( via PRN/ “Wolves of Psycho Street”)

    I swear, I couldn’t make up a story like that- despite being naturally creative.

  26. #26 mho
    March 5, 2014

    TwistBarbie
    My guess is they want young women coming in to get their birth control scripts so they can then sell them vitamins and get those “well women” exams booked.

    And then, if an ND can prescribe antibiotics, no one has to know that the onion earmuffs and frozen socks treatments didn’t work.

  27. #27 lurker
    March 5, 2014

    Re. NH Primary Care Doctor @ 12:

    Speaking of C.Diff, I hear there are MDs telling their C.Diff patients to start taking probiotics along with the prescription for Flagyl. That raises my scepticism flag.

    Is there any legitimate use for probiotics in treating C.Diff, and if so, how can one tell the difference between that and quacky use of probiotics for C.Diff? For example, how long should a patient be on probiotics after completing a course of oral Flagyl, how many probiotic pills/capsules/whatever per day, and what sort of claims differentiate the legit medical use (if any) from the woo?

    I’m reluctant to wade into the murky waters online and start crying ‘fowl’ (spelling deliberate;-) unless I’m sure. Obviously, any mention of ‘healing energy’ or homeopathic power-placebos or whatnot, gets called out. But I don’t want to make an arse of myself by raising the sceptic alarm over something that might turn out to be backed by science after all.

  28. #28 Brook
    March 5, 2014

    So what’s a pharmacist to do when a naturopath lays out a course of treatment that includes iridology and crystals as preferred treatment with penicillin as backup?

  29. #29 Pareidolius
    Ancient Languedoc
    March 5, 2014

    Morgellons was named after an illness described in the 1500s in Languedoc, France in which “harsh hairs” erupted from sufferer’s backs. The crank that started all this was a Mary Leitao who most probably suffers from Muchausen by Proxy. Her son had lesions on his lips and she used a toy microscope to examine them. The rest is history.

  30. #30 palindrom
    March 6, 2014

    mho @26 — Yow. My wife works in GYN, and from this I understand that there are many different formulations of birth control pills on the market, with a bewildering variety of side effects and contraindications. They’re not something that any old quack can dole out indiscriminately, or they shouldn’t be.

  31. #31 AlisonM
    http://adhdcommunity.boards.net/
    March 6, 2014

    Whatever happened to “the body’s innate ability to heal itself?” Do they realize that by pursuing the right to prescribe the dreaded “Western Medicine,” they’re outright admitting that they were lying about that all along?

  32. #32 Rob
    March 6, 2014

    If all that is required is taking the course and passing a test, can any ole yahoo then become licensed to prescribe meds?

    I’m not a doctor, but I’m thinking I’m probably as capable of meeting this requirement as anyone.

    Can I take the class? Or, do I have to be a ND? And if so, I’m really wondering what qualifies the ND as having the prerequisites for this course.

  33. #33 dragondoc
    March 6, 2014

    Definitely exists some supportive literature for probiotics in C. diff., and there a reasonable degree of prior plausbility to the idea. See http://www.ncbi.nlm.nih.gov/pubmed/23728658 from good old Cochrane.

  34. #34 lurker
    March 8, 2014

    Dragondoc @ 33: Thanks. Probiotics have been identified with alt med, so I thought they were just more power-placebos. This seems to be one of those instances Orac talks about where ‘alt med’ becomes real medicine once there’s science-based support for it.

  35. #35 DLC
    March 14, 2014

    Lurker : I happen to have survived a C.Diff -inspired colitis late last year, and was given big doses of flagyl and a probiotic. that seems to be becoming the standard of care these days, even though the studies I’ve seen indicate that oral probiotic doesn’t seem to add much to gut flora. Perhaps I’m wrong, I’m not an internal medicine specialist.

  36. […] rights that would allow them to prescribe real pharmaceutical medications, despite their utter lack of qualifications to do so and their hostility towards […]

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.