As we mentioned earlier this week, a brouhaha has erupted north of the border (or just a bit east for our Detroit-area colleagues) whereby graduates of Canada’s two naturopathy schools may be given drug prescribing rights by the Ontario legislature. Editor-in-chief of the Skeptic North blog, Steve Thoms, put up this detailed background in “Fake Doctors with Real Drugs,” at the JREF Swift blog:
Bill 179 was introduced in the spring of this year as a way of expanding scope-of-practice for health care professionals in Ontario, including (but not limited to) nurses, midwives, pharmacists and radiologists. Such an expansion was recommended by the Health Professions Regulatory Advisory Council (HPRAC), and this organization also recommended further that naturopaths be granted prescription rights. The Bill would have aimed to do this by amending a previous act of the Ontario Legislature, the Naturopathy Act, 2007. In this act, a “naturopath” is defined simply as someone who graduated from one of the two naturopathic colleges in Canada (neither of which are affiliated with any Canadian accredited university, and have extensive courses in homeopathy, Traditional Chinese Medicine, and colonic hydrotherapy). After the first reading of the bill, the HPRAC’s recommendation for naturopath prescribing rights were soundly rejected. Before the bill’s second-reading, a coalition of naturopathic associations organized a write-in campaign to put the naturopathic amendment back into the bill, and they were successful on Oct 20.
The bill itself has gone through two readings so far, and the third and final reading has been ordered (but not yet scheduled). The current session of the Ontario legislature will likely be over in less than a month, so the bill will likely be presented for it’s third reading, at which point it will be enshrined in law. Then naturopaths, homeopaths, acupuncturists, and Reiki practitioners will have the right to prescribe anti-inflammatory, anti-biotic, and narcotic (just to name a few) medications.
Supporters of the naturopath expansion have framed this issue in two disingenuous and/or problematic narratives: one of freedom, and one of access. The former is being presented as allowing Ontario citizens the freedom to seek out alternative health modalities and freedom for naturopaths to prescribe medications that they need to; the latter as a way of dealing with the doctor shortage. Both of these arguments are deeply concerning, because a) there is no law in Canada that prohibits citizens from seeking alternative treatments, and b) if a person who requires legitimate medical attention and feels they are unable to see a doctor in a timely manner, they are far more likely to seek out alternative avenues, potentially finding a dangerously-untrained and under-qualified naturopath.
This is not a matter of freedom of choice, nor is it a matter of helping deal with the doctor shortage. This is about granting political legitimacy to a pseudo-science when it’s practitioners are unable to gain legitimacy the way that conventional medicine does: through science, evidence, testing, and peer-review. Most people are not skeptics, and when they hear “Naturopathic Doctor,” many are just as likely to see the holder of title as just another primary care provider. Think about that when your mother needs heart medication, or your nephew gets an ear infection.
Defeating a bill in its third reading is rare, but not impossible. I’m asking for all Swift readers (especially the Canadians and Ontarians) to email the Ontario Premier, Dalton McGuinty, and (firstname.lastname@example.org), as well as the Minister of Long-Term Health and Care, Deb Mattews, (email@example.com). It would also be wise to CC the same email to Andrea Horwath, leader of the New Democratic Party (ahorwath-qp@ndp. on.ca) and Tim Hudak, leader of the Progressive Conservative Party (firstname.lastname@example.org). The bill is under review by the Standing Committee on Social Policy (for a complete list of the members of the committee, click here), so Ontario residents would do well to email them as well. Remember to CC all correspondences, so that everyone knows who else is reading what.
One of our Canadian pharmacy colleagues had published his own objection to this bill in Canada’s National Post earlier this week that has now been followed by this rebuttal from the naturopathic community.
What strikes me as quite inconsistent is that the writers want it both ways: they want the right to prescribe regulated medicines while simultaneously decrying medicine and science-based investigative methods.
It is also pointed out that naturopathic colleges teach pharmacology just like a real medical school. In isolation, this is indeed a true statement. A review of the curriculum of the Canadian College of Naturopathic Medicine (CCNM) reveals that a 5-credit hour Pharmacology course is required. I don’t have access to a syllabus but I would assume from the description that this is an appropriate, science-based course.
However, this course is then offset in the curriculum by three other courses in Homeopathic Medicine for a total of 12-credit hours. Homeopathy is diametrically-opposed to dose-response pharmacology. This seems to fly in the face of their National Post rebuttal title, “No ‘magic’ involved in naturopathic medicine.”
If you teach pharmacology and then expect someone to also believe homeopathy, that is magical thinking.
There are at least 7.5 credit hours in a total of two Botanical Medicine courses where my field of natural products (called pharmacognosy) is at least somewhat represented. However, very few botanical medicines (crude plant products or solvent extracts) actually have biological activity when one considers the bioavailability and pharmacokinetics of active components following oral administration. So if you want someone to prescribe real drugs, I think I’d be doing something different with this total of 19.5 credit hours.
Finally, I just want to post a nice rebuttal to the rebuttal by Steve Thoms – the NP site doesn’t permit direct linking to the comment like we do here at ScienceBlogs and it’s difficult to sift through the current count of 63 comments to do so. It’s worth a read to arm oneself with quick, concise facts in response to naturopathy claims:
The science-based community is always at a disadvantage in these sorts of outcries, because we’re limited to the evidence, and we can’t just make stuff up. There’s a lot to respond to.
1) With 23,000 doctors in Ontario, and fewer then 1000 naturopaths, the argument that granting naturopaths prescription rights will ease the burden on the healthcare system is a bit silly.
2) The assertion that the body has the potential to heal itself is not a scientific one. When given “natural” support only, the body will die by the age of 45, probably of infectious diseases. Modern advances in medicine make long-life possible, not herbs and roots from a 2,000 year old playbook.
3) Saying “science” doesn’t make it so. The call of “the healing power of nature at work” to be not magic, but good science, is ridiculous on its face….the human body is really good at succumbing to pathogens and injury, and the “natural” world is really good at killing us.
4) Old and tradition do not a science make. Yes, herbal supplements have been around for centuries. So has prostitution. Old doesn’t mean effective. It means old. I want my medicine to be new, awesome, and if possible, administered by a robot from the future.
5) Regulation does not a science make, even if it was 85 years ago.
6) I wonder, what is the naturopathic remedy for a broken bone? For that matter, how effective is naturopathic birth control?
7) Why the natural fetish? If you’re dying from a disease, do you really care if your treatment is “natural” or not? Why take an herbal supplement that a person tells you *might* work, when you could take the most recent advances in medical technology that we know *will* work?
8) Natural doesn’t mean safe. It doesn’t mean effective. Arsenic, poisonous mushrooms, gravel and bird-crap are also natural and you don’t see me putting them into my body.
9) Lets not forget that many people see a naturopath because they’re dazzled by the word “Naturopathic Doctor, or ND”. Let’s be perfectly clear: Naturopaths are NOT doctors. The Naturopathy Act, 2007 allows them to be called “Naturopaths”, not “doctors.” You need to go to medical school to be called a doctor. Naturopaths just granted themselves that title as a subtle PR stunt.
10) What is the diagnostic method a naturopath uses to test if a body is “in balance”? What laboratory equipment can you use to check for “wellness”?
11) The calls that naturopaths aim to treat the root cause is nonsense, otherwise they wouldn’t be asking to prescribe pain-killers, and anti-inflammatories.
12) If naturopathy is just as effective as medicine, then why don’t these naturopaths just go to med school?
13) The medical community is constantly advocating good health, diet, nutrition and exercise…naturopaths don’t have a monopoly on knowing the merits of preventative health.
14) Naturopathic college of Ontario requires a 4-year Bachelor’s eduction, but does not require for a Bsc or any science pre-requisites. The historical GPA for entry to the CCNM is 3.3 (ranging from 2.8-3.7). Compare that to Med school, which is turning away people with 4.0 averages.
15) The length of time for training is meaningless if the education quality is so lackluster. I can study levitation for 20 years but it doesn’t mean that I could fly.
16) “Every review of our record has recognized the safety of the more natural approach of naturopathic care.” Every review? Really? Black Cohosh, anyone?
17) The authors conveniently left out the deaths attributed to naturopathic prescriptions in Washington and Oregon, showing once again their contempt for honest data-gathering and fondness for cherry-picking whatever information suits their pre-conceived narrative.
18) The CCNM is NOT associated with ANY Canadian university, and it’s dishonest to artificially conflate the two together, even if you’re being indirect about it.
19) “The need for NDs to have prescribing authority was accepted by every other regulated health profession” Not even close to accurate! The bill passed the first two readings because the relevant health care communities had approved of their OWN amendments, and was not reflective of the naturopathy amendments.
20) The CCNM also is also teaching homeopathy and colonic irrigation, neither of which do anything beyond a placebo effect….Back from your cherry-picking trip yet?
21) If passed, the committee to decide which drugs would be prescribed would be made up of naturopaths! Unelected naturopaths deciding what they can prescribe!
22) Since naturopaths *are unqualified* to prescribe medication, granting them these powers will create needless risk of drug contra-indications.
23) This is not about freedom of choice for the patient, and it never has been. This is about granting naturopathy legislative and legal legitimacy because it can’t do so under the rules of science and evidence.
The scientific community is crystal clear on medicine, yet these people would have our very modern system degenerate with some very 19th century modalities.
A superb and time-consuming response by Steve Thoms – again, go to his post or scroll up to find e-mail addresses of officials to whom you can register your objections.