I live about ten miles due north of “Canada’s automotive capital”. We often look across the straits to the medical system in Ontario, one in which all citizens have a provincial insurance card. We see how everyone has access to care—or at least some care. I’ve treated many Canadian patients who have access to American insurance and prefer to get their care on this side of the border, where there are fewer hassles. Of course if you have no insurance at all, hassles abound, and we’ll leave a discussion of the merits and difficulties of the Canadian system to another day. But one move being considered by the province of Ontario promises to take a modern health care system one step closer to the 19th century.
Ontario wants to license naturopaths to prescribe medications. To see if this is wise, we have to re-examine what naturopathy is. Naturopathy is an approach to health care based on mistaken ideas about disease cause, prevention, and treatment. Naturopaths like to think of themselves as primary care physicians, but their education and training is based on a biology that doesn’t exist in this world. The foundations of modern medicine are compassion, scientific principles, and evidence. When formulating a differential diagnosis, we can only consider what is biologically plausible. Chest pain has many different possible causes, but spiritual possession isn’t one of them. We must also look at evidence: how likely are people with chest pain and a normal EKG to have serious heart disease? Does the evidence support immediate intervention is this case, or can it wait? Once we figure it out, how do we prevent either the onset or progression of heart disease? Knowing the biological basis of heart disease is critical. Most heart attacks occur when an arterial plaque ruptures. Aspirin, for example, helps prevent this, as does a class of medications called statins. Understanding the pathology of coronary heart disease isn’t a matter of philosophy as much as microscopy.
Naturopaths often refer to their philosophy of “finding and treating the cause of chronic problems, not just treating symptoms.” It is important to realize that symptoms and cause are not that easily separated. Chest pain, plaque rupture, heart attack—these are the disease. We can treat the “symptoms” of heart disease without treating the disease itself. Nitroglycerin can relieve chest pain but it doesn’t prevent heart attacks the way aspirin, statins, and beta blockers do. But that’s not what we do. We try to intervene early, before symptomatic heart disease develops, and if we cannot, we try to prevent further progression of disease.
Naturopaths like to present themselves as walking a different path to the same destination, but the truth is not so pretty. If we were to, as the naturopaths put it, help nature heal itself, we would die toothless and miserable before we hit fifty. Most of us are likely to die of either cancer, heart disease, or stroke. We are pretty good at catching some of these early, and at preventing development and progression of disease. The modern, scientific approach to medicine has allowed people with heart disease to live longer, symptom-free lives. It has allowed us to prevent colon cancer in most people. But we can’t make people live forever.
There is no “other path”. To say that one approach “supports the body’s healing ability” and another does not is just plain wrong. It is impossible to separate out the intervention from the patient, to separate medicine from nature. If someone with high blood pressure and high cholesterol (many of whom have very good diets) is left untreated, nature left alone will create inflammation in the blood vessels in an attempt to heal itself. This inflammation can eventually lead to plaque rupture, heart attack, stroke, kidney failure, impotence, blindness—you get the idea. When someone gets real medicine for hypertension and high cholesterol, we fight the body’s natural tendency to kill itself, and allow them to live pretty normal lives.
Naturopaths offer a different path—one based on fantasy. For a government to legitimize this fantasy is to tell its citizens that science is meaningless. If naturopaths are treated as doctors, there is no reason that faith healers, shamans, and some dude with a knife should not also be licensed. Anyone who truly believes that we are infused with magic substances such as qi shouldn’t be trusted to understand how real medicines work, and shouldn’t be allowed to prescribe them.