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.
I always thought the whole point of Naturopathy was to avoid the use of drugs. According to NCCAM's Introduction to Naturopathy:
"A central belief in naturopathy is that nature has a healing power (a principle called vis medicatrix naturae). Another belief is that living organisms (including the human body) have the power to maintain (or return to) a state of balance and health, and to heal themselves. Practitioners of naturopathy prefer to use treatment approaches that they consider to be the most natural and least invasive, instead of using drugs and more invasive procedures."
Absolutely true!!spot on!!
Things like this make me pretty ashamed of being Canadian.
Also...here's the course description on their site of that Pharmacology course:
"The study of pharmacological principles develops a strong foundation in understanding the factors that influence drug action. This course examines the indications, mechanisms of action, adverse effects and interactions of the most influences on the practice of naturopathic medicine."
CCNM Grammar fail.
Oh, and a quick Google search found a very detailed course outline of the CCNM Pharm course. It's about two years old and gives you a good idea of what they cover, although it's unclear how much lecture time is involved.
Maybe a silly question, but how do you reconcile giving out pharmaceutical drugs and yet still following homeopathy? If someone needs antibiotics would you prescribe the evidence-based recommended dosage, or would you dilute the antibiotic using homeopathic standard? Or would you tell them that instead of antibiotics they could use a homeopathic version of antibiotics.
Or pick any medication instead of antibiotics. E.g. heart medication. Do you give someone the standard meds that have been shown to work, or do you dilute foxglove (digitalis)?
Furthermore, what is actually being taught in those pharma classes? This would be a course that conflicts with many peoples' ideologies (big bad pharma, drugs=bad natural=good, more dilutions=stronger medicine, etc). And how could it not conflict with the people who teach it? It would be like a young earth creationist trying to teach a 4.2 billion year old earth; or a geologist who knows the earth is ancient trying to teach students the earth is 6,000 years old.
Or, taking the above example again, even if those two people were able to teach what they believed, you can bet the geologist will be demonstrating why claims of a young earth are based on ignorance, misunderstandings, and sometimes outright fraud. That will create conflict in the faculty. To avoid this conflict chances are they will have people with similar beliefs which means you'll end up with a homeopath who doesn't follow or can't recognize evidence-based medicine trying to teach pharmacology.
I left ND school particularly because I was required to do 3 homeopathy courses and treat patients with it to graduate. I ethically couldn't.
Remember, the ND licensing exam, the NPLEX, labels homeopathy a "clinical science".
Think you'll find that you go south from Detroit to Windsor...
I found some of the comments in this post surprisingly ignorant. For example, this comment:
"2) The assertion that the body has the potential to heal itself is not a scientific one."
When was the last time you had a cut, scratch, or bruise? Did you have to have a surgeon reconstruct your skin? Nope, your body did it.
The body has a variety systems that repair injuries and bring physiologic systems into balance. Many modern medicines, (some derived from traditional remedies), work in concert with ("rely on") the body's own systems to recover from disease states. To suggest the body isn't able to heal itself demonstrates either gross ignorance or an unhealthy level of emotional engagement in this discussion.
"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."
The author of this diatribe conveniently leaves out the US NIH study that conservatively estimates that between 40,000 and 90,000 people *DIE* in the US from preventable medical errors. Yes, you read correctly, *preventable* medical errors. In other words, there are techniques that can prevent these errors that caused people to die, but highly educated Doctors chose not to implement them in their practices and hospitals.
While we're on the subject, what about all the people who have been injured by prescription medicines? How about Vioxx, Lipitor, Celebrex, or Accutane? What about thalidomide, which Doctors ignorantly claimed was safe for pregnant women? While the history of allopathic medicine is filled with glorious victories, it is also littered with injuries and deaths from incorrect diagnoses, incorrect treatments, and drugs that injure more than they help.
Frankly, I'm not impressed by advanced degrees from top schools. I'm impressed by one thing: *results*. Modern allopathic medicine has many things it is very good at. If I'm in a car accident, I want to be treated at a top-notch allopathic emergency room. Once I'm home, I want good pain management from an allopathic pharmacy. In addition, however, I'll also investigate whether there are complementary (aka naturopathic) treatments that can speed my recovery or make me more comfortable while I recover.
I let the science, not emotion, direct my choices about which remedies I choose. I'm happy to use whatever kind of medicine actually works, whether it is new or old.
Unless you have some emotional hangup... why wouldn't you use what works?
@Curious Skeptic, How do you know what "works" if not through science? Nothing that is truly naturopathic (they borrow from real medicine on occasion) has withstood scientific scrutiny.
As for medical errors, doctors have far more patients than NDs have customers, so raw numbers cannot be compared. Also, as you suggested, if you have a serious problem you'll go to a health professional rather than an ND. Overall, real doctors see way more, and sicker, people than do NDs; thus, bad outcomes are more common.
Go to www.naturowatch.org and educate yourself.
Hey, while they're at it, why don't they let nurses diagnose illnesses, let radiologists interpret X-rays, and let the cab drivers perform surgery?
@#9...That actually may work. For most of the minor complaints filling an ER nurses could diagnose illnesses. Radiologists do interpret x-rays. And in Canada, it is likely that the cabbie was a surgeon in whatever country he come from before ending up here. Unlike the US, the Canadian Medical Association and the government believe that foreign doctors aren't really doctors, and rarely let them retain in the Canadian system. So go with the cabbie...it was probably harder to get through medical school anywhere else than in Canada.
CCNM follows similar program as MDs and DCs do, with additional courses in Asian Medicine, Homeopathy and Nutrition. The ND program is 4 years long, same as DCs and MDs. final year or 4th year is an internship year. In addition we take NPLEX 1, and 2. similar to the NBME (MDs) or NBCE (DCs)or LMCC / CCEB in Canada.
Before attacking you should review the curriculum carefully or discuss with the ND Association in your province / state.
Dr. Michael Smith, BSc, ND, MPH
I am amazed at the ignorance of this author. So many "facts" that he has cited are false. The ND program requires a 4 year bachelor degree WITH science courses before admission.
I have have a chronic autoimmune disease drastically improve after a year of treatment with an ND, after 10 years on pharmaceutical med's (with a list of side effects as long as this page!) that made me sicker. It saddens me to see the misinformation campaign that has been unfairly launched against ND's.
It is always okay to have an opinion, but in my opinion, allopathic medicine has never worked for me, I went for 2 years of infertility treatment and before the doctor even did a test on me he wrote a presciption for clomid!!?? After two years of nothing but blood tests IVF and IUI's costing me in around 20,000 CANADIAN I went to see an ND, he spent hours with me, researching my whole self, the gave me homeopathic medicine, made a small change in my diet, and I was pregnant 2 months later! Magic or not, ND is safe medicine. Allopathic medicine is the number one cause of death! and we watch people die everyday from using it... Say for Arthritis, they prescrip you drugs that in the end dont cure you or help you just make you even worse, giving you first kidney disease then liver disease, you are then given drugs to help with them problems which then gives you high blood pressure and a heart attack... ND have just as much education as a REAL DOCTOR. 4 years of Univiersity and 4 5 years of training. Get your facts striaght. Goodluck to you and the robots of the future, hopefully there is not a power outage during heart surgery!!!
When was the last time you had a cut, scratch, or bruise? Did you have to have a surgeon reconstruct your skin? Nope, your body did it.
Naturopathy is an unusual chimera. It is basically a collection of old fashioned medical superstitions presented under a veneer of highly speculative, quasi-scientific assertions. But given its popularity, it is important, from time to time, to evaluate specific claims made by this particular non-science-based belief system.
Chimera no, snake-oil yes.
Watch these two unnaturopaths on the 06/22/10 Michael Coren show regarding Alternative Medicine:
The quackery begins after Coren comments on divorce.
The unnaturopaths seem to hold their own against the skeptics and sound quite reasonable. If I were on the fence, after watching this I might fall on the side of unnaturopathy, or at least still be unsure aboot the inefficacy.
One thing Mr. Coren does do which is very NB is to get the unnaturopaths to giggle at homeopathy. This prompted me to dig further into the curriculum on offer at their "lurnin' place":
- cupping - creating vacuum on the skin to improve qi
- moxibustion - a burning stick of mugwort is waved aboot the area or acupuncture point to improve qi
- auricular acupuncture - needles inserted into the parts of the ear which correspond to other parts of the body to improve qi
- scalp acupuncture - needles inserted into areas of the scalp which correspond to other parts of the body to improve qi
Those examples are from the three year "Asian Medicine" course.
The last two methods sound suspiciously like phrenology or reflexology where areas of the scalp or foot are rubbed to improve other areas or organs. Just like reflexology, auricular acupuncture has several different maps for what the ear affects. There is the traditional Chinese map or the more modern map "discovered" in the 1950s by a French neurologist who thought the ear resembled an inverted fetus and so assembled his points accordingly. This contradiction implies it doesnât seem to matter where you poke the patient.
Surprisingly, but not really, one of the unnaturopaths is responsible for the second year curriculum which prominently features what the CAND calls a "widely accepted" and "powerful system of medicine" - homeopathy.
Yet these two medical wannabes laugh at it.
"We don't do that!" they exclaim. However, the curriculum adminstrator also serves at a "inturgrated heelin' place" which offers homeopathy. Hmmm.
And yet, after three years of lurnin' homeopathy to become what they are, these two unnaturopaths laugh at one of the core disciplines of their "profession" and lump it with, reiki, chiropractic and crystal ball healing. Coren excoriated chiros and these guys went along with him - after saying they integrate with chiros...
I've had many cuts scratches and bruises over the years and yes a real doctor of some kind patched me up on several of the occaisions. In one case, the necrotic flesh had to be cut away before I could be stitched up. Left to its own devices, my body would not have healed that wound which likely would have become infected. A minor cut could give you tetanus even if the wound healed without intervention.
Unnaturopaths spending roughly the same amount of time in a school as a real doctor is meaningless if the curriculum would be right at home in Hogwarts.
Doctors are human and make mistakes. Unnaturopaths are taught how to be perfect healthcare providers are they?
All while "learning" how to restore qi by giving people hickeys with cups...