2024-03-25 16:47:42
Vanessa Lindsay, a Vancouver naturopath, has long treated a patient’s high blood pressure through nutrition and exercise.
” She has lost weight. She is stronger. She eats well. She is hydrated. She sleeps better,” she summarized.
But the patient is still on two blood pressure medications — and because naturopathic doctors in British Columbia are allowed to prescribe medications, Lindsay works with her patient on those medications, too.
“I can help monitor and wean safely when appropriate,” said Lindsay, who is also president of the Naturopathic Physicians of British Columbia.
“So using complementary care when appropriate, but also integrating these conventional tools when necessary. »
British Columbia, along with the Northwest Territories, has the broadest scope of practice for naturopathic physicians in Canada, including the ability to prescribe medications and be certified to administer vaccines.
The Canadian Association of Naturopathic Physicians wants practitioners across the country who have received similar training to be authorized the same scope of practice.
Its executive director, Shawn O’Reilly, has touted a four-year training program that she says includes science and distinguishes “naturopathic doctors” from unregulated practitioners who call themselves naturopaths without any standardized training.
Amid a shortage of family doctors in Canada, many naturopathic doctors are presenting themselves as a solution, arguing that they have the training to be a patient’s primary care provider.
Different training and approach
That worries doctors and health experts who say they aren’t equipped to be the primary source of medical care for patients.
“We need to be very careful,” warned Dr. Michelle Cohen, an assistant professor of medicine at Queen’s University and a family physician in Brighton, Ontario.
“When it comes to naturopathic doctors, I fear that many of them — and some of their organizations — present them as if they are simply a different form of family doctor. »
“That’s not the case,” she argued.
They learn a little anatomy and a little physiology, but there are also a lot of things they don’t do, she pointed out.
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. This training involves “biomedical and clinical sciences”, including pharmacology and learning about vaccinations, Ms O’Reilly said.
“It’s really the philosophy and approach that naturopathic doctors take with their patients that sets them apart from other healthcare professionals,” she explained.
“Their approach is to look at the person as a whole. So not just its physical aspects, but also its mental, emotional, social and environmental (factors). »
Naturopathic doctors are regulated in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and the Northwest Territories, O’Reilly said, and are in the process of becoming so in Nova Scotia.
Ms. O’Reilly said that in some provinces, many people calling themselves “naturopaths” are neither qualified nor regulated. These practitioners give the profession a bad name and are the most likely to be anti-vaccine, she said.
But Dr. Cohen disputed any notion that naturopathic doctors — even those who go to college — could be considered a kind of family doctor.
“They have completely different training and follow a different path,” she argued.
Dr. Cohen said she looked “pretty carefully” at the training of naturopathic doctors. She judges that neither the program nor the requirements of clinical practice equip them to diagnose and treat serious illnesses.
Although naturopathic doctors say they follow a four-year program like a doctor does, “the way they present it is misleading,” she said.
Doctors must complete at least two additional years of residency after their four years of medical school before they can practice, she said.
And while naturopathic doctors must have at least 1,200 hours of clinical training, family doctors have closer to 10,000, she adds.
The type of clinical training also differs, she noted, because trained family doctors see a wide variety of patients, many of them very ill, in hospital rotations.
Without this kind of experience, a practitioner may miss a “red flag” that could indicate serious illness in a patient with certain symptoms, leading to a misdiagnosis, she said.
A complementary role?
Nevertheless, Dr. Cohen considers it useful for naturopathic doctors to work cooperatively with family doctors and nurse practitioners, “as part of a team providing care that corresponds to their area of expertise.” This could include lifestyle and dietary advice and providing evidence-based information about supplements and how they might interact with other medications.
Some may also be particularly qualified to provide scientific advice on vaccines to people who are hesitant and who do not trust the medical system, Dr. Cohen said, noting that naturopathic doctors have participated in COVID-19 vaccination campaigns in Ontario.
Dr. Tahmeena Ali, president of BC Family Doctors, agreed that naturopathic doctors can play a specific role within a patient’s primary care team and said she values their contributions.
“They are often better informed about the preventative and more holistic aspects of diet and lifestyle in terms of health promotion, prevention and cure,” she explained.
She emphasized that communication and coordination between providers is essential for patient well-being and to avoid ordering duplicate diagnostic tests or treatments.
A “pseudoscientific rhetoric”
But other health experts are much more skeptical.
“Naturopaths who present themselves as a solution to the current crisis are misleading to say the least. And from a family doctor’s point of view, it’s pretty horrible,” said Dr. Sarah Bates, interim president of the family medicine section of the Alberta Medical Association.
“I fundamentally believe that primary care is a team sport. 100 %. 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 for naturopathic doctors,” she judged.
“A lot of it is pseudoscientific rhetoric,” she said. There is a lot of harm to be done. »
Dr. Bates still remembers a patient about 15 years ago who suffered from rectal bleeding; she therefore referred her for diagnostic tests, including a colonoscopy.
But his patient did not opt for the intervention.
“She went to see her naturopathic doctor, and a year and a half later she came back to me with more bleeding and weight loss. She looked terribly ill,” she said.
The naturopath was treating the patient for Candida yeast, a fungal infection, she said.
“She died about six months later from colon cancer. »
Dr. Bates realizes that this may seem like she’s trying to protect her “turf,” but she said she was just trying to protect the patients.
“There is enough work here for everyone,” she said. But the solution is not to introduce a practitioner without the appropriate training to provide a certain level of care. »
Blake Murdoch, senior research associate at the Health Law Institute at the University of Alberta, agrees.
“Much of naturopathy is based on the principle that modern medicine only treats the symptoms rather than the underlying cause, which is demonstrably false, except when there is no effective treatment known to science “, explained Mr. Murdoch by email.
“This is where alternative medicine is supposed to ‘fill in the gaps’ — with things that don’t work or are untested and potentially dangerous. »
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