Naturopathic doctors are not a solution to the crisis in primary care: doctors, health experts

Vancouver naturopathic doctor Vanessa Lindsay treated a long-time patient’s high blood pressure through diet and exercise.

“She lost weight. She is stronger. She eats well. She has a lot of fluids. She’s sleeping better,” Lindsay said.

But the patient is still taking two blood pressure medications – and since naturopathic doctors are allowed to prescribe medications in British Columbia, Lindsay is working with her patient on those medications, too.

“I can assist with monitoring and safe weaning when appropriate,” said Lindsay, who is also president of BC Naturopathic Doctors.

“So we use complementary care when appropriate, but also incorporate traditional tools when necessary.”

British Columbia, along with the Northwest Territories, has the most extensive naturopathic physician practice in Canada, including the ability to prescribe medications and become certified to administer vaccines.

The Canadian Association of Naturopathic Doctors wants similarly trained doctors across the country to be allowed the same scope of practice, said executive director Shawn O’Reilly.

She touted a four-year training program that she said incorporates scientific evidence and distinguishes “naturopathic doctors” from unregulated doctors who call themselves naturopaths and have no standardized training.

Given the shortage of primary care physicians in Canada, many naturopathic doctors are positioning themselves as a solution, arguing that they have the training to act as primary care providers for patients.

This is causing concern among doctors and health professionals who say they are unable to be a patient’s primary source of medical care.

“We have to be really careful,” said Dr. Michelle Cohen, assistant professor of medicine at Queen’s University and physician at Lakeview Family Health Team in Brighton, Ontario.

“When it comes to naturopathic doctors, my fear is that many of them — and some of their organizations — portray them as just another form of family doctor,” Cohen said.

“They’re not,” she said.

“They learn some anatomy and they learn some physiology, but there’s a lot they don’t do.”

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. That training includes “biomedical and clinical sciences,” including pharmacology and learning about vaccinations, O’Reilly said.

“It’s really the philosophy and approach that naturopathic physicians take to their patients that sets them apart from other medical professionals,” O’Reilly said.

“Their approach is to look at the whole person. So not just its physical aspects, but also mental, emotional, social and environmental (factors),” she said.

“They also really focus on educating their patients about things like lifestyle and nutrition.”

Naturopathic physicians are regulated in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and the Northwest Territories, O’Reilly said, and Nova Scotia is currently regulated.

O’Reilly said that in some provinces many people who call themselves “natural health practitioners” are unqualified and unregulated. These practitioners give the profession a bad name and are most likely to be anti-vaxxers, she said.

But Cohen disputed any notion that naturopathic doctors — even those who graduate from college — could be considered a type of family doctor.

“They have a completely different education and take a different path.”

Cohen said she looked “quite thoroughly” into the training of naturopathic doctors and found that neither the curriculum nor the demands of clinical practice equip them to diagnose and treat serious illnesses.

Although naturopathic doctors argue that they complete a four-year program like a doctor, “the way they portray it is deceptive,” she said.

After completing their four years of medical school, doctors must complete at least two more years of residency training before they can practice, she said.

And while naturopathic doctors are required to have at least 1,200 hours of clinical training, primary care physicians are closer to 10,000 hours, Cohen said.

The type of clinical training also varies, she said, as those who train to be family physicians care for a variety of patients, many of them very sick, on hospital rotations.

Without that kind of experience, a doctor could miss a warning sign that could indicate a patient is seriously ill with certain symptoms and lead to a misdiagnosis, she said.

Still, Cohen sees the role of naturopathic physicians as collaborating with primary care physicians and nurses, as “part of a team that provides care appropriate to their specialty.” This could include advice on lifestyle and nutrition, as well as providing evidence-based information about dietary supplements and their possible interactions with other medications.

Some may also be particularly qualified to offer science-based advice on vaccinations for people who are hesitant and may not trust the medical system, Cohen said, noting that naturopathic doctors have taken part in COVID-19 vaccination campaigns in Ontario.

Dr. Tahmeena Ali, president of BC Family Doctors, agreed that naturopathic doctors can play a special role as part of a patient’s primary care team and said she welcomes their contributions.

“They often have more education about preventative and more holistic nutritional and lifestyle aspects for health promotion, prevention and healing. And I don’t think it has to be an ‘either or,’ but a ‘both,'” Ali said.

She emphasized that communication and coordination between providers is critical for the well-being of the patient and to avoid ordering duplicate diagnostic tests or treatments.

However, other health experts are much more skeptical.

“Natural practitioners who present themselves as a solution to our current crisis are, to say the least, misleading. And from a primary care physician’s perspective, it’s pretty frightening,” said Dr. Sarah Bates, acting president of the Alberta Medical Association’s Division of Family Medicine.

“Now I fundamentally believe that primary care is a team sport. One hundred percent. We should work with nurses, nurse practitioners, pharmacists and psychologists, complementing each other’s practices rather than competing with them. But there isn’t.” “There’s no place for naturopathic doctors there,” Bates said.

“A lot of this is essentially pseudoscientific rhetoric,” she said. “Damage can be done.”

Bates remembers a patient from about 15 years ago who had rectal bleeding, so he referred her for diagnostic tests, including a colonoscopy.

But her patient refused to undergo the procedure.

“She went to her naturopath instead and a year and a half later she came back to me with more bleeding and weight loss. She looked terribly ill,” Bates said.

The naturopath treated the patient for yeast Candida, a fungal infection, she said.

“She died about six months later of colon cancer.”

Bates recognizes that it may sound like she’s trying to protect her “turf,” but she said she’s just trying to protect patients.

“There is enough work for everyone here,” she said. “But the solution is not to hire a doctor who doesn’t have the training to provide a certain level of care.”

Blake Murdoch, senior research fellow at the University of Alberta Health Law Institute, agreed.

“Much of naturopathy is based on the principle that modern medicine only treats symptoms and not the underlying cause, which is patently false unless there is no effective treatment known to science,” Murdoch said in one E-mail.

“This is where alternative medicine supposedly ‘fills in the gaps’ – with things that don’t work or are untested and potentially unsafe.”

This report by The Canadian Press was first published March 25, 2024.

The Canadian Press Health Insurance is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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