Vancouver naturopathic doctor Vanessa Lindsay has been treating a longtime patient’s high blood pressure through nutrition and exercise.
“She’s lost weight. She’s stronger. She’s eating well. She’s hydrated. She’s sleeping better,” said Lindsay.
But the patient is still on two blood pressure medications – and because naturopathic doctors in British Columbia are allowed to prescribe drugs, Lindsay works with her patient on those, too.
“I can support her in monitoring and safely weaning off one when it’s appropriate,” said Lindsay, who is also the president of BC Naturopathic Doctors.
“So using the complementary care when it’s appropriate, but also integrating those conventional tools when necessary.”
British Columbia, along with the Northwest Territories, has the most extensive scope of practice for naturopathic doctors in Canada, including the ability to prescribe drugs and be certified to administer vaccines.
The Canadian Association of Naturopathic Doctors wants to see the same scope of practice allowed for similarly trained practitioners across the country, said executive director Shawn O’Reilly.
She touted a four-year training program that she said includes science and distinguishes “naturopathic doctors” from unregulated practitioners who call themselves naturopaths without any standardized training.
Amid a family doctor shortage in Canada, many naturopathic doctors position themselves as a solution, arguing that they have the training to be a patient’s primary care provider.
That’s raising alarm among medical doctors and health experts who say they are not equipped to be a patient’s principal source of medical care.
“We've got to be really careful,” said Dr. Michelle Cohen, assistant professor of medicine at Queen’s University and a physician on the Lakeview Family Health Team in Brighton, Ont.
“When it comes to naturopathic doctors, my concern is that many of them – and some of their organizations as well – will present them as though they are just a different form of family doctor,” said Cohen.
“They’re not,” she said.
"They’re learning some anatomy and they’re learning some physiology, but there’s a lot that they don’t do.”
To become a naturopathic doctor in Canada, students must have a bachelor’s degree and then take four years of training at the Canadian College of Naturopathic Medicine. That training involves “biomedical and clinical sciences,” including pharmacology and learning about immunization, said O’Reilly.
“It’s really the philosophy and approach that naturopathic doctors take with their patients that differentiates them from other health-care professionals,” O’Reilly said.
“Their approach is to look at the whole person. So not just their physical aspects, but mental, emotional, social, environmental (factors),” she said.
“They also really focus on educating their patients on such things as lifestyle and diet.”
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 regulated in Nova Scotia.
O’Reilly said that in some provinces, many people calling themselves “naturopaths” are unqualified and unregulated. Those practitioners give the profession a bad name and are the most likely to be anti-vaccine, she said.
But Cohen disputed any notion that naturopathic doctors – even those who go through the college – can be considered a type of family doctor.
“They have a completely different type of training and they follow a different path.”
Cohen said she has looked “pretty thoroughly” into the training of naturopathic doctors and found neither the curriculum nor the clinical practice requirements equip them to diagnose and treat serious illnesses.
Although naturopathic doctors argue they do a four-year program like a medical doctor does, “it’s deceptive the way they present that,” she said.
Medical doctors must do at least two more 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 do closer to 10,000 hours, Cohen said.
The type of clinical training also differs, she said, as those training to be family doctors see a wide variety of patients – many of them very sick – through hospital rotations.
Without that kind of experience, a practitioner can miss a “red flag” that could indicate serious illness in a patient with certain symptoms, leading to misdiagnosis, she said.
Still, Cohen sees a role for naturopathic doctors to work in co-operation with family doctors and nurse practitioners, as “part of a team providing care that’s along their line of expertise.” That could include consulting on lifestyle and diet and providing evidence-based information about supplements and how they might interact with other medications.
Some may also be uniquely qualified to provide science-based counselling on vaccines to people who are hesitant and may not trust the medical system, Cohen said, noting that naturopathic doctors took part in COVID-19 vaccination campaigns in Ontario.
Dr. Tahmeena Ali, president of BC Family Doctors, agreed that naturopathic doctors can play a specific role as part of a patient’s primary care team and said she welcomes their contributions.
“They often have more education on the preventive and more holistic diet and lifestyle aspects to health promotion and prevention and healing. And I don’t think that there has to be an ’either or,' but a ’both,’” Ali said.
She emphasized that communication and co-ordination between the providers is essential for the patient’s well-being and to avoid ordering duplicate diagnostic tests or treatments.
But other health-care experts are much more skeptical.
“Naturopaths presenting themselves as a solution to our current crisis is at the very least misleading. And from the perspective of a family physician, it’s quite horrifying,” said Dr. Sarah Bates, acting president of the Alberta Medical Association’s family medicine section.
“Now, I do fundamentally believe that primary care is a team sport. One hundred per cent. We should be working collectively with nurses, with nurse practitioners and pharmacists and psychologists and complementing each other’s practice, not competing with it. But there is no place in there for naturopathic physicians,” Bates said.
“A lot of (it) is essentially pseudoscience rhetoric,” she said. “There is harm that can be done.”
Bates still remembers a patient from about 15 years ago who had rectal bleeding, so she referred her for diagnostic tests, including a colonoscopy.
But her patient didn’t go for the procedure.
“She went to her naturopathic physician instead, and a year and a half later, she returned to me with further bleeding, weight loss. She looked terribly sick,” Bates said.
The naturopathic practitioner had been treating the patient for yeast Candida, a fungal infection, she said.
“She died like six months later from colon cancer.”
Bates realizes that it might sound like she’s trying to protect her “turf,” but said she’s just trying to protect patients.
“There’s enough work here to go around,” she said. “But the solution is not to introduce a practitioner without the appropriate training to provide a certain level of care.”
Blake Murdoch, a senior research associate with the Health Law Institute at the University of Alberta, agreed.
“Much of naturopathy is based on the principle that modern medicine only treats symptoms rather than (the) underlying cause, which is patently false other than when there is no effective treatment known to science,” Murdoch said in an email.
“This is where alternative medicine supposedly ’fills the gaps’ – with things that don’t work or are untested and potentially unsafe.”
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