Naturopath prescribing: The hill to die on

Some issues ago I wrote about the fact that the recent Bill 25 permitted pharmacists to renew and adapt prescriptions. I argued that pharmacists who are masters of pharmacopoeia, given limits and conditions, could reasonably be allowed some expansion of their scope of practice. I argued that fighting this legislation would not be a good hill to die on.

Unfortunately I found another hill, one worthy of dying on; naturopath prescribing.

At first glance naturopath prescribing appears to be an oxymoron.
“I like the natural nonpharmaceutical approach,” boasts one Canadian Association of Naturopathic Doctors TV ad.

Moreover, as the British Columbia Naturopathic Association (BCNA) states, the philosophy of naturopathic treatment is threefold:
1. Vis medicatrix naturae: the body has the inherent capacity to heal in the proper therapeutic environment. NDs believe in the recuperative power of the organism, given the correct climate for healing. Determining the correct individualized therapeutic environment is at the core of naturopathic medicine.
2. Tollum causum: remove the cause. Instead of treating the symptoms of disease the ND tries to cure the cause of the disease.
3. Prima non nocere: do no harm. The ND is trained to use therapies that will not cause adverse side effects or cause secondary problems (i.e., iatrogenic disease) as serious or more serious than the original disease.

So why would naturopaths want to prescribe? The answer can be found by going back to 2001 when a review by the Health Professions Council of the scopes of practice of each regulated health profession concluded that prescribing by naturopathic doctors should not be allowed based on questions about their adequacy of clinical training and pharmacology. Shortly after, in the course of a review of federal drug schedules, a large number of so-called natural medicines such as tryptophan, previously available to naturopaths, were moved from over-the-counter status to Schedule 1.

In December 2006 the College of Naturopathic Physicians of BC (CNPBC) petitioned the BC government to return their former formulary access. However, their request was not just for access to a limited amount of “natural” medicines, but for unrestricted access to all Schedule 1 and 2 drugs, which is identical to the formulary access of physicians in British Columbia, with the exception of Schedule 1A drugs, which are controlled substances. The CNPBC argued that un­restricted access, rather than limited access, was necessary because “… as medical knowledge changes rapidly, concurrent with research and therapeutic advances, so do standards for clinical practice.” It is unclear whether a rational analysis ever took place of the CNPBC’s petition, but what we do know is that following the conversation on health, the 2008 throne speech stated “… Naturopaths will be permitted to prescribe medicinal therapies as appropriate and restrictions on their access to medical labs for prescribed tests for patients will be removed.” A subsequent comment from the BC Naturopathic Association stated, “Government has recognized that the shortage of health professionals continues to grow and the best way to combat that challenge is to allow naturopathic physicians and all health professionals to practise to the full extent of their training and ability.”

So finally we have the answer! In order to address physician shortage the government has decided to reverse the 2001 stance of the Health Professions Council in response to public concerns of health care shortages.

The government’s plan to action was crystallized in the January 2009 draft of the Naturopathic Physicians Regulations, which included, among many things:
• The use of the title “physician or doctor” without the “naturopathic” modifier.
• The use of X-ray and ultrasound for diagnostic purposes.
• The ability to perform allergy skin testing and treatment by desensitizing.
• The use of electricity for the purpose of defibrillation.
• The use of hyperbaric chambers.

I, like many of you, respect my patients’ right to make choices in health care. I have had many patients who attended naturopaths when I had nothing more to offer. However, I always felt it strange that once I had exhausted allopathic treatments that patients could then be sold snake oil with absolutely no proof of benefit. I am not afraid to keep an open mind about remedies I know nothing about, but I research their scientific evidence. What I see now, however, is not just an unprincipled expansion of naturopaths into allopathic medicine, but I also fear their contamination of allopathic medicine. So far, allopathic and non-allopathic physicians have been able to live relatively peacefully side by side. However, naturopath prescribing and their expanded scope of practice proposal is a deep foray into the boundaries of allopathic medicine, and gives the appearance of allo­pathic investiture for the purpose of attempting scientific credibility.

We sing from a different hymnal—keep it that way.

—WRV