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Should Naturopaths write Western prescriptions? Eeek! And why would they want to?

February 20, 2009

This one is definitely going to piss some people off.

Recently, my provincial government has extended the prescribing rights of pharmacists. Do they know their drugs? Yes, and way better than doctors, and so we consult them on a daily basis. Can they diagnose or chronically manage a patient? No. So, they are allowed to prescribe refills and substitution medications. In most cases this will be a safe, convenient, and economical way for patients to get the medications they need. However, I may have to start writing “no substitutions” on prescriptions of carefully chosen meds, and may discover patients who got refills on their recently started med or long-term med that needs clinical monitoring, without checking in with me.

Now, the BC government is proposing to give greater privileges to Naturopathic doctors. The College of Physicians and Surgeons of BC (CPSBC) isn’t keen on the idea, as described in their letter to the ministry of health. Nor am I. While I think naturopaths have a place in whole-person care, I don’t think their job is to prescribe medications that a physician normally would. I also question whether practising naturopaths really think that it is their mandate to dish out synthetic meds. Also, is it their right to collect MSP fees, or will they bill patients directly, violating the Canada Health Act? I thought naturopathy was meant to be complimentary or alternative, not comprehensive medicine. I recognize there is some overlap, but if so keen to write Western ‘scripts, why not go to medical school?

KC Atwood (Newton-Wellesley Hospital, Newton, Massachusetts, USA) takes an extreme view and writes:

“Naturopathic medicine” is a recent manifestation of the field of naturopathy, a 19th-century health movement espousing “the healing power of nature.” “Naturopathic physicians” now claim to be primary care physicians proficient in the practice of both “conventional” and “natural” medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices. Despite this, naturopaths have achieved legal and political recognition, including licensure in 13 states and appointments to the US Medicare Coverage Advisory Committee. This dichotomy can be explained in part by erroneous representations of naturopathy offered by academic medical centers and popular medical Web sites.

Naturopaths argue that they have adequate pharmacological training to write prescriptions. Maybe? I don’t know. I do know that NDs vs MDs look at diagnosis, physical examination, and management in different ways. Their industry (yes, I’m saying Industry rather than Profession) is not regulated or accredited in the same way as Canadian medical doctors are. They don’t have a code of ethics, provincial care guidelines, and the services they provide are not considered a fundamental human right. But it is changing. The Canadian Association of Naturopathic Doctors might be the start; they have a good summary of education and regulation on their site, indicating that The Council on Naturopathic Medical Education (CNME) is “the only government-recognized accrediting body for naturopathic medical schools in Canada and the United States.” Ok. Sounds decent, right? Looks trustworthy.

But . . . Looking at their Handbook of Accreditation , the ONLY mention of a pharmaceutical curriculum is as follows:

The Basic Sciences portion of the curriculum provides an in-depth study of the human body, using both lecture
and lab. These subjects are taught in the Basic Sciences curriculum:
a. Anatomy (includes gross anatomy, dissection and/or prosection, neuroanatomy, embryology, histology)
b. Physiology (lecture and lab)
. . .
f. Pharmacology and Pharmacognosy

Great. That was thorough! I’m sure they can prescribe safely, based on that information.

Despite my negativity on the prescribing issue at present, I do think Naturopathy can become a legitimate practice. I have met hundreds of patients who’ve met with success. There are some great Naturopathic physicians out there and they have the luxury of time to spend with patients, which is a healing practice unto itself. Many of those I’ve met are keen to grow the clinical scientist within them, and I’ll be eager to collaborate with them in this respect when I’m in practice.

Many ‘allopathic’ remedies were originally derived from plant and animal sources (eg. aspirin from willow bark), but are now synthesized in a lab because it is cheaper to do so. And there are many ‘natural’ remedies that work. For example, Cranberry Tablets seem to be appropriate for preventing UTIs in younger women, there are many nonpharmacologic treatments that are helpful for chronic back pain, and St. John’s Wort proved therapeutic for mild-moderate depression. CAVEAT EMPTOR: SJW has tonnes of interactions; with common drugs (eg .oral contraceptive pills) and with very horrible possibilities (eg. the not uncommon occurrence of rejection of a transplanted kidney via CYP 450 3A4 induction, clearing immunosuppresant too quickly from blood).

We don’t get much teaching about efficacy and safety of Complimentary and Alternative Medicines (CAM). Accordingly, I’m not seeking to recommend or distribute them to patients. Let’s first get the safety measures in place. Then, if there’s evidence-based medicine (EBM) behind them, I’ll welcome natural remedies with open arms. Alternative products are without a Drug Identification Number (DIN #) and to get a DIN, a medication must pass vigorous animal and clinical trials. Without a DIN, the label of a substance can contain no medical promises, and a consumer cannot be sure of the contents. Yes, the cost to patients will be higher if regulation happens, but in my mind, safety and efficacy studies are incredibly important. If the CAM community understood that  need, I think they’d have a better understanding of Western meds.

At present, I would not be comfortable having someone who doesn’t support formal safety trials and EBM prescribing me pharmaceuticals. I hope the BC government agrees.

Do you?

4 Comments leave one →
  1. February 20, 2009 5:59 pm

    Herbs can have an effect on the human body and mind; that’s a given. The standard example I use is that of Willow bark; you can chew it and take away that headache. You could also take the purified, measured, and much more convenient version of it in a handy little pill that you can buy 100 of for a couple bucks, likely within 100 meters of anywhere you might be in the western world. You know that 100 mg (no idea on dosing) of aspirin is 100 mg of aspirin.

    Aspirin also makes a good case for Big Pharma being completely able to make a reliable income off of herbal and natural remedies through proper testing. What is it about St. John’s Wort or Cranberry tablets that actually helps? Isolate, perfect, and test…

    How much willow bark should you chew if you’re forced to buy from an unknown vendor or you have to source the material yourself? What if it’s something more dire, like a heart medication or an anti-psychotic you’ve run out of? Even the bottled brands of herbs can’t be relied on to provide a reliable amount of active ingredient bottle to bottle or batch to batch… this was something that C-51 was supposed to address, but the last government folded before that was passed.

    Also, I have huge problems with homeopathy, which is something often taught in ND (Not a Doctor) programs. I fear for NDs trying to take the place of real doctors as primary care givers. These are people who already can do anything from recommend a ‘detox’ regimen of coffee enemas, reiki treatments, live blood analysis, can steer people away from MMR vaccinations, prescribe homeopathic potions or any other non-evidence based modality and then can also prescribe anti-depressants? That’s a recipe for disaster.

    I agree that the real healing that happens in these ND offices is that they practice active listening. They sit down with the client, and they look them in the eyes and they listen. The offices are calm, and they don’t feel sterile (though I kind of like to think that a place I’m getting medical treatment would be sterile…) and there’s likely a pleasant receptionist and soft music playing and free herbal tea…

    Hell, I’d go to one just to be listened to if I was being told by a doctor that I was fine, as he blasts by at warp speed on the way to see his next patient. CAM practitioners are often working as placebo dispensing unlicensed psychologists, and that’s why they’re winning. Selection bias on the part of the patient just adds to the anecdotal ‘evidence’ and they find more and more clients as real doctors just can’t keep up. I wrote about this as part of my investigation into what exactly an ND studies… http://foo.ca/wp/2008/05/07/healing-the-natural-way/

    • February 20, 2009 10:40 pm

      Thanks Richard.

      I think homeopathy is quite a different kettle of fish. Unfortunately, I get a little closed-minded when it comes to thinking about it, so I thought it best not to write about it.

      Naturopathy, on the other hand can be complimentary to Western medicine. Here, I struggle with terminology, unsure of what to call the MD flavour of medicine. Some say “allopathic,” which has it’s roots in ‘ignorant of symptomatology.’ Others use “modern” or “scientific,” but I worry that this shuts out the NDs who are evidence-oriented. Can’t use “Western” with full confidence, either, since many natural remedies are derived from or used in the Western world.

      At any rate, I do fear letting myself fall into the same trap as some CAM practitioners do, and denying anything that seems foreign (eg. MMR vaccinations). So, I am not quick to dismiss all naturopathic methods as ‘bunk,’ but rather give them the benefit of critical thought.

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  1. Should Naturopaths write Western prescriptions? Eeek! And why would they want to?
  2. Follow-Up to “Should Naturopaths write Western prescriptions?” « Dr. Ottematic

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