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.”
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
