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Naturopathic doctors aren’t solution to primary care crisis: doctors, health experts

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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.”

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

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Nicole Ireland, The Canadian Press

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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