A Doctor by Any Other Name

Csilla Egri, Tasneem Pirani-Sheriff

ABSTRACT

This interview–style commentary piece addresses some key concerns medical professionals might have about the care provided by complementary health care practitioners, specifically naturopathic doctors (NDs). As relative content experts in their respective fields, questions are asked by a medical student and answers provided by a student of naturopathic medicine. Readers will gain a first hand understanding of the ND route of education, scope of practice, as well as answers to some common myths around the practice of naturopathy.

INTRODUCTION

As a student tasked with learning all of the anatomy, physiology, and pathology of the human body, I sometimes feel I’m barely able to tell up from down. But I do know that I want to do good. I want to make people, patients, feel well. And from the biopsychosocial model of health that is by now all–too–familiar, I am aware that wellness is more than just being free from disease.

As a medical student, I certainly identify with the above statement. But so does my colleague, a third year student at the Boucher Institute of Naturopathic Medicine. In fact, the above statement is an accurate description of both our experiences in our respective medical educations, as well as our motivations for choosing them. We both attended graduate school at Simon Fraser University, both working late hours by the benchside, cursing our cell cultures, and writing and rewriting our theses. It was after we finally secured our title as “Master’s of Science” that our paths diverged. The pursuit of a four–year degree that differs by one letter in the alphabet will have a profound impact on how we are viewed by society, the respect we are given, and the stereotypes we give one another.

To better grasp this one letter divide and address the misinformation, I simply decided to ask them some questions and share with you the answers.

What defines naturopathic medicine?

Naturopathic medicine is a system of healthcare that integrates modern scientific knowledge with traditional medicine. Six basic principles govern our treatment:

  1. First, do no harm
  2. The healing power of nature
  3. Prevention
  4. Identify and treat the root cause
  5. Treat the whole person
  6. Doctor as teacher

Our philosophy is to first remove the barriers to health and then stimulate and support the body’s own innate healing power. We emphasize prevention, but in the case of disease, we stress the importance of identifying the underlying cause of dysfunction. NDs in British Columbia are regulated by the College of Naturopathic Physicians of British Columbia (CNPBC) and governed by legislation and bylaws within the Health Professions Act.[1,2]

How does the level of training compare between MD and ND?

ubcmj_7_1_2015_25-27 Fig 1

Figure 1: Total educational hours: a comparison of various health professionals Average total undergraduate (or equivalent) education hours of DC (Doctor of Chiropractic), DO (Doctor of Osteopathy), MD (Medical Doctor), ND (Naturopathic Doctor), PT (Physical Therapist), RMT (Registered Massage Therapist), LMT (Licensed Massage Therapist). Adapted from ProHealthSys.[3]

The ND and MD programs are both very similar in structure and length (Figure 1).[3] A successful ND student must complete:[4]

  1. A Bachelor’s degree including specific premedical science courses
  2. A four–year degree program at an accredited school of naturopathic medicine which includes training in:[5]
  3. Biomedical sciences: anatomy, physiology, histology, microbiology, biochemistry, immunology, pharmacology, and pathology
  4. Clinical disciplines: physical, clinical, differential and lab diagnosis, radiology, naturopathic assessment and orthopaedics, emergency medicine, and minor surgery
  5. Naturopathic modalities: clinical nutrition, botanical medicine, traditional Chinese medicine and acupuncture, naturopathic osseous manipulation, homeopathic medicine, hydrotherapy, and lifestyle counselling
  6. A passing grade on two comprehensive Naturopathic Physicians Licensing Examinations written after the second and fourth years of study

Following graduation, NDs are required to obtain continuing medical education credits each year as outlined by the provincial regulatory boards.[6]

This combined knowledge, experience, and skill allows us to differentially diagnose and treat patients with a wide variety of health conditions.

Are ND’s against conventional medicine?

No. Both naturopathic and conventional medicine have unique roles in patient care. Situations that require specialist–specific or emergent medical care go beyond our scope or level of expertise. In these cases, NDs recognize their limitations and choose to refer patients to MDs for collaborative management.

When discussing the spectrum of care, NDs excel at optimizing lifestyle and health, preventing disease, and treating chronic conditions, whereas MDs excel in emergency and critical conditions. The area in between is ideally where NDs and MDs can work together to provide integrative, patient–centered medical care.

What are some common conditions patients present with and what is an ND’s approach to treatment?

As primary health care providers, NDs see and treat a wide spectrum of patients with varying conditions, similar to general practitioners. However, many NDs choose to focus their practice on more specific areas including, but not limited to, oncology, paediatrics, women’s health, and sports medicine. Regardless of their type of practice, most NDs treat patients with concerns related to gastroenterology, endocrinology, mental health (depression, anxiety), and allergies, primarily because of our extensive training in these areas.[7] Though we treat chronic disease, as mentioned, our primary goals are emphasizing prevention and maintaining optimal health.[8]

Is naturopathic medicine the same as homeopathy?

No. A naturopathic doctor is a licensed medical professional who provides comprehensive patient–centered care. Naturopathic medicine and homeopathy are not synonymous, and unlike NDs and MDs who are licensed physicians regulated by the government, homeopaths are not doctors and do not have a regulated profession.[9]

Are all NDs anti– vaccine?

No. NDs are not anti–vaccine, though as a profession made up of individual practitioners with their own thoughts and beliefs, there are a number of perspectives on the topic. The British Columbia Naturopathic Association (BCNA) does provide a position statement with regard to communications around giving vaccinations.[10] Prevention is one of our primary principles, and vaccinations, proper hygiene, and adequate nutrition fall within that category. Our responsibility as NDs is to educate on the benefits and risks of any treatment, allowing patients to make informed choices about their health, vaccinations included.[10]

Are naturopathic practices rooted in evidence?

We rely on the integration of scientific advancements with traditional forms of medicine to better diagnose and treat our patients (for example, with laser stimulation of acupuncture points and herbal support for multi-drug resistance in cancer and chemotherapy).[11,12,13] Conventional medical research continuously presents support for the use of naturopathic medical practices, such as highlighting the importance of polyunsaturated fatty acids and the intestinal biome in health and longevity.[14,15]

I’m grateful to my colleague for answering my questions and providing a better insight into the naturopathic profession. I know, however, that these few pages will not be enough to mend the historically poor relationship between MDs and NDs. As future physicians, some of our patients will seek alternative care, and it’s at this critical point we must not let our personal or cultural biases sabotage our efforts at optimal and continuous patient care. Our methods and approaches may differ, but we are colleagues in healing and wellness, and in this spirit I encourage you to keep the dialogue open.

EDITORIAL STATEMENT

Traditionally, students studying in Canadian medical schools receive limited exposure to the practice of naturopathy and other forms of complementary and alternative medicine (CAM). In this issue, the UBCMJ has sought to increase students’ awareness of CAM practices by presenting multiple opinions regarding their use. In this article, Csilla Egri, a third year medical student, interviews a naturopathic student and explores a number of common questions and concerns about this profession. The views expressed in response to these questions, as presented in this article, are solely those of the interviewee and do not necessarily reflect the ideas or values of the UBCMJ or the Faculty of Medicine. Please note that that the UBC Faculty of Medicine follows the Provincial Health Services Authority (PHSA) guidelines on vaccinations.

REFERENCES
  1. Legislation and Bylaws [Online]. Vancouver: College of Naturopathic Physicians of British Columbia; 2014 [cited 2015, Feb 19]. Available from: http://www.cnpbc.bc.ca/about-us/legislation-bylaws/
  2. Health Professions Act [Online]. Victoria: Queen’s Printer; 2015 [cited 2015, Feb 19]. Available from: http://www.bclaws.ca/civix/document/id/complete/statreg/96183_01
  3. Professional Comparison [Online]. Burnaby: Professional Health Systems, Inc; 2015 [cited 2015, Feb 19]. Available from: http://prohealthsys.com/site/students/professional-comparison/
  4. Naturopathic Training [Online]. Toronto: Canadian Association of Naturopathic Doctors; 2015 [cited 2015, Feb 19]. Available from: http://www.cand.ca/index.php?45&L=0
  5. Accredited Programs [Online]. Great Barrington: Council on Naturopathic Medical Education; 2014 [cited 2015, Feb 19]. Available from: http://www.cnme.org/programs.html
  6. BCNA Continuing Education 2015 [Online]. Vancouver: British Columbia Naturopathic Association; 2015 [cited 2015, Feb 21]. Available from: http://www.bcna.ca/continuing-education-2015/
  7. ND Curriculum & Synopsis [Online]. New Westminster: Boucher Institute of Naturopathic Medicine; 2015 [cited 2015, May 10]. Available from: http://www.binm.org/prospective-students/nd-curriculum-and-synopsis
  8. Guiding Principles [Online]. Toronto: Canadian Association of Naturopathic Doctors; 2015 [cited 2015, May 10]. Available from: https://www.cand.ca/index.php?49&L=0
  9. List of Regulatory Colleges [Online]. British Columbia: BC Health Regulators; 2015 [cited 2015, May 10]. Available from: http://www.bchealthregulators.ca/#list-of-colleges
  10. BCNA Vaccination Position Paper [Online]. Vancouver: British Columbia Naturopathic Association; 2015 [cited 2015, Feb 21]. Available from: http://www.bcna.ca/about-bcna/articles/bcna-vaccination-position-paper/
  11. Siedentopf CM, Golaszewski SM, Mottaghy FM, Ruff CC, Felber S, Schlager A. Functional magnetic resonance imaging detects activation of the visual association cortex during laser acupuncture of the foot in humans. Neurosci Lett [Online]. 2002 Jul [cited 2015, Feb 21];327(1):53‑6.
  12. Zhang WT, Jin Z, Luo F, Zhang L, Zeng YW, Han JS. Evidence from brain imaging with fMRI supporting functional specificity of acupoints in humans. Neurosci Lett [Online]. 2004 Jan [cited 2015, Feb 21];354(1):50‑3
  13. Chai S, To KKW, Lin G. Circumvention of multi–drug resistance of cancer cells by Chinese herbal medicines. Chin Med [Online]. 2010 Jul [cited 2015, Feb 25];5(26):1‑9
  14. Calder PC. Omega-3 Polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? Br J Clin Pharmacol [Online]. 2013 March [cited 2015, May 13];73(3):645‑662.
  15. Kau AL, Ahern PP, Griffin NW, Goodman AL, Gordon JI. Human nutrition, the gut microbiome and the immune system. Nature [Online]. 2011 June [cited 2015, May 13];474(7351)327‑336.

Egri C, Pirani-Sheriff T. A Doctor by Any Other Name. UBCMJ. 2015: 7.1 (25-27).