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Naturally Trained, Medical Pains

“True or false? Naturopathic doctors are medically trained. Of course we are. I’m a naturopathic doctor,” responds Dr. Jennifer Forgeron, as her name, along with the dubious title “ND” appear next to her on screen.

The Canadian Association of Naturopathic Doctors has produced several television ads featuring Naturopathic doctors sporting white lab coats and stethoscopes highlighting their apparent medical training. “True or false? Naturopathic doctors are medically trained. Of course we are. I’m a naturopathic doctor,” responds Dr. Jennifer Forgeron, as her name, along with the dubious title “ND” appear next to her on screen. Other commercials attempt to dispel the notion that Naturopathic Doctors aren’t regulated, as small text in the corner of the screen subtly notes that ND’s are currently only regulated in five provinces. The screen then fades to the slogan “Medically Trained. Naturally Focused. ™” Just like their medical training, the validity of these television spots should be seriously questioned.

While the Canadian College of Naturopathic Medicine (CCNM), one of the two accredited Naturopathic schools in Canada provides some refreshing clarity on the pre-requisite basic sciences courses, as well as medical science-based courses in the ND curriculum as far as the names of the courses go, there is a depressing drop off in information subsequently. For example, the CCNM course description for Embryology lists the following only, “Basic principles and mechanisms of human development from conception to shortly after birth are discussed. The normal development of each of the body's systems is reviewed, and examples of how abnormal development may occur are given.” No suggested texts are offered, or qualifications of the professors are included. Compounding the concern, it is immediately striking to see that courses such as “Homeopathic Medicine I” and “Massage/Hydrotherapy” are taught alongside these more legitimate courses.

Perhaps as confusing as the slogan CAND has adopted, is the near-ubiquitous association Naturopaths have with the stethoscope. If there was one instrument that isn’t more intimately tied to a doctor, I am not aware of it. A survey of the CCNM course list shows courses such as “Physical and Clinical Diagnosis Practicum I” which offers “competence in taking a patient history and performing a physical examination efficiently and accurately…the skills necessary to conduct a thorough systems-based physical examination, interpret physical findings, elicit a complete medical history, and document the information appropriately.” This would imply training in the use of a stethoscope under the supervision of a Naturopath preceptor, which raises the concern on whether students are being taught to use the device correctly, and more importantly, what conditions are being taught to diagnose. It is difficult to make a sweeping statement about a Naturopath’s proficiency with a stethoscope, but one thing is certain – they are not cardiologists.

The ultimate demonstration of proficiency however, is successfully passing an accreditation exam. One would suspect that in order to boast about being “medically trained,” an aspiring ND should have to complete the same medical licensing exams as a Medical Doctor. This is not the case – not by a long shot. The Naturopathic Physicians Licensing Examinations (NPLEX), while similar in structure to the American USMLE and Canadian LMCC exams are fundamentally different exams. The NPLEX is consistently shorter than the LMCC and USMLE in terms of questions asked and time allotted to write, notwithstanding that it has the additional burden to testing Naturopathic in addition to the Medical content. I wonder how Naturopaths would fare writing the USMLE…

Most concerning about these videos is the underlying message that a Naturopath is sufficient on their own to treat a health issue. The saddening events surrounding the death of Ezekiel Stephan from meningitis after being misdiagnosed and treated with echinacea instead of antibiotics by a Naturopathic doctor is a reminder of the harm those claiming to have a medical training can do. Meningitis is a diagnosis that fundamentally cannot be missed, and one that is taught to medical students early on and repeatedly throughout their training.

Allopathic, or medically-trained doctors are certainly not immaculate when put under the spotlight either. It would be foolish to not suggest that some MD’s have abused their training in similar ways to ND’s, or failed to treat serious medical issues to a reasonable standard. The separation lies with the fact that medicine is a science that subjects itself to the dominion of evidence over all else. What can be proved to not be effective is discarded from the arsenal of medical science, a concept quite the contrary to naturopathy, which makes a nest from the discarded scraps of evidence-based medicine, and then calls it “alternative.”

No doubt, these videos by the Canadian Association of Naturopathic Doctors have been produced reflexively to the increasing public and media attention they have received after cases like Ezekiel Stephan. They insidiously mask that beneath the stethoscope-wielding, white-coated pseudophysician lies an organization in turmoil, struggling to increase their legitimacy and breadth of care, paying little attention to the training they provide and even less to the impact they will have.

One has to wonder then, when a Naturopathic doctor asserts to you that they are medically trained, will they point to a poster in their office, written in small hardly visible text, listing the terms and conditions?

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