For years, naturopaths have lobbied to be recognized as regulated health professionals under provincial law. The argument in favour of regulation is that it gives the public more choice in the health-care system while ensuring all naturopaths adhere to professional standards. In some provinces, such as British Columbia, Alberta and Ontario, those lobbying efforts have been successful. But how well is the public being served?
A good case study in how well the new regulatory system is working is in Ontario, which has one of the most comprehensive regulatory systems for naturopaths in Canada. Under provincial regulations, which came into force last July, naturopaths can treat most conditions under a very broad scope of practice. They are, however, required to adhere to advertising standards as well as professional rules that prohibit them from engaging in areas outside their expertise, such as vaccination.
According to the advertising standard, which applies to websites, flyers, TV and all other forms of public media, naturopaths must ensure statements made are "accurate, verifiable, comprehensible, professionally appropriate and in compliance with the standards of practice of the profession." Guidelines posted on the College of Naturopaths of Ontario website spell out exactly the types of things that are unacceptable, such as statements that create unwarranted and unrealistic expectations about the effectiveness of a treatment or service, the use of endorsements or testimonials, the implication that naturopaths are superior to other regulated health professionals and the use of misleading information.
I recently analyzed the websites of the naturopaths licensed to practice in Toronto. Of the roughly 300 regulated, active Toronto naturopaths with an online presence, nearly half appear to be in breach of the college's rules based on claims made online. The promises are wide-ranging, from naturopaths describing their services as "cutting edge," to those claiming they can reverse the course of dementia, to others who make blanket statements that naturopathy can help anyone with any ailment fully restore his or her health.
One Toronto naturopath, Mark Fontes, promotes himself online as an oncology expert who says naturopathic treatments can have a "significant impact" in cancer care and that in some cases, naturopathic medicine can "act as primary treatment" for cancer. He promotes remedies such as high doses of vitamin C, which he says can break cancer cells "from the inside out." There is no solid evidence that this is true. The U.S. National Cancer Institute says some studies involving animals show high doses of vitamin C can slow the growth of cancer, while other studies show it makes cancer drugs less effective. Fontes did not respond to an interview request.
Naturopath Pat Nardini wrote a blog post on his site touting unproven homeopathic remedies for the prevention of flu – which is also breaking the rules – and reminding anyone feeling "pressure to get vaccinated" should be aware that "nature offers safe and effective options for the prevention and treatment of many seasonal infections, not just the flu." The college's policy on vaccinations states "there are no known alternatives to vaccinations … and a member should offer no alternative therapy." Nardini declined an interview request.
Allison Freeman advertises breast thermography as a non-invasive, painless alternative to mammograms. Her website says thermography, which uses digital infrared imaging, can detect early breast changes "before the growth of a tumour." Both Health Canada and the Canadian Cancer Society have issued public warnings about the ineffectiveness of breast thermography and note the machines aren't authorized to detect cancer. After I contacted her, Freeman deleted references to thermography from her website. She said in an e-mail that she stopped offering the service to comply with the province's new rules, but hadn't had time to update her website in the past nine months.
It's important to keep in mind that these online promotions belong to naturopaths who are licensed as health professionals in Ontario under a regulatory system similar to those in place for other health professionals – a regulatory system that enables them to use the title of doctor.
The College of Naturopaths of Ontario is a self-regulating, complaints-based organization that has the authority to investigate when general concerns are raised. The college declined several interview requests. In an e-mail statement, the college said it would review the three examples listed above to determine if they breach the rules. If there is reasonable risk to the public, the college registrar will ask its Inquiries, Complaints and Reports Committee to investigate. If the risk is lower, the college may discuss the issue with the individual.
From July 1, 2015, to March 31, the college said it received 10 complaints, of which seven are being investigated by the ICRC. The college also initiated 12 investigations, of which 10 remain active.
Alfred Hauk, chair of the Ontario Association of Naturopathic Doctors, an industry association representing licensed naturopaths, did not address specific examples, but said he would be surprised if many naturopaths were in breach of the college's rules. "Our understanding is that the vast majority of NDs in Ontario are being compliant," he said. "I know that people are not purposefully not being compliant."
The Canadian Association of Naturopathic Doctors, which represents members of the naturopathic profession nationally, also declined interview requests but said in a statement that it "supports the important role of regulatory colleges but is not involved with the regulation of the profession." The association has hired public-relations firm Hill & Knowlton to lobby the federal government for broader prescribing powers for naturopaths across the country. Specifically, they are asking for naturopaths to be able to prescribe narcotics and other controlled substances. The association declined to provide details on the specific drugs they are looking to prescribe.
That's a snapshot of what's happening in Ontario, but there are misleading promises and unscientific claims being made online by regulated naturopaths across Canada.
Some naturopaths say they can detect possible diseases years before symptoms appear by studying the appearance of a patient's iris – a field that has no basis in science. Another popular service is chelation therapy, often offered to people with autism or cardiovascular problems as a way to cleanse the body of heavy metals. The website for B.C.'s Kelowna Naturopathic Clinic says many Canadians take medication or undergo surgery to control heart problems: "Although many are satisfied with this approach, some are not and seek alternate treatment. One such treatment is chelation therapy." The site goes on to say that the "ultimate effect of chelation therapy is to restore the health of the arteries" and that studies show a "majority of patients that undergo chelation show a definite improvement in circulation and arterial pulses."
Earlier this year, the U.S. Food and Drug Administration issued an advisory that chelation products are not approved for use in any health condition and may cause dehydration, kidney failure and death. In an e-mail, clinic medical director Garrett Swetlikoff said his website clearly notes that chelation "is not a panacea." "Do not take things out of context," he added.
Many people are fed up with conventional health care – waiting lists, drug side effects, busy doctors who have no time for a discussion – and the limits of medicine when it comes to chronic health problems. Many naturopaths are branding themselves as the solution, promising they have the keys to help anyone get rid of what ails them.
Instead of rushing to legitimize naturopathy, homeopathy and other alternative-care practices, governments across Canada should consider what, exactly, they are getting us into. If naturopaths want the authority that comes with regulation, the profession must also ensure it plays by the rules.
Carly Weeks