Pioneering Ontario clinic hopes to make naturopathy mainstream

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If it weren't for the slender acupuncture needles protruding from Jo-Anne Degabriele's calves and knees, you would never guess she is being treated by a naturopath.

The 73-year-old is in a hospital, lying flat on her back in a treatment room that is, by day, part of Brampton Civic Hospital's ambulatory care clinic. The intern overseeing Ms. Degabriele's care is garbed in a crisp white lab coat. So is the clinic's lead supervisor, Jonathan Tokiwa, who bustles around toting patient files, a stethoscope slung around his neck. The whole scene is about as far removed from the old hippie-healing reputation of naturopathy as a herbal remedy is from an antibiotic.

The Brampton Naturopathic Teaching Clinic, where Ms. Degabriele is being treated for her osteoarthritis pain, is the first naturopathic clinic inside a hospital in Canada, making it a pioneer in an emerging and controversial movement to make naturopathy more mainstream.

Ontario is poised this spring to grant naturopaths permission to prescribe some drugs and order lab tests, a proposition that has prompted a fierce backlash from the province's doctors' association and their regulatory college, both of which warn the changes could compromise patient safety.

Those who support expanding the scope of practice say Canadian naturopaths, who require at least seven years of post-secondary education to earn a licence, can help alleviate the burden of chronic, lifestyle-related diseases using natural techniques such as dietary advice, vitamin treatments, herbs, teas, acupuncture, traditional Chinese medicine, water therapy and homeopathy, among others.

But opponents argue the field's problems outweigh its benefits: Naturopathic treatments are generally not subjected to the same rigorous testing and clinical trials as mainstream drugs and treatments. "I think the majority of the medical profession holds the same view we have long held, which is that this is a discipline outside of medicine and therefore one not to be trusted or followed," said Matthew Stanbrook, deputy editor of the Canadian Medical Association Journal.

If the Ontario regulations pass as expected, Canada's most populous province will be following the lead of British Columbia, which in 2010 began allowing naturopathic doctors to prescribe some medicines, order lab tests and X-rays, and perform ultrasounds in their clinics.

Five provinces now regulate naturopathic medicine, including Alberta, which elevated naturopathic doctors to self-regulated professional status in 2012.

"There is a wider acceptance of what we do now," said Nicholas De Groot, a naturopathic doctor and the dean of the Canadian College of Naturopathic Medicine, the Toronto-based postsecondary institution that runs the Brampton clinic. "Ask me five years ago, [I would have given a] different answer."

Although Dr. De Groot has seen a thaw in relations with some individual physicians, years of behind-the-scenes wrangling over the proposed regulatory update in Ontario shows there is still a passionate debate over the place of naturopathy in the country's health-care system.

"The [Ontario Medical Association] remains deeply concerned that much of the proposed expanded scope of practice for naturopaths involves the practice of medicine and not naturopathic medicine," the OMA wrote last fall in a formal response to the latest version of the draft regulations, designed to flesh out a law passed in 2007.

The OMA and College of Physicians and Surgeons of Ontario pointed out a slew of proposed drugs they say are too dangerous for naturopaths to prescribe, including intravenous potassium chloride and potassium phosphate, which are flagged as "high alert" substances by the Institute for Safe Medication Practices in Canada, and intravenous magnesium sulphate treatments for pregnant women with pre-eclampsia or eclampsia.

"Such treatment in a non-hospital setting is extremely dangerous as the risk of seizure in the mother and death to both mother in child is very high," the CPSO wrote.

Both organizations declined interview requests, as did the Transitional Council of the College of Naturopaths of Ontario, which is preparing the regulations on behalf of Ontario's ministry of health.

However, Bob Bernhardt, the president of the Canadian College of Naturopathic Medicine, said patient safety has not been a problem in B.C. – where naturopaths have to take a special University of British Columbia pharmacy course if they want to prescribe – or in the 12 U.S. jurisdictions that allow naturopaths to prescribe.

"Over the last 12 years there have been no recorded incidents of patient harm," he said. "So how can people say that it's not safe when actually it's happening in other places with incredibly good records of safety?"

In an era of tight provincial budgets, naturopaths offer care at no cost to taxpayers. And they can spend more time with patients than busy family physicians. (An average first visit to a naturopath lasts an hour and costs $150, some of which is covered by more generous private insurance plans.)

Dr. Stanbrook, a staff respirologist at two Toronto teaching hospitals, penned an editorial last April defending the CMAJ's decision to publish the results of a randomized clinical trial that found naturopathic care slightly reduced patients' cardiovascular risk. He cast some doubt on the study's findings, but argued the medical community should welcome naturopathy's fledgling efforts to anchor its work in science.

"We can't just wish that this body of people who we consider quacks, frankly … would just go away," he said in an interview. "I think we have to acknowledge that our patients are seeking this group of people out and come to terms with that."

Ms. Degabriele is one of those patients who prefers receiving care from a physician and a naturopath. The retired customer-service agent for a pharmaceutical company started attending the Brampton clinic last September at the urging of her daughter, a nurse.

Along with acupuncture, Ms. Degabriele began a vitamin regime – which included magnesium, calcium, vitamins C, B6 and B12 – and eliminated foods from the nightshade family, such as peppers, white potatoes and tomatoes. She's dropped 27 pounds and noticed a "big, big difference in the inflammation."

The bottom line, she said, "is, I believe, a mixture of natural products plus medication is good for you."