This summer has been a busy month for naturopathic doctors, professional regulators and the Ministry of Health. Since 2007 Naturopaths have been fighting to be regulated under the Regulated Health Professions Act to join the likes of medical doctors, midwives, nurses, pharmacists, dieticians and psychologists (among others). It was a long time in the making….just 8 years…., but it’s finally here. Aside from the improvement in regulatory status, a number of interesting and frankly bizarre changes have happened. Perhaps most bizarre; oxymoronic actually, is the provision of pharmaceutical prescribing rights by your ND. That’s right….your naturopathic doctor….the one who attended 4 years of post-University education to learn about how to use natural alternatives to drugs….is finally being granted….the ability to prescribe drugs. Presumably few NDs wanted this, but this is the biggest change they have received.

As an outsider to the process my tendency is to view these changes from the perspective of the patient; not as a nutritionist nor as the husband of a naturopathic doctor. If I were a patient of a naturopath I would be excited for a number of positive changes.

Positive Changes

· Improved regulatory oversight by the Ministry of Health and Long Term Care (MOH) along with a (relatively) new regulatory body TC-CONO.

· The ability for an ND to prescribe medication when necessary will be in the best interest of the patient should no suitable natural alternative exist or with enough evidence to support its use. This will take the strain off the OHIP system by granting you the ability to pay out of your pocket twice (once as taxes directed to OHIP) to manage your health. As I understand it however, only drugs prescribed by an MD will be covered by OHIP. How’s that for a privileged system?

· In order to prescribe medications, NDs will receive continuing education from the Canadian Pharmacists Association and be required to pass an exam before given the rights to prescribe, ensuring ND competency and patient safety.

Well; that’s about it for the good stuff as I see it, much of it is business as usual for NDs but with more strings attached. This short list can summarized as a bump in regulatory restrictions and the inclusion of drugs into their scope of practice.

But here’s a laundry list of things that have been a little thorny since the beginning. I’m being honest here; my public relations hat has been removed and is nowhere to be found. As an outsider looking in, I can’t help but bear witness to a number of sacrifices, regulatory screw-ups and downgrades to service that I really hope are rectified tout-suite.

Negative Changes

Penalizing the One Most Qualified

These regulations are exclusionary; which means that the general public is not bound by many of the rules that limit NDs. As an example, Joe Blow who works down at Health Stores R’ Us can recommend a dose of vitamin D within Health Canada’s safe range guide; up to 4000IU per day (or even outside the recommendations). With the new regulations, NDs are muzzled to recommend these dosages until they complete new training that is redundant to the training they already received prior to graduating as an ND. The government doesn’t allow Joe Blow to recommend or sell Lipitor; that’s the job of an MD, so why would they allow Joe Blow to recommend vitamin D in any dose he chooses while muzzling the professional most qualified to offer that advice to their patients? The level of logical incongruence is too much for me. These rules DO stretch further in that they allow a myriad of non-regulated practitioners to say and do whatever they so choose but muzzle and restrict NDs from free practice. A more prudent method of regulation would be to restrict these practices for everyone EXCEPT the people most qualified (the NDs) and not the reverse; just as we do with drug prescribing, driver licensing, law practicing, dentistry etc. etc.

Pressure to Gain Drug Prescribing Rights

A number of NDs as you might imagine are less than enthusiastic about earning the right to prescribe medications. Most NDs I’ve had the pleasure of meeting have always suggested that getting their patient access to a drug has never been a hurdle; that’s what MDs and OHIP are for. So the new regulations take practices (such as recommending vitamin D in dosages that are consistent with Health Canada’s safe range or TUI) that have always been part of naturopathic practice, and have removed those rights received upon graduation as an ND and held them hostage in the pharmaceutical course. The only way to win back what was stolen by regulators is to learn about prescribing drugs. Do you think NDs were given a grace period to study up on drugs before losing access to their methods of treatment? Nope. Does the pharmaceutical course even cover vitamin D and vitamin D dosages? Nope. Prohibiting NDs from freely using vitamin D despite no mention in the pharmacy course was purely a move of forceful aggression on part of the regulators in my eyes.  I use vitamin D as an example, but the restrictions certainly don't stop there.  This is deliberate restriction of patient care; and one could argue that the health of patients is needlessly being put at risk by regulators.  

Limiting ND / Patient Access to Bloodwork

Prior to the regulations, NDs had access to a wide range of bloodwork. NDs dealt with labs in Ontario, Alberta, and even in the US, depending on what laboratory tests were available in which location. With these new changes, the Ministry of Health has rewarded all of the laboratory business to Ontario-based labs and restricted access to anywhere else. This ensures that all business conducted with these labs will be fully HST taxable and that patients will have a greater number of hurdles to jump through with their ND to gain access to tests outside of the province. Some tests are not offered by Ontario-based labs so they are looking into acting as a middle-person for these out of province tests. We’ll keep you posted in the future as things progress.

Limiting ND / Patient Access to Imaging

Naturopathic doctors are primary health care providers. It is their job to ensure they adequately identify and diagnose your health condition. While the MOH expects this level of responsibility, it has denied NDs access to all imaging and diagnostic capabilities. It’s like enforcing your dentist to properly do her job but denying her the ability to perform an X-ray.

Limiting Convenience for Patients and Increase Lab Wait Times

ALL blood samples previously collected in-clinic by your ND are now only available at a lab. The convenience of in-clinic blood draws is gone for patients, and waiting times and lineups are now even bigger at your local lab. Some tests like the finger prick test for food sensitivities is now a full vial blood draw which is bad news for kids who prefer a prick to a blood draw.

Still no OHIP Coverage

Despite the MOH imposing these restrictions on NDs as a payment for entry into the Regulated Health Professions Act, and despite the regulations by the NNHPD that has been regulating natural health products for nearly 10 years, you can be assured that only your prescription drugs and services provided by your MD will be covered by OHIP. Healthcare is free in Ontario, so long as you visit a medical doctor and take his drugs. Visit an ND and take those exact same drugs and you’ll be paying 100% of the bill. Health Care may be free here in Ontario, but I can’t help but feel it’s a system that rewards the privileged (Conventional medical models and Big Pharma) while leaving the rest of the health professionals and product manufacturers privately competing for whatever is left.

After all is said and done, and all of the facts are distilled to their basic elements, it appears as though NDs, and by extension their patients are losing access to better care. So many sacrifices were made for the sake of getting that “gold sticker” badge of honor that places NDs at the top of the regulatory framework. But with no practical benefit to patients or their NDs, one has to question whether such prestigious regulation is worth it. If you have questions or concerns, feel free to communicate them to us and contact your local MP and let your voice be heard!