Why can naturopaths mislead the public about their credentials? Because no one bothers to stop them

The College of Physicians and Surgeons of New Brunswick recently conducted an investigation and found that 41 per cent of the province's naturopaths were using restricted terms like "physician" and "medical practitioner" in contravention of New Brunswick's Medical Act.

That number may surprise you, but Canadian doctors will tell you that have noticed an uptick in health provider misrepresentation over the past several years. These are practitioners without medical degrees who are calling themselves "family doctors" or even experts in the field of oncology, and some imply in their marketing materials that they have graduated medical school.This sort of labelling contravenes regulations in other provinces, too.

'Medically trained. Naturally focused'

And yet, we can hardly blame individual naturopaths for misinformation when their representative organizations model the same behaviour. In 2016, the Canadian Association of Naturopathic Doctors adopted the tagline "Medically trained. Naturally focused."

The Ontario Association of Naturopathic Doctors confidently notes on its website that, like most medical schools, naturopathic school is four years long, with students learning basic science and racking up 1,200 hours of supervised clinical study. This supports claims like those of one Ontario naturopath, who states on her website that naturopathic doctors (NDs) and MDs "get similar levels of training" that are "almost identical."

However, medical students amass, by conservative estimates, about 4,000 hours of supervised clinical study most of which is in the hospital, not a naturopathic office. More importantly, all doctors undergo years of residency training after they get their MD. In the time between graduating medical school and becoming a family doctor, I accrued at least 6,000 additional hours of supervised clinical study. Many of my colleagues train for far longer. If the comparison is to a newly minted MD, then it's highly deceptive to omit the fact that an MD alone does not a doctor make.

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To be sure, naturopathic education does involve basic science and clinical skills, but it's unquestionably false advertising to claim that this represents "medical training." Many health professionals complete multi-year programs where students memorize anatomy, see patients in supervised settings and get tested on clinical skills. That's not "medical" training it's the essential background for almost everyone in health care.And just like "dentistry" and "nursing" are clear and unambiguous ways to describe one's background, so too should "naturopathy" be a sufficient descriptor.The only reason to start throwing the term "medical" around is to deliberately sow confusion about your education.

Five provinces (B.C. Manitoba, Alberta, Saskatchewan and Ontario) have naturopathic colleges that regulate the profession and are mandated to protect the public. This past summer, Alberta surgeon Dr. Carrie Kollias contacted the College of Naturopathic Doctors of Alberta about a naturopath claiming to have "recently graduated from medical school." They replied that this was "not in any way misleading" because his website listed the naturopathic school he attended. But patients shouldn't be required to fact check their provider's background. Using the terms "naturopathic" and "medical" as if they are interchangeable is a bait and switch designed to confuse. Condoning this behaviour as a regulator is a dereliction of duty.

Providing informed consent

Patients need straightforward information about their providers. The spread of misinformation targeting people interested in alternative health demands the attention of our medical regulators. If you're misled about the education of your provider, then that provider does not have your fully informed consent. And since informed consent is a basic health care right, this isn't just a patient safety issue it's a patient autonomy issue as well.

Two concerned physicians, Dr. Quynh Nguyen-Giang and Dr. Linda LeBlanc from Ontario and New Brunswick respectively, have been writing letters to the provincial medical colleges and health ministries, urging them to address this issue. They're also hoping to create an online registry where anyone can report provider misrepresentation. This will help expedite complaints, allow for a more organized response and track the extent of the problem. It's a commendable grassroots effort in light of a mostly lacklustre response from medical regulators.

Institutional lack of concern

While New Brunswick's medical college has launched a legal challenge against several naturopaths for their false advertising, other regulators seem downright uninterested at least in response to appeals from Drs. Nguyen-Giang and LeBlanc. Just like rules around naturopathy vary from province to province, so too does the apparent concern evinced by the medical colleges, with some refusing to even address this problem.

So if we can't reliably count on the medical and naturopathic colleges to take this seriously, then the government must step in. Issues of patient safety particularly ones in which laws are being openly flouted are too important to ignore. Our health ministries need to start pushing back against misrepresentation, challenge naturopathic organizations that promote misinformation and enforce the rules around false health advertising. Expecting this to be solved by a professional turf war is irresponsible. The government owes the public real and tangible efforts to protectaccuracy in health provider information.

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