Naturopaths in Ontario granted right to prescribe certain drugs
December 2, 2009
Firstly I'm excited to announce to the Centre for Inquiry community a new blog called Skeptic North which bring together leading bloggers and commentators in the skeptic and critical thinking community of Canada. And they've already made a name for themselves. Our friends and allies at Skeptic North blew the whistle on a Bill that would - or rather will - grant naturopaths the right to prescribe some medications. This just passed Third Reading in the Ontario legislature so it's essentially a done deal. But I'm posting some of the writings of Skeptic North bloggers here because this matter is anticipated to be coming to other provinces very shortly.
You should start by reading this: Magician Prescriptions: Ontario Poised to Let Naturopaths Prescribe which was reposted in the National Post.
The following is a re-post of an important piece by Steve Thoms, Editor-in-Chief of Skeptic North, which follows up and clarifies some of the issues:
Why Bill 179 Matters and is a threat to Medical Standards
Pretty messed up, huh? Bill 179 is itself, not explicitly about granting naturopaths the right to prescribe. Its original intent is to offer modest expansion of treatment powers to nurse practitioners, pharmacists, physiotherapists, midwives, dietitians, and medical radiation technologists. After the first reading of the bill, that's all it was going to be, and despite the recommendation of the Health Professions Regulatory Advisory Council (HPRAC), Naturopathic 'Doctors' (ND's) were explicitly shut out of the expansion of powers. After the Bill's second reading however, the recommendations of the HPRAC were put back in, and that ND's should be granted prescription rights was worked into the bill. But not directly: it is being done by amending the existing Naturopathy Act, 2007. This process of amending existing acts is not unusual, but it is a slightly more roundabout way to introduce new health powers (and such, it makes it more difficult to repeal in the future).
Bill 179 now seeks to expand the ability of prescription of schedule 1 drugs to ND's. This will be done by adding the following phrase to subsection 4(1) of the Naturopathy Act, 2007 (which deals with the authorized acts of a Naturopath): "Prescribing, dispensing, compounding or selling a drug designated in the regulations."
Further complicating this is that nowhere in the Naturopathy Act, 2007 is it clear what is defined by "Naturopath", and only defines it as someone who graduated from the College of Naturopaths of Ontario. The problem with this 'standard' is that once a person leaves the college, they can practice just about anything that falls under the loosely defined umbrella of naturopathy, including (but not limited to) homeopathy, traditional Chinese medicine (TCM), Reiki, acupuncture, hydrotherapy (in today's form, it's known as colon cleansing), and therapeutic touch. The naturopathic industry in Canada is largely self-regulated, and naturopathic disciplinary hearings are rare occurrences. So not only does this inclusion allow for non-qualified medical personnel with questionable credentials to prescribe science-based medicine, but it also allows the same power to alt-med practitioners who have a demonstrable record of having treatments that are at best placebo (which violates medical ethics), at worst bogus and dangerous.
The other key amendment to the Naturopathy Act, 2007, deals with regulations in subsection 11, wherein the "Subject to the approval of the Lieutenant Governor in Council and with prior review by the Minister, the Council may make regulations...". Bill 179 would add,
(g) designating the drugs that a member may prescribe, dispense, compound or sell for the purpose of paragraph 7 of subsection 4 (1), prescribing the purposes for which, or the circumstances in which, the designated drugs may be prescribed, dispensed, compounded or sold and prohibiting the prescribing, dispensing, compounding or selling of drugs other than the ones designated.
In other words, the government will create the list of drugs that the ND (and remember, it doesn't even have to be an ND, just someone who went to the Naturopathic College) can prescribe. The list is not finalized yet, and may take up to three years to get to that point But the list of recommendations made by the HPRAC is extensive, and includes anti-inflammatories, antibiotics and some narcotics (which is alarming on two counts: 1) naturopathic education teaches a non-scientific explanation about the nature of infection, and 2) Canada has been in the process of instituting tighter controls on narcotics like Demerol, and morphine, so why increase the number of untrained people that have access to this addictive drug? Once the ND's have a set list of drugs that can be prescribed (as determined by the government), the hard part is over: the naturopathic lobbying groups can pressure the state to expand that list at anytime.
Most successful bills go through three readings (unless special circumstances warrant), and parliamentary convention dictates that the three readings roughly go through these stages: First reading - presentation, Second reading - refinement and fine-tuning, Third Reading - formality. Once a bill gets passed the 2nd reading, it rarely gets rejected or modified for the third reading. There is nothing that says the bill necessarily has to stay in its 2nd stage form, but there is also no reason it can't be defeated (besides convention of course, which is a powerful government tradition in Canada). Defeating a bill at the third reading is unusual, but so is changing a bill so drastically in the 2nd reading in the way that Bill 179 has.
I can't offer better advice than what Scott said the other day: let your voice be known. Let your MPP's know that this bill is a dangerous threat to healthcare standards.
This is not a freedom-of-choice issue for the supporters of naturopathy. There are no laws in the books that disallow anyone from seeking naturopathic treatment. This is about naturopaths and other pseudo-scientific modalities gaining a stamp of legitimacy that non-experts can use to wedge their way into scientific credibility. Like the battles fought by chiropractors in the UK, naturopaths in Canada fight on political grounds, not evidence and science. Their arguments don't stand up to scientific rigor, if they did, they'd be medicine.
While it is true that BC was the first province in Canada to grant ND's the right of prescription, it is generally the case that where Ontario goes, so goes the rest of Canada. We need to stop them here.