Naturopathic doctors (NDs) aren’t the first health-care providers that come to mind when thinking about vaccines, so it came as a surprise to several people at a Toronto Public Health COVID-19 mass vaccination clinic that an ND was administering vaccines.
Naturopathic medicine is a distinct system of traditional, complementary and integrative medicine (TCIM) recognized by the World Health Organization; it is often seen as an alternative health system in opposition to science-based practices, and as such many would not expect NDs to be involved in vaccinations.
However, numerous people attending the clinic expressed relief at being able to discuss their vaccine worries with an ND, someone they trusted to be skeptical of broad public health measures and knowledgeable of the medical establishment’s flaws. Seeing a provider who they felt understood their health values gave comfort to some of the more hesitant visitors. One particularly hesitant person had a long list of concerns based on information posted online and on social media. The ND listened, responded to the questions, reviewed the risks and benefits of vaccination, and proactively explained side effects. Grateful for the respectful conversation, the hesitant person left the clinic that day but returned a week later to ask for the ND on site to administer a COVID-19 vaccine.
NDs are a regulated health profession in six provinces/territories in Canada. Educational requirements for licensure eligibility include a Bachelor’s degree, graduation from a Council for Naturopathic Medicine Education (CNME) accredited program, and completion of entry-to-practice examinations. The four-year training covers physiology, pathology and diagnostic skills as well therapeutic use of herbs and other natural health products, lifestyle management and disciplines such as Traditional Chinese Medicine.
Naturopathic doctors emphasize nonpharmaceutical interventions, primarily diet and lifestyle modification for health promotion and prevention. Additionally, NDs use nutritional supplements, herbal medicine, mind-body therapies, manual therapies, acupuncture and prescription drugs. Whereas lifestyle education and motivational counselling are broad skills in the wheelhouse of many health-care workers, NDs are uniquely qualified to advise patients with respect to evidence-informed use of natural health products, including patient education regarding effectiveness, dosing, contraindications, adverse effects and drug-herb interactions. No other health-care worker has the specific training in natural health products that NDs do, so this puts them at an advantage in communicating with patients. Use of Traditional, Complementary and Integrative Medicine (TCIM) is high in Canada, with approximately 56 per cent using at least one TCIM therapy, according to a 2015 survey.
NDs have a deep knowledge of the wellness industry, more so than any other regulated health professional. As the wellness industry continues to boom and become more mainstream, it’s uniquely valuable to have a provider with this particular content-matter expertise in health care. NDs can counsel patients on how to separate misinformation and disinformation from the available evidence so that they can safely integrate TCIM into their overall health care.
Criticism of naturopathic medicine has largely stemmed from the perspective that it eschews the use of evidence-based practice. Indeed, individual NDs have been rightfully criticized for pseudoscientific practices. While concern about the need for increased uptake of evidence-based practice in naturopathic medicine is warranted, the perspective that naturopathic medicine is in opposition to evidence-based practice is not consistent with research. Studies demonstrate that NDs have increasingly embraced evidence-based attitudes, education and practice. Research also suggests that multi-modal naturopathic medicine may be effective at managing conditions commonly seen in primary care, including cardiovascular disease, chronic low back pain, depression, anxiety and diabetes. Certainly, MDs concerned about the harms of pseudoscience should be open to dialogue and partnership with NDs who follow evidence-based approaches rather than summarily dismissing the entire profession.
The role of NDs in helping patients to differentiate between nonsense and useful wellness industry information, as well as the time they can allocate toward patient education, is particularly helpful in counselling those who may be vaccine hesitant. During the height of the COVID-19 vaccination effort, NDs worked for local public health units in British Columbia and Ontario at mass vaccination clinics. At these clinics, NDs offered understanding and validation of hesitancy; provided relatability and credibility; and built vaccine confidence through understanding, education and shared values. Although NDs in B.C. are able to administer vaccines as part of their scope of practice, Ontario only temporarily amended the Regulated Health Professionals Act to enable NDs to specifically administer COVID-19 vaccines. With minor regulatory changes, NDs could not only make ongoing contributions to public health but could also become an important part of primary care.
Primary care providers are increasingly burdened by a capacity crisis related to worker shortages, an aging population, pandemic-specific challenges and increased prevalence of chronic disease and multimorbidity. Team-based, interdisciplinary approaches like those employed by family health teams, community health centres and Aboriginal health centres enable more effective and efficient care for patients with multiple health concerns, thereby reducing the workload on family doctors. Much like social workers, pharmacists, dietitians and physiotherapists do in these interprofessional settings, NDs could collaborate in primary care clinics to increase health-care access, support public health measures, prevent and address chronic diseases and reduce unnecessary visits.
Despite standardized training and licensing exams, NDs remain unregulated in a few provinces and territories, which can lead to friction with other health-care providers due to inconsistencies in regulatory guidelines between jurisdictions. These factors can exacerbate ideas of an unbridgeable divide between MDs and NDs that only serves to harm patients.
Differences in provincial regulation of NDs and scope of practice are vast. In Ontario, NDs can requisition laboratory tests, prescribe some prescription drugs and perform Pap tests. In B.C., NDs can prescribe most primary care medications, administer vaccines, insert IUDs and order diagnostic ultrasound and X-rays. Unfortunately, few models currently exist and research is limited on the opportunities and challenges of integrating NDs into the health-care system more broadly and into team-based primary care specifically.
Qualitative research at Anishnawbe Health in Toronto suggests NDs can contribute to positive health outcomes, patient satisfaction and improved access to health care among Indigenous clients. With more than 2.2 million Ontarians who don’t have a family doctor, there is a strong case for leveraging the skills and scope of NDs in helping to address health and human resource shortages, particularly in northern and rural communities.
Innovative, solution-based thinking will be required to navigate working equitably within both public and private health-care systems and insurance models unless government funding is made available to hire NDs on salary. National licensing and scope equivalency across jurisdictions is important to ensure consistency of care and practice standards and guidelines. A pilot project to assess the viability of ND integration into team-based primary care models is necessary to determine appropriate staffing, as well as to evaluate patient outcomes and experiences.