Introduction
The popularity of naturopathic medicine has recently increased among Canadians. (1) In 1997, about 39 percent of Canadians had visited a naturopath in the previous twelve months, and by 2006 this number increased to 49 percent. (2) The average number of visits per user per year has also increased from 4.9 to 5.6. (3) However, despite this increase in popularity, controversy still exists around the efficacy and scientific legitimacy of many naturopathic treatments, including, for example, homeopathy, hydrotherapy and various forms of detoxification. (4)
Health-related practice regulations are a matter of provincial legislative jurisdiction in Canada. In the context of naturopaths, there is a high level of variability in adopted approaches to regulation. (5) In recent years, Canadian naturopaths have sought to increase the number of provinces in which they are regulated, while simultaneously attempting to broaden their scope of practice to certain activities traditionally reserved for medical doctors, such as testing for allergies and prescribing pharmaceuticals. (6)
The purpose of this analysis is to present and critique the publicly available justifications provided by proponents of recently-passed regulatory amendments that expand the scope of practice for naturopaths practicing in the provinces of British Columbia and Ontario. In particular, our team sought to assess the type of arguments used to support such regulatory changes, specifically exploring whether any empirical evidence (defined here as non-anecdotal research, including categories set out by the Ontario Health Professions Regulatory Advisory Council: randomized control trials, analytic cohort or case control studies, time series analyses, and expert reports) supporting the efficacy of naturopathic medicine was used. (7) Over the past decade, there has been a general movement toward both evidence-based health care and evidence-based health policy. Indeed, many traditionally-recognized health professionals are required by their professional bodies to adopt an evidence-based approach, and provincial governments have stated a commitment to such an approach. (8) From a scientific perspective, this is logical. Determinations of medical efficacy in a scientific context require an evidence-based or, at least, evidence-informed, approach--one that is based upon established empirical principles (the double blind, three arm clinical trial is often viewed as the "gold standard"). (9) As such, it seems appropriate to gain an understanding of the degree to which evidence of efficacy served as an argument for legitimacy in this context. Our analysis, however, showed that arguments as to the efficacy of naturopathic medicine were either unsubstantiated or missing altogether. Given the aforementioned movement toward evidence-based healthcare, and given the controversy surrounding the efficacy of naturopathic medicine, the evidence should have been more transparent, informing and directing the policy debate.
The Nature of Naturopathy
The traditional scope of practice for a naturopath focuses on natural remedies and lifestyle alterations that are meant to be preventive in nature. The Canadian Association of Naturopathic Doctors (CAND) states that "Naturopathic Medicine emphasizes disease as a process rather than as an entity." (10) One particular core philosophical tenet of naturopathy is medicatrix naturae, which means "the healing power of nature." (11) Naturopaths traditionally oppose what they...