Naturopathic Examiners Board admits deficiencies in pharmacology education

Naturopathic Examiners Board admits deficiencies in pharmacology education

A recent announcement from the North American Board of Naturopathic Examiners (NABNE),* which administers the Naturopathic Physicians Licensing Examinations (NPLEX), confirms what we've long known: that education and training in pharmacology at naturopathic "medical" schools is insufficient to give naturopaths prescription drug authority in their scope of practice. NPLEX is now trying to play catch-up by creating pharmacology exam. Why? Because, they explain,

"as new jurisdictions pass laws governing the regulation of naturopathic medicine, and as regulatory authorities expand the scope of practice . . . more NDs are being granted the authority to prescribe drugs."

Thus, they need

"to ensure that NDs who are authorized to prescribe drugs have the requisite knowledge to do so safely."

So, they are going to

"test the competence of entry-level NDs who will have actual prescriptive authority."

This is necessary because, although NPLEX does test examinees' knowledge of commonly prescribed drugs,

"the emphasis on that examination is on drugs that are being prescribed by other practitioners, and the focus is on what an ND needs to know about how those drugs affect the patient and future treatment options."

Meaning, conversely, the exam does not test NDs on whether they have the knowledge to safely and effectively prescribe drugs on their own. They only need to know what everyone else is doing.

Wait a minute. Have we been misled? Naturopathic licensing bills, which are drafted by the naturopaths themselves, regularly include the authority to prescribe drugs. If they fail to get prescribing privileges initially, naturopaths will return to the state legislatures year after year to expand their scope of practice. Once they get authorization to prescribe drugs, they will lobby for expansion of that authorization to include even broader privileges. 

At every step along the way, naturopaths have represented to the public and to legislators that they are trained as primary care physicians and that their education and training in pharmacology is adequate for the task.  For example, according to the American Association of Naturopathic Physicians, naturopaths are "highly trained primary care providers" whose standards are "on par with that of conventional medicine." The AANP represents that

"Naturopathic physicians are trained extensively in pharmacology, including drug-to-drug and drug-to herbs interactions. Their training includes managing patients' medications and coordinating prescription medications with herb/nutritional supplementation." [Emphasis added.]


"NDs are trained to utilize prescription drugs . . ."

We know otherwise, of course. Naturopaths with a four-year ND degree fall 15,000+ hours short of family practice physicians in education and training. Britt Hermes did an audit of the 2016-2017 curriculum at Bastyr University and found that naturopathic students get only 27.5 hours dedicated to pharmacology. Yet, in pushing for expanded prescribing privileges, naturopaths represented to California lawmakers that they can competently prescribe (including controlled substances) based on a claimed 72 pharmacology course hours. In successfully beating back expanded prescribing privileges in North Dakota recently, Hermes did a detailed analysis of her own education and training at Bastyr, debunking naturopathic charts supposedly showing an equivalency in naturopathic and real medical education.

For these and other uncomfortable revelations, Hermes has been viciously attacked by naturopaths. Now, the organization officially charged with testing naturopathic competence admits what she's been saying all along: ND education and training in pharmacology is insufficient.

As a first step in concocting a pharmacology exam, NPLEX is doing a practice analysis to determine which drugs naturopaths' patients are typically taking, or need to be taking, and which drugs naturopaths typically prescribe. In yet another disturbing revelation, NPLEX also wants to know,

"which drugs they need to be able to prescribe in order to take a patient off them."

In other words, unless a naturopath has the legal authority to prescribe a particular drug, she cannot take a patient off that drug. For example, suppose a patient is on Ritalin, prescribed by his physician for ADHD. The naturopath wants the patient to forego Ritalin in favor of naturopathic treatments for ADHD, like homeopathy, cranial osteopathy, dietary supplements, removing eggs from the diet, and acupressure.  If she can legally prescribe Ritalin, she can tell the patient to stop taking it and institute her own regimen of useless, but lucrative, treatments.

So eager was NPLEX to get naturopaths to take the survey (which had to be completed by August 12) that it is giving NDs one hour of continuing education credit in pharmacology for completing it. In other words, while admitting naturopathic pharmacology education is inadequate, NPLEX will give pharmacology education credit to NDs who complete an exercise that will do nothing to improve their pharmacology education.

While there is a passing reference to concerns about safety, optics are never far from the naturopathic mind. According to NPLEX,

"The stake you have in this is that having a legitimate way to test pharmacological knowledge will give further credibility to the profession, and may make legislators more likely to consider expanded scope of practice."

Well, maybe. The problem is that, unlike the USMLE or COMPLEX-USA for MDs and DOs, we don't know what is on the current NPLEX exam. Almost certainly, NPLEX won't reveal what questions are on the pharmacology exam they are going to create. There will be no one outside naturopathy to assess whether NDs can safely and effectively prescribe. Once again, we'll have accept the naturopaths' word for it. Unfortunately, as we see here, their word isn't reliable.

*The NPLEX announcement was included in an email from the Naturopathic Medicine Committee of Osteopathic Medical Board of California, a public agency, sent to all licensed naturopaths. However, curiously, there is no information about the survey on the NABNE or the Naturopathic Medicine Committee websites so I am unable to provide a link. Unfortunately, the actual survey is no longer available online. 

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