Dalton McGuinty’s big FAIL

As a physician, I am somewhat perturbed by the idea of allowing pharmacists limited prescribing privileges. From what I understand, the reasons behind physicians not being permitted to dispense are multifold.

We’re not trained to do so.
The multiple steps involved in writing and filling prescriptions allow for more chances to catch interactions and errors.
There could be a conflict of interest if the prescriber also collected money for a medication, leading to prescribing of more expensive medications or medications that have a higher profit margin instead of perhaps a more appropriate medication for the patient.

Why none of these are an issue with pharmacist prescribing is beyond me. I don’t want to dispense. I am trained to diagnose and manage various conditions, through lifestyle advice, counselling, surgical intervention, and yes, medication.

Pharmacists have an excellent understanding of medications, dosing, delivery, interaction, and biological effects, far superior to mine, and I do call and ask for advice when I’m in doubt. They call me and query my nonstandard or off-label uses, but a short conversation regarding thought processes and safety usually clears things up. But they do not have my training any more than I have theirs, so I’m not in favour of pharmacist prescribing.

All of that said, pharmacists have a highly evidence-based training. They have, as I have said, an excellent understanding of pharmacologic effects on human physiology.

Naturopaths on the other hand?

Not so much. Phytotherapy, as an example, being the study of herbal medications, must needs be limited to those herbs for which there either lacks scientific evidence for effect, and those for which there is actual evidence for lack of effect. If there is evidence for an effect, mainstream science quickly and merrily assimilates it. And aromatherapy? Seriously?

Naturopathy is based upon the idea that left to its own devices the body heals itself.

With which statement, fair credit, evidence-based medicine agrees, to a point. Macrobid, for example, is a common antibiotic used to treat bladder infections. If the body was not participating in its own cure, this particular antibiotic would be useless, as it merely prevents growth of the bacteria, and relies upon the body’s own defences to cure the infection.

Naturopaths have long been opponents of the evidence base that medicine uses to decide the standard of care. They demand to be allowed special privileges regarding the standard of evidence they use. They cite “other ways of knowing,” and “there are limitations to the randomised placebo-controlled trial.” Indeed there are limitations, but anecdotal evidence, while making for great advertisements and internet arguments, is, if anything, a starting point in science.

Shorter: pftft to other ways of knowing, it’s either useful or it’s not.

Naturopaths are part of the anti-vaccine movement. They buy into the “toxins” theory of disease. They have long argued against the medications they now argue to be allowed to prescribe. If they think medications are so toxic, why on earth do they want to be prescribing them?

In Ontario, Dalton McGuinty’s Liberals originally removed Naturopaths from the list of professions with prescribing privileges. Pressure in the form of a letter-writing campaign put the Naturopaths back on Bill 179, which will soon see its third reading. They are going to allow Naturopaths- anti-evidence based woo practitioners- to prescribe powerful biologically active medications about which they have no understanding. I don’t get it.

This is the government which is currently doing a great job on the largest mass immunisation campaign in Canadian history.

Message to McGuinty and Party: stop this stupidity in its tracks, before you fuck up, something fierce.