By Cliff Harvey
Caveat emptor….let the patient beware
The honorific ‘Doctor’ carries with it a certain mystique. We tend to pay more attention to the opinion of someone with a doctorate…and rightly so. The years of study, research and application required to earn a doctorate deserve a certain level of respect, and anyone that has embarked on post-graduate study knows that it’s not an easy journey!
It is exactly this legitimacy that has promoted the drive towards ‘doctorisation’ in many professions, and has also spurred the proliferation of diploma mills and unaccredited colleges.
The health field is perhaps the area most affected by this and there are a plethora of colleges (especially in US states with lax requirements for educational standards such as Hawaii and California) that provide ‘doctoral’ (and Masters) degrees of varying standards. Some of these are simply ‘pay for paper’ colleges that for a fee (and often a ‘recognition of life experience’) will grant an undergraduate, masters or doctoral degree. Others may have an actual course of study which may or may not be of decent quality—but without accreditation it is nearly impossible for a consumer to know whether the coursework is actually of a legitimate standard, and thus many of these colleges have been criticised for not providing a doctoral level of education. Indeed qualifications from some of the more popular (such as the now defunct Clayton College of Natural Health, the University of Natural Medicine and Hawthorne University) are illegal to use in several states in the US (such as Texas ) and are not recognised as accredited programs of Naturopathic medicine by the American Association Of Naturopathic Physicians (AANP)*.
I have reviewed some of the Doctoral Theses from the University of Natural Medicine and in my opinion (coming from being involved in the process of writing a Thesis at AUT University) they are far from what would be considered Doctoral level writing at an accredited University, and typically contain no original research (in other words they are basic narrative reviews).
In New Zealand there is no legal protection of the titular use of the word doctor, but there is some legislation protecting the public from misleading use of the term.
Section 20 of The Summary Offences Act of 1981 provides some umbrella protection for New Zealanders with respect to people falsely representing themselves as holding a degree, qualification or membership that they do not in fact hold. However it does not appear to necessarily protect people holding qualifications and titles that are perhaps dubious (in that they are not accredited or generally recognised).
However, the Health Practitioners Competency Act 2003 (HPCA) offers greater protection. Namely that “A person may only use names, words, titles, initials, abbreviations, or descriptions stating or implying that the person is a health practitioner of a particular kind if the person is registered, and is qualified to be registered, as a health practitioner of that kind”
Therefore we might assume that someone calling themselves ‘Doctor’, in the absence of a recognised doctoral degree (a PhD or similar) or a registered medical doctor (or properly qualified and registered chiropractors who have a history of use of the honorific), and thus providing a confusing representation to the public may be in contravention of the law.
The Act goes on to say: “No person may claim to be practicing a profession as a health practitioner of a particular kind or state or do anything that is calculated to suggest that the person practices or is willing to practice a profession as a health practitioner of that kind unless the person:
Thus someone holding an unaccredited ‘Doctoral’ or Masters degree in 'Holistic Nutrition', ‘Natural Medicine’, ‘Integrative Medicine’ or a ‘Traditional Naturopath’ from one of the many (usually US based) unaccredited colleges and representing themselves as a practitioner or doctor, may also fall foul of this.
Section 8 of the HPCA deals with health practitioners acting outside scope of practice. If someone is representing themselves as practicing in a field such as medicine and yet it is not completely clear that they are not a duly qualified and registered physician (and thus not holding the applicable practicing certificate) they may fall foul of this aspect of the Act also.
Is it fair?...
The Fair Trading Act 1986 specifies (Part 1 section 9) that “No person shall, in trade, engage in conduct that is misleading or deceptive or is likely to mislead or deceive”.
(section 11) “No person shall, in trade, engage in conduct that is liable to mislead the public as to the nature, characteristics, suitability for a purpose, or quantity of services.”
Further section 12A dealing with unsubstantiated representations “A person must not, in trade, make an unsubstantiated representation”. It could be considered then that the use of the term ‘Doctor’, especially when couched in generally confusing terminology and representations that can easily be confused with a medical doctor may well constitute a breach of this section of the Act.
Why does it matter?
1. Safety and assurance: Accreditation provides at least some measure of safety and assurance for the consumer. While it is likely that some unaccredited colleges provide a high standard of education it is nearly impossible for any of us to know.
2. It provides an unfair perception of superior skillset: There are many great nutritionists, naturopaths and other practitioners in New Zealand. We don’t call ourselves ‘Doctor’ unless we have a PhD, but the perception would often be that the ‘Doctor’ has a superior level of knowledge and skill-set, when in fact the opposite may be true.
Some common red flags:
A ‘certified traditional naturopath’ in the US and Canada often implies that the person did not go to an accredited college of natural medicine and cannot therefore use the term ND / Naturopathic Doctor.
Multiple Doctoral Degrees
There are many great practitioners and researchers that have spent countless years accumulating several different doctoral degrees, but do be wary as some of the unaccredited colleges provide multiple qualifications and a flexibility of which qualification the graduate chooses to use. For example a graduate may be granted a doctorate in natural medicine and a PhD at the same time, for the same work—something a legitimate university would never do and that often is in contravention of the convention of a PhD being a research doctorate (more on that below).
A PhD without appropriate research
A PhD is a research degree. Typically one would only be granted after a significant amount of original research has been performed, and this research should provide significant progress in the field. In other words it needs to be primary research that adds significantly to the body of evidence in that field. Many of the dissertations required for unaccredited doctorates do not require actual ‘research’ and are simply narrative reviews of the literature (and can be of a highly variable standard).
Not stating plainly where the degree/s were earned
It can often be quite a task to actually find out where someone studied! Typically a practitioner with a legitimate qualification will be very up front about where they gained their degree or diploma.
What can I do?
1. Ask your practitioner where they studied and check whether it is an accredited college.
In the US: http://ope.ed.gov/accreditation/Search.aspx
Note: If they are a Naturopath to be properly qualified in the US and Canada they will have studied at one of six universities: http://en.wikipedia.org/wiki/List_of_accredited_schools_of_naturopathic_medicine_in_North_America
In New Zealand: http://www.nzqa.govt.nz/providers/index.do
2. Check whether the practitioner is registered with an accrediting body in New Zealand. For nutrition these are: Dieticians New Zealand, New Zealand Nutrition Society and the Clinical Nutrition Association.
My issue is not with complementary and alternative practitioners seeking non-traditional education. My issue is solely with a misrepresentation of qualification and skills that seeks to create an (unearned) perception of superiority to other great practitioners in the field. It seems disingenuous to use an honorific to garner a greater goodwill from the public and a competitive advantage if that use is unwarranted, or ethically and legally dubious.
* In the United States and Canada a licensed naturopathic physician (N.D.) attends a four-year graduate-level naturopathic medical school and is educated in all of the same basic sciences as an M.D., but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology, and counseling (to encourage people to make lifestyle changes in support of their personal health). A naturopathic physician takes rigorous professional board exams so that he or she may be licensed by a state or jurisdiction as a primary care general practice physician. Additional information on naturopathic schools can be found through the American Association of Naturopathic Medical Colleges at www.aanmc.org or the AANP at www.naturopathic.org.
Texas Higher Education Coordinating, B. (2015). THECB - Institutions Whose Degrees are Illegal to Use in Texas. from http://www.thecb.state.tx.us/?objectid=EF4C3C3B-EB44-4381-6673F760B3946FBB