MAR
27
0

Are NDs primary care physicians? Maryland says "no"

In Maryland, bills licensing naturopaths for the first time in that state recently passed in both the House (HB 402) and Senate (SB 314).  The Senate Bill is now before a House Committee, apparently for procedural reasons. The licensing legislation will likely go to the Governor soon and I have no reason to believe he won't sign this into law. 

The wheels of legislation were obviously greased for these bills after major amendments which severely curbed the scope of practice NDs wanted.  This allowed the bills to move through both chambers with lightening speed despite being rejected by the Maryland legislature in previous years. Just exactly who was behind this is not clear, although the Maryland Board of Physicians met with naturopaths last year and issued a report which the Maryland Association of Naturopathic Physicians thinks smoothed the way.  We're still on the case, with a more complete review coming up Thursday over on the Science-Based Medicine blog.

No one wants to see NDs licensed to practice, of course. But this particular legislation may actually cramp the style of Maryland NDs. If you look online, you'll find Maryland NDs claiming they specialize in treating ADHD. Others are offering "detoxification," "complete salivary hormone profile," dietary supplements based on your individual biochemistry, an "adrenal stress index test," and homeopathic remedies for treating chronic illnesses.  And, of course, the usual bashing of "conventional" medicine.   

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5039 Hits
MAR
23
0

Physical Therapists may win one in turf war with chiropractors

Chiropractors have for years tried to block physical therapists from performing spinal manipulation by claiming that PTs don't have the education and training to do so safely and effectively. This is laughable coming from a group that purports to detect and correct the non-existent "subluxation" and proceeds to reduce this phantom problem with spinal manipulation. Their objective is to unblock "nerve impulses" and thereby "restore health." So much for effectiveness of chiropractic manipulation.  To add insult to injury, some chiropractors maintain that manipulation of the cervical spine does not present a risk of stroke. So much for safety. 

Physical therapists are trained to employ spinal manipulation as a conservative manual therapy for treating back pain. Some chiropractors employ spinal manipulation in the same manner. The evidence of effectiveness for back pain is slim, no matter who does it.  PTs do not, however, purport to detect and correct the chiropractic vertebral subluxation because they, like the rest of us, realize there is no such thing.  

Chiropractors have been successful in preventing PTs from using spinal manipulation by getting state legislation passed barring them from doing so, even though there is not a shred of evidence that PTs are any less capable at it. PTs using their signature treatment scares them, because patients might start using PTs just to avoid the woo-ishness of chiropractic.  And, of course, MDs prefer to refer patients to PT, so when manipulation is in order the PT will get the business.

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4963 Hits
MAR
16
0

Naturopathic scope of practice expansion

Naturopaths who graduate from 4-year naturopathic "medical schools" claim they are primary care physicians with education and training comparable to medical doctors and doctors of osteopathy.  This is easily refuted.  Naturopathic school graduates can go straight into practice without doing the usual three-year residencies of medical and osteopathic doctors. This is, of course, after many hours spent in clinical training during the last two years of medical school.  In fact, the sum total of clinical training in naturopathic school is roughly equivalent to about 20 working days in a primary care physician's office.  So, let's see, 20 days of naturopathic school clinical experience equals medical school clinical experience plus three years ?  Does not compute.  And then there's the fact that the naturopathic clinical training takes place largely in clinics associated with their schools, not the real-world experience of medical and osteopathic students or the hospital-based training of residents. 

Nor is the classroom education equivalent.  Naturopathic students spend large chunks of time learning about homeopathy, acupuncture and herbs.  They even have classes in humoral medicine.  Yes, that humoral medicine.  The ancient Greek system that postulated the human body is controlled by black bile, yellow bile, phelgm and blood.  It is the source of the idea that bleeding to eliminate excess blood is good for what ails you.  Ask George Washington, who may have been bled to death at the hands of his physicians. 

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4727 Hits
MAR
10
0

Alabama Acupuncture

Alabama does not currently license acupuncturists. It is one of the few remaining holdouts among the 50 states, 43 of which grant acupuncturists a license to practice, with varying definitions of what they can and cannot do.   That may change this year if an acupuncture practice act passes in the Alabama legislature.  I grew up going to south Alabama to see relatives and, frankly, the cultures of acupuncture and Alabama don't seem compatible.  But that was a long time ago. 

Some of the more recent attempts to license acupuncturists have gone all out, defining acupuncture as a form of health care that is based on a theory (using the term loosely) of 

energetic physiology that describes and explains the interrelationship of bodily organs or functions with an associated acupuncture point or combination of points that are stimulated in order to restore the normal function of the bodily organ or function.

Not that the use of twirled needles stuck into patients to unblock "qi" makes any more sense than "energetic physiology," but maybe the acupuncturists are backing off on the more exotic definitions.  This is Alabama, after all. Better to stick with the tried and true here. That is not to say that the acupuncturist couldn't get away with an awful lot under this bill if it becomes law. Acupuncture is defined as being derived from "traditional and modern Oriental medicine concepts and modern research." Whatever Oriental medical concepts are, traditional or modern -- they don't say.  I suppose those parameters are left up to the Alabama Board of Acupuncture and Oriental Medicine, which would consist of three acupuncturists and one public member. And modern research?  That would pretty much knock out everything they do because "modern research" into acupuncture doesn't allow us to "derive" anything other than the conclusion that acupuncture does nothing.  Unless you count the placebo effect, which is, unique among researchers, counted as effective in alternative medicine. 

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3903 Hits
MAR
03
0

Vaccine-preventable diseases: out the front door, in the back door?

You could become easily dismayed by scanning the list of pro-CAM bills over on the "Legislative Updatespage.  Licensing naturopaths as primary care providers, giving prescribing privileges to chiropractors, and so on, leaves one with a distinct impression that none of the state legislators who introduced these bills, or who will vote for them, would know science if it bit them on the behind.  

So let me cheer you up a bit.  It seems that when it comes to protecting children from vaccine-preventable diseases, the state legislatures are starting to get it. A review, published in a recent edition of JAMA, found that not one of 36 bills either creating or expanding personal belief exemptions from school vaccination requirements introduced between 2009 and 2012  passed. None!  At the same time, 3 of 5 bills tightening exemptions did pass. One of these was in Washington State, which we'll return to in a minute.

You'll also be pleased to learn that the survey was based on the database of an organization called the Immunization Action Coalition, a terrific group dedicated to providing accurate, science-based information to the public and health care professionals.  It is a much-needed antidote to the celebrity-fueled, fear-mongering, science-free attempts of the anti-vaccination crowd to hype imaginary vaccination dangers. 

Only Mississippi and West Virginia do not allow anything other than medical exemptions from school vaccine mandates.  The rest of the states either allow religious belief exemptions or both religious and personal belief exemptions.  While the religious belief exemption is easy enough to slip by, the personal belief exemption is so porous it can serve to exempt pretty much any child whose parents will take the time to fill out a form.  Some states do require that parents go through some sort of education about the importance of vaccination.  But the firm believer will remain undeterred. 

 

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4872 Hits
FEB
24
0

Chiropractic "primary care" threatens to invade another state

Just as Hawaiian legislators were pushing back against the overly broad scope of naturopathic practitioners, they turned around and decided to expand the scope of chiropractic practice.  What the right hand giveth to consumer protection, the left hand taketh away.  

The bills (House Bill 1831; Senate Bill 2478) are ostensibly an attempt to modernize the legal definition of chiropractic "to fit the standards, practices, and terminology accepted by the National Board of Chiropractic Examiners."  In other words, a default to the faulty chiropractic educational system to decide what Hawaiian chiropractors can and cannot do.  Unfortunately for patients, chiropractic education simply reflects the turmoil endemic in the chiropractic profession itself.  

At one extreme of the spectrum are the traditional "straight" chiropractors, devoted to the detection and correction, via spinal "adjustments," of the chiropractic subluxation.  They view subluxations as the source of "nerve interference" which, if not promptly removed, cause ill health and disease.  In fact, the patient must be ever vigilant, going in for regular chiropractic checkups to find and eliminate subluxations.  Success is guaranteed because post-treatment examination will reveal that the patient is indeed subluxation-free.  Actually, we are all subluxation-free, but it's because subluxations don't exist, not because any chiropractor found them and took them out. 

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4721 Hits
FEB
15
2

A bit of disinfectant sunshine for Hawaiian naturopaths

A couple of weeks ago, we lauded Hawaii State Senator Josh Green, MD, who introduced a bill (Senate Bill 2577) requiring naturopaths to have the same education and training as MDs and DOs in order to prescribe drugs.  Drugs require a prescription for good reason. You can sicken, even kill, a patient if you don't know what you're doing. 

I did a bit of Googling and was shocked to find just how little exposure to prescribing drugs naturopathic students have in their clinical training.  In fact, they don't have much clinical training at all, in anything. The Council on Naturopathic Medical Education, the accrediting agency for naturopathic "medical" schools, requires the equivalent of what would amount to about 20 days worth of an MD or DO seeing patients in an average family practice clinic.  That's all the clinical training naturopaths need to graduate.  And they don't even do residencies, unlike MD and DO family practice doctors, who must complete a three additional years before going into practice.  

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Recent Comments
Alan
"...unlike MD and DO family practice doctors, who must complete a three additional years before going into practice." However, you... Read More
Monday, 10 November 2014 17:25
Alan
"...unlike MD and DO family practice doctors, who must complete a three additional years before going into practice." However, you... Read More
Monday, 10 November 2014 17:25
6917 Hits
FEB
13
0

Dangerous Liasons: chiropractors and drugs

New Mexico is a microcosm of the intra-fraternity war among chiropractors. The most liberal faction, "chiropractor as primary care physician," (or "DC as PCP") has gained a foothold there, but not without a fight from the traditional "straight" chiropractors.  The latter still has an undying faith in the existence and clinical significance of the non-existent vertebral subluxation, even as some chiropractors are abandoning the concept, much to the straights' chagrin.   Let me hasten to add that the liberals have nothing on the straights in the science department, simply a fervent desire to practice medicine without having to go through the bother and expense of medical school and residency.

The liberal faction scored a victory in 2008 when New Mexico become the first state to legalize a new iteration of chiropractor called the "advanced practice chiropractic physician."  (Chiropractors are all about being called "physicians.") Much to their delight, with 90 hours of additional training (yes, that's right, all of 90) these chiropractors could prescribe certain drugs of, let's just say, dubious efficacy. A few years of legal wrangling over the chiropractic formulary followed that, with the liberals mostly on the losing end.

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5987 Hits
FEB
03
0

Good news, bad news for Coloradans

Last year, legislation passed in Colorado permitting naturopathic doctors who graduate from naturopathic "medical schools" to practice. All the usual pseudo-scientific naturopathic diagnoses and treatments are allowed.  Coloradans will now find themselves diagnosed with diseases of which they were previously unaware, such as chronic yeast overgrowth and adrenal fatigue. The reason for their new diagnoses is not some medical breakthrough, but the fact that NDs made up them up.  Having created these diseases, the NDs can then proceed to treat patients with the faux diagnoses with dietary supplements, homeopathy, colonic irrigation and the like. They can also employ real prescription drugs as long as the drugs are listed on the naturopathic formulary.

Another bill passed which allows pretty much anyone (convicted felons included) to practice medicine. Except they don't call it "medicine."  They call it "complementary and alternative health care services." The bill provides a safe harbor from prosecution for the unlicensed practice of medicine. No education or training is required to offer these services.  In fact, the practitioner can simply make up a treatment and legally sell it to the public. Or he could employ a ready-made fabrication like reiki, therapeutic touch, iridology and the like. 

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Law
4584 Hits
JAN
27
0

A Hawaiian Senator who gets it and other legislative updates

There were just a few bills added to our roster this week, but it does include that rare attempt to actually curb the normally expansive scope of practice enjoyed by CAM practitioners.  

Hawaii licenses naturopaths who graduated from an accredited naturopathic "medical school" and allows them a broad scope of practice.  Unfortunately, this includes prescription privileges for drugs listed in a formulary devised by the naturopathic board. And there are some real drugs in this formulary, including anti-depressants, steroids, anti-coagulants, and drugs for impotence. With additional training, naturopaths can administer drugs IV and IM.  This being naturopathy, injection privileges includes glandulars

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5253 Hits
JAN
14
0

Advocacy

One advantage CAM practitioners (chiropractors, acupuncturists, naturopaths and the like) have over science-based medicine practitioners is the ability to make things up and pretend they are real. They can then sell these creations to the public as health care. State licensing of CAM practitioners helps tremendously in marketing this pseudo-medicine, especially when the product itself is enshrined in state law.

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Law
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