Naturopathic licensing and practice expansion bills filed in state legislatures

Naturopathic licensing and practice expansion bills filed in state legislatures

Via the magic of Legislative Alchemy, the new year brings a flurry of naturopathic licensing and practice expansion legislation to the halls of state legislatures. The goal of the American Association of Naturopathic Physicians is full primary care scope of practice for naturopaths in all 50 states. Their efforts, fueled by lobbying funds from dietary supplement and dubious diagnostic testing companies, are filling up the state legislative dockets.

Licensing bills introduced in Mississippi and Indiana would give naturopathic "physicians" an extremely broad scope of practice. In both states, they would be able to diagnose and treat the "undifferentiated patient," that is, a patient of any age with any disease or condition, giving them the same scope of practice in this regard as an MD or DO primary care physician, even though they have about 15,000 hours' less education and training than real physicians and rarely see anything other than mild, self-limiting conditions in the woefully inadequate clinical training they do get. (For more on their insufficient education, see here.)

Both bills would allow naturopaths to use worthless remedies like dietary supplements, herbs, homeopathic remedies and colon hydrotherapy to treat real disease, as well as imagined conditions naturopaths have fabricated, like adrenal fatigue and "toxic overload."

Both states would give the naturopaths authority to order and interpret lab tests, giving them the ability to use quack tests like IgG food "intolerance" testing," unreliable saliva testing for hormonal "imbalances," and dubious MTHFR genetic testing. In Mississippi, they would be able to order diagnostic imaging; in Indiana, they could order and interpret it. For example, naturopaths, instead of radiologists, could interpret mammograms and MRIs.

Naturopaths would also be allowed to prescribe drugs on a naturopathic formulary. In Connecticut, 2014 report by the Department of Public Health found their education and training, plus passing the NPLEX exam, insufficient for prescribing privilege, a fact that has since been admitted by the Board of Naturopathic Examiners. In Mississippi, the formulary would be created by a council consisting of two naturopaths, two pharmacists and one physician. In Indiana, the formulary would simply be approved by the naturopathic board. In both states, naturopaths would be regulated by a board consisting only of naturopaths and public members. The latter are prohibited from being licensed health care professionals, virtually guaranteeing that they will be unable to recognize naturopathic quackery for what it is.

Both states would allow naturopaths to administer drugs, herbs, vitamins, minerals, homeopathic remedies and other substances via all the usual routes, including IV. This would permit them to inject patients with dubious unproven and potentially unsafe concoctions, like high dose Vitamin C, Myers cocktails, mistletoe injections for cancer, hydrogen peroxide injections, and HCG injections for weight loss. They could also perform minor office surgery.

Mississippi naturopaths would be allowed to practice "naturopathic childbirth attendance," which includes management of normal pregnancy, labor and delivery, the postpartum period and newborn care. "Naturopathic childbirth attendance" training is essentially the same as that of a direct-entry midwife, that is, a midwife who is not eligible to become a certified nurse midwife because she is not a nurse and does not have a medical background.

This is only a small sampling of the many dubious practices that would be unleashed upon the citizens of Indiana and Mississippi if naturopaths were allowed to practice legally. Practices of licensed naturopaths in California and Canada should give legislators pause. Of special concern should be the connection between naturopathic care and their patients being behind on immunization, as well as acquisition of vaccine-preventable diseases, due to naturopathic antipathy toward vaccination. 

A trio of bills expanding naturopathic prescription privilege is before the Joint Committee on Public Health of the Connecticut legislature: Senate Bill 125, Senate Bill 314, and House Bill 6250. The bills are vague on specifics. SB 125 says that naturopathic "physicians" who "meet certain [unspecified] requirements" should be allowed to prescribe medication from a specific formulary. SB 314 simply states that the law should be amended to allow naturopaths to prescribe medication "to keep costs down;" although there is no evidence that naturopathic prescribing achieves this goal. 

HB 6250 would allow naturopaths to prescribe medication, but only through a collaboration with a physician or advanced practice nurse. Connecticut naturopaths lobbied for prescription privileges in 2014, when the state "modernized" their scope of practice, but didn't get them. They've failed in subsequent years as well. As mentioned, the state's own Department of Public Health found their education and training, plus passing the NPLEX exam, insufficient for prescribing privilege, a fact that has since been admitted by the Board of Naturopathic Examiners.

In North Dakota, Senate Bill 2256 would allow naturopaths to prescribe, dispense or administer prescription drugs listed on a naturopathic formulary established by a committee consisting of a physician, naturopath, pharmacists and advanced practice nurse. The formulary could not include Schedule I - IV drugs, with the exception of endogenous anabolic androgenic steroids, a potentially dangerous dietary supplement. The bill would also permit naturopaths to perform minor office surgery and if "certified" practice "naturopathic childbirth attendance."

In 2015, former naturopath Britt Hermes helped defeat a similar bill by detailing the deficiencies in naturopathic education and training. North Dakota legislators would do well to heed her advice again.

Washington state law limits naturopaths to prescribing legend drugs and Schedule III, IV and V codeine and testosterone products. Washington Senate Bill 5369 would expand naturopathic prescription privileges to include all Schedule III through V controlled substances, which they could administer by, among other methods, injection. The naturopathic board can require additional education and training. For current prescribing privileges, the board requires a paltry four hours of classroom instruction, even though naturopathic education is admittedly insufficient for prescribing drugs.

In addition to dietary supplements, homeopathy and other typical naturopathic remedies, practice is expanded, cryptically, to include "other nutrients, compounds, and natural substances consistent with naturopathic medical practice" in accordance with rules of the naturopathic board. The naturopathic board will also decide what minor office surgery naturopaths will be able to perform.

In 2014, the State Office of Laboratory Quality Assurance cited a Spokane naturopathic clinic for conducting "live blood cell analysis" tests, which are pure quackery, and asked the Washington State Board of Naturopathy to weigh in on which agency had jurisdiction over the matter. Such is the scientific acumen of the Board that it had no problem whatsoever with the naturopath ripping off patients with worthless "live blood cell analysis." Yet these are the people who'll be making the rules under which naturopaths can prescribe controlled substances and perform office surgery.

Finally, there is a legislative request pending in Maine to expand naturopathic prescribing authority, but no further details are available now. 

You can find out more about these bills and follow them weekly on the Legislative Updates page. Armed with this information, find out how to contact state legislators to oppose these bills here

Points of Interest 01/24/2017
Points of Interest 01/22/2017