Connecticut naturopaths gain "modern" scope of practice

Connecticut naturopaths gain "modern" scope of practice

Connecticut's naturopaths (or "naturopathic physicians" as they like to call themselves) felt their state's "antiquated" naturopathic practice act was cramping their style, so they set out to change it.  The practice act defines naturopathy (or "natureopathy," as it is spelled in the Connecticut statutes) as 

the science, art and practice of healing by natural methods . . .

Naturopaths are limited in their practice to counseling and naturopathic standards like colonic hydrotherapy, physiotherapy and "treatment by natural substances."  There is no specific authority to diagnose or to perform or order diagnostic testing.  Unfortunately, all of that is about to change.

The Connecticut Legislature recently passed Senate Bill 437, giving naturopaths, according to the American Association for Naturopathic Physicians, a more "modern" scope of practice. An odd choice of words considering that naturopathy is based on vitalism, a pre-scientific belief that some incorporeal "life force," unknown to science, governs bodily functions. Nothing modern about that.

As even the CAM-friendly National Center for Complementary and Alternative Medicine points out

Some beliefs and approaches of naturopathic practitioners are not consistent with conventional medicine, and their safety may not be supported by scientific evidence. For example, some practitioners may not recommend childhood vaccinations . . .


Relying exclusively on naturopathic treatments and avoiding conventional medical care may be harmful or, in some circumstances (for example, a severe injury or an infection), have serious health consequences.

The bill specifically defines the practice of naturopathy as

diagnosis, prevention and treatment of disease and health optimization by stimulating and support of the body's natural healing processes . . .

This bill also considerably expands the scope of practice to include:

Ordering diagnostic tests and other diagnostic procedures; . . . ordering medical devices, including continuous glucose monitors, glucose meters, glucose test strips, barrier contraceptives and durable medical equipment; and . . . removing ear wax, removing foreign bodies from the ear, nose and skin, shaving corns and calluses, spirometry, tuberculosis testing, vaccine administration, venipuncture for blood testing and minor wound repair, including suturing . . . 

I imagine this is the only time in all of medical history that the phrase "shaving corns and calluses" has been used in the same sentence as "spirometry" in describing the range of services one might expect from a health care provider.  It is reminiscent of Jethro Clampett's career ambitions on the Beverly Hillbillies. When asked, he'd always answer that he wanted to be either a fry cook or a brain surgeon. It's that kind of a juxtaposition.  

The only way (that I could find) to determine whether Connecticut's Governor Malloy has signed this bill is to wade through dozens of bills on the governor's website, listed not by bill number or in alphabetical order, or anything logical like that, but by the date he signed them.  If he hasn't already signed it, I imagine he will. It passed by a unanimous vote in the Senate.  I tried to find out on the website of the Connecticut Naturopathic Physicians Association but, for all their lobbying efforts to get this bill through the legislature, they don't seem to be aware that it passed.  And I am not going to be the one to tell them.

This increased authority to order diagnostic tests is ironic, considering the only reliable research available shows that naturopathic care is associated with underutilization of cancer and STD screening tests. 

Let's consider some of the disturbing implications of the bill.

  • Naturopaths now have specific authority to diagnose any disease (including their imagined diseases, like adrenal fatigue and chronic yeast overgrowth) and to treat it.  It doesn't matter if they've never seen a case of this disease before in their lives.  Assuming they recognize it in the first place.  Their clinical training doesn't include residency and their school clinics see and treat a very limited number of diseases and conditions.  
  • They can order any diagnostic test, including x-rays, CAT and PET scans, MRIs and mammograms. They can also order blood work, which gives them a golden opportunity to tell patients that, while the lab test may show their results are within the normal range, the patient is actually suffering from "nutritional deficiencies," which can be remedied with dietary supplements, conveniently available from the naturopath.  (These imagined "nutritional deficiencies" are a specialty of "functional medicine," a naturopathic favorite.)
  • Their ability to order glucose monitors, meters and test strips means they will be treating diabetes,perhaps without consultation with a medical doctor.  After all, if the patient is getting his monitoring done through a naturopath, why would he need to see an MD?
  • Spirometry is a means of testing lung function. It is used for patients with diseases like asthma and COPD, whom they will presumably be diagnosing and treating as well.  
  • They will be able to administer vaccines, which will allow parents who believe in the discredited "too many, too soon" anti-vaccine ideology to find a health care provider willing to follow their desired vaccination schedule.  

There are also implications for coverage under the Affordable Care Act.  CAM providers are pushing for an interpretation that would require their inclusion in all provider panels covered by an insurer.  If successful, this means that Connecticut insurers will be forced to reimburse naturopaths for diagnosis and treatment to the same extent as if the naturopath were an MD or DO. 

As scary as this looks, we can find some comfort in these stats from the State of Washington, which gives naturopaths an even broader scope of practice.  Two studies demonstrated less than two percent of insured patients made a health insurance claim for naturopathic services in that state even though coverage of their services has mandated by state law since 1996.   










Points of Interest 06/23/2014
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