Naturopaths win a couple; chiropractors and acupuncturists strike out (so far)

Naturopaths win a couple; chiropractors and acupuncturists strike out (so far)

No man's life, liberty or property are safe while the Legislature is in session.

Or health, we might add. State legislatures are in large measure responsible for the pervasive infiltration of pseudo-medicine into the American healthcare system.  The states hold the power to license chiropractors, acupuncturists, Traditional Oriental Medicine practitioners, naturopaths and homeopaths.  And, unfortunately, they do license them.  It is thus that subluxations, adrenal fatigue, chronic yeast overgrowth, and blocked qi become legally permissible diagnoses instead of fraud. Ditto for pseudo-remedies such as green tea suppositories, homeopathy,glandulars, colonic irrigation, cupping, subluxation adjustments, auricular acupuncture detox and the ever-increasing number of other illegitimate treatments for both real and imaginary conditions being dreamed up by CAM practitioners. 

To give credit where credit is due, Congress is responsible, via passage of the misleadingly named Dietary Supplement Health and Education Act, for the plague of vitamins, minerals and dietary supplements scarfed down by Americans to mostly no benefit, but great cost.   And it is Congress that allows the sale of homeopathic products as remedies for various diseases, mild (colds) to major (influenza).  Not to mention Congress's creation of the taxpayer-funded ($2 billion and counting) National Center for Complementary and Alternative Medicine.  

(And, also to give credit where credit is due, that quotation is from New York County Surrogate (i.e., probate judge) Gideon J. Tucker, who penned it in a probate case in 1866, although it is sometimes incorrectly attributed to Mark Twain.)  

Fortunately for our life, liberty, property and health, some of the state legislatures are starting to wind down for the year, and others weren't in session at all in 2014.  In case you thought (if you thought about it at all) that all state legislatures operated just like the one in your state, you would be wrong.  They all make up their own, totally different, rules, session times, operating procedures and so on. Tiny Delaware's legislature meets for 6 months this year; behemoth Texas doesn't meet at all. Go figure.  

Let's take a look at how the CAM lobby is making out this year in states where legislative sessions are ending.  A quarterly report, if you will. 

Naturopaths had one major success so far -- getting licensed in Maryland. Although the Governor has not yet signed off, he almost certainly will. But as I opined both here and over at Science-Based Medicine, this may turn out to be somewhat of a pyrric victory.  Unfortunately, naturopaths will be able to diagnose and treat any patient with any disease or condition. Legislatures do not seem to "get" that limiting the treatments available to CAM practitioners, while important, is of limited benefit if you don't curb their ability to diagnose all comers with their made-up conditions and diseases, the aforementioned being but a sample of their creativity in finding pathology where none exists.  Or not finding pathology where it does exist because of lack of training.  (There is no residency training for the vast majority of CAM practitioners, and, even there, it is largely in outpatient clinics.).  Maryland NDs will be able to rely on their standard "natural" remedies, such as homeopathy, dietary supplements, herbs, hydropathy (but not colonic irrigation), and the like.  But they will be watched!  NDs will be under the jurisdiction of the Maryland Board of Physicians, a job the Board is undertaking reluctantly.  And they must have a collaborative and consultation agreement with an MD or DO.  I wonder what sort of physician would wade into that?  And speaking of physicians, NDs can't call themselves "physicians."

The American Association of Naturopathic Physicians is leading a campaign to get NDs licensed as primary care physicians with the same scope of practice as an MD or DO family practice physician, including full prescription privileges.  In states where they are licensed but short of that goal, they keep coming back to the legislatures, year after year, for more.  In Utah, they were partially successful.  The Governor just signed a bill giving them the right to administer percutaneous injections with local anesthetics, nonscheduled prescription drugs and "natural substances." (Imagined ND conversation with patient:  "I'm going to inject your knee with a little homeopathic remedy  here to relieve that pain.")  As a sort of quid pro quo, the bill removes one ND from the committee that approves the ND formulary and added a position for an MD or DO.  

NDs were not as fortunate in Idaho, where a bill that would have clarified their scope of practice was defeated.  Idaho licensed NDs in 2005, but it's not doing them much good because the law was never implemented.  Best I can tell, this leaves them pretty much where they were before licensing.  Generally, in states where NDs are not licensed, they practice anyway, gliding under the medical board's radar by saying they don't diagnose and don't treat diseases.  (Wink, wink, nod, nod.)  But they don't get to kick out the traditional naturopaths, who don't have 4-year degrees.  Once the NDs get licensed, practicing naturopathy without a license is against the law, giving the NDs a monopoly.  This year a bill was introduced clearing things up for them.  The bill would have defined naturopathy as a "comprehensive system of primary care" and put them under the jurisdiction of a Board of Naturopathy.  They would have been able to prescribe, administer and dispense prescription drugs and medical devices.   

Chiropractors have already gotten pretty much of what they want.  Or, at least most of what most of them want, although not the ones who want to be primary care physicians and prescribe drugs.  The latter have been trying to expand their scope in a few states, without much success so far, except in New Mexico.  In that state, they've already created a new iteration, called the "advanced practice" chiropractor, with the authority to prescribe a limited formulary of drugs.  Most of which no respectable physician would use, such as glandulars, or at least use in the way these guys do. But they want more.  This year, a bill  was introduced allowing chiropractors to get their hands on real prescription drugs, although not what is termed "dangerous drugs," if approved by the chiropractic board (now there's a safeguard!).  The "advanced" types could prescribe, inject and dispense all drugs, except Schedule I and II controlled substances, used in primary care practice. Fortunately, the bill never even made it out of committee before the legislature adjourned for the year.  

In Washington, of all states, chiropractors suffered two setbacks.  A bill allowing them to perform physicals for school athletics and commercial driver's licenses failed.  A bill allowing physical therapists to use spinal manipulation passed and was signed into law by the Governor.  This is a significant defeat, as chiropractors have long claimed, with no evidence, that physical therapists cannot safely employ spinal manipulation.  Their political power has allowed them to get laws passed in a number of states prohibiting PTs from using this manual therapy.  Now PTs are fighting back, and winning.  

Finally, if  states are going to license acupuncturists, they should following Mississippi's example by requiring a physician referral before they can see patients.  A bill to remove that requirement in certain instances failed this year.  Although it might be considered something of a medical backwater by some, Mississippi was one of the last states to license chiropractors, and is one of the handful of states that doesn't recognize either religious or philosophical exemptions from vaccination.  Good for Mississippi, for showing a lot more common sense than some of those funny-talking Yankees.

Rhode Island becomes the latest state in push for ...
Points of Interest 04/05/2014