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Legislative Alchemy 2014 (so far)

Legislative Alchemy is the process by which credulous state legislators turn practitioners of pseudoscience into state-licensed health care professionals. In addition to unleashing quackery such as homeopathy, colonic irrigation, moxibustion, reiki, cranial sacral therapy and the detection and correction of subluxations on the public, these practice acts typically give chiropractors, naturopaths and acupuncturists the freedom of being governed by their own regulatory boards, to which the practitioners themselves are appointed. The boards, in turn, write the administrative rules governing practitioners and handle public complaints about their services. In the worst cases, legislatures simply hand out the privilege of practicing medicine to pretty much anyone.

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State practice acts also establish the education and training standards for practitioners by requiring graduation from their accredited schools. Here the federal government lends a hand, by turning accreditation over to private agencies run by the practitioners themselves. The federal government also supports the schools by giving them taxpayer-funded student loans and research money.

If the legislature doesn’t give CAM practitioners everything they want the first time around, they return year after year until fully satisfied. The brass ring is full primary care practitioner status with full health care insurance coverage.

Over half of the state legislatures have either shut down for the year or didn’t have a session in the first place. CAM practitioners haven’t been particularly successful in 2014 but there is still plenty of mischief to be done in the statehouses. Let’s look at how they’ve fared so far.

Chiropractic

Chiropractors are licensed in all 50 states and all of their practice acts include the detection and correction of subluxations. What more could they want? Well, prescription privileges, for one thing, and turf protection for another.

It would be nice if those chiropractors who want to see their profession move toward evidence-based practice would begin with reform of the chiropractic practice acts, but there is no evidence they are taking this route. Perhaps they can get their act together and begin with next year’s legislative sessions.

For now, in what I see as a glimmer of hope that legislators are beginning to “get it,” chiropractors are seeing some pushback. For years, chiropractors have, via protective legislation, successfully blocked physical therapists from performing spinal manipulation, making the argument that PTs aren’t sufficiently educated and trained, which compromised safety. There is no credible evidence to support this position. There is yet another these attempt at turf protection pending in California right now.

But Washington State’s governor just signed a bill into law permitting PTs to perform spinal manipulation, although the requirements for getting the necessary “spinal manipulation endorsement” from the state are somewhat onerous. PTs still can’t legally advertise that they perform chiropractic “adjustment, spinal adjustment, maintenance or wellness manipulation, or chiropractic care of any kind.” Of course, why would they want to?

Chiropractors suffered another defeat in Washington as well. A bill allowing them to perform physicals for school sports and commercial driver’s licenses failed to pass.

Two attempts to expand chiropractic practice, one obvious and one a bit sneakier, also didn’t make it. In Hawaii, chiropractors are limited to the diagnosis and treatment of neuromusculoskeletal conditions related to the spine. A bill would have permitted chiropractors to call themselves “physicians” and to diagnose and treat any patient with any disease or condition by any physical, chemical, electrical or thermal method (including dietary supplements), using diagnostic imaging, ordering lab tests, or using any other method of diagnosis or treatment taught by chiropractic schools and approved by the state chiropractic board. In other words, as long as a chiropractic school taught it and the chiropractic board approved it, you can do it, no matter how ludicrous or dangerous.

In New Mexico, the festively-named Sen. Cisco McSorley once again went to bat for chiropractors and once again struck out. New Mexico is the closest chiropractors have gotten to being full-fledged PCPs, and even at that they have a ways to go. (Despite continued efforts, as Harriet Hall and I have discussed.) As of now, with a little additional training, “advanced practice” chiropractors have limited prescription privileges. Sen. McSorley’s bill would have substantially expanded their ability to prescribe and administer drugs.

In response to SBM posts on chiropractic’s dedication to the subluxation, DCs post comments that we are out of date, that chiropractic schools don’t teach the subluxation any more except as a historical concept, and that only the old-timers still believe in it. Tell that to the Minnesota legislature, where Senate Bill 1665 and House Bill 1850 are pending, redefining chiropractic as:

The health care discipline that recognizes the innate recuperative power of the body to heal itself without the use of drugs or surgery by identifying and caring for vertebral subluxations and other abnormal articulations by emphasizing the relationship between structure and function as coordinated by the nervous system and how that relationship affects the preservation and restoration of health.

Sure sounds like the old subluxation to me. The bills would also allow detection of these non-existent subluxations by CAT and PET scans and MRI.

Chiropractors have long denied the risk of stroke from chiropractic neck manipulation. In Wisconsin, Senate Bill 518 is now before the House Public Health Committee. It would create a Task Force on Neck Manipulation to:

examine risks, benefits, and alternatives to procedures associated with manual and manipulative treatment of the cervical spine. The task force shall also determine the necessity of informing patients of possible side effects resulting from treatments of the cervical spine.

The Task Force would consist of three chiropractic representatives, plus on MD, one DO and one PT, as well as legislative members, giving science a fighting chance.

Naturopathy

In the last two years, naturopaths added Colorado and Maryland to the list of states where they can legally diagnose and treat patients, for a total of 18. In those states where they aren’t licensed or registered they can still offer advice as long as they don’t claim the ability to actually diagnose and treat patients, a limitation that appears to be honored mainly in the breach. The goal of the American Association of Naturopathic Physicians is full primary care physician status in all 50 states. Naturopaths fell short of that goal in their latest efforts, with both Colorado and Maryland putting substantial limitations on their scope of practice.

As the AANP promised, the naturopaths will come back year after year and try for more until they get what they want. True to their word, they were back before the Colorado legislature this year in an attempt to expand their scope of practice. Currently, NDs cannot see patients who are under two years of age at all. If the patient is between two and eight, they must give the parents a list of CDC-recommended vaccinations and urge that the child have a relationship with a licensed pediatric health care provider. (A fortunate provision, considering yet another survey demonstrates that ND students are anti-vaccination.) They must also disclose to patients that they are not physicians. Fortunately, a bill to do away with these limitations was defeated. The bill would also have lifted similar restrictions on practitioners of “complementary and alternative medicine,” which, in Colorado, means pretty much anyone who wants to set up shop as a CAM provider. A bill to expand the ND scope of practice also failed in Alaska.

In Hawaii, naturopaths have limited prescription privileges. A Hawaiian physician-legislator introduced a great bill that would have made it a requirement that naturopaths have the same education and training and MDs and DOs to obtain these privileges. Unfortunately, what actually passed, and is now on the Governor’s desk, simply requires beefed up continuing education in pharmacology and prescribing.

A bill to license naturopaths (Iowa) and a bill to implement a 2005 licensing law (Idaho) did not pass. ND licensing bills are still pending in Illinois, Michigan, New Jersey, Rhode Island, New York (passed in Senate, Assembly bill still under consideration), and Pennsylvania (Passed in House, now before Senate). While they vary in specifics, all of these bills would allow NDs to see any patient with any disease or condition, use pseudoscientific treatments like colonic irrigation and functional medicine, prescribe and sell homeopathic remedies and dietary supplements, diagnose and treat nonexistent diseases like chronic yeast overgrowth and adrenal fatigue, and order lab and other diagnostic tests, such as “live blood analysis.” Some would permit limited prescription privileges, like IV administration of “natural” substances. All would allow self-regulation and default to naturopathic organizations to determine who could practice.

Acupuncture

Bills favorable to acupuncturists aren’t doing so well in the Deep South. Acupuncture is not licensed in Alabama, and things don’t look too promising. A bill to license and regulate practitioners of acupuncture and Oriental Medicine is stuck in the Senate Committee on Health with the legislature scheduled to adjourn on May 19th. Next door, in Mississippi, a bill to get acupuncturists out from under the requirement that the patient obtain a physician’s referral failed again this year. And next door to them, in Louisiana, another state that doesn’t license acupuncturists, a bill to create a commission to study whether the state should license them is still pending.

A bill pending in Arizona expands the scope of practice of auricular acupuncture to include treatment for post-traumatic stress disorder, although it limits treatments to five needles per ear, as if that matters. In California, a bill to certify Traditional Chinese Medicine Traumatologists passed in the Senate and is now before the Assembly. TCM traumatology is defined as a system of treatment of musculoskeletal conditions by stimulation of “acupressure points” to “open the body’s defensive chi and stimulate energy movement in the meridians.”

Other CAM-friendly legislation

I’ve saved one of the worst for last. A “chronic Lyme disease” bill passed in the Vermont legislature and is now on the governor’s desk. In an indication of just how strong the Chronic Lyme lobby is, the bill had 31 co-sponsors in the Vermont House.

Not only does it buy into the fictitious disease itself, it includes diagnosis and treatment of multiple systemic infectious disease syndrome. Although the bill doesn’t call it by that name, the syndrome (discussed by Harriet Hall here) is described in its provisions.

The bill notes “a range of opinions in the medical community regarding proper treatment of Lyme disease.” Actually, the “medical community” is confident that CLD is an inappropriate diagnosis and that long-term antibiotic therapy is unwarranted and potentially dangerous. Only outliers, who have created an equally fictitious specialty, Lyme-Literate Medical Doctors (LLMDs), believe CLD is a reality. Naturopaths, on the other hand, don’t seem to have a problem with the widespread condemnation of health care professionals who exploit patients by telling them they have CLD, and why would they? Fortunately for them, NDs, who have a broad scope of practice in Vermont, including prescribing privileges, are included among those who can diagnose and treat CLD.

Apparently because CLD is more of a collection of symptoms looking for a label, diagnosis need not include an actual lab test showing an infection. It can include:

a clinical diagnosis . . . that does not meet the [CDC’s] surveillance criteria but presents other acute and chronic signs or symptoms of Lyme disease as determined by a physician [including NDs]. The clinical diagnosis shall be based on knowledge obtained through medical history and physical examination alone or in conjunction with testing that provides supportive data for the clinical diagnosis.

Naturally, physicians who diagnose and treat CLD do so under the threat of being disciplined for substandard practice. The bill eliminates that possibility. Long-term antibiotic therapy “for the purpose of eliminating or controlling a patient’s infection or symptoms” is permitted and physicians cannot be subject to discipline for prescribing long-term antibiotics as long as the patient is monitored and certain medical record requirements are met. Health insurance will have to cover long-term antibiotic treatment, eliminating cost to the patient as a factor in treatment decisions.

And now, a pitch

The Society for Science-Based Medicine keeps a running tab of CAM-friendly (and the occasional not-so-friendly) bills in the state legislatures. We can’t track all of them, nor can we track every move every bill makes as it wends its way through various legislative committees and onto the floor of legislative chambers and then to the governors’ desks for signing or veto. However, you can keep up with bills in your state and, by going to your state’s legislative website, track them yourself. If you don’t like what you see, contact your legislators and let them know. If you do, let them know that too. There are plenty of posts on SBM with plenty of reasons to support or oppose (depending on what the legislation is trying to do) legislation. Over on the Oppose Naturopathic Licensing! website, I also keep up with naturopathic licensing bills, as well as other bills affecting naturopaths. Plus, you’ll find lots of information on why naturopaths should not become licensed health care practitioners. Even if all you can do is send a link, please do it.

You can bet the chiropractors, naturopaths and acupuncturists, and their lobbyists, are wandering the statehouse halls, even as you read this. Unfortunately, science-based medicine doesn’t have a lobbyist.

Posted in: Acupuncture, Chiropractic, Homeopathy, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

Leave a Comment (30) ↓

30 thoughts on “Legislative Alchemy 2014 (so far)

  1. JohnAW24 says:

    God help us. I can understand how people can fall for this nonsense, but you would think that our elected officials would know better. I live in NY, i didn’t realize that a bill was passed by the state senate, thanks for informing us of that. I now have to go see what chromosomal miscreants voted yes on this bill, hopefully no one I voted for.

    1. mho says:

      Here’s a link to the bill. http://assembly.state.ny.us/leg/?default_fld=&bn=A07860&term=2013&Summary=Y&Actions=Y&Votes=Y

      Especially if your guy is on the Education committee, call!

  2. Mike says:

    Thank you Jan for all you are doing. I’m looking forward to seeing the formation of SFSBM chapters in every state and at every medical school.

  3. goodnightirene says:

    How do we get a lobbyist(s)? What needs to be done beyond fundraising? I’m game–anyone else? Do I send you an email with my contact info?

    I’m not sure I could BE a lobbyist–I sort of have Tourette’s these days when pseudoscience is the topic. I don’t suffer fools. But I am ready to get involved in doing something more constructive than posting comments.

    1. Jann Bellamy says:

      The best thing supporters of science-based medicine can do at this point is keep up with legislation and make your opinion known to legislators. If pro-CAM legislation is opposed at all, it is usually the medical societies and they get written off as protecting their turf.

      We are beginning efforts to have a voice in the legislative process at Society for Science-Based Medicine and we could certainly use financial support, so please become a member and/or donate. As for hiring an actual lobbyist, that will take a lot more money than we have now. The Institute for Science in Medicine is a policy organization that opposes health care legislation not based on sound science. Their website has position statements and white papers on some subjects you can send to your legislators. (For example, a White Paper on Chiropractic and a policy statement on licensing CAM practitioners.)

      1. irenegoodnight says:

        I joined SSBM the first day. I could be more serious about raising money than about lobbying as one person. I have written many times to reps, papers, etc., and get only generic replies (thank you, Rep Doodlebutt loves all her constituents and respects all their views and will consider carefully–blah, blah) that leave me nonplussed.

        The Institute For Science sounds promising–perhaps their position papers would strengthen my letters.

        I will get busy on raising some funds to donate. My daughter and I have a couple of schemes in mind, although one involves setting ourselves up as Phrenologists.

    2. Windriven says:

      Seconding Ms. Bellamy’s point, lobbyists ain’t cheap and many of these battles are fought at the state level and that means lots of lobbyists.

      But it isn’t difficult being your own lobbyist. State representatives and senators are easy to meet and get some time with. You will find that many are at least somewhat sympathetic. But you should remember that they have a broad constituency and an acute sense of which battles are worth fighting. Sometimes the best you can do is to turn awful into bad. That doesn’t make it not worth doing.

      1. irenegoodnight says:

        For the reasons you state, this doesn’t sound like a very effective approach. Also, I can no longer be diplomatic about this subject and would make a terrible lobbyist–professional or citizen.

        1. Windriven says:

          It beats doing nothing, Irene. The other side isn’t doing nothing. We can’t either.

    3. The Midwesterner says:

      GoodNightIrene – Do I remember correctly that you live in Minnesota? Is that’s the case, perhaps we could work together. If I am mistaken, some general information about lobbyists is that while they are very helpful, many citizens routinely lobby on their own. Legislators at both the state and federal level are used to being lobbied by individuals or small groups and they do listen.

      1. irenegoodnight says:

        Actually, I live in Wisconsin, but thanks :-)

  4. nyudds says:

    I’m repeating myself. It’s election season (It’s ALWAYS election season.) Time to renew your friendship with your local, state and federal legislators because they control who practices what and how . If they say chiropractors are PC providers then chiropractors (or any other person(s) are PC providers. There is no substitute for personal contact. You should be the “go to” person when it comes to medical questions and legislation. Legislators are not well-versed in medical science and are subject to all the ruses and anecdotes regularly foisted on the public. They crave useful information, which you should be supplying. If not, alternatives will fill the void. You are better than a lobbyist because you wear a white coat and live with your legislators. You treat them and their families. You have a precious personal advantage: it’s called “access and trust.” You should willingly give of both on this two-way street. Your expert advice and counsel is invaluable. So is your body and family at political gatherings and of course, so is your checkbook. In the end, believe it or not, it will do you as much good as it does the public and your legislators: you will learn how politics directs policy, every single day. You will gain a new appreciation of the pressures and players that make politics work and you will appreciate Jann’s postings even more.

    1. Windriven says:

      Amen.

    2. irenegoodnight says:

      One of my Senators is Ron Johnson–a total Tea Party loon. I might try Tammy Baldwin or Gwen Moore (my rep), but I don’t see how I’m to convince them I am any kind of expert?? Anyone I’ve approached about this pretty much goes with some version of choice, or “to each his own”.

      I couldn’t even get either of the Candidates for Alderman to stand up for the backyard chickens proposal–both professed amnesia when I asked if they voted for it!

  5. Yodel lady says:

    A friend of mine is a Citizen Lobbyist on this issue. I think it would really help if the individuals who are opposing these bills in different states could find each other to share talking points, debate prep materials, charts, graphs, etc.

    Opponents in different states could also share videos of the state hearings and information on who the proponents are bringing in to testify and perhaps information on who the proponents’ paid lobbyists are.

    I think sharing information among us should not be expensive or difficult.

    As I understand it the Goldwater Institute was the author of several of this year’s bills. I heard that one patient from Massachusetts testified at hearings in at least two distant states. Perhaps she paid her own airfare and hotel bills, but being a skeptic I doubt it. If we could nail down some factual information on these things, those facts could be presented to the legislatures, lest any of them think this is a grassroots movement. Looks like AstroTurf to me.

    1. Jann Bellamy says:

      The supplement industry has contributed money to licensing for NDs in Massachusetts — I think it was $25,000, but I can’t put my hands on the cite right now. There are 26 NDs in Maryland, yet they were able to hire a professional lobbyist to get their licensing bill passed — I don’t know who paid his fee but I doubt it was 26 NDs.
      The Goldwater Institute is behind the “right to try” legislation, which both David Gorski and I blogged about on SBM. If they are behind other CAM legislation I wasn’t aware of it.
      If there are some features you think would enhance efforts to oppose CAM on the SfSBM website, please let me know. You can contact me either through SBM or SfSBM.

      1. Yodel lady says:

        Jann, I’m sorry. You are quite right, it’s the “Right to Try” legislation that has the Goldwater Institute behind it. And now I can’t remember about the Massachusetts woman who testified at hearings in other states — that was probably right to try legislation too. My bad!

  6. Windriven says:

    There is a Legislative Action group at SfSBM that I hoped would be that sort of forum. Slow start. If you know a better forum, I’d be happy to contribute for WA. I have some experience with the legislature.

    1. Jann Bellamy says:

      I am keeping up with legislation at SfSBM — if there is anything I can do to enhance this effort please let me know. I wasn’t aware of a Legislative Action group.

      1. Windriven says:

        Thanks. The group only has a handful of members. We’ve tracked one minor initiative in WA pretty well. Not much more though.

        I’ve been consumed with some business issues for the last couple of months but I’m about to dive back into SfSBM. I’ll keep you posted.

  7. CommonSenseBoulder says:

    Unfortunately special interest groups, like quacks, have a strong interest in gaining the favor of licensing from the government to grant themselves credibility. In contrast those who oppose it have far less to gain from opposing it. There are vast numbers of special interests out there so each person in the general public doesn’t have the time to learn about them all, let alone actively oppose them. Economists who study how governments operate in reality (rather than wishful thinking about them) explain it is usually to be *expected* that special interests will win out over the general public interest. (e.g. see “public choice theory”, whose co-founder James Buchanan won a nobel prize for his work and describes it as “politics without the romance”).

    Unfortunately government certification misguidedly leaves people who think the government operates in their interest thinking that alternative medical practitioners must therefore be safe and effective. Unfortunately some people engage in the fantasy that if they just wish hard enough that government will operate in the public’s interest rather than to benefit special interests, but those who study the issue explain that there is no rational reason to expect that to magically happen.

    The problem is that doctors opened the door to this approach by getting the government involved in certifying them, to begin with which inspires other groups to copy that approach. A better approach would be to rely solely on private certifications which set their own standards, such as say a “Science Based Medical Doctor” certification. Then private individuals and insurance companies can decide which ones to trust, and we can argue that they not trust alternative medical certifications. Each certification group would argue why it is better than the others. That removes certification from the hands of a political process that caters to special interest groups. Unfortunately doctors wish to preserve the status quo rather than risking change. Some people conservatively fear change and often dismiss what isn’t being done right now as apriori somehow wrong merely since it isn’t the approach we use now.

    1. irenegoodnight says:

      You must be as lonely in Boulder as I was in Port Townsend :-)

      Your comment is interesting, but it seems there would be chaos if every other practitioner had a certification status granted by himself–how would anyone know the validity of anything?

  8. Thanks for adding fuel to the rising cost of healthcare and patient suffering.

    Ignorance is blissful, enjoy it while it last, because the truth will piss you off whenever you get your head out of the sand.

    “Father, forgive them; for they know not what they do.”

    1. WilliamLawrenceUtridge says:

      “The Bible – Great for metaphor, terrible for morality, reasoning and evidence”.

      I don’t mind changing my mind, along with many here. I just want there to be valid evidence that I should do so. To date, the evidence for acupuncture has been sorely lacking. Needling location is irrelevant. Skin penetration is irrelevant. Elaborate diagnostic techniques, irrelevant. If acupuncture is so great, why can’t it be shown effective in well-controlled clinical trials?

      The truth makes me happy – I can correct my thinking. But in order to consider something “the truth” I need some reason to believe it is actually true.

      1. Impossible for some to see the truth if they are blinded by dogma.

  9. bdcguard-19 says:

    Funny I cured my wife’s breast cancer without the today’s quackery science based medicine. All disease is caused by environment. I don’t need some talking head to tell me what is true. I do it by example.

    As I watch many friends and friends of friends die from so called conventional cancer treatment, I saw the truth. The truth is there is a place for allopathic medicine in emergency and orthopedic treatments but there is only real healing in homeopathic treatment. This site is for quacks lol

    1. AdamG says:

      An entirely evidence-free comment, although this is not surprising given that the commenter believes vaccines played no role in the decline of VPDs.

      http://naturalsociety.com/publicized-study-vaccination-schedule-bombshell/#comment-1118236264

      Please, do tell us more about your cancer cure! Was it homeopathic in nature?

    2. WilliamLawrenceUtridge says:

      Funny I cured my wife’s breast cancer without the today’s quackery science based medicine.

      No you didn’t.

      All disease is caused by environment.

      Two things:
      1) Really? All disease? Huntington’s disease is caused by environment?
      2) Even if true, so what? Environmental diseases need to be prevented and treated. If we know the cause or contributor – then that should be discouraged or banned (i.e. smoking, asbestos), which society does. And if we don’t, then there’s not a damned thing we can do about it and we still have to treat it.

      Also, your statement essentially blames your presumably nonexistent wife for her cancer. Think about that for a second. Go up to your not-at-all-imaginary wife and say, to her face, “Honey, I know you got breast cancer, but it’s your own fault.” I hope she punches you in the nonexistent ball sack.

      I don’t need some talking head to tell me what is true. I do it by example.

      And this statement is proven false in 3…2…1…

      there is only real healing in homeopathic treatment.

      There it is. Homeopathy can’t work, and it doesn’t. They had homeopathy for two hundred years, life expectancy only started increasing dramatically with the advent of real medicine, vaccination, nutrition, antibiotics, public health, sanitation, etc. All things unknown to Hahnemann.

    3. Windriven says:

      “This site is for quacks lol”

      Well it wasn’t until you arrived.

      Homeopathy requires a very special kind of stupidty – a breathtaking ignorance of physical reality combined with a credulity uncommon even in a four year old.

      ” I don’t need some talking head to tell me what is true.”
      Well of course not! Several hundred years of careful scientific progress has nothing on the delusions of some crank in a foil-lined room. Now that you’ve found the one true cause of all disease, we’re waiting breathlessly for you to elucidate the nature of dark matter and to reveal your true identity as Napoleon Christ.

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