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Legislative Alchemy 2015: Another losing season for CAM practitioners

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One of the main, but perhaps underappreciated, reasons quackery thrives in the United States is that the states legalize it by licensing practitioners of pseudoscience as health care providers. These practitioners are placed under the regulatory jurisdiction of, well, themselves. I call the whole deplorable process Legislative Alchemy, and you can see all posts on the topic here. It gives practitioners an underserved imprimatur of state authority and leaves public protection from harmful practices to the oversight of those who are themselves engaging in the very same conduct. Each year, dozens of bills are brought before the state legislatures to establish initial licensure or, once that goal is achieved, scope of practice expansion.

Most attempts fail, but CAM practitioners are a dogged bunch, and they will come back each year until they get what they want. It took chiropractors about 60 years to become licensed in all 50 states. Acupuncturists are almost there. Naturopaths lag far behind, but are slowly gaining ground each year, even if it is only via practice expansion in states where they are already licensed. 2015 was a losing season for all, but not without advancement toward larger goals.

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Posted in: Acupuncture, Chiropractic, Diagnostic tests & procedures, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation

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The DC as PCP: the battle resumes

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

It has been almost five years to the day since I wrote my first post in “The DC as PCP” series. These posts (listed here) chronicle the continuing battles among various factions within the chiropractic profession over the subluxation and its many iterations, educational requirements for chiropractic colleges, their legal scope of practice, and whether chiropractors are – or are not—primary care physicians (PCPs). At its heart, the controversy boils down to this essential issue: what is “chiropractic” and what is it that chiropractors do? Or, perhaps, should do.

At one end of the spectrum is the straight chiropractor, who wants to make his living detecting and correcting subluxations for all manner of problems. These are the chiropractors who claim newborns need adjustments for “birth trauma” and maintenance care is necessary to good health. At the other end are those promoting the idea that chiropractors are primary care physicians capable of seeing the undifferentiated patient, form a differential diagnosis, and either treat the patient or coordinate the patient’s care with other health care professionals.

Neither has any basis in reality. The subluxation is a chiropractic fiction. And the notion that chiropractors have the necessary education and training to act as primary care physicians is no less a fiction.

Apparently unrepresented in this battle is the chiropractor who wants to see the profession as evidence-based spine care specialists based on a model of specialty care like podiatry and dentistry. (more…)

Posted in: Chiropractic, Politics and Regulation

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The DC as PCP? Drug Wars Resume

Coming soon, to a chiropractor's office near you?

Coming soon, to a chiropractor’s office near you?

Chiropractors are once again engaged in intra-fraternal warfare over the chiropractic scope of practice, a saga we’ve chronicled before on SBM. (See the references at end of this post.) Every time it looks like the warring factions have buried their differences, they come rising to the surface like zombies.

The International Chiropractors Association (ICA), representing the “straight” faction, wants chiropractic to continue as a drugless profession. They are happy to detect and correct subluxations, thereby removing “nerve interference” and “allowing the body to heal itself” in the tradition of Daniel David Palmer. But the American Chiropractic Association (ACA) has bigger fish to fry.

This time, the ICA is upset that the ACA House of Delegates up and decided to establish a “College of Pharmacology and Toxicology,” which would operate under the auspices of the ACA Council on Diagnosis and Internal Disorders. The ACA’s announcement of the “College” is rather vague on details:

The purpose of the College is to further educate the chiropractic profession on clinical matters related to the widespread use of both prescription and over-the-counter medications and nutritional supplements.

I e-mailed the ACA several days ago asking for more information but have yet to receive a reply.

The ICA sees this move as yet another attempt by:

forces at work within some organizations actively promoting incorporating drugs into the chiropractic scope of practice.

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Posted in: Chiropractic, Herbs & Supplements, Humor, Legal, Nutrition, Pharmaceuticals, Politics and Regulation

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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. (more…)

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

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The Exciting Conclusion

On the slim chance that you’ve been perched on the edge of your seat wondering how the New Mexico appellate court ruled on chiropractic prescription privileges, whether the Council on Chiropractic Education got approved for another three years as an accrediting agency, if NCCAM ever came clean about spinal manipulation, and the fate of Brandon Babcock, DC, at the hands of the judicial system, here are your updates.

Prescription privileges for New Mexico chiropractors

A surprisingly titillating tidbit about New Mexico “advanced practice” chiropractors.

As discussed in previous posts, New Mexico “advanced practice” chiropractors succeeded in getting limited prescription rights. The statute specifically says they can:

prescribe, administer and dispense herbal medicines, homeopathic medicines, over-the-counter drugs, vitamins, minerals, enzymes, glandular products, protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for special dietary use, bioidentical hormones, sterile water, sterile saline, sarapin or its generic, caffeine, procaine, oxygen, epinephrine and vapocoolants.

However,

Dangerous drugs or controlled substances, drugs for administration by injection and substances not listed [above] shall be submitted to the board of pharmacy and the New Mexico medical board for approval.

Apparently, the Chiropractic board couldn’t read the plain language of the statute and blew off this requirement, even though their own lawyer told them they couldn’t. This got them hauled into court by the medical and pharmacy boards. The International Chiropractors Association joined the fight. (more…)

Posted in: Chiropractic, Health Fraud, Legal, Politics and Regulation

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The Council on Chiropractic Education Straightens Up?

Three years ago, we reported that the Council on Chiropractic Education (CCE) was deeply embroiled in a heated dispute among various chiropractic factions over its new accreditation standards for chiropractic colleges. In a June, 2012 update of that post, we found the CCE still deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. Current events, however, require that we now report that the CCE remains deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. And it has come to this:

CCE does not represent me

Ostensibly, the debate is about whether chiropractic students should be taught to detect and correct the putative subluxation and CCE’s commitment to chiropractic’s remaining a drug and surgery-free practice. As we have discussed several times here at SBM, a faction of chiropractors fancy themselves as primary care physicians who are competent to diagnose and treat patients with a wide variety of diseases and conditions, such as diabetes and cardiovascular disease, with various methods, such as “Functional Endocrinology.” This is, in fact, the position of the largest and most mainstream of the chiropractic trade associations, the American Chiropractic Association (ACA). (The ACA is actively promoting reimbursement of chiropractors for required primary care benefits under the Affordable Care Act.)

At the other end of the spectrum, the chiropractic purists (or “straights”) believe chiropractors should limit themselves to the detection and correction of the (non-existent) chiropractic subluxation. And they are adamant about chiropractic remaining “without drugs or surgery.”

Protestations to the contrary notwithstanding, chiropractic belief in the subluxation is widespread among chiropractors in North America and in Australia. And as far as I can tell, chiropractors who eschew belief in the subluxation have merely renamed it and redefined it in terms so vague as to be meaningless. Those who want to expand chiropractic to include a broader range of treatments do not exclude the subluxation as a relevant clinical entity. They’ve simply tarted it up in an attempt to obscure its lack of scientific viability. (more…)

Posted in: Chiropractic, Legal, Politics and Regulation

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CAM Docket: Functional Endocrinology Update

Sometimes the media gets it right.

From time to time, SBM has reported on the disheartening credulity of reporters when they cover so-called “alternative” medicine. Denver’s Channel 7, an ABC affiliate, is a happy exception to the rule. Reporter Theresa Marchetta first broke the story of Brandon and Heather Credeur, chiropractors practicing “Functional Endocrinology.” And for three years Marchetta, with the assistance of reporter Phil Tenser, followed up, interviewing hundreds of patients who lost thousands of dollars paid to the Functional Endocrinology Center of Colorado for treatment of their diabetes and other endocrine disorders. They’ve reported regularly as the Credeurs legal travails progressed through various judicial and administrative forums. Channel 7 and its reporters deserve substantial credit for pursing this story. The Credeurs might have escaped further censure without their persistence.

Another recurring frustration at SBM is medicine’s embrace of alternative medicine, expressed repeatedly at SBM in posts on quackademic medicine and the branding device known as integrative medicine. We’ve also lamented the seeming complicity of the state medical societies in allowing quackery to be legalized in the form of complementary and alternative medicine provider practice acts.

But sometimes medicine gets it right.

The Colorado Medical Board has somewhat redeemed itself in ordering Brandon and Health Credeur to cease and desist the unlicensed practice of medicine. That’s right. A medical board has finally put its collective foot down and pushed back against chiropractic’s increasingly aggressive push to practice medicine.

And sometimes SBM appears to be making inroads into the hostile incursion of alternative medicine.

I recently discovered that if you google “functional endocrinology”, first up on the list is CAM Docket: Functional Endocrinology, the very post updated today. Admittedly, it appears at the head of a depressingly long list of chiropractic websites advertising the practice, but at least we get a first crack at anyone who might be considering paying thousands of dollars and wasting time, and perhaps their health, on this useless nonsense.

A trifecta in the war on quackery! Revel in this victory, supporters of science-based medicine, for it is small and the victory may be fleeting. Let’s see how the battle is going. (more…)

Posted in: Chiropractic, Health Fraud, Herbs & Supplements

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Legislative Alchemy: Chiropractic 2013

Via the magic of legislative alchemy, chiropractors are already licensed health care providers in all 50 states. Thus their legislative efforts tend to focus on expanding their scope of practice and forcing public and private insurers to cover their services, in some cases at the same rate as medical doctors. Those efforts continue in 2013 with 65 bills impacting chiropractors introduced so far. Of those including substantive provisions (as opposed to, say, simply raising fees), only one is not to their advantage.

New Mexico chiropractors are once again attempting expansion of their scope of practice. In 2008 and 2009, the New Mexico legislature created a new iteration of chiropractor, called “the certified advanced practice chiropractic physician.” A certain faction of the chiropractic industry is attempting to rebrand chiropractors nationwide as primary care physicians and this was a signature event in those efforts. With 90 hours of additional education, these advanced practice chiropractors can administer a bevy of dubious remedies, such as bioidentical hormones.

The new law also permitted prescription of dangerous drugs and controlled substances and administration of drugs by injection, but only if on a formulary approved by the state pharmacy and medical boards. The chiropractic board didn’t like having to get approval from pharmacists and medical doctors, so they went ahead and added what they wanted to the formulary, ignoring the other boards despite their own attorney’s advice that they couldn’t do this. This got them into a couple of court battles with the pharmacy and medical boards. The International Association of Chiropractors (ICA), the traditional, subluxation-only chiropractic faction, jumped into the fray to oppose this power grab. The ICA believes chiropractic should remain drug and surgery free.

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Posted in: Chiropractic, Herbs & Supplements, Homeopathy, Legal, Pharmaceuticals, Politics and Regulation

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The DC as PCP? The battle continues

Chiropractors are trying to rebrand themselves as primary care physicians, a topic both Harriet Hall and I have addressed (here and here) on SBM.  Toward this end, they are seeking the expansion of their scope of practice, via the magic of legislative alchemy, to include the prescription and administration of drugs.  Not drugs that any self-respecting M.D. would use, but drugs nonetheless.  That effort succeeded to an extent in New Mexico.  Recently Colorado got into the act.  Other states have followed suit.

Chiropractors have claimed from the very beginning they are primary care physicians. Chiropractic was born in 1895 with the notion that virtually all diseases could be resolved with chiropractic treatment.  This was Daniel David Palmer’s original contention, that the interruption of “nerve flow” by “subluxations” caused disease which could be remedied by spinal adjustment to restore the flow, thereby allowing the body to heal itself.

State chiropractic practice acts have always given chiropractors a broad scope of practice which allows them to diagnose and treat virtually any condition as long as they can squeeze the treatment into the “chiropractic paradigm.”  If they can pretend the condition is amenable to chiropractic treatment via the detection and correction of subluxations, they can diagnose and treat it legally.  This is how they are able to claim, falsely, that asthma, allergies, colic, and many other health problems can be resolved by chiropractic care.  This is how “straight” chiropractors still practice.

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Posted in: Chiropractic, Health Fraud, Herbs & Supplements, Homeopathy, Legal, Politics and Regulation, Vaccines

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CAM Docket: Functional Endocrinology

One of the signature abilities of CAM practitioners is the creation of new diagnostic methods and treatments which convincingly demonstrate they have only a superficial understanding of human physiology. Here at SBM, posts have addressed such sterling examples of this phenomenon as cranial sacral therapy, applied kinesiology and chiropractic neurology. Now we have a new one on the horizon: functional endocrinology.

I don’t know who thought up this idea, but a primary promoter appears to be a Colorado chiropractor, Brandon Credeur, a 2002 graduate of Parker Chiropractic College in Texas. In additional to operating the Functional Endocrinology Center of Colorado, in Denver (where he practices with his wife, Heather Credeur, D.C.), he sold (and may still be selling) practice-building courses on functional endocrinology to other chiropractors.

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Posted in: Chiropractic, Science and Medicine

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