Naturopathic practice expansion fails in California; opportunity to end practice approaches

Naturopathic practice expansion fails in California; opportunity to end practice approaches

Senate Bill 538 failed in the California Assembly on the last day of the legislative session, leaving naturopaths under physician supervision when prescribing drugs and without the greatly expanded scope of practice they sought. As originally drafted, "naturopathic doctors" would be able to order and interpret diagnostic studies, such as X-rays and mammograms, and prescribe drugs without physician supervision, including controlled substances. The bill would also allow naturopaths to use parenteral therapy, perform minor office procedures and biopsies, and added "cervical" to permitted routes of administration.

In addition to physician groups, the gigantic Kaiser Permanente health care system opposed the bill. The AARP supported the expansion, seeing it as a means of cost containment and "efficient delivery of optimal care." Yet, on its website, the AARP says patients and clinicians need the "best possible evidence about the effectiveness of medical interventions." The AARP needs to know that there is no good evidence that naturopathic care is "optimal," "efficient," or contains costs. In fact, seeing a naturopath is associated with substandard care, including failure to follow CDC vaccination guidelines and acquisition of vaccine-preventable disease.

The bill underwent major surgery during its two year trip through the legislature, surviving a near-death experience in an Assembly committee. After revival, it bounced back and forth between committee and second readings in the Assembly, only to finally expire on the Assembly floor. Along the way, interpretation of diagnostic studies, parenteral therapy, minor office procedures, biopsies and cervical administration were dropped, leaving prescribing privileges to fight over. At one point, physician supervision would be required for only one year, leaving naturopaths free to prescribe on their own after that. At another point, only Schedule V drugs were eliminated from supervision after one year. And so on.

Fortunately, on August 17, Britt Hermes came out with another one of her devastating critiques of naturopaths and their practices, this one directed specifically at SB 538 and published in Forbes as an "Editor's Pick." We can't know whether this dealt the fatal blow to the bill, but it certainly didn't help its chance of survival. And, to confirm what we already knew, we learned recently in an email from the Naturopathic Medicine Committee of the Osteopathic Medical Board of California that the organization responsible for testing naturopaths pretty much admits that their pharmacology education is inadequate.

California naturopaths are left with their current scope of practice, which requires physician supervision over any drug prescribing, including the development of a standardized procedure. For controlled substances, the supervising physician and naturopath must agree on specific drugs the naturopath can prescribe. If on Schedule III, there must be a patient-specific protocol in place.

It is impossible to reconcile the naturopathic quackery practiced freely in California with the scientific knowledge and extensive training required to properly prescribe drugs. How can one believe in the basic homeopathic principle that the more you dilute something, the more powerful its effect, and at the same time understand dose response relationships? How can one think that IV infusions of vitamins, minerals, amino acids and "other agents" will "jumpstart the healing process" and "restore balance" and at the same time pretend to understand pharmacology basics like ADME? How can one believe in "detoxification" and yet claim to understand physiology? How can naturopathy, which has no standard of care, be reconciled with prescribing privileges, for which a standard of care is a matter of life and death?

California's naturopathic practice act is automatically repealed as of January 1, 2018, unless the legislature enacts a law deleting or extending that date in the 2017 session. It's a great opportunity to reverse the state's unfortunate experiment in letting poorly educated, insufficiently trained, anti-vaccination and quackery-filled pseudo-primary care practitioners loose on the public.

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