Society for Science-Based Medicine

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​Naturopathic doctor registration bill before Pennsylvania Senate

The Pennsylvania House passed a naturopathic doctor (ND) licensing act (House Bill 516) last year. On October 18, a Senate Committee radically altered HB 516 by striking it in its entirety and replacing it with a naturopathic registration bill, which is now before the Senate for "second consideration" on Monday, Oct. 24th. The bill passed out of the Senate committee unanimously. If passed by the legislature and signed by the Governor, the new law would take effect January 1, 2018.

What's the difference? My brief research did not disclose a definitive answer under Pennsylvania law. Generally, however, health care practitioner licensing grants an exclusive privilege to perform certain acts (e.g., surgery and prescribing drugs for MDs) for those who have demonstrated they have sufficient education and training. Registration, under some state laws, is simply providing the state authorities with a name, contact and perhaps other general information, so as to establish a record of who is providing certain services. However, it is not indicative of competency or expertise. In other states, registration is more exclusive. For example, in Colorado, naturopaths are registered, but not licensed. Yet, they have a practice act that defines what they can and cannot do. In Massachusetts, the terms "license" and "registration" seem to be synonymous.

This particular registration act seems to be of the title protection variety: one cannot use the term "naturopathic doctor" unless one enjoys the dubious distinction of having graduated from a four-year naturopathic college and passed the NPLEX exam. Unlike the original version of the bill, which granted NDs an extensive scope of practice, naturopathy is not defined and there is no indication of what naturopaths can and cannot do.

NDs would be overseen by the Board of Medicine, which is authorized to enact regulations governing their practice. According to the bill, the Board can discipline a naturopath for

"making misleading, deceptive, untrue or fraudulent representations."

Considering the fact that a good chunk of what naturopaths do is misleading, deceptive, untrue or fraudulent, this provision could spell the end of naturopathic practice in Pennsylvania if it is properly enforced. Naturopathy, as SFSBM's own Board chairperson, Dr. David Gorksi, has pointed out, is

"nothing more than a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to "pick one from column A and one from column B" when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophic medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine."

If you think he's being uncharitable, read former naturopath Britt Hermes's Naturopathic Diaries blog, SBM pharmacist Scott Gavura's series on Naturopathy vs. Science, or look behind the curtain at what naturopaths say to each other when no one is listening. As if all that weren't bad enough, naturopaths are anti-vaccination to boot (also here).

One review of 300 naturopathic websites by a newspaper reporter found many unsupported claims,

"from naturopaths describing their services as 'cutting edge,' to those claiming they can reverse the course of dementia, to others who make blanket statements that naturopathy can help anyone with any ailment fully restore his or her health."

Another investigation, published in a medical journal, reached a similar conclusion.

The bill also says that registered naturopaths can be disciplined, even in the absence of patient harm, for "unprofessional conduct," which includes

"departure from or failing to conform to an ethical or quality standard of the profession. . .(i)the ethical standards of a profession are those ethical tenets that are embraced by the professional naturopathic medicine community in this commonwealth. (ii)a naturopathic doctor departs from, or fails to conform to, a quality standard of the profession when the naturopathic doctor provides a medical service at a level beneath the accepted standard of care. The board may promulgate regulations that define the accepted standard of care. In the event the board has not promulgated an applicable regulation, the accepted standard of care for a naturopathic doctor is that which would be normally exercised by the average professional of the same kind in this commonwealth under the circumstances, including locality and whether the naturopathic doctor is or purports to be a specialist in the area."

Apparently, the good Pennsylvania legislators are don't realize that the anemic naturopathic ethics code permits such obviously unethical conduct as selling dietary supplements and homeopathic remedies one prescribes to one's patients.They are obviously unaware that there isn't really any naturopathic standard of care. There are no standardized medical protocols, evidence-based guidelines or consensus panels. Naturopathic doctors reject science and evidence as proper controls for patient diagnosis and treatment.

You could think that giving the medical board oversight over naturopaths, including the authority to enact rules and prosecute them for misconduct, is a good idea. It's possible that a dedicated board could enact rules requiring an evidence-based practice standard of care and energetically enforce them. But I see this headed in a different direction. The goal of the American Association of Naturopathic Physicians is to have naturopaths licensed in all 50 states by 2025 with full primary care scope of practice. However, the AANP will settle for a reduced scope of practice as a foot-in-the-door strategy, only to come back to the legislature year after year with requests for an expanded scope.

This very strategy proved successful for Pennsylvania acupuncturists and Oriental Medicine practitioners. Originally, they were simply allowed to register with the state. Since then, their lobbying efforts have resulted in a licensing act and increased scope of practice.

We've seen this playbook work for naturopaths in a number of other states recently: Connecticut "modernized" its naturopathic practice act to greatly increase scope of practice, Oregon gave patients the option to choose a naturopath as a PCP and Colorado expanded their prescription privileges. There have been failures too, most recently in California, where a bill removing NDs from physician supervision over prescribing failed. But they will be back, year after year, until they get what they want. Now that dietary supplement and diagnostic testing companies are funding their lobbying efforts, the risk is even greater they will succeed.

Registration will confer undue legitimacy on naturopathic practice. Naturopaths who meet the statute's minimum requirements will be allowed to use the title "Dr." and claim they are registered practitioners to a public that likely has little notion of the difference between registration and licensing, however Pennsylvania may define those differences.The use of the word "registered" already carries some connotation of respectable authority in medicine – "RN" stands for "registered nurse" – simply adding to the confusion.

Pennsylvania should not put the imprimatur of the state on what is "essentially witchcraft." House Bill 516 should be defeated.


Points of Interest 10/26/2016
Points of Interest 10/22/2016

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