Legislative Alchemy 2016: A Review

Legislative Alchemy 2016: A Review

Legislative Alchemy is the process by which state legislatures transform pseudoscience and quackery into licensed health care practices. By legislative fiat, chiropractors can detect and correct non-existent subluxations, naturopaths can diagnose (with bogus tests) and treat (with useless dietary supplements and homeopathy) fabricated diseases like "adrenal fatigue" and "chronic yeast overgrowth," and acupuncturists can unblock mythical impediments to the equally mythical "qi" by sticking people with needles. By passing chiropractic, naturopathic, acupuncture, and Traditional Chinese Medicine (TCM) practice acts, states license what are essentially fraudulent health care practices and give them an undeserved imprimatur of legitimacy.

During 2015-2016, over a dozen bills were introduced in the state legislatures to license naturopaths and acupuncturists as health care professionals. Several dozen more were introduced to expand the scope of practice for chiropractors, naturopaths and acupuncturists. This count does not include bills trying to force public and private insurers to cover CAM practitioner services.

Today, we'll wrap up our coverage of 2015-2016 by looking at how bills pending during the past year fared. For the full story, check out the Legislative Updates page under the Advocacy tab

A major goal of the American Association of Naturopathic Physicians is full primary care scope of practice privileges in all 50 states. Currently, they've achieved that status in exactly one state: Oregon, although they have some form of regulation in 16 states. In 2016, naturopathic licensing acts were pending in Illinois, Iowa, Massachusetts (for the 11th time), Michigan, Mississippi, New Jersey, New York (for the 8th time), North Carolina, Pennsylvania and Rhode Island.

New Jersey's bill remains pending in 2017. In Pennsylvania, a licensing bill giving naturopaths a broad scope of practice was replaced by a registration bill, which simply permits them to register with the state without defining their scope of practice. The registration bill passed. However, the privilege of writing the regulations governing naturopathic practice was given to the Pennsylvania State Board of Medicine, not a naturopathic board, which is what the naturopaths wanted. The remaining 8 licensing bills failed, as did a request for a study of naturopathic licensing in Indiana.

Naturopathic practice expansion bills in California, Connecticut, Hawaii, Oregon, Vermont and Washington failed. In California, Hawaii, and Washington, naturopaths wanted expanded prescription privileges, but the legislatures refused. The Maryland legislature passed a bill establishing a naturopathic formulary committee, which will list drugs naturopaths can prescribe and administer. With a few exceptions, the formulary cannot include prescription drugs and control of the formulary is in the hands of the Maryland Board of Physicians.

In sum, naturopaths gained little in 2016: registration in one state and a formulary in another, both of which will be controlled by medical doctors.

Chiropractors are already licensed in all 50 states, so their 2016 bills continued to focus on practice expansion, including efforts by some chiropractors to rebrand themselves as primary care physicians, a boondoggle both Harriet Hall and I have covered extensively over on the Science-Based Medicine blog.

Their only success in 2016 was in Ohio, where a bill passed allowing chiropractors to recommend, administer and sell to patients vitamins, minerals, antioxidants, enzymes, glandulars, homeopathic remedies, non-prescription drugs and other dietary supplements to "restore and maintain health."This conflict of interest is frowned upon in medical practice but is considered perfectly ethical among chiropractors and naturopaths. Except for non-prescription drugs, most of these have never been tested for safety or efficacy prior to sale. Glandulars are dried and ground-up animal glands, like bull testicles, used by quacks to treat real or imagined hormonal imbalances. Homeopathic remedies rarely contain even one molecule of an active ingredient and are useless for any disease or condition. Despite these deficiencies, clueless Ohio Representatives and Senators passed the bill unanimously.

Similar bills allowing chiropractors to use what is euphemistically called "clinical nutritional methods" failed in Hawaii and Idaho.The Idaho bill would have allowed chiropractors to administer vitamins, minerals and herbal remedies via injection, including IVs, leading the way to their operating infusion clinics for IV administration of high dose vitamin C, Myers cocktails, and other dubious substances.

Chiropractors also wanted the right to perform school physicals in California, return concussed student athletes to play in Oregon, and prescribe physical therapy in Michigan. All those bills failed as well.

Acupuncturists nailed another state – Kansas – in their quest for licensure in all 50 states.The new law defines acupuncture as the use of needles and "related modalities" for 

"assessment, evaluation, prevention, treatment or correction of any abnormal physiology or pain by means of controlling and regulating the flow and balance of energy . . . and stimulating the body to restore itself."

Since physiology is, by definition, a branch of biology that deals with the functions and activities of all life and living matter, it appears the Kansas legislature has granted the acupuncturists an extremely broad scope of practice. One wonders exactly what patient complaint couldn't be shoehorned into the "abnormal physiology" category.

In addition to traditional needle acupuncture, Kansas practitioners will be able to employ "auricular detox," magnetic and electromagnetic treatments, cupping and dispense herbal remedies and dietary supplements. "Aricular detox" is another name for ear acupuncture, which is based on the "understanding" that the external ear represents all parts of the human body, including the internal organs, and provides acupuncture points corresponding to these parts. Proponents claim it is effective in treating addiction, but they've failed to prove it.

This year, Delaware added the practice of "Eastern Medicine" to its acupuncture practice act, defined as

"the practice of acupuncture, Chinese herbology and Asian bodywork therapy as part of a comprehensive health care system encompassing a variety of traditional health care therapies that have been used for more than 3,000 years to diagnose and treat illness, prevent disease and improve well-being."

Of course, "used for" is not synonymous with "is effective for." Practitioners can make recommendations based on "eastern dietary therapy," supplements and lifestyle and offer information about herbs, vitamins, amino acids, carbs, sugars, enzymes, food concentrates, and dietary supplements. It's always a wonder how acupuncturists and the like bootstrap themselves into legitimacy with the argument that their methods are "thousands" of years old, then tack on all sorts of stuff that the ancients either had no idea existed, like amino acids and enzymes, or simply didn't exist "thousands" of years ago, like dietary supplements and food concentrates.

Rhode Island added the practice of "Oriental medicine" to its acupuncture practice act last year, defining it as a form of "primary health care." This year, the Rhode Island legislature gifted acupuncturists with self-regulation, creating a Board of Acupuncture and Oriental Medicine. The state also has a new law allowing chemical dependency professionals to use "auricular acudetox." Like Ohio, Rhode Island is treating its addicts with magical thinking.

New York also expanded the acupuncturists' scope of practice. They may now recommend "traditional remedies and supplements," and, with additional training, custom-made remedies and herbal formulations. Gov. Cuomo, to his credit, vetoed a bill that mandated coverage of acupuncture treatments under worker's comp.

But on it goes. A bill allowing naturopaths and chiropractors to return students to play following a concussion is already being drafted in the Oregon legislature for consideration in 2017. We'll be watching as this and other Legislative Alchemy as makes its way through the state legislatures in the coming year. 

Points of Interest 01/02/2017
Points of Interest 12/31/2016