A bit of disinfectant sunshine for Hawaiian naturopaths

A bit of disinfectant sunshine for Hawaiian naturopaths

A couple of weeks ago, we lauded Hawaii State Senator Josh Green, MD, who introduced a bill (Senate Bill 2577) requiring naturopaths to have the same education and training as MDs and DOs in order to prescribe drugs.  Drugs require a prescription for good reason. You can sicken, even kill, a patient if you don't know what you're doing. 

I did a bit of Googling and was shocked to find just how little exposure to prescribing drugs naturopathic students have in their clinical training.  In fact, they don't have much clinical training at all, in anything. The Council on Naturopathic Medical Education, the accrediting agency for naturopathic "medical" schools, requires the equivalent of what would amount to about 20 days worth of an MD or DO seeing patients in an average family practice clinic.  That's all the clinical training naturopaths need to graduate.  And they don't even do residencies, unlike MD and DO family practice doctors, who must complete a three additional years before going into practice.  

 
The Senate Health Care Committee recently voted in favor of the bill but with substantial amendments that essentially rewrote it. As the bill stands now, the education and training requirement is gone.  A naturopath with prescribing privileges would need to have a "collegial relationship" with an MD or DO who will review the naturopath's prescriptions quarterly and report any concerns to the naturopath and to the naturopathic board. Of course, they may choose to do absolutely nothing in response to these concerns. In addition, naturopaths have to maintain a list of all prescriptions and report to the Board monthly what was prescribed.  The Board will report this information to the Legislature annually.

"Collegial relationship" is defined as "a professional relationship intended to foster cooperation and collaboration in integrative care."  The physicians who would be willing to oversee naturopaths on these terms might well be the very ones willing to tolerate the incorporation of "alternative medicine" into medicine, thereby simply enabling the naturopaths to employ their evidence-free treatments. 

The bill also limits the type of drugs that may be prescribed to 7 categories.  Unfortunately, the list includes non-prescription and prescription vitamins, minerals, nutritional supplements, dietary supplements, botanical medicines, homeopathic "medicines," and "all biological substances including extracts or their products and residues."  This still leaves naturopaths free (as they are now) to administer these substances IV. Vitamin "cocktail" anyone? The list also includes all hormones except those that are controlled substances. This leaves open the possibility of such nonsensical diagnostics as saliva testing for alleged hormone deficiencies and prescription of hormones to relieve these purported deficiencies.

Each naturopath who wants prescribing privileges will have to complete 15 hours of continuing medical education in pharmacology annually.  Of course, the quality of these courses is key to their success in moving naturopaths toward evidence-based prescribing, if that is indeed possible. Fifteen hours in, for example, in mixing IV vitamin cocktails and chelation therapy for "detoxification" will not serve the best interests of patients.

The bill has now moved to the Senate Committee on Commerce and Consumer Protection. Hopefully, the bill, if passed, will create enough of a public record via its reporting requirements to shed much-needed light on naturopaths' unconventional prescribing practices.  Perhaps the possibility of being outed for some of their nonsensical diagnostics and treatments will have a chilling effect that serves to curb this abuse of patients and their health. A little disinfectant sunshine would be good for Hawaiian NDs.

Points of Interest 2/16/2014
Points of Interest: 2/14/2014

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