Naturopaths de-licensed in Idaho, practice expansion nixed in North Dakota

Naturopaths de-licensed in Idaho, practice expansion nixed in North Dakota

April 2 was a terrible, horrible, no-good, very bad day for naturopaths, only without the heart-warming ending.

First, not only did an expansive licensing bill fail to pass in Idaho, naturopaths were actually de-licensed by the Idaho Legislature.  I suppose the Governor could veto the de-licensing bill, but there are no indications that he will. After all, only 5 of the 100 Idaho naturopaths are actually licensed. 

Idaho first licensed naturopathic "doctors" in 2005.  Because of difficulties that aren't quite clear to me, the licensing statute was never fully implemented. The naturopaths tried to remedy that for several years but failed each time. This year, they came roaring back with an expansive licensing bill.  As always, licensing turned into a bone of contention between the traditional naturopaths and those who have degrees from naturopathic "medical" schools. 

House Bill 181, pretentiously titled "The Naturopathic Medical Physicians Practicing Act," offered an entirely new iteration of the naturopath.  Gone was the usual statutory language defining naturopathy in terms of the "body's self-healing ability," i.e., vitalism.  "Naturopathic medicine" was defined as "a distinct and comprehensive system of primary health care practiced by naturopathic physicians" and "natural health care services" as a "broad domain" including "diagnosis and treatment," but left the content of naturopathic practice largely up to a Board of Naturopathic "Physicians" using the vague standard that the practices permitted by the new law must be "consistent with naturopathic education and training."

Naturopaths would be able to perform minor office procedures and prescribe drugs and medical devices as determined by a formulary approved by the Board. The Board could approve "specialties," which weren't defined in the bill but which would include such things as "naturopathic oncology."  

Despite being defined as "primary care" doctors with a scope of practice that was very close to that of an MD or DO family practice doctor, naturopaths would not have to carry malpractice insurance. According to the bill, naturopaths could not be disciplined solely for using "unconventional"  practices unless a patient is actually harmed and the patient has signed a waiver acknowledging the practice is unconventional. Presumably, no actual informed consent would be required, just a "waiver." Who knows what a naturopath might consider unconventional, as the science-based practitioner would categorize a good bit of their practice as unconventional. It would be cold comfort to the patient injured by one of these unconventional practices that the naturopath had been disciplined for her transgression, given the fact that his "doctor" might have no money to pay for his injuries. 

As is typical of licensing statutes, naturopaths would have to graduate from a 4 year accredited naturopathic school and pass an exam administered by the North American Board of Naturopathic Examiners, a subterfuge we'll return to in discussing the North Dakota practice expansion bill.

House Bill 181's progress through the Idaho Legislature was a real nail-biter. It squeaked by in the House and almost didn't make it to the Senate Floor before the Legislature adjourned on April 3. As it turned out, getting to the Senate didn't do the naturopaths any good because on March 30, the bill was resoundingly defeated. 

But, wait! That's not all that happened in the Senate. Senate Bill 1177 repealed the problematic licensing statute enacted in 2005. Whether the repeal was originally drafted simply in anticipation of the new licensing act being passed, I don't know. But repealed it was. The bill passed 22-13-0 in the Senate on March 30. It then passed in the House by a huge margin, 56-13-1, on April 2.

Of course, this doesn't mean naturopaths will be out of business in Idaho. But they won't be able to call themselves "doctor" or "physician" or say they practice primary care. They can't force insurers to pay for their services under the Affordable Care Act's non-discrimination clause.  They can't get their hands on real drugs, shoot people up with IVs full of "nutrients," or claim they are naturopathic "oncologists." They won't be able to order lab tests to diagnose fake diseases like chronic yeast overgrowth or adrenal fatigue. In fact, they won't be able to diagnose at all. They'll pretty much be limited to health advice, which will probably include a bunch of dietary supplements and homeopathic products they sell to patients. But the damage will be contained. 

The second terrible, horrible, no-good, very bad event of April 2 occurred in North Dakota, where naturopaths failed to get a substantial practice expansion. That was a real nail-biter too. 

Senate Bill 2194 would allow naturopaths to prescribe drugs if on a formulary established by a subcommittee of the Board of Integrative Medicine. This would be an entree to shooting patients up with substances like vitamins, minerals and homeopathic remedies via an IV, used for such things as "flu prevention" in lieu of the flu vaccine. Naturopaths would also be able to perform minor in-office surgical procedures. 

They could perform "naturopathic childbirth attendance" with additional training, consisting of a 3-year certified professional midwifery curriculum and passing a Board-endorsed standardized test. One possibility was the exam offered by the North American Registry of Midwives, which certifies direct-entry midwives -- those who don't have any prior medical training, such as a nursing degree. This seems an admission, certainly unintentional, that naturopathic education and training isn't quite up to snuff. If naturopaths were, as advertised, equal in ability to primary care MDs and DOs upon graduation from naturopathic school, why do they need to go to school for 3 more years to learn midwifery and pass an exam designed for direct-entry midwives? 

In February, the bill failed in the Senate, by a vote of 22 yeas to 25 nays. But the very next day, it was reconsidered and passed, 25-22. It then went to the House, where it was voted out of committee with a "do pass" recommendation. But when it went to the House Floor, the bill failed by a wide margin, 35-56.

What happened? Britt Marie Deegan Hermes told the truth. Britt is the former naturopath who is telling us things naturopaths don't want anyone to know. And people are listening, including legislators. 

She's recounted her written testimony before the North Dakota Legislature on her blog, Naturopathic Diaries. There, she exposes the misrepresentations naturopaths make to the state legislatures: the subjects they actually study (homeopathy, botanicals), their medically useless textbooks and the lack of clinical training. She's done her homework too: a chart compares the pharmacology training of naturopaths versus that of Physician Assistants and Nurse Practitioners, who must practice under the supervision of a physician, and convincingly demonstrates how naturopathic education pales in comparison. 

Over several posts on Naturopathic Diaries as well as a guest post on Science-Based Medicine (more to come), Britt reveals how naturopaths are really educated and trained and how they really practice. Not the PR version they like to sell to the public. Anyone who thinks naturopaths should be licensed as primary care physicians, or be allowed to practice as health care providers at all, will have his eyes opened to the reality of naturopathy. And it isn't pretty. 

In the middle of the last century, naturopathy began to fade, and naturopaths lost their practice acts in several states.  But in the 1970s and 1980s, they rode the tide of "alternative medicine" back to the steps of the state legislatures. So far, they're licensed in 17 states and D.C., although they've failed to get nearly the scope of practice they wanted in the last couple of years. And many states have rejected their licensing efforts again and again. 

Will there be more terrible, horrible, no-good, very bad days ahead for naturopathic licensing and scope of practice efforts? We hope so. 

Points of Interest 04/06/2015
Points of Interest 04/04/2015

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