| Boyd Landry, executive director of the Coalition for Natural Health, testified to oppose SB1300. He explained his opposition to licensing of naturopathic physicians. The Coalition for Natural Health is headquartered in the District of Columbia with a regional office in San Diego.
The Coalition for Natural Health (CNH) is a non-profit organization representing over 2,500 individuals nationwide who share a common goal: to promote the holistic approach to health and to ensure that natural health alternatives remain widely accessible to the public. The mission of the Coalition for Natural Health is: - to educate the public as to the true meaning and benefits of traditional naturopathy;
- to educate legislators on the efficacy of traditional naturopathy; and
- to prevent legislation that would prohibit traditional naturopaths from practicing now and in the future.
Before addressing the specific reasons for our opposition, I would like to address the proponents' true need to pass this legislation. As opposed to their stated need, the "naturopathic physician's" true agenda for this legislation is economic protection. The proponents need this bill because a new law creating a new medical profession is necessary to allow them to perform the range of medical services they want to perform and because some of these services would be interpreted as the practice of medicine. In other words, it is all about money and self-interest. Dr. Rena Bloom, a Denver "naturopathic physician" was quoted in the Colorado Daily (Exhibit 1) on Monday, January 18, 1999, as stating "We need this bill because at this point, we're illegal we're practicing medicine without a license."
REQUIREMENTS OF LICENSURE - There are several contentious parts to SB1300: 1) Qualifications for Licensure; 2) Scope of Practice; and, 3) Title Protection. The proponents of this legislation will argue that twelve states have passed licensing legislation, of this type, and that Idaho should follow suit. However, since 1996, twenty states (Rhode Island, Massachusetts, North Carolina, West Virginia, Pennsylvania, New York, Florida, Texas, Minnesota, Kentucky, Iowa, Kansas, Missouri, Oklahoma, Louisiana, Arkansas, New Mexico, Colorado, Ohio, and Idaho) have rejected licensing legislation and twelve of these (Minnesota, Pennsylvania, Ohio, Oklahoma, Missouri, Idaho, Colorado, Massachusetts, New York, Florida, Rhode Island and Texas) rejected it more than once. In total, it has been rejected on over 50 different occasions in the past seven years.
Section 54-5102(1) provides as follows for all would-be licensees to be graduates from approved naturopathic colleges:
1) "Approved naturopathic medical program" means: (a) A course of study from a college or university granting the degree of doctor of naturopathy or doctor of naturopathic medicine accredited by an accrediting agency recognized by the state or federal government; or (b ) A college or university granting the degree of doctor of naturopathy, or doctor of naturopathic medicine that has the status of candidate for accreditation with the accrediting agency; or ( c ) A postgraduate degree granting college or university of the healing arts approved by the examining board and state or federal accrediting agency. Such college or university shall require a minimum of sixty (60) semester units for admission and a minimum of four thousand (4,000) hours in basic and clinical sciences, naturopathic philosophy, naturopathic modalities, and naturopathic medicine, of which not less than two thousand (2,000) hours shall be academic instruction and not less than two thousand (2,000) hours shall be school or college approved supervised clinical training. The college or university shall provide adequate instruction to maintain naturopathic medicine as a separate and distinct healing art."
A close look at "naturopathic medical" schools reveals inherent problems with this type of education. The faculty of Bastyr University (Exhibit 2), the only fully "accredited school" highlights the limitations of the "medical" education claimed by graduates of these schools. Recent information from www.bastyr.edu shows a total of 46 faculty members in the "naturopathic medicine" program with 43 of those listing degree of "N.D." as their primary qualification. Of the three "non-N.D." degreed professionals, there is only one M.D.! Thirty-nine of Bastyr's faculty, forty-six members hold N.D. degrees from Bastyr as their primary qualification. Seventeen of the thirty-nine have had their degrees for five years or less. Three hold N.D.'s from National College of Naturopathic Medicine in Portland.
Southwest College of Naturopathic Medicine (SCNM) located in Tempe, Arizona, is the newest "candidate" for accreditation. However, SCNM has an extensive list of problems. Initially, for the majority of time in SCNM's existence, the school could only attain candidacy status for accreditation with the Council on Naturopathic Medical Education (CNME). SCNM was only able to reach full accreditation with CNME after the CNME violated its own policies to accredit the school. Incredibly, CNME granted full accreditation less than 90 days after SCNM suspended operations to address severe financial problems in the summer of 1999. These egregious violations of its own policies resulted in the revocation of CNME' s recognition as an accrediting agency by the United States Department of Education.
In addition, The Arizona Republic (Exhibit 3) reported hazardous environmental conditions at SCNM in a September 12, 2001 article which stated, "Several students have alleged that the school, one of four of its kind in the country, has made them sick because of improper ventilation of its cadaver lab, among other things."
The Auditor General for the State of Arizona in a June 2000 (Exhibit 4) report to the Legislature reported that at least 19 individuals received a license to practice naturopathic medicine without properly passing the required examination given by the Arizona Board of Naturopathic Medicine. The report stated, "Everyone passed the February 1999 exam, but without scoring adjustments, no one would have passed." In fact, the auditor herself who had absolutely no training in naturopathic medicine took the exam and passed after using the same scoring adjustments. What does that say?
In the past, proponents of this bill have provided legislators with a chart that compares the three "naturopathic medical" schools to top medical schools such as Johns Hopkins, Yale, and Stanford. This chart compares course hours, and implies that these "naturopathic medical" schools are academically on par with, or better than, the best medical schools in the United States. However, these schools have practically no medical doctors on staff, and the first of these schools to be accredited (Bastyr) was not accredited until the late 1980s. National College and SCNM only have candidacy status. Most of the instructors at these schools are "naturopathic physicians," which means that most instructors either graduated from unaccredited schools or are relatively new to practice. I ask you to closely examine the faculty at National College in Exhibit 5 where you will find that 24 (60%) of the 40 faculty members with National College degrees received their degree prior to National receiving candidacy status. In fact, the faculty member who teaches oncology and gynecology lists National College as her only credential. Moreover, National College has had three different presidents in the past two-years, which is cause for additional concern.
The truth is "naturopathic medical" education and training mimics medical education and training in form, but not in content! Conventional medical students start clinical work under physician supervision in their third and fourth years, and are assigned to work in major teaching hospitals and clinics. Even after four years of medical school, graduates are ineligible for full medical licenses but must enter residency programs which last between three and eight years. It is clear that "naturopathic medical" colleges in the United States do not provide the equivalent of a medical education. Dr. Richard Roberts, Board Chairman of the American Academy of Family Physicians summed it up best in The Wall Street Journal, August 22, 2002, when he said, "Naturopaths should not be the coordinator of care. There's a world of difference [compared with M.D.s] in terms of the training, the ongoing education, and the day-to-day work. It is like having the flight attendants fly the plane."
The Council on Naturopathic Medical Education (CNME), the accreditation board that recently accredited naturopathic medical institutions and programs, had its recognition withdrawn in 2001 by the United States Department of Education (Exhibit 6) because it demonstrated "pervasive non-compliance" in "not following its own standards." If they are willing to cut corners with their accrediting agency, who is to say that they would not cut corners on the Advisory Committee on Naturopathic Medicine? History does have a way of repeating itself.
NATUROPATHY VS. NATUROPATHIC MEDICINE - A person who feels ill and sees an allopathic physician will typically be given a diagnosis to name the disease and then a prescription for medication to kill the germs that cause the illness. Once the symptoms have disappeared, the person is considered healthy. The allopathic approach to healing is to find the agent of disease-that is, bacteria or virus--and then to kill it.
Vis medicatrix naturae, or the healing power of nature, is central to traditional naturopathic philosophy. This philosophy holds that disease occurs when toxins that have accumulated internallyusually due to incorrect lifestyle, a poor diet, and improper care of the body which weakens the body. Bacteria and viruses, which are always present, seldom cause problems in a healthy body. While allopathic methods of treatment may get rid of symptoms, these treatments alone do not bring healing. The human body is designed to heal itself. Traditional naturopathic modalities stimulate the body's inner forces to get rid of accumulated toxins and thereby allow intrinsic healing to take place. Rather than trying to attack specific diseases, traditional naturopaths focus on cleansing and strengthening the body.
Traditional naturopaths avoid procedures that are common to medical care-diagnosing disease, treating disease, prescribing drugs and pharmaceuticals, and performing invasive procedures. Instead, traditional naturopaths focus on health and education, teaching their clients how to create internal and external environments that are conducive to good health. This is how naturopathy was meant to be practiced as described by Benedict Lust's obituary reported in The New York Times, "The members of the American Naturopathic Association do not believe in ...drug treatments, medicinal remedies or vivisection. " (Exhibit 7)
Traditional naturopathy is simply not the practice of medicine. Diagnosing and treating disease, prescribing drugs and pharmaceuticals, performing major and minor surgery, giving injections and drawing blood, and performing other invasive procedures are medical practices that are outside the scope of traditional naturopathy. Anyone who performs these procedures without a license is illegally practicing medicine and, under existing laws, can be and should be prosecuted for doing so without a license.
While self-styled "naturopathic physicians" seek to claim the same core philosophy as traditional naturopaths, in practice, they move into territory long held by allopathic physicians. "Naturopathic physicians" seek to have laws enacted that would authorize them to perform minor surgery, practice obstetrics including episiotomies, prescribe certain drugs including some synthetic antibiotics, and use many allopathic diagnostic procedures including X-rays, electrocardiograms, ultrasound, and clinical laboratory tests. These procedures move "naturopathic medicine" far from the realm of traditional naturopathy and into the practice of medicine. This is why, "naturopathic physicians" are seeking to be licensed; otherwise, in conducting their desired scope of practice they would be illegally practicing medicine.
FISCAL IMPACT - A close look at Senate Bill 1300 reveals that the potential licensees will not support the cost of regulation through fees. Given the fact that the program has no way to support itself, it is inappropriate for Idaho to create a new program for which only eleven (11) individuals will be eligible, especially a program Idaho would have to subsidize. There is no need for a new medical profession and certainly no legitimize basis for Idaho to subsidize it! Furthermore, if a person needs any surgery or prescription drugs there are already licensed medical doctors to fill this need. Practically and fiscally speaking there is simply no demonstrated need for this hybrid profession.
SCOPE OF PRACTICE - If "naturopathic physicians" are allowed by Idaho to "diagnose and treat" disease, prescribe medications, and perform surgery , a "new medical profession" will be created and they will be elevated to the status of primary care physicians. This promotion is high on their agenda because of the status and the money associated with it. Thomas Kruzel, Chief Medical Officer at Southwest College of Naturopathic Medicine and former President of the American Association of Naturopathic Physicians, was quoted in the Spring 1994 edition of The Naturopathic Phvsician (Exhibit 8) as saying, "Naturopathic physicians are primary care, family practice physicians, and as such are gate keepers to the medical system, along with family practice MDs and DOs." By licensing "naturopathic physicians" Idaho would be equating "naturopathic physicians" with MDs and DOs, because "naturopathic physicians" will inform their "patients" that there is no need to continue to see a regular medical physician, as they have consistently done in states where they are licensed. These "patients" assume "naturopathic physicians" have an education from legitimate medical schools approved by the Liaison Committee on Medical Education. The lack of a need for a "new medical profession" is one of the primary reasons licensing efforts like this one have been rejected on over 50 separate occasions in the last seven years.
In a sworn deposition (Exhibit 9) Mr. Kruzel defined minor surgery in this way:" . . . generally it means that you do not enter a body cavity." The Oregon "naturopathic medicine" licensing law defines minor surgery as "the use of electrical or other methods for the surgical repair and care incident thereto of superficial lacerations and abrasions, benign superficial lesions, and the removal of foreign bodies located in the superficial structures; and the use of antiseptics and local anesthetics in connection therewith." It is difficult to reconcile Kruzel's definition of minor surgery with the actual wording of the Oregon law.
Furthermore, Kruzel has given the following sworn testimony regarding his qualifications to perform vasectomies:
Q: You mentioned that you could do vasectomies on male gonads; is that correct? A: That's correct...Q: You don't consider that to be an invasive procedure? A: Certainly it's an invasive procedure, but it doesn't invade a body cavity, the scrotum is considered an appendix. Q: And is this procedure taught at National College? A: I don't know if it is or not. ..I'm saying that it's within the scope of naturopathic medical practice, and I believe that it probably is taught in school. ..Q: How many vasectomy operations did you do in school? ...A: I did no vasectomies. Q: Do you feel that the fact that you did no vasectomies in school qualifies you to do them in the scope of practice out here with the public? A: Yes. It's a relatively simple procedure to do. Q: Could you learn this procedure by a video tape? A: Possibly.
The Washington Association of Naturopathic Physicians (WANP) exposed their real agenda of displacing medical doctors as justification to expand prescriptive rights for "naturopathic physicians" to include Schedule II drugs. In a 1998 report to the Washington legislature, the WANP stated, "The primary reason for this language change is to ensure that patients seeking naturopathic care will not unnecessarily be burdened with seeking a second office visit by another licensed practitioner (i.e. a real medical doctor) in order to get, for example, codeine cough syrup or an antibiotic which is not currently in the list of legend drugs that a naturopathic physician can prescribe."
Fortunately, the Washington legislature exposed the ruse and did not grant additional scope.
UNIVERSITY OF CALIFORNIA. SAN FRANCISCO -CENTER FOR HEALTH PROFESSIONS - The Center for Health Professions at the University of California, San Francisco, released a study funded by The Arkay Foundation in September of 200 I titled, "Profiling the Professions: A Model for Evaluating Emerging Health Professions" and an accompanying profile titled, "Profile of a Profession: Naturopathic Practice." The study recognized the right of professions to not seek state regulation choosing to allow market forces and consumer choice to protect the public. It stated, ". ..professions have declined regulation, basing their decision on the low potential risk of harm to the public, evidence that regulation can negatively affect access to care, and the capacity of the market to weed out the lower qualified members of the profession."
The study also spoke to the true reason that groups seek state regulation-POWER -when it stated that:
" Although regulation is the legislatures' decision, legislatures virtually never seek to regulate a profession on their own. When it is enacted, it is almost always after long and contentious battles between competing or would-be competing professions. Therefore, though informative, the existence of regulation mayor may not mean much more beyond the capacity of the would-be regulated profession to gamer sufficient political power ."
WHITE HOUSE COMMISSION ON COMPLEMENTARY AND ALTERNATIVE MEDICINE POLICY (WHCCAMP) - By Executive Order 13147, the White House Commission on Complementary and Alternative Medicine Policy was created in March of 2000 and completed its work in March 2003 with the submission of its report, http://www.whccamp.hhs.gov/finalreport.html, to the Office of the President. The Commission was comprised of 20 members, and the Commission held 10 meetings in Washington, DC, and four town hall meetings around the United States. It is important to recognize that a study of this magnitude will have a number of divergent opinions on a wide variety of topics. The proponents sometimes represent that the Commission recommended that every state should license "naturopathic physicians." However, an accurate reading of the report reveals such representations are untrue. In the section titled " Access and Delivery," the commission provided guidance to Idaho when it stated, "Now is the time to look at policy options for the future and to design strategies for addressing potential issues of access and safety .Beyond these basic concerns, protecting the public, maintaining free competition in the provision of CAM services, and maintaining the consumer's freedom to choose appropriate health professionals are issues to be considered when developing strategies and policies."
Secondly, the Commission made it clear that concern exists in the CAM community over appropriate regulatory frameworks for CAM, especially frameworks designed using current regulatory models. The report stated, "Some CAM professionals believe that to reorganize CAM on the conventional professional model, with the kind of licensure, registration, or exemption procedures that this implies, will damage the fundamental character of much of CAM. Some believe that in the past, legislation to "protect the public" was often used to restrict competition in the provision of services."
Thirdly, a well-respected physician and a member of the Commission, Dr. Tieraona Low Dog, teamed up with another member of the Commission to send a letter to the Secretary of Health and Human Services to address a number of issues included in the report. One issue related to equating CAM practitioners with designated primary care specialties. They stated:
"While we endorse demonstration projects that seek to identify what, if any, value "CAM" providers add to established primary care teams, we want to go on record noting that we do not believe that CAM providers are fungible with the primary care providers enumerated in Title VII. Further, "Efforts (such as Senate Bill 1039) to equate their degree of training, or the scientific basis of their practice, with that of the designated primary care specialties puts the public at risk of receiving unvalidated and non-evidence based primary care."
CONCLUSION - The reasons set forth above demonstrate why licensure for this new "medical profession" should not be considered. It is clear that the education of "naturopathic physicians" does not meet the standards one would expect from primary care providers who diagnose and treat disease, prescribe medications, deliver babies, and perform surgery, and this is a role already being filled by medical doctors. If licensure is granted, those so-called "naturopathic physicians" will be so elevated in stature that they will be perceived by the public as equal to the far more extensively- trained allopathic physicians, thus creating the potential for confusion and providing of improper medical care.
If licensure is not granted, "naturopathic physicians" may continue to practice in the same manner that is legal today- without making diagnoses, without prescribing medications, and without performing invasive procedures. Those who perform these procedures without a license will be practicing medicine without a license and will be breaking the law. Legal procedures are already in place for addressing this problem, at no added cost to the state.
There has been no change in Idaho since last year that would establish a need for this legislation. There is absolutely no demonstrated need to create a new medical profession by licensing "naturopathic physicians." In the over 50 different occasions state legislatures have looked at this question in 1997, 1998,1999, 2000, 2001,2002, 2003, and thus far in 2004, they concluded that there is no need to create a new medical profession styled as "naturopathic medicine."
Since the public is not crying out for the licensure of "naturopathic physicians," then who is? The cry for licensure is coming from eleven (11) "naturopathic physicians" in the State and their trade organization, the American Association of Naturopathic Physicians. This is not about public protection. This is about trying to obtain legislative economic protection, status, and power. These three "naturopathic physicians" gambled on going to school for a profession that is not licensed in 38 of the 50 states, and they now expect Idaho to bail them out! Nancy Aagenes, Past-President of the American Association of Naturopathic Physicians, stated in 1996 and it is still true today, "Nonetheless a student coming out of our schools, uncertain and anxious anyway often simply will not practice in an unlicenced state. If enough of us default on our loans, a major source of income for our schools is cut off."
The State does not need to create a new medical profession known as "naturopathic medicine." Idaho needs to reject the position of the AANP as the nineteen states that considered this type of legislation in 1997, 1998, 1999, 2000, 2001, 2002, 2003, and thus far in 2004, rejected such licensing.
This legislation is nothing but a self-serving attempt by a minuscule special interest group to legitimize their alternative approach to the practice of medicine by mandating the creation of their own licensing process and to steal by legislative action the titles that have been used by registrants for over twenty years.
The attached above mentioned exhibits during this testimony, and also a CD-R containing a copy of the Arizona Office of the Auditor General Performance Audit, Arizona Naturopathic Physicians Board of Examiners - June 2000 report were presented. (See Attachments #1 and #2). |