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This week we’ll take a break from lambasting the National Center for Complementary and Alternative Medicine, as worthy as that task is, in order to confront some of the latest events involving the pseudomedical cult that calls itself “naturopathic medicine.”* Intrepid nurse and anti-healthfraud activist Linda Rosa reports that Colorado is dangerously close to becoming the next state to endorse “NDs” as health care practitioners, and Scott Gavura of Science-Based Pharmacy called my attention to a report that British Columbia is considering enlarging the scope of practice for NDs, who are already licensed there, and that Alberta is on the verge of licensing them. In each case, those whom the public trusts to make wise decisions have betrayed their ignorance of both pseudomedicine and the realities of governmental regulation.

To explain why, it will first be necessary to make a few assertions, which are linked to developed arguments where necessary:

Now let’s look at the current events. These will be presented by quoting statements of some of those involved. I have added hyperlinks, emphasis, and, when needed, comments. Please keep the list above in mind as you read this material, although there is little to add to Linda Rosa’s arguments.

Colorado

On 2/8/09, Linda Rosa wrote:

The Colorado Naturopaths are trying for licensure once again — HB1175: The bill, on scanning, looks much like last year’s, but it additionally (and ridiculously) calls for a 3-year task force to report annually to the legislature “concerning the practice of naturopathic medicine in Colorado” and to sunset in 2014.

The most disturbing change is not in the bill itself: organized medicine—for better or worse, usually the last hope for resisting state endorsements of quackery—has finally caved to the pressure. Ms. Rosa expressed her concerns to Diana Protopapa, the Director of Political Affairs and Education at the Colorado Medical Society (CMS):

Dear Ms. Protopapa and CMS Leadership: Thank you for speaking with me yesterday about HB1175, the bill that would legitimize naturopathy as a profession in Colorado. It is very disheartening to learn the Colorado Medical Society supports passage of HB1175, though I understand your House of Delegates is strongly opposed to such legislation. I would like to help clear up some misconceptions and offer reasons why CMS leadership should work to kill this bill: ————- 1) You indicate that CMS believes that many Coloradoans are using the services of naturopaths and that is why the state should take steps to protect the public. But there is no evidence supporting this belief. A large NIH ( NCCAM ) survey in 2007 indicates a very small percentage of the public uses naturopaths (0.2%). That translates to about 10,000 Coloradoans using Naturopaths. Compare that to some 430,000 who use Chiropractic in our state. (Note: Loveland’s McKee hospital closed its alternative medicine center for lack of interest and financial loss.) ————- 2) CMS apparently believes that naturopaths offer some valuable services. You mentioned nutrition counseling as an example. Nutrition is actually a big problem area. Naturopaths do not use science-based practices, and that includes the area of nutrition. Naturopath nutrition counseling includes dangerous detoxing regimens and expensive, worthless supplements. Naturopaths of all sorts are infamous for recommending highly restrictive, low calorie diets for cancer patients, which can be lethal for this population. A leading “degreed” naturopath (Bastyr University) recommends the infamous Gerson Therapy/Diet for cancer patients: it consists of several coffee enemas each day with a diet of juiced vegetables, fruits and raw calf liver. Last year, the Colorado Association of Naturopathic Physicians legislative activities were sponsored by 13 “Big Supplement” companies. ————- 3) HB1175 would require registered naturopaths to follow public health policy for some children. But naturopaths are “vitalists” who reject germ theory. They are educated to oppose public health policy, such as immunization, fluoridation, and pasteurization. How does that make them qualified to carry out these policies effectively or reliably? ————- 4) Please read (below) what a cancer patient who is under the care of a licensed naturopath wrote. All the testing and treatments recommended to this woman are worthless, expensive — and some would likely shorten her life. Note the “treatment” program was determined before the bogus labs were done. The restrictions in HB1175 would do little to prevent such exploitation. ————- 5) Members of the task force required by HB1175 will be picked by a DORA employee with an obvious bias for naturopathy. This same DORA employee, a lawyer, would make all final decisions regarding appropriate care. Requiring evidence-based practices can be gotten around, because alternative medicine practitioners have their own “journals” and their own low standards for “evidence.”

(It is notable that NIH-funded research, which began in 1991, has not validated a single CAM practice.) ————- 6) CMS may not have been fully aware of all the nonsense in naturopathy when it helped craft this bill. Attached is a disturbing list of *all the practices* the ‘degreed’ naturopaths in Colorado have offered on their websites. ————- 7) With HB1175, registered naturopaths would be exempt from the Medical Practice Act.

————-

8) “Degreed” naturopaths also kill, but they don’t go to prison like [Colorado] naturopath Brian O’Connel did for killing Sean Flanagan:

When 16-year-old Megan Wilson of Kenmore, WA, had a severe asthma attack, her mother took her to her “primary care physician,” Lucinda Messer, a licensed, degreed naturopath. Megan got some acupuncture, a shot of vitamin B-12, an herbal preparation, and was sent home. She died. If Messer had taken her to an emergency room across the street from her office, Megan most certainly would have survived.

While the parents won a wrongful death case against Messer, who is a licensed naturopath in Arizona and Washington, the naturopath boards in both those states cleared her of all charges of incompetence.

(see http://www.seattleweekly.com/2005-06-08/news/death-by-natural-causes.php “Death by NATURAL Causes” – Seattle Weekly, June 8, 2005)



————- 9) This bill, if it passes, will not be the end of naturopath bills. Naturopaths consider themselves the equivalent of primary care physicians and are now seeking in other states more and more privileges (full prescription, OB/GYN services, minor surgery, etc.) ————- 10) Some legislators look to naturopaths to serve poor and rural populations. This would set up an two-tiered healthcare system. CMS would clearly not want to encourage that. ————- I implore CMS leadership to reconsider its support of HB1175. First do no harm. Thank you for your time and attention. Sincerely,

Linda Rosa, RN

Executive Director

Advocates for Children in Therapy

http://www.childrenintherapy.org

—-

Quackwatch

Board of Scientific & Technical Advisors

http://www.quackwatch.org

—-

Colorado Director &

National Board Member

National Council Against Health Fraud

http://www.ncahf.org/ A CANCER PATIENT WROTE: Now, this Doctor scared me even more than the first one I went too. Her

nurse asked me, “Are you going to commence the blood test?” I said,

“Sure!” When she shows me how much I must come in with by the next day,

3,253.75 dollars.. I was stunt. I said, “What blood test is that?” She

was adding all the testing with out the treatment program. Here is all the testing Complete digestive analysis test $550.00 (A higher cost than the other

Doctor I saw) Comprehensive liver Detox $260.00

RBC Minerals $270.00 Essential Fatty Acids $320.00 Amino acids $480.00

Spectracell 3000 $420.00

Heavy metal challenge $385.00

Estronex $180.00 24 hour hormone/ HGH $550.00 I would get a 15% discount if paid all at once. Treatment program Which they want to do

MHA $351.00 Colonic Therapy 10x $540.00 (can we do this at home?)

Reflorestation 10x $225.00 Allergy Elimination 30x $950.00 Vitamin C IV 10x $850.00 Nutritional Consultation 4x $435.00 Physician APPTS 5x $500.00 Peroxide 8x $760.00 Now I wonder, How much of this do I really need and how much is just

excess and adding to my bill?”

Ms. Protopapa replied to Ms. Rosa:

Linda, I am happy to visit with you anytime regarding your concerns on CMS’ support of HB 1175. According to your assertions below, it appears that you misunderstood many of the issues we discussed yesterday and I feel it’s important that we all understand Colorado’s long history with naturopathic regulation legislation and the varied reasons why CMS is supporting HB 1175. But before I do that, it’s very important that I make the distinction for you that CMS policy opposes licensure of naturopaths. HB 1175 registers naturopaths. This is the lowest form of regulation. Registration does not allow for a rule making board (like physicians, nurses, chiropractors, etc., have) but ensures that the subjects to be registered meet certain qualifications in order to be registered and gives consumers recourse in the event that they are harmed.CMS’ goal with this legislation is to tightly restrict the scope of practice of naturopathy while creating a process to ensure that consumers have timely recourse to regulatory relief when they have been harmed by naturopaths – something the current system does not provide.



Legislation regulating the practice of naturopathy has been introduced in Colorado for the past 14 years. It initially bore little credibility and was predictably defeated. As the years progressed the naturopaths’ assertions that regulation was necessary in order to protect the public began to gain ground with the Colorado Department of Regulatory Agencies (DORA) and in 2005, after several deaths occurred at the hands of an unqualified naturopath, DORA recommended licensure. Three years later the division once again gave the nod for regulation. DORA argued that regulation would: * Protect the public from the dangers of unskilled naturopaths and unsound treatment or advice, and;

* Protect the public from reliance on unskilled naturopaths, as well as directing them to proper medical care. Over the years, the Colorado Association of Naturopathic Physicians’ (CANP) desire for regulation increased. Their case was strengthened by the support of many respected legislators on both sides of the aisle who agreed with DORA that regulating naturopathy is a consumer protection issue particularly in light of the fact that the Board of Medical Examiners doesn’t have the resources to police this discipline. CMS understands that naturopathy and patient safety may sound like fundamentally incompatible concepts to many physicians. After all, naturopathy is not founded in western science and many of its treatments have not been subjected to rigorous clinical tests to determine their effectiveness. CMS also recognizes that a growing number of consumers turn to naturopathy for the treatment of various ailments. And, equally significant, because the practice of naturopathy isn’t regulated, neither the state nor patients have sufficient recourse in the case of harm. This year, naturopathic regulation legislation resurfaced and CMS got the green light from the Council on Legislation (COL) and its Scope of Practice Subcommittee (SOP) to seek common ground in the name of patient safety. After several months of discussion between organized medicine and CANP and many iterations of draft legislation we crafted a bill that features a very limited scope of practice for naturopathic doctors – one that the physicians of CMS, the Colorado Academy of Family Physicians and the Colorado Chapter of the American Academy of Pediatricians feel is appropriate and will adequately protect those members of the public who choose to seek naturopathic care. HB 1175 will create a regulatory scheme that protects consumers, gives them the ability to report substandard care and file grievances against those who are not qualified to practice naturopathic medicine. It also creates a very narrow scope of services that naturopathic doctors can perform. Among the many patient protection provisions, HB 1175 will: * Register only those individuals who graduate from a post-graduate, four-year residential academic program recognized by the U.S. Department of Education; * Provide “truth in advertising” protections by prohibiting naturopathic doctors from using the terms MD, DO, medical doctor or physician; * Required naturopathic doctors to provide a host of disclosures aimed at educating consumers on the qualifications of a naturopathic doctor, the differences between a naturopathic doctor and a physician (M.D./D.O.) and those practices that naturopathic doctors are prohibited from performing; Additionally, HB 1175 creates a narrow scope of practice in which naturopathic doctors may practice naturopathy. Indeed there are more prohibitions than allowances. Naturopathic doctors are prohibited from practicing or treating the following:

* Prescribing, dispensing or administering prescription drugs other than vitamin B-12 injectables;

* Performing surgical procedures or the use of laser devices;

* Use of anesthesia other than topical anesthetics;

* Administering ionizing radiation or radioactive substances;

* Practicing obstetrics;

* Recommending the discontinuation of care recommended by any other licensed health care provider;

* Treating cancer;

* Providing chelation therapy;

* Performing colonic irrigations;

* Treating a host of conditions that don’t improve with documented evidence within 25 days without advising the patient to consult a licensed physician; and

* Treating children less than two years of age. When treating children between the ages of two and eight, the naturopathic doctor is statutorily required to follow all public health laws. Finally, you note below that 1175 will make naturopaths exempt from our MPA. Currently, the CO Board of Medical Examiners is not pursuing any complaints filed against naturopaths for practicing medicine because they do not have the resources to do so. HB 1175 will create a funded regulatory structure that will police naturopaths and will sanction those who are practicing medicine without having a medical degree. Without HB 1175, the BME will continue to be unable to pursue such complaints and patients will remain “in the dark” and vulnerable.

If you have any other questions, please don’t hesitate to contact me.

Regards,

Diana Protopapa

Of all the misconceptions in Ms. Protopapa’s note, two are particularly disturbing. First, it is misleading to write that “the Board of Medical Examiners doesn’t have the resources to police this discipline.” The reality is that the Director of the Division of Registrations has, for dubious reasons, refused to allow the BME to aid in the prosecution of naturopath physician-impersonators, even though the language of the Colorado Medical Practice Act requires the board to do exactly that. If money is the issue, then money should be the remedy—not creating a more expensive bureaucracy that will dupe unwary citizens into believing that NDs and their claims have been validated by government.

The Director of the Division of Registrations, by the way, is the “DORA employee with an obvious bias for naturopathy” mentioned in Ms. Rosa’s first note to Ms. Protopapa, and was also responsible for the misguided DORA Sunrise Review linked from #12 of my list at the beginning of this post. Who do you suppose will be responsible for disciplining NDs under the proposed legislation? The Director of the Division of Registrations!

Second, the “very narrow scope of services” is inaccurate, because there is no formal scope of practice in the bill. Even the “prohibitions” are subject to change. According to whose advice? According to the advice of the Naturopathic Doctors Task Force, which will

…CONSIST OF THE DIRECTOR; REPRESENTATIVES FROM THE DEPARTMENT DESIGNATED BY THE EXECUTIVE DIRECTOR OF THE DEPARTMENT; AND EQUAL NUMBERS OF PHYSICIANS LICENSED UNDER PART 1 OF ARTICLE 36 OF THIS TITLE AND NATUROPATHIC DOCTORS APPOINTED BY THE DIRECTOR.

What else will the Task Force be asked to consider?

(a) WHETHER COLORADO SHOULD ESTABLISH A REGULATORY PROGRAM TO OVERSEE THE PRACTICE OF NATUROPATHIC MEDICINE BY NATUROPATHIC DOCTORS; (b) THE QUALIFICATIONS OF NATUROPATHIC DOCTORS AND WHAT SCOPE OF PRACTICE SHOULD GOVERN NATUROPATHIC MEDICINE IN COLORADO; (c) WHETHER NATUROPATHIC DOCTORS SHOULD BE ALLOWED TO PRESCRIBE PRESCRIPTION DRUGS AND, IF SO, UNDER WHAT FORMULARY AND HOW SUCH FORMULARY IS TO BE DETERMINED; (d) WHETHER SPECIFIC DISCLOSURES SHOULD BE PROVIDED TO PATIENTS OF NATUROPATHIC DOCTORS AND, IF SO, WHAT SUCH DISCLOSURES SHOULD CONTAIN; (e) THE TERMS NATUROPATHIC DOCTORS MAY AND MAY NOT USE TO DESCRIBE THEMSELVES AND THE PRACTICE OF NATUROPATHIC MEDICINE; (f) WHETHER, AND IN WHAT INSTANCES, IT WOULD BE BENEFICIAL FOR NATUROPATHIC DOCTORS TO CONSULT OR COLLABORATE WITH PHYSICIANS LICENSED PURSUANT TO ARTICLE 36 OF THIS TITLE; (g) WHETHER THERE ARE TREATMENTS PERFORMED BY NATUROPATHIC DOCTORS THAT SHOULD REQUIRE ADDITIONAL CERTIFICATIONS AND WHAT QUALIFICATIONS SHOULD BE REQUIRED TO OBTAIN SUCH CERTIFICATIONS; (h) THE APPROPRIATE AMOUNT OF MALPRACTICE INSURANCE A NATUROPATHIC DOCTOR SHOULD BE REQUIRED TO CARRY; AND (i) WHETHER NATUROPATHIC DOCTORS SHOULD BE ALLOWED TO PERFORM ANY OF THE PROHIBITED ACTS SPECIFIED IN SECTION 12-37.7-107.

A recent amendment, according to Ms. Rosa, which is not yet in the online version of the bill, is this:

2) THE TASK FORCE SHALL CONSIDER ISSUES RELATED TO THE PRACTICE AND REGULATION OF NATUROPATHIC MEDICINE. SUCH CONSIDERATION SHALL BE BASED UPON STANDARD EVIDENCE OF EFFECTIVENESS AND SAFETY IN LIGHT OF QUALITY, PEER REVIEWED PUBLISHED OR WIDELY VETTED RESEARCH. THE ISSUES CONSIDERED SHALL INCLUDE, BUT NEED NOT BE LIMITED TO: (a) THE QUALIFICATIONS OF NATUROPATHIC DOCTORS AND WHAT SCOPE OF PRACTICE SHOULD GOVERN NATUROPATHIC MEDICINE IN COLORADO INCLUDING, WITHOUT LIMITATION, ANY ADDITIONAL TREATMENTS THAT MAY BE APPROPRIATE FOR NATUROPATHIC DOCTORS TO PERFORM;

According to Ms. Rosa, the Colorado Medical Society believes that this amendment “will limit NDs to safe and effective practices.” The CMS is apparently naive to points 4 and 8 in my list at the beginning of this post.

The fix, it would seem, is in. Linda Rosa responded to Ms. Protopapa by observing that key NDs are unconcerned about the “prohibitions,” because it would be ridiculously easy to get around them. Regarding treatment of cancer, for example, the bill states:

EXCEPT THAT A NATUROPATHIC DOCTOR MAY TREAT CONCOMITANT CONDITIONS AND THE SYMPTOMS AND SIDE EFFECTS OF CANCER;

Ms. Rosa added, wryly:

The “degreed” naturopaths also admitted to long defying our Medical Practice Act. It seems the more they defy the law, the more support they find. Meanwhile, rumor has it CMS leadership is giving Colorado nurses a hard time at the capitol about their scope of practice…

Ms. Protopapa replied:

Linda, The bill strictly prohibits naturopaths from treating cancer other than the symptoms and side effects. Any naturopath treating cancer outside of this narrowly defined criteria is violating the law. Fortunately, should this bill pass, consumers will now have an avenue for recourse if they are the victims of a naturopath treating cancer. I respect your concern with CMS, the Colorado Academy of Family Physicians [!–KA] and the Colorado Chapter of the American Academy of Pediatricians [!!–KA] supporting HB 1175 but as I stated earlier, these organizations worked diligently [!!!–KA] to craft legislation that creates a very narrow scope of practice in which naturopaths may practice and strong consumer protections. This is far more protection than what we currently have in place, which is nothing at all. Should you have any further concerns, you can reach me at the numbers below. Thank you for your comments,

Regards,

Diana

To which Ms. Rosa replied:

Ms. Protopapa, I am amazed CMS leadership considers HB1175 to have “strong consumer protections.” Under HB1175, the “degreed” Naturopaths: * Will have no requirement for malpractice insurance * Will have no defined scope of practice * Can conduct “naturopathic diagnoses,” whatever those are… * Can perform “naturopathic treatments,” whatever those are… * Must adhere to a *mythical* set of “generally accepted standards of naturopathic practice” * Are allowed to provide substandard, worthless, unvalidated or dangerous treatments to a child with the parent’s consent Regarding (ND) Rena Bloom’s statement about the bill’s restrictions: Naturopaths understand cancer in unconventional terms. They can characterize their treatment of cancer (e,g, “boosting the immune system” and “detoxifying”) as “concomitant” or “adjunctive” treatment, and hence allowed by HB1175. Amendment L005 to HB1175 exempts some 900 “traditional” naturopaths from the bill. There would be no restrictions that affect their practice. They could even continue to call themselves “naturopaths” or “NDs.” The degreed naturopaths are so hungry for state recognition that they have even forgone their pretense that this is a “consumer protection” bill. Consumers would be better protected by complaining to the Medical Board, as they do today, instead of to a lawyer who has the power to rule on all matters, including about what is appropriate and inappropriate practice. The only good thing about this bill is that another amendment has done away with the provision exempting registered/degreed NDs from the Medical Practice Act. Again, I urge CMS and the other two organizations to reconsider support of HB1175. Thank you for your time and attention. Sincerely,

Linda Rosa, RN

Pay special attention to the amendment regarding “traditional” naturopaths, the obvious purpose of which is to remove a major source of opposition to a naturopathic practice act. “Educated” naturopaths always portray their petitions for regulation as a “public safety” issue (“don’t be fooled by fake psychics!”), and this group was no different—at first. The CMS fell for that gambit, as evidenced by each of Ms. Protopapa’s notes. Yet now it isn’t even part of the bill. As Linda Rosa observed, such cynicism was not lost on “traditional” naturopaths:

One traditional ND summed up the situation. He told me that the degreed NDs are so desperate for legal recognition that they’ll give up anything to get it. I would add …but without the intention of giving up anything in practice.

Will the CMS finally realize that the NDs real intent is to make themselves appear to be legitimate “health care providers,” with all the rewards of that designation, e.g., protection to practice their brand of quackery, greater patient volume, insurance coverage, etc.?

∏=3

It seems unlikely. The naivete of the three medical organizations appears boundless. According to Linda Rosa, physician representatives of all three misused the term “allopathy” in their testimonies to the legislature. The bill itself repeats the usual falsehoods about science, medicine, and naturopathy, quoted verbatim from naturopathic litany, that exist in almost every naturopathic practice act. That not one of these physicians seemed to recognize this, or at least to give a damn, is mind-numbing.

The only good news from Ms. Rosa is that the bill is not yet law:

The bill has only passed the House Health and Human Services Committee. It next goes to Appropriations. If Appropriations finds the bill will be more expensive than the bill anticipates, the bill will go back to the HHS Committee. (That’s how we killed it two years ago — i.e. showing it would cost the State of Colorado millions, based on a study done in Hawaii.) So the bill hasn’t faced a full House vote yet. No senate vote yet either. Since 1992, this is the 6th try for an ND bill in Colorado.

British Columbia and Alberta

According to an editorial in Wednesday’s Calgary Herald, British Columbia is considering allowing “naturopathic doctors” to prescribe pharmaceuticals and order x-rays:

B. C. Minister of Health George Abbott says the regulations are about choice. Naturopaths would be limited to prescribing Schedule I and Schedule II drugs, including antibiotics, painkillers and anti-depressants. The naturopaths would also have authority to order lab X-rays, instead of having to refer their patients to a medical doctor to do paper work. … There is an argument to be made for giving naturopathic doctors the power to prescribe certain drugs, such as those which replace natural hormones. Bruce Lofting, a naturopathic doctor and vice-president with the Alberta Association of Naturopathic Practitioners, says there’s really only a “handful” of medications that are useful to naturopaths, mainly hormones. Antibiotics are also important, in that a patient might have an infection, in which case naturopathic doctors have no choice but to send them to a medical doctor for treatment. That’s inconvenient, costly, and unnecessary.

The same article calls for “regulation” of naturopaths in Alberta (hmmm, I thought naturopathy was already a “regulated profession” in Alberta), making the same, erroneous assumptions that are being made in Colorado:

The bigger dilemma in Alberta is that this profession still needs to be regulated. Albertans deserve the choice of going to a naturopathic doctor and being assured certain standards, training and disciplinary measures are in place. A college has already been established, and rules written, but the province must first give final reading to the legislation. Lofting says the Health Ministry has indicated proclamation is expected during the current Parliamentary session. Considering the speed with which this profession is expanding next door, those regulations can’t come soon enough.

I am out of time and out of gas, so I won’t discuss these misconceptions further. At this point it probably isn’t necessary.

…………….

*The Naturopathy Series: