Response by the Coalition for Natural Health, Inc

The Coalition for Natural Health

response by the coalition for natural health, inc.,

(CNH)

to the 2004 naturopathic physicians sunrise application

DC OFFICE: PMB100-408 1220 I Street, N.W. §'Washington, DC20005-4018

I

^S CALIFORNIA OFFICE:

'fust Office Box 16246 Son Diego, CA 92176-6246

!-800586-4CNH (4264) |C Residents 202-216-9488 fox 1-800-598-4CNH (4264)

( Sw.noturalheolth.ofg

For the past eight years, naturopathic physicians through their trade organizations, including the Colorado Association of Naturopathic Physicians (CANP), have continued to seek licensure in all 50 states. While they have succeeded in passing licensure in one state, California, the overwhelming majority of state legislatures have rejected these attempts. This is the third sunrise application in the last 11 years, with all previous attempts failing before the Colorado legislature. In this response to the CANP's sunrise application, we will show, that yet again, the CANP failed to meet the statutory requirements for sunrise.

Before providing CNH's response to the application, I want to introduce the Coalition for Natural Health. CNH is headquartered in Washington, DC with a regional office in San Diego. It is a non-profit organization representing thousands of individuals nationwide, and in Colorado, 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 with regard to the true meaning and benefits of various natural health practices including traditional naturopathy;

• To educate legislators with regard to the efficacy of natural health and traditional naturopathy;

• To prevent legislation that would prohibit practitioners of natural health modalities including traditional naturopaths from practicing now and in the future; and

• To keep natural health practices including traditional naturopathy in the public domain. HISTORY

The first Sunrise Application in Colorado was submitted to the Department of Regulatory Affairs in 1993. In the Department's report to the legislature, the Department determined that licensure should not be granted, hi recommending that the General Assembly should not license naturopathic medicine, the Department concluded:

"The Colorado Association of Naturopathic Physicians has not shown that the public is being substantially harmed by the unregulated practice of naturopathic physicians. In addition, the number of naturopathic physicians in Colorado comprises such a small number that a regulatory program is not appropriate at this time. Civil, criminal, and administrative means exist to address the unlicensed practice of medicine by naturopathic physicians and there are no documented cases of harm, no further benefit would accrue to the public by regulating the profession. Concerns do exist concerning the scope of practice of naturopathy physicians and the public's perception of their title 'physician'. By licensing naturopaths, the State would be giving recognition to the profession. This may mislead the public about the effectiveness of certain naturopathic services, which may have no clinically proven value. The Department has not found any significant harm to the public resulting from the unregulated practice of naturopathic physicians that could be effectively addressed by the proposed regulatory scheme."

Despite the Department's determination of a lack of a need for regulation, the ColoradoAssociation of Naturopathic Physicians (CANP) submitted yet another application 5 years later.

Although the 1998 Sunrise Review recommended licensing to the legislature, the Office of Policy and Research admitted that the proponents had not met the sunrise.criteria for regulation. In fact, even with a report recommending licensure, the state legislature, in 1999, soundly rejected a licensing bill sponsored by Representative Russ George, Speaker of the House at the time. As we fast-forward to today, you have yet another sunrise application with essentially the same information that you had six years ago. The only difference between then and now is a single case of harm in Colorado that involves the unlicensed practice of medicine, not the misuse ofnaturopathy.

2004 APPLICATION

Before getting into the specifics of this year's application, we would like to clarify a number of issues, and set the proper context for the application and subsequent review. Many different approaches to healthcare are available in the United States today. The most widespread is the conventional - or "allopathic" - care that people have generally known since childhood and which is practiced by medical doctors/physicians. Another approach is "Traditional Naturopathy," as practiced by "Traditional Naturopaths." "Naruropathic medicine," as defined and described by the American Association of Naturopathic Physicians (AANP) and the CANP, is an attempt at combining allopathic and naturopathic techniques and is practiced by self-styled "naturopathic physicians."1

In the following pages we will look at some ofthe attributes of allopathic medicine, traditional naturopathy, and AANP-style "naturopathic medicine". We will show that traditional naturopathy and AANP-style "naturopathic medicine" are two distinctly different approaches to healthcare. We will also show that naturopathy, as practiced by traditional naturopaths, is

inherently safe and is not in need of regulation. By contrast, we will show that there are definite health and safety issues involved in the practice of AANP-style "naturopathic medicine" and that Colorado should not license it.

Principles Contrasted

A person who is ill and sees a conventional medical doctor will typically receive a diagnosis to identify the disease and then a prescription for medication to eradicate the germs that cause the illness. Once the symptoms have disappeared, the person is considered healthy. This 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 practice. This theory of practice holds that disease occurs when toxins that have accumulated internally - usually due to incorrect lifestyle, a poor diet, and improper care of the body - weaken a person. Bacteria and viruses, which are always present, seldom cause problems in a healthy body. While conventional medical treatments may rid the body of symptoms, these treatments alone do not bring about true healing. The human body is designed to heal itself. Naturopathic modalities muster the body's inner forces to rid it of accumulated toxins and thereby allow true healing to take place. Rather than trying to attack specific diseases, naturopaths focus on cleansing and strengthening the body.

Traditional Naturopaths do not use procedures that are common to medical care such as -prescribing drugs and pharmaceuticals, performing invasive surgical procedures, and delivering babies. Instead, naturopaths focus on health and education, teaching their clients how to create internal and external environments that are conducive to good health. This is the function that traditional naturopathy was meant to serve as evidenced by a New York Times story on the death

1 The AANP and the CANP are trade organizations whose primary goal is to seek licensure for so-called naturopathic "physicians" to practice

of Benedict Lust, universally regarded as the father of naturopathy, "The members of the American Naturopathic Association do not believe in ...drug treatments, medicinal remedies or vivisection " (Exhibit 1) The common person on the street knows, and has known for over 100 years, the generally accepted meaning of the word "naturopathy" is synonymous with NOT using drugs or surgery. The American Heritage Dictionary of the English Language. 3rd edition, copyright 1996, defines naturopathy as "naturopathy, n. a system of therapy that relies on natural remedies, such as sunlight supplemented with diet and massage.”

Traditional naturopathy is not a medical practice. Prescribing drugs and pharmaceuticals, performing surgery, giving injections and drawing blood, and performing other invasive procedures are medical practices that are outside the scope of naturopathy. A naturopath who performs these procedures is practicing medicine and can be prosecuted for doing so without a license. While self-styled "naturopathic physicians" seek to claim the same core philosophy as naturopaths, in practice, they move into territory long held by conventional medical doctors.

"Naturopathic physicians" seek to have laws enacted that would authorize them to perform minor surgery, practice obstetrics including episiotomies, prescribe certain drugs including synthetic antibiotics, ephedrine, morphine, coumadin, etc., and use many conventionalmedical diagnostic procedures including X-rays, electrocardiograms, ultrasound, and clinicallaboratory tests. These procedures move "naturopathic medicine" far from the realm oftraditional naturopathy and into the practice of medicine. This is why, "naturopathic physicians"are seeking to be licensed; otherwise, under their desired scope of practice, they would be illegally practicing medicine. Dr.Rena Bloom, a Denver "naturopathic physician" was quoted inthe Colorado Daily (Exhibit 2) on Monday, January 18, 1999, as stating, "We need this bill .

~their new style of "medicine," which is neither traditional naturopathy nor conventional allopathic medicine.

because at this point, we're illegal — we're practicing medicine without a license." Interesting to note is Ms. Bloom's admitted incentive for seeking licensure - it's not for the good of the public, but rather it is to legitimize her own violations of the law for her own self-interest.

In 1997, the State of Minnesota Legislature directed the Department of Health to complete a comprehensive study of complementary and alternative medicine. The Legislature directed the Commissioner of Health to convene a Complementary Medicine Advisory Committee. The Advisory Committee recognized and clearly stated the difference between "naturopathy" and "naturopathic medicine." The committee defined naturopathy as,

"...a distinct system of non-invasive health care and health assessment in which neither surgery nor drugs are used, dependence being placed only on education, counseling, naturopathic modalities, and natural substances, including without limitation, the use of foods, food extracts, vitamins, minerals, enzymes, digestive aids, botanical substances, topical natural substances, homeopathic preparations, air, water, heat, cold, sound, light, the physical modalities of magnetic therapy, naturopathic non-manipulative bodywork, and exercise to help stimulate and maintain the individual's intrinsic self-healing processes."

In contrast, the Minnesota Advisory Committee defined "naturopathic medicine" as:

"... the following diagnostic and treatment modalities: utilization of all methods of clinical and laboratory diagnostic testing including diagnostic radiology and other imaging techniques; minor surgery and naturopathic obstetrics (natural childbirth), nutritional medicine, psychotherapy and counseling; dietetics and therapeutic fasting; medicines of mineral, animal and botanical origin; hygiene and public health measures; homeopathy; acupuncture; Chinese medicine; naturopathic physical medicine, including naturopathic manipulative therapies; hydrotherapies; heat and cold; ultrasound; and therapeutic exercise."

This definition is consistent with that which has been generally used by the promoters of so-called "naturopathic medicine" during its short history, and is confusing to a consumer who is

trying to find a true naturopath, but may wind up receiving "medical treatment." In fact, so-called "naturopathic physicians" are not "naturopaths" at all, and mislead the consumer who is seeking true natural healing, not legend drugs or surgery.

WHAT IS THE JUSTIFICATION FOR LICENSING?

The proponents argue that licensing is necessary to "protect the public" and to allow so called "naturopathic physicians" to "practice to the full extent of their training." Regarding public protection, there has been no demonstrated harm or need to protect the public regarding true naturopathic practice. In fact, there are already sound and effective consumer protections in existing law. Further, the only incidence of harm in the State of Colorado, which we will discuss in greater detail below, is a case about an individual who practiced medicine without a license; this was not an incident about a naturopath practicing naturopathy! This is an important distinction. Regarding the "naturopathic physicians'" demand for authority to practice to the fullest extent of their training, this boot-strap argument can not legitimately be used to justify the licensing of a new profession. This is especially true because the quality of that training is itself suspect, as we will show later. A new licensing law would permit them to prescribe drugs, perform minor surgery, and deliver babies; services that are already available from conventional medical doctors who are much better trained and qualified to provide these services than are the so-called "naturopathic physicians." In fact, allowing "naturopathic physicians" to practice to the full extent of their training seems likely to provide lessconsumer protection than currently exists. Since the public is not requesting the licensure of "naturopathic physicians," then who is? The movement for licensure is coming from exactly thirty-four, 34, "naturopathic physicians" in Colorado, and their special interest group, the Colorado Association of Naturopathic Physicians (CANP). This movement for licensure has nothing to do with public protection: it is motivatedby economic protection of this small group. The thirty-four "would-be physicians" who comprise the CANP made an informed decision to go to school for a profession that did not then, and does not now exist in 38 of the 50 states, and they are now trying to get the State of Colorado to recognize them as a distinct new medical profession. In demonstrating the AANP's need to protect their economic self-interest, Nancy Aagenes, Former President of the American Association of Naturopathic Physicians, made the following statement 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 unlicensed state. If enough of us default on our loans, a major source of income for our schools is cut off." Another motivation for the naturopathic physicians to seek licensure is third-party reimbursement, which will put more money into their pockets, but will almost surely push up the costs of health care for everyone else.

Further documented reasons why naturopathic physicians seek licensure were detailed by Bruce Milliman, ND, faculty member at Bastyr, when he presented to the AANP Leadership Convention in January of 2004. He discussed with the attendees the dangers facing naturopathic physicians if they do not secure licensing and third party reimbursement. Restated,

"Failure to prioritize the securing of our role in reimbursement an

preservation and advancement of our role in primary care will result in:

• Graduates unable to earn a living

• Loan default -

• Loss of accreditation

• Failure of Educational Institutions

• Extinction of Naturopathic Medicine."

A study titled "Profiling the Professions: A Model for Evaluating Emerging Health
Professions," conducted by the Center for the Health Professions at the University of California,San Francisco, September 2001, stated,

"Although regulation is the legislature's decision, legislatures virtually never

seek to regulate a profession on their own. When regulation is sought, it is

always at the behest of members of the profession. 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 may or may not mean much more beyond the capacity of the would-be

regulated profession to garner sufficient political power."(Page 13)

Licensing will create more problems than it will solve. Naturopathic physicians seek"primary care status" which would put them in a position to be gatekeepers to real medicaldoctors. Thomas Kruzel, Chief Medical Officer at Southwest College of Naturopathic Medicineand former President of the American Association of Naturopathic Physicians, was quoted in the Spring 1994 edition of The Naturopathic Physician (Exhibit 3) as saying, "Naturopathicphysicians are primary care, family practice physicians, and as such are gate keepers to the medical system, along with family practice MDs andDOs." Granting licensure for "naturopathic physicians" would legislatively create a new medical profession and create anexpectation that initial and continuing medical competence is assured. Since licensure signifiesapproval by the state, those "naturopathic physicians " will be so elevated in stature that theywill be perceived by the public as being equal to the far more extensively-trained allopathic and osteopathic physicians, thus creating the potential for harm.With "naturopathic medicine" the potential for harm exists, and the training of"naturopathic physicians" is so questionable that this form of medicine does not justify a "stamp of approval" by the State. The State simply does not need to create a new medical profession known as "naturopathic medicine." The office has no basis for endorsing the position of theCANP just as it did not in 1993, and just as the twenty states that considered and rejected this type of legislation since 1996 did not. There has been no change in circumstances since the Colorado legislature last rejected the proposal for licensing.

A Look at the 2004 Sunrise Application

Before addressing specific aspects of the application, we question the basic premise of the application which suggests that the problem in Colorado is that naturopathic physicians are not licensed by the State. The fact is, problems occur when individuals without proper medical education and training attempt to practice medicine. Unfortunately, the licensing of medical doctors cannot stop charlatans and misguided people from doing illegal things. However, the state already has adequate means to deal with unfortunate situations such as the one involving Brian O' Connell by prosecuting perpetrators to the fullest extent of the law.

In making their proposal to license the practice of so-called "naturopathic medicine," the CANP answered a number of questions concerning who would be affected and other ramifications of their proposed law. Following is a commentary on some of these questions and answers:

Question 2: What is the occupational group for which the applicant is seeking regulation? Is this group known by more than one name? If so, please specify. The CANP listed a number of different job titles or descriptions in addition to "naturopathic physician". By including "naturopaths" and "naturopathic practitioners" as part of the group that would be licensed, the CANP is clearly attempting to subsume (and thereby gain control of) traditional naturopathy into "naturopathic medicine" and lead the Department of Regulatory Agencies or the Legislature to think there is not a difference between these disciplines.