Alternative Health Care:
Marjorie Roberts says licensure is the problem

by Cliff Bostock
(Originally published in the "Paradigms" column of Creative Loafing)

It is a well known that the American people now spend about 50 percent of their health care dollars on so-called alternative care. It is less known that this shift has been accompanied by the adoption of stricter licensure laws for all kinds of health care professionals.

"What that means," says Marjorie Roberts, president of the Complementary Alternative Medical Association, "is that licensure is not about protecting the public. It's about protecting the turf of the practitioners. They don't care about the public, which certainly ought to have a right to choose their own type of care. They care about eliminating competition."

Roberts, a registered nurse, is particularly steamed these days about a proposed law before the Georgia General Assembly, the Acupuncture Act of Georgia (HB 814), that will create licensure for acupuncturists. The law will effectively put the ancient form of oriental medicine under the control of medical doctors.

"Twenty years ago," Roberts says, "the AMA was literally saying that any doctor who practices acupuncture should lose their license. Now that patients are using it with so much success, they don't want anyone but doctors or people controlled by doctors to be able to practice it."

Roberts is herself trained in acupuncture but doesn't practice it - except at the State Capitol where she gives free demonstrations as a lobbyist to members of the General Assembly. "I think they'd take my nursing license if I practiced it openly for a fee, since I'm a troublemaker" she says. "Right now acupuncture is not technically illegal. However, the former attorney general wrote an opinion that it is the practice of medicine and should therefore be regulated. But there is presently no law. Most of the acupuncture that is practiced openly is by allopathic doctors or in underground settings. People are afraid to do it openly. So basically it's controlled that way. This new law will basically make it illegal for most people to practice."

Roberts and I recently discussed the practice of alternative health care and licensure and the work of CAMA.

Most of us just presume licensure sets standards that protect the public from quacks and charlatans.

Yes, we think that but numerous studies have demonstrated that they have no such effect. What they really do is make it very difficult for people to seek out alternative care. It is strictly about money, turf protection. People interested in this can check out our web site, www.camaweb.net, and find links to the studies that have shown this to be true over and over again.

So, you think anyone should be able to call themselves a healer?

The whole movement in medicine itself, even among the most conservative advocates, is for people to take a more active part in their own health care. Hardly anyone disputes this. But at the same time, they're telling people they can't make their own educated choices without the direction of the usual medical types. In England, you have unlicensed and licensed practitioners. In some places, you can register as a practitioner but don't have to be licensed. The attitude is that the consumer can educate himself and make his own informed decisions. This ought to be self-evident. It works just fine.

I certainly know this is true in the delivery of psychological services. When there was an effort a few years ago to create a Master's-level psychologist, the PhD-level psychologists went utterly berserk and it was clearly about turf protection. The social workers fight the counselors. This year, I know, there was an effort to adopt a law that created a mental health specialist who could give tests, and everyone went crazy about that too.

Well one of the problems is that once you regard licensure as a valid tool, you end up with a ridiculously complex set of laws which just have more people fighting one another for the money. Everyone is trying to legislate and protect their turf. It just doesn't work. I mean the reality under the present licensure law is that an M.D. can go take a weekend class in acupuncture and then say he's an expert in it while someone who has long-term training in oriental medicine but is not an M.D. can't safely practice. It's insane. It's certainly not a solution for alternative practitioners to begin licensing themselves, too. It just adds to the problem.

I know, even as I've been a victim of the way the licensure laws become stricter and more exclusive, that I have a somewhat ambivalent attitude toward this. I remember early in the AIDS epidemic how many of my friends became desperate and underwent expensive and often patently absurd treatments in the hope of prolonging their lives. Shouldn't people be protected?

Well, this is a problem of education. You see people just don't realize that it is not any more dangerous to see an alternative practioner than a medical doctor. I've spent most of my career in teaching hospitals and I know that along with the wonderful physicians the schools graduate there are as many who can't think their way out of a paper bag. Consumers need to fully educate themselves - not just about alternative medicine but about allopathic medicine too. What does it mean that the 4th leading cause of death in hospitals is adverse drug reactions, that the 6th to 8th leading cause is hospital error? How in the world, this being true, can we talk about it being dangerous to see someone who practices energy medicine or homeopathy, especially for preventative care? Where is the greater risk? The big loser is the patient. The licensure boards - which are never sued for malpractice, let's notice - simply make money for the groups they represent. The consumer, treated too stupid to make his own choices, doesn't get the affordable care he might. We have introduced a bill to change this. It's , the Complementary and Alternative Health Care Freedom of Access Act (HB 749).
What would this law accomplish?

Basically, it's an informed consent law. It would let consumers decide what kind of health care they want. The practitioner would fully inform the consumer that he's not a licensed allopathic doctor, an M.D., and supply all information about the treatment, risks, and so forth. The patient in turn would sign a consent form acknowledging risk.

That's more disclosure than the average M.D. or other licensed professional provides!

That's right. Even though it's the law, people are supposed to be informed of all sorts of things in hopsitals they aren't much of the time. People undergo unnecessary surgeries and take risky, dangerous drugs all the time without knowing it. Part of our education effort is to help people realize how little educated they already are when they see any kind of practitioner. A license does not lower risk for an educated consumer.

I'm guessing this proposal will meet with a lot of resistance from the turf-protecting professionals who, of course, will claim it permits the sale of snake oil…I know some people claim the solution is not to eliminate licensure but to extend it to alternative practitioners.

We oppose that. It just makes the situation worse. Research demonstrates repeatedly that licensure serves absolutely no function in protecting patients. It is only about protecting the pockets of the practitioners. It's no more right for acupuncturists to begin turf protection than doctors. So, we don't want to add to the problem….As to the claim that alternative medicine is quackery, it may be that some forms are useless, but it ought to be up to the consumer to decide. I don't even like what Andrew Weill calls "integrated medicine." This is where doctors appropriate alternative forms of care - integrate it into their practices. Some people just do not want to deal with allopathic doctors. Some people want access to alternative care without the high prices doctors charge. Some people don't need the validation of allopathic medicine….

Of course we have a long history of this in this country. I know homeopathy, which is so popular in Europe, is making a comeback here after being outlawed. Doctors here claim it doesn't work, but I grew up with an M.D. trained in homeopathy and I know it works. Most Europeans know it works.

Yes, the doctors think homeopathy is riskier than radiation, drugs and surgery. It's crazy. An educated consumer seeing a practitioner who is required by our new law to give full disclosure is not taking an undue risk.

Of course, that's the irony. When you outlaw a practice, rather than granting it legal status and giving it some ethical regulation, you make it more dangerous.

Yes, exactly. They claim homeopathy can't work because it makes no sense but they really have no idea how much allopathic medicine works, either….Doctors already know they need to loosen their grip. It used to be a nurse couldn't do anything, even the simplest thing. We'd tell hospital patients with fever that they'd have to wait to see the doctor before they could take an aspirin. Finally they let us start doing a few things. Even Kaiser now has classes to help people take more charge of their health care. They know medicine is over-regulated. They're just not prepared to give up their control fully. It will happen eventually though, as the public gets more educated. The more the medical community tries to regulate and control, the angrier they are going to make the public.

This isn't just doctors. It's also drug companies, isn't it?

Yes. The drug companies won't do research and marketing of drugs they can't make a lot of money on. A friend of mine on a university faculty has done a lot of research into the way HIV positive people can be helped greatly through nutrition - through something as simple as selenium supplementation - but nobody will support his research because they won't make any money off it.

Consult CAMA at www.camaweb.net

Copyright 2000 by Creative Loafing

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