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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