2013 Legislative Review: placenta take out

Oregon, where you can now get take out placenta

Now, why would anyone want a placenta? Well, SBM is nothing if not your complete source of all things CAM and Harriet Hall has already covered the subject. The short answer is that in Traditional Chinese Medicine placenta-eating is thought to confer all sorts of health benefits on the new mother. I learned of this new law from USA Today, which explains that “some experts say” it has positive health benefits. Well, thank goodness for that. Wouldn’t want a new law passed without “experts” weighing in.

But if handling a placenta makes you squeamish, not to worry. The Placenta Power Wellness Service in Portland (among others) will steam, dehydrate and encapsulate it into a handy pill form for about $150-$250. (Each placenta will make 80-120 capsules, according to the website). If you wish, you can get raw placenta encapsulation instead. Placenta tincture, placenta salve and a print of your placenta (sort of like those newborn footprints) are available for extra. That would be a real conversation starter, sitting there on the mantel.

According to Placenta Power Wellness Service, anecdotal evidence shows women experience an increase in energy, mood enhancement, milk supply and feelings of elation. Plus, it’s been used in Traditional Chinese Medicine “for centuries.”

And folks, that is all you need to get a statute passed adding practices or products to the legally-available health care armamentarium: anecdotes, sometimes relayed by “experts.” Traditional use is icing on the cake. (Or maybe the placenta.) It’s the reason for the DSHEA, the chiropractic, acupuncture and naturopathic practice acts, “health freedom” laws, and getting the Homeopathic Pharmacopoeia dumped in toto into federal law, with updates courtesy of the homeopathic industry. “I’ve seen it work!” “It worked for me!” Depending on the method, the evidence for the astounding variety of practices and products legally permitted by these laws generally ranges between none and some, with, I’d wager, most hovering in the “it can’t work” to the “we don’t know if it works” range. Not to mention the evidence of safety, or lack thereof.

This past year was no exception. Although 2013 wasn’t an outstanding year for pro-CAM legislation, CAM proponents did manage to gain a bit of ground in the states, especially in Colorado. Of course, one might argue that they have been so successful in legalizing CAM in the past that a saturation point of sorts has been reached and there really isn’t that much more to do except perhaps expand naturopathic licensing.

Chiropractic

Chiropractors have been spectacularly successful in the legislative arena. For example, all states permit the detection and correction of the non-existent subluxation. Insurers, however, are not as generous as the government and policies typically exclude unproven diagnostic and treatment methods they employ as well as limit the number of treatments they can give. Chiropractors must then resort to their friends in the legislature for help.

But whether it is because they think the non-discrimination provision of the Affordable Care Act will take care of this alleged “discrimination” against chiropractors, whether states are afraid of paying for mandates themselves (as the ACA may require in some cases), or whether legislators are beginning to wise up, I don’t know. My Lexis search turned up almost 30 bills that in some way attempted to expand payment for chiropractic services. These included coverage of chiropractic services by Medicaid, worker’s compensation and private insurance, lifting limitations on treatments, and requiring that chiropractors be paid the same reimbursement as medical doctors. None of these bills passed in 2013. This doesn’t mean they won’t pass in states that have not completed their legislative sessions, but only a handful of states have sessions that extend from 2013 into this year.

Chiropractors did enjoy some legislative successes although a couple of them were merely cosmetic. The Pennsylvania legislature adopted Senate Resolution 192, once again recognizing September as “Vertebral Subluxation Awareness Month.” The resolution, which could have been drafted by Daniel David Palmer himself, begins:

Optimum performance and health of the human body depends on the unfettered, free transmission of mental impulses, or nerve impulses, between the brain and all cells, tissues and organs of the body. . .

It goes on to warn of the deleterious effects of “blockages of mental impulses,” which “can occur regardless of the presence or absence of symptoms” and “compromise a person’s health and well-being.” And so on, ending with a commendation of the Chiropractic Fellowship of Pennsylvania “for educating the public about the importance of having spinal checks for vertebral subluxations.” Small wonder, then, that the Pennsylvania House was willing to pass naturopathic licensing legislation which includes “organ repositioning” as a mode of naturopathic treatment. (A naturopathic licensing bill is still pending before the Senate.)

In Rhode Island, the legislature passed a “Joint Resolution Prohibiting Discrimination Against Chiropractic Physicians in Rhode Island.” It affirmed that:

chiropractic physicians are entitled to the same rights and privileges as all other allopathic and osteopathic physicians, consistent with . . . the Federal Affordable Care Act prohibiting discrimination against chiropractic physicians.

I suppose this bit of political theater is meant to boost chiropractors’ arguments that they are primary care physicians under the ACA. It conveniently avoids the messy prospect of actually having to get the legislature to amend their Rhode Island practice act to give them the same scope of practice as a PCP. It just gives them a piece of paper to wave around and declare that’s what the legislature intended.

A number of legislative efforts were directed toward permitting chiropractors to perform physicals. (Harriet Hall has explained why they should not be permitted to perform sports physicals.) An added bonus will no doubt be another pretext upon which to argue they are PCPs.

Nevada added a requirement this year that taxi drivers obtain a certificate from a medical examiner that they meet certain health requirements. “Medical examiner” is defined to include medical doctors and chiropractors. In California, chiropractors were added to the list of health care providers who can perform physicals on school bus and farm labor vehicle drivers.

A new statute in Delaware unintentionally reveals a disturbing aspect of chiropractic practice in that state. Delaware law requires the presence of a parent or guardian, or an adult staff member of the same sex, during examination and treatment of minors who are disrobed. Chiropractors are now required to abide by the law when providing treatment to a minor who is undressed or during an exam “involving the breasts, genitalia or rectum.” I suppose this is both good news and bad news. It is good that chiropractors must now have a guardian or staff member present. The bad news is that any chiropractor would examine the breasts, genitalia or rectum of anyone. Exactly what within a chiropractor’s scope of practice would require such an examination? In Delaware, chiropractors are limited to “manipulation/adjustment of the spine and other skeletal structures and the use of adjunctive procedures not otherwise prohibited.” They are specifically prohibited from obstetrical or gynecological exams or treatment.

Chiropractors see physical therapists as an economic threat to their livelihood. They have been successful in getting legislation passed in a number of states prohibiting physical therapists from performing spinal manipulation even though there is no evidence supporting their position.

In Indiana, a new law contains a limitation (although not a complete ban) on PT use of spinal manipulation. While PTs were able to get a limited right to direct access by patients (that is, without a referral), spinal manipulation was specifically excluded. We can all guess who was among those responsible for that exception. PTs still cannot perform spinal manipulation without a referral from a doctor or chiropractor who has examined the patient before referral.

But PTs are fighting back. A 2014 bill has been filed in Washington State specifically allowing PTs to perform spinal manipulation. It will be considered this year and I hope it passes.

While this post focuses on legislation enacted in 2013, one chiropractic bill still pending before the New York legislature bears mentioning. (Legislation pending in 2013 carries over to 2014 in New York.) Current law requires the director of school health services to conduct scoliosis screenings as designated by regulation. The necessity of scoliosis screening of asymptomatic adolescents is debatable but fortunately administrative regulations can adapt to changes in evidence for or against the screenings more easily than any schedule imposed by statute. (Whether NY regulations actually abide by current recommendations, I do not know.) Assembly Bill 6998, however, mandates that:

a scoliosis screening shall be performed by a chiropractor during child’s third, sixth and ninth year of school. [Emphasis added.]

Considering that New York is the fourth most populous state in the U.S., that is a lot of mandatory screenings. What a boon for chiropractic income! And a great way to get the word out that chiropractors treat childhood scoliosis, as this New York chiropractor’s website tells us:

Who Else Wants to Reverse Scoliosis Without Ugly Braces Or Painful Surgery?

The Scoliosis CLEAR treatment system [“adjustments” of “subluxations” included] that helped thousands of Scoliosis sufferers reverse their conditions and take back control of their lives.

Naturopaths, acupuncturists and assorted others

Colorado became the 17th state to license naturopaths. Licensing bills failed in 4 states and but were carried over to this year in 5 states, where they remain pending. (Another bill, in New Jersey, has until January 14th, making passage unlikely.) A couple of attempts to force insurance coverage and one to expand their prescription privileges failed.

The New Mexico legislature passed a bill to exempt “expanded practice doctors of Oriental medicine” from the requirement of getting a state medical imaging certificate to perform “diagnostic ultrasound or ultrasound procedure guidance.” This intrigued me in two ways. One, learning that there was an “expanded practice” version of the Oriental medicine doctor, and two, that any state would think of permitting them to use these procedures at all. Of course, New Mexico is the birthplace of the “advance practice” chiropractor, whose battles over expanded prescription privileges and other accoutrements of primary care practice are well documented on SBM. We should not be surprised to learn, then, that New Mexico also licenses Oriental medicine practitioners as primary care providers with prescription privileges that echo those of chiropractors in that state. Fortunately, the New Mexico governor had the good sense to “pocket veto” this exemption legislation.

Colorado (them again!) expanded the scope of acupuncture practice. Formerly, acupuncture was defined as being based on “traditional oriental medical concepts.” It now includes “traditional and modern oriental medical concepts,” whatever that means. Actually, it probably means pretty much anything they want it to mean.

Colorado law was also amended to authorize “aricular acudetox by trained mental health professionals.” Aricular acudetox is defined as:

The subcutaneous insertion of sterile, disposable acupuncture needles in the following five consistent, predetermined bilateral locations: (I) Sympathetic; (II) Shen Men; (III) Kidney; (IV) Liver; and (V) Lung.

The mental health professional must:

successfully complete a training program in auricular acudetox for the treatment of alcoholism, substance abuse or chemical dependency that meets or exceeds standards of training established by the National Acupuncture Detoxification Association [NADA] or another organization approved [by the state].

NADA presents this summary, dated 2013, of the evidence for auricular acupuncture on its website. Interestingly, not mentioned is a Cochrane review, published on-line in 2008, finding no evidence that auricular acupuncture is effective for cocaine addiction.

Of course, there is absolutely no reason to believe that sticking needles in the ear, or elsewhere, at the “liver” location or otherwise, will affect substance abuse and one could predict that no well-conducted study would show any effect beyond placebo. Fortunately, the legislatures of Alabama and Wyoming showed better judgment than Colorado (admittedly a low bar) and rejected licensing for acupuncturists altogether.

Colorado also enacted the Quack Full Employment Act, officially known as the Colorado Natural Health Care Consumer Protection Act, which, in fact, substantially weakened consumer protections in that state. Fortunately, it is the only state to pass one of these “health freedom” acts last year, perhaps because the so-called health freedom movement has its hands full trying to stop GMOs, or at least get them labeled.

Must we put up with this?

In case you haven’t heard, the Society for Science-Based Medicine is a new organization formed, in part, in response to you readers who wanted a group to represent their interests in the promotion of science-based medicine. I am proud to be a member, and a Board Member, and you can join too. Too often, legislators hear only the pro-CAM side of proposed laws. Opposition generally comes from medical groups, who can easily be painted (fairly or not) as “protecting their turf.” Sensible citizens who support science-based solutions to health care are rarely heard from. But we can change that. Part of my duties will be to keep you abreast of new pro-CAM legislation pending in Congress and the states or, in the rare case, legislation that actually curbs CAM abuses. We’ll include contact information for your state and federal representatives. My plan is to update the list weekly. (You won’t need to join to access the information, but please do anyway.)