UPDATE: The bill described in this post passed in the Maine Legislature and became law without the Governor’s signature on June 11, 2019.
Quacks who misrepresent the safety and effectiveness of their treatments or cause physical or financial injury to patients will be protected from accountability for their harms under a bill now before the Maine Legislature. The “Right to Practice Complementary and Alternative Health Care Act” would protect CAM practitioners, such as homeopaths, herbalists, energy healers, and assorted other purveyors of pseudoscience, from prosecution for violating state health care regulations, including the unlicensed practice of medicine or any other health care profession, in exchange for, well, pretty much nothing in the way of protecting their patients.
The bill, S.P 104 (also referred to as L.D. 364), allows any person who provides “alternative or complementary health care services,” but who is not licensed in Maine as health care practitioner, to provide those services as long as he or she doesn’t do some things that normally fall within the purview of physicians or other licensed health care practitioners, such as surgery, setting fractures, prescribing drugs, performing chiropractic adjustments, administering or prescribing ionizing radiation, or recommending the discontinuance of drugs or devices prescribed by a licensed practitioner.
In exchange for this substantial protection, all the CAM practitioner has to do is give the patient some contact information (address, phone number), tell the patient about his “degrees, training, experience, credentials or other qualifications” (although no such education and training is required, nor does anyone check on its content) and that he is not licensed, and explain “the nature of the health care services to be provided.” Once these boxes are checked, the bill declares, the CAM practitioner is deemed not to have violated “any law relating to the licensing of health care professionals”, no matter what he does or the harm he may cause.
Several deficiencies immediately come to mind:
- The bill does not define what is meant by “healthcare services,” other than they be “complementary or alternative,” which is also undefined. Basically, this leaves it up to individual CAM practitioners to determine their scope of practice.
- There is no prohibition on diagnosing or treating any disease or condition, real or fabricated.
- There is no requirement that the CAM practitioner urge the patient to seek medical advice or refer to a licensed health care practitioner when a condition is outside of his scope of practice, whatever that might be.
- There is no requirement of informed consent. The patient need not be told of the risks of a therapy, the evidence (if any) of its benefits, nor advised regarding what other treatments may be effective for the patient’s condition.
- There is no oversight of these CAM practices by any regulatory body. The Board of Medicine, as well as other health care regulatory authorities, would have no power to step in and stop any CAM practitioner, no matter how dangerous. The state cannot set education and training requirements; require criminal background checks; prevent false advertising, conflicts of interest, or financial or sexual exploitation of patients (at least those prohibitions established by the state’s licensing laws); or require reporting (e.g., of infectious diseases, adverse events, or child or elder abuse).
- While patients maintain their right to sue for negligence or seek other civil remedies, there is no requirement that practitioners have insurance to satisfy their claims. (Which, in turn, is a huge impediment to finding an attorney to take one’s case, not to mention collecting on any judgment.) And because there is no standard of care, how would one define negligence? What is, for example, the standard of care for, say, iridology and how does one fall below it?
- There is no requirement that a practitioner maintain patient records of symptoms, examination, diagnosis, prognosis, or treatment and response thereto, nor are there confidentiality requirements for patient information.
S.P. 104 was heard by a joint Committee on Health Coverage, Insurance, and Financial Services on April 17. According to the Maine Legislature’s website, the Committee voted “ought to pass” with an amendment, but no information on the amendment is available. There were 81 separate testimonies on the bill filed with the Committee. Of those, only one, the Maine Nurse Practitioner Association (MNPA), to their credit, testified against the bill. The MNPA made a number of very good points, for which none of the promoters offered any solutions. In addition to some of the problems listed above, the MNPA noted
these unlicensed providers can perform an exhaustive list of things normally assigned to a licensed health care provider, including counseling, evaluations (including mental health evaluations, diagnosis, and therapy), procedures such as pelvic, breast, rectal exams and wound care, osteopathic manipulation, occupational and physical therapy, and dental hygiene.
Homeopaths; herbalists (including the “intuitive energetic” variety); reiki masters (including long-distance reiki); healing touch practitioners; “certified” “holistic” health coaches; Ayurveda practitioners; essential oil sellers; and practitioners of polarity and cranial sacral therapies, Emotional Freedom Technique, Neuro-Linguistic Programming, and other assorted purveyors of pseudoscience, submitted testimony in favor of the “right” to practice complementary and alternative medicine unimpeded by pesky state regulators who might call them to account for their actions. Some of their patients chimed in with their “it worked for me” anecdotes. In reading these testimonies, several themes were repeated:
- CAM is “popular” so it must be allowed, with no acknowledgment that this alleged “popularity” could be based on optimistic expectations of benefit promoted by practitioners but unsupported by the evidence.
- The absolute conviction that their treatments “worked” despite not one citation to convincing evidence of effectiveness, although there was a heavy reliance on anecdotes.
- The equally absolute conviction that CAM treatments do no harm.
Testimony from the committee hearing demonstrates these convictions, as well as the proponents’ attempts to paint the most benign portrait possible of CAM practices. This soft-pedaling is belied in some cases a perusal of their websites, which revealed more enthusiastic claims for their abilities. Some examples:
A healing touch practitioner told the committee about its use for cancer “support services” such as pain management, yet the website of her practice claims healing touch actually “enhances the immune system accelerating the body’s self-healing abilities” and “speeds up recovery time from surgery” (neither of which is proven) based on a totally implausible mechanism of “clearing energy congestion that forms in our energy fields and centers.”
A “certified holistic health coach” and reiki practitioner told the committee she does not diagnose or treat disease, yet her website claims that regular treatments with reiki and doTERRA essential oils will “support the body in healing” during “an acute health crisis” and prevent disease. She says that proactive health care and doTERRA essential oils take care of “most health issues for her and her family”, implying that the same can be true for you. A video on her website maintains that the positive health benefits of essential oils are “boundless”.
One woman, a Bowen practitioner, conveniently failed to explain to the committee just what that is. Her website claims Bowenwork can “help” with “practically anything” by, among other nonsensical mechanisms of action, “trigger[ing] the autonomic nervous system to switch from ‘fight – flight’ to ‘rest – restore’ mode.” She says Bowenwork is effective for asthma, concussions, migraines and depression, and, for babies, colic, and digestive issues.
One homeopath told this disturbing anecdote in her testimony:
When my son was born with the cord around his neck and after receiving oxygen would not stop screaming. The midwife gave him a homeopathic remedy for shock. Within seconds my son stopped screaming and looked into my eyes for the first time.
Her website claims, without evidence, that homeopathic remedies prescribed by her after consultation “help” depression, addition [sic], diabetes, eating disorders, cancer, high blood pressure, Lyme disease, STDs, autism, ADD/HD, Alzheimer’s, infertility and hormonal imbalances. She also offers homeoprophylaxis “to expose the individual to the energy state of a disease prior to exposure” for childhood “infections [sic] diseases.”
Another homeopath testifying in favor of the bill (who also practices Heartmath, therapeutic touch, flower essences and “attunement” as well as homeopathy) is less coy about the uses of homeoprophylaxis on her website: She openly promotes it as an alternative to vaccination. Understandably, neither woman mentions homeoprophylaxis to the committee.
Other homeopaths supporting the bill testified, more openly, that they have used homeopathy to treat epidemics in third-world countries and trained medical personnel and birth attendants there in “acute care homeopathy” and that homeopathy “has demonstrated efficacy” in treating addiction and decreasing relapse rates among those with opioid dependence.
(It hardly bears repeating, but, for the record, homeopathy is not, and cannot be, effective for anything.)
One reflexologist benignly described reflexology as
the application of pressure to reflex maps found in the feet, hands, and outer ears. The techniques applied stimulate neural pathways and the relaxation response, to support the body to function optimally.
Yet, on her website she says that reflexology improves the “function of internal organs and glands” and “balance all body systems” and that the reflexologist has the requisite knowledge to understand “how the body works and how specific conditions or illnesses work.” She also claims that something called “reflexology lymph drainage” “really works” for autoimmune diseases, depression, pain and Lyme disease, but needs to do “one or two case studies” on effectiveness for Parkinson’s disease, so “please get in touch if you are interested, and we can chat about it,” “it” apparently meaning your becoming a guinea pig in an non-IRB approved human trial.
An “intuitive energetic herbalist” and herbal apothecary owner with no medical training told the committee her current specialty is providing “herbal support options and information to those suffering from Lyme Disease and Lyme Co-infections,” presumably including “Chronic Lyme.” Her website claims she creates “extraordinary medicines”. Another herbalist maintained that she is not diagnosing and treating but appears to be doing exactly that by, per her website, considering a patient’s symptoms and recommending herbs (in other words, untested, unpurified drugs that are only lightly regulated by the FDA) for treatment. A third herbalist told the committee she has given herbal remedies to everyone from a five-day-old infant to patients in their 90s. Another herbalist who testified believes, according to her website, that “chronic Lyme” is a valid diagnosis and that ILADS is a “wonderful resource” on Lyme disease.
Others presenting testimony to the committee included an Ayurvedic practitioner who is clearly diagnosing and treating patients without any sort of license, and practitioner of “biosonic repatterning,” a nonsensical method on Quackwatch’s list of questionable therapies, and a practitioner of polarity therapy (also nonsensical) who claims it is “profoundly effective in resolving or relieving physical and mental health issues.”
In an obviously unintentional demonstration of just how effective CAM practitioners are in selling patients on their nostrums, people told the committee that homeopathy had improved a son’s autism, helped a child recover from a serious auto accident, cured migraines, asthma, allergies, and food poisoning (in 15 minutes!), helped with digestive issues, and ameliorated a detached retina to the point that less extensive surgery was required. Ayurveda treatments cured “hyperthyroid” and anemia in one month; herbal remedies and Qigong cleared up psoriasis.
According to the National Health Freedom Action, an organization that promotes a consumer’s right to be bamboozled by quackery (as well as “vaccine choice”), nine states currently have some sort of “health freedom” law protecting quacks from accountability for their actions, and bills similar to Maine’s are pending or about to be introduced in three additional states. Other states have somewhat greater protections, though, such as registration requirements, additional disclosures, prohibitions against convicted felons from practicing CAM, penalties for violations, and prohibitions against sex with patients. Nevada requires that the practitioner advise the patient to tell his real doctor what he is up to, prohibits diagnosing, defines (sort of) the services that can be provided and imposes liability on the practitioner in some situations, although only the most egregious.
None of this makes so-called “health freedom” laws a good idea. Ironically, healthcare practitioners with the most education and training are subjected to licensing requirements (even if they are inadequate) while those, including convicted felons, with credentials from on-line “certification” outfits, or no education and training at all, are free to lie to patients about the safety and effectiveness of their remedies, as well as act as infectious agents for pseudoscience promoted by others. Patients harmed financially, emotionally and physically will be left with virtually no redress and state regulators are rendered helpless to act on their behalf.
