Just as nobody steps on a church in Peter Venkman's Manhattan, nobody licenses quacks in my state...I hope.

Just as no giant marshmallow man steps on a church in Peter Venkman’s Manhattan, nobody licenses quacks in my state…I hope.

Over the years, I’ve taken care of women with locally advanced breast cancer so advanced that it’s eroded through the skin, forming huge, nasty ulcers filled with stinky dead cancer tissue that’s outgrown its blood supply, leaving the patient in chronic pain. If the patient is fortunate, her cancer has not metastasized beyond her axillary lymph nodes (the lymph nodes under her arm), and her life might still be saved by a combination of chemotherapy, radical surgery, and radiation. If the patient is not fortunate, either the cancer has metastasized and she is doomed or hasn’t metastasized yet, but it’s invaded into the chest wall and the nerves in her axilla (the structures under the arm), making it impossible to remove surgically but not likely to kill her any time soon. In the latter case, chronic pain, infection, and blood loss is what the patient will look forward to until the cancer either metastasizes or invades a vital structure. Fortunately, I’ve only seen a handfull of these patients over the last 20 years. Fortunately, the number of such patients I’ve seen and taken care of has been small.

I fear that, before long, I’m going to bee seeing a lot more of them. Leave it to Jann Bellamy to wake me up to that possibility.

I’m referring, of course, to her post last week about yet another attempt by naturopaths to expand their scope of practice. Worse, this is happening in my state through Michigan House Bill 4531, which has been approved by the Michigan Committee on Health Policy and referred to the full House for consideration. Yes, of these patients I’ve seen with horrific neglected breast cancers, at least half of them had relied on naturopaths before they came to the attention of real oncologists and surgeons. The last time I wrote about naturopaths trying to expand their scope of practice in my state was in 2013 in the form of a bill that was not as broad as HB 4531, namely HB 4152. Fortunately, it went nowhere and, in contrast to HB 4531, didn’t even make it out of the Committee on Health Policy.

Although Jann has already ably discussed the bill and occasional Science-Based Medicine (SBM) contributor Peter Lipson has referred to naturopaths as fake doctors in white coats (which is true), as well as why naturopathy is unscientific and how he as a primary care internist not infrequently has to clean up the messes left when local naturopaths treat patients incompetently, this is my state, and I can’t help but chime in myself. What I will try to do is to predict what the potential consequences will be if HB 4531 passes and expands the scope of practice to be nearly as broad as that of MDs practicing primary care medicine. I will do that by looking at real world examples of naturopathic shenanigans and disasters both within our very own state, because these are the people with whom the reins of primary care will be shared if HB 4531 were to pass.

Naturopathy: The pseudoscience that is “natural medicine”

We at SBM have written extensively about naturopathy in the past. Perhaps the definitive explanation of why naturopathy is pseudoscience and quackery was written 13 years ago by Kimball Atwood (who, alas, no longer blogs for SBM) for Medscape and entitled “Naturopathy: A Critical Appraisal.” You can also find much more about naturopathy from this very blog.

Naturopaths like to represent naturopathy as “natural medicine.” In reality, naturopathy is the modern day iteration of the 19th century “natural living” movement in Germany. Early naturopaths objected to contemporary science-based medicine, particularly germ theory and vaccinations, instead advocating the “water cure,” fasting, herbs, homeopathy (or, as I like to call it, The One Quackery To Rule Them All), colonic “detoxification,” and other popular methods of the era. Unfortunately, little has changed in naturopathic practice in 150 years, although naturopaths are much better at cloaking their quackery in scientific-seeming trappings, and some of them have embraced laboratory tests in a big way as part of their embrace of the dubious specialty of functional medicine.

Despite the efforts of modern naturopaths to argue that their profession is scientific, in reality naturopathy is now, as it was in the 19th century, rooted in prescientific vitalism. Basically, naturopathy is based on a belief in the “healing power of nature“:

The body has an inherent ability to establish, maintain, and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The physician’s role is to facilitate this process, to identify and remove obstacles to health and recovery, and to establish or restore a healthy internal and external environment.

For those of you who aren’t familiar with the lingo, any time you hear someone refer to the “life force,” you’re looking at vitalism, the idea that there is some sort of mysterious, yes, “life force” that is present in living matter and makes it alive. In essence, vitalism is the philosophical doctrine that states that life has a quality (the “life force,” “vital force,” or any of a number of other terms such as “life energy”) independent of physical and chemical laws, such as an immaterial soul. Many forms of alternative medicine are based on vitalism. For instance, chiropractic posits an “innate intelligence” whose properties are very similar to the “vital force.” This “innate intelligence” flows from the central nervous system but can be blocked by subluxations, which chiropractors claim to relieve. Acupuncture claims that sticking needles into “meridians” through which qi (the life energy or force) flows will redirect the flow and relieve symptoms and/or cure disease. Reiki practitioners claim that they can direct life energy from the “universal source” into patients for healing effect, which is why I like to say that if you replace the term “universal source” with “God” you have faith healing. Basically all “energy medicine” claims that its practitioners can somehow manipulate “life energy” to healing effect. Not surprisingly, naturopathy embraces pretty much all of these modalities, and more.

Particularly popular among naturopaths is a belief that disease is caused by “toxins.” These toxins are seldom validated by science. In many cases, they aren’t even identified. Yet, “detoxification” is a major theme in naturopathic treatments, with unscientific and sometimes dangerous treatments, such as chelation therapy (to “detoxify” heavy metal overload) and colon cleanses, including the infamous coffee enemas, being advocated to help patients “detoxify.”

Basically, if you peruse some of the links above (and, as you will see as I examine what naturopaths really advertise on their websites), you will learn that naturopathy is nothing more than a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophic medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine.

Within naturopathy, there are two types of practitioners, traditional naturopaths and “naturopathic physicians.” In reality, from my perspective there is little difference between the two, other than that “naturopathic physicians” have graduated from “accredited” schools of naturopathic medicine and hold the “ND” degree for “naturopathic doctor” (or, as I like to call it, “not a doctor”). Both naturopaths and NDs embrace a wide variety of quackery, which they mix with some sensible lifestyle and diet advice, which is “rebranded” as somehow being unique to naturopathy. In a way, NDs are worse in that they are much better than traditional naturopaths at cloaking their activities under the mantle of science and have added to their armamentarium a wide variety of unproven or disproven diagnoses and treatments that sound medical, such as treatments for “adrenal fatigue” and “chronic yeast overgrowth“.

Despite their affinity for non-science-based medical systems, naturopaths crave the imprimatur of science. As a result, they desperately try to represent what they do as being science-based, and they’ve even set up research institutes, much like the departments, divisions, and institutes devoted to “complementary and alternative medicine” (CAM) that have cropped up on the campuses of legitimate (and prestigious) medical schools, academic medical centers, and even community hospitals, like so many weeds poking through the cracks in the edifice of science-based medicine. Naturopaths also really, really don’t like it when they encounter criticism that their “discipline” is not science-based. I discovered this a year and a half ago when I managed to get a review article on the pseudoscience of “integrative oncology” published in a high profile journal.

This incident was particularly instructive, as well, because a lot of the criticism came from physicians who have become advocates of integrative oncology, who particularly objected to my criticism of homeopathy as pseudoscience. Their responses boiled down to, “Oh, no, we would never approve of the use of homeopathy. We know it’s total pseudoscience.” I responded by pointing out that naturopaths (one of whom co-authored the Society for Integrative Oncology’s (SIO) “evidence-based” guidelines for breast cancer care) learn homeopathy as an integral part of their training and that, indeed, they are tested on it as part of the NPLEX, the naturopathic licensing examination. I further responded by pointing out that one of the co-authors of their guidelines (Dugald Seely) was the principal investigator for an N-of-1 study of homeopathic treatment of fatigue in patients receiving chemotherapy. Basically, real, honest-to-goodness MDs, who have fallen under the spell of “integrative medicine” and are happy to collaborate with naturopaths, don’t even know what naturopathy is or what naturopaths really do.

Oddly enough, I haven’t seen a retort from the SIO yet. Maybe they need to speak with Britt Marie Hermes, a real naturopathic doctor who realized how full of quackery naturopathy is and left it behind.

Unfortunately, because of the lack of knowledge most people (and physicians) have about what naturopathy really is and how naturopaths really practice, videos like this Indiegogo campaign for the Michigan Association of Naturopathic Physicians (MANP) are effective:

As you will see, the shiny happy video above is a massive distortion of what naturopaths are and do.

What HB 4531 does

Before you can understand why those of us in Michigan who support SBM are alarmed by this bill, it’s necessary to take a look at it. Unfortunately, naturopathy is a licensed medical profession in 17 states, the District of Columbia, and the United States territories of Puerto Rico and the United States Virgin Islands. Jann explained that, if passed, SB 4531 would give naturopaths in Michigan one of the broadest scopes of practice in the US, essentially equaling that of a family practice MD or DO.

As Jann recounted, HB 4531 defines “naturopathic medicine” as:

…a system of practice that is based on the natural healing capacity of individuals for the diagnosis, treatment, and prevention of disease.

And I can’t help but recount and revise my retort to that definition, which is simple. The invocation of “natural healing capacity” as something that naturopaths uniquely utilize to treat disease is nonsense. Think of it this way. Science-based medicine relies on the natural healing capacity of individuals for the diagnosis, treatment, and prevention of diseases. Setting broken bones would be pointless if the body weren’t able to heal itself naturally and knit the two bone ends together. Surgery itself (my specialty) relies on the ability of the body to heal itself; otherwise cutting into the body to rearrange its anatomy for therapeutic intent would be the gravest of folly. The very definition of naturopathy is a false dichotomy between conventional medicine and “natural healing.” Of course, as I discussed above, what naturopaths mean by “the natural healing capacity” is a mystical vitalism that is based in prescientific religious belief systems about life and disease.

That being said, HB 4531 would amend 1978 PA 368, entitled “Public health code,” (MCL 333.1101 to 333.25211) by adding section 16348a and part 186 to create a board of naturopathic medicine to license and regulate naturopaths. In doing so, HB 4531 would also grant naturopaths who have graduated from an “accredited” naturopathy school (like, for instance, Bastyr University), attained the degree of “doctor of naturopathic medicine” or “doctor of naturopathy,” and have passed the NPLEX the authority to diagnose, treat and prevent disease in any patient, of any age, with any disease or condition. Here is the key passage:

SEC. 18615. A NATUROPATHIC PHYSICIAN MAY DO ANY OF THE FOLLOWING, CONSISTENT WITH HIS OR HER NATUROPATHIC EDUCATION AND TRAINING:

(A) ORDER AND PERFORM PHYSICAL AND LABORATORY EXAMINATIONS FOR DIAGNOSTIC PURPOSES, INCLUDING, BUT NOT LIMITED TO, PHLEBOTOMY, CLINICAL LABORATORY TESTS, ORIFICIAL EXAMINATIONS, OR PHYSIOLOGICAL FUNCTION TESTS.

(B) ORDER DIAGNOSTIC IMAGING STUDIES.

(C) DISPENSE, ADMINISTER, ORDER, OR PRESCRIBE OR PERFORM ANY OF THE FOLLOWING:
(i) FOOD, EXTRACTS OF FOOD, NUTRACEUTICALS, VITAMINS, AMINO ACIDS, MINERALS, ENZYMES, BOTANICALS AND THEIR EXTRACTS, BOTANICAL MEDICINES, HOMEOPATHIC MEDICINES, ALL DIETARY SUPPLEMENTS, OR NONPRESCRIPTION DRUGS AS DEFINED BY THE FEDERAL FOOD, DRUG, AND COSMETIC ACT, 21 USC 301 TO 399D.
(ii) PRESCRIPTION OR NONPRESCRIPTION MEDICINES AS DESIGNATED BY THE NATUROPATHIC FORMULARY COUNCIL.
(iii) HOT OR COLD HYDROTHERAPY; NATUROPATHIC PHYSICAL MEDICINE; ELECTROMAGNETIC ENERGY; OR THERAPEUTIC EXERCISE.
(iv) DEVICES, INCLUDING, BUT NOT LIMITED TO, THERAPEUTIC DEVICES, BARRIER CONTRACEPTION, OR DURABLE MEDICAL EQUIPMENT.
(v) HEALTH EDUCATION OR HEALTH COUNSELING.
(vi) REPAIR AND CARE INCIDENTAL TO SUPERFICIAL LACERATIONS OR ABRASIONS.
(vii) MUSCULOSKELETAL MANIPULATION.

(D) UTILIZE ROUTES OF ADMINISTRATION THAT INCLUDE, BUT ARE NOT LIMITED TO, ORAL, NASAL, AURICULAR, OCULAR, RECTAL, VAGINAL, TRANSDERMAL, INTRADERMAL, SUBCUTANEOUS, INTRAVENOUS, OR INTRAMUSCULAR CONSISTENT WITH HIS OR HER NATUROPATHIC EDUCATION AND TRAINING

(E) OTHER NATUROPATHIC THERAPIES AS APPROVED BY THE BOARD.

Basically, the only things NDs couldn’t do that MDs can if HB 4531 were to pass would be to prescribe controlled substances; do surgical procedures other than office procedures as described elsewhere in the bill (such as suturing small lacerations or doing punch biopsies of the skin); administer general or spinal anesthetics; use laser devices or ionizing radiation therapeutically; perform surgical procedures involving the eye, ear, tendons, nerves, veins, or arteries; and, of course, chiropractic manipulation (which would intrude on the turf of licensed chiropractors). Basically, in practice, with the exception of the power to prescribe controlled substances, HB 4531 would grant naturopaths roughly the same scope of practice as primary care physicians have.

As Jann pointed out, the naturopathic board proposed in the bill would consist of three naturopaths, two licensed MDs or DOs, and two public members who have never been licensed health care professionals and do not have any financial or legal interest in “naturopathic education, business, or practice.” Jann is correct to be concerned that the naturopaths on the board outnumber real physicians and that the governor could potentially easily be influenced to appoint as members from the general public people who are sympathetic to alternative medicine.

How naturopaths in Michigan actually practice

In her post, Jann pointed out how naturopaths practice, but only briefly looked at Michigan naturopaths. Since I live in the actual state, I really wanted to look more closely at naturopaths whose patients I might see or who might see my patients with breast cancer. Having over the years seen women with locally advanced, neglected cancers who had been relying on naturopaths to treat their disease until it started ulcerating through the skin to produce a painful, bleeding, stinking mess, I am very concerned with the legitimization of quackery that Michigan HB 4531 would produce. So I perused the MANP website to find NDs in Michigan, and then I perused their websites to see what they advertise. Of course, I included NDs that I have already discussed before, in particular Doug Cutler, who runs the largest naturopathic practice I know of in the state, Cutler Integrative Medicine.

Let’s take a look at a few naturopathic practices in Michigan, in alphabetic order, and see the sorts of practitioners whose scope of practice would be widened to treat pretty much anyone as a primary care provider:

Cutler Integrative Medicine, Bingham Farms. Doug Cutler is the granddaddy of Michigan naturopaths and runs what is, to my knowledge (and I could be mistaken, but there’s no doubt that Cutler is very successful), the largest naturopathic practice in the Detroit area, if not in the state. He is well-known nationally among naturopaths and was a major contributor to the discussions within the NatChat naturopathic discussion group whose contents were leaked on two occasions. He is very, very antivaccine (in my opinion), and, if you have any doubt that this is true, please go and read some of his comments in NatChat about “toxins” and a variant of the “too many, too soon” trope. Of course, the vast majority of naturopaths are antivaccine, with very few exceptions, and some of those exceptions still flirt with being antivaccine.

He offers constitutional and colon hydrotherapy; applied kinesiology; The One Quackery To Rule Them All (homeopathy); Nambudripad Allergy Elimination Technique (NAET); and, of course, TrueRife Technology. I had never heard of NAET before; so I looked it up. Nambudripad’s Allergy Elimination Technique is described as a “non-invasive, drug free, natural solution to alleviate allergies of all types and intensities using a blend of selective energy balancing, testing and treatment procedures from acupuncture/acupressure, allopathy, chiropractic, nutritional, and kinesiological disciplines of medicine.” In other words, NAET is clearly nonsense. As for TrueRife, Rife is a form of electricity quackery whose proponents use to treat a variety of diseases, including cancer, with electromagnetic impulses at different frequencies. There is no compelling scientific evidence that it is efficacious for treating any disease or condition, including cancer.

Healing Paths Naturopathic Care, Flint. This is the practice of Michelle Hoppe, ND. She offers (of course) clinical nutrition, even repeating “Let thy food be thy medicine and thy medicine be thy food”; botanical medicine; traditional Chinese medicine, particularly acupuncture; The One Quackery To Rule Them All (homeopathy); and NAET as well.

Holistic Care Approach, Grand Rapids. This practice includes several practitioners, but the naturopath there is AnnAlisa Behling, ND. Behling touts her training in homeopathy, hydrotherapy, oriental medicine, naturopathic manipulation, low level laser therapy, physical medicine, botanical medicine, as well as psychological and lifestyle counseling. She treats, among other conditions. She also treats “parasites” and, of course, candida, both of which represent favorite fake diseases in naturopathy, just like adrenal fatigue.

Huron Valley Naturopathic Clinic, Ann Arbor. This is the practice of Michelle Loewe, ND. Sadly, Loewe is apparently employed at nearby Madonna University, “where she teaches workshops to teachers on integrating nutrition and movement into the curriculum to enhance student wellness and academic achievement.” She offers the usual services, such as “nutrition”; herbal medicines; “detoxification” and fasting; The One Quackery To Rule Them All (homeopathy); and hydrotherapy, among others.

Naturopathic Health Services, Clarkston, MI. This is the practice of Nancy Caruso, ND. She offers a typical roster of naturopathic therapies, first and foremost being nutrition. Of course, when a naturopath talks about using “nutrition” to treat disease, she doesn’t mean what a physician does. She means using “personalized diets, vitamin and mineral supplements, and enzyme therapies are implemented in each treatment plan.” Caruso also offers homeopathy (again, The One Quackery To Rule Them All); biotherapeutic drainage to ‘restore normal physiology through detoxification and re-education of organs to bring the body back homeostatic balance’; hydrotherapy; and aromatherapy. She also offers something I’ve never heard of before, Ortho-Bionomy, which is basically a form of musculoskeletal manipulation that sounds a lot like a lot of the other forms of musculoskeletal manipulations out there. Of course, anyone who offers homeopathy cannot be considered a science-based practitioner.

Sleeping Bear Natural Health, Traverse City, MI. The naturopath here is Abigail Ellsworth, ND, who offers: The One Quackery To Rule Them All, homeopathy, along with the other usual naturopathic nonsense. What is interesting about Ellsworth is that she takes pains to point out that she is “unable to legally practice medicine and/or offer services to the full scope of: her training and that she does not “provide Primary Care, diagnose or treat disease or prescribe medications.” Imagine if HB 4531 passes and naturopaths like her become able to provide primary care.

Troy Naturopathic, Troy. This is the practice of Dimpi Patel, ND, who offers botanical medicine; The One Quackery To Rule Them All (homeopathy); supplements; hydrotherapy; and traditional Chinese medicine.

I could go on, but you get the idea. Wait. I should mention one more: William Beaumont Hospital, a very large private hospital system in the Detroit area, which added naturopaths to its staff in 2008 and offers naturopathy to this day, complete with The One Quackery To Rule Them All, which is described on Beaumont’s site thusly:

Homeopathy is based on the understanding that natural substances, prepared in very diluted doses, can prompt the body to self correct. Symptoms that may respond well to homeopathy include auto-immune conditions, allergies, trauma recovery and conditions that don’t fit into a clear conventional diagnosis.

Yes, this is the website of a respected hospital touting homeopathy as something that is pure quackery. Seriously, go and read the Beaumont Hospital webpage on naturopathy. It might as well have been written by one of the private naturopaths in Michigan. Oh, wait, it probably was. Worse, a representative for Beaumont Health System testified in favor of HB 4531.

Certain recurring themes are apparent in these practices around the state. The first is that nearly all of them offer The One Quackery To Rule Them All (homeopathy) plus a selection of other pseudoscientific and mystical therapies, such as acupuncture, other traditional Chinese medicine, detoxification, “personalized” diet advice, and others. The second recurring theme is that many of these naturopaths are unhappy that they cannot practice to the “full extent” of their “educations.” Personally, I’m glad that that is true, and remain amazed that any of them, in any state, can do so. Like Peter Lipson, who deals with the fallout from naturopathic mismanagement of patients far more than I ever have, I truly fear what might come to pass for my patients and other patients at my cancer center if HB 4531 were to pass.

Who wants HB 4531 to pass?

How has this effort to license naturopaths with a very expansive scope of practice has somehow been resurrected, this time to the point of actually making it out of the House Committee on Health Policy to the full House for consideration? Obviously, the MANP has been pushing for licensure and an expanded scope of practice all along, but that’s to be expected. Also not unexpected is who introduced this bill: Representative Lisa Posthumus Lyons, who represents District 86, which encompasses a rural area in the western Lower Peninsula. As was the case last time with HB 4152, the predecessor of HB 4531, I perused her Facebook and House page and was unable to find any mention of HB 4531, even though she seems to tout everything else she does there. One might almost think she’s ashamed of having sponsored HB 4531.

In any case, this time around, instead of just one co-sponsor, Rep. Lyons (R-Alto) has persuaded four additional Representatives to co-sponsor HB 4531 with her, a bipartisan group: Andy Schor (D-Lansing), George Darany (D-Dearborn and co-chair of the Committee on Health Policy), Jeff Irwin (D-Ann Arbor), Brandon Dillon (D-Grand Rapids), and Kathy Crawford (R-Novi). One notes that Brandon Dillon resigned late last year to become the Chairman of the Michigan Democratic Party. The interesting thing here is that searching for all of these Representatives plus either “naturopathy” or “HB 4531” turned up a whole lot of nothing. Not only did I fail to find much in the way of any of them bragging about introducing this legislation (as most legislators do when they introduce anything), finding news stories on HB 4531 that mention much beyond some very basic facts is almost impossible. Also odd is that this bill was introduced more than a year ago, as a naturopath named Kelly Hassberger exulted on Facebook:

Now, I realize that the wheels of government grind slowly. But what happened recently, a year after HB 4531 was introduced, to push it through the Committee on Health Policy to the floor of the House? The video I cited above mentions that the MANP hired a lobbyist to push HB 4531 through the legislature. MANP also lists various sponsors at various levels, such as Platinum ($5,000 a year), Gold ($2,500 a year), Silver ($1,00 a year), and Bronze ($500 a year). Donors include Commonwealth Labs, the manufacturer of a breath test for “Small Intestinal Bacterial Overgrowth,” or “SIBO” (Platinum Sponsor); Designs for Health, a supplement manufacturer (Gold Sponsor); Viotron International, LLC, another supplement manufacturer (Silver Sponsor); and Integrative Therapeutics, yet another supplement manufacturer (Bronze Sponsor). So supplement manufacturers and the maker of a test for a questionable condition are supporting MANP’s campaign? Color me surprised.

So are Madelon and Kurt Hassberger. Remember that there is some sort of link between the Hassbergers and Rep. Lyons. Kelly Hassberger, who appears to be Madelon and Kurt Hassberger’s daughter, owns Grand Rapids Natural Health. Whatever’s going on, the forces pushing for naturopathic licensure in Michigan have gotten further than they ever have before. To figure out why, perhaps we should look at the other side of the equation.

Who opposes HB 4531?

HB 4531 is a danger to patients in the state of Michigan. Of that there is no doubt. Licensing naturopaths would add nothing to the quality of health care in Michigan, but would under the Affordable Care Act possibly force insurance companies to reimburse for the services of naturopaths and at the same time legitimize a whole lot of quackery. So you’d think that our major medical societies in the state would be very much against HB 4531, wouldn’t you? So are they? I don’t know. Certainly, it’s very hard to find any mention of this bill at all. For example, the Michigan Health & Hospital Association lists various pending bills and its positions on the bills, ranging from support to neutral to oppose to no position. What does the MHHA say about HB 4531? It says, “To Be Determined.” Come on, MHHA! You’ve had a year to figure out whether you oppose or support this bill. In contrast, it sure does oppose a bill that would require the development of an acuity system and staffing plan for nurses!

What about the Michigan State Medical Society? One notes that a search on its website for “naturopath” or “HB 4531” reveals exactly zero mentions of either. Now, I’ve taken MSMS to task before for its intractable opposition to a bill that would expand the scope of practice of advanced practice nurses (a.k.a. nurse practitioners) to be in line with their training. I’ve called out MSMS for this being nothing more than an example of turf protection by physicians. I note that MSMS appears to have taken down its videos and material opposing this bill since then, but I’d be willing to bet that’s just because the bill being opposed was successfully scuttled. In contrast, I note that the MSMS did not testify against HB 4531 or even offer a statement opposing it when it was debated before the Committee on Health Policy on May 3, 2016. At the very same meeting, an MSMS representative did submit written testimony opposing HB 5587, a bill that would allow a pharmacist to refuse to dispense a prescription for a controlled substance if there is reason to believe the prescription was not written in good faith or would not be used for legitimate medical purposes.

I note that MSMS stated unequivocally that every “discussion in Lansing about health care and health policy should start and end with what is best for Michigan patients.” Its silence in the face of HB 4531 is directly the opposite of that nobly expressed sentiment. I can only concluded that its silence is because MSMS is either ignorant of the contents of HB 4531 (a charitable interpretation), ignorant of what naturopaths actually do (another charitable interpretation), or doesn’t view naturopaths as a threat to its turf (the cynical interpretation). Take your pick of one or more. It’s hard for me not to take the cynical interpretation, though, given how much effort and expense MSMS plowed into opposing Senate Bill 2, which would have expanded the scope of practice of nurse practitioners to be appropriate to their training, compared to its silence on HB 4531.

It’s not all bad news, though. Other Michigan medical societies did better than MSMS. For example, during that aforementioned May 3 meeting of the Committee on Health Policy, the Michigan Academy of Family Physicians, the Michigan Osteopathic Association, and the Michigan Orthopedic Society each submitted a testimony card in opposition to HB 4531. At an earlier meeting of the committee on April 19, the Michigan Academy of Nutrition and Dietetics testified in opposition to the bill. Unfortunately, they did so for the wrong reason:

Yes, it was turf protection. Note how the Academy stated that it is “not opposed to the licensure of naturopaths, we feel Michiganders should have the freedom and ability to keep receiving the great care they are getting from their trusted health care practitioners.” Ugh.

What next?

If there’s one thing I’ve learned about Michigan politics, it’s that our legislature is very good at passing bills “under the radar.” For instance, I had no idea that our “right-to-try” law had passed until two weeks after, when Governor Snyder signed it into law, this despite having had Google Alerts set up and checking local news sites on a near-daily basis. I fear the same thing happening with HB 4531, which has received very close to zero news coverage even in local newspapers and other news outlets.

The answer is sunlight. When light is shed on bills like HB 4531, good things can happen. This is true not just in Michigan, but anywhere naturopaths try to expand their scope of practice. For physicians, that means pressuring your state medical societies, particularly ones to which you belong, to put their full muscle behind opposing bills like HB 4531. For lay people and physicians both, it means contacting your legislators and letting them know that you don’t want practitioners of unscientific, prescientific, and pseudoscientific medicine to be legitimized by state licensure. Remember that these efforts by naturopaths are not going away. Naturopaths play the long game. When they fail, they wait until the time is right and try again, as they are doing now in Michigan.

If we advocates of science-based medicine don’t mobilize, the state of Michigan could well be licensing fake doctors soon.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.