"The most meticulous regulation of nonsense must still result in nonsense.
– Edzard Ernst, M.D., PhD.
In the US the practice of health care is regulated by the states. Each state board of health issues professional licenses, manages complaints and compliance, and essentially regulates the standard of care. This means that the state legislatures pass the laws that establish which professions will be licensed and under what rules.
In other words - in the US alone there are at least 50 legal fronts along which we need to defend the scientific legitimacy of health care.
There are also multiple issues that need to be monitored: the licensure of specific professions, expanding the scope of practice of existing professions, mandated insurance coverage of treatments or practitioners, and so-called "health care freedom laws" which seek to water down or even eliminate the standard of care, to name just the biggest four.
The overall purpose of all these various endeavors is to legitimize and legalize health fraud, quackery, and dubious practices. They accomplish this by carving out, in various ways, protected areas that are exempt from the science-based standard of care. All the while proponents of such measures market them as promoting fairness and consumer choice, when in fact they are simply anti-consumer. They remove basic protections so that fraud and pseudoscience may thrive.
Naturopaths are licensed in 16 states. They were recently successful is getting licensure through the Massachusetts legislature, but fortunately the bill was vetoed by Governor Deval Patrick. They are currently pushing for licensure in Michigan.
A major challenge is that naturopaths have a great deal to gain from being licensed, and so they are tireless in pushing for licensure. Like chiropractors before them, all they have to do it keep plugging away over the years and the number of states licensing their brand of nonsense will ratchet up.
In case any readers are unfamiliar with naturopathy, its practitioners have their own take on medicine which, as far as I can tell, boils down to using any treatment, diagnostic method, or health product as long as it is not based on science and evidence. They favor unscientific methods like homeopathy, iridology, acupuncture, useless supplements, dietary changes, and other forms of medical nonsense. Kimball Atwood argues quite well why naturopaths should not be licensed.
Often I am met with disbelief that naturopathic practice can be that bad, so please do a Google search for yourself and see what authoritative naturopathic references have to say. For asthma, for example, a typical naturopathic recommendation can be found here.
"Another useful Physical Medicine technique is that of Hydrotherapy, discussed at length in the Introduction to Modalities section. Placing a hot, wrung out towel over the chest can relax the breathing muscles and restore normal breathing. For an acute asthma attack try a steam inhalation (draping a towel over your head and a bowl of hot water) with a few drops of eucalyptus oil in the water. Be careful that the water is not so hot that the steam burns your face. Some doctors recommend taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry. This method can be performed preventively. Another technique for an acute attack is to drink some hot water with the juice of one clove of garlic."
There is not evidence to support the use of any of these interventions. I especially like the recommendation to use hydrogen peroxide in the water so that the skin will absorb oxygen to help out the lungs. This displays a shocking ignorance of basic physiology.
Asthma is a serious illness, and an acute attack can even be fatal. Relying upon worthless interventions can be very harmful.
Proponents of licensure often argue that it will provide a mechanism by which the profession wishing to be licensed can be effectively regulated, thereby increasing quality control. This is simply not the case, however.
First - if the entire profession lacks a culture and basis in science, there is no mechanism for quality control. Adhering to some internal measure of "good naturopathic practice" is irrelevant if it is all based on nonsense from top to bottom.
Once states license a profession, well then they are a licensed profession, and subsequent regulation of standards will be in the hands of licensed professionals. In other words - as soon as the profession is licensed, the wolves are in charge of the hen house from that point forward.
The real reasons that naturopaths (or homeopaths or acupuncturists) want to have licensure often has to do with limiting competition. One brand of naturopath wants to keep other brands out of the profession by being made the gatekeepers.
Further, licensure puts them on the path to respectability and insurance coverage. The public will interpret licensure as government certification of legitimacy, and even endorsement. This is why licensure of nonsense represents a betrayal of the public trust.
In my next post I will discuss the other legal fronts faces by those attempting to defend science-based medicine.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.