naturopathydigest.com -- Predictable But Puzzling

While the AMA's efforts to control patient choice are nothing new, the scope of its current campaign - now targeting the naturopathic profession - is raising eyebrows.

With consumers becoming increasingly discontent with conventional medical care, and naturopathic physicians and alternative health care practitioners offering various forms of noninvasive, equally effective or more effective care, the American Medical Association (AMA) is fighting back in the form of an aggressive, well-funded campaign now focusing squarely on the naturopathic profession while continuing to advance against all forms of non-MD/DO care.

As reported in the July issue of ND, the AMA recently adopted Resolution 814, calling for a study of the qualifications, education and academic requirements of "limited-licensure health care providers and limited independent practitioners." The resolution also officially established the "Scope of Practice Partnership" to help oversee and fund this study.¹ The Scope of Practice Partnership is a conglomeration of state medical associations and specialty groups created, according to one association newsletter, "to marshal the medical community's resources against the growing threat of expanding scope of practice for allied health professionals."

Since then, more pieces of an apparent conspiracy puzzle against non-allopathic medicine appear to be falling into place in the form of a second AMA House of Delegates resolution (Resolution 209) - specifically addressing the naturopathic profession; the "Healthcare Truth and Transparency Act" (H.R. 5688); and an affiliated coalition of medical and dental organizations (The Coalition for Healthcare Accountability, Responsibility and Transparency - CHART).

Resolution 209, introduced by the Florida delegation at its June 2006 House of Delegates meeting in Chicago, reads as follows: "RESOLVED, That our American Medical Association work through the Scope of Practice Partnership and interested Federation partners to oppose the licensure of naturopaths and report back to the House of Delegates at the 2006 Interim Meeting."

In its post-meeting report, the AMA also stated, "Resolution 209 asks that our American Medical Association work through its Board of Trustees to outline a policy opposing the licensure of naturopaths to practice medicine and report this policy to the House of Delegates no later than the 2006 Interim Meeting. Testimony heard by your Reference Committee was unanimously supportive of Resolution 209. Your Reference Committee also heard testimony requesting amendments to this resolution seeking to strengthen both its purpose and intent. As physicians, our priority is ensuring that patients receive the highest quality of care. In furtherance of this priority, your Reference Committee agrees with the testimony and recommends that Resolution 209 be adopted as amended."²

Resolution 209 fails to distinguish between those who have graduated from a CNME-accredited school and those who have not. Resolution 209 simply uses the term "naturopath." One wonders if the AMA actually will concentrate its anti-licensure efforts specifically on those in the naturopathic profession who may represent the greatest "threat" in terms of their comparable education and training.

The AMA also issued Report 24, titled "Limited Licensure Health Care Provider Training and Certification Standards," presented by Duane M. Cady, MD. This report outlines the history of the Scope of Practice Partnership (SOPP) which, according to this report, has met quarterly either in person or via conference call for the last two years. According to the report's conclusion, "The AMA will continue to play an active role as a convener and consensus builder between state medical associations and national medical specialty societies with respect to scope of practice issues. In this role, the AMA will continue to support the SOPP and be an active member of its Steering Committee. The Federation has been energized by the development of the SOPP and the AMA will continue its work in bringing organized medicine together to fight these scope of practice battles."³

Upon requesting comment on the AMA's latest action, Naturopathy Digest received the following from Jane Guiltinan, ND, president of the American Association of Naturopathic Physicians (AANP):

As if the Scope of Practice Partnership and Resolution 209 weren't ominous enough, on June 27, 2006, Oklahoma Rep. John Sullivan introduced House Resolution 5688, the "Healthcare Truth and Transparency Act," in Congress. Commenting on the new legislation, Rep. Sullivan said, "All health care providers are of vital importance to our nation's health care system, but people should not be confused about whether or not they are seeing a trained and licensed medical doctor. False and misleading advertising is fueling patient confusion. This bill will protect patients from providers who aren't being clear about their qualifications."⁵

The Health Care Truth and Transparency Act makes it unlawful for any licensed health care provider who is not a medical doctor, doctor of osteopathy, doctor of dental surgery or doctor of dental medicine to "make any deceptive or misleading statement, or engage in any deceptive or misleading act, that deceives or misleads the public or a prospective or current patient" into thinking that the provider is an MD, osteopath or dentist, or possesses the same education, skills or training. Deceptive or misleading statements include "advertising in any medium, making false statements regarding the education, skills, training, or licensure of such person, or in any other way describing such person's profession, skills, training, experience, education, or licensure in a fashion that causes the public, a potential patient, or current patient" to believe the provider is a medical doctor, osteopath or dentist.⁶

Licensed health care providers who violate the act would be subject to charges of participating in an "unfair or deceptive act" brought about by the Federal Trade Commission. Any provider found guilty of knowingly participating in an unfair or deceptive act would be subject to civil penalties of up to $10,000 per violation.

The bill also directs the FTC to conduct an investigation of all health care providers who engage in "deceptive or misleading" acts to determine how frequently they occur, and to identify any instances of harm or injury resulting from said acts. In addition, as part of the investigation, the FTC is charged with identifying instances "where any state public policy has permitted such acts and practices."

3. The Coalition for Healthcare Accountability, Responsibility and Transparency (CHART)

On the very same day H.R.5688 was introduced in Congress, a new group of medical and dental organizations called the Coalition for Healthcare Accountability, Responsibility and Transparency (CHART) released the results of a survey claiming the majority of Americans are unaware of the differences in the training and education between medical doctors and other licensed providers of health care services. The CHART survey findings, released June 27, allege that there is "significant confusion" among the American public about the qualifications of health care providers.

"The AMA is one of the 10 organizations that comprise CHART, and one of six organizations to have an official relationship with both CHART and the Scope of Practice Partnership,"⁵ explained Dr. Rebecca Patchin, a member of the American Medical Association's board of trustees. CHART's members include the AMA, the American Academy of Ophthalmology (AAO), the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS), the American Psychiatric Association (APA), the American Dental Association (ADA), the American Society of Anesthesiologists (ASA), the American Osteopathic Association (AOA), the American College of Surgeons (ACS), the American Society of Cataract and Refractive Surgery (ASCRS), and the American Academy of Orthopedic Surgeons (AAOS). Five of those organizations - the AAO, AAOHNS, APA, ASA, and AAOS - are also charter members of the Scope of Practice Partnership.

Putting the Pieces Together: H.R.5688's Sponsors Linked to CHART, Organized Medicine

Rep. Sullivan and the five congressional co-sponsors of H.R.5688 have direct ties to the medical community. A review of Rep. Sullivan's recent legislative actions revealed that while the Health Care Truth and Transp-arency Act represents his boldest effort to target the qualifications and practice rights of health care providers who aren't medical doctors, it is not his first. In November 2003, Sullivan introduced the Veterans Eye Treatment Safety Act, which would have mandated that only medical doctors and doctors of osteopathy be allowed to perform eye surgery at any Department of Veterans Affairs facilities or under contract with the Department of Veterans Affairs.

According to the Center for Responsive Politics, the health care industry was one of the largest contributors to Sullivan's 2004 congressional campaign. Sullivan received more than $68,000 in campaign contributions from various health care organizations, including $10,000 from the AMA, $10,000 from the American Academy of Ophthalmology, and $7,000 from the American Society of Anesthesiologists.⁷

Two of the co-sponsors of H.R. 5688 appear to be directly linked to CHART and the Scope of Practice Partnership. Rep. Michael Burgess (R-TX) is a 1977 graduate of the University of Texas Medical School at Houston. He founded an obstetrics and gynecology practice in Lewisville, Texas, and is a former president of the Denton County Medical Society. Dr. Burgess also is a member of the Texas Medical Association. That association's delegation introduced the original resolution calling for an examination of "limited-licensure health care providers" at the AMA House of Delegates interim meeting in November 2005. Nine of the 10 organizations in CHART contributed to Burgess' 2004 congressional campaign, donating more than $52,000.

Rep. Joe Schwarz (R-MI) has been a practicing physician since the 1970s. He is a fellow of the American College of Surgeons and a member of the American Academy of Otolaryngology-Head and Neck Surgery - both of which are founding members of CHART. In its 2005 annual report, the academy listed the election of Dr. Schwarz to Congress as one of its "Top Ten Accomplishments for 2005." CHART members donated more than $49,000 to help Schwarz get elected to Congress in 2004.

The bill's other three co-sponsors also have received significant campaign contributions from CHART members in the past few years. Rep. Pete Sessions (R-TX) received $49,500 from CHART members in 2004, including $10,000 each from the AMA, the AAO and the ASA. Rep. Charlie Bass (R-NH) received $14,000 in campaign contributions for his 2004 campaign. And Rep. Michael Bilirakas (R-FL) received contributions from all 10 CHART members in 2004, totaling more than $60,000.

Even within its own ranks, there is some confusion regarding complementary and alternative medicine. The Medical Student Section of the AMA introduced Resolution 306, titled "Increasing Awareness of the Benefits and Risks Associated with Complementary and Alternative Medicine." As introduced, the resolution reads: "RESOLVED, That our American Medical Association support the incorporation of complementary and alternative medicine (CAM) in medical education as well as continuing medical education curricula, covering CAM's benefits, risks and efficacy."

However, the AMA did not adopt Resolution 306 as introduced. The House of Delegates adopted a substitute resolution. Substitute Resolution 306 reads: "RESOLVED, That our American Medical Association promote awareness among medical students and physicians of the wide use of complementary and alternative medicine, including its benefits, risks and evidence of efficacy or lack thereof. (Directive to take action.)

In its post-meeting report, the AMA cited the following reasons for the change: "Resolution 306 asks the AMA to support the incorporation of complementary and alternative medicine in medical education as well as continuing medical education curricula, covering benefits, risks and efficacy. Your Reference Committee heard testimony that the medical school curriculum cannot be all encompassing. Concern was expressed that the teaching of complementary and alternative medicine could preempt other critical portions of the curriculum. The importance for physicians to be aware of all therapies used by a patient was stressed. However, due to the sheer volume and absence of evidence of effectiveness of complementary and alternative medicine, teaching such practices is not supported."⁸

It seems the younger generation of MDs recognizes patients are utilizing complementary and alternative medicine, whether or not they actually inform their doctors they are doing so. These up-and-coming practitioners are looking for the information necessary to best serve their patients - a goal the AMA says it is striving for by way of all its ongoing actions. However, when asked for more information about CAM, these same students are told that, "the medical school curriculum cannot be all encompassing." According to the AMA policy H-480.964: "Physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated."⁸

As the AMA continues its campaign against the naturopathic profession and other forms of non-allopathic care, one wonders what else the AMA has in store - and what course of action the naturopathic community will take to counter this growing threat.

Michael D. Maves, MD, MBA. Memo to Delegates and Alternate Delegates; State Medical Associations; State Presidents and Presidents-Elect; National Medical Specialty Societies, "Implementation of Resolutions and Report Recommendations (I-05) and Follow-Up Implementation Chart (A-05)," May 2006. Click to view it online.
Report of Reference Committee B of the American Medical Association House of Delegates. Resolution 209 (A-06), introduced by the Florida Delegation, chaired by John M. Zerwas, MD. www.ama-assn.org.
Duane M. Cady, MD, Chair. Report of the Board of Trustees, Report 24-A-06, "Limited Licensure Health Care Provider Training and Certification Standards." www.ama-assn.org.
American Association of Naturopathic Physicians statement from President Jane Guiltinan. E-mail to Naturopathy Digest, received Wednesday, June 28, 2006.
"Physician and Dentist Coalition Announces Support for Health Care Truth and Transparency Act of 2006." PRNewswire press release, June 27, 2006.
The Healthcare Truth and Transparency Act of 2006. Available online at http://thomas.loc.gov.
Center for Responsive Politics; www.opensecrets.org.
Report of Reference Committee C of the American Medical Association House of Delegates. Resolution 306 (A-06), introduced by the Medical Student Section, chaired by Erin E. Tracy, MD. www.ama-assn.org.