Sunday, June 08, 2008

Minnesota naturopaths can order MRIs

Michael Paymar is our state representative. I want to know how he voted on this bill. Note, this was a DFL bill!
A bitter fight over who can be called 'doctor'

It took 99 years, but Minnesota has finally given official recognition to the practice of naturopathic medicine, which relies on the body's powers to heal itself.

Under a new state law, naturopaths -- who use everything from herbal remedies to biofeedback -- will be allowed to register with the state and call themselves doctors without fear of running afoul of the medical establishment.

... "I didn't realize how much of an issue it was going to be," said Rep. Neva Walker, DFL-Minneapolis, who championed the bill for years before it finally passed and was signed into law in May. "[I] didn't realize somebody who had supported all forms of alternative healing for years was going to be an enemy."

It allows those who qualify to use the title "naturopathic doctor" and expand their "scope of practice" to include such things as ordering blood tests and MRIs, and admitting patients to hospitals....

...The Minnesota Medical Association (MMA), representing conventional doctors, objected to allowing naturopaths to prescribe drugs and perform minor surgery. When those items were dropped, the MMA withdrew its opposition.

So, if a naturopath orders an MRI, do payors have to pay for it?

I'll ask Mike Paymar that question.

In the meantime the DFL dominated Minnesota legislature has decided that they want to continue to limit medical decision making to "professionals". What's new is that they've decided that medical science is no longer the basis for measuring professional expertise. Social judgment alone is the new criteria.

It's the same sort of reasoning that brings creationism into science classes. People who believe solar variation explains most climate change fall into this category. We're used to this, it's a familiar fight. I don't think there is any alternative to science for making judgments about the natural world, but I accept most of society doesn't agree with me.

So I object to the decision on the basis of using social fashion as the basis for measuring expertise, but that's not my primary objection.

My real problem with this bill is that it doesn't go far enough.

If you abandon science as the basis for expertise, then you shouldn't stop with naturopaths. Certainly nurses should be included, but also teachers, chiropractors, shamans, plumbers, lawyers, accountants, radiology technicians, cab drivers, flight attendants, mothers, fathers and, heck, children too.

Nor should the boundary be artificially set at test ordering. An MRI is not a small procedure, nor necessarily benign.

Let us open up all of medicine and surgery. If Naturopaths are ordering MRIs, then carpenters should be doing hip replacements. If you've every seen a 110 lb orthopedic surgeon rear back to slam the silver hammer down, you'd appreciate the role a good carpenter can play.


If you abandon science as a measure for expertise, then there are no more boundaries. I expect the courts will, in time, agree with me.

Payors and insurance companies will love this. Plumbers are not only much cheaper than neurosurgeons, the follow-up care will also be much shorter and less costly.

Caveat emptor.

Update 6/14/08: Representative Michael Paymar responded promptly by mail. He's guilty - he vote for this sucker. To his credit he doesn't mince words. He's a believer, Mike Paymar is not a rationalist. The Minnesota Medical Association approved the bill, so he felt he had cover to proceed.

Shame on them too.


Paymar is a very good representative, he wins this district by huge margins, and it's not like I'm going to vote for anyone else. On the other hand, it will be much harder now to send him our yearly campaign donations.


alanbooker said...

“If you abandon science as a measure for expertise, then there are no more boundaries. I expect the courts will, in time, agree with me.”

Doesn’t science create boundaries that make alternative points of view difficult at best! I would rather that common sense be used in most matters and that the variance between what is scientific or naturalistic be left to those who might be receiving. If by “Caveat emptor” you point to the insurers we are indeed in trouble.

I also suspect that in time the courts will be in agreement with you and we will all be one more step removed from managing our own lives.

Whilst the above law might save some from serious problems it also demonstrates that government and the pharmaceutical industries lobbyists are in control of our lives.

Regards, Alan

John Gordon said...

I respect the intellectual strength of the libertarian perspective on this issue.

I do think we need very strong laws to protect against fraud however. So it's fine to do neurosurgery if you're a naturopath, but not fine to pretend your learned your neurosurgery at the Mayo clinic (unless, of course, you did).

Practically speaking I fear many people will make unwise choices. That's fine for fully aware adults, but what about their children, the aged with cognitive decline, and special needs adult?

I think they need some special protection.

I also do worry that payors will waste a lot of resources on therapies I personally consider to be no better, and sometimes worse, than placebo measures.

Lotus lady said...

They are trained to read MRI's. It is up to the insurance company to decide if they are going to pay for it. So it has nothing to do with science, but with money.

Anonymous said...

It seems that some of you may not understand the scope of practice and training of Naturopathic Physicians. To be licensed and practice in a licensed state (as an ND) you must have completed a 4 year undergraduate degree (the same as MD's), 4 years of doctoral education (same as MD's), and passed rigorous basic medical science and clinical board exams. Naturopathic medical curriculum includes all of the medical sciences (gross anatomy, biochemistry, histology, microbiology, histology, infectious diseases, pathology, physiology, immunology...) plus nutrition, botanical medicine, psychology, counseling, physical medicine, pharmacology, and homeopathy. DId you know that this actually averages out to about 311 units? Did you also know that is more than the basic training at most allopathic medical schools in North America?

There is another important point you may want to consider. Naturopathic Physicians scope of practice is that of a family medicine physician in that they are not going to perform neurosurgery, remove an appendix, or work in the ER for example. Therefore, their training is arguably more comprehensive than that of most GP's. Many patients end up at an ND practice and find relief after exhausting all options with their 'conventional' physician.

Lastly, look at who fights to limit ND's! Pharmaceutical companies, some members of the AMA, MD's (some), insurance companies. You know what all of these people have in common? They stand to potentially loose their stronghold on the medical industry!

In health,


John Gordon said...

It's a lot of years of training Vanessa, but Naturopathy is not science.

Priests do a lot of training as well.

Anonymous said...

Those classes are science unless physiology and such are not. A very good percentage of medications get there active ingredients from herbal medicines so again to say that is not science is ludicrous. There are an incredible amount of double blind placebo studies on vitamins, herbs, and nutrition and many more clinical studies. Many allopathic medical schools have done these studies. Training also consists of pharmacology and minor surgery, again science. Many classes at Naturopathic school are taught by the same instructors at allopathic, osteopathic, and dental schools. To say these courses are not science would be coming from passion or emotion and not objective therefore a very unscientific opinion.

John Gordon said...

I never said herbal remedies couldn't be effective. The only magical aspect of the use of herbal medications is the common belief that they are particularly safe.

If Naturopathy stuck to science it would be allopathy.

Anonymous said...

I absolutely agree and allopathic physicians know very little in these areas, therfore you have the layman treating thereselves. Naturopathic physicians feel this enormous gap with training in medicine and natural medicine resulting in a more comprehensive primary care physician.

Terra said...

It is true that “natural” does not necessarily mean “safe”, why do you think so many companies are using it as a marketing technique? Natural remedies can be very dangerous, water is natural, but you can still drown in it.

This is why licensed Naturopathic Doctors (ND’s) are needed, people are self-treating and what they are taking may interact with prescriptions their MD is giving or they may have a condition that may be adversely affected by a plant, herb, or even vitamin or mineral. I am not saying that one is better than the other, they are different, and people are afraid of what they do not know. At this point most people only know the allopathic model, why not expose them safely to another paradigm, with the modalities working together in the best interest of their patient.