License to Heal

A few years ago, when she was running a Raleigh advocacy organization for low-income citizens, Barbara Zelter came down with a case of bronchitis that lasted for months. She went to several doctors, tried antibiotics and other medications, but instead of getting better, she just got worse.

Finally, after more than a year of persistent illness, she came across the name of a Durham homeopath in a health and wellness tabloid and made an appointment. Over the next year Zelter says she made a “miraculous” recovery through homeopathy, a healing system that uses tiny quantities of natural substances that, in larger doses, mimic effects of the disease being treated. “I’ve been perfectly fine since then,” she says. “In fact, I can’t seem to get sick.”

But Zelter, who now works as a program associate for the North Carolina Council of Churches, is worried that state legislators are poised to shut off access by other patients to the type of treatments that cured her. A bill recently introduced in the General Assembly would increase penalties for practicing medicine without a license from a misdemeanor to a felony. Zelter is one of numerous citizens who’ve been calling, e-mailing and writing lawmakers over the past month with concerns that the bill unfairly targets alternative medicine–much of which is performed by unlicensed practitioners.

The measure’s sponsor, state Sen. James Forrester (R-Gaston), says patient safety is at the heart of his proposal–not any particular form of medicine. “This isn’t a witch hunt,” says Forrester, an MD whose bill has the backing of the North Carolina Medical Society. “I’m just changing the penalties, not the definition of what practicing medicine is. Right now, if you steal a newspaper from my box, it’s the same penalty as practicing medicine without a license.”

But proponents of alternative therapies fear that whatever Forrester’s intentions, his bill will mean more inspections and prosecutions of health care providers not covered by current medical licensing. Those include homeopaths, naturopaths, massage therapists, herbalists–even midwives in some cases.

The penalties are a technicality that can be used to discourage alternative practitioners, says Anthony Noto, co-founder of Citizens for Healthcare Freedom, a consumer network that’s been organizing against Senate Bill 144.

“The medical industry is extremely powerful,” he adds. “And they’re going to do whatever they can to keep their monopoly.”

This isn’t the first time such “scope of practice” issues have come before the General Assembly. Three years ago, a bill identical to Forrester’s drew overflow crowds to a legislative hearing room in protest. That bill died in committee–as did a study group that was supposed to explore less punitive ways to achieve quality provision of alternative medicine.

Already, outcry over Forrester’s bill has been loud enough to discourage at least one legislator from signing on. State Sen. Austin Allran (R-Catawba) confirmed that he withdrew his initial sponsorship of the measure, though he did not respond to more detailed questions about why. On the House side, state Rep. Paul Luebke (D-Durham) says he’ll introduce a bill next week that would exempt those practicing alternative medicine from penalties under existing licensing laws. The bill would require practitioners to fully disclose the type and extent of their training to patients.

Similar “health freedom” bills have become law in three states (Minnesota, California and Rhode Island), and are pending in at least four others. On the other hand, a measure recently passed by the Georgia Senate would make the unlicensed practice of dental hygiene, diet therapy and marriage counseling–among other treatments–a felony.

In North Carolina, the number of health care providers who’ve been cited under existing licensing laws is very small. Last year, the state Medical Board referred only one case of practicing without a license to the state Attorney General’s office. In 2001, the board referred four cases, and in 2000 it referred three. In a fiscal note accompanying Forrester’s bill, the state Administrative Office of the Courts reports there have been no convictions during the past three years for practicing without a license.

Backers of Forrester’s bill insist that even if penalties are stiffened, those numbers are unlikely to rise. “Stepping it up to a felony gets the prosecutorial interest up,” says Mike Edwards, a spokesman for the North Carolina Medical Society, which represents more than 10,000 doctors and physicians assistants statewide. “But it’s not a significant number of people involved.” Edwards says the “big picture” the Senate bill aims to address is accountability. “What we’re trying to do is make sure there is competence,” he says. “We feel like there is a standard of care that’s been established and we want to maintain that.”

But alternative practitioners say that’s just the problem–those standards don’t account for a host of treatments that lie outside the mainstream. Licensing doesn’t insure safety, they say, so much as it reserves the official stamp of approval solely for conventional therapies. Some worry privately that after years of laissez-faire tolerance, the Medical Board is gearing up for a major assault on alternative healers–a charge board officials dismiss.

What can’t be dismissed is the growing popularity of non-traditional medicine. A seminal Harvard Medical School study found that in 1997, Americans made more visits to “complementary and alternative” health care providers than to all primary care physicians. Out-of-pocket spending on such therapies that year was $12.2 billion–higher than expenditures for all U.S. hospitalizations.

In North Carolina, Citizens for Healthcare Freedom estimates that as many as 3.3 million people now receive a substantial portion of their health care from alternative practitioners–even though few have health insurance that will cover such services. Medical schools at the University of North Carolina, Duke and Wake Forest have founded programs in “integrative medicine” designed to bridge education in established and alternative therapies. Even Blue Cross Blue Shield, the state’s largest insurer, has created a discount program for therapies such as acupuncture, biofeedback and massage. There are now 365 providers under “Alt-Med Blue.”

Zelter is one consumer who hopes state legislators will bow to such pocketbook power by soundly rejecting Forrester’s bill and opting instead, for the “health freedom” approach. “It’s hard times in the medical profession and somehow the popularity of alternative medicine is threatening,” she says. “I don’t think legislators have evil intentions. There’s just a lot of ignorance out there.”