Raising the stakes

Local defenders of alternative medicine mobilized last week to stop a piece of legislation that would have turned some practitioners into potential felons.

A physician licensure bill in the N.C. General Assembly contained wording that would have made it a felony to practice medicine without a license. Currently, this violation is classed as a misdemeanor. And since the state doesn’t have licensing procedures for naturopaths, homeopaths, herbalists and some other alternative medical practitioners, the bill raised the potential consequences for those who practice in such disciplines. (The state does, however, license acupuncturists and chiropractors.)

In Asheville, critics of the bill included 250 people who signed protest petitions at the French Broad Food Co-op and the Earth Fare grocery store.

“People are just outraged,” said Melissa Fryar, health and beauty-care buyer at the Co-op.

The petitions read, in part: “We demand that our alternative health care retain its place in our lives beside allopathic/conventional health care. Do not interfere with the people’s ability to make decisions about what works the best for us.”

The petitions were faxed to members of Buncombe County’s legislative delegation, Fryar notes.

Legislators said they received thousands of phone calls and e-mail messages protesting the bill. And at least 100 people packed a meeting of the N.C. House Finance Committee last week, where the bill was set to be discussed, according to the Raleigh News & Observer.

In the face of such outcry, Rep. George Miller of Durham, the bill’s sponsor, withdrew the felony provision.

A wake-up call

Although the aborted legislative action caught many by surprise, others had been expecting some sort of fallout after an 8-year-old diabetic girl died last fall in Asheville after she was taken off insulin, says Laura Radecki, an herbalist who works at the Co-op. Laurence N. Perry, who allegedly billed himself as a naturopath, is awaiting trial in Buncombe County on charges of manslaughter and practicing medicine without a license.

But herbalist Peggy Ellis, founder of the N.C. School of Natural Healing in Asheville, considers the failed legislative effort to be a strange — even sneaky — first step toward restricting alternative practitioners. (Her school offers certification in massage therapy, an herbal-studies program, and courses in meditation instruction and energy healing.)

Instead of clamping down, Ellis thinks legislators should have gone to the alternative medical community to see how they could work together.

Ellis first entered the world of alternative medicine years ago in Michigan, when she was seeking relief from rheumatoid arthritis, which kept her in such pain that she had to sleep sitting up. After visiting naturopaths, homeopaths and herbalists, she was finally able to come up with a treatment that works for her.

“If it would have been illegal for them to share information with me … I can only assume that I’d be crippled up and not doing as well as I am today,” declares Ellis.

Obviously, she says, people who seek out alternative treatments (which typically aren’t covered by insurance policies) are doing so for a reason.

“It’s only common sense,” asserts Ellis. “It’s helping people, or they wouldn’t keep doing it.”

And while she doesn’t think it should be illegal to assist others with their health concerns, Ellis does favor making sure that people giving medical advice have the proper training — perhaps by means of a review board.

“We have to look at it as kind of a wake-up call,” Ellis says, adding that she hopes the recent legislative action will motivate herbalists to start working together to win more respect and recognition for their profession.

Taking aim

Although the N.C. Medical Board supported the bill in its original form, the board’s public-affairs director, Dale Breaden, says the felony provision wasn’t aimed at a particular group of people — merely at those who practice medicine without a license. The board licenses and regulates physicians, nurse practitioners and physician assistants — not other health-care practitioners.

“This is not an attack on alternative medicine,” Breaden emphasizes. “It’s simply an effort to assure the public in this state, and elsewhere, that they can rely on and expect appropriate care wherever they choose to seek it.”

Breaden notes that many alternative medical techniques are now being taught in traditional medical schools.

In much the same way that people expect a pilot to know how to fly a plane, people should expect their health-care provider to be knowledgeable and responsible, says Breaden.

“Some level of responsibility, some oversight, seems responsible,” he maintains.

Breaden poses this scenario: Suppose he were to come to Asheville, put on a white coat and start taking patients. “You ought to have some sense I know what the hell, what the heck, I’m talking about,” he declares.

Although the felony provision got all the attention, Breaden was much more interested in talking about another part of the bill that would raise the annual license fee for physicians from $100 to $125. Neither the license-fee increase nor other parts of the bill affecting physicians drew criticism from proponents of alternative medicine.

Asheville’s history

This isn’t the first time the state has come down on alternative medical practitioners.

In 1990, the state Board of Medical Examiners (now the N.C. Medical Board) won a five-year battle to prevent Asheville family physician George Guess from administering homeopathic remedies.

In June 1985, the Board of Medical Examiners charged him with unprofessional conduct, alleging that his use of homeopathic medicines did not meet state standards. Although Guess won appeals in both Superior Court and the Court of Appeals — which upheld his right to practice homeopathy — the state Supreme Court ruled against him. The N.C. Supreme Court ruled 6-1 that using homeopathic medical remedies departed from the “standards of acceptable and prevailing medical practices in North Carolina.”

The Board of Medical Examiners revoked Guess’ medical license — but then stayed the revocation, as long as Guess refrained from practicing homeopathy.

Guess said then that homeopathy “offers real promise that allopathic medicine, for a number of conditions, cannot match.” He later gave up his medical practice in Asheville to open a practice in Charlottesville, Va.

Also in 1990, State Bureau of Investigation agents (at the Board of Medical Examiners’ urging) raided Asheville acupuncturist Cissy Majebe’s office in another effort to crack down on alternative health care. The agents seized patient medical records and investigated the practitioner for practicing medicine without a license. Majebe, who graduated from the American College of Chinese Medicine in Sante Fe, got a court order to reopen her clinic. Although the state didn’t charge her with a crime, the ordeal still cost her thousands of dollars in legal fees.

What’s next

Rep. Miller suggested on the floor of the legislature last week that a legislative study commission be formed this fall to look at alternative medicine in the state, the News & Observer reported.

That suggestion sat well with Dr. Marty Sullivan of Duke University, who offered his institution’s resources for such a commission. Duke, in fact, has an integrative medical program (and clinic) that includes courses in some forms of alternative medicine.

Sullivan — who didn’t agree with the felony provision — says the state needs to look at the evidence available on alternative medicine, investigate what practices are reasonable, and find out how other states regulate alternative medicine, before determining what’s best for North Carolina.

“It’s a balance between regulation and getting competent practitioners, and yet allowing an appropriate mix of providers for the state,” he says.

In the meantime, Fryar, who is studying to be an herbalist, has resigned herself to the idea that she may be viewed as committing a misdemeanor by answering questions about herbal remedies.

“I can get arrested any day of the week for practicing medicine without a license,” she states.

As Fryar understands it, she’s legally allowed only to show Co-op customers a product and refer them to third-party resources for more information. But most people want to know what they should take for a particular ailment. If Fryar has experience with a particular herb, such as goldenseal for sinus infections, she is likely to mention that. If she doesn’t, she may refer them to literature on the subject.

While acknowledging that there are a lot of “delicate gray lines” in the law, Breaden says he doubts that an herbalist could be viewed as practicing medicine without a license if all she does is say what remedy has worked for her. In layman’s terms, the practice of medicine is generally regarded as the individualized diagnosis of diseases and the treatment of diseases, he says.

The current law reads, in part: “Any person shall be regarded as practicing medicine or surgery … who shall diagnose or attempt to diagnose, treat or attempt to treat, operate or attempt to operate on, or prescribe for or administer to, or profess to treat any human ailment, physical or mental, or any physical injury to or deformity of another person.”

The law lists 16 exceptions — including administering domestic or family remedies in cases of emergency, and treating the sick or suffering by mental or spiritual means without using any drugs or other material substances.

Fryar, however, remains concerned that the state might choose to interpret her actions as practicing medicine.

“There’s a risk, and I definitely would hate to be arrested for helping people,” she says. “But at the same time, it’s worth it.”

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