Complementary and alternative medicine Homeopathy Medicine Naturopathy

Naturopathy advances in Hawaii

Naturopathy is quackery.

That can’t be said often enough. After all, any “discipline” that not only incorporates homeopathy as a major part of its training but also requires that its graduates pass a test with a section on homeopathy certainly can’t be considered science-based. Actually, to be more accurate, naturopathy is probably at least 80% quackery and 20% science-based modalities like diet, exercise, and lifestyle changes rebranded and infused with woo. Moreover, whenever naturopaths are misguided enough not to know their limitations, leading them to treat real diseases (rather than made-up naturopathic diseases like “adrenal fatigue”), bad things almost always happen.

None of this has prevented naturopaths and their “professional organizations” (and I use the term loosely in this context) from trying to convince clueless legislators to pass bills in various states, first to license their profession. After they achieve licensure in a state, naturopaths are relentless in pressing for an expansion of their scope of practice, some arguing that they should be considered primary care practitioners, a truly frightening prospect given the pseudoscience at the heart of their “medicine.”

Take Hawaii, for instance.

Ever since my wife and I took a vacation to Oahu three years ago, we’ve been having fantasies about seeing if we can get jobs there. However, I know one thing about Hawaii that would annoy me. Unlike Michigan (where I am now), Hawaii grants naturopaths a broad scope of practice, including prescribing privileges according to the naturopathic formulary. Even in Michigan, I see the occasional patient with locally advanced breast cancer eating through her skin who had been treated by a naturopath; I’m guessing that such occurrences would be more frequent in Hawaii.

Of course, naturopaths are a persistent bunch. If they can’t get what they want through the law, they keep at it and, if necessary, get what they want through other means. In this case:

The Hawaii health insurance provider Hawaii Medical Service Association (HMSA) will let you choose a naturopathic doctor as your primary care physician, according to a recent agreement between the insurer and the Hawaii Society of Naturopathic Physicians. This is a big step forward for naturopathic doctors, according to Dr. Karen Frangos, a practicing naturopathic physician on Maui and the President of Hawaii Society of Physicians.

“It allows us all kinds of privileges in terms of being able to be part of a professional physician organization like all other medical doctors do,” says Frangos. “Potentially admission privileges in hospital settings, so it’s a big big deal. It helps close the gap in the shortage of primary care physicians in Hawaii.”

No. It. Does. Not. That’s because naturopaths are not primary care physicians. They are not trained to be primary care physicians. They are most certainly not qualified to be primary care physicians, their claims otherwise notwithstanding. What HMSA has done is to make a deal with a bunch of quacks to provide their quackery to its subscribers.

Consider this. Would you want naturopaths to have hospital admitting privileges? (I wouldn’t.) What would they do with those privileges anyway? After all, I always thought that the very philosophy of naturopathy precluded the inherently “unnatural” interventions that hospitals excel at. On the other hand, a lot of what naturopaths do isn’t exactly that natural, such as intravenous vitamin drips or colon hydrotherapy, the name “naturopathy” notwithstanding.

The funny thing is that naturopaths themselves aren’t completely happy with this deal. Witness what Marsha Lowry, a naturopath at Whole Body Wellness in Makawao and Hale Malu in Wailuku, has to say about it:

“On paper I love the idea of PCPs, but what concerns me is if there is a situation that they may choose to not reimburse for the visit if naturopathic treatments are used or recommended,” says Lowry. “I love that people would be able to have coverage. But right now they have been really great to me as an out-of-network provider, and that hasn’t happened. What has happened with other insurance companies is they are auditing our charts and kicking back things like prescribing an herb, and saying it’s not MD standard of care. It’s possible, only because it’s happened recently with UHA [University Health Alliance].”
Things could be different as an in-network provider for HMSA, but the Hawaii Society for Naturopathic Doctors is calling it a success with regard to the Affordable Care Act.

Oh, dear. Other insurance companies are apparently not as misguided as HMSA appears to be. They’re actually auditing the charts of naturopaths and flagging items that are not science-based standard of care. The nerve of them! Normally, I’m not a huge fan of health insurance companies, particularly after I’ve had to argue with a the medical drones belonging to a couple of them over some fairly straightforward and obviously medically indicated tests that I ordered. Really I’m not. But in this case these “other” insurance companies are actually doing what they’re supposed to do: Not reimbursing for treatments that are not science-based, as so much of naturopathy is not.

Not that that stops Hawaii naturopaths from spewing the same old propaganda:

“Several meetings over the last month with them in Honolulu–them being some of the management, upper management, and the chief medical officer within HMSA–have culminated in a willingness to comply with the Affordable Care Act,” says Dr. Frangos. “There is a non-discrimination clause in Section 2706 of the Affordable Care Act that states all the insurance companies are to reimburse for services rendered within the state for licensed practitioners practicing within their scope, effective January 2014. But none of the insurance companies have been compliant. So for the last two years, we have been working on this. HMSA has finally agreed to naturopathic physicians in Hawaii to be credentialed as primary care physicians. Hawaii’s licensing law allows us to be primary care physicians yet none of the insurance companies have been allowing us to be participating primary care providers in their plans.”

First of all, this is perhaps the most pernicious effect of naturopathic licensing laws (or laws licensing other quackery, such as homeopathic “physicians” or chiropractic. On the surface, it might not sound so unreasonable for the Affordable Care Act to require that insurance companies reimburse for services provided by health care providers licensed in that state. Unfortunately, states like Hawaii license quacks like naturopaths, which means that the ACA can be leveraged to force insurance companies to pay for quackery.

Actually, Marsha Lowry’s practice is an excellent example of this. Just look at some of the quackery she offers her patients, which includes homeopathy and IV nutritional therapy, which usually means “treatments” like intravenous vitamin C and other vitamins.

Meanwhile, naturopaths push for more:

Frangos says the Hawaii Society of Naturopathic Doctors is also involved in other legislation this year, like SB 318, which compels insurers to cover care provided by naturopathic doctors.

She is also working on SB 1034, which will lift the cap on the number of visits related to personal injury protection benefits provided through motor vehicle insurance. And Frangos says the Hawaii Society of Naturopathic Doctors will work on HB 1952, regarding network adequacy, and SB 2332, which allows naturopathic doctors to prescribe controlled substances like Viagra and pain medication.

Again, when I see stories like this, I always wonder why naturopaths would even want to prescribe controlled substances. For instance, why would they want to prescribe opiates, if their methods are so great? The cynic in me thinks that it’s because they’ve come to realize that the “naturopathic” methods they’ve been taught don’t work, while good old-fashioned science-based medicine does work. I mean, seriously. Why would naturopaths want or need to prescribe Viagra? I just don’t get it. If you want to prescribe science-based medicines, then you should be trained in how to do it in the same way that physicians are, starting in medical schools and continuing to completion in residency.

Unfortunately, Hawaii is not alone. It is just ahead of the curve in legalizing quackery. After all, according to the article, HMSA is the largest health insurance provider in Hawaii, and where it goes, others will likely follow. In the meantime, reimbursement for naturopathic care as a standard part of their health plans will soon become a reality for large numbers of Hawaiians.

One wonders if this is a harbinger of things to come.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]


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