Legislature(2003 - 2004)
02/18/2004 03:20 PM House L&C
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 18, 2004
3:20 p.m.
MEMBERS PRESENT
Representative Tom Anderson, Chair
Representative Carl Gatto, Vice Chair
Representative Nancy Dahlstrom
Representative Bob Lynn
Representative Norman Rokeberg
Representative Harry Crawford
Representative David Guttenberg
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 434
"An Act relating to the practice of naturopathic medicine; and
providing for an effective date."
- HEARD AND HELD; ASSIGNED TO SUBCOMMITTEE
HOUSE BILL NO. 389
"An Act relating to certain monetary advances in which the
deposit or other negotiation of certain instruments to pay the
advances is delayed until a later date; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 434
SHORT TITLE: NATUROPATHIC MEDICINE
SPONSOR(S): REPRESENTATIVE(S) HOLM
02/04/04 (H) READ THE FIRST TIME - REFERRALS
02/04/04 (H) L&C, JUD
02/04/04 (H) HES REFERRAL ADDED AFTER L&C
02/18/04 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
REPRESENTATIVE JIM HOLM
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the sponsor of HB 434.
SCOTT LUPER, N.D.
Fairbanks, Alaska
STATEMENT: Testified in support of HB 434 as a naturopathic
physician, explaining the bill and sharing his professional
experience.
CLYDE B. JENSEN, Ph.D.
Oregon Health and Science University
Portland, Oregon
POSITION STATEMENT: Testified in support of HB 434 and offered
a comparison of naturopathic physicians with allopathic and
osteopathic physicians.
DANIEL YOUNG, N.D.
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 434.
NANCY THERRELL
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 434.
FRANK THERREL
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 434.
MARY MINOR, N.D.
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 434 and shared
her background of 20 years of licensure as a naturopathic
physician.
ACTION NARRATIVE
TAPE 04-14, SIDE A
Number 0001
CHAIR TOM ANDERSON called the House Labor and Commerce Standing
Committee meeting to order at 3:20 p.m. Representatives
Anderson, Gatto, Dahlstrom, and Guttenberg were present at the
call to order. Representatives Lynn, Crawford, and Rokeberg
arrived as the meeting was in progress.
HB 434-NATUROPATHIC MEDICINE
CHAIR ANDERSON announced that the only order of business would
be HOUSE BILL NO. 434, "An Act relating to the practice of
naturopathic medicine; and providing for an effective date."
Number 0082
REPRESENTATIVE JIM HOLM, Alaska State Legislature, sponsor,
explained that HB 434 is offered to ensure professional, safe,
naturopathic healthcare for all Alaskans; it brings 17-year-old,
outdated statutes up to date and in line with 14 other states.
It provides for quality health care through continuing education
requirements and improved services in the practice of
naturopathic medicine; addresses Alaska's shortage of
physicians; provides alternative care and reduces health care
costs to "all the rest of Alaska"; places continuing education
requirements in statute; says naturopathic physicians may
prescribe "legend" or prescriptive drugs based on examining
board licensure, and/or controlled substances as registered by
the federal Drug Enforcement [Administration]; and specifies
that naturopathic physicians may perform minor surgery based on
their education, training, and licensure.
Number 0260
SCOTT LUPER, N.D., a naturopathic physician who practices and
lives in Fairbanks, testified in support of HB 434 and shared
his professional experience. He noted that he received his
undergraduate degree with honors from Portland State University;
graduated with honors in research from the naturopathic college
in Portland; opened a practice; moved to Tempe, Arizona, as the
department chair of diagnostics; taught and supervised the
training of naturopathic physicians for two years; last year
became chief medical officer and supervised 22 doctors; and
then, after deciding against being an administrator, moved to
Alaska and opened up a practice.
DR. LUPER turned attention to HB 434, saying the intent of the
bill is to allow naturopathic physicians to practice as they are
educated. They are trained to function as primary care
providers, deciding the appropriate action, investigation, or
referral for individual cases. He pointed out a JAMA [Journal
of the American Medical Association, 1998] article in the bill
packet that says their clinical education, which is entirely
outpatient-based, is designed to prepare them to be primary care
providers.
Number 0487
DR. LUPER focused on Appendix C in the bill packet, "A
Comparison of Licensed Medical Professions in the State of
Alaska," which compares levels of education of all health care
providers in Alaska and shows those for naturopathic physicians
to be among the highest. Appendix D compares Alaska with other
states in the document entitled "Comparison of Naturopathic
Governance in Licensed States." This points out that Alaska is
unique in not allowing naturopathic physicians to practice up to
the full scope of their licenses. He specifically mentioned the
areas of minor surgery and some prescription rights.
DR. LUPER reported that malpractice costs for naturopathic
physicians are among the lowest of all the professions; he
personally pays $3,000 a year. He turned to Appendix E,
"Comparison of Naturopathic and Major Medical Schools," in which
three leading naturopathic colleges, National, Bastyr, and
Southwest, are compared with three leading allopathic colleges,
Johns Hopkins, Yale, and Stanford; the comparison is further
broken into basic and clinical sciences, clerkships, and
allopathic therapeutics. He explained that the first two years
of medical education are devoted to basic sciences, and the last
two years to therapeutics and practical applications. He said
the hours of education are comparable, though not identical,
within the six colleges.
DR. LUPER referred to the next supporting document, "Comparison
of Pharmacology Training," and explained:
What we did was gather information from over 100
colleges and pull them all together. Under the
pharmacology list you see that for allopathic,
osteopathic and naturopathic colleges, ... the amount
of hours in pharmacology training is about 100 hours,
... again comparable.
DR. LUPER pointed out that the teachers for all types of
physicians in the area of pharmacology are the same. The second
table looks at the numbers of hours involved in clerkships and
clinical therapeutics, with the hours for all types of
physicians being comparable.
Number 0720
DR. LUPER related that a naturopathic education includes
learning how to use nutrition, botanicals, and a wide variety of
therapeutic agents to help patients. He said N.D.s get special
training on the interactions between drugs and nutrients, and
are recognized experts in that field. He gave an example of a
Fairbanks hospital that brought up an N.D. from Washington State
to consult in its oncology program on the interactions between
nutrients and chemotherapeutic agents. He said patient care is
the motivating factor for pursuing an expanded scope of practice
in Alaska for naturopathic physicians; it is inconvenient and
expensive for his patients to go to another physician to get an
antibiotic or hormone prescription when he, as a naturopathic
physician, is well trained to perform these functions.
Number 0891
REPRESENTATIVE LYNN noted that he'll soon be 71 years of age,
with aches and pains. He asked how he should choose a health
care provider.
DR. LUPER shared that most patients come to his practice by word
of mouth when they want to find the cause of a particular
problem. They generally experience an hour-long initial intake
process in order to find out what predisposes them to a
particular problem, such as diet, sleep habits, genetics, or
motor patterns. He added, "You'd have to be willing to spend
the time, and you'd also have to be willing and open-minded
enough to perhaps change something about your lifestyle,
something about your diet, something about the things that you
take, for example. You'd have to be willing to be coached."
DR. LUPER, in further response, said state insurance provides
coverage, but Medicare and Tricare insurance don't. He
explained that Alaska has an insurance-equality law that
requires recoverage in state group policies for naturopathic
services. The federal government doesn't have this requirement.
He noted that currently he has to go to an M.D. to get
prescriptions written for his patients, and those prescriptions
are covered by state and federal insurance programs. In
response to a question from Representative Dahlstrom, he said
legend drugs are sold by prescription only; schedule drugs are
drugs with an abuse or addictive potential. Legend drugs
comprise a wide category of drugs, whereas schedule drugs are a
subcategory of legend drugs.
Number 1120
REPRESENTATIVE GATTO referred to Appendix E and asked Dr. Luper
what the Johns Hopkins, Yale, and Stanford medical schools are
doing "that you are not doing."
DR. LUPER replied that the Johns Hopkins, Yale, and Stanford
students are doing specialty rotations such as oncology,
neurology, or nephrology, while naturopathic physicians in
training are learning naturopathic modalities such as homeopathy
and hydrotherapy. The basic knowledge - what it takes to become
a doctor, how to listen to people, how to run lab tests, and how
to do a differential diagnosis - is similar for both groups. He
informed the committee, "The therapeutics are where the
differences begin to multiply."
Number 1145
REPRESENTATIVE GATTO asked for clarification with regard to
residency requirements.
DR. LUPER replied that there was no requirement to do residency
for naturopathic physicians. He further explained that the
profession experiences a scarcity of residency placements. He
gave the example of a residency program that he directed at
Southwest College. He had three residency positions and eleven
well-qualified applicants. A further difference between the
naturopathic profession and the allopathic profession is that
the federal government subsidizes residencies so that each and
every allopathic physician has the ability to get a residency.
Number 1199
REPRESENTATIVE GATTO gave an example of someone suffering from
cancer. He asked whether [naturopathic physicians] will say
something is out of their league if that's the case.
DR. LUPER replied that many of his patients have cancer and come
to him looking for alternatives; he is trained to let them know
the best treatment for their particular problem. For example,
the treatment for testicular cancer is actually quite good, with
a success rate higher than 85 percent; thus he'll tell such a
patient, "The best treatment available for you is to go and get
chemotherapy." For pancreatic cancer, though, the effectiveness
of chemotherapy is less than 2 percent. He explained:
I know of a treatment where the average lifespan
increases from two months to nineteen months. So I
let him know, "There's an alternative for you.
There's a ... program ... that's been put together by
a doctor in New York City by the name of Gonzales.
Here's his results from the published research. This
is what it takes to do this. Frankly, I think this is
a good option for you."
DR. LUPER added that he never tells his patients what to do, but
instead tells them what he knows. He pointed out that some
people do "wacky things" in any profession. In his role as a
teacher, he noted, he trained naturopathic doctors to know the
boundaries of their expertise. He felt that experience played
an important role in confidence building and that many
naturopathic doctors go on to become experts in a particular
field such as cancer.
Number 1255
REPRESENTATIVE GATTO asked what Dr. Luper thought of PC SPES [a
dietary supplement marketed for "prostate health"].
DR. LUPER replied:
PC SPES is a substance that was touted to treat
[prostate] cancer, and the results of the initial
research looked quite good. I was suspicious of it
... and did not use it with any patients. It turns
out that PC SPES was adulterated with a hormone, and
that's why it worked. Once that came out, it was
like, forget it. If we wanted to use hormones, we'd
refer for hormone treatment.
There are things in the world which are new and
unproven. And, frankly, I stay away from those. ...
I'm willing to look at new things as long as there's a
reasonable approach and some research behind it.
Number 1525
CHAIR ANDERSON read from a letter submitted to the committee by
Alex Malter, M.D., president of the Alaska State Medical
Association, which read in part [original punctuation provided]:
The Alaska State Medical Association (ASMA) represents
physicians statewide and is primarily concerned that
Alaskans receive high quality healthcare.
The Association urges you and your committee to not
support HB 434. The expansions of the scope of
practice for naturopaths through the bill would not
enhance patient care nor would it improve access to
care.
Medical treatments fall into three broad categories:
1) Those that have been proven to work; 2) Those that
have been proven not to work; and 3) Those that have
not yet been adequately studied to know whether or not
they work. Unfortunately, naturopathic treatments
often fall into the third category, being based on
anecdote as opposed to scientific proof.
Training for naturopaths is significantly less
rigorous than that for physicians, in both length and
depth of study. Its emphasis on natural healing does
not allow adequate opportunity for its students to
fully learn the accepted pathology, physiology, and
pharmacology necessary to safely treat most medical
conditions. Yet HB 434 would allow naturopaths to
practice many aspects of medicine heretofore (and
appropriately) limited to physicians and those other
with training based in proven medical science. This
could be unsafe for Alaskan patients.
Additionally, expanding the scope of practice for the
35 naturopaths in Alaska will not realistically
improve access to care in the state. Indeed, few
naturopaths practice in those rural areas in which
access issues are most critical.
Finally, anyone not licensed as a physician but
seeking to practice in any like manner should be
legally held to the same standard of care as a
licensed physician. ASMA suggests that if HB 434 is
enacted, it should first be amended to keep existing
law pertaining to naturopaths in place (AS 08.45.010 -
200), and a subsection should be added to hold
naturopaths to the same standard of care as licensed
physicians in their treatment of any patient.
CHAIR ANDERSON asked Dr. Luper to respond to this letter,
particularly in the area of standards.
Number 1648
DR. LUPER replied that, to the best of his ability, he'd
presented the committee with information about the extent of a
naturopathic physician's education. He acknowledged that not
all naturopathic students get residencies, but they are all
trained as primary care providers; they sit for national board
exams, and this indicates a certain level of safety, he
suggested. The national board exams include minor surgery and
pharmacology. He commented, "You go to school, you learn how to
do it, you take a test, then you go do it. That's ... the
system. That's how it works."
DR. LUPER took issue with Dr. Malter's assertion that this bill
would not have a large impact on healthcare in Alaska. He sees
approximately 30 patients a week, 1,500 visits annually. He
estimated there are about 20 practicing naturopathic doctors in
Alaska and, as a result, many people's health is affected. He
said his patients would certainly argue that what he does is
significant. He said he felt that even if naturopathic doctors
helped only a handful of patients improve their health because
of this bill, then it would be worthwhile. He explained, "We're
asking ... to be able to practice up to the level of our
education, to be able to practice up to the level of our
training, so that we can provide the best quality care we can
for our patients."
CHAIR ANDERSON noted, from his discussions with several
physicians, that there is fear that this legislation could
result in someone getting hurt. Referring to Section 13,
page 6, paragraph (6), where minor surgery is defined, he said
concerns he'd heard included lack of justification to perform
this type of procedure without proper medical training and
whether [naturopathic physicians] are prepared to deal with
problems that may arise from anesthetics when performing minor
surgery.
DR. LUPER responded that naturopathic physicians are well
trained in this area, since they are trained in the use of
sterile technique and local anesthetics, and they have "crash
carts" available in case of serious drug reactions or heart
problems.
Number 1883
CHAIR ANDERSON noted that Section 15, on the last page of the
bill, repeals AS 08.45.040, pertaining to required disclosures
to a patient. He asked why this should be repealed.
DR. LUPER clarified that that section refers to a disclosure,
that "we have to say we are not physicians."
REPRESENTATIVE ROKEBERG asked Dr. Luper if he could get
malpractice insurance and currently has to disclose to patients
that he has malpractice insurance. He also asked if medical
doctors have to disclose to patients that they have medical
malpractice insurance.
DR. LUPER replied that he has insurance and has to, at this
point, disclose this fact to his patients. He didn't know if
this was the case for allopathic doctors.
Number 1977
REPRESENTATIVE LYNN asked if naturopathic physicians are
admitted to practice in any hospital in Alaska or any of the
other 49 states.
DR. LUPER replied that they don't have admitting privileges,
although in the past they did. He explained:
The profession almost died out in the '50s, and it's
experienced a resurgence, ... starting in the '70s.
... Fully one-third of the profession ... is in
school, learning to be naturopathic physicians. We've
had ... a net gain of eight doctors in the state in
the last three years. So, in time, we will achieve
these goals of ... having hospital privileges. In a
way, we are at the position where D.O.s [doctors of
osteopathy] were back in the '50s and '60s.
Number 2050
REPRESENTATIVE ROKEBERG asked for clarification on the minor-
surgery examination that naturopathic doctors take.
DR. LUPER responded that it is a national board, multiple-choice
exam. He gave some background information:
As part of the program, naturopathic ... students have
to take a course of study in minor surgery to learn
the technique. Then, when they're in the clinic, they
have to perform the procedures on a specialty minor-
surgery shift where they observe first, and then do
with assistance, and then do on their own. Now, to my
surprise, I found that I had a talent for this and I
liked it. ... Let me remind you, ... every state that
licenses naturopathic physicians allows minor surgery,
except Alaska.
Number 2123
REPRESENTATIVE GATTO requested Dr. Luper's comments on the
practice of prescribing naturopathic medications and selling
them in the same office.
DR. LUPER replied that many of his patients need specialty
nutrients that are not sold locally. He orders them, prescribes
them, and sells these nutrients. But if there is another local
source, his patients will often use them. He gave an example.
CHAIR ANDERSON asked if Dr. Luper ever bought these nutrients in
bulk to sell to his patients.
DR. LUPER replied that, yes, he does this in order to save his
patients money.
Number 2198
CLYDE B. JENSEN, Ph.D., Oregon Health and Science University,
testified in support of HB 434 and offered a comparison of
naturopathic physicians with allopathic and osteopathic
physicians. He provided some background qualifications, noting
that he'd held senior positions in osteopathic, allopathic, and
naturopathic medical schools. He said he became the president
of the National College of Naturopathic Medicine in 1996 and
served in this capacity for five years.
DR. JENSEN said he learned several valuable things while
teaching and performing administrative responsibilities at the
nation's oldest naturopathic medical school. He said the
criteria for admission into each of the three types of medical
colleges are virtually identical. He found that the people who
applied to naturopathic medical school had very strong feelings
about the type of care the naturopathic physician can provide.
They would have succeeded in conventional medical schools but
chose naturopathy because it is a less invasive, more preventive
type of medical practice. He reiterated that the admissions
criteria is credible and almost identical to those of
conventional medical schools.
Number 2307
DR. JENSEN stated his second point, that the basic biomedical
sciences are taught at generally the same level of intensity and
order of magnitude, with the same number of hours of instruction
and so forth in each of the three types of medical disciplines.
He said he was surprised to find that basic pharmacology is
taught in the same way and at the same level as at conventional
M.D. medical schools, where the reliance on drugs is greater
than in the naturopathic profession.
DR. JENSEN said he has learned that naturopathic physicians have
some advantages in their training over what allopathic and
osteopathic physicians have in areas of nutrition, physical
medicine, and, at least in the case of allopathic physicians,
herbal medicine and homeopathic medicine. He said he feels
these areas of knowledge are effective and useful, and they give
naturopathic physicians training in the area of preventive
medicine and chronic health care that is, in many ways, superior
to that which conventional health care providers receive.
TAPE 04-14, SIDE B
Number 2362
DR. JENSEN said instructors of naturopathic physicians realize
it is imperative for students to know how and when to refer
their patients; he was pleased to see that the curricula of
naturopathic medical schools emphasize the responsibility of
naturopathic physicians to refer cases that fall beyond their
scope of practice.
DR. JENSEN listed the advantages of a conventional allopathic
and osteopathic medical education, including more training in
in-patient facilities where the student has the benefit of
seeing the broad scope of pathology. He said conventional
medical students receive more and better training in the area of
pharmacotherapeutics because the teaching physicians use more of
them. Because those medical students see more drugs used, they
have an advantage in knowing how to use those pharmaceutical
drugs.
Dr. JENSEN mentioned that graduate medical education is not as
well developed among naturopathic medical education; residencies
and fellowships are typically paid for through federal
entitlement programs in conventional medicine, and naturopathic
physicians do not have access to entitlement programs. Without
that federal reimbursement, naturopathic educational programs
cannot afford to provide the level of graduate medical education
that conventional medical schools provide.
Number 2189
CHAIR ANDERSON said he didn't believe opposition to this bill on
the part of conventional physicians that he had spoken with was
based on competition. He asked Dr. Jensen why there was such
opposition to this bill from medical doctors.
DR. JENSEN replied:
I certainly came from mainstream medical education
into a naturopathic medical school, knowing very
little about naturopathic medical education and,
frankly, being somewhat skeptical of what I was going
to encounter there. My guess is that the majority of
conventional health care providers have that same
skepticism because they have had little experience
with the naturopathic profession and are not aware of
the intensity and scope of training, ... [and] don't
know enough about the profession to know how to
interact with it.
Number 2110
REPRESENTATIVE GATTO asked whether Dr. Luper would prescribe
that his patients take one-a-day vitamins and that those
vitamins are ones he sells.
DR. LUPER replied that he wants his patients to get what they
need, and he went on to discuss the effects of vitamins. He
agreed that there could be a conflict of interest if the
physician was unscrupulous.
REPRESENTATIVE LYNN noted that when he was young, medical
doctors sold medicine out of their offices; even today, doctors
pass out samples.
REPRESENTATIVE GATTO talked about a naturopathic physician's
prescribing a medicine that was harmful to him. He ascribed his
active interest in patients and their care to his background as
a paramedic.
DR. LUPER remarked that all physicians make mistakes.
Number 1926
REPRESENTATIVE GUTTENBERG referred to Dr. Malter's letter and
the statement therein, saying naturopathic treatments fall into
the category of "not being adequately studied." He asked Dr.
Luper to respond to that statement.
DR. LUPER disagreed, citing his experience with reviewing
research. He said he is a well-trained physician and uses his
knowledge and experience to help patients. He said he depends
on the knowledge and experience of other medical people, as
reported in the literature.
CHAIR ANDERSON gave an example of a conventional prescription of
medication for hair loss that he believes is narrow and
absolute.
DR. LUPER contended that there are alternatives to remedies that
are approved by the FDA [Federal Drug Administration].
Number 1813
REPRESENTATIVE CRAWFORD told of his 17-year experience with
chronic hives that was not cured by conventional medicine. He
said he'd met a naturopathic physician who was able to diagnose
and cure him. He offered his belief that many remedies aren't
studied because there is no profit motive to do so.
REPRESENTATIVE LYNN noted that many over-the-counter medications
have a warning that they haven't been tested. He wondered why
they had not been tested.
DR. LUPER replied that he thought most had been tested and that
FDA approval costs hundreds of thousands of dollars. He said he
thinks many medicines are not FDA-approved because there isn't a
large enough market for them.
Number 1565
DANIEL YOUNG, N.D., Eagle River, testified in support of HB 434,
noting that he had been practicing in Alaska since 1995 in a
practice he shares with his wife, also a naturopathic physician.
He provided his educational and professional background. He
said his first love is being on the frontline with his patients.
Saying he came to represent his patients, he drew the
committee's attention to their packets, where there was a list
of 700 names, categorized by district, of people who want to be
able to access naturopathic medical health care.
DR. YOUNG mentioned letters being submitted by medical doctors
in Alaska, whom naturopathic physicians work with on a routine
or daily basis and who support this legislation because they
support naturopathic doctors' ability to practice to the full
scope of their training. He noted that naturopathic physician
services are requested by medical doctors in medical clinics,
specifically, Alaska Regional Medical Park. He continued:
The goal of this bill is to bring our scope up to a
level that is representative and commensurate with our
education. It is not about "us and them." It is
about complementary health care. If you're in a car
wreck, break an arm, and come into our office, you're
going right to the orthopedic doctor because that's
where they shine. But if you have arthritis and
you've tried every drug in the world and you still
have arthritis, you might seek me out, and I might be
able to help you a whole lot.
Number 1379
DR. YOUNG surmised that a large amount of money is pent on
alternative medicine, which isn't naturopathic medicine, where
the goal is to teach people to live healthy lifestyles rather
than consume supplements. He related that "doctor" in Latin
means teacher. Naturopathic doctors teach their patients to
make the changes necessary to improve their health. He opined
that research is manipulated and that the natural product
industry has been bought out by the pharmaceutical industry. He
remarked, "They don't care if you're on St. John's wort or
Zoloft, because they're marketing both." In contrast, he
described the naturopathic approach:
We have a hierarchy of therapeutics, and that means we
start at the beginning - nutrition and diet and
exercise, stress reduction. Then we work up to
manipulation or homeopathy or different ways that we
can help the body to heal itself. ... It's different
than going into a medical primary-care situation where
there's a whole cabinet of bright-colored and popular
name brands of pharmacological substances. There's
lots and lots of fluff in that area. ... We can
provide complementary care in Alaska, which is good
for Alaskans, and it's what our patients want.
Number 1124
REPRESENTATIVE GATTO noted that there is criticism about lack of
regulation with regard to natural medicines sold at Wal-Mart and
Costco. He asked if Dr. Young exercises a greater control over
the quality of the medicines he prescribes and also markets what
he prescribes.
DR. YOUNG replied that he obtains medicines from reliable
sources. He acknowledged that often there are different grades
of natural medicines, with associated costs. He said he was
against the purchase of medicines from Wal-Mart because he felt
"those are an exploitation of the tools that we sometimes rely
on in natural medicine." He gave several examples of medicines
that he feels are exploited by big business. He added that he
prescribes substances that he knows will help; has a one-to-one
relationship with his patients; and trusts the people who make
the products he uses. He continued:
I have a very tight rein on the products that I use in
my practice. Those are the tools of our trade. We
have that right in naturopathic medicine. Our
education is part of that component. We are trained
in nutrition. We're Ph.D. levels in nutrition, and we
know about botanical medicines. We're the best
trained on them. When M.D.s learn of our training,
they write us letters of support because they're glad
we do what we do, because they don't have time.
DR. YOUNG went on to describe patients coming in with shopping
bags full of self-selected medications; he described their
confusion and vulnerability to marketing.
Number 0748
NANCY THERRELL, Fairbanks, testified that she supports HB 434
and works at a naturopathic clinic. She spoke of her improved
health and life, and of the importance of having a choice for
patients.
Number 0704
FRANK THERRELL, Fairbanks, testified in support of HB 434. He
provided personal experience with conventional medicine that had
had poor outcomes, and then spoke of being cured of his ailment
by naturopathic medicine.
Number 0635
MARY MINOR, N.D., Anchorage, testified in support of HB 434.
She noted that her background included 20 years of licensure as
a naturopathic physician and practicing since 1990 in Anchorage.
She said patients she sees are in four categories. Probably the
most common is already seeing both a conventional provider and
her. For the second, she is the primary care provider; if
another level of expertise is needed, she refers them to other
kinds of providers. Third is a person who, like Mr. Farrell, is
suspicious of conventional medicine and doesn't want to see
another conventional provider. She remarked, "I can't explain
to you why a person with diabetes will accept a prescription
from me, but that same prescription, from a conventional
provider, they're suspicious of." Noting that the fourth
category contains people already on multiple prescriptions, some
of which may be interacting in a way that isn't helping their
quality of life, she said:
I need the flexibility to help them wean down to the
least amount that is going to be conducive to a good
quality of care. With the web of providers that I
have in my community that I refer to, and who also
send patients my way, I think I'm in a good position
to manage that situation. That's why I think although
our licensing law was good for its day, 17 years ago,
it's now time that we need to expand it.
Number 0366
CHAIR ANDERSON assigned HB 434 to a subcommittee consisting of
Representative Gatto, chair; Representative Crawford; and
Representative Dahlstrom. He requested that the bill return to
the committee by February 25, 2004. He asked subcommittee
members to look at a compromise with the Alaska State Medical
Association; review Section 13, [paragraph] (6), on minor
surgery; review Section 15 to see if that complete repealing is
necessary; and determine whether current or proposed revisions
relating to the sale of medication from these naturopathic
offices are grounded in a question of ethics or potential fraud.
[HB 434 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:50 p.m.
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