Legislature(2023 - 2024)DAVIS 106
03/25/2023 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 115 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 25, 2023
3:02 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative Dan Saddler
Representative Jesse Sumner (via teleconference)
MEMBERS ABSENT
Representative CJ McCormick
Representative Zack Fields
Representative Genevieve Mina
COMMITTEE CALENDAR
HOUSE BILL NO. 115
"An Act relating to the practice of naturopathy; establishing
the Naturopathy Advisory Board; relating to the licensure of
naturopaths; relating to disciplinary sanctions for naturopaths;
relating to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 115
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE
SPONSOR(s): REPRESENTATIVE(s) PRAX
03/17/23 (H) READ THE FIRST TIME - REFERRALS
03/17/23 (H) HSS, JUD, L&C
03/25/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
RILEY NYE, Staff
Representative Mike Prax
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Prax, prime
sponsor, gave a PowerPoint on HB 115.
NATALIE WIGGINS, ND
Vitae Integrative Medical Center
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on HB 115.
CARRIE BALDWIN-SAYRE, ND, Director of Development
National University of Natural Medicine
Portland, Oregon
POSITION STATEMENT: Provided invited testimony on HB 115.
CLYDE JENSEN, PhD, MS, Pharmacologist
College of Osteopathic Medicine
Rocky Vista University
Ivins, Utah
POSITION STATEMENT: Provided invited testimony on HB 115.
ROB DOWNEY, MD
Seaworthy Functional Medicine
South Peninsula Hospital
Homer, Alaska
POSITION STATEMENT: Provided invited testimony on HB 115.
SCOTT LUPER, ND
Alaska Association of Naturopathic Doctors
Fairbanks, Alaska
POSITION STATEMENT: Provided invited testimony on HB 115.
GLENN SAVIERS, Deputy Director
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
115.
ACTION NARRATIVE
3:02:03 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at 3:02 p.m. Representatives
Ruffridge, Saddler, Sumner, and Prax were present at the call to
order.
HB 115-NATUROPATHS: LICENSING; PRACTICE
3:03:11 PM
CHAIR PRAX announced that the only order of business would be
HOUSE BILL NO. 115, "An Act relating to the practice of
naturopathy; establishing the Naturopathy Advisory Board;
relating to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to the
Department of Commerce, Community, and Economic Development; and
providing for an effective date."
3:03:38 PM
CHAIR PRAX passed the gavel to Vice Chair Ruffridge.
3:04:34 PM
The committee took two consecutive at-eases from 3:04 p.m. to
3:08 p.m. [to address technical difficulties].
3:08:47 PM
CHAIR PRAX stated that HB 115 would clarify statutory guidelines
on the practice of naturopathy, allowing these practitioners to
offer a full scope of services to Alaskans. He suggested that
this would help with the increasing shortage of primary care
providers in Alaska. He reported that the proposed bill had
been heard before during previous legislatures, and this had
created a large amount of available documentation.
3:10:40 PM
RILEY NYE, Staff, Representative Mike Prax, Alaska State
Legislature, on behalf of Representative Prax, prime sponsor,
gave a PowerPoint on HB 115 [hard copy included in the committee
packet]. He began on slide 2 and explained that naturopathic
doctors (NDs) are primary care providers who hold a four-year
post graduate medical degree. He explained that NDs practice
evidence-based primary care, prioritizing disease prevention by
discovering the root causes of illness, with treatment focusing
on lifestyle modifications, nutrition, and low-risk
intervention. He continued to slide 3 and discussed the
educational requirements to become an ND, which includes four
years in a medical school program accredited by the Council of
Naturopathic Medical Education. To become licensed to practice
they must pass the two-part Naturopathic Physicians Licensing
Examination. He moved to slide 4, which outlined who would not
be considered an ND.
3:13:57 PM
MR. NYE continued to slide 5, which displayed a map of states
that have licensing for NDs, of which Alaska does. He moved to
slide 6 to explain a subsequent map, showing the states that
also allow NDs prescriptive authority. On the map on slide 7,
he described which states allowed NDs prescriptive authority for
controlled substances.
3:16:01 PM
MR. NYE continued to slide 8, describing that HB 115 would
modernize statutes for NDs and clean up outdated language. He
continued that it would allow the same public health duties for
NDs as other medical providers have, and it would update the
scope of practice to include limited prescriptive authority and
minor office procedures. He suggested that the proposed
legislation would eliminate duplicative office visits for
patients. He explained that duplicative office visits were
common for patients because NDs could diagnose a medical issue,
but they are not able to prescribe medication for the issue. He
gave an example of a patient having to schedule an additional
appointment with a medical doctor (MD) for an antibiotic. He
added that it would also create improved access to care by
giving more health care choices.
3:17:27 PM
MR. NYE paraphrased the first two sections of the sectional
analysis for HB 115 [copy included in the committee packet],
which read as follows [original punctuation provided]:
Section 1 Amends AS 08.02.010(a) Professional
designation requirements t
Requires naturopathic doctors to use appropriate
letters, titles, and specialist designations in all
forms of communication.
Section 2 Amends AS 08.45 to add a new section:
AS 08.45.015 Naturopathy Advisory Board
Establishes a five-person Naturopathy Advisory
Board for the purpose of making recommendations
on adoption of regulations and other matters
relating to the functions of the department under
AS 08.45. The Board consists of:
Two naturopathic doctors (ND)
One licensed pharmacist
One doctor of medicine (MD) or one doctor of
osteopathy (DO), and
One public member.
3:18:24 PM
REPRESENTATIVE SADDLER pointed out that because of the density
of the sectional analysis, time would be saved if committee
members read the analysis on their own.
CHAIR PRAX concurred.
VICE CHAIR RUFFRIDGE sought consensus from committee members to
skip the sectional analysis. Seeing no objection, he moved to
invited testimony.
3:19:55 PM
NATALIE WIGGINS, ND, Vitae Integrative Medical Center, provided
invited testimony on HB 115. She expressed the opinion that HB
115 would be in the best interest of Alaska residents because of
the state's health care shortage. She reported that Alaska has
the highest cost of medical care in the country, a statistic
that she contributed to the low number of medical providers.
She asserted that NDs are available and ready to help fill this
need. The proposed legislation would allow this by updating
NDs' scope of practice to reflect their training. She stated
that safety concerns were the main reason NDs have not been
granted full practicing capabilities, and she opined that this
was because of the misunderstanding about training. She
expressed agreement that patient safety is a key priority;
however, she reiterated that all licensed NDs must have a four-
year bachelor's degree, pre-med courses, and a four-year
doctoral medical degree from an accredited naturopathic medicine
program. She listed several of the required aspects of
training for NDs, including prescriptive management and many
hours of clinical training. She reported that this was
commensurate to the training received by nurse practitioners
(NPs) and physicians' assistants (PAs), who have been granted a
broader scope of practice.
DR. WIGGINS continued that the proposed legislation would give
NDs the same scope to what has been safely practiced in other
states. She pointed out her experience as an ND in Arizona,
arguing that she was able to take better care of patients there
because of her ability to safely prescribe medications instead
of referring patients for prescriptions. She asserted that NDs
are trained to give sutures, prescribe medication, administer
vaccines, and utilize many other tools necessary for primary
care. She described a hypothetical situation where a family's
child had an acute urinary tract infection, and they visited an
ND. In the current system, she explained that the ND would have
to refer the family to an additional appointment with a PA so
the child could receive an antibiotic. Emphasizing the
importance of the patient-practitioner relationship, she stated
that now patients of NDs are forced to have an unfamiliar
physician manage their medication. She also explained that
getting an appointment with another provider is often difficult,
with patients either waiting or going to an urgent care or
emergency facility to receive the prescription. She argued that
these duplicative appointments pose an increased financial
burden to patients, along with more time missed from work. She
expressed the understanding that emergency departments in Alaska
are overwhelmed with primary care needs. She pointed out that
NDs are ready and equipped to address these needs. She
reiterated that being unable to practice medicine to the full
extent of her training and abilities is a disservice to
Alaskans, as there are close to 50 licensed NDs in the state.
She argued that supporting HB 115 would be a step toward solving
Alaska's problems with access to care and the rising health care
costs.
3:25:53 PM
REPRESENTATIVE SADDLER asked whether naturopathic health care
was generally more or less expensive than other forms of care.
DR. WIGGINS replied that most NDs take insurance, so the cost
would be similar; however, she reiterated that HB 115 would
supply a savings in eliminating the need for duplicative
appointments.
3:26:35 PM
VICE CHAIR RUFFRIDGE referred to Dr. Wiggins describing herself
as a "physician." He questioned the restriction in the proposed
legislation of NDs' ability to use "physician" in their title.
DR. WIGGINS clarified that when she called herself a physician,
this was in direct reference to her practice in Arizona, where
NDs are called physicians. She reported that the language
difference is unique to Alaska, and she posited that this usage
restriction has been "funneled down" from MDs in the state who
believe the term should only be applied to primary care
providers who are MDs.
3:28:02 PM
REPRESENTATIVE SADDLER stated that he has repeatedly heard the
similarity of naturopathy to other medical models. He
questioned what makes naturopathy different.
DR. WIGGINS explained that the main differences are that
naturopathic medicine focuses on preventative care, which
involves long conversations with patients to discover and treat
the root cause of disease. She observed that conventional
models use faster visits, with care focused on symptom
suppression. She allowed that those types of visits would
address urgent medical needs quickly.
REPRESENTATIVE SADDLER shared his understanding that there was
not an essential difference in terms of the disease paradigm
between naturopathy and conventional medicine. He sought the
confirmation that NDs are focused on addressing the cause of
illness rather than the symptoms.
DR. WIGGINS confirmed this understanding.
3:29:46 PM
DR. WIGGINS, in response to a question from Vice Chair
Ruffridge, stated that the other focus of NDs is addressing the
root cause of a patient's symptoms instead of simply managing
the symptoms.
VICE CHAIR RUFFRIDGE expressed the belief that the difference
described could be applied to all medical providers. He
discussed that a main difference between a physician and a
medical practitioner, like a pharmacist, is that physicians have
the ability to provide diagnoses, while a pharmacist does not.
He asked whether NDs diagnose their patients.
DR. WIGGINS confirmed that as primary care providers, it is a
necessary part of an ND's practice to diagnose.
VICE CHAIR RUFFRIDGE suggested that a NP would also work to find
the underlying cause for a patient's illness, spending time on
preventative care as well. He questioned the functional
difference between an ND and a conventional medical provider,
such as a NP.
DR. WIGGINS replied that a large part of this comes down to time
spent with patients, and she shared her experience working in
Arizona with an MD who would only see a patient for up to 15
minutes at a time; therefore, this approach is focused on how to
treat the symptoms. She reported that spending more time with
patients allows symptoms to be filtered through to get to the
underlying cause. She expressed agreement that the goal for all
medical providers would be to get to the root cause of symptoms;
however, the key difference is the approach to treatment. She
reiterated that NDs would use a prevention model, focusing on
lifestyle management, such as stress, nutrition, and sleep. She
acknowledged that the prevention model is utilized in
conventional medicine as well; however, she argued that NDs use
this to a much greater extent. She added that in search for the
least invasive and most effective treatment, NDs are trained to
work with botanical medicine. She explained that in some cases
of acute illness, herbal remedies would be the least invasive
and most effective, but for others it would be an antibiotic [or
other conventional medicine].
3:34:14 PM
VICE CHAIR RUFFRIDGE clarified his understanding that although
NDs focus on alternative and botanical treatments, the process
for identifying needs would be similar to other medical
professionals who use many of the same tools, such as testing
and physical assessment.
DR. WIGGINS concurred. She added that she did not mean to
insinuate that NDs "did better" than MDs. She expressed the
opinion that NDs would hold all forms of health care
practitioners in high regard.
3:35:57 PM
REPRESENTATIVE SADDLER asked why patients would choose
naturopaths over MDs for primary care.
DR. WIGGINS replied that patient preference and choice is a
major factor because some patients have concerns about side
effects from conventional medication, and they turn to
naturopathy in search of treatments that would not have the same
risk profile.
REPRESENTATIVE SADDLER clarified that some patients may have a
predisposition on their health care when they choose an ND.
DR. WIGGINS responded in the affirmative.
3:37:09 PM
VICE CHAIR RUFFRIDGE suggested that most alternative therapies
were not prescriptive in nature and already readily available to
NDs. He asked why NDs would want access to prescribe other
drugs if the goal of using naturopathic care is to avoid
"harsher substances" that require a prescription.
DR. WIGGINS responded that, depending on the patient and his/her
illness, it comes down to what treatment would be the least
invasive and most effective. She added that there are times
when treatment needs to be prescriptive. She gave the example
of a patient with hypertension significant enough that it needed
to be addressed immediately, as the condition had not responded
to botanical treatments. She suggested that there is a time and
place for everything, and NDs are trained in prescriptive
medicines for when this time and place arises.
VICE CHAIR RUFFRIDGE requested an explanation on an ND's first,
second, and third option concerning the hypertension example.
DR. WIGGINS emphasized that the naturopathic approach is very
dependent on treating each patient as unique; therefore, there
would be no "one-size fits all" treatment. She stated that
understanding a patient's lifestyle choices, along with stress
levels, sleep issues, and other components of a healthy life,
are all a large part of the treatment plan. She said that if
the hypertension was of a lower grade, the use of botanicals
like hawthorn berry could be beneficial, as well as adding
magnesium and other herbs to the patient's diet. She reiterated
that these would be used in tandem with lifestyle changes, such
as limiting salt intake and increasing hydration. She stated
that the step progression for every patient is unique, and
medications would be prescribed when needed.
3:40:56 PM
VICE CHAIR RUFFRIDGE asked for an example of a pharmaceutical
that would be prescribed for hypertension and whether it would
be used as a third or fourth option. He inquired about the
pharmaceuticals that Dr. Wiggins had personally prescribed for
hypertension.
DR. WIGGINS restated that it would depend on the patient and in
some cases, medication would be the first option. In other
cases, she reported that a patient may want to try other modes
of treatment. Depending on the patient she may prescribe a low
dose of hydrochlorothiazide, lisinopril, or beta blockers.
3:42:24 PM
CARRIE BALDWIN-SAYRE, Naturopathic Doctor, Director of
Development, National University of Natural Medicine, provided
invited testimony on HB 115. She testified about the education
and training NDs would receive. She advised that the training
would be overseen and regulated by national accreditation
organizations. She reported that licensed NDs must attend an
accredited natural medicine school whose accreditation is
overseen by the United States Department of Education. She
stated the institution she is associated with is overseen by two
accreditation organizations: the Council on Naturopathic Medical
Education (CNME) and the Northwest Commission on Colleges and
Universities (NWCCU). She reported that CNME was the program
accreditor that set the standards for curriculum delivery,
performance outcomes, the financial stability of institutions,
student services, and the college board of directors'
functionality. She stated that NWCCU is the regional
institutional accreditor which oversees many other medical
schools in the region, including Oregon's allopathic medical
program and the University of Alaska. She described the
accreditation process as rigorous, and this includes annual
reports and site visits. She stated that naturopathic medicine
programs are four-year, in-person, graduate training programs,
which require thousands of hours of education and over 1,200
hours of direct clinical exposure. She reported that this is
comparable to the educational requirements and standards of
competency for other medical providers and programs.
DR. BALDWIN-SAYRE listed other similarities between naturopathic
medicine programs and other medical programs, including nearly
identical pre-requisites for admission and a two-year foundation
in human biology. She added that during the first two years of
the ND programs, students would go through the extensive study
of diagnostic measures and procedures. At the end of the second
year, she reported that students would be tested with the
Biomedical Science National Board exam. She described the
second two years of the ND program as focusing on transferring
scientific knowledge to the clinical setting. This is done
through courses on cardiology, gynecology, disease management
and prevention, nutrition, life-style counseling, botanical
medication and pharmaceutical prescribing, and minor surgical
procedures. She reported that NUNM graduates complete nearly
1,300 hours of clinical training, with the requirement of
passing 3 clinical exams. This would include a full year
serving their own patient load in a primary care medical home,
treating patients with complex medical needs. She added that
after graduation, potential NDs must past two national board
examinations to qualify for licensure. She described licensed
graduates of an accredited program as effective medical
providers with the ability to assess and meet primary care needs
of patients. She opined that allowing NDs to have prescriptive
authority for nonscheduled medication and to administer minor
in-office procedures would be low-risk and well within the
confines of training. She stated that the benefits would
include a reduction in the cost to the patient by eliminating
duplicate visits and reducing the risk of more severe illnesses
while the patients wait for a second appointment with an MD.
She reiterated that in many other states, including Oregon, NDs
had provided these services safely for decades.
3:49:09 PM
VICE CHAIR RUFFRIDGE noted the significant effort and energy
that people put into becoming an ND. He questioned why so many
states do not allow NDs prescription authority.
DR. BALDWIN-SAYRE opined that in many states powerful medical
lobbyists are concerned about the competition NDs might pose.
Also, she reported that there are some states with large
populations of people practicing naturopathy who have not gone
through an accredited program. She expressed the opinion that
these people are used to practicing in an unregulated manner;
therefore, this creates "a loud voice" [in opposition to
instating licensure for NDs]. She said that she has seen
instances where insurance companies would rather not pay for
services from NDs. She described all this as examples of
barriers.
VICE CHAIR RUFFRIDGE shared his awareness of the complex
relationship between MDs and NDs. He questioned whether any
states have a collaborative-practice arrangement that would
allow NDs a limited scope of prescriptive authority.
DR. BALDWIN-SAYRE asked Vice Chair Ruffridge to clarify whether
he is asking about a situation where a naturopathic practitioner
could prescribe under the supervision of an MD.
VICE CHAIR RUFFRIDGE clarified his question with a hypothetical
of an ND with limited need for prescribing pharmaceutical
medications, and this practitioner entered into a collaborative
agreement with an MD to give written authorization for the ND to
prescribe specific drugs, such as antibiotics. He asked whether
this practice exists in any states.
DR. BALDWIN-SAYRE expressed uncertainty concerning this specific
model. She added that she is familiar with NDs and MDs working
together in integrated medical practices.
3:52:41 PM
REPRESENTATIVE SADDLER asked how insurance companies generally
categorize or "deal with" naturopathic care.
DR. BALDWIN-SAYRE replied that there are different models in
use. She reported that Oregon has passed legislation which
allows NDs to decide how they want to be categorized by
insurance companies, and they can choose to be identified as
either a primary care or a specialty care physician. She stated
that this model allows patients to see naturopaths as options
for primary care within their network. In response to a follow-
up question, she stated that those who chose to be classified as
a primary care physician would be covered by health insurance
companies; however, this would only apply if the ND chose to be
in the network. She said that if the ND chooses to operate a
cash-only model, then they would be able to also choose how they
categorize themselves.
REPRESENTATIVE SADDLER asked for a more general view of how
insurance for NDs works across the country.
DR. BALDWIN-SAYRE said that Medicaid in several states cover
NDs, but she expressed uncertainty concerning insurance
policies.
3:55:31 PM
REPRESENTATIVE SADDLER asked the sponsor of the bill whether
there would be an expert on national insurance coverage present
in future hearings.
CHAIR PRAX responded that this has not been scheduled, but he
could investigate it.
3:56:20 PM
CLYDE JENSEN, PhD, MS, Pharmacologist, Rocky Vista University,
provided invited testimony on HB 115. He gave an overview of
his professional background. He expressed interest in helping
NDs and other medical professions practice to the full extent of
their training. He opined that widening the scope of practice
would be an economical and responsible decision. He shared the
belief that the training in pharmacology that NDs receive is
sufficient to prescribe most, if not all, prescription drugs
available to other mid-level practitioners. As a pharmacology
professor, he reported that the quantity, intensity, and
scientific accuracy of the pharmacology training an ND would
receive is the same as an MD and a Doctor of Osteopathic
Medicine (DOs) would receive. He stated that NDs would receive
the same content in his lectures as all types of medical
students. He reported that all healthcare professional
education programs have two components: preclinical lectures and
clinical practice. He stated that in clinical practice MDs and
DOs learn through hands-on experience in hospitals, out-patient
clinics, and other care settings. During those clinical years,
he asserted that students learn how to prescribe and administer
many different kinds of drugs; however, he added that the
naturopathic clinical experience focuses on prevention and less
invasive medication. He opined that embracing preventative
measures and less invasive treatments is advantageous for NDs,
as they would likely follow their training and try alternative
forms of medication, such as herbal remedies, which are less
dangerous and costly than pharmaceuticals. He reminded the
committee that he is not an ND but an advocate for all health
care professionals to be able to practice in their scope. He
expressed the belief that this would be in the best interest of
patients, providers, and taxpayers.
4:02:20 PM
REPRESENTATIVE SADDLER suggested that naturopathic practitioners
could be biased towards a certain style of medication. He asked
whether most NDs would see prescribing "western" medication as a
competitive model.
DR. JENSEN expressed the belief that naturopathic medicine
exists on a continuum, as NDs enter the profession with the
intent of practicing the best medicine possible, but with a
preference for the use of noninvasive and preventative medicine.
However, he asserted that any medical provider, including NDs,
would utilize other forms of medicine when it is in the best
interest of the patients.
4:04:29 PM
REPRESENTATIVE SADDLER asked for the definition of the terms
used to describe different medical professions, and he
referenced "faith healers."
DR. JENSEN replied that the categorization of the different
medical professions began at the turn of the 20th century, with
practitioners being grouped into three major groups: MDs, DOs,
and NDs. At that time, he suggested that these professions had
an overlap. As the pharmaceutical market became more advanced,
he posited that the professions have drifted apart in the use of
prescription drugs, with MDs and DOs prescribing more drugs,
while NDs do not. He reported that as the education for NDs
advanced and the variety of drugs available has increased, there
has been the movement towards utilizing the best of both worlds.
He defined PAs as physicians' assistants and NPs as nurse
practitioners. He reported that the NP profession was developed
to broaden the scope of nurses in order to meet the health care
needs of the country's growing population.
4:08:09 PM
VICE CHAIR RUFFRIDGE questioned the safety profiles of
naturopathic options compared to pharmaceuticals.
DR. JENSEN responded that from his personal observation as a
pharmacologist, the nutritional and herbal products used by NDs
are safer in 98 percent of cases; however, he explained that
natural medications could become dangerous when taken in concert
with pharmaceutical drugs. Because of the potential danger in
drug and herb interactions, he reported naturopaths are trained
to avoid these types of unsafe interactions. He advised that
the training for all medicals students on drug-herb
complications have been stepped up over the past 15 years. He
posited that passing HB 115 could help further avoid dangerous
herb or nutrient and drug interactions. He reiterated that
natural remedies are much less toxic on their own than
pharmaceutical drugs.
4:12:14 PM
ROB DOWNEY, MD, Seaworthy Functional Medicine, South Peninsula
Hospital, provided invited testimony on HB 115. He shared that
he is dual certified in family medicine and functional medicine.
He described functional medicine as being a very similar
approach to naturopathic medicine, and he has the unique
opportunity of "living in both worlds." He expressed the belief
that his experience has informed him on the power and safety of
naturopathic medicine. He spoke about his experience with
nontraditional medical practices and gave the example of a
patient with an autoimmune disorder who was not responding to
conventional medication; however, the patient saw drastic
improvement to naturopathic treatments, such as stress
management, a whole food diet, probiotics, and botanical anti-
inflammatories. He reported that he worked in tandem with an ND
for eight years to treat patients together in a model very
similar to the one used by Cancer Treatment Centers of America.
He shared that after moving to Alaska to be the medical director
for the Seldovia Village Tribe Health and Wellness, he met
another ND, Dr. Abby Liang. He noted that the NDs he has worked
with are his "clinical heroes." This is because of their
dynamic and caring approach along with the ability to solve
complex clinical cases he has struggled with, even as a dual-
trained physician.
DR. DOWNEY expressed the opinion that NDs are just as well
trained and are perfectly positioned to meet the critical
primary care deficiency in Alaska. He reiterated that NDs are
trained in pharmacological agents equivalent to MDs. He
expressed the belief that if HB 115 passes, it would not
endanger patients. Based on 17 years of working collaboratively
with NDs, he expressed the anticipation that the rest of the
country would be passing similar legislation, and the public and
legislative reservations about NDs' abilities would go by the
wayside. Addressing the potential concern that NDs may "lose
control" once given prescriptive authority, he stated that NDs,
"by temperament," use medication as a last resort. He
emphasized that NDs have the same clinical judgment as MDs, and
they would know when a situation is an emergency and
pharmaceutical medicine is necessary. He opined that the
theoretical notion that NDs could collaborate with a
practitioner with prescribing authority falls short, as this
would only add a step in the communication chain. He continued
that many studies have shown that the more steps there are, the
worse the outcome. He asserted that allowing licensed NDs to
have prescribing authority would get to the "heart" of Alaska's
primary care shortage by meeting the need with already existing
practitioners.
4:20:41 PM
VICE CHAIR RUFFRIDGE expressed the concern that there is tension
between MDs and NDs. He questioned Dr. Downey's perspective as
a dual trained medical practitioner.
DR. DOWNEY explained that there is heightened intensity about
"doing no harm" within the medical field because people's lives
are at stake. He posited that when this intensity was combined
with the negativity bias, or the inherent need to focus on
threats rather than abundance, NDs and MDs split paths, and the
relationship between the two professions was poisoned. He
shared that in medical school, he observed the consensus that
anyone not trained as an MD would not be as safe in practice as
a primary care physician. He expressed distress that these
feelings remain intact today, especially since NDs have the same
critical decision-making skillset as MDs. He described the
tension between the professions as a historical artifact of
misunderstandings. He asserted that collaborative work and
allowing all physicians to practice to the full scope of their
abilities would be the best path forward.
4:24:26 PM
REPRESENTATIVE SADDLER asked whether there was a tradition of
naturopathy in the rest of the world beyond the United States.
DR. DOWNEY stated that part of the answer encompasses the
previous question about the distinction between naturopathy and
faith healing. He explained that the key difference would be
that the treatments and practices naturopaths use are backed by
clinical studies from scientific journals, and faith healing
lacks this. He reported that nutrition-based, botanical
remedies are used all over the world, but only the best aspects
of these healing traditions are vetted by science and "pass
muster" for the naturopathic practice. He gave the example of
acupuncture, noting that its benefits for arthritis and other
ailments have been well studied, and it has been shown as
effective on both humans and animals. He reiterated that in the
United States, the naturopathic and functional medicine
communities make sure only the "best of the best" of the many
alternative remedies are selected.
REPRESENTATIVE SADDLER referenced that most herbal supplements
are labeled not Federal Drug Administration (FDA) approved, and
he suggested that this leads to the assumption these methods are
not scientifically valid. He questioned whether naturopathic
medicines would be of the same quality as FDA approved
pharmaceuticals.
DR. DOWNEY commented that during his 17 years in the field he
has experienced the public's issues with supplements and the
scientific background of naturopathy. To prove that there is a
scientific basis to naturopathy and supplements, he used the
example of scientific studies showing that turmeric's high level
of curcumin reduces inflammation in the same way as the common
anti-inflammatory pharmaceutical prednisone. He said that
because these supplements were not regulated or approved by the
FDA, naturopaths and functional medicine practitioners rely on
companies to impose standards when creating pharmaceutical grade
medication. He posited that the public has confused the high
quality of supplements that NDs use with the supplements
available at the store, many of which have gone through
nationwide recalls because of contaminated ingredients. He
expressed the belief that this conflation has led to the
negative connotation with the botanical treatments used by NDs
because they are not FDA approved. He explained that the NDs
and functional medicine practitioners source supplements from
companies that utilize third-party testing of products, and this
creates a domain of safe supplements for practitioners to use.
He reiterated that the issues with supplements "on the shelves"
are unfairly associated with the naturopathic practice.
4:30:42 PM
VICE CHAIR RUFFRIDGE commented that he has encountered this
issue often in his profession [as a pharmacist] and added that a
law in the 1990s required nutritional supplements to have a "not
approved by the FDA" label.
4:31:50 PM
SCOTT LUPER, Naturopathic Doctor, Alaska Association of
Naturopathic Doctors, stated that he does not have a prepared
testimony but is available for questions. He gave a brief
professional history, stating that he was a teacher before
becoming a doctor, and he has worked at the Southwest College of
Naturopathic Medicine as the chairman of diagnostics. While he
was at the college, he shared that he oversaw the second year of
education, which he described as "the year you became a doctor"
by learning how to run diagnostics, conduct a physical exam, and
use other common clinical tools. He stated that he moved to
Alaska and continued to teach young doctors through the
residency program. He stated that he would be able to address
the question concerning a collaborative prescribing system
between NDs and MDs, and he could also speak to the naturopathic
approach to treatment of a condition, such as hypertension.
REPRESENTATIVE SADDLER questioned what the current structure of
regulation is for NDs in Alaska.
DR. LUPER replied that NDs are regulated through the Division of
Corporations, Business and Professional Licensing, and the
division accepts applications and investigates any complaints
about an ND through the use of an ad hoc advisory committee. He
reported that complaints are rare, only occurring once every few
years. He noted the efforts by NDs to make the process more
formal through the introduction of an advisory board.
4:36:14 PM
REPRESENTATIVE SADDLER sought to confirm whether it would be an
advisory board or a licensing board.
DR. LUPER confirmed that it would be an advisory board rather
than a regulatory board, and it would be overseen by the
division. He argued that the current system works and is
inexpensive, so rather than "fix something that isn't broken" by
instating a new system with a regulatory board, he opined that a
proposed advisory board would make slight improvements to an
already working system.
4:37:38 PM
VICE CHAIR RUFFRIDGE asked whether a collaborative practice
between MDs and NDs for prescribing authority has occurred in
other states.
DR. LUPER responded that the current law in California requires
an ND to have a collaborative practice with an MD for
prescriptions. However, he stated that there have been issues
putting this policy into practice, with the main problem being
that the collaboration had to be voluntary, and it has been
difficult for NDs to find practitioners who are willing to take
the time out of their busy workloads.
VICE CHAIR RUFFRIDGE commented that he has been interested in
the possibility of a collaborative approach after hearing from
Dr. Downey about the synergy that could be achieved between NPs
and MDs working together and teaching each other.
DR. LUPER stated that naturopathy is in its essence
collaborative, and in order to be a good doctor, especially in
Alaska, knowing when to refer patients is essential. He noted
that not every doctor can be an expert in every area. He gave
an example of a recent patient he treated who was going through
chemotherapy. The patient came to see him to treat many of the
symptoms associated with the chemotherapy. He reported that the
side effects are often hard on the body, and patients often must
stop the chemotherapy to stay alive. He asserted that his
knowledge of herbs and alternative treatments have allowed
patients to stay healthy enough to continue cancer treatments.
He reported that doctors in cancer centers he has worked with
have voiced appreciation of his training because of the overall
success of patients. He expressed the opinion that more people
are alive today because of the combination of care. He
acknowledged that there has been an increase of appreciation for
NDs as the result of collaboration, but he advised that many MDs
will still not work with NDs. He posited that this is because
of ignorance of [exactly what NDs do]. He expressed the belief
that collaboration will grow with time, and the passage of HB
115 would assist this goal by allowing NDs to practice to their
full extent of training, as this in turn would make the teams
stronger.
4:44:28 PM
REPRESENTATIVE SADDLER questioned whether an ND could become
licensed as a PA in order to obtain prescriptive authority.
DR. LUPER expressed uncertainty concerning any practitioners who
have both a PA and ND license, but he acknowledged that it is
possible, as he knows an ND who is also licensed as a NP;
therefore, this person has prescriptive authority. He mentioned
that he had considered becoming dual licensed; however, he was
not able to justify stopping practice for four years to go back
to school, and this is why there is a push from the ND
profession to change the law.
REPRESENTATIVE SADDLER stated that he was unaware there would be
a four-year schooling requirement associated with dual
licensure.
DR. LUPER commented that it would depend on the degree the
practitioner wishes to pursue.
4:46:56 PM
GLENN SAVIERS, Deputy Director, Department of Commerce,
Community, and Economic Development, Division of Corporations,
Business and Professional Licensing stated that she was
available for questions.
4:47:09 PM
REPRESENTATIVE SADDLER inquired how a naturopathy advisory board
would be different in its authority and activities than a
licensing board.
MS. SAVIERS reported that this would be the division's first
advisory board, and it is envisioned as splitting the difference
between having a regulatory board and no board at all. She
stated that it would offer an organized structure for the
division to accept expertise from licensed members while
avoiding the expense of a full regulatory board. She advised
that this would be important for a small pool of licensees, like
naturopaths. She stated that adding a regulatory board would
complicate licensure, while an advisory board would allow the
division to continue implementing the actual licensing process
with the option to confer with experts when an issue arises.
REPRESENTATIVE SADDLER questioned whether advisory boards are
used in other states.
MS. SAVIERS expressed uncertainty and offered to report back to
the committee.
4:49:13 PM
CHAIR PRAX commented that in any complex situation, people often
view stressful issues through a binary. He expressed the
importance of expanding the view on the different ways to do
things. He argued that the point of the bill is to allow people
to do more. He gave a personal anecdote about his experiences
looking at alternate treatment options when his mother had
cancer many years ago. He stated that after trying traditional
radiation therapy, his mother was treated in Mexico with an
experimental treatment, and it worked for her. He opined that
medical treatments should focus on the betterment of an
individual's life rather than "success." He stated that the
proposed bill would allow NDs to provide more services, giving
power back to the consumer.
4:52:32 PM
VICE CHAIR RUFFRIDGE announced HB 115 was held over.
4:52:46 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:52 p.m.