HB 434-NATUROPATHIC MEDICINE Number 1900 CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 434, "An Act relating to the practice of naturopathic medicine; and providing for an effective date." The committee took an at-ease from 5:55 p.m. to 6:01 p.m. Number 1805 REPRESENTATIVE JIM HOLM, Alaska State Legislature, as sponsor of HB 434, presented the bill and answered questions from the members. He told the members that he offered HB 434 to ensure professional safe naturopathic health care for all Alaskans. It will bring an outdated 17-year-old Alaskan statute on the practice of naturopathic medicine up to date and in line with about 14 other states that already have these provisions. It provides quality health care to Alaskans through continuing education, requirements, and improved services in the practice of naturopathic medicine. It addresses the shortages of physicians in Alaska while providing alternative care and reducing health care costs to Alaskans. The bill places a continuing education requirement in statute for naturopathic physicians of Alaska. It specifies that naturopathic physicians may perform minor surgery based upon their education, training, and licensure, he said. Number 1520 DANIEL YOUNG, ND, LAC, AKANP Legislative Task Force, testified in support of HB 434, and answered questions from the members. He provided the following testimony to the committee: [Original text, but some formatting changes were made]   Chair Wilson and Honorable members of the committee. Thank you for allowing me to testify on behalf of HB 434. Thank you for staying later to hear this. HB 434 would allow naturopathic physicians to prescribe substances that they are trained to use and to perform minor surgery. You all know the issues before you. You have a packet with all the comparisons and it is pretty comprehensive packet. We have all met with you all on an individual basis and have plead our case. By now you have heard from naturopathic doctors and patients of naturopathic medicine that are in support of this bill. You have also heard from the medical doctors, doctors of osteopathic medicine, and even the pharmacy board. I don't think that you have heard from patients of allopathic or osteopathic doctors. Unfortunately, I had a nice conversation with Dr. Alex Malter the head of the Alaska State Medical Association in the fall and we had a good discussion. It is too bad he had to leave to care for a patient because I think it would have been helpful to have the two of us here would have been helpful in this issue. With your permission I would like to direct your attention briefly to facts: Fact 1: Education   Naturopathic doctors are trained for general family practice. We are not trained to be specialists and do not work in hospital environments, but in out patient in the trenches. Naturopathic doctors complete 8 years of higher education. Some receive more, but it is a minimum of 8 years. Requirements to enter a naturopathic medical school are almost identical to that of any other medical school. I almost went to an allopathic medical school and was ready to do that. The curriculum of a naturopathic medical school compares with allopathic (MD) and osteopathic (DO) schools, in intensity and comprehensiveness. The clinical studies in naturopathic medical school also compare to allopathic (MD) and osteopathic (DO) schools. Outpatient based clerkships prepare us for how we practice. In your packets you can see charts that compare our education with medical schools. There has also been expert unbiased testimony by Dr. Clyde Jenson in previous committee meetings and with the other body. He has a unique position to comment on the education between these three areas. He has been a president or administrator of allopathic (MD), osteopathic (DO) and (ND) medical schools for long periods of time and is quite versed to attest to the nature of their curriculums. Their first two years are almost identical. That is when you learn your sciences. That is anatomy, physiology, pharmacology, clinical physical diagnosis, and the lab diagnosis, x- ray, radiology, things like that. The second stage is the clinical sciences that are learned in the third and fourth years. At this time naturopathic physicians go through broad based training. They work in manipulation, botanical medicine, nutrition, dietetics, homeopathy, and some pharmalogical therapeutics, though not as extensive as a pharmalogical therapeutics in a hospital situation. As you know medical doctors and doctors of naturopathic medicine work extensively on very rigorous internships where all that is studied is pharmalogical therapeutics and they are the experts of that realm of medicine. Number 1570 We are skilled in the 40 percent of drugs that are coming from a natural substance and there are different generations of that that we are very well versed in the use of that. Fact 2: Licensure Graduates of naturopathic medical schools pass rigorous nationally administered board exams. These exams have been examined by federal institutions that determine the level of education that you would need to pass them. That is for bio-medical general practice of medicine. Fact 3: Federal Regulation Naturopathic medical institutions are recognized by Federal and State Accrediting Bodies as well as by the Council of Naturopathic Medical education. We wish only to be able to practice how they say we are trained to practice. Fact 4: Naturopathic Medicine is Safe No patient complaints in 17 years of practice in Alaska. Naturopathic medicine is safe. I have numbers to show you on a national level in comparison that and we can talk about that. Fact 5: Scientific Basis There is research- see your packet "Naturopathic Collaborative Events" In the packet there is a very nice presentation, Representative Coghill has it. That shows all of the clinical research and all the things that are being done in Naturopathic medicine and complimentary care across the United States. Number 1497 Fact 6: Naturopathic Physician = Primary Care The Journal of American Medical Association or J.A.M.A. in 1998 - there is an article in the packet by Dr. Cooper. They are saying that we are trained as primary care and outpatient based, which means we do not work in the hospitals, but we work seeing patients in our clinics. And that is how our training is and it is adequate for that. Complimentary medicine is the wave of the future; already Alaska's clinics have MD's, DO's and ND's working side by side. It is not as much as in the Lower 48, but it is happening. We have letters of support from medical doctors who work with us, as well as other types of practitioners. We have thousands of signatures from patients in your districts that want access to complete Naturopathic scope of practice. Our current statute is out of date and needs to be updated to reflect the quality of Naturopathic education. Number 1443 These letters of opposition clearly indicate to me that there is a misunderstanding about the level of our education as naturopathic physicians in this state. Often times these letters indicate that it is a licensing issue. We have been licensed for 17 years. All it is expanding our scope to include what should be rightfully ours. For 17 years we have been providing service to 30,000 Alaskans. I'm going to cut this short, and ask you to consider this bill. I appreciate your time and can answer any of your questions at this time. Number 1413 REPRESENTATIVE GATTO asked why the e-mails he has been receiving have expressed concern that the legislature may take away their right to practice naturopathic medicine. He commented that he does not know how that information got into the community, but for the record, he said, there is nothing in this bill that diminishes anything naturopaths are doing. He asked Dr. Young if he would agree with that. DR. YOUNG replied that he would agree with respect to the intent of the bill. There is wording in the bill that has been insulting for 17 years and would like to see that corrected, he said. He told the members that his main concern is patients who want their naturopaths to be able to provide the care that they are trained to provide. For example, natural estrogens, natural progesterone, and natural thyroids are prescription drugs that naturopaths are trained to use, Dr. Young stated. He emphasized that it is not their intent to use schedule 2 drugs; naturopathic physicians do not use those drugs. Naturopaths refer their patients to other providers in cases where there is a need for more specialized treatment. When a patient comes into the office for a pap [smear], and it is found that the patient needs a special estrogen prescription that can be made for her, but the naturopath cannot write the prescription, then that is a problem. The insurance company gets billed twice; there is a waiting list; and a patient's health care is at risk. The same thing applies to patients with diabetes and hypertension, he added. Dr. Young commented that naturopaths are not interested in using anti-psychotic drugs because we are not trained for that. Naturopaths would refer appropriately for treatment outside of our area of training, he commented. Dr. Young pointed out that the current bill does not have the [drug] schedules in it. Number 1301 REPRESENTATIVE GATTO reiterated that everyone who currently sees a naturopath will be able to continue to see his or her naturopaths. If the bill passes there will be additional privileges that will be available to the public. He asked Dr. Young for clarification that schedules were taken out of the bill. DR. YOUNG replied that he understands the [drug] schedules were taken out of the bill in order to get it out of the House Labor and Commerce Standing Committee. He explained that naturopaths did not want schedules [one and] two because they did not want drugs that have a high incidence of physiological and physiological dependence and are hot topics. Drugs that are listed on schedules three, four, and five are far below naturopaths' level of training, he commented. There are only certain drugs within those levels that a naturopath would use anyway. The bill was originally written with the intent that naturopaths would have access to drugs they would use, he said. CHAIR WILSON asked if Representative Holm would point out where the language was removed from the bill. Number 1234 REPRESENTATIVE HOLM referred to CSHB 434(L&C), Section 08.45.120 (4), page 5, line 23, language addressing scheduled drugs was after the following: (4) prescribe and implement barrier devices for contraception; REPRESENTATIVE HOLM commented that in the original version of the bill, the above language was numbered (5) and the language addressing scheduled drugs preceded this language as (4). CHAIR WILSON asked where in the current bill does it authorize naturopaths to prescribe schedule three, four, and five drugs. She said she believes all of that language was removed. REPRESENTATIVE HOLM agreed that all the language authorizing use of scheduled prescription drugs was removed. CHAIR WILSON stated that the only thing that is left in the bill is as follows [page 5, lines 14 through 17]: (1) prescribe or administer for preventive and therapeutic purposes the following: food, extracts of food, vitamins, minerals, enzymes, whole gland substances, botanical medicines, and homeopathic preparations; (2) if authorized under regulations of the department, prescribe or administer legend or prescription drugs, CHAIR WILSON told the members that legend drugs are anti-biotic, drugs for high blood pressure, diabetes, and most medications in general that can be refilled for one year. She asked if someone from the Department of Health and Social Services is available to speak to this part of the bill. Number 1103 REPRESENTATIVE SEATON asked if legend or prescription drugs covers schedule three, four, and five drugs. DR. YOUNG responded that controlled substances represents a relatively small part of what is in a pharmacy. Since 1971 the Controlled Substance Act put prescription drugs into schedules so that there are schedules one, two, three, four, and five. The schedules are based on the physiological and psychological dependence. Five being a relatively minimal dependence compared to one which is only used in research and in governmental research. Examples of schedule one drugs is heroin, LSD, or marijuana. Schedule two drugs are primarily narcotics such as oxycodone. Schedule three, schedule four, and schedule five drugs are other controlled substances as well, but they are of less physiological and psychological dependence. Dr. Young explained that legend drugs is an old term for the legend that use to be on the side of foods which was instituted by the FDA. He clarified that legend drugs are prescription drugs that are not controlled substances. Number 1029 REPRESENTATIVE SEATON asked for further clarification on the term "legend drugs" and asked if it refers to all five scheduled drugs. DR. YOUNG replied no. He told the members that his understanding of this terminology is that this language would not allow naturopaths to provide any legend drugs. However, natural thyroid or anti-biotic could be prescribed. CHAIR WILSON noted that naturopaths would not be allowed to prescribe those drugs unless the department authorizes it. DR. YOUNG agreed with Chair Wilson's statement. REPRESENTATIVE SEATON said he is trying to ascertain whether the department's authorization would include schedule three, four, and five drugs. He asked if legend or prescription drugs are something other than schedules three, four and five drugs. CHAIR WILSON replied that prescription drugs cover any schedule drug. That is a pretty broad category which could include morphine. She commented that she would like to discuss this point with the department. Number 0935 REPRESENTATIVE HOLM clarified that without an FDA license naturopaths cannot prescribe a prescription drug. Number 0905 DR. YOUNG pointed to the original bill and told the members that the language was changed. He read from HB 434, 23-LS1574\D, page 5, lines 16 and 17 as follows: (4) after becoming registered with the federal Drug Enforcement Administration, prescribe a controlled substance; DR. YOUNG commented that this language is no longer in the bill that is before the committee. The original intent was that naturopaths could use prescription drugs, but not controlled substances, he explained. Dr. Young added that there is a misconception that prescription drugs are controlled substances. He summarized that the language was removed from the bill in order to get it out of the House Labor and Commerce Standing Committee. CHAIR WILSON commented that by removing that language and leaving prescription drugs in the bill it allows a doctor to write a prescription for anything. DR. YOUNG clarified that doctors can only write prescriptions for controlled substances if he/she has a Drug Enforcement Administration (DEA) number. Number 0871 CHAIR WILSON stated that a DEA number is required in order to have insurance payment. She questioned how it would be paid. DR. YOUNG said he has never come across that problem because he has always worked in states where he has had a DEA license. CHAIR WILSON responded that whenever completing insurance forms it is necessary to provide the doctor's DEA number. Without that number, insurance will not pay for the prescription. Number 0772 REPRESENTATIVE GATTO pointed to page 5, lines 29 and 30, which reads as follows: (7) use the title of "doctor of naturopathy," "naturopath," "naturopathic physician," or their abbreviations. REPRESENTATIVE GATTO commented that the use of "naturopathic physician" became a contentious point in House Labor and Commerce Standing Committee meeting. The thought there was that the term "physician" means very specific things and it is a guarded term. Representative Gatto said just because someone is a doctor, does not make him/her a physician. He suggested that naturopaths would not want to use the term because it clouds the issue. Number 0683 REPRESENTATIVE HOLM responded that Representative Gatto makes a good point. However, he offered that the term physician in layman terms means healer. There are different methodologies of healing. There are illness such as psychosomatic illness which have no traditional ways of treatment. Those are addressed through a change in attitude, and can improve an individual's health and truly be considered physicians. Representative Holm commented that nurse practitioners are every bit as much a healer as an allopathic physician. He commented that usually when a person refers to a physician it is a reference to someone who has a doctorate degree versus a nurse practitioner. It is just one level up, he said. Representative Holm suggested the members might wonder if the level has risen to the place where naturopaths should be call physicians or true healers. He stated that he believes it does. REPRESENTATIVE GATTO replied that if this bill becomes law then any discipline where healing occurs would merit the term physician. He questioned whether the legislature wants to make the term physician so broad that it cannot be used anymore to identify what is now known as a physician. Currently, this term is reserved for doctors of medicine, Representative Gatto commented. Number 0547 DR. YOUNG agreed that Representative Gatto made some good points. He explained that the term "physic" is actually a Latin term for nature. He pointed out that chiropractors are also called chiropractic physicians. Naturopathic physicians is a term used in licensed states where naturopaths are differentiated from those who have gone through a medical school and have a doctorate in medicine, so they are able to refer to themselves as physicians. He explained that a naturopath can go into any unlicensed state and hang a shingle which says "naturopath," but could not hang out a sign that says medical doctor or physician. This bill would protect that term for those who are practicing naturopathy as physicians. Number 0457 REPRESENTATIVE COGHILL referred to AS 08.02.010, under Miscellaneous Provisions, which says: Sec. 08.02.010. Professional designation requirements. (a) An acupuncturist licensed under AS 08.06, an audiologist or speech-language pathologist licensed under AS 08.11, a person licensed in the state as a chiropractor under AS 08.20, a professional counselor licensed under AS 08.29, a dentist under AS 08.36, a dietitian or nutritionist licensed under AS 08.38, a marital and family therapist licensed under AS 08.63, a medical practitioner or osteopath under AS 08.64, a direct-entry midwife certified under AS 08.65, a registered nurse under AS 08.68, an optometrist under AS 08.72, a licensed pharmacist under AS 08.80, a physical therapist or occupational therapist licensed under AS 08.84, a psychologist under AS 08.86, or a clinical social worker licensed under AS 08.95, shall use as professional identification appropriate letters or a title after that person's name that represents the person's specific field of practice. The letters or title shall appear on all signs, stationery, or other advertising in which the person offers or displays personal professional services to the public. In addition, a person engaged in the practice of medicine or osteopathy as defined in AS 08.64.380, or a person engaged in any manner in the healing arts who diagnoses, treats, tests, or counsels other persons in relation to human health or disease and uses the letters "M.D." or the title "doctor" or "physician" or another title that tends to show that the person is willing or qualified to diagnose, treat, test, or counsel another person, shall clarify the letters or title by adding the appropriate specialist designation, if any, such as "dermatologist", "radiologist", "audiologist", "naturopath", or the like. REPRESENTATIVE COGHILL clarified that under Alaska statutes the term is very broad. Number 0406 REPRESENTATIVE SEATON referred to the Journal of the American Medical Association (JAMA), 1998 article where there is discussion about naturopathic physicians. He said he thinks the distinction that he sees being made through opposing comments is that naturopath are an unlicensed, unregulated group; whereas naturopathic physicians are licensed in state and have the background and training. These are two different groups, he emphasized. For example, currently a naturopath can practice right now with no training, but to be a naturopathic physician an individual must meet the licensing requirements. That is what is really being discussed here, he commented. He suggested that the committee look at the policy call of restricting the word "naturopath" to refer to only naturopathic physicians to prevent the confusion that has occurred in the testimony the members have heard. REPRESENTATIVE COGHILL told the committee that anyone who is licensed must have the credentials. He added that he has a friend who is called doctor, but he is not a medical doctor. Representative Coghill questioned what the committee wants to define. Number 0284 REPRESENTATIVE CISSNA asked the committee to look at page 3, lines 26 through 28, which reads as follows: (B) addiction or severe dependency on alcohol or a drug that impairs the applicant's or licensee's ability to practice safely; or (C) physical or mental disability; or REPRESENTATIVE CISSNA pointed out that (C) does not have the same qualifying terms after the condition that (B) does. She pointed out that there are physical or mental disabilities that exist that would not impair an individual's ability to practice safely. She suggested including the same language in (C) that is included in (B). REPRESENTATIVE CISSNA moved Conceptual Amendment 1 as follows: On Page 3, Line 28, after "disability" Insert: "that impairs the applicant's or licensee's ability to practice safely;" Number 0051 REPRESENTATIVE COGHILL objected for discussion purposes. REPRESENTATIVE CISSNA told the members that there are many kinds of disabilities, both mental and physical, that would not be an impairment. Many disabilities do not affect an individual's competency in their professional lives. REPRESENTATIVE GATTO agreed with Representative Cissna. For example, if a person has had an arm amputated, it would not affect that person's ability to practice safely. TAPE 04-32, SIDE A DR. YOUNG commented that the Division of Occupational Licensing will regulate naturopaths appropriately. He pointed to the flow chart in the members' packet. REPRESENTATIVE COGHILL said the Division of Occupational Licensing will have a hearing officer and if there is an appeal it can go straight to the court. Number 0079 REPRESENTATIVE SEATON pointed to page 3, lines 23 and 24, which reads as follows: (6) is [CONTINUED TO PRACTICE AFTER BECOMING] unfit to  practice naturopathic medicine due to REPRESENTATIVE SEATON commented that he is not really opposed to the conceptual amendment; however, he said he believes Representative Cissna's amendment is already covered under (6) where it says "is unfit to practice naturopathic medicine due to." He clarified that this language means that it would have to first be determined that the individual is unfit to practice due to a physical or mental disability. Number 0131 REPRESENTATIVE CISSNA questioned why the language is included in (B). She withdrew her motion to adopt Conceptual Amendment 1. Number 0204 VERENA NILSSON testified in support of HB 434. She told the members that she is a patient of Avanti Medical Center in Anchorage and supports the idea of her doctors being able to write prescriptions for medicines. Ms. Nilsson explained that she has had medical problems for the last 12 years and had gone to traditional doctors; however, it was not until she went to a doctor of naturopathy that she discovered what was wrong with her. She is now taking hormones in order to get some of the problems taken care of. It is still a problem for her because she has to go back to the conventional doctor to get a prescription written. Ms. Nilsson told the members that she would like all of her family go to naturopathic doctors. Number 0346 STEVE COMPTON, M.D., Alaska Heart Institute, testified on HB 434 and answered questions from the members. He detailed his training which consisted of four years of college, four years of medical school, three years of internal medicine residency, three years of cardiology fellowship, and another year of an electrophysiology fellowship. Dr. Compton told the members that he finished training at the age of 33, then taught at the University of Utah for four years. He said he is pretty familiar with the research basis behind allopathic medicine. DR. COMPTON told the members that he is not sure the members are aware of the profound differences between allopathic medicine and alternative medicine practices. The single most important thing that defines allopathic medicine is that it is evidence based on scientific methods, he explained. Dr. Compton said what that means is that if patients have a clinical problem and are considering therapy to treat that problem or disease, scientific methods are used to design clinical trials. Randomized placebo controlled trials are used to determine if therapy will actually benefit a patient, he said. Dr. Compton told the members that using this approach helps them in developing new treatment so patients will have longer better lives. Number 0526 DR. COMPTON said he believes what is not being understood is that most naturopathic practices do not involve the scientific method. It tends to be more of a faith-based practice. He said that the judgment that a treatment is effective should be based on the quality of the scientific evidence. Naturopaths are very good at convincing people that evidence exists when it actually does not or convincing people to accept substandard evidence. DR. COMPTON explained that some of the practices of naturopathy would not stand up to scientific scrutiny. For example, iridology, which says that it can be determined if something is wrong with an individuals organs by looking at the color of a person's eyes. He said that this is no different than palm reading. Dr. Compton told the members that many of these practices would be determined to be health fraud if perpetrated by medical doctors. He added that the differences between naturopathic medicine and allopathic medicine has not been over come. Number 0661 DR. COMPTON said when the Massachusetts legislature considered licensing naturopaths three years ago it had a special commission working for fifteen months to study the issue. He read the conclusion of that study into the record as follows: For an occupation with little semblance of objective scientific and ethical basis, licensure legitimizes an otherwise illegitimate and dangerous activity. It is the opinion of the Massachusetts Medical Society that it would be irresponsible and unconscionable for the commission to recommend the licensure of naturopathy in the Commonwealth of Massachusetts. DR. COMPTON said this is an issue because prescription drugs can be dangerous. It takes a lot of training and judgment to use them. He told the members that he knows of no medical physician that learned how to prescribe medications during their medical school years. He added comparing naturopath training to medical school training is not appropriate. Prescription training occurs as an intern, resident, and fellow, Dr. Compton said. His internship was hardcore training of 90 to 100 hours per week. Number 0769 DR. COMPTON told the committee that two patients were hospitalized in Denver a couple of weeks ago after being treated by a licensed naturopath. One was a 17 year old girl who had cardiac arrest after having UV blood irradiation. This is a procedure where the blood was removed from the girl's body, irradiated with ultra violet light and then infused back in her. Another case in 2002, Lawrence Perry, a naturopath, persuaded an 8 year old diabetic girl's parents to stop her insulin. Type I diabetes requires insulin for survival. There have been several diabetic deaths, Dr. Compton said. DR. COMPTON shared another example of a naturopath named Reginald Fenn who in February of 2004 was jailed because he persuaded parents of an 18-day old baby with aortic stenosis not to seek surgery. He told the members the only way to treat aortic stenosis is through surgical repair. The child died after treating it with herbs and proclaiming the child was cured. Dr. Compton continued to share other examples of naturopathic malpractice in which patients were harmed. After the death of a young girl following a procedure of a naturopath, Alberta rescinded all licensing of naturopaths. DR. COMPTON said that naturopaths will say that this is mainstream medicine, but it is not. He told the members that they will be told that naturopaths have these privileges in other states, but that is not true. He told the members that it will not be mentioned that two states have outlawed naturopathy, and only 11 states that even bother with licensure. Whether licensure should be offered is debatable and he said, in his opinion prescriptive authority is unconscionable. Number 0905 DR. COMPTON suggested that the members look on the web site of the American Association of Naturopathic Physicians. He read a statement from the web site into the record as follows: Naturopathic practice excludes major surgery and the use of synthetic drugs. DR. COMPTON commented if the members are considering giving naturopaths prescriptive authority, what is being discussed is not naturopathy, but medicine. He advised the members to talk to people who prescribe drugs and understand them before passing a bill like this. He told the members that there are dozens of drugs when used aggressively can hurt, maim, or kill people. The few classes in naturopathy schools is unlikely to provide the training to prescribe these drugs. DR. COMPTON urged the members to educate themselves on this issue and protect Alaskans. Number 1036 REPRESENTATIVE WOLF commented that Dr. Compton made reference to iridology. He asked if a patient came to him with yellow itchy eyes, what would be his first reaction. DR. COMPTON responded that he believes Representative Wolf is thinking of liver disease, but that is not the iris. He explained that iridology suggests that by looking at specific color patterns of a person's iris and a specific diagnosis can be made. Dr. Compton agreed with Representative Wolf that a person with liver disease can get yellow discoloration in the white part of the eyes called jaundice. DR. COMPTON said another questionable practice is homeopathy. Their premise is to take whatever active drug it is believed a patient needs, and repeatedly dilute it down. The idea behind this is that by doing this the essence of the drug is captured and the more diluted it is the more powerful it is. He said this makes absolutely no sense. He pointed out that homeopathy won't hurt anyone, but it is promoted as a way to make people better and there is no basis in physiology or pharmacology for the effectiveness of homeopathy, but this is another main stay of naturopathic medicine. He told the member that naturopath is not based upon science. Dr. Compton told the members that a great way to blow a lot of money on health care is to spend it on therapies that have not been proven to be effective. Number 1212 REPRESENTATIVE WOLF told Dr. Compton of a family member's experience where after seeing and MD for an itchy condition she was told to put on calamine lotion and soak in Epson salts. He took her to a naturopath who immediately had her get a blood test. It was found that she had a tumor in her bile duct. She was within a couple of months of dying and it was a naturopath that saved her life, he stated. The MD did not address her medical condition. Number 1263 DR. COMPTON replied that he thinks that there is a lot that naturopaths can offer. A lot can be said for a good diet and exercise. He said well-trained physicians do miss diagnose. REPRESENTATIVE WOLF clarified that he is not talking about diet and exercise. DR. COMPTON admitted that there are some naturopaths that are very sharp and well intentioned. There are also those whose training does not include science. In allopathic medicine if a doctor were to provide a patient with a treatment that had no scientific or rational basis and which had not been shown to help people, it would be considered malpractice, he said. Dr. Compton commented that Representative Wolf's mother had an unfortunate experience, but believes that another allopathic doctor would have eventually diagnosed the jaundice she was experiencing. REPRESENTATIVE WOLF asked if Dr. Compton is familiar with multiple myeloma and asked what he would prescribe for treatment. DR. COMPTON responded that multiple myeloma is usually treated with chemotherapy. He clarified that he is a cardiologist and has not worked in oncology in over 12 years so he is not an expert in that field. Number 1408 REPRESENTATIVE WOLF said that several treatment centers in the Lower 48 are now saying that chemotherapy will not touch myeloma. He explained that a dear friend who passed away had myeloma and the doctors wanted to prescribe chemotherapy for him. DR. COMPTON replied that this is an especially vulnerable group of people. A good oncology practice will be involved in clinical trials. The heart of it is that therapies for cancer are all pretty miserable. He said that if a therapy is offered it is important to know if it works or not. There are nationwide protocols to see if survival rates can be improved. A competent oncologist can tell a patient what the state of the art treatment is for whatever cancer a person has. He said if a cancer patient goes to a naturopath he/she could be assured of getting better with an herb or therapy, but there is no clinical or trial data available for the treatment. All the data comes from testimonial studies or belief systems, he added. In conclusion he said the strength of allopathic medicine is based on scientific methods. All therapies have a potential for harm and it is essential to know that a therapy's benefit outweighs the potential for harm, Dr. Compton stated. Number 1589 CHAIR WILSON announced that the bill will be held in committee.