Saturday, May 26, 2012

Vermont Bill S.209 - Lorilee Schoenbeck, ND - Written Testimony


Lorilee Schoenbeck, ND
Vermont Bill S.209 
House Health Care Committee
April 11, 2012

The oral testimony presented by Schoenbeck is available from the Legislative Council, tel. 802-828-2424. It is recorded on CD # 163, House Committee On Health Care, April 11, 2012. The CD costs $1. They can also provide hardcopy of her written testimony.

Her written testimony along with my comments:


VANP Health Notes. This consisted of 2 printed pages in which the organization’s web address was given, www.VANP.org, without a publication date or a specific URL. I was not able to find it on the organizations site. Some quotes from VANP Health Notes :

“They” NDs “are experts in the effective clinical use of nutrient, herbal and other natural therapies and are the only providers trained in herb/nutrient/drug interaction potentials, guiding patients who prefer a natural approach to their health care in the safe and appropriate use of these remedies.” 

That hit me in the face like a wet towel. NDs use “remedies” long before they are every studied which means that there is no data on those products and therefore no one can be an expert on them or know if they offer benefits or are deadly. My greatest fear is that one of them will turn out to be as lethal as cigarettes but by the time that is known it will be too late to save many from premature deaths.

After remedies become popular or evidence appears linking them to deaths and serious injuries, they are studied by scientists who report their findings in the medical literature which is indexed. Competent practitioners who practice evidence-based medicine, meaning most but not all MDs, closely follow the studies that are relevant to their specialties. (Based on my experience with silver, I have to conclude that NDs do not review or read the indexed medical literature as practitioners of evidence-based medicine do.) 

But if any of you has gotten a prescription drug lately, you have seen the list of possible side effects and food and drug interactions that comes in the package with the drug as well as the admonition to discuss the use of any supplements you take with your doctor or pharmacist. The list doesn’t come from naturopaths. It comes from pharmacists who like MDs carefully follow these studies as they become available. It is their job. It is what they are trained for. In fact, like MDs, pharmacists often do the studies to determine these things. If you browse PubMed, the online index of medical journals, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed, you will see that those who practice scientific or evidence-based medicine have been conducting and reporting on such studies for decades while NDs have rarely done them in the past and are only now just beginning to do them. 

Health News also stated:
“Naturopathic medical college prepares NDs with a biological and biomedical education of the same breadth and depth that prepares an MD to be a primary care physician”.

Even if that were true, and I don’t believe that it is, it is besides the point which is that NDs are never taught the most fundamental principle of science which is that one does not assume, one tests, one experiments and in medicine one strives to objectively test all drugs and therapies for safety and efficacy before using them which is the exact opposite of what NDs routinely do.

Health News:
“2012 ND stats: Percentage of insurance credentialed NDs practicing primary care: 82%; Precentage of these taking new PC patients: 95%; number of VT primary care NDs: 40 and growing; percent increase in ND PCPs in VT in the last 5 years: 82%; Today 7.4% of VT’s primary care physicians are NDs” 
Note: PC = primary care; PCP = primary care physician; insurance credentialed = reimbursed by insurance.

Assuming that all of those statistics refer to VT, two things catch my attention. First if so many NDs are taking new patients, I don’t think that Vermonters need NDs. I think we have too many already. Second, In testimony by the Director of the Office of Professional Regulation at another hearing, he said that there are 241 NDs licensed in VT. I wonder what the others do and how many of them live in VT.  

Ms. Schoenbeck submitted this written statement:

Lorilee Schoenbeck, ND
from the Vermont Association of Naturopathic Physicians
Testimony to the House Health Committee
4/11/12

S.209 - A Necessary Step Toward Improving the
Primary Care Delivery of Naturopathic Physicians

S.209 does not expand scope of NDs. It is needed so that naturopathic doctors (NDs) and their patients will be included in VT’s health reform.

NDs (naturopathic doctors) are trained in primary and specialty care in 4-year medical colleges recognized by the US Dept. of Education. They have been licensed as physicians in VT since 1996.

NDs provide routine primary care such as Pap smears, cardiovascular screenings and treatment of most chronic and minor acute illness. Most NDs in VT function as PCPs.

ND treatment involves nutrition, lifestyle counseling and natural remedies whenever appropriate, but also prescription medications like antibiotics, statins, hormones, pain medication and referrals to conventional physicians when necessary. NDs often find that 90+% of common complaints in primary care practice can be treated effectively without the use of pharmaceuticals.

There are currently over 40 NDs (and growing) serving an estimated 5,000 + Vermonters as their primary care physicians (PCP).

VT intends that all primary care physicians (PCPs) become medical homes by 2014. Currently, NDs are not recognized as eligible to become medical homes.

Failure to pass S.209 could result in thousands of Vermonters now currently enrolled with an ND as their primary care doctor to have to re-enter the pool of those without a PCP. Vermont could lose a significant percentage (7.4%) of its current primary care physicians.

Becoming PCMHs will enhance quality of ND primary care by holding NDs to the same structural standards as MD primary care. This is a win-win.

S.209 also clarifies language in Act 59 pursuant to the PCP status of NDs, which this Committee passed in 2007.

S.209 also levels the playing field to make NDs eligible for IT incentive funding that could also be available to MDs, which is currently not the case.

Comments: 

Being licensed by the US Department of Education does not mean that the agency has evaluated the school to see if it prepares students to practice medicine or if course work corresponds to the title of the course. While NDs have been licensed in Vermont since 1996 they are continually being given more and more privileges. What NDs were permitted to do here in 1996 is not what they are permitted to do here now or what they will be permitted to do here in a few years when new laws take effect. H.524 was just passed and will give NDs the same prescription privileges as MDs have.

To evaluate Ms. Schoenbeck’s comment about only treating 10% of patients with pharmaceuticals, one would need to know things like: are the common complaints people see NDs for the same as what they see PCPs who are MDs for; the percentage of patients with common complaints that MD PCPs treat with drugs; the % of patients ND & MD PCPs see who are hypochondriacs or the “worried well”; and other extenuating circumstances. 

For instance, a man with Crohn’s disease, an often debilitating inflammatory bowel disease that "usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus)." 
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295/, saw an MD who treated him with drugs in addition to a naturopath who gave him nutrition advice and lifestyle counseling. Since the ND didn’t have prescription privileges, he didn't prescribe drugs for the patient and couldn't have even if he had wanted to, but that may change once he has prescription privileges. Till then the naturopath practices in the capacities of a dietician and exercise physiologist, not a PCP.

If NDs have about 125 patients each, how many do MD PCPs have on average?

Why should anyone conclude that including NDs in Medical Homes will mean that they are held to the same standards that MDs are? The State of Vermont has never even held them to the standards they’ve set for themselves. They were supposed to review their formulary annual but didn’t. The bar has always been lowered for them. When they were required to pass a pharmacology test, 2 of their advisors drew it up and took it along with the other NDs in the state. It was a 48 hour open book test passed by at least one person who had no medical training whatsoever. 

Lorilee Schoenbeck; naturopathic schools; vermont; naturopaths; supplement, drug, food interactions; S.209; VANP; Vermont Association of Naturopathic Physicians

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