Respectful Insolence

More on legalized quackery in Arizona

Yesterday, when I wrote about a death in Arizona caused by a homeopath doing liposuction, what amazed me the most was that homeopaths are licensed in Arizona. Although I alluded to it only briefly in yesterday’s post, I was truly astounded at what homeopaths are allowed to do in Arizona. It piqued my curiosity–and horror. Consequently, I decided to delve a bit more deeply into the website of the Arizona Board of Homeopathic Medical Examiners.

There are more horrors in there than I thought. Those of you who live in Arizona should be afraid–very afraid!–about what these quacks are permitted by law to do in your state. It completely betrays its motto of:

The Board’s mission is to protect the health, safety and welfare of Arizona citizens by examining, licensing and regulating homeopathic physicians.

Of course, given the nature of homeopathy, it’s a hopeless mission.

Let’s look at the “scope” of homeopathic practice, as defined by the Board:

The scope of a homeopathic license includes the practice of acupuncture, chelation, homeopathy, minor surgery, neuromuscular integration, nutrition, orthomolecular therapy and pharmaceutical medicine (see A.R.S. § 32-2901(22)).

[...]

Homeopathic Physicians who intend to dispense general, homeopathic or nutritional medications, substances or devices from an office, must apply for and receive a dispensing permit.

In other words, Arizona is licensing woo! What do chelation therapy, orthomolecular therapy, and acupuncture, for instance, have to do with homeopathy?

Nothing! It’s all just a bunch of seemingly randomly chosen woo lumped under the rubric of the term “homeopathy.” I’ve written about acupuncture several times before. I still haven’t quite made up my mind whether to classify it completely as “woo,” although the rationale given for how it “works” (namely, somehow altering the flow of qi, or “life essence or energy” by sticking small needles in the skin) most definitely is woo. If acupuncture “works” as anything more than an elaborate placebo, it most certainly does so not because of magical life forces, but because of a biochemical and physiological mechanism. Either way, though, acupuncture has absolutely nothing to do with homeopathy, as far as “alternative medicine” disciplines go. There’s nothing about “like cures like” or diluting remedies to the point of nothing in acupuncture (although the concept of homeopathic acupuncture, I’m sure, could lead to as many, if not more, jokes than the concept of “homeopathic surgery).

But what are the other therapies? Regular readers of this blog hardly need me to go on another rant about chelation therapy. Other than in the fairly rare case of clearly documented acute heavy metal poisoning, chelation therapy is almost always quackery. This is especially so when it is used to treat autism or cardiovascular disease. I’ve also blogged extensively about an autistic child who died as a result of being treated with chelation therapy. Once again, I fail to see how chelation therapy is related to homeopathy. Chelation therapy has one big problem that makes it by definition nonhomeopathic: There’s actual detectable drug in chelation therapy, which has actual detectable physiological effects up to and including death. There’s nothing homeopathic about that.

Another big bit of woo that the State of Arizona licenses under the purview of homeopaths is orthomolecular medicine. Late in his life, Linus Pauling became a big booster of orthomolecular therapy in general and high dose vitamin C therapy for cancer in particular. This particular form of woo is defined by its advocates as “the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body.” What’s amusing about the way Arizona lumps orthomolecular medicine in with homeopathy comes from way orthomolecular medicine is “practiced,” which couldn’t be more different than homeopathy. In general orthomolecular “practitioners” tend to treat diseases with nutritional supplements and sometimes megadoses of vitamins. At least that seems to be the practice, as far as I can tell. Whether it be massive doses of vitamin B3 for mental illness in the 1950s or the enthusiasm of its advocates for high dose vitamin C for cancer, despite the lack of evidence for any efficacy. In fact, orthomolecular medicine seems to be the exact opposite of homeopathy. Where homeopathy is about the dilution to nonexistence, orthomolecular medicine seems to be all about megadoses of whatever vitamins, minerals, or nutrients are being used to “treat” illness. The two couldn’t be more dissimilar in concept. Perhaps Arizona is allowing homeopaths to cover all the bases from dilution to placebo to megadoses.

Amazing how plastic homeopathy is, at least in Arizona, isn’t it?

But if you really want to laugh (or cry for the codification of quackery into state law), check out the rules governing homeopaths. First, the State of Arizona helpfully defines two flavors of homeopathy:

  • “Classical homeopathy” means a system of medical practice expounded by Samuel Hahnemann in the Organon of Medicine that treats a disease by the administration of minute doses of a remedy that would in healthy persons produce symptoms of the disease treated.
  • “Complex homeopathy” means a system of medical practice that combines one or more homeopathic remedies that are not described in the Organon of Medicine.

I’m guessing that all that other woo, when combined with “classical” homeopathy make up “complex homeopathy.” Even so, it’s still hard to see any logical justification for lumping acupuncture or orthomolecular medicine in with homeopathic woo. But what’s really frightening is the low bar that’s set for being “qualified” to do some of these therapies. For example, the most frightening is how little training is needed for a homeopath in Arizona to administer chelation therapy:

Chelation therapy: Completing at least 16 hours of postgraduate courses offered by the American Board of Clinical Metal Toxicology, American College of Alternative Medicine, International College of Integrative Medicine, or the American Academy of Environmental Medicine or other sponsor approved by the Board that provides equivalent training.

That’s right. All you need is 16 hours of quack training, and, in Arizona at least, you too will be legally permitted to administer a potentially dangerous therapy for no medically supported indication! In fact, if you don’t like chelation therapy being called “experimental,” the State of Arizona’s got your back with this Substantive Policy Statement Regarding Chelation Therapy SPS 04-01. It’s truly manna from heaven for chelation quacks:

Whereas in A.R.S. § 32-2901 Definitions, states that chelation therapy means an experimental medical therapy to restore cellular homeostasis employing some form of the chelator EDTA (Ethylenediamine Tetraacetic Acid). Chelation therapy is not an experimental therapy if it is used to treat heavy metal poisoning. Therefore, the Board of Homeopathic Medical Examiners’ updated policy statement regarding newer methods of chelation therapy is hereby stated to be the following:

It has long been known that the primary function of Chelation or Metal Binding therapy is to deal with Heavy Metal Detoxification. Licensed Homeopathic physicians also utilize chelation therapy in the State of Arizona for purposes such as vascular disease and other non heavy-metal related health problems…

Due to the relative high cost and until now, the lack of widespread availability, the disodium salt of EDTA, which is discussed in detail in the ACAM protocol, has been the most common form of EDTA employed by our licensees in Arizona. In Europe, however, the Calcium salt of EDTA, which has been widely available and very affordable there, is far more commonly employed, and this form of EDTA, given orally as well as parenterally, has been considered by some to be the preferred form of EDTA, particularly when given primarily for the treatment of increased body burden of toxic heavy metals. There are also other salts of EDTA, including Magnesium EDTA and Potassium EDTA, which are also available. For various reasons some physicians may prefer one form of EDTA over another in a specific case. We hereby acknowledge that all of these are recognized as legitimate and acceptable variations of the chelation therapy modality for our licensees.

That’s right. Homeopaths can use any form of chelation therapy they desire, without worrying about anything like…oh, that pesky lack of scientific evidence that it has any therapeutic effect for cardiovascular disease, autism, or any of the other conditions blamed on “heavy metal toxicity.”

It’s one thing for homeopaths to be using treatments that are so dilute that they are nothing more than water; i.e., an elaborate placebo. Doesn’t it warm the cockles of your heart to know that quackery is legal in Arizona? But it’s even better than that, if you’re a quack. According to Section R4-38-115, you can claim the special title of “homeopathic doctor”:

A. The use of the abbreviation “M.D.(H.)” (with or without periods), is equivalent to the written designation, “Doctor of Medicine (Homeopathic)”.

B. A Homeopathic physician practicing in this state who is not licensed by the Arizona Board of Medical Examiners or the Arizona Board of Osteopathic Examiners in Medicine and Surgery shall not use any designation other than the initials MD or DO to indicate a doctoral degree, which shall be followed by the full, written designation, “Homeopathic Physician.”

C. A physician licensed by the Board and any state Board of Medical Examiners or the Board and any state Board of Osteopathic Examiners in Medicine and Surgery shall use one of the following designations, as appropriate (with or without periods):

1. “MD, MD(H)” or “DO, MD(H)”;
2. “MD, Homeopathic Physician” or “DO, Homeopathic Physician”; or
3. “MD, Doctor of Medicine (Homeopathic)” or “DO, Doctor of Medicine (Homeopathic)”.

Looking over this again, this is a bit confusing, but it appears that homeopathic physicians can be licensed just as homeopathic physicians or both as homeopathic physicians and regular physicians if they meet the requirements for regular medical licensure as well. It’s also entirely unclear to me why any physician licensed in the normal manner would want to be licensed as a “homeopathic physician.” It’s just a lot of money paid to the state for something that he or she could probably do without interference from the state if desired anyway. (Really, does anyone think that the Arizona Board of Medicine would do anything substantive to a physician who administered homeopathy without a homeopath license? I tend to doubt it, given this law on the books.) No, physicians who can’t get a medical license in the normal way are the only ones who would likely bother with the homeopathic license.

But do you want to know what’s even better than this? Do you want to know what makes Arizona truly a quack paradise, where a homeopath can do things that no science or evidence supports letting homeopaths do? Where a homeopath can do things that a homeopath, if true to his or her philosophy of healing, should even want to do? In Arizona, apparently licensed “homeopathic physicians” who are not licensed by the state as regular physicians can nonetheless obtain permits to dispense controlled substances:

A. A homeopathic physician shall not dispense unless the physician obtains from the Board a permit to dispense. The physician may renew the permit annually at the same time the license is renewed. The physician shall include the following on the permit application or renewal form:
1. The classes of drugs the physician will dispense, including controlled substances, pharmaceutical drugs, homeopathic medications, prescription-only drugs, natural substances and non-prescription drugs defined in A.R.S. §32-1901(46), and devices defined in A.R.S. §32-1901(18);
2. The location where the homeopathic physician will dispense; and
3. A copy of the physician’s current Drug Enforcement Administration (DEA) registration or an affidavit averring that the physician does not possess a DEA registration and that the physician will not precribe or dispense controlled substances.

My only hope is that the DEA won’t issue DEA permits to homeopathic “doctors” who aren’t also licensed as regular medical doctors, although I don’t know whether they will or won’t. A lot of these homeopathic doctors do appear to have graduated from a medical school somewhere before they started practicing woo; so I guess that, woo-meister or not, they are, in fact, “doctors,” the only question remaining being the type of license in Arizona. Once again, however, I have to ask: Why on earth would a “homeopathic physician” ever need or want to prescribe controlled substances? Is it just me, or doesn’t this seem to go against homeopathic principles in such an amazingly blatant way, that I have to wonder why any homeopath would put up with it. After all, like chelation therapy, narcotics are actual drugs, with easily detectable amounts of therapeutic substance in them that have easily detectable and demonstrable physiologic effects. Of course, this brings me back to the risible idea of homeopaths doing surgery of any kind. It occurs to me. If homeopaths really had the strength of their convictions that “like heals like,” they really wouldn’t need to bother with those nasty opiods. Of course, patients who were foolish enough to let a homeopath operate on them wouldn’t much like it.

Once again, I’m glad I don’t live in Arizona. After all of what I described above, it should be clear to you that Arizona has in essence legalized quackery and created a board that in essence licenses physicians who don’t qualify for regular medical licenses in the state, many of whom are cast-offs from other states. But if you’re not sufficiently convinced, just consider this: Arizona also licenses naturopaths as well, most of whom are not even physicians.

Weep, citizens of Arizona.

Comments

  1. #1 Blake Stacey
    July 25, 2007

    I wonder if those “controlled substances” are administered in homeopathic doses. I mean, if homeopathy worked, you could get high without inhaling.

  2. #2 Dunc
    July 25, 2007

    I don’t know whether to cry, or get a full ethicectomy and move to Arizona to make my fortune…

  3. #3 Acad Ronin
    July 25, 2007

    1) People have a right to be stupid. Fools and their money…
    2) The problem is generally self-correcting in a Darwinian way; the only downside is the effect on the children of seekers after woo.

  4. #4 Andrew Dodds
    July 25, 2007

    Blake -

    It dosen’t not-work like that..

    For instance, the homeopathic ‘treatment’ for being drunk would be an ultra-diluted beer, since that’s what produces the symptoms. So to the homeopath, ultra-diluted beer (cf ‘Distilled water’, or ‘Budwieser’) would have the same effect as, say, coffee.

    So a problem could arise.. if you had a mug of coffee, washed it out several times, and then drak water out of the same mug – you would end up drunk. Drinking water out of an over-washed beer glass probably dosen’t bear thinking about..

  5. #5 the DVM from Up North
    July 25, 2007

    Interesting recollection: Arizona is one of the few states (or maybe the only, now that Indiana finally joined the 21st century) which refuse to observe daylight savings time. Hmmm. Makes one wonder about the antiquated legislative mindset in the state with the funky flag.

    I, too, am baffled by the controlled substances issue, but the Big Baffler, which will be getting plenty of light in the aftermeath of this tragic case, is what Orac has already stated much more eloquently: what the hell was this putz doing with a knife in his hand?

    Finally, regarding the “MD(H)” designation, it is absolutely OUTRAGEOUS that this is permissible. As others have posted elsewhere, the lay public is plenty confused already (ask a random sampling of people to explain the difference between an optician, an optometrist and an ophthalmologist, and you’ll get the idea), and allowing this sort of confusion to legally exist is, IMO, unconscionable. What baffles me (again–but most of the woo-related stuff out there baffles me) is why the AMA/AOMA (osteopathic physicians association) hasn’t been screaming about this. Or maybe they have and we just haven’t heard it. If someone were allowed to legally use the initials DVM (H) to designate that he/she was a homeopathic veterinarian (and let me tell you, this woo exists in my profession as well–GRRRRR, but to my knowledge, nobody identifies himself with confusing initials), the national association (AVMA) would be screaming from the rooftop.

    My proposal: all homeopathic “physicians” shall immediately be designated by the initials “PW”, e.g. Joe Jones, PW, to mean, of course, “Practitioner of Woo”.

    Or better yet, Joe Jones, PBS.

  6. #6 Warren
    July 25, 2007

    Orac, I live in Arizona, and while I agree entirely that quackery is reprehensible, I have to say I somewhat resent your suggestion that we’re all a bunch of asshat cretins.

    Here’s a graf or two you might find interesting:

    What is the status of licensure and certification?
    Currently there are three states that license homeopaths who are also physicians: Arizona, Connecticut and Nevada.

    California, Rhode Island, and Minnesota have new Health Freedom laws that allow unlicensed practitioners to practice homeopathy. The Health Freedom movement has also introduced similar bills in other states.

    Why don’t you put some energy into bashing a few other states for a while?

  7. #7 Rose Colored Glasses
    July 25, 2007

    This has been bugging me for years. In controlled double-blind studies of homeopathic remedies, what do they use for a placebo?

  8. #8 KeithB
    July 25, 2007

    “Arizona is one of the few states (or maybe the only, now that Indiana finally joined the 21st century) which refuse to observe daylight savings time.”

    What is wrong with this? Arizona has plenty of daylight – it does not need to save any!

    And guess who benefits the most from DST? It is the retailers. There is no net energy savings from DST, since people don’t sit at home with the lights off. They drive places and buy stuff:

    http://www.npr.org/templates/story/story.php?storyId=7779869

  9. #9 Lepht
    July 25, 2007

    hell, don’t just move out of Arizona, move to Britain, where the… uh… trained touch therapists assist operations… and you can get Reiki on the NHS but you have to pay for your painkillers…

    um, why don’tcha stay where you are, get a beer, kick back some. try not to get ill at all.

    Lepht

  10. #10 Orac
    July 25, 2007

    Orac, I live in Arizona, and while I agree entirely that quackery is reprehensible, I have to say I somewhat resent your suggestion that we’re all a bunch of asshat cretins.

    I made no such suggestion. Mocking idiotic laws is not the same thing as suggesting that Arizona citizens are “all a bunch of asshat cretins.” Did my concluding by saying “Weep, citizens of Arizona” strike you as characterizing you all as a bunch of “asshat cretins”?

    My guess was that most of its citizens probably have no idea what a problem Arizona has and pointing out that Arizona’s laws regulating homeopaths are horrendous, at the same time applying some much-needed not-so-Respectful Insolence™ to them. How Arizona’s laws regulating homeopaths and naturopaths got that bad, I do not know, but I hope my tweaking the Board got the attention of some citizens of Arizona who value evidence-based medicine and detest quackery. You’re the only ones in any position to do something about this. From what I can gather, Arizona’s laws been that way longer than in the unfortunately increasing number states with such laws (since 1982 for homeopathy). See this article for more and for just how incompetent the homeopathy board is. One quote:

    Only two other states, Nevada and Connecticut, license homeopathic physicians, but Arizona allows the widest range of alternative medical practices.

    In any case, in light of the recent death caused by a homeopath doing surgery, singling out Arizona as an example seems quite reasonable to me, and I make no apologies.

  11. #11 PalMD
    July 25, 2007

    That’s what bothers me…i understand why people believe in woo, but when the state endorses it, people think it’s the real thing. I’d like to know who sponsored the legislation allowing quack licenses without the actual picture of a duck on the seal.

  12. #12 Coin
    July 25, 2007

    Interesting recollection: Arizona is one of the few states (or maybe the only, now that Indiana finally joined the 21st century) which refuse to observe daylight savings time. Hmmm. Makes one wonder about the antiquated legislative mindset in the state with the funky flag.

    No, no, that’s actually a good thing. Daylight savings time is stupid. The lack thereof was almost the only good thing about Indiana when for a time I lived there.

  13. #13 Warren
    July 25, 2007

    I made no such suggestion.

    Beg to differ. With virtually every graf you (1) made fun of inane homeopathic quackery and (2) pointed out that such inane homeopathic quackery is legal here.

    It’s not #1 that I have an issue with.

    This is a state with some incredibly bizarre legal issues, some of which are utterly baffling; however I think it’s only fair to point out that, were most states’ citizens given a chance to decide in the ballot box whether licensure of homeopathists should be legal, they’d almost certainly say yes.

    I entirely agree that we’ve got a problem here. The mere thought of a homeopathist being able to legally slice human beings open is ghastly. But when paragraph after paragraph in a post contains phrases such as “Arizona is licensing woo!” and “Another big bit of woo that the State of Arizona licenses under the purview of homeopaths is orthomolecular medicine.” and “For example, the most frightening is how little training is needed for a homeopath in Arizona to administer chelation therapy:”, the tone is undeniably one of browbeating, with a healthy undercurrent of “Jesus, look at what a bunch of idiotic rubes they are in Arizona!”

  14. #14 PalMD
    July 25, 2007

    I love AZ…lived there for a while…beautiful. Someone (ahem) should organize an email or letter campaign on this issue…someone in AZ.

  15. #15 Jess
    July 25, 2007

    but when paragraph after paragraph in a post contains phrases such as “Arizona is licensing woo!” and “Another big bit of woo that the State of Arizona licenses under the purview of homeopaths is orthomolecular medicine.”

    Would that not be because he’s talking about how this is all legal in Arizona? I fail to see how Orac could post about this and not have a negative tone in regards to Arizona. But nowhere has Orac said “and to boot, they are all slack jawed yokels!”.

    If Utah or Washington had the same laws, you can bet it would have been the same tone.

  16. #16 Joseph Hertzlinger
    July 25, 2007

    It sounds like Arizona is diluting homeopathy.

    Hmmmm… If you dilute irrationality enough, will you obtain rationality?

  17. #17 wrg
    July 25, 2007

    Those of you who live in Arizona should be afraid–very afraid!–about what these quacks are permitted by law to do in your state.

    That doesn’t suggest to me that Orac thinks that the people of Arizona are uniformly behind quackery. All the time we see governments doing foolish things. It’s important to bring these to public attention so that people might think to do something about them. Is it more polite to decide not to upset the people of Arizona than to let them know that they should be concerned about a little (H) after MD?

  18. #18 PhysioProf
    July 25, 2007

    “The scope of a homeopathic license includes the practice of acupuncture, chelation, homeopathy, minor surgery, neuromuscular integration, nutrition, orthomolecular therapy and pharmaceutical medicine (see A.R.S. § 32-2901(22)).”

    These nutjobs are licensed to perform “minor surgery”!?

  19. #19 Michael Suttkus, II
    July 25, 2007

    Orac:There’s nothing about “like cures like” or diluting remedies to the point of nothing in acupuncture (although the concept of homeopathic acupuncture, I’m sure, could lead to as many, if not more, jokes than the concept of “homeopathic surgery).

    You don’t understand. Acupuncture is homeopathic injury healing.

    “Doc! I was stabbed with a sword!”

    “Not a problem, son. Poking you with a few needles will clear that right up! Like cures like, if diluted!”

    “Er, doc, how about diluting it further. You can poke me with needles that USED to be in your hands, but aren’t now.”

    “Brilliant!”

    and thus, acupressure was born!

    Acad Ronin:
    1) People have a right to be stupid. Fools and their money…

    I don’t mind the fools being parted from their money, but when the government, insurance companies, and hospitals cover this stuff, the fools are parting me from my money!

    More to the point, you can’t really characterize everyone who accepts this stuff as fools. They don’t know any better. It’s easy for us, sitting here having researched these topics, to disbelief anyone could fall for this stuff. Most of the public has never researched this stuff and feels no need to. They don’t think they need to. Every single time I bring up the idiotic “head on” commercials in public, someone in the audience, sure as sunlight, will say, “if it didn’t work, they wouldn’t be allowed to advertise it on TV!”

    People believe the government protects them from this stuff, that lying in an advertisement is illegal. Technically, it is, but it’s so badly enforced, it might as well not. (At least the FTC is moving against those atrociously awful Enzyte commercials.)

    Acad Ronin:
    2) The problem is generally self-correcting in a Darwinian way; the only downside is the effect on the children of seekers after woo.

    If that was going to work, all forms of quackery would have been extinguished long ago. Sadly, it doesn’t.

    Hmm, don’t let the creationists know we just disproved EVILution. I hope the Global Conspiracy of God Haters doesn’t kick me out for this.

    Rose Colored Glasses:
    This has been bugging me for years. In controlled double-blind studies of homeopathic remedies, what do they use for a placebo?

    They don’t need to do any such things! Don’t you know? It’s been proven beyond a shadow of a doubt that randomized, double-blind, placebo-controlled studies are NOT the way to test homeopathy. Really, they don’t work. This was stated by the PR person for one of the big British homeopathy groups. I’ve been laughing at it ever since.

    It should be pointed out that homeopathy isn’t just materials diluted to the point of non-existence, you have to dilute it in a special way, with lots of vigorous shaking and focusing and what not. (Different schools of homeopathy have different rules, like if you can stir it with a wooden stick or if it has to be glass, or if only metal works, or no sticks, just shaking, or whatever.) So, you can placebo-control any one type of homeopathic “remedy” by simply not following the instructions. Use mundane dilution techniques instead of the magic shaking and stirring and you have diluted, non-homeopathic remedies! This means that, despite the oft-heard joke about every glass of water having the properties of every substance in the universe at maximal dilution, it wouldn’t by their “theory” because it wasn’t diluted “the special way”.

    Irregular Webcomics on Homeopathy:
    http://www.irregularwebcomic.net/675.html

    (The one webcomic you need to increase your regular dose of physics and mathematics!)

  20. #20 coz
    July 26, 2007

    Most of them probably live in Sedona …I love Sedona, its beautiful, but it is Woo Crystal Sucking Central.
    I moved across the world to live in Arizona.
    Don’t try to scare me to leave ;)
    Haven’t needed a doctor yet but this will make me look around before going to one.
    The one thing I have noticed about Flagstaff, there is Chiropractors everywhere, never seen so many in one town. Another place I won’t be going to.

  21. #21 Vjatcheslav
    August 4, 2007

    Chiropractors? You mean those dangerous meat-eating dinosaurs haven’t disappeared? Help, I’ve found another conspiracy!

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