Yesterday, I wrote about SB 31, a proposed law in North Carolina against which uber-quack Mike Adams had mobilized his “health freedom” minions and a crank organization Citizens for Health Freedom and apparently managed to bring some pressure to bear on legislators to water down the bill. The whole incident reminded me how fragile and easily dismantled even the most rudimentary laws and regulations designed to enforce a science-based standard of care and prevent the proliferation of quacks are. Dr. Rashid Buttar, for instance, can team up with a bunch of “integrative medicine” practitioners and pressure the North Carolina legislature to make it easier for him and physicians like him to use unscientific, pseudoscientific, or superstitious “remedies” on patients.
Something else happened that reminded me of past blogging, specifically the case of Dr. Rolando Arafiles. As you may recall, Dr. Arafiles is a physician in Winkler County, Texas who was reported to the medical authorities by two courageous nurses for his dubious medicine and selling supplements to emergency room patients. As a result, Arafiles’ good buddy and former patient (not to mention business partner in hawking supplements ) Sheriff Robert Roberts transformed himself from a combination of Inspector Jacques Clouseau and Sheriff Roscoe P. Coltrane into a veritable Sherlock Holmes. Basically, he tracked down the identities of the two nurses who had made the anonymous complaint against Dr. Arafiles, even going so far as to access their computers in order to find evidence that they were the ones who had written the complaint to the Texas Medical Board. Then he got his buddy Winkler County Attorney Scott Tidwell to prosecute the two nurses, who were both fired from their jobs at Winkler County Memorial Hospital. When it all was over, the nurses were out jobs, out thousands of dollars (which, fortunately, were replaced by the Texas Nurses Association legal defense fund), and out many months of their lives. True, the one nurse of the two who actually ended up going on trial was acquitted, and the Texas Medical Board continued to go after Dr. Arafiles. Even better, the administrator who abused his power and fired the nurses was sentenced to jail time while the Texas Attorney General pursues cases against Sheriff Robert Roberts and County Attorney Scott Tidwell.
Leave it to Texas legislators to try to make sure that this never happens again, but not in a good way:
The House Public Health Committee put its stamp of approval this morning on a much-watered-down version of State Rep. Fred Brown’s Texas Medical Board bill, a measure designed to protect doctors from unfounded complaints.
As altered, HB 1013 would ban all anonymous complaints other than those filed by patients, their guardians or their family and open up the process by which doctors are investigated. These measures would include setting statutes of limitations, providing doctors with details of the charges against them and giving them more time and legal remedies to respond or appeal.
In an interview, last week, Brown said he’s gotten tired of watching Texas doctors get pursued for minor infractions or crippled by long, drawn-out investigations based on anonymous complaints. “We want the Texas Medical Board to go after bad doctors,” Brown said, “but we want it to be fair.”
Not surprisingly, Brown can’t actually provide evidence that the acceptance of anonymous complaints led to the frivolous investigation and prosecution of good doctors, which is the ostensible reason for this bill. In fact, only 2% of complaints against doctors are filed anonymously. there are serious questions about the motivations of the bill’s main supporters. It turns out that the bill’s biggest supporter is Dr. Steve Hotze:
Health care observers have said those elements mirror the very public concerns of the bill’s biggest proponent, Dr. Steve Hotze, a major Republican donor who has built a lucrative practice in suburban Houston around nontraditional therapies and treatments for allergies, thyroid problems and yeast infections. Hotze is best known for promoting natural progesterone replacement therapy for women, a treatment whose effectiveness has been questioned by the federal Food and Drug Administration. He also has a daily health and wellness show that airs on Republican Sen. Dan Patrick’s Houston radio station, KSEV.
It also turns out that Dr. Hotze runs a PAC known as Conservative Republicans of Texas and that many of the legislators supporting the bill have been beneficiaries of the largesse of this PAC, including the bill’s sponsors. He also trots out the same sorts of “health freedom” nonsense that opponents of North Carolina’s SB 31 have been spewing:
Hotze contributed at least $60,000 personally and at least $640,000 via his PAC to GOP House and Senate candidates in the last election cycle (Brown received less than $2,000). In testimony before the House Public Health Committee last month, Hotze espoused the merits of alternative therapies, as well as the off-label prescribing that led the public to discover what else the medications now known as Rogaine and Viagra — both originally intended to treat high blood pressure — could be used for. “Our opponents have said this is all about snake oil. What they mean is these doctors use natural approaches to health,” Hotze testified. “This is a turf war between conventional medicine and alternative natural approaches to health.”
Advocates of alternative medicine frequently complain that the law is a tool that enforces the monopoly of conventional medicine. Would that were the case! If that were the case, then there would not be such a proliferation of “complementary and alternative medicine” (CAM) and “integrative medicine” (IM), which “integrates” pseudoscience and quackery with science-based medicine and tries to argue that that’s a good thing. It’s not.
Dr. Hotze tries to argue that the reason he is pushing this bill is because he had been the victim of baseless anonymous complaints and believes that these complaints originated from competitors. While that is possible, one has to come back again to the fact that only 2% of complaints against Texas physicians are anonymously filed. It also ignores what happened to Anne Mitchell, RN, and Vickilyn Galle, RN. They are the two nurses who reported Dr. Rolando Arafiles and suffered as a result of it. Their story shows that the mechanism of anonymous complaints against doctors isn’t a trivial matter that isn’t needed. Their case demonstrates just how dangerous it can be to file a complaint against a physician, particularly a popular physician in a town that needs physicians, especially when that physician is connected. Mitchell and Galle demonstrate just how far some physicians and hospital administrators will go to track down whistleblowers.
In fact, Dr. Hotze reminds me of Dr. Arafiles in his advocacy of dubious therapies. For example, Dr. Hotze advocates woo such as bioidentical hormones, various remedies for hypothyroidism that is or isn’t, testosterone replacement therapy, and various allergy therapies. Dr. Arafiles treated Morgellons. Both clearly know how to make a buck plying therapies that are not based in science.
It’s not just alt-med practitioners, either. In Texas, at least, the anti-vaccine movement has hooked up with the “health freedom” movement, even going so far as to have Andrew Wakefield speak in favor of “functional medicine,” while in the meantime Texans for Health Freedom are promoting a variety of bills that include HB 1013, among others. Of particular interest is HB 2455, which would codify into law “integrative medicine” as a fully legal health care modality defined as:
…a medical system of diagnosing, treating, or correcting real or imagined human diseases, injuries, ailments, infirmities and deformities of a physical or mental origin and includes acupuncture, chelation therapy, homeopathy, minor surgery, and nonsurgical methods, the use of devices, physical, electrical, hygienic, and sanitary measures, and all forms of physical agents and modalities, neuromuscular integration, nutrition, orthomolecular therapy, and pharmaceutical medicine.
It would even establish a board of integrative medicine, with six practitioners and three lay members. Yes, HB 2455 would license quackery like homeopathy, making it perfectly legal in the state of Texas, co-equal with science-based medicine in the eyes of the law. I don’t know what the odds of this bill passing are, but given the history of Texas and pseudoscience, specifically the success creationists have had in the legislature, I wouldn’t necessarily bet against it.
Practitioners and advocates of CAM and IM like to paint themselves as being the underdogs. They especially like to portray themselves as being “persecuted” by conventional medicine and the law, the victims of a grand conspiracy between the AMA, big pharma, and the government to keep them down. Indeed, Mike Adams has made a veritable cottage industry out of just that bit of paranoia. In reality, the law in most states is incredibly lax, and most state medical boards underfunded, outgunned, and out-funded. CAM has become big business, even to the point where chambers of commerce promote it as a new health care industry. It’s also become politically powerful, as Drs. Rashid Buttar and Steve Hotze demonstrate. It is not the underdog anymore. Until advocates of science-based medicine understand that, they will never realize how to combat it.