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.