The Skeptics Society & Skeptic magazine


Draw Them A Picture:
How Skeptic Activists and a Cartoon Kept Quacks Away from Infants

For over two decades a few dozen “degreed” naturopathic “doctors” (DNDs) in Colorado repeatedly failed to achieve, through political means, the recognition they craved as “the equivalent of physicians.” But in the last two years, a change in the local political landscape has given Complementary and Alternative Medicine (CAM) unprecedented leeway in the state.

Since the early 1990s, a total of eight bills proposing Naturopathic Doctor (ND) licensure were voted down by Republican-controlled legislatures, even though these bills went largely unopposed by the state’s medical societies. A lobbyist for the Colorado Medical Society (CMS) claimed licensure would allow MDs to “keep an eye” on DNDs. Other issues took priority with the CMS leadership. They could hardly be bothered by a handful of fringe practitioners—less than a hundred—even though they kept practicing in the state in spite of their unlicensed status.

The DNDs kept losing even though they had the financial backing of numerous alternative supplement companies. Even in the growing healthcare market, they required outside recognition in order to appear legitimate and useful to a wary public.

There were a number of reasons legislators rejected licensure over the years. Many Republicans recognized the additional budgetary burden of including DNDs in the healthcare system. Some legislators had their doubts about naturopathy after consulting their own physicians. One Democrat saw licensing DNDs as a threat to the state’s Hispanic curanderos (traditional healers).

Additionally, a few legislators heeded the testimony of skeptics, specifically Mark Johnson, MD, the articulate medical director of the Jefferson County Health Department, serving one of Colorado’s largest counties. Dr. Johnson was, at the time, president of the American College of Preventive Medicine. He had grown up with naturopathy in his family and knew its foibles well. He testified about naturopathy’s undefined scope of practice and about a litany of serious medical procedures not prohibited by the bill’s language—procedures that DNDs are dangerously unqualified to perform. But he could charm everyone, as when he thanked the DNDs for introducing so many bills that he had come to discover the best parking and restaurants near the Capitol.

The greatest obstacle to legislative success by DNDs were the hordes of angry “traditional” naturopaths (TNDs) who filled hearing rooms, claiming hundreds of them in the state would be put out of business by state requirements for licensure. The TNDs protested that the motive behind these licensing bills was to create special-interest guild legislation allowing only a small minority of practicing naturopaths—those who went to the “right” schools —to enter the “profession.” More than once, legislators told the feuding DNDs and TNDs not to come back until they had “kissed and made up.”

2013: Democrats Take Control

Fired up over the defeat of a Colorado civil unions bill in 2012, Democrats swept the fall elections and stormed the Colorado House and Senate in the 2013 session with a vengeance. For the first time since the 1960s, Democrats were in complete control of both houses of the legislature and the governorship. Callow, self-assured freshmen now ruled the roost. For the first time, there was a gay caucus, and it insisted on strict party discipline on every bill authored by members of their caucus. A record 400 bills were passed, most notably regarding civil unions and gun control, with precious few authored by Republicans. Not one bill sent to the governor’s desk was vetoed, causing considerable public comment.

The DNDs saw their opportunity to get a bloc of Democratic votes and reintroduced their failed bill from 2011, this time authored by a member of the gay caucus. Everyone ignored the procedural fact that the Department of Regulatory Agencies (DORA) was in the middle of a statutorily required “sunrise review” that could not be finished until after the session.

Meanwhile, the TNDs came up with a solution to their family feud with the DNDs: a “Health Freedom Act” (HFA), allowing all CAM practitioners to also practice unimpeded by exempting them as well from provisions of the Colorado Medical Practice Act. The same bill language that gave practice exemptions to DNDs because of their education would also give exemptions to anyone off the street calling himself a “CAM provider.” This parity was characterized by the TNDs and CAM providers as a “fairness” issue, claiming there was no discernible difference between their practices and those of the DNDs. (Ironically the TNDs made a good point—it could even be argued the DNDs posed an even greater danger to the public since they considered themselves the equal of physicians.)

Both of these bills were industry-driven and clumsy, with precious little in the way of consumer protections. For example, DNDs were required to have $1 million in malpractice insurance, but it was not specified whether the requirement was per lifetime, per year, or per incident. And while the HFA only protects CAM providers from regulators, the language was grafted onto the Colorado Consumer Protection Act.

The bill hearings quickly turned into street theater. Gone was the traditional courtesy, both between legislators themselves and between legislators and the public. Some Democrat legislators rudely left the room, or turned their backs on people offering testimony. Legislators got personally nasty with some bill opponents, while effusively thanking allies of the bill. One representative gushed about how homeopathy helped her child’s teething. Astounded skeptics heard another legislator give an impromptu speech about a wonderful guy named Stanislaw Burzynski—whose alternative cancer treatments had been discredited—and how Colorado needed more practitioners like him.

In the end, it was Democratic party-discipline that won the day for both bills. On four different occasions in different committees, the DND bill would have failed if one Democrat had voted against it. A dramatic example of this was when one legislator announced that he would vote for the bill (“to move it along”)—but who then went on to list a litany of problems the bill would create for consumers and the state budget. The bill passed the committee, 6-5.

Medical professionals were late coming out against these bills, although when they eventually did so, they managed to affect the final language. Pediatricians succeeded at the last minute to restrict the treatment of younger children. As passed, DND, TND, and “CAM practitioners” are not allowed to treat children under 2 years of age, and there are special requirements for treating children between 2 and 8.

All in all, the 2013 legislative session in Colorado was a frustrating experience and a huge defeat for science-based healthcare. But the Democrats were to get a come-uppance. The same ill-mannered process detailed here when used on the gun lobby resulted in the recall of two senators (one being the Senate President). A third senator, facing a recall, resigned. This was a first in Colorado history, and it served to rein in legislators.

2014: An Alternative Medicine Rematch

The 2014 Colorado legislature is still controlled by Democrats, but now they are falling all over themselves to be more accommodating to public input. Some might say too polite. Everyone gets to testify, even if the hearings last until midnight. They listen attentively and ask polite questions. But despite this rediscovered wisdom, votes are still cast along strict party lines.

Predictably, alternative medicine proponents returned to press their luck. This time around they wanted unimpeded access to children, a major part of their business. SB-32 would allow TNDs and “CAM providers” to treat anyone of any age. The bill authors had extended the privilege to DNDs as well, preserving the symmetry between the two groups.

But the DNDs were apparently uncomfortable with changing the deal struck the year before that had reconciled the pediatricians with accepting DND licensure, even though DNDs were undoubtedly miffed about the restrictions on treating children. (One Colorado DND wrote online that she intended to continue treating infants anyway.) But the DORA rule-making process for DNDs was still unfinished, delaying the start of licensure until June 2014. SB-32 might delay it further. And besides, the DNDs already had what they wanted: licensure gave them the state imprimatur for their profession, and as noted in their newsletter, positioned them for “major insurance offering” under the non-discrimination provisions of Patient Protection and Affordable Care Act (PPACA).

So the DNDs said “no thanks” and excused themselves from SB-32. Thereafter, the bill was strictly about TNDs and CAM providers—framed as a “parental rights” bill that would allow parents to choose CAM providers and “natural remedies” for their infants.

Among the many healthcare professionals and skeptics testifying against SB-32, the Colorado chapter of the American Academy of Pediatrics was the biggest player at the table. They described at length the fragile nature of infants and the dangerous anti-vaccination influence of CAM practitioners and naturopaths. But their Achilles’ heel was having to acknowledge that their national organization considers it appropriate for pediatricians to work jointly with CAM providers.

The Colorado Medical Society, the Institute for Science in Medicine, and Colorado Citizens for Science in Medicine also testified against the bill. Warnings about the true nature of CAM and the need for science, ethics, professional education and training—all seems to go in one legislative ear and out the other. SB-32 got solid bipartisan support in the Senate.

I had testified about the importance of having science as the standard in healthcare when a representative from Boulder responded: “Science? What’s so great about science? Look at Scientology!”

SB-32 was then expected to sail through the House. It’s first stop would be that den of CAM enthusiasts known as the House Health Committee. The situation was developing much like the defeats of previous years when I first learned what we were up against. Flashback: I had testified about the importance of having science as the standard in healthcare when a representative from Boulder responded: “Science? What’s so great about science? Look at Scientology!”

A Skeptic’s Long Shot

About the time the bill was up for its public hearing, issue 19.1 of Skeptic magazine reached mailboxes nationwide. Therein was a very clever, fullpage illustration by Kyle Sanders, a pilot and cartoonist who pens a skeptical comic strip called Carbon Dating (available at Carbon-Comic.com) and contributes regularly to Skeptic. This simple comic put “alternative medicine” in sharp perspective by applying its principles to aviation.

When well-reasoned arguments, long lists of risks, and compelling testimony by esteemed health professionals had all failed to persuade senators against the alternative medicine bill, what else was there to try? With nothing to lose (after gaining support from both Skeptic magazine and Sanders), I distributed the cartoon to members of the House Health Committee, along with a short plea to kill SB-32: “The below cartoon is a perfect illustration of what we would get if ‘Alternative Medicine’ were applied to aviation.” The satirical cartoon certainly addressed the high stakes of this situation.

To everyone’s surprise, the bill was killed by a vote of 6 to 3—not even a squeaker, but a clean kill. How did that happen? We may never know the specific reasons behind SB-32’s demise, but nothing else had changed to account for this turnaround. The variable that did change was the cartoon, dispatched at the last minute.

When it comes to legislators with a negligible understanding of science or ignorant of alternative medicine, maybe what’s needed is to literally draw them a picture. END

About the Author

Linda Rosa is a Colorado registered nurse who currently serves as Executive Director for the Institute for Science in Medicine. Ms. Rosa acknowledges the contributions of Maureen Maker and Larry Sarner, citizen lobbyists for Colorado Citizens for Science in Medicine.

Holistic Airlines Carbon Comic, by Kyle Sanders

Click the comic to enlarge it.

About Carbon Comic

Carbon Comic is created by Kyle Sanders: a pilot and founder of Little Rock, Arkansas’ Skeptics in The Pub. He is also a cartoonist who authors Carbon Dating: a skeptical comic strip about science, pseudoscience, and relationships. It can be found at carboncomic.com.

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