By Elaine A. Lisko, Health Law & Policy Institute

Americans are consulting alternative or complementary health care practitioners with greater frequency. The increasing demand for alternative treatments stems in part from the public’s concern with the accessibility, cost, and disease-oriented approach of conventional medicine. The growing acceptance of alternative medicine is reflected not only in the number of people who seek out these treatments but in the number of health insurers that are beginning to cover them.

The Journal of the American Medical Association reports that conventional medical schools have also responded to the public’s expanding desire for alternative medicine. Sixty-four percent of U.S. medical schools that responded to a recent survey indicated that they offer courses in alternative medicine, including acupuncture, homeopathy, herbal therapies, and mind-body techniques. Miriam S. Wetzel, Ph.D., David M. Eisenberg, M.D., Ted J. Kaptchuk, O.M.D., Courses Involving Complementary and Alternative Medicine at U.S. Medical Schools, 280 J.A.M.A. 784 (Sept. 2, 1998). The conventional medical profession’s current receptiveness is somewhat surprising in light of its historical resistance to alternative medicine.

The latitude given to alternative health care providers will depend in large part on whether and how the states decide to regulate their practice and the role that conventional medical practitioners take in that regulation. The practice of homeopathic medicine provides a good example.

Homeopathic medicine uses natural substances to promote health, prevent disease, and treat acute and chronic health problems. The natural substances are often highly diluted before being administered. At least five states have established or considered establishing a board of homeopathic medical examiners to license and regulate homeopathic physicians. The composition of the boards or proposed boards varies under the terms of the statutes. The referenced, enacted and proposed state statutes addressing the composition of homeopathic medical boards are:
 

State	Statute/Bill	Homeopathic Board Membership
Arizona	Ariz. Rev. Stat. Ann.  § 32-2902(A)	4 homeopathic physicians + 2 public members
Connecticut	Conn. Gen. Stat. Ann.  § 20-8	3 homeopathic physicians + 2 public members
Nevada	Nev. Rev. Stat. Ann.  §§ 630A.100 & 630A.110(1) & (2)	4 allopathic or osteopathic physicians (engaged in the practice of homeopathic medicine) + 3 non-physicians (not actively engaged in the administration of any medical facility and not having a pecuniary interest in any medical facility)
Oklahoma	Okla. H.B. 3259 (introduced on 02/02/98; 1998 regular session adjourned without any carryover)	3 homeopathic physicians
Texas	Tex. S.B. 1390 (introduced on 02/18/97; 1997 regular session adjourned without any carryover)	4 homeopathic physicians + 2 public members

While the states that have considered or have actually established boards of homeopathic medicine essentially provide for self-regulation, with the exception of public members, the presence of conventional physicians remains an integral part of the process. As noted, Nevada expressly requires that homeopathic board members be licensed to practice conventional medicine. Additionally, Arizona appears to have a similar requirement. Although its statute on homeopathic board membership does not expressly state that conventional licensure is required, its statute setting forth the prerequisites for homeopathic licensure provides that an applicant must hold a license to practice conventional medicine. Ariz. Rev. Stat. Ann. § 32-2912(A)(3). As a result, any homeopathic physicians on its board have to be licensed to practice both conventional and homeopathic medicine. The Texas bill had a comparable requirement. To the extent that other states take an even more extreme position, requiring the presence of conventional physicians without also requiring that the physicians be licensed or engaged in the practice of homeopathic medicine, the historical friction between conventional and non-conventional, alternative medicine will more than likely persist.

Interestingly, Virginia has instituted something of a middle position, establishing a single board of medicine with regulatory powers over practitioners of conventional as well as alternative medicine. The board consists of one medical physician from each congressional district, one osteopathic physician, one podiatrist, one chiropractor, one clinical psychologist, and two public members. Va. Code Ann. § 54.1-2911. A multi-faceted board of this nature appears to move toward a more integrated system of medicine than exists in the U.S. currently.

Another form of alternative medicine, naturopathy, has been recognized and regulated by even more states. Naturopathic medicine uses natural therapeutics and procedures in conjunction with modern medical scientific diagnoses to remove toxic conditions in the body. Over ten states license and regulate naturopathic physicians, including Alaska, Arizona, Florida, Hawaii, Maine, Montana, New Hampshire, and Oregon.

State regulation of alternative medicine can be expected to continue especially if Congress passes the Access to Medical Treatment Act. The Act provides in pertinent part that, "an individual shall have the right to be treated by a health care practitioner with any medical treatment (including a medical treatment that is not approved, certified, or licensed by the Secretary of Health and Human Services) that such individual desires … if … the administration of such treatment does not violate licensing laws." Arguably, the Act affords patients greater freedom to choose alternative treatments, subject to certain limitations. The Act was introduced to the U.S. House of Representatives and the U.S. Senate through the following bills:
 

Bill	Sponsor	Status
H.B. 746	DeFazio (D-Oregon) With 70 cosponsors	Introduced and referred to House Committee on Commerce on 02/13/97; Referred to Subcommittee on Health and Environment on 03/7/97; No floor action taken
S. 578	Daschle (D-South Dakota) With 13 cosponsors	Introduced and referred to Senate Committee on Labor and Human Resources on 04/15/97; No floor action taken

09/23/98