Susan Delaney has been trying for more than a decade to get the state to license her profession. A graduate of one of the nation's few accredited schools for naturopaths, Delaney has been working to convince lawmakers that licensing is needed to elevate standards and protect the public from untrained practitioners of her branch of "alternative medicine."
While public demand for alternative therapies is growing (studies show more than one-third of American adults are using them to the tune of $40 billion annually), regulation of the field has been spotty. In North Carolina, massage therapists, acupuncturists and chiropractors are currently the only non-traditional healers who are recognized by law.
Delaney wants North Carolina to join 12 other states that license naturopathic physicians and set standards for their training. "Right now, it's a free for all," she says. "To really bring the practice to where it belongs, people need to have credentials."
The state Medical Society has been one major roadblock to licensing. Many doctors are reluctant to grant naturopaths--who focus on preventing disease through diet, exercise, biofeedback and herbal remedies--an official stamp of approval.
But an equally serious challenge is coming from within--from naturopaths and other alternative practitioners who see licensing as a threat to their livelihoods.
At a Jan. 11 legislative hearing on the issue, members of the Joint Select Study Committee on Naturopathic Licensing reported receiving nearly 100 e-mails from such opponents of regulation. "They say a bill would prevent them from doing what they do," said state Sen. William Purcell (D-Scotland County), one of 16 lawmakers on the study committee, which will meet again Feb. 1 to decide whether to recommend legislation.
Julia Insley was one of those voices. A practitioner of homeopathy--which, like naturopathy, uses natural substances to treat illness--Insley told the committee that licensing will limit consumer choices by effectively outlawing all but a select few therapies.
"This small group of naturopaths is looking to control everyone else," said Insley, who is vice president of the statewide consumer group Citizens for Healthcare Freedom. "The clauses and language in this bill would allow this group to define the scope of practice in such a way that it would put hundreds of other practitioners out of work."
A draft bill circulated at the hearing would grant licenses only to naturopaths who have degrees from accredited schools--about 22 people statewide, according to the committee proceedings. Those who earn their degrees through correspondence courses or other non-accredited routes would be unable to call themselves naturopathic doctors.
In a worst-case scenario, said Insley, such practitioners could be prosecuted for practicing medicine without a license. That's why her group supports a "health freedom" bill that would exempt alternative healers from penalties under existing law, so long as they disclose the type and extent of their training to patients. State Rep. Paul Luebke (D-Durham) introduced such a bill last session (HB 923), but it died in committee.
Efforts to license naturopaths in other states have run into stiff resistance from groups like the Coalition for Natural Health, whose lead lobbyist, Boyd Landry, spoke to an earlier meeting of North Carolina's legislative committee. Delaney says Landry's group has a vested interest in scuttling licensing bills because it represents correspondence schools whose graduates would not be recognized under the law.
Delaney has complained to the state Attorney General's office about such schools. And she reminded committee members that in 2002, a correspondence school graduate, Buncombe County naturopath Laurence Perry, was convicted of involuntary manslaughter and practicing medicine without a license after an 8-year-old diabetic girl died of insulin deprivation under his care.
Anthony Noto, co-founder of Citizens for Healthcare Freedom, counters that Delaney's group likes to cite such cases because it has an interest in limiting who can practice.
"The naturopathic doctors are really trying to get a monopoly on this," he says. "Licensing really protects those individuals more than the public."
Arguments over licensing will only get louder as alternative medicine grows more popular, says Michael Cohen, assistant professor of medicine and director of legal programs at Harvard Medical School. Cohen, who has written about credentialing efforts in other states and has a blog on the issue (www.camlawblog.com) says licensing proposals have led to "deep philosophical debates" about whether alternative medicine should be regulated the way conventional medicine has been for a century or more.
"Protectionism is the dark side of quality control," Cohen says. "The debate is over whether we want and need this. Does it protect the public?"
At the legislative committee meeting in Raleigh, members were wrestling with the same question.
Except for the Asheville case, there have been few reported problems with alternative medical practitioners in North Carolina. In 2002, the state Medical Board referred four cases of practicing without a license to the state Attorney General's office, according to the board's Web site. In 2003, it referred only one.
"If we have people who are practicing and no major complaints, what is the compelling state interest in passing a licensing bill?" asked Rep. Earl Jones (D-Guilford).
But supporters of licensing say the lack of complaints is mainly due to the absence of an official mechanism for gathering them.
The same could be said of appeals to the legislative committee. "There are thousands of people who are interested in alternative medicine," said Sen. Ellie Kinnaird (D-Orange), a committee co-chair. "We're not hearing from them because they don't even know we exist."
Kinnaird believes the committee can craft a licensing bill that will satisfy both the medical establishment and factions within the alternative community--and expand treatment choices in the process. She asked that a new draft be created that contains language protecting alternative practitioners, as well as "tightening up what we demand from someone who practices naturopathy."
But some say the absence of consumer hue and cry makes it unlikely that a bill will emerge this session.
"I think this train is a long way off," said Rep. Dewey Hill (D-Brunswick), another committee co-chair, as the recent meeting drew to a close. The Feb. 1 meeting will be held in room 1124 of the legislative building.