Alternative Medicine Debated by Nevada Legislators

As more people turn to alternative practitioners for their medical needs, Nevada needs better regulation of alternative medicine to protect consumers, lawmakers were told Wednesday.

Sen. Mike Schneider, D-Las Vegas, said some doctors can't do alternative therapies because the regulatory structure isn't there. He asked the Senate Commerce and Labor committee to pass five bills affecting alternative medicine.

The main part of Schneider's plan is SB432, which would get rid of the state Board of Homeopathic Medical Examiners and replace it with a board regulating "complementary integrative medicine," or alternative medicine. Schneider said the current board's authority is too narrow in focus.

That bill also changes the makeup and scope of several other state regulatory boards.

SB413 would mandate that insurance companies accept "ABC Codes," a new type of coding system that has more detail about alternative therapies. Using that system would make it easier for practitioners such as chiropractors, massage therapists and homeopathic doctors, said its supporters.

Using ABC codes could make it easier for massage therapists to get respect -- and money -- from insurance companies, said Billie Shea, head of Nevada's Board of Massage Therapy. But she worried that other aspects of Schneider's proposals could over-regulate some massage therapists.

Non-medical massage therapists don't make more than $40,000 or $50,000 annually, and already have to pay for multiple business and professional licenses, she said.

Larry Matheis, director of the Nevada State Medical Association, opposed all the bills. Schneider's approach wouldn't do anything to integrate alternative medicine into the existing health care system, which already is occurring, said Matheis. Rather, it would create a new state bureaucracy that could endanger patient safety, he said.

The existing medical boards offer sufficient regulation while Schneider's plan would allow unlicensed practitioners to get into the medical field, Matheis said.

"That is a dangerous step," said Matheis. "Your responsibility is patient safety, is public safety. If you're going to err, you have to err on that side."

Deborah Klein, representing the Nevada Dietetic Association, said proposed regulations for "medical nutritionists" in SB432 were vague and should be stricken. They would deceive the public into believing that nutritionists are qualified to do what dietitians do, said Klein.

"Basically, anyone can call themselves a nutritionist," said Klein. "However, they do not have the qualifications of a registered dietitian."

Some of the opposition to his bills came from traditional practitioners who "don't want to give anything up," said Schneider.

"The goal is to get more health care to more people are a more reasonable price," he said.

Should NICE evaluate complementary and alternative medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In last week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary and alternative medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary and and alternative therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.

Head To Head: Should NICE Evaluate Complementary And Alternative Medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In this week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.