Wednesday, August 09, 2000

Alternative medicine regulation remains inconsistent

As more people choose holistic treatment, debate continues about licensing procedures

By Peggy O'Farrell
The Cincinnati Enquirer

        Frustration with traditional medicine is sending more people to acupuncturists, energy healers and other alternative health care providers.

[photo] Dr. James Robert Leonard discusses acupuncture treatment with Carissa Simpson of Blue Ash
(Glenn Hartong photo)
| ZOOM |
        More than 40 percent of all Americans now participate in some alternative treatment, studies show.

        “Women are completely frustrated,” says Hyde Park chiropractor Dr. David Dahlman. “They're driving the paradigm shift from traditional medicine to the alternative therapies. They're tired of being drugged, and they know full well that drugs only suppress symptoms. They offer no cures.”

        But from state to state, the regulation of alternative medicine varies widely. That doesn't mean practitioners in Ohio are better or worse than they are in Kentucky or Indiana. In fact, many of these practitioners train in one state and obtain a license in another.

        As practitioners work to gain wider acceptance, standards are changing.

        As of this month in Ohio, acupuncturists will no longer have to be physicians. And this fall, Ohio physicians who practice alternative medicine will be required to meet the same standards of care as those who offer traditional remedies.

        Here are the requirements for credentials:

        • In Ohio, all practitioners must be licensed by the state to offer any kind of treatment.

  Ohio has about 2,000 practicing chiropractors Kentucky has 664 licensed chiropractors.
  Butler County: 82
  Clermont County: 48
  Hamilton County: 472
  Warren County: 88
  Kentucky doesn't license massage therapists.
Sources: State Medical Board of Ohio, Ohio State Board of Chiropractic Examiners, Kentucky Board of Chiropractic Examiners
        • In Kentucky, physicians, chiropractors and nurses must be licensed. Kentucky law requires only a certificate from the institute where the massage therapist, energy healer or other “hands on” practitioner trained.

        • In Indiana, practitioners of any kind of “hands on” treatment must be licensed. The state also licenses hypnotists.

        Having a license “does add credibility” for practitioners and care centers, says Kathy Ison, interim regional director at the Mercy Holistic Health and Wellness Centers.

        For consumers who want to know what kind of credentials a particular practitioner has, experts have a simple piece of advice: ask.

        “The consumer should ask questions about what kind of education and training the provider has received,” says Tom Dilling, executive director of the State Medical Board of Ohio.

Tristate variables
        Ohio's medical board licenses physicians, certified massage therapists, physician's assistants, cosmetic therapists and napropaths and mechanotherapists, uncommon specialists whose techniques resemble chiropractic.

        The State Board of Chiropractic Examiners licenses chiropractors.

        Also in Ohio, practitioners have to have a state license, either as a physician, massage therapist, chiropractor or nurse, to offer any kind of treatment to consumers, Mr. Dilling says.

        In Kentucky, physicians, chiropractors and nurses are licensed by the commonwealth, but a practitioner without any of those licenses can hang out a shingle as a massage therapist, energy healer or touch therapist with just a certificate from the training institute he or she attended.

        Individual clinics, hospitals or other sites might have stricter requirements for practitioners. St. Elizabeth Medical Center requires its therapists to be state licensed, says Toni Schklar, who oversees the hospital's complementary therapies program in Edgewood. Most of St. Elizabeth's practitioners are also licensed in Ohio, either as nurses or certified massage therapists.

        Until this year, all three states required acupuncturists to be licensed physicians, either MDs or osteopaths, with additional hours of education and internships in acupuncture.

        Although Ohio has eliminated the requirement that acupuncturists be physicians, the practitioners must complete training and internships and work under the supervision of a physician, Mr. Dilling says.

Background debate
        Most practitioners agree acupuncturists should either have a medical background or work under a physician's supervision.

        There is some disagreement, though, as to whether a healing touch practitioner, for example, needs a medical background.

        Healing Touch International, the Colorado-based foundation that endorses and oversees training of its practitioners, doesn't require its therapists to have any medical background. But many practitioners are nurses or certified massage therapists.

        Sue Williams, a registered nurse and certified healing touch practitioner, says nursing recognizes energy field disruption as a specific diagnosis, which might explain why so many nurses are in the practice.

        But, she adds, “to do energy work, it's not necessary to have that medical background. One part of healing touch is healing touch and spirituality, so it addresses people who are in pastoral care.”

        Ms. Williams doesn't think practitioners without licenses are any less qualified than those with licenses, as long as they've completed the required training.

        “I don't see them as charlatans at all. I think (licensing) is something people get caught up in,” she says.

        At Mercy, Healing Touch is offered as part of an overall plan and patients have to have a doctor's diagnosis for a specific illness before getting the therapy, says Mary Barth, a nursing practitioner and certified healing touch therapist and instructor.

        Offering the therapy without a diagnosis “could be setting up a not-so-safe environment of practice,” Ms. Barth says.

        At the hospital-based centers, alternative or complementary therapies are touted as being offered in support of traditional medical care, not in place of it.

Alternatives grow
        Depending on your definition of alternative medicine, more than 40 percent of Americans use some form of it, says Dr. Steve Amoils, medical director of the Alliance Institute for Integrative Medicine in Kenwood. Eighteen percent of Americans use herbal supplements to try to improve their health.

        Dr. Amoils is a medical acupuncturist. He doesn't believe acupuncturists must be physicians, but he does think they should have a good background in medicine “plus competency in their art” as acupuncturists.

        “I'm much more comfortable with physicians. Physicians are well-trained in infections and in when to worry and when not to worry,” he says. “But there are excellent acupuncturists who are not doctors.”

        More and more physicians are using alternative therapies or referring their patients to practitioners. Several hospitals and hospital systems in Greater Cincinnati — including Health Alliance, Tri-Health, Mercy and St. Elizabeth — have opened centers focused on complementary therapies.

        That physicians and hospitals, once strongholds of Western medicine, are beginning to endorse some complementary therapies may lend those practices more credibility in consumers' eyes.

        At Mercy's holistic centers, only 10 to 20 percent of patients are referred by a physician. The rest choose to come on their own, Ms. Ison says.

        More research is focusing on how and why those therapies work. St. Elizabeth is participating in some of that research, Ms. Schklar says. There is evidence that tai chi, for example, helps lower blood pressure and that massage can strengthen the immune system.

        “We're trying to get more data to support that,” Ms. Schklar says. “Just because something feels good is nice, but it's good to have the data to go along with it.”


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