history of the regulation of alternative medical therapies, particularly
Homeopathy, is extremely interesting and sheds a great deal of light
on the current regulatory environment. In this short review of that
history, it can be seen that the current attempts at regulation
have roots as far back as 200 years ago.
early 1800's was a time of great transition in medicine. Whereas
the standard, allopathic form of treatment was dominant at the turn
of that century, that was not to last. The two most popular alternatives
to the orthodox practice were herbal medicine and Homeopathy.
the time Homeopathy was introduced to America in 1825, herbal medicine
was already well established. Equally well established was the allopathic
doctors' animosity towards any competition. The rise of Homeopathy
particularly coincided with a dramatic decline in the prestige of
allopathic medicine and its methods. There was a general and pervasive
disdain and mistrust of allopathic medicine. One author concluded
that "to many people the interests of the medical profession
as a whole were opposed to the best interests of society."
15 years of being introduced to America, Homeopathy was offering
serious competition to allopathic medicine and by 1860, Homeopathy
was flourishing with many doctors available in every state. The
biggest asset to the spread of Homeopathy was the home prescriber,
or unlicensed lay practitioner. America of the 1800's was predominantly
rural and most areas had no physician close at hand. Mothers treating
their children's problems easily and inexpensively caused the news
of Homeopathy to spread like a brush fire throughout the mid-west
and eastern seaboard. While political battles and turf wars raged
between the doctors, many people successfully treated typhoid, cholera,
measles, mumps, tuberculosis, smallpox and other diseases with their
Homeopathic remedies and without doctors.
the press of the day were favorable to Homeopathy and its articles
often reflected the general public's contempt for allopathic medicine.
One such article condemned "the rigidly anti-innovative attitude
which the Old School doctors have so consistently maintained for
centuries" and recommended that there be free and open competition
between the two systems, "where the public will act as umpires,
deciding after a careful perusal of the undertakers bills on either
a consequence, extreme hatred and economic jealousy was aroused
in the allopaths. These economic concerns were well documented.
One review wrote of Homeopathy, "quackery …. by fraud and
deception, too frequently triumphs and grows rich, where wiser and
better men scarcely escape starvation." In 1846, The New
York Journal of Medicine stated, "quackery occasions a
large pecuniary loss to us."
public was quite willing to pay high fees for Homeopathy, much to
the consternation of the economically struggling allopaths. Most
Homeopaths had higher incomes than their allopathic counterparts,
having busy, thriving practices in the same areas where allopaths
couldn't earn enough to live. The annual income for an allopath
in 1871 averaged $1000, whereas a Homeopath's averaged $4000.
allopaths blamed the public for the situation, contemptuously regarding
them as ignorant, undiscriminating and easily deceived, clearly
needing to be protected from their own perverse ignorance. It never
occurred to the allopathic doctors that the public, rather than
being ignorant of orthodox medicine, were very familiar with it
and consequently didn't like it.
you think doctors have outgrown this attitude from 1800, I will
refer you to the recent article in the prestigious allopathic journal
The New England Journal of Medicine. After reviewing the
habits of a large cohort of patients, it was concluded that one
third of Americans use some method of non-conventional medical treatment
and pay more out of their own pocket to do so than the combined
money spent on all primary care allopathic office visits. As a result
of this startling finding, the authors did not suggest further investigation
as to why such a large number of patients prefer non-traditional
treatment, nor was it suggested that these treatments must have
something valuable to offer. Instead, in a move reminiscent of attitudes
over 150 years old, the authors advised that doctors inquire if
their patients are using some form of non-conventional therapy so
that they can better bring these errant patients back to conventional
brunt of the blame for declining allopathic fortunes was laid at
the door of the Homeopaths. The allopaths had concern about the
growing competition from Homeopathy, stated as "quackery in
the profession." They felt the apparently declining standards
of medical education was the cause of physicians converting to Homeopathy
and these ideas were the prime motives in the founding of the American
Medical Association in 1847. It is interesting to note that the
professional organization for Homeopathy equivalent to the AMA,
the American Institute of Homeopathy, was founded earlier in 1844,
making it the oldest professional medical organization.
efforts were used to advance the allopaths by discrediting, restricting
and abolishing the Homeopaths. Typical were the laws passed in the
early 1800's to prevent any practitioners of medicine other than
the allopaths from being able to go to court to collect non-payment
of fees. In every case, these and other similar laws were unenforceable
and extremely unpopular with the citizenry. All were repealed within
a few years.
the allopathic doctors then turned to their own medical societies
rather than the legislative process to carry out their desire for
effective restriction of Homeopathy. Allopaths granted themselves
the right to restrict society membership, which was tantamount to
licensing powers. Fines were levied against anyone practicing medicine
without such a society membership. They had successfully usurped
the power to control who could practice. Eventually even these fines
were also rescinded due to unpopularity with the citizens.
and New York were the first states to forbid membership in the society
by medical doctors who practiced Homeopathy. State medical society
membership and representation in the AMA required that these societies
purge themselves of any member Homeopaths. After 1847, all state
societies did this, except Massachusetts. In addition, professional
exchange, consultation and even conversation between allopaths and
Homeopaths were banned. This ban on interaction between the two
groups is a striking example of how a private organization, the
AMA, could completely flout the public will, and take punitive action
for something that was totally legal.
this speaks of the restraint of trade. All professions have used
laws, licensing, legislation, unions and guilds to protect their
own economic interests. Not surprisingly, the suppression of Homeopathy,
then and continuing to this very day, is seeped with the same motives.
of the efforts at abolishing Homeopathy, including state society
expulsion, were particularly effective until the turn of this century.
Then, it wasn't legislation or licensing that was responsible for
the decline of Homeopathy. The infusion of large amounts of money
from Carnegie and Rockefeller to the cause of allopathic medicine
was instrumental in tipping the scales in its favor. It is ironic
that Rockefeller, a beneficiary of Homeopathic treatment himself,
should fund its demise. The final shove out the door of popularity
was the discovery of antibiotics and the dawning of the age of chemical
the middle of this century, Homeopathy was all but eliminated. The
thousands of practitioners had vanished, the hundred or so medical
schools had closed and the vast majority of the general population
had never even heard of Homeopathy.
reemergence of Homeopathy started in the early 1970's as disillusionment
with the pharmaceutical approach of medical therapeutics began to
surface. Natural foods, exercise, natural living, concern about
pollution and chemical toxins in our bodies and the environment
began to take center stage. In addition to which, the sterling reputation
of technological and pharmacological medicine for invincible prowess
and superiority was becoming more and more tarnished. Just as occurred
150 years ago, the public had experienced the side effects, personal
cost and problems of allopathic medicine and was voting with their
feet. Now Homeopathy becomes more and more popular each and every
year. In the 5 years between 1985 and 1990, the sale of Homeopathic
products increased 1000%. Now when I tell the person seated next
to me on the plane that I am a doctor who practices Homeopathy,
he doesn't mistake that for making house calls.
vast majority of people prescribing and administering Homeopathy
today are in the group of non-licensed lay practitioners. There
are thousands of such practitioners and their numbers continue to
grow. This small army undoubtedly has an impact on the allopathic
medical revenues and public attitudes. Laws and legislation do not
now and never have curbed the growth in the ranks of this category
of practitioner. Historically, Homeopathy has always had a large
number of non-medical unlicensed people practicing. In the 1800s
America's rural culture and lack of clear laws about who could and
could not practice medicine created a permissive environment for
these non-licensed practitioners. Today, the situation is quite
different. Although strong in number, they are all practicing illegally
and are at risk for legal problems.
the twentieth century progressed there has been increasing legislative
control of the practice of medicine, both at the state and federal
level. State medical societies have been replaced by official government
sanctioned state licensing bodies. Although Homeopathy is no longer
proscribed by name, review of individual state laws governing the
practice of medicine shows that 20 out of 50 states have a clause
which distinctly applies to any doctor wishing to practice Homeopathy.
These laws, called the Standard of Practice provisions, declare
that each physician must practice up to the standard of care of
his community, as the other doctors in the state practice. Although
these provisions are promoted as a way of keeping incompetent doctors
from practicing, they also are extremely effective in keeping any
doctor from practicing differently from the majority. The first
doctor in a state to advocate nutrition, exercise, grief counseling,
Homeopathy or any other cutting edge idea is, by law, proscripted
from doing so. The lone innovator or Homeopath is at risk.
Guess, a licensed medical doctor practicing Homeopathy in the state
of North Carolina discovered this the hard way. The Medical Board
of North Carolina took away his medical license in 1985 because
he practiced Homeopathy which was not consistent with the standard
of care of the medical community. How could it be; he was the only
Homeopath in the state. The battle was long and bloody. Over the
8 years in and out of courts, including the state supreme court
and spending in excessive of $150,000, it was concluded that Dr.
Guess was a knowledgeable doctor, had not harmed anyone, had the
support of his patients and was generally a credit to his profession
except, he was not doing what all the other doctors were
doing – allopathic medicine. When the favorable decision of
the state superior court exonerating Dr. Guess was overturned on
appeal, the ACLU agreed to sponsor his case before the US Federal
Court. The highest court refused to hear the case, necessitating
Dr. Guess to leave his home and move to another state to practice.
While he was gone, North Carolina legislature passed a law allowing
for the practice of alternative medicine by doctors. Although the
price for this was the devastation and upheaval of Dr. Guess's life
and career, at least now one more state had a definite law protecting
few Homeopaths have had or will have the ordeal that Dr. Guess faced,
the law provides that they could. The biggest protections now for
licensed medical doctors wanting to practice Homeopathy is the public
sentiment so favorably disposed to Homeopathy. The verdict in the
court of public opinion is definitely not so predisposed to the
persecution of alternative therapies as it once was.
the legal standing of Homeopathy and Homeopaths is in limbo. Whereas
in all but a few states, the restrictive laws are still on the books
yet Homeopathy is thriving and riding high on a tidal wave of popular
support. There is definitely an economic impact of all this popularity,
yet much of it cannot be measured because the majority of Homeopaths
are illegal practitioners whose work is not counted in statistics.
Efforts at restricting the practice of Homeopathy today, as in the
last century, have proven almost completely ineffective. People
want Homeopathy and for that reason alone, it is here to stay and
so is its impact on the economics of medicine.
Johnston, MD, DHt, (send
her mail), a graduate of the University of Washington School
of Medicine and certified in Homeopathy by the American Board of
Homeotherapeutics, is in private practice in Los Angeles. She is
the author of Everyday
Miracles: Homeopathy in Action.
co-authored a research paper entitled Regulatory Barriers to
Entry into Health Care Industry: The Case of Non-Traditional Medicine
with California State University Northridge professors of economics
D. Halcoussis, A. Lowenberg and G. Anderson which appeared in the
Federation Bulletin: The Journal of Medical Licensure and Discipline,
Vol 86, Number 2 1999. The focus of the paper was to examine
each state's regulations restricting alternative medicine, particularly
Homeopathy, and the effect on allopathic medical incomes. The above
was her address when they presented this paper to the Public Choice
Society's Annual meeting in New Orleans in March 1998.