• Homeopathy, Economics, and Government

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    The
    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.

    The
    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.

    By
    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."

    Within
    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.

    Even
    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
    side."

    As
    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."

    The
    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.

    The
    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.

    If
    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
    treatment.

    The
    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.

    Many
    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.

    Undaunted,
    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.

    Pennsylvania
    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.

    All
    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.

    None
    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
    therapeutics.

    By
    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.

    The
    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.

    The
    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.

    As
    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.

    George
    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
    Homeopaths.

    Although
    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.

    Today,
    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.

    October
    3, 2002

    Linda
    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
    .

    She
    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.

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