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.