Holistic Health Care and California's Board of Medical Quality Assurance JOHN P. BUNKER, MD, and WILLIAM G. GERBER, MD ALTHOUGH IT IS impossible to offer a definition of holistic health care on which all will agree, it is possible to agree on certain features. One such feature is the strong holistic emphasis on individual freedom of choice in treatment, conventional or otherwise. In this respect, the holistic and consumer movements are similar. It is, perhaps, this consumer orientation that best explains the special interest of the California State Board of Medical Quality Assurance in holistic health care: the Board is, after all, administratively a part of the state's Department of Consumer Affairs, and more than a third of its members are nonphysicians or public members. The Board's concern over the issue of freedom of choice is reflected in its recent action regarding the California Senate Bill No. 1011 (Campbell), a bill which would have removed the present requirement that new therapies be efficacious as well as safe. The Board is under some obligation to take a position, in support or in opposition, of bills that would affect its duties, as this one certainly would. After a motion to disapprove the bill failed, a motion to approve it was one vote short of the majority necessary to carry. The support of nearly half of the Board's members reflects a strong conviction that the choices open to the public should not be limited only to conventional treatments sanctioned by the medical establishment. The holistic health movement offers practical as well as conceptual challenges to the Board. The Refer to: Bunker JP, Gerber WG: Holistic health care and California's Board of Medical Quality Assurance. In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131 :484.485, Dec 1979 Dr. Btunker is Professor, Departments of Anesthesia; and Family, Community and Preventive Medicine, Stanford University School of Medicine, Stanford, California, and a former member of the California State Board of Medical Quality Assurance; and Dr. Gerber (Berkeley, California) is President, Division of Licensing, California Board of Medical Quality Assurance. Reprint requests to: John P. Bunker, MD, Dept. of Family, Community and Preventive Medicine, Health Services Research, Stanford University School of Medicine, 703 Welch Road, Suite G-1, Stanford CA 94305.
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legal definition of the practice of medicine in the state of California states that Any person, who practices or attempts to practice, or
who advertises or holds himself out as practicing, any system or mode of treating the sick or afflicted in this State, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury or other mental or physical condition of any person, without having at the time of so doing a valid, unrevoked certificate as provided in this chapter, or without being authorized to perform such act pursuant to a certificate obtained in accordance with some other provision of law, is guilty of a misdemeanor. (Section 2141 of the Business and Professions Code)
This definition has been criticized for its broad language. It was the legal basis for the arrest of a health food store operator in Sacramento last year for practicing medicine without a license. Her offense was giving nutritional advice to her patrons. It is hardly surprising, therefore, that increasing numbers of health professions have recently sought legal protection (such as state licensure) for practicing their art. Physicians' assistants and acupuncturists have been the most recent groups of health professionals to have their modes of practice legally defined, sanctioned and integrated with traditional medical practice. Should holistic practitioners, most of whom are unlicensed at present, be added to this list? Some holistic practitioners are attempting independently to define the scope of their various practices, to articulate a code of ethics, and to explore alternatives to licensure, including certification, which might protect them from prosecution for illegally practicing medicine. Among the obstacles faced in this effort in California is the fact that there is, at present, no coordinated and explicit State policy on new health manpower categories. Until such a policy is adopted, the Division of Allied Health Professions of the Board of Medical Quality Assurance has taken the position of disapproval of any new licensing categories.
At present, the Board is seeking private funding for a proposed two-year study of the legal definition of the practice of medicine in an effort to clarify the licensing dilemma. The study will examine the roles of patients, providers and government in promoting health, and how they are affected by Section 2141 of the Medical Practices Act. Among specific questions to be asked are the following: Does Section 2141 needlessly restrict alternative modes of health care? Does Section 2141 needlessly infringe upon persons' rights to the treatment of their choice? Does it enhance patients' rights? Pending completion of the study, and the enactment of legislative remedies that may be appropriate, the Board must, of course, continue in its attempt to interpret and apply current law. In doing so, the Board must also consider its broader responsibilities to protect the public's health. These responsibilities, in turn, should be viewed from the perspective of current epidemiologic evidence on the determinants of health and longevity. Within this perspective, it is sobering to note that holistic health care, if defined to include all those determinants other than the practice of medicine, surely contributes a larger positive effect than does the practice of medicine itself. This is not to say that the practice of medicine is not an extremely important contributor to health and longevity. But, it does mean that the contribution of other factors, such as nutrition, life-style and the environment, over which the holistic practitioner makes some claim, is greater. And it is not to say that the
holistic movement may not open the door to quackery by some; it certainly does. There are those who assert that holistic health care encompasses alternative methods of healing from which traditional medicine is, by definition, excluded. Others maintain that efforts to integrate holistic health care and traditional medicine ar.e at least premature, and that more time is required for the holistic mo-ement to establish itself. But if holistic health care and humanistic medicine are seen as extending the areas of responsibility or the horizons of medicine to include all of these other determinants, and if we bend our energies to integrate the many members of society, at whatever level, working towards this goal, the public and its health will surely be better served. Leon Eisenberg has recently written If the twin goals of improving the public's health and reducing the demand for medical care are to be attained, three kinds of efforts are required: (1) research in educational methods must be undertaken to encourage health-promoting behavior; (2) biological research must be fostered for disease prevention; and (3) social innovation must be attempted on a new scale if a more humane society is to be created. . . . As physicians, our daily practice with human ailments makes us aware of the extent to which problems of ill health flow from failures in our political, economic, and social institutions.'
Seen within this broader context, holistic health care is simply one component of a broad social effort to improve both the public's health and its quality of life. Let us encourage its practitioners in their search for productive roles. REFERENCE 1. Eisenberg L: The search for care. Daedalus, Winter 1977, pp 235-246
THE WESTERN JOURNAL OF MEDICINE
485
484
DECEMBER 1979 * 131
* 6
legal definition of the practice of medicine in the state of California states that Any person, who practices or attempts to practice, or
who advertises or holds himself out as practicing, any system or mode of treating the sick or afflicted in this State, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury or other mental or physical condition of any person, without having at the time of so doing a valid, unrevoked certificate as provided in this chapter, or without being authorized to perform such act pursuant to a certificate obtained in accordance with some other provision of law, is guilty of a misdemeanor. (Section 2141 of the Business and Professions Code)
This definition has been criticized for its broad language. It was the legal basis for the arrest of a health food store operator in Sacramento last year for practicing medicine without a license. Her offense was giving nutritional advice to her patrons. It is hardly surprising, therefore, that increasing numbers of health professions have recently sought legal protection (such as state licensure) for practicing their art. Physicians' assistants and acupuncturists have been the most recent groups of health professionals to have their modes of practice legally defined, sanctioned and integrated with traditional medical practice. Should holistic practitioners, most of whom are unlicensed at present, be added to this list? Some holistic practitioners are attempting independently to define the scope of their various practices, to articulate a code of ethics, and to explore alternatives to licensure, including certification, which might protect them from prosecution for illegally practicing medicine. Among the obstacles faced in this effort in California is the fact that there is, at present, no coordinated and explicit State policy on new health manpower categories. Until such a policy is adopted, the Division of Allied Health Professions of the Board of Medical Quality Assurance has taken the position of disapproval of any new licensing categories.
At present, the Board is seeking private funding for a proposed two-year study of the legal definition of the practice of medicine in an effort to clarify the licensing dilemma. The study will examine the roles of patients, providers and government in promoting health, and how they are affected by Section 2141 of the Medical Practices Act. Among specific questions to be asked are the following: Does Section 2141 needlessly restrict alternative modes of health care? Does Section 2141 needlessly infringe upon persons' rights to the treatment of their choice? Does it enhance patients' rights? Pending completion of the study, and the enactment of legislative remedies that may be appropriate, the Board must, of course, continue in its attempt to interpret and apply current law. In doing so, the Board must also consider its broader responsibilities to protect the public's health. These responsibilities, in turn, should be viewed from the perspective of current epidemiologic evidence on the determinants of health and longevity. Within this perspective, it is sobering to note that holistic health care, if defined to include all those determinants other than the practice of medicine, surely contributes a larger positive effect than does the practice of medicine itself. This is not to say that the practice of medicine is not an extremely important contributor to health and longevity. But, it does mean that the contribution of other factors, such as nutrition, life-style and the environment, over which the holistic practitioner makes some claim, is greater. And it is not to say that the
holistic movement may not open the door to quackery by some; it certainly does. There are those who assert that holistic health care encompasses alternative methods of healing from which traditional medicine is, by definition, excluded. Others maintain that efforts to integrate holistic health care and traditional medicine ar.e at least premature, and that more time is required for the holistic mo-ement to establish itself. But if holistic health care and humanistic medicine are seen as extending the areas of responsibility or the horizons of medicine to include all of these other determinants, and if we bend our energies to integrate the many members of society, at whatever level, working towards this goal, the public and its health will surely be better served. Leon Eisenberg has recently written If the twin goals of improving the public's health and reducing the demand for medical care are to be attained, three kinds of efforts are required: (1) research in educational methods must be undertaken to encourage health-promoting behavior; (2) biological research must be fostered for disease prevention; and (3) social innovation must be attempted on a new scale if a more humane society is to be created. . . . As physicians, our daily practice with human ailments makes us aware of the extent to which problems of ill health flow from failures in our political, economic, and social institutions.'
Seen within this broader context, holistic health care is simply one component of a broad social effort to improve both the public's health and its quality of life. Let us encourage its practitioners in their search for productive roles. REFERENCE 1. Eisenberg L: The search for care. Daedalus, Winter 1977, pp 235-246
THE WESTERN JOURNAL OF MEDICINE
485
