Monday, May 28, 2012

Vermont Bill S.209 - Craig Jones, MD


Vermont House Health Care Committee 
Hearing On Bill S.209
April 11, 2012
Craig Jones, MD

Dr. Jones’s testimony is recorded on a CD which can be purchased for $1 from the Legislative Council, tel. 802-828-2231. It is CD # 164, House Committee On Health Care, Wednesday, April 11, 2012.

This is my report on what Jones, the Director of the Vermont Blueprint for Health, http://healthvermont.gov/admin/legislature/documents/blueprint_leg_report.pdf, told the committee.

Jones believes it is important to include NDs, naturopaths, in the Blueprint because they are already practicing as PCPs, primary care physicians, in Vermont and aside from Medicare are already reimbursed by insurers for the services they provide in that capacity. Once included, NDs will be scored like “tradition medical practices” are against the “fairly rigorous” Medical Home national  standards set by NCQA, http://www.ncqa.org/, National Committee for Quality Assurance. This will in turn help to evaluate the quality of health care offered to all Vermonters seeing all PCPs, not just MDs.

According to Jones, the services of NCQA are used by many states to evaluate how well medical practices: comply with guidelines for basic care; provide access to doctors; communicate with patients; coordinate with team members like social workers; and, whether or not their outcomes are tracked electronically. Because of that, Jones believes that including NDs in the system will: guarantee the quality of the services they provide; and, give their patients access to the other team members like dietitians, social workers and counselors. 

Jones pointed out that since NDs are already practicing in the system, scoring them according to the same standards by which MDs are scored and giving them access to the other professionals MDs have access to would only improve the situation and the quality of care provided which is in line with the intention of the Blueprint that aims to improve the quality of care and to coordinate the services provided to Vermonters.

Jones said that he had had discussions with NCQA and found that they would be willing to receive and score data collected from VT ND practices and report the scores to the state. He added that NCQA now recognizes and scores nurse practitioners, NPs, and physicians assistants, PAs, as primary care provides, although it did not do so a few years ago. 

According to Jones, NCQA did an exhaustive review of how each state regulates naturopaths and found that out of the 50 only 16 have any laws pertaining to them. Among those 16, there is no consistency, no national standards or protocols for NDs that apply broadly across states as there are for MDs, NPs and PAs. For that reason NCQA couldn’t give their “stamp of approval” to NDs because although NCQA is not a licensing body, it wants its stamp of approval accepted by all the states. 

In a compromise Jones worked out with NCQA, the agency agreed to score VT NDs using the same standards used for all practitioners in the system and report their scores to state officials. They would not, however, include NDs as a profession officially recognized by NCQA on their website. 

Bill S.209 would, Jones said, take something already included in the health care system, NDs practicing as PCPs, and add it to the Blueprint/Medical Home thereby making the Blueprint more “holistic” while assuring the quality of the additional services by measuring them against objective standards. 

Under the Blueprint, teams from UVM, University of Vermont, medical school go into practices and score them against NCQA’s national standards. The way they do that will be the same for NDs as it is for MDs. The UVM team sends the documents and support material it gathers during its reviews to NCQA in Washington, DC where they are tested against national standards. Then the scores are sent to VT officials. But under the compromise Jones worked out, with NDs, unlike others, the final step of stating on the official NCQA website that the practice is an NCQA officially recognized Medical Home will be omitted.  

The Blueprint has teams of facilitators that work with practices for 4 - 6 months to teach them how the system works. The same teams that work with MDs will also work with NDs.

Jones repeated again that including NDs in the plan would make an “existing situation stronger”. He believed that VT is setting the standards for including NDs in Medical Homes across the nation. 

The Blueprint director concluded by saying that it is his personal belief that MDs wrongly frame the question as “us versus them” when the entire point of the Blueprint is to provide more holistic care offering “complete services” for the general public. In his opinion the “hurdle” is cultural.

Comment:

I am in the process of attempting to verify the claims Jones made about NCQA, its agreement with VT and its accreditation procedures and may have more to report on that later.

When I heard Dr. Jones speak, I found him very persuasive. Listening to him for the first time on the CD, I thought that he was correct. If all those practicing as PCPs are evaluated by the same yardstick, the public’s interest is served. However, as I thought more about the doctor’s talk I changed my mind. I saw some very serious hurdles that are not cultural. They are factual. It appears to me that Jones’s conclusions are based on assumptions and the unverified, self-serving claims that naturopaths make about themselves.

1. Jones said repeatedly that Vermonters are already being treated by NDs. Really? Where’s the evidence, Doc?

Looking over the material presented to the committee, I noticed a handout submitted by Lorilee Schoenbeck, ND stating that somewhere over 5,000 Vermonters are using NDs as PCPs, the number of VT NDs practicing primary care is “40 and growing”. 82% of those are “credentialed” to be reimbursed by insurance and of those 95% are taking new patients. 7.4% of the PCPs in VT are NDs. http://rosemary-jacobs.blogspot.com/2012/05/vermont-bill-s209-lorilee-schoenbeck-nd.html.

But what does that mean? I don’t think we have all the statistics needed to know. 

According to the US census, http://quickfacts.census.gov/qfd/states/50000.html, the population of Vermont was estimated at 626,431 in 2011. If only about 5,000 of those people are using NDs as PCPs, in reality there are very few Vermonters already seeing them. I wonder what the reason for that is. But if Schoenbeck, who said in her oral testimony that many MDs are not taking any more primary care patients and that many who are have long waiting lists yet 95% of Vermont’s ND PCPs are looking for more patients, it would seem to me that few Vermonters want their services.

If you look at the members listed on the NDs official site, VANP, http://www.vanp.org/member_directory.php, you will note that several of those who practice in VT also practice in adjoining states like NY and MA where they cannot be licensed. And a few work out of more than one office in VT. 

If you investigate individual VANP members, you find that in addition to seeing patients most sell supplements, some do Skpye consultations, at least one teaches and one gives advice in a natural products store. You will also see that NDs claim that they spend a long time with each patient. One says an initial consultation takes 90 minutes and it seems as if repeat visits for most are at least 35 minutes.

Considering all that, it sure doesn’t sound to me as if a lot of Vermonters are using the services of NDs. In fact it doesn’t sound as if Vermonters want their services. It sounds as if NDs need more Vermont patients to stay in business, especially when you consider that according to the Director of the Office of Professional Regulators there are 241 of them licensed in Vermont. Presumably, they are either employed in other occupations or are residing and practicing naturopathy somewhere outside the state.

My guess is that it is the failure of most NDs to attract enough customers to stay in business practicing their profession that is the real reason that naturopaths are lobbying so hard to be granted all the same privileges that MDs have. Think about it. Even though Vermont licenses NDs as PCPs and insurance reimburses for their services, Vermont is reporting a shortage of PCPs yet 95% of the ND PCPs here are looking for more patients. That sounds to me as if Vermonters want more MD PCPs in the system, not more NDs.

This raises another question. With so few Vermonters using the services of NDs, why is it that the NDs have so much influence on the legislators and the state bureaucracy which is advocating for them? I have no evidence, but I believe that the billion $$$ dietary supplement industry is behind it because NDs promote, use and sell their products. 

Then there is the other side of the coin. 

In addition to NDs Vermonters “are already seeing” many other kinds of old hippy, New Age “health care practitioners”. Check out the rest of the practices that share the building with Lorilee Schoenbeck, http://www.easternviewvt.com/, by clicking on “the practices” button. 

According to Jones’s logic, we should let any of them who requests it practice in Vermont Medical Homes because they are already practicing here and people want to use their services. They probably want to have third party payers reimburse them too. Isn't everyone in Vermont who thinks he practices medicine entitled to be given what he wants or is it just a lucky few? Maybe we should give them all prescription privileges too like the legislators just gave to the NDs when they passed H.524. http://rosemary-jacobs.blogspot.com/2012/02/vermont-bill-h524-vt-nds-prescription.html.

I’d have a great deal more respect for libertarian politicians who say they voted for laws giving NDs the same privileges as MDs have in order to guarantee the public’s “freedom of choice” if they passed laws decriminalizing street drugs, legalizing assisted suicide and doing away with the requirement that a prescription is needed to buy legend drugs so that Americans, just like their Third World cousins, could buy whatever antibiotic, heart med, pain killer, etc. they wanted without having to convince a doctor that they needed it. If politicians did those things, I’d believe that “freedom of choice” and not political expediency motivated their actions.

2. Dr. Jones thinks that by including NDs in the Blueprint that their patients will have access to other professionals included in the team like dietitians, social workers and counselors. 

Does he know anything about naturopaths? They constantly insist that nutrition and counseling are included in their scope of practice. They claim that they practice “holistic” medicine and treat the “whole person”, his “mind, body and spirit”. They believe that they are shrinks, healers and preachers.
http://www.bastyr.edu/sites/default/files/images/pdfs/course-catalog/School_Naturopathic_Medicine_11-12.pdf (p. 70 & 74)
http://www.drhaff.com/Services.html
http://www.aanmc.org/naturopathic-medicine/nd-primary-care-provider.php
Does Jones really think they believe they need to refer patients to team members competing with them in what they believe are their areas of expertise? 

The team concept is a model traditionally used by MDs who refer patients to dietitians, physical therapists, psychologists, social workers, etc. The holistic concept is an alt. med. model in which the practitioner believes he can and should treat the patient’s entire or whole being, his mind, body and spirit.

3. Dr. Jones reports that NCQA discovered that NDs don’t have a national standard like MDs, NPs and PAs.

HELLO, LEGISLATORS! HELLO BUREAUCRATS! DID YOU HEAR THAT? Have you also heard and read the continuously repeated claim by NDs that they have to pass the USMLE, United States Medical Licensing Examination, and that it is a rigorous test the passing of which shows that they know as much as MDs do? IS THERE A FACT CHECKER IN THE HOUSE?

4. Jones tells us that those who do not meet the NCQA standards will not be permitted to practice. Really?

Based on my experience with the way Vermont has “regulated” NDs, I don’t believe it. The state let them write their own formulary in consultation with a pharmacologist. When the pharmacologist objected to the inclusion of IV substances, he was ignored, http://rosemary-jacobs.blogspot.com/2012/04/do-naturopaths-in-vermont-use-silver.html, # 6. They let 2 ND advisors write a test that those two and their colleagues took. Passing it gave them the right to use the drugs in the formulary that they had drawn up. It was a 48 hour test the person could take anywhere his heart desired. A person with no college science courses did just that and passed, http://vimeo.com/37305517. According to their rules, NDs were supposed to annually review and update their formulary. Between 1996 and 2012, they did that once. My complaints about their using dangerous snake oil and breaking federal drug laws have never been looked into. The state bureaucrats take whatever the NDs tell them at face value without independently verifying a word of it. 

All of that tells me that the State of Vermont is doing all it can to empower naturopaths to do whatever they want as long as they don’t get caught hurting anyone because that would make the state look bad, and if, as Jones stated, the official NCQA website will list all Medical Home practices that the agency has officially recognized, except those of NDs, there will be no way for the public to verify that they have met the agency’s standards. We will just have to take the state’s word or it.  

5. Jones and Schoenbeck think it will be wonderful to include NDs in the Blueprint so that they can have their practices evaluated.

Excuse me. I thought professions had to be evaluated before they were let in the door to see if they were qualified to perform the job. Has any other profession gotten through the door before it gathered the appropriate data to show that its members were capable of doing what they claimed they could? MDs have kept records for as long as I can remember and I’ll be 70 before the end of summer. Somehow I suspect that record keeping is a relatively new practice with NDs. It certainly is according to VANP’s rep, Lorilee Schoenbeck, who stated in her oral testimony that including them in the Blueprint is a good idea because it will let them capture data that will show whether or not their beliefs about the benefits of their “preventive” medicine are accurate. Schoenbeck’s statement is an admission that her profession hasn’t gathered the data needed to determine if their claims of safety and efficacy are correct, but that has never kept them from insisting that they are.

6. According to Jones, the Blueprint was intended to provide Vermonters with more “holistic” care. Really?

I thought the intention was to provide improved outcomes with lower costs.

7. Dr. Jones believes that MDs are framing this as “us versus them” when they shouldn't be. 

Wait a minute. Aren’t the naturopaths and their advocates doing that? Haven’t they been doing that ever since they entered the picture?

Hinda Miller said in her testimony, “There has always been tension between those of us who feel nutrition and diet and all those things can help us maintain our health…” and those other guys, the MDs, http://rosemary-jacobs.blogspot.com/2012/05/vermont-bill-s209-hinda-miller.html. She includes herself with NDs and considers MDs “them”. This attitude is a strong element running through all alternative medicine and has been there ever since the term was coined. It is usually accompanied by rants much stronger than Hinda’s about big, bad, medical doctors on the take and pharmaceutical companies conspiring to keep us all sick so that they can rake in the gold. I myself have repeatedly been falsely and viciously accused of being funded by “the medical establishment, the drug cartel” and the government too because alts don’t like what I say about silver and their belief-based systems of medicine and can’t comprehend that anyone not paid to do so would ever disagree with them. They are so certain that their beliefs and feelings are right and that those of us who base our conclusions on objective evidence that contradicts their beliefs and feelings are wrong.

Critics like Jones, Miller, et. al should be discussing the reasons why MDs who practice evidence-based medicine contend that NDs are not qualified to practice medicine safely and effectively and they should investigate to see if their allegations are correct rather than simply dismiss them out of hand. If in fact, NDs had the same education that MDs have, why would it disturb MDs that they were permitted to practice as PCPs too, especially given the fact that there is an acute shortage of such practitioners in the state? If their educations were the same, MDs would welcome NDs into the fold with open arms.

And the state bureaucrats should stop telling us how safely NDs practice as PCPs based on what they did yesterday which is different than what they are doing today or what they will be doing tomorrow. Till very recently naturopaths practiced as “drugless healers”, not PCPs. Even now most states refuse to license them.

There is no way to draw conclusions based on the number of complaints filed against NDs unless you know how many people they’ve treated, what they treated them for, whether or not those people were sick, hypochondriacs or the worried well who the NDs simply gave diet and exercise advice to. You also have to know things like whether or not their patients were being treated by MDs or other practitioners at the same time, practitioners who maybe told them not to drink the silver or take the botanical because it might poison them or interfere with their heart medication. 

Even with such information, the statistics wouldn’t take into account the harm and premature deaths that don’t show up for years and which may never be associated with the “remedies” or practitioners who caused them. That is a lesson those who practice scientific medicine learned years ago and is why they strive to throughly test their drugs and therapies for safety and efficacy before they use them.. Remember thalidomide? NDs sure don’t. http://guides.main.library.emory.edu/content.php?pid=156723&sid=1327606, http://pubs.acs.org/cen/coverstory/83/8325/8325thalidomide.html
Naturopaths with their untested “natural medicine” bring us right back to where we were when thalidomide deformed so many innocent children. They are creating a two tiered system of medicine, one with rigid standards, the other with virtually no standards, but worse yet, they are blurring the line between the two so that patients can’t tell one from the other.

The vast majority of people injured by unscientific or alternative medicine never complain or sue. Many never realize that their health problems could have been caused by a “natural remedy” and most of those who do are too embarrassed to say anything. They feel like fools when they realize that all the alt BS they believed about how horrible evidence-based medicine and its practitioners are and how good the alternative kind and its practitioners are is bunk. I know this all too well from dealing for years with silver victims. And to date, the vast majority of people attracted to alts have been the most gullible and sometimes the most desperate among us, but thanks to the lobbying efforts of naturopaths, many less gullible people will use their services tricked into believing that they offer the same evidence-based medicine as MDs do because the state implies it by giving them all the same privileges. 

As for the unseen harm they do, consider the fact that alts, including NDs, have traditionally opposed vaccinations. Most still do. Vaccination rates are lower in the areas where there are a lot of alts. So let’s say you live in one of those areas. Vaccination rates are down. Your infant is too young to be vaccinated against whooping cough, contracts the disease and dies. Do you sue the naturopath down the road who convinced your neighbors not to vaccinate their children?


Craig Jones; Vermont Blueprint for Health; NCQA; VANP; naturopaths; Vermont Bill S.209; Vermont House Health Care Committee



Saturday, May 26, 2012

Vermont Bill S.209 - Lorilee Schoenbeck, ND - Written Testimony


Lorilee Schoenbeck, ND
Vermont Bill S.209 
House Health Care Committee
April 11, 2012

The oral testimony presented by Schoenbeck is available from the Legislative Council, tel. 802-828-2424. It is recorded on CD # 163, House Committee On Health Care, April 11, 2012. The CD costs $1. They can also provide hardcopy of her written testimony.

Her written testimony along with my comments:


VANP Health Notes. This consisted of 2 printed pages in which the organization’s web address was given, www.VANP.org, without a publication date or a specific URL. I was not able to find it on the organizations site. Some quotes from VANP Health Notes :

“They” NDs “are experts in the effective clinical use of nutrient, herbal and other natural therapies and are the only providers trained in herb/nutrient/drug interaction potentials, guiding patients who prefer a natural approach to their health care in the safe and appropriate use of these remedies.” 

That hit me in the face like a wet towel. NDs use “remedies” long before they are every studied which means that there is no data on those products and therefore no one can be an expert on them or know if they offer benefits or are deadly. My greatest fear is that one of them will turn out to be as lethal as cigarettes but by the time that is known it will be too late to save many from premature deaths.

After remedies become popular or evidence appears linking them to deaths and serious injuries, they are studied by scientists who report their findings in the medical literature which is indexed. Competent practitioners who practice evidence-based medicine, meaning most but not all MDs, closely follow the studies that are relevant to their specialties. (Based on my experience with silver, I have to conclude that NDs do not review or read the indexed medical literature as practitioners of evidence-based medicine do.) 

But if any of you has gotten a prescription drug lately, you have seen the list of possible side effects and food and drug interactions that comes in the package with the drug as well as the admonition to discuss the use of any supplements you take with your doctor or pharmacist. The list doesn’t come from naturopaths. It comes from pharmacists who like MDs carefully follow these studies as they become available. It is their job. It is what they are trained for. In fact, like MDs, pharmacists often do the studies to determine these things. If you browse PubMed, the online index of medical journals, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed, you will see that those who practice scientific or evidence-based medicine have been conducting and reporting on such studies for decades while NDs have rarely done them in the past and are only now just beginning to do them. 

Health News also stated:
“Naturopathic medical college prepares NDs with a biological and biomedical education of the same breadth and depth that prepares an MD to be a primary care physician”.

Even if that were true, and I don’t believe that it is, it is besides the point which is that NDs are never taught the most fundamental principle of science which is that one does not assume, one tests, one experiments and in medicine one strives to objectively test all drugs and therapies for safety and efficacy before using them which is the exact opposite of what NDs routinely do.

Health News:
“2012 ND stats: Percentage of insurance credentialed NDs practicing primary care: 82%; Precentage of these taking new PC patients: 95%; number of VT primary care NDs: 40 and growing; percent increase in ND PCPs in VT in the last 5 years: 82%; Today 7.4% of VT’s primary care physicians are NDs” 
Note: PC = primary care; PCP = primary care physician; insurance credentialed = reimbursed by insurance.

Assuming that all of those statistics refer to VT, two things catch my attention. First if so many NDs are taking new patients, I don’t think that Vermonters need NDs. I think we have too many already. Second, In testimony by the Director of the Office of Professional Regulation at another hearing, he said that there are 241 NDs licensed in VT. I wonder what the others do and how many of them live in VT.  

Ms. Schoenbeck submitted this written statement:

Lorilee Schoenbeck, ND
from the Vermont Association of Naturopathic Physicians
Testimony to the House Health Committee
4/11/12

S.209 - A Necessary Step Toward Improving the
Primary Care Delivery of Naturopathic Physicians

S.209 does not expand scope of NDs. It is needed so that naturopathic doctors (NDs) and their patients will be included in VT’s health reform.

NDs (naturopathic doctors) are trained in primary and specialty care in 4-year medical colleges recognized by the US Dept. of Education. They have been licensed as physicians in VT since 1996.

NDs provide routine primary care such as Pap smears, cardiovascular screenings and treatment of most chronic and minor acute illness. Most NDs in VT function as PCPs.

ND treatment involves nutrition, lifestyle counseling and natural remedies whenever appropriate, but also prescription medications like antibiotics, statins, hormones, pain medication and referrals to conventional physicians when necessary. NDs often find that 90+% of common complaints in primary care practice can be treated effectively without the use of pharmaceuticals.

There are currently over 40 NDs (and growing) serving an estimated 5,000 + Vermonters as their primary care physicians (PCP).

VT intends that all primary care physicians (PCPs) become medical homes by 2014. Currently, NDs are not recognized as eligible to become medical homes.

Failure to pass S.209 could result in thousands of Vermonters now currently enrolled with an ND as their primary care doctor to have to re-enter the pool of those without a PCP. Vermont could lose a significant percentage (7.4%) of its current primary care physicians.

Becoming PCMHs will enhance quality of ND primary care by holding NDs to the same structural standards as MD primary care. This is a win-win.

S.209 also clarifies language in Act 59 pursuant to the PCP status of NDs, which this Committee passed in 2007.

S.209 also levels the playing field to make NDs eligible for IT incentive funding that could also be available to MDs, which is currently not the case.

Comments: 

Being licensed by the US Department of Education does not mean that the agency has evaluated the school to see if it prepares students to practice medicine or if course work corresponds to the title of the course. While NDs have been licensed in Vermont since 1996 they are continually being given more and more privileges. What NDs were permitted to do here in 1996 is not what they are permitted to do here now or what they will be permitted to do here in a few years when new laws take effect. H.524 was just passed and will give NDs the same prescription privileges as MDs have.

To evaluate Ms. Schoenbeck’s comment about only treating 10% of patients with pharmaceuticals, one would need to know things like: are the common complaints people see NDs for the same as what they see PCPs who are MDs for; the percentage of patients with common complaints that MD PCPs treat with drugs; the % of patients ND & MD PCPs see who are hypochondriacs or the “worried well”; and other extenuating circumstances. 

For instance, a man with Crohn’s disease, an often debilitating inflammatory bowel disease that "usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus)." 
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295/, saw an MD who treated him with drugs in addition to a naturopath who gave him nutrition advice and lifestyle counseling. Since the ND didn’t have prescription privileges, he didn't prescribe drugs for the patient and couldn't have even if he had wanted to, but that may change once he has prescription privileges. Till then the naturopath practices in the capacities of a dietician and exercise physiologist, not a PCP.

If NDs have about 125 patients each, how many do MD PCPs have on average?

Why should anyone conclude that including NDs in Medical Homes will mean that they are held to the same standards that MDs are? The State of Vermont has never even held them to the standards they’ve set for themselves. They were supposed to review their formulary annual but didn’t. The bar has always been lowered for them. When they were required to pass a pharmacology test, 2 of their advisors drew it up and took it along with the other NDs in the state. It was a 48 hour open book test passed by at least one person who had no medical training whatsoever. 

Lorilee Schoenbeck; naturopathic schools; vermont; naturopaths; supplement, drug, food interactions; S.209; VANP; Vermont Association of Naturopathic Physicians

Lorilee Schoenbeck & Me


Lorilee Schoenbeck And Me
Vermont Bill S.209 
House Health Care Committee
April 11, 2012

The oral testimony presented by Lorilee Schoenbeck is available from the Legislative Council, tel. 802-828-2424. It is recorded on CD 163, House Committee On Health Care, April 11, 2012. The CD costs $1. They can also provide hardcopy of her written testimony. 

During a break in the hearing after we had both already spoken, Schoenbeck, came over to me and with a look of what appeared to be feigned compassion said that she was very sorry for what had happened to me adding that: she didn’t know of any ND who used silver; NDs don’t know how silver got into their formulary; and, they’ve been trying to get it out for years. 

Hearing NDs  deny they know any naturopaths who use silver when I do and when they included it in their state formulary makes me furious. http://www.vtprofessionals.org/opr1/naturopaths/info/Naturopathic Physician Formulary 20091211.pdf [pdf download]. (colloidal silver, p. 1; silver that “may be administered IV”, p.5). Lorilee telling me that she didn’t even know how it had gotten into their formulary made me livid. Who did she think put it there? God?

When I pointed out that she had been at the October 16, 2010 alt. med conference sponsored by Senator Bernie Sanders that Arline and I had attended, she looked confused apparently never having noticed either of us. http://rosemaryjacobs.com/naturopaths.html(Scroll to the bottom to see Arline’s picture.) Lorilee was probably the only one there who hadn’t noticed us which is actually funny since she constantly claims that her medical education is the same as an MD’s. 

At the Sanders’s conference, we were definitely noticed as argyric people always are. One man I’d never met said, “Hello, Rosemary,” as he walked by. I assume he was a naturopath who had read my blog. But obviously there was at least one ND who hadn’t noticed us and that was Lorilee, although she may well say that she remembers us after reading this. 

The reason, aside from the obvious one, that it is strange that Schoenbeck didn’t notice us is because she is convincing legislators that she as an ND has the education of an MD, but health care professionals like MDs and RNs are trained to notice people with our discoloration because it usually indicates a medical emergency. It looks like we need oxygen and are about to drop dead, which is why nurses and doctors who haven’t seen us before often rush over to ask if we are alright. In fact Arline and many other argyric people, but not me, hate to visit anyone in the hospital because of all the health care practitioners who run over to check on us. (Personally, I know they are doing their job and am glad to see them do it.) When we tell them that we are fine, many ask about our skin color, a medical curiosity. I suspect that those who don’t only refrain for fear of offending us although many doctors, especially older ones, realize that we have argyria, that we were poisoned by silver. 

An RN who saw me in person after having seen my photo said that the picture hadn’t prepared her to see me in person. When she did, she thought that I was either the embodiment of the walking dead or five seconds short of collapsing on the floor in need of resuscitation. She was greatly relieved when I smiled at her and held out my hand which she grasped reassured by its warmth indicating to her, a medical professional, that my heart was beating normally. Then she noticed the scars from dermabrasion on my face and could not understand how it was possible that silver supplements were still being sold and disfiguring people.

A lady who got argyria recently from a silver supplement told me how happy she is to be able to speak with me since I understand what it is like to be stared at too. She said that people often come up to her and ask if she is dying and she has to explain her discoloration to them. Recently a young boy seeing her in a store started to cry and wanted to call 911 because he thought she was about to drop dead. She hugged him and told him not to worry. She was okay.

Flying home from Germany before I was dermabraded, a stewardess came over and wanted to give me oxygen. When I told her I didn’t need it, she told me that another passenger was very worried about me. I’ve had several people tell my relatives and friends that I was terminally ill with heart disease. I  assume that they had known people who had died that way who had skin the color of mine. 

The first lady I met who got argyria from a silver “dietary supplement”, had an extremely mild case. She looked a “little off”. She is the only truly lucky silver supplement victim I know. With myself and every other argyric person I've learned about, by the time someone notices our discoloration, it is severe. At that point, we learn the cause, stop taking silver but still startle strangers in the street. 

The lady with the mild case saw her MD for a regular visit. He noticed her discoloration which, as I said, is one of the things those who practice evidence-based medicine are trained to notice. First, he checked her for heart disease. When she didn’t have it, he checked further and leaned that she had been taking silver. A biopsy showed the metal in her skin. She stopped taking the stuff and has stayed the same.

But, of course, NDs, unlike MDs and RNs, rarely work in hospitals, especially those like Lorilee who have been out of school for about 17 years meaning that when she was studying to be a naturopath, there were very few, if any, states where they had the kind of MD privileges that they have in several states today. So unable to work with patients in hospitals in acute care situations, NDs, just like laypeople, don’t often see many very sick people or medical emergencies. 

I would have had a lot more respect for Lorilee if she had admitted that: there are NDs who promote, use and sell silver; it never should have been included in the VT ND formulary; there is no excuse for its having been included and no excuse for its not having been removed immediately after I told the NDs of the problem; there is no excuse for the way that NDs, the colleagues she officially represents, ignored me and Arline and our concerns. 

If I know that there are NDs who promote and sell  silver for internal use and who use it intravenously, how is it possible that the NDs themselves don’t know it? If they really don’t, and I don’t believe that for a minute, they should.

I didn’t want Lorilee’s sympathy. I wanted her and her profession to take responsibility for a very serious mistake it had made and to act like real doctors, real professionals or at least like responsible adults.  

To me Schoenbeck’s words directed to me personally and her exhibit of concern smelled like damage control. She sounded as if she were thinking, “We got caught. This is really bad PR. I’ve got to butter her up to make her shut up.” 

Her words also came suspiciously on the heels of testimony in which I had compared the crass behavior of the NDs with that of those who practice evidence-based medicine when they see my facial disfigurement. http://rosemary-jacobs.blogspot.com/2012/05/vermont-bill-s209-rosemary-jacobs.html

I will soon be 70 years old and am not aging well. During the last few years my hearing has been noticeably deteriorating. I thought I had heard all of what Schoenbeck said during her oral testimony. I heard her deny that NDs use silver intravenously, heard her say, “I will mention that we do not provide toxic things such as IV silver,” emphasis hers. “Never have. Neve will.” (4:30 CD 163) “That is a comment based on possible future testimony that you’ll hear here.” But it wasn’t until I obtained and listened to the CD that I heard her refer to me as “an individual who is opposing naturopathic physicians in general….." I was absolutely livid when I did.

I was livid because I believed that instead of accepting responsibility for their own actions Schoenbeck and the naturopaths she represented were trying to marginalize me and make it sound as if I were unjustly maligning wonderful NDs for reasons that they simply couldn’t fathom. I was also livid because I didn’t believe that NDs don’t use silver, even intravenously. I know perfectly well that there are NDs who use and sell it and can’t believe that Schoenbeck and her colleagues who put it in their state sanctioned formulary don’t know that too. http://www.vtprofessionals.org/opr1/naturopaths/info/Naturopathic Physician Formulary 20091211.pdf [pdf download]. (colloidal silver, p. 1; silver that “may be administered IV”, p.5) 

Neither can I believe that some licensed VT NDs don’t also use it, even intravenously. Why else would they have included it in their formulary for IV use? Although I don’t have evidence showing that a specific VT ND uses it that way, I most certainly do have evidence that NDs who have graduated from ND school inject people with silver. 

Originally, I intended to write a summary of Schoenbeck’s oral testimony, but after hearing the way she had dismissed me and my concerns just like she and her colleagues have been doing since 2010, I decided that could wait. Meanwhile if any of you wants to hear it, you can get the CD. Actually, I’m not sure that I will bother summarizing and commenting on Schoenbeck’s testimony. I don’t know how many would want to wade through it. I certainly hate to have to do it again. I wish Ben would post the video, but it seems as if he has decided that it is useless trying to get through to Vermont politicians and moved on to more enjoyable endeavors. 

At the end of Schoenbeck’s oral testimony, the committee Chairman, Representative Michael Fisher who had hopefully read the written testimony that I’d submitted, http://rosemary-jacobs.blogspot.com/2012/05/vermont-bill-s209-introduction.html, said to Schoenbeck, “You mentioned earlier aluminum, uh silver, sorry. Can you tell us where this comes from? You said very matter of faculty, ‘Naturopathic doctors don’t do this and have never done this.’”  (19:20 CD 163)

Schoenbeck responded, “In other committees in other issues in the State House there has been testimony by an individual who’s opposing naturopathic physicians in general. My understanding is she was harmed by IV administration of silver that was performed by a medical doctor, an MD, and naturopathic physicians have never used IV silver, never have, never will. We don’t understand why this particular person is pursuing naturopathic physicians (unintelligible). I just want to make it very clear that that’s not something that we do.”  (19:53 CD 163)

Well, Sweetie, I just want to make it very clear that I am that “particular person”. I have a name. Unlike your presumed colleague who comments on my blog, I never have and never will be anonymous on these issues. I’m out there in your face. I attended the conference you were at in October 2010, the one you didn’t notice me at, and spoke up at a workshop. The ND manning your information booth said that VANP (Vermont Association of Naturopathic Physicians), www.vanp.org/, your official state agency, the one you represented at the hearing, met once a month. She said she was going to tell them about me and hoped that the issue would be “resolved at the next meeting”. She was also going to phone all VT licensed NDs to tell them not to use silver, presumably along with the reason why, and then if she had to she was going to walk into the Secretary of State’s Office with an updated formulary in hand, one that did not include silver or colloidal silver, to replace the 2009 one that does contain those things. You, Lorilee, are very active in VANP. Did you miss this or did the young woman, the only ND I’ve dealt with so far who has in my opinion acted like an honest, decent, caring human being, not do what she said she would? She never got back to me to report and I didn’t contact her because I thought it was out of her hands.

Did you also miss the blog I’ve had about this since 2010, the one that your colleagues and regulating agency have been reading? 

I’ve been speaking to your state regulating agency since 2010 and they have been speaking with your advisors. Didn't they mention this to you? 

My story is on my webpage and has been there for about 15 years. When you finally heard that I was “pursuing naturopathic physicians” and expected that I’d give testimony to the same committee you were giving it to, didn’t you review my material to find out why I was “pursuing” you and the details of my case? I think I’ve made the reasons very clear on my blog.

I am raising major issues about the competency of your profession to practice medicine. I am shouting that naturopaths lack the competency, skills and education required to practice medicine safely and effectively. I am saying you are dangerous and that you terrify me. I’m screaming it at the top of my lungs in a very public way and have been for two years now. Many if not most of your colleagues in Vermont know that, yet in April 2012 you didn’t know my name or the details of my case, even though you knew I was probably going to give testimony before the same committee that you would be speaking to. I find it truly incredible that you never even wondered, “why this particular person is pursuing naturopathic physicians…” 

From my observations, Ms. Schoenbeck, this is totally typical of the way your profession deals with unpleasant issues and with the way you “practice” medicine. It is one of the reasons why you terrify me! Is that clear? Have I explained yet why “this particular person” is “pursuing naturopathic physicians”? Or are you still inhabiting your pretty little imaginary garden where everyone loves and needs NDs? 

In case you still don’t get it, let me try again. I think your profession is dangerous. Naturopaths terrify me. I’m afraid that you will harm people. I think you are as ignorant as my medical doctor was over 50 years ago and that you are replacing the evidence-based or scientific medicine that took us out of the Dark Ages with the folkloric kind that never helped and often killed our ancestors and is still doing that today. Here is why I think that since you’ve obviously missed it all. http://rosemary-jacobs.blogspot.com/2010/08/what-vermont-naturopaths-apparently.html, http://rosemary-jacobs.blogspot.com/2012/04/naturopaths-terrify-me-nds-do-not.html, http://rosemary-jacobs.blogspot.com/2012/05/deadly-folk-medicine.html

And it gets worse Lorilee. I think that you are infecting the entire American health care delivery system with your naturaopathic disease. Your profession has been the most successful of all alts in breaking down the door and blurring the distinction between evidence-based and belief-based medicine. Many MDs and what used to be scientific institutions now offer a smorgasbord of evidence-based drugs and therapies right alongside of the untested belief-based folkloric kind so that it is impossible for most patients to know which is which. I fear that in no time at all those of us who believe in scientific or evidence-based medicine will no longer have the freedom to use it because the entire system will be diluted by practitioners of the “integrated” “holistic” kind. Some will be true believers like many NDs are. Others will be outright quacks like those NDs who see a way to make a lot of money fast using bogus tests to diagnose imaginary diseases which they proceed to “treat” with useless, hopefully harmless, remedies and therapies that they also sell to “prevent” people from getting the diseases that they fear whether or not they are at risk of getting them or not. Others will be MDs who take the path of least resistance. They will decide, “You can’t beat city hall. These fools are going to buy this stuff from someone. Might as well be me. I can easily make a fortune here and protect people from dangerous products and practitioners at the same time.  It sure beats treating sick people and trying to juggle all the serious, often life threatening problems they have. A win-win situation.” 

But it isn’t that at all, not in the longterm. In the longterm it is a lose-lose situation. People will be injured and killed by untested drugs erroneously assumed to be  harmless, http://rosemary-jacobs.blogspot.com/2012/05/deadly-folk-medicine.html, and the cost of medical care will increase exorbitantly as people shell out money for snake oil, both the dangerous and useless kind.

Naturopaths have succeeded in getting third party payers who get their money from everyone else in the system including those of us horrified by what you do, to reimburse you for your “services”. That’s money from the pockets of those of us who are terrified of your drugs and therapies. It marks the end of our freedom of choice and raises the costs of everyone’s already exorbitantly high health care costs. 

The fact that naturopaths do not understand that the only way to accurately evaluate the safety and efficacy of drugs and therapies is through the use of rigorous, objective, scientific tests truly terrifies me, but, unbelievable as it sounds, you compound the problem as far as I’m concerned by the way you and your colleagues have responded to me and my concerns since 2010. You ignored me for as long as you could. Then you repeatedly told legislators that NDs do not use silver and for some strange reason the politicians never asked you how it got into your formulary, not once but twice.  

As for the details of my case which you should have checked before giving testimony about me, Ms. Schoenbeck, - I was not given silver IV. I was given it in the form of nose drops. The skin condition I have has a medical name. It is called argyria. It is well known and well documented in the medical literature, and if you had toxicology courses in your “4 year medical schools” like MDs do in theirs you would have learned that argyria is caused by taking silver internally. It causes skin discoloration that disfigures people. This is all very basic stuff. I would think that naturopaths of all people who believe they are experts on “natural medicines” would know which natural substances are toxic. It is certainly information that any competent doctor could easily find for himself simply by cracking open a toxicology textbook or searching for “silver” in PubMed, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed, the online data base where medical journal articles are indexed.  

There is a wealth of medical literature on silver and argyria and has been for over 100 years. I guess it just never got into the toxicology courses at “naturopathic medical schools”. Oops, sorry. I didn’t notice any toxicology courses in the school curriculum you gave to the committee, http://www.ncnm.edu/academics/Program_Layouts_2010-11.htm, click on “5 yr ND track), but I expect there will be a course listed with that name there soon now that I've brought it up, in time for your next lobbying effort. 

Lorilee Schoenbeck; Vermont House of Representatives; House Health Care Committee; Michael Fisher; naturopaths; S.209; VANP; Vermont Association of Naturopathic Physicians