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Dissed herbing: A new law may change the practice of alternative medicine
Story by Heidi Kyser
Does a new state law protect consumers from quacks, or target health food experts
Next time you’re at your local natural foods store, and you ask an employee about curing heartburn or lowering your blood pressure with foods or herbal supplements, pay close attention to the answer. A new state law that goes into effect Oct. 1 is intended to regulate dietitians — but could impact the business of nutritionists and herbalists by limiting the advice they can give.
At stake is some $50 billion of alternative medicine expenditures in the U.S., according to a May report by Salon. Health care industry website TheMedica.com estimates that, as of December 2008, 38 percent of Americans over the age of 18 and 12 percent of children used some form of complementary or alternative medicine.
Ask either dietitians or nutritionists, though, and they’ll say they only want the greater good.
“It’s consumer protection,” says Pam Wagner, a registered dietitian and president-elect of the Nevada Dietetic Association, explaining the new law, Assembly Bill 289, which passed in the recent legislative session.
According to Wagner, who helped craft the bill, it was aimed only at regulating the dietetics trade by giving the State Board of Health oversight of licensed dietitians. The Nevada group based its bill on a template from the National Dietetic Association, including industry standards and scope of practice. Wagner says those elements “make us different from a nutritionist or a naturopath. … Dietetics is evidence-based.”
The new law was necessary, she adds, because the national organization administers tests and grants licenses to dietitians, but doesn’t enforce the rules. That’s each state’s job, just as it is with doctors, nurses and other healthcare practitioners.
“We’ll be watching to make sure that people maintain their continuing education like they should, that they haven’t operated out of the scope of practice” by doing things such as giving injections, Wagner says.
Once the state board gets up and running, it will create an online resource where consumers can find information about licensed dietitians. Assemblywoman April Mastroluca, who introduced the bill, says it will give people “a level of comfort that these (dietitians) have a certain level of training and have passed certain tests and, therefore, can properly diagnose and counsel them in relation to food and nutrition.”
A longtime sufferer of celiac disease, Mastroluca believes the law will regulate dietitians without limiting consumers’ reliance on “nutritionists or holistic doctors or other people whose advice they’ve trusted for many years. … I’ve given many people advice on things they should and shouldn’t eat for celiac disease,” she says. “Why would I support a law that makes that illegal?”
Still, some feel the language of the bill is too broad — even after it was amended to exclude a variety of professions, including chiropractor, massage therapist and “doctor of Oriental medicine.”
“Although (the law) looks to be only controlling dietitians, it is so broad that it may be interpreted in many different ways. If so, the natural/holistic industry is in for major problems in Nevada,” says Pauline Alwes, a naturopathic doctor in Las Vegas. Of particular concern are herbalists and nutritionists, whose job could be construed as including “nutrition services” designated by the bill as the purview of dietitians.
Wagner says nutritionists should be wary of offering these services; the problem, she explains, is that the state has no well-defined term for nutritionists.
“Anybody could put a sign in the back of their car saying that they’re a nutritionist, and there’d be nothing stopping them.” But, Wagner warns, “If you begin to operate in (dietitians’) scope of practice, there may be something to that. And our scope of practice is outlined in the law.”
The next step is for the state board to write the actual regulations, which will govern the practice of dietetics, as defined. Among other things, the board will let the public know what to expect when visiting a dietitian and provide a place for consumers to lodge complaints. It won’t, however, have any say in what happens when you visit, for instance, an Ayurvedic consultant who doesn’t have a license to practice dietetics or claim to be a dietitian.
For the average consumer, the distinction is a question of semantics.
“A nutritionist cannot prescribe, claim to treat, diagnose, or provide information to cure one’s ailment. There is strict language when working with a client that you have to be mindful of,” says Melissa Blynn, a fitness trainer certified through the National Academy of Sports Medicine and a holistic nutritional consultant certified through the Global College of Natural Medicine.
Her example of language not allowed: “If you take aloe vera juice, it will cure you of your heartburn.”
Example of language allowed: “I suggest trying aloe vera juice as an alternative option for your heartburn.”
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The big takeover?
Despite complaints from some holistic practitioners, Wagner says the law is “absolutely not” meant to give dietitians control of the health food and supplements industry by putting a gag on others in the business.
“We wanted consumers to be able to access a nutrition professional that was licensed, just like you can know the difference between a licensed nurse and an unlicensed nurse. It’s not going to shut anything down,” she says.
Furthermore, Wagner adds, it may help people get insurance coverage for nutrition services provided by licensed dietitians, since an obstacle to that in the past has been the lack of state standards for preventive therapies.
Mastroluca stresses that the state board is only charged with overseeing nationally licensed dietitians in Nevada. From the health care practitioner’s perspective, the new law won’t affect anyone other than the state’s 681 registered dietitians — unless someone calls himself a dietitian or offers services defined under the scope of dietetics.
Which circles back to the sticky question of when talking about the health benefits of food crosses the line between nutritional suggestion and dietetic consultation.
The solution? Either become a licensed dietitian (which requires a four-year degree, plus 1,200 hours of additional training, plus accreditation exams and fees) or make sure you know the law and abide by it.
Despite its success in getting the law amended to exclude many occupations, the alternative medicine side is retrenching. Jim Jenks, owner of Herbs Plus in Washoe Valley and an unpaid lobbyist for the alternative medicine industry, says he’s already pushing for a bill in the next legislative session that defines the scope of practice for his field.
“It says that if you want to sell herbs and talk about nutrition to the public, you need to put up on the wall your education, so that the consumer is not overly informed by your enthusiasm, and they know you’re not trying to play doctor,” he says.
In addition, Alwes is leading the charge to have a volunteer board qualify holistic practitioners by their training and background, and make that information available to the public.
But perhaps the most compelling evidence that the fight isn’t over is the wait-and-see attitude of health food stores. A spokesperson for Whole Foods Market says, “We’re still evaluating how this legislation may affect our company when it comes to selling supplements in our stores.”
Whatever the forthcoming regulations of the new dietetics board do say, one thing seems certain to James Cox, co-owner of Rainbow’s End Natural Foods in Las Vegas: It stands to affect his business more than that of large chain stores, which can afford to hire $30-an-hour dietitians.
If that turns out to be necessary, he says, “it will hurt mom-and-pops… like us.”
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