Bitter pill

On a clear December morning, a local doctor runs through a visual exercise with a patient. The physician holds in front of the man's face a stick painted with black stripes; he then instructs the patient to follow the stick with his eyes. There is not a sound in the room, but as the man moves his eyes from left to right, the sound of the office door being kicked in startles both doctor and patient. Law-enforcement officials rush the doctor and wrestle the stick from his hand. They charge the physician with practicing medicine without a license.

That was 41 years ago; those cops were the Texas Rangers, sent to Dallas County to enforce the law. Seems the doctor, who practiced something called naturopathy, wasn't a real doctor--at least not according to the state of Texas.

Maybe that's why today, the Naturopathic Center of North Texas sits in a nondescript office building on Midway Road, off LBJ Freeway. People driving past can't help but ignore the dull-brown brick building, with its darkly tinted windows. If not for cars parked here and there around it, one might never even know the building is occupied. There isn't even an office directory, which is just fine with Stephen Sporn, the naturopathic physician who runs the center where patients go for non-invasive, natural procedures--meaning no surgery, no unnatural medicines, and no machines. It would be good to get some walk-in business, but he doesn't want to call too much attention to himself.

After all, the man's a medical outlaw, practicing without a license. Sporn and his fellow naturopathic practitioners have been illegal for more than four decades. They could suffer the penalty for practicing medicine without a license in this state: a $20,000 fine and up to five years in prison. So he goes about his business as unobtrusively as possible.

Once, it was legal to be a naturopathic physician in Texas. In the late 1940s and early '50s, anyone who completed a four-year, post-graduate program and received the degree of doctor of naturopathic medicine was considered the real thing. Holistic practitioners could get a license to treat illnesses using only herbs, hydrotherapy, homeopathy, and counseling--all that Mother Nature allows.

Not anymore. Only now, there are no Texas Rangers breathing down the doctors' necks. Rather, the Texas Association of Naturopathic Physicians is running into trouble from the powerful and wealthy Texas Medical Association, which helped defeat a bill during the final moments of the recently ended state legislative session that would have allowed naturopaths to practice legally in Texas once again.

State Sen. Greg Luna of San Antonio had proposed Senate Bill 146, the Naturopathic Physicians Act, which would have licensed naturopaths to practice legally in Texas. Luna, whose son is a naturopath, was doing nothing more than trying to re-enact legislation that existed until 1957. In the bill, Luna wrote that the purpose of the proposed act is to provide standards for licensing and regulating naturopaths in order to provide "the public with freedom of choice in health care."

And it looked as though the bill was going to pass--until, according to Sporn, the TMA flexed its lobbying muscle and crushed it at the last possible moment.

"On April 19, we had the votes to get this bill out of committee," says Sporn, who had been practicing illegally in California for 13 years, until moving to Dallas in 1995. "On April 20, the TMA walked into committee offices and turned them."

Sporn contends that the Texas Medical Association perceives naturopaths, and their holistic medicine, as a threat to their business. After all, according to the Journal of the American Medical Association, consumers spent $27 billion on alternative health care in 1997, and insurance companies are starting to cover the less expensive treatments. Med-school grads could potentially stand to lose millions of dollars to the herbalists and healers--dispensers of what critics refer to as "the new snake oil," the headline of a recent anti-alternative medicine piece in the journal Commentary.

But Alfred Gilquist, the TMA's director of legislative affairs, dismisses Sporn's contention that his organization is out to quash naturopaths. Rather, he insists, Luna's bill has "everything to do with lowering the standard of medical care in the state of Texas." For instance, Gilquist asserts, S.B. 146 "allows people who did not go to medical school to perform surgery, prescribe medications, and deliver babies."

Alice Breard, Luna's executive assistant, contends that's hardly the case. Breard, who was charged with shepherding the bill through the Legislature when Luna became seriously ill from complications of diabetes during the last session, insists the TMA is taking the bill's language out of context. Indeed, the bill states that naturopaths can perform childbirth only with a certificate of specialty practice in naturopathic childbirth.

It also would have allowed for naturopaths to use "operative, electrical, or other methods for the repair of, and care incidental to, superficial lacerations and abrasions" and other minor office procedures. The bill explicitly states that naturopaths are not allowed to administer general or spinal anesthesia or perform major surgery.

Breard insists that naturopaths would be regulated like any other medical specialty. "Anything that's already licensed in the state--like acupuncture, midwifery--they would have to meet the minimum [state] requirements in that field before they could do it," she explains.

Sporn's and Breard's frustration with the TMA stems from the fact that they are both throwing pebbles at a mountain. Recently, both The New York Times and The Wall Street Journal have chronicled the TMA's rising power in the Texas Legislature. Both papers noted that the TMA pours $650,000 into various state elections during each campaign season. And, the papers note, the TMA often has the personal physician of many elected officials make hard-sell phone calls to state officials on the organization's behalf. There are thousands of members in the TMA, and their lobbying organization, Texpac, has a full-time staff of 43. Subsequently, it has been reported, more than 90 percent of TMA's agenda has passed since 1995.

On the other, very smaller hand, Sporn's Texas Association of Naturopathic Physicians consists of only eight members and is strapped for cash.

But Gilquist denies that the TMA pulled any strings to kill Luna's bill. He says that the bill was "weak" to begin with, and that it couldn't withstand the infighting among naturopaths--and he does have a point.

Nationally, the American Association of Naturopathic Physicians and the American Naturopathic Medical Association have been at odds over the licensing issue. The members of the former are degreed graduates from one of only four naturopathic colleges across the country, while members of the latter organization have, essentially, mail-order degrees received from correspondence courses. The difference is quite clear: AANP members have had clinical training, while ANMA members know how to lick a stamp.

As a result, AANP members want their mail-order colleagues to be regulated; it would legitimize their own practices. But a majority of ANMA members don't want any form of state regulation, because it would essentially put them out of business.

Sporn and Ken Looney, president of the Texas Naturopathic Medical Association (which certifies its members through the mail), insist there exists no such rift in Texas. Looney claims his group broke away from the national mail-order association to support S.B. 146. He says his organization welcomes the opportunity to have some regulation brought to a field of medicine that might be growing out of control.

"Stephen Sporn and I basically co-authored this bill," Looney insists. But he does admit there has been a split in his own organization over this issue, with some members of the Texas mail-order faction siding with the ANMA.

As a result of this squabble, says Alfred Gilquist, "we were able to just watch the bill go down the drain."

To say this isn't a new issue would be understatement. On January 31, 1957, the Texas Naturopathic Law was killed by the courts, and naturopathic physicians who had been licensed under state law for almost 10 years became medical outlaws. That same year, the Texas Rangers arrested 61 naturopaths in 29 counties--what Sporn, who's also the historian for the Journal of Naturopathic Medicine, likens to a witch hunt.

"There has been no other medical profession that has been so persecuted and prosecuted as the naturopaths," he says. "From 1955 to 1965, we went from being as many as 11,000 or 12,000 practitioners throughout most of the country down to a couple of hundred."

Luna's bill has been around for a while; it was written in 1993. But it was two years ago, with the bill before the house's Health and Human Services Committee, that it began to gain momentum. Indeed, committee vice chair Mike Moncrief, a Democrat from Tarrant County, co-sponsored the bill in 1997.

And according to Sporn, he, Luna, Breard, and Looney met with TMA executives--including Gilquist and Kim Ross, the head lobbyist for the organization--only last year to see if they could smooth out their differences. (Gilquist denies being present at the meeting.)

But Sporn says the group got nowhere: "They met with us to find out more about us so that they could use it against us," he insists. Sporn claims that the TMA agreed to make naturopaths legal only if they didn't call themselves doctors, write prescriptions, or perform surgery. He and his colleagues would have none of it.

But this spring, Luna's bill suffered an ailment no alternative medicine could cure when committee chair Jane Nelson, a Republican from Flower Mound, and Moncrief allowed it to die. Sporn says he knows why Nelson failed to support Luna's bill--"Her kid's a doctor," he offers--but says he can't figure out why Moncrief "betrayed" the legislation.

Nelson couldn't be reached for comment, but through a spokesman, Moncrief said that he was trying to bring together the "divided parties"--the TMA and the naturopaths--but that it simply wasn't possible. Breard and Sporn say Moncrief did little more than sit back and read the last session's bill to the committee--without offering any support.

Sporn says the bill died for one simple reason. When the TMA sneezes in the Capitol building, everyone comes running out of the woodwork waving a hanky. "Who you gonna listen to--somebody you got $10,000 from, or somebody you never heard of?" he offers.

Breard says that the TMA doesn't want anyone who didn't go to their medical schools to call himself a doctor. She points out that the TMA also resisted licensing chiropractors, osteopaths, and acupuncturists for years before finally relenting.

The irony is that the Texas Board of Medical Examiners recently passed a measure allowing physicians to practice alternative medicine under loose guidelines--without receiving the two years of formal training that naturopaths now receive in their graduate schools.

"[Naturopathy] is the medicine people want," Sporn says, as he looks at the stack of files on his desk and shakes his head. "Why? Because we take care of business. We tell you what to do at home, and we keep you out of the office...I feel that by rational discourse and by presenting my case--if it were heard--people would want me to have a license to practice, to do what I can for the health care of the people of this state."

But for now, all he can do is hope and keep trying to fight the law. Still, Sporn admits the thought of what could happen to him if he continues to practice in Texas without a license does keep him up at night.

"I don't have the money for a lawyer," he says. "I don't want to bring this into the courts, but if this is the thing that needs to happen for us to be free..." He pauses for a minute. "Benjamin Lust, the founder of our profession, was arrested 17 times for practicing medicine without a license." No doubt, Sporn would be proud to add his name to the list.


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