Practice Act Creep: Stem Cell Procedures vs Naturopathic Practice Acts

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One of the more fascinating and concerning phenomena is how naturopaths are offering invasive regenerative medicine procedures that are often well beyond what’s authorized in their practice acts. While I’ve previously focused on an analysis of Utah’s act and lax enforcement that produced a naturopath practicing interventional spine, here I’ve broadened that out all states that have a naturopathic practice act. As you’ll see, the delta between what these acts allow and what is being done is concerning.

What is a Practice Act?

A practice act is what each state will allow a health professional to do based on their training. Physicians (MD and DO) have the broadest scope of practice and as a result, have the most intense and lengthy training. For naturopaths, a little under half of the 50 US states issue a license and regulate this profession. In many of the other states, it’s illegal for naturopaths to operate or if they do, they are unregulated and can easily run afoul of the problems encountered when practicing medicine without a license.

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What is a Naturopath?

Depending on where you live, you may or may not have ever met a naturopath. These are healthcare professionals who learn herbal and alternative medicine instead of how to prescribe drugs and perform surgeries. They don’t go to medical school and residency training like an MD or DO physician, instead, they attend a naturopathic college. These colleges allow naturopaths to train in clinics and generally don’t have a hospital setting that mimics how physicians train. Because of this lack of parity in training, unlike medical doctors, naturopaths are usually only allowed a limited set of things they are permitted to do.

Why Should You Care?

Regenerative medicine in terms of the use of stem cells and other autologous and allogeneic biologics has been a wild west of late. Hence, if you’re a naturopath trying to push the boundaries of what the state has authorized that you can do, this is a great place to operate. Why? While a naturopath can’t get into an orthopedic surgery or interventional spine residency or fellowship, there are countless for-profit courses in regenerative medicine that will allow you to train alongside physicians. So the wildness of the wild west helps.

The problem? After all, why can’t naturopaths perform the same procedures as MD and DO physicians? As discussed earlier, naturopaths don’t go through the same large hospital-based training where they get to make decisions about life and death every day. Hence, they don’t have the training to manage the complications which may occur, especially with more invasive procedures. Could naturopaths perform these procedures if taught? Yes, but to do that safely, they would need to train in more than clinics for the worried well, which is what they have now. They would also need strict practice standards that are rigorously enforced. Rather than what they have now, which is their own version of the wild west.

Two Things to Research

The two areas to explore are what naturopaths are allowed to do procedurally and what they’re allowed to inject or implant into someone’s body. This review will focus on the former. Given what I’ve researched online, I believe this is the first published attempt at looking at the procedural side of what naturopaths are permitted to do on a state by state basis and vetting that against some of what they’re actually advertising.

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An Analysis of US Naturopathic Practice Acts in Terms of Procedures

Most of the attention on naturopaths to date has focused on what they can prescribe or administer in terms of drugs. However, what they can do surgically is also a big deal, especially now that regenerative medicine has opened that door. So let’s review.

The table above goes through a little under half of the US states that have naturopathic practice acts (click on the image above to see a PDF). I read and reviewed each of those acts for the purposes of determining if they would allow three key regenerative medicine procedures I see naturopaths performing that have the most risk:

  1. Bone marrow aspiration
  2. Liposuction or lipo-aspiration
  3. Spinal injections

I have included the verbiage from each practice act on this topic as well as a link to the act.

What did I find? Naturopaths in some states can perform no surgical or office-based procedures at all. In many, they can only perform minor office procedures and when those are defined, they’re defined in terms of terms like “superficial”. They are also sometimes defined exactly as I have defined them in past posts, with language that makes it clear that the naturopath can only do things like removing a foreign object from the superficial skin or subcutaneous area. NONE of these practice acts contemplate nor authorize the three regenerative medicine procedures I have outlined above.

The Reality and the Law

Next, I did some quick Internet searches of a few locations around the country for naturopaths and stem cells to see what was being done versus what the practice acts authorized. What I found was quite a few practices clearly operating outside of what’s authorized in the practice acts:

  • I’ve blogged on Utah already, so please see that post
  • Arizona-naturopaths advertising adipose stem cell therapy despite the fact that the Arizona act only allows intramuscular injections (not liposuction which is how these cells are harvested).
  • An Oregon naturopath advertising adipose stromal vascular fraction (fat stem cell injections that are currently illegal per FDA). This is despite the state regulation stating that naturopaths can’t perform any procedure deeper than the deep superficial fascia. They also advertise spinal injections with PRP. Spinal injections are not contemplated in the Oregon practice act.
  • In California, multiple naturopathy clinics are advertising stem cell injections for the joints and spine, despite the act only authorizing muscle injections. Meaning what was contemplated was a superficial injection and what is being injected are areas deep into the joints and spine.

Where is this All Headed?

What’s happening here is pushing the boundaries of what naturopaths can do. While that might be fine if they had an education anywhere close to the rigor of a physician, that’s not reality. Instead, my analysis as a physician expert in this space finds that the average naturopath is pushing the limits of his or her practice act. Regrettably, that also means that these naturopaths are placing patients at risk.

The upshot? As you can see, what’s actually being done versus what each state authorizes is way out of whack. How can this be happening, given that these procedures have risks that go beyond the ability of the naturopaths to manage? Lax enforcement and nobody really focusing on what’s allowed versus what’s being done.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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