Board of Homeopathic Medical Examiners

A REPORT

TO THE

ARIZONA LEGISLATURE

Performance Audit Division Performance Audit and Sunset Review

Board of Homeopathic Medical Examiners

August ? 2007 REPORT NO. 07-07

Debra K. Davenport Auditor General

The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of five senators and five representatives. Her mission is to provide independent and impartial information and specific recommendations to improve the operations of state and local government entities. To this end, she provides financial audits and accounting services to the State and political subdivisions, investigates possible misuse of public monies, and conducts performance audits of school districts, state agencies, and the programs they administer.

The Joint Legislative Audit Committee

Senator Robert Blendu, Chair

Senator Carolyn Allen Senator Pamela Gorman Senator Richard Miranda Senator Rebecca Rios Senator Tim Bee (ex-officio)

Representative John Nelson, Vice-Chair

Representative Tom Boone Representative Jack Brown Representative Peter Rios Representative Steve Yarbrough Representative Jim Weiers (ex-officio)

Audit Staff

Melanie M. Chesney, Director Kim Hildebrand, Manager and Contact Person Cheya Wilson

Copies of the Auditor General's reports are free. You may request them by contacting us at:

Office of the Auditor General

2910 N. 44th Street, Suite 410 ? Phoenix, AZ 85018 ? (602) 553-0333

Additionally, many of our reports can be found in electronic format at:



DEBRA K. DAVENPORT, CPA AUDITOR GENERAL

STATE OF ARIZONA

OFFICE OF THE

AUDITOR GENERAL

August 22, 2007

WILLIAM THOMSON DEPUTY AUDITOR GENERAL

Members of the Arizona Legislature

The Honorable Janet Napolitano, Governor

Mr. Charles Schwengel, President Board of Homeopathic Medical Examiners

Ms. Christine Springer, Executive Director Board of Homeopathic Medical Examiners

Transmitted herewith is a report of the Auditor General, A Performance Audit and Sunset Review of the Board of Homeopathic Medical Examiners. This report is in response to a May 22, 2006, resolution of the Joint Legislative Audit Committee. The performance audit was conducted as part of the sunset review process prescribed in Arizona Revised Statutes ?41-2951 et seq. I am also transmitting with this report a copy of the Report Highlights for this audit to provide a quick summary for your convenience.

As outlined in its response, the Board of Homeopathic Medical Examiners agrees with most of the findings and plans to implement, or implement in a different manner, all of the recommendations directed to it.

My staff and I will be pleased to discuss or clarify items in the report.

This report will be released to the public on August 23, 2007.

Sincerely,

Enclosure

Debbie Davenport Auditor General

2910 NORTH 44th STREET ? SUITE 410 ? PHOENIX, ARIZONA 85018 ? (602) 553-0333 ? FAX (602) 553-0051

SUMMARY

The Office of the Auditor General has conducted a performance audit and sunset review of the Board of Homeopathic Medical Examiners (Board) pursuant to a May 22, 2006, resolution of the Joint Legislative Audit Committee. This audit was conducted as part of the sunset review process prescribed in Arizona Revised Statutes (A.R.S.) ?41-2951 et seq.

The Board was organized in 1981 after certain physicians regulated by the Arizona Medical Board (AMB) alleged that the the AMB was antagonistic toward nontraditional medicine. In order to obtain a license, applicants must have an active allopathic (MD) or osteopathic (DO) license from Arizona or another U.S. state, district, or territory. However, after obtaining a homeopathic license, the physician can allow the allopathic or osteopathic license to lapse. As of May 2007, the Board had 104 licensed homeopathic physicians; 11 of these had active Arizona DO licenses, 44 had active Arizona MD licenses, and 21 practice under their MD(H) license without an Arizona MD or DO license. The remaining 28 homeopathic physicians reside out of state.

Homeopathy is traditionally a system of medicine that seeks to stimulate the body's own healing response when health problems develop. It was developed by Samuel Hahnemann in Germany in the late 1700s. In 1810, he published the Organon of Medicine, which describes the homeopathic philosophy and practice. Homeopathic medicine is holistic. Homeopathic physicians treat the body as an integrated whole and view symptoms as attempts by the body to heal itself. Therefore, homeopathic drugs administered in microdosages stimulate the symptoms of a disease and help the body to heal. However, in Arizona the statutory definition of homeopathy encompasses numerous other therapies, including:

z Acupuncture--The diagnosis and treatment of ailments using needles, heat, or physical and electromagnetic impulses or currents.

z Chelation therapy--The use of a synthetic solution injected into the body where it binds with metals and is excreted through the kidneys.

z Homeopathy--A system of medicine that treats symptoms in accordance with the principle that a substance that produces symptoms in a healthy person will cure those symptoms in a sick person.

z Minor surgery--Surgical procedures performed in an outpatient setting, including repairing injuries to the skin or mucous membranes and using topical, local, or regional anesthetics.

Office of the Auditor General

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State of Arizona

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z Neuromuscular integration--The use of manual methods, physical agents, and physical medicine procedures and devices to normalize body structure.

z Nutrition--The recommendation of therapeutic or preventive dietary measures, food factor concentrates, fasting and cleansing regimens, and the rebalancing of digestive system function.

z Orthomolecular therapy--The use of an optimum concentration of vitamins, minerals, and other substances normally present in the human body.

z Pharmaceutical medicine--The use of prescription-only and nonprescription pharmaceuticals, as well as botanical, biological, or mineral medicines.

Legislature should consider best regulation method (see pages 13 through 25)

The Legislature should consider whether there is a need to continue the Board. Both board members and supporters continue to support the Board's existence. Some board members argue that the Board's presence increases access to care and continuity of care because patients can see one physician for all of their care rather than several different practitioners. Homeopathic treatments are available from practitioners other than homeopathic physicians, such as naturopaths. However, some board members assert that homeopathic physicians have a greater depth of medical knowledge and therefore a better understanding of how to treat disease or dysfunction. Board supporters also believe that the AMB and the Osteopathic Board are still intolerant of homeopathic physicians. In fact, at the January 2007 board meeting, several patients of homeopathic physicians reported that the Board was critical to ensuring they could continue to obtain their healthcare of choice. Although allopathic and osteopathic physicians are not restricted from practicing any of the therapies that the Homeopathic Board regulates, the use of chelation therapy is more strictly limited by the AMB and is not embraced by the Osteopathic Board (although some procedures may be within its standard of care). Furthermore, the Osteopathic Board reports that it considers orthomolecular therapy to be an experimental treatment and would expect any physician using the therapy to comply with statutory requirements for experimental therapies, including informed patient consent, periodic analysis of results, and peer review. These regulations are not required for homeopathic physicians to practice orthomolecular therapy.

Although the Board was created to address perceived intolerance for nontraditional care, nontraditional medicine is more accepted than it was in the 1980s. According to the Centers for Disease Control and Prevention, National Center for Health Statistics, in 2002, 36 percent of adults reported using nontraditional medicine. In addition, during the 2002-2003 academic year, 98 out of 126 medical schools in the

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