Random weirdness, or a story of interesting bedfellows: My extremely strong impression has always been that...
Random weirdness, or a story of interesting bedfellows: My extremely strong impression has always been that physicians historically didn't respect dentists as healthcare providers. Other than the small blip of oh, yeah, your mouth health affects your cardiac health. Which, if it really mattered, people would have been battering down the insurance industry's doors to demand that dental care be regarded as integral to health insurance, not some random separate thing many people can't afford.
Anyway, there was apparently some foofaraw in NC where the state dental board had said no, random cosmeticians in a mall can't offer tooth whitening procedures. The FTC felt otherwise. As far as I can tell, the AMA (that is, physicians) was part of how this went to the SCOTUS. They were looking to protect the role of professional regulatory boards. They lost.
Professional boards of various types exist specifically to regulate "practitioners", ideally this helps protect the public when knowledgeable and experienced people say that people who aren't shouldn't be able to do things, especially without oversight and regulation.
The main problem, as far as I can tell, is that this was argued to be illegally anti-competitive in their own self-interest, rather than properly administering state regulation. And something about medical boards are not immune to anti-trust laws even if states are. So while this was obviously about money, since nobody would have brought this lawsuit all the way to the SCOTUS if it wasn't about money, it got an interesting group of people together to argue about the effects of the ruling on state regulation that relies on professional boards.
So it would seem this isn't about whether or not tooth-whitening is potentially damaging to teeth, and whether that is practicing dentistry, but about who is qualified to determine that and how do you address inherent conflicts of interest? Although it does mean that you can get much cheaper tooth-whitening from just about anybody offering just about anything in NC. Frankly, I was kind of under the impression that you could already get all sorts of stuff, some of which worked, some which didn't, anyway.
On another historical note, the formalization of medical training and practice in this country is inextricably entwined with getting women out of providing care for people. Thus, you will likely be unsurprised that the groups that joined in supporting the FTC (and opposing the dental board and AMA) were a number of large nursing organizations. I'm pretty sure they don't care about tooth whitening, but they do care about scope of practice. Which this ruling may help them defend or expand. Interestingly, there are Nursing Boards in every state, just like there are Medical and Dental Boards. Presumably, this ruling applies to all professional boards. What happens when somebody challenges them?
Anyway, there was apparently some foofaraw in NC where the state dental board had said no, random cosmeticians in a mall can't offer tooth whitening procedures. The FTC felt otherwise. As far as I can tell, the AMA (that is, physicians) was part of how this went to the SCOTUS. They were looking to protect the role of professional regulatory boards. They lost.
Professional boards of various types exist specifically to regulate "practitioners", ideally this helps protect the public when knowledgeable and experienced people say that people who aren't shouldn't be able to do things, especially without oversight and regulation.
The main problem, as far as I can tell, is that this was argued to be illegally anti-competitive in their own self-interest, rather than properly administering state regulation. And something about medical boards are not immune to anti-trust laws even if states are. So while this was obviously about money, since nobody would have brought this lawsuit all the way to the SCOTUS if it wasn't about money, it got an interesting group of people together to argue about the effects of the ruling on state regulation that relies on professional boards.
So it would seem this isn't about whether or not tooth-whitening is potentially damaging to teeth, and whether that is practicing dentistry, but about who is qualified to determine that and how do you address inherent conflicts of interest? Although it does mean that you can get much cheaper tooth-whitening from just about anybody offering just about anything in NC. Frankly, I was kind of under the impression that you could already get all sorts of stuff, some of which worked, some which didn't, anyway.
On another historical note, the formalization of medical training and practice in this country is inextricably entwined with getting women out of providing care for people. Thus, you will likely be unsurprised that the groups that joined in supporting the FTC (and opposing the dental board and AMA) were a number of large nursing organizations. I'm pretty sure they don't care about tooth whitening, but they do care about scope of practice. Which this ruling may help them defend or expand. Interestingly, there are Nursing Boards in every state, just like there are Medical and Dental Boards. Presumably, this ruling applies to all professional boards. What happens when somebody challenges them?
As I understand, what the 6-3 SCOTUS majority concluded (reasonably, IMO) is that the power of a professional licensing board to restrict trade has to be directly supervised by some third party which doesn't have a (direct) financial stake in the decision. That way, there's a check-and-balance against a professional licensing board excluding competition simply for economic competition's sake, as opposed to a clear public benefit (like, say, restricting the prescription of chemotherapy agents to trained physicians, as opposed to also letting naturopaths prescribe vincristine). In other words, the power to limit scope of practice can't be made solely by people who have a financial stake in scope of practice, but must also be subject to review and approval (or disapproval) by a third party that doesn't have said financial stake.
ReplyDeleteFrom the (generally excellent) SCOTUS Blog:
http://www.scotusblog.com/2015/02/opinion-analysis-no-antitrust-immunity-for-professional-licensing-boards/
Reasonable, I just love the bedfellows.
ReplyDelete