Colon Hydrotherapy is Challenged
At the time of writing, the profession of colon hydrotherapy (colonic irrigation) is challenged in its current medical structure and practice. Several US states have decreed that colonic irrigation is a medical procedure to be used only when medically-indicated with prescription and supervision by a licensed medical practitioner (e.g. Texas, Louisiana, Illinois…). To add to prevailing confusion, many states do not have clear guidelines for the use of the procedure, such as a designation of “authorized operators”.
Federal and State regulatory agencies have not reached consensus opinions on the use of colonic irrigation. That said, there are three medical device categories described by the US Food and Drug Administration (Classes I, II and III). In simple terms, Class I is an enema (freely available for use and able to be purchased over the counter). Class II is an irrigation apparatus approved by the FDA, to be purchased by a physician’s prescription and used where “medically-indicated”. A Class III device has not received approval because it is reserved for broader treatment indications that are not acknowledged by the FDA in the United States.
The purchase of a colonic irrigation machine requires a prescription by a licensed medical practitioner. There is an unanswered question. What responsibility does the prescribing physician have concerning subsequent use of the machine by a non-licensed medical practitioner?
Arguably, in at least three states (Texas, Louisiana and Illinois) it would appear that liability exists for the “prescription-filling physician” who may have no role in the subsequent use of the colonic irrigation equipment, other than fulfilling the initial prescription for machine purchase. I am not aware of any sanctions posed against an initial purchase prescription by a physician, but most medical licensing authorities do not permit a practicing physician to aid or abet the practice of medicine by non-licensed individuals. A “Catch-22”?
Colon hydrotherapy is growing in popularity. It was used in a widespread manner in hospitals and physicians offices in the early part of the 20th Century, but its popularity waned. There is now a major renaissance interest in colon hydrotherapy. These days “colonics” (colon irrigation) are available in medical spas, beauty parlors and most often in independent clinics, run by colon hydrotherapists who have variable degrees of training. In response to this circumstance, various societies have been formed (e.g. I-ACT, www.i-act.org) to support professional standards by delivery structured teaching programs and preceptorship education (“hands on training”). In addition, there are a number of “private” colon hydrotherapy “schools” that provide different curriculae for training. Some of these “schools” are endorsed by larger organizations (e.g. I-ACT).
A consensus appears to have emerged that untrained personnel should not be engaged in the practice of colonic irrigation (I-ACT guidelines, www.i-act.org). In this context, training would constitute an engagement in structured educational programs, such as those administered by the International Society of Colon Hydrotherapists (I-ACT) (www.i-act.org). That said, there is no official accreditation procedure or endorsement of such training in the U.S.
It is unfortunate that some professional organizations have admitted members who do not have formal training. Therefore, such organizations may not have complied with their own guidelines. This circumstance is indefensible.
A large number of licensed medical practitioners consider colonic irrigation to be of very limited value and some have relegated the procedure to the realms of “frank quackery”. While protagonists of colon hydrotherapy claim widespread benefits of the procedure, there is a paucity of research to define its positive clinical outcome (if any, in some circumstances).
A ray of hope exists for the procedure, where the State of Florida has acknowledged the act of colonic irrigation and issues licenses for the practice of colon hydrotherapy. However, a Florida “license” is not portable to other States of the Union.
The practice of “colonics” is beleaguered by an injunction that was filed in the State of Texas. The consequences of this injunction are far-reaching and they seem to have percolated to other US States, with growing momentum. The only way to portray the importance of this injunction is to reproduce it without comment. That said, the injunction has been described as interfering with “freedom of healthcare”.