They walked purposefully, stone-faced, wearing bulletproof vests over their hooded jackets. Two wore black ski masks. In the commotion, she barely noticed the two people rushing in after the cops, dressed in crisp business suits. "They came in a big surge," Nusser says. "It was overwhelming."
The officer in charge, Toledo Sergeant Carol Connelly, asked the secretary whether Dan Nuzum was in. For three years, Nuzum had practiced mechanotherapy, a type of massage. His clients, mostly senior citizens, seek his help to stretch and soothe their aching muscles.
Nusser was so surprised, she could barely speak. She managed to tell Connelly that her boss was in.
"He's under arrest," the sergeant said.
Just then, Nuzum appeared. He's 28, stands 5 foot 11, and likes to work out, but his glasses and close-cut blond hair give him a studious look. The four largest cops rushed him, forcing Nuzum into an examination room. "Sit in the chair," one officer ordered as the door closed.
The rest got to work. They demanded that the 10 clients waiting in Nuzum's office provide their names and driver's licenses. The clients refused. They demanded to know the officers' names and badge numbers instead. "The police were very confrontational with the people in the lobby," Nusser says. "But they picked the wrong day to come. Everyone in the office that day was in their 50s and 60s, older people, who are pretty savvy."
The officers confiscated Nuzum's appointment book and files. They took two computers and three padded massage tables, and they removed Nuzum's diplomas and certificates from the walls. They even took Nuzum's nameplate off the door. Everything was loaded into a moving van. The entire process took three hours. The officers in ski masks never removed their masks.
Finally, Nusser asked the people in business suits who they were. The woman introduced herself as an investigator with the Ohio State Chiropractic Board. The man was an investigator from the Ohio Medical Board. They had been spying on Nuzum for seven months, they told Nusser, sending in undercover police to pose as clients.
Nusser told them that their tactics were over the top. Her boss was a nice man, she said, whose wife had just delivered her second baby two weeks before. He never prescribed drugs. He had no criminal record. So why the paramilitary raid? Why not make a phone call, send a letter, set up a meeting?
"Well, we didn't have our guns out," Sergeant Connelly said.
Nuzum was led away in handcuffs. He spent the night in jail. His crime: practicing chiropractic without a license, a felony.
The charge is ridiculous, Nusser says. Her boss never practiced chiropractic, which concentrates on quick manipulations of bones and joints. He practiced mechanotherapy, a form of slow massage, concentrating on the muscles. "Our patients know the difference between mechanotherapy and chiropractic," Nusser says. "I think it's quite amazing that the chiropractic board doesn't know the difference."
Like many of Nuzum's clients, Don Zell also sees a chiropractor. "Dan does it different," says Zell, 63, who drives 45 minutes from his home in Ann Arbor to see Nuzum every week. "When you go to a chiropractor, they grab ahold of you and twist your neck. When Dan does it, he massages your neck, and it makes me feel better than the chiropractor does."
Zell was entering Nuzum's office when he encountered the cops in the middle of their raid. He refused to give his name. The state is overstepping its authority, Zell says. "Who are they to tell me who I can see and who I can't?" he asks.
One state legislator agrees. "It's ludicrous!" says Representative Linda Reidelbach, a Republican from the Columbus suburb of Worthington. "I was appalled when I heard about these overbearing tactics."
The chiropractic board stands by its methods. "It's just not our practice to send out letters," says Kelly Caudill, the board's executive director.
When Nuzum goes to trial May 16, it will mark the latest round in a fight over medicine and its boundaries that has dragged on in Ohio for almost a century. The central dispute: What's medicine, and what isn't? And how much power should state bureaucrats hold over people who operate at the margins?
The answers are not as obvious as they seem. Thirty years ago, chiropractors were widely viewed as quacks. The Ohio Medical Board regularly investigated them. Today, chiropractors have a licensing board of their own, and they're doing much the same thing as was done to them.
Dietitians were allowed to practice virtually unregulated before 1987. Today, Ohio's Board of Dietetics is the most aggressive in the nation.
Many people on the margins of medicine fall under the broad banner of "natural health care." It includes more than a hundred different disciplines, with exotic names like reiki, shiatsu, rolfing, and iridology. Some practitioners specialize in giving foot rubs. Some study the whites of your eyes to figure out your ailments. Others simply suggest that you try some herbal tea.
There's no agreement over whether any of this stuff actually works. What is known is that lots of people want it.
According to the National Institutes of Health, 36 percent of American adults regularly use some form of alternative medicine -- spending between $36 billion and $47 billion on it every year.
"The pent-up demand for natural and alternative medicine in Ohio is incredible," says Daryl Kulak, a consultant for hundreds of alternative-health-care providers. He estimates that there could be as many as 60,000 such providers in Ohio.
What most have in common is a desire to help people live healthier lives without the invasive methods of Western medicine -- no surgeries, no needles, no drugs with potentially dangerous side effects. "Look at the 50,000 people who have died because physicians prescribed Vioxx for their arthritis," says Pam Popper, a Columbus nutritionist and one of Ohio alt-medicine's leading voices. "Can you blame people in Ohio for wanting to get a second opinion? People deserve choice."
But it seems as if the only other thing natural-health providers have in common is their fear of state licensing boards, which have the power to write their own rules and investigate almost anyone they want. Instead of policing abuses by their own members, they're spending much of their time harassing other professions, providers claim.
Some natural-health providers, such as Nuzum and Popper, have the money to fight back. But most simply close. Those who stay in business usually operate underground. "Its kinda like the Mafia," says Kulak. "If you don't pay for protection, they'll come and get ya. So people lay low and try not to upset them."
Natural-health providers believe that the boards care little about public safety. The real issue, they say, is turf-protection. "If public safety is really the issue, how come the medical boards never brought forward a single person who's been hurt by an unlicensed practitioner?" asks Popper, who owns the Wellness Forum, a Columbus company that offers classes on nutrition and sells diet supplements. "That tells me that this isn't about public health. It's about power."
Moreover, at a time when bureaucratic budgets are tight everywhere, it seems an odd use of police resources to be busting people who give backrubs and nutritional advice. Yet such providers make easy targets. Many are earnest almost to a fault, low on cash, and operating out of their living rooms. "Most of these people have very little money," Popper says. "They just want to help. Nobody's getting hurt here."
But medical watchdogs counter that many who practice alternative medicine are quacks and con artists, who endanger the public to enrich themselves. "It's pretty simple. People who practice medicine need to have the proper training and education," says Kay Mavko, director of the Ohio Board of Dietetics. "If a physician cuts off the wrong finger, you know it pretty quickly. If someone misleads you about your diet, you'll still be injured. You just won't realize for a long time."
Now, with battles flaring from the Toledo courthouse to the halls of the Statehouse, the fight over alternative medicine is nearing its climax.
Dr. Don Griffith was leaving for a Florida vacation when he received the summons. The Ohio Chiropractic Board was hitting him with criminal charges. This must be a mistake, he thought. How could a veterinarian ever be confused with a chiropractor?
Griffith is a well-respected vet in Columbus. He worked for years as head vet at the Columbus zoo, and last year he won an award from the American Animal Hospital Association for meeting its highest standards for 25 straight years.
Griffith started doing acupuncture on pets in 1987. In 1994, he started doing chiropractic, mostly on dogs. "The reason I do it is, I believe it's safer," Griffith says. "Chiropractic doesn't do the damage that serious drugs do."
Then the chiropractic board noticed Griffith's ad in the yellow pages. In 1998, it ordered him to appear in court for practicing chiropractic without a license. "I was outraged by the whole thing," Griffith says. "They charged me as a criminal. This is not funny stuff. This is big time."
Griffith and his lawyer tried to get the board to explain how a state agency created to regulate human medicine had any power over a veterinarian. The board never responded, and it refused to negotiate a deal. After a two-year standoff, both sides were eager to take the matter to court. If Griffith lost, a conviction meant that he would immediately lose his veterinary license.
On the day of the trial, the Franklin County prosecutor blinked. He asked the two sides to negotiate. "I think he realized how embarrassing it would be -- how bad he would look," Griffith says.
The board agreed to drop the case. In exchange, Griffith agreed not to sue. The year that the board took him to court, Griffith made $1,200 from his chiropractic service, he estimates. He wound up spending $15,000 on his legal fight.
"The only reason I didn't sue them is because I couldn't afford to," Griffith says. "But if they ever come after me again, I will sue. That's abuse of power. It's persecution by the state."
The board says that its motives are pure. "Our No. 1 mission here is to protect the public," says Caudill.
But since dogs and cats aren't normally considered members of the public, it seems as if the real issue in Griffith's case was something else entirely. "At one point, they wanted to settle the case by me agreeing never to use the word chiropractic," Griffith says. "That's when I realized it was a turf battle."
Ohio has 27 licensing boards, which regulate everything from barbers to speech pathologists. The three boards that govern medicine -- dietitian, chiropractic, and medical -- are among the state's most zealous. Their directors defend their aggressive tactics, saying they're necessary to protect public health. "The public is better protected when people have to attain a certain level before they go out and practice," says Tom Dilling, executive director of the Ohio Medical Board. "Is that protection of turf? No."
But many who practice natural medicine -- and many more who seek their advice -- disagree with the way medicine is commonly practiced in the West. And as long as no one gets hurt, they believe, the state should butt out.
Carol David-Roscoe owns Claudia's Natural Food Market in Toledo; she's been giving nutritional advice for three decades. She could have applied for a dietitian's license years ago. But she hates what she sees as the dietitian board's food biases.
For years she counseled people to stop eating margarine due to its highly processed fats, Roscoe says. She also told people to avoid aspartame, the artificial sweetener, because one of its ingredients turns to toxic formaldehyde in the body. But the dietitian board continued to recommend both as safe years after their dangers became widely known, Roscoe says. That's because dietitian associations receive major funding from food companies.
"A lot of people don't want to eat white bread and drink formaldehyde," Roscoe says. "They're understanding the basic truth that man-made chemicals are making them feel crummy. That's their right as Americans to make that choice, no matter what the dietetics board thinks."
As all boards do, the dietitians raise their entire $330,000 annual budget from licensing fees. Its funding, says director Mavko, has no bearing on its investigations. "We base our recommendations on science, not emotion."
In 1998, an investigator appeared at Roscoe's store. A dietitian had complained that Roscoe was giving nutritional advice without a license. Roscoe screamed at the investigator, then threw her out. The board sent Roscoe a letter ordering her to stop her counseling.
Roscoe spent three years and $14,000 in legal fees fighting the board. Finally, in 2001, she agreed to stop calling herself a certified nutritionist, even though she has a degree in nutrition from a state-certified school. But she remains as defiant as ever. "The real issue is that they don't own food," Roscoe says. "No trade group should have a monopoly on the right to talk about food. This is an infringement of people's ability to choose and their freedom of speech."
Aggressive tactics by Ohio's medical bureaucrats have scared many natural-health providers into silence. Those who still practice often do so underground. They usually don't have the money for advertising, and they've stopped posting fliers in health-food stores, which investigators regularly scan for unlicensed practitioners. "Everyone I know is afraid," says Patty Schipley, a Columbus naturopath. "We can't advertise. We're in hiding. Everything we do is by word of mouth."
Some worry that, by driving natural health into the shadows, Ohio's boards actually harm public health, rather than promote it. "Every time I refer somebody to a physician, I'm taking a risk," Pam Popper says. "Because this is all happening underground and illegally. I know people who should make referrals to doctors, but they don't, because they're justifiably afraid of getting caught."
One person who's afraid just wanted to rub feet for a living. We'll call her Jane. She doesn't want her real name used, because she's almost bankrupt, and she's worried about what the chiropractic board might do if it finds her again.
Jane worked for 17 years as a computer specialist at the Longaberger company, which makes designer baskets at its factory in Newark, Ohio. The company had laid off hundreds of workers in recent years, and Jane feared she might be next.
So she decided to become a reflexologist, giving a type of massage that uses pressure points in the hands and feet to cure ailments elsewhere in the body. Jane did everything she could to guarantee that her business was straight up. She paid $1,100 for a four-month course at the Central Ohio School of Massage, a state-certified school in Columbus. She dropped a few hundred more on a special massage chair. She called the city of Newark, Licking County, and the Secretary of State's office to learn how to legally register her business. She also called the Ohio Medical Board to see whether she needed a license. The woman who answered the phone said she didn't, Jane says.
When she graduated last spring, Jane quit her job at the basket company and started practicing in a Newark spa, gradually gaining clients.
Two months later, an investigator from the chiropractic board paid her a visit. Jane wasn't in, but her co-workers told the investigator that she had just graduated, with her diploma in reflexology. The investigator left. A few days later, Jane received a letter from the board ordering her to cease and desist.
"I canceled my appointments for the rest of the week and basically closed up my shop," Jane says. "I don't want to be doing anything illegal."
Jane called two lawyers for advice. She called attorneys at the Ohio Medical Board and spoke to people from the Ohio Association of Reflexologists. Some said she was allowed to practice with just her diploma. Others said she needed to become a licensed massage therapist. "Some people even told me that I should become an ordained minister," Jane says. "That way I could legally do a laying-on of hands."
But after months of research, Jane decided that she was screwed. She gave up on reflexology and started looking for another job. "I don't have the money to fight back," she says. "Had I known any of this beforehand, I wouldn't have quit my job at Longaberger."
The chiropractic board believes that people like Jane pose a health threat. "If you don't have the proper training or experience, you could really hurt someone," says Caudill.
That's ludicrous, say those in the natural-health community. "How can I hurt somebody by rubbing their feet?" Popper asks.
Others point out that it wasn't long ago that chiropractors operated under similar conditions -- low public respect and constant harassment by the state. "They need to pull back and remember their own history," says Kathleen Jones, a chiropractor who's also vice president of the Ohio Association of Naturopathic Medicine. "I believe they're trying to protect their own, and I don't think that's in the best interests of the patients."
Jane never learned who ratted her out; licensing boards usually keep their investigations secret. But it probably wasn't one of her clients. The complaint most likely came from one of Jane's competitors. "Most members of the public aren't aware of the licensing boards or what we do, so we rely on complaints from our licensed members," says Caudill.
A review of state records shows that Jane's case was typical. Representative Linda Reidelbach requested access to more than 100 investigation files from the Ohio Board of Dietetics, covering a four-year period from 1998 through 2002. None of those files, reviewed by Scene, started with a complaint from an injured client. Instead, they were all initiated by licensed dietitians, chiropractors, and doctors, people in direct competition with natural-health providers. "It's pretty clear to me that these boards are simply protecting their own," Reidelbach says.
Popper has spent the last four years lobbying to change investigation rules. The legislature has held countless hearings on the issue. During that time, the boards have yet to bring forward a single person injured by natural medicine. "Where are the dead bodies?" Popper asks. "Where are the injured and maimed people? This has nothing to do with public health. It has everything to do with turf."
And the turf battle is more heated in Ohio than in any other state. In 2001, Colorado's Department of Regulatory Agencies studied whether to create a licensing board for dietitians. Reviewing the records of 40 states that already had boards, researchers found that most agencies investigated between 5 and 10 cases a year, usually involving fraud or malpractice. Alabama had the second-most active board in the country, investigating 100 cases from 1989 to 2000.
But in Ohio, the dietetics board investigated 936 cases from 1987 through 2000. It opened 141 new cases in 2001 alone, 10 times more than in any other state. Over half those investigations were against people accused of unlicensed practice. Only one case involved an allegation of a patient actually being hurt. "To what extent should the states go in protecting consumers against the results of their own decisions?" the researchers wrote. "Is the proven or threatened harm from the unregulated practice of dietetics so great that the state must impose restrictions?"
Apparently not. Colorado decided its residents would be just fine without a dietitian's board.
Bob McKinney sits in a hushed meeting room in the Ohio Capitol building and tries to keep his voice down. He doesn't want to disturb the hearing across the hall, where supporters of a new health-freedom law are giving testimony.
But McKinney is getting excited, and his assistant, Gina Holstein, keeps telling him to shush. His feet bounce on the marble floor with nervous energy. He punches his fist into his palm for emphasis as he speaks.
McKinney is under investigation by the Ohio Medical Board for practicing without a license. He owns Central States College of Health Sciences, which teaches natural healing, and says that he's been too busy to see any patients for five years. Besides, he practiced mechanotherapy, not medicine. "These are bogus, trumped-up charges!" McKinney says in a too-loud voice that earns him a stern look from his assistant. "They say we don't know what we're doing. But that's just because we're competing against them."
A tall, thin man in a tailored suit walks into the room. It's Tom Dilling, executive director of the medical board. McKinney falls silent. Dilling passes within a few inches of McKinney. When he's nearly to the door, Dilling says in a low voice, "Hello, Mr. McKinney."
McKinney jumps to his feet. "That's Dr. McKinney to you!"
Dilling spins on the toe of his tasseled leather shoe. "You're practicing medicine without a license!" he shouts back. Dilling takes a few steps toward McKinney and wags his finger. "You're breaking the law!"
"I'm not practicing anything!" McKinney says, his hands balled into fists. "The medical board illegally delicensed mechanotherapy, and now you're coming after me with an illegal, bogus investigation!"
"What are you talking about?" Dilling shouts. "Look up Ohio Revised Code number 4731.34! It is illegal to practice medicine in the state of Ohio without a license!"
Both men's faces turn bright red. They are screaming at the top of their lungs. A woman in the hearing room opens the door and watches them with a worried face. The Statehouse sergeant-at-arms runs into the room. "What's going on in here?" he asks.
Dilling spins on his heel and walks into the hearing room, leaving McKinney to deal with the sergeant. "Did you see that?" asks McKinney, who holds a Ph.D. in naturopathic medicine. "This is how Ohio's government treats its own citizens. They insult us and intimidate us."
The fight between natural health and the boards is more than an arcane argument over licenses and certificates. People on both sides genuinely dislike each other. Tempers are running especially high, now that Popper and Reidelbach have introduced House Bill 117, dubbed the "Ohio Health Freedom" bill. While most of her colleagues in alt-medicine try to keep a low profile, Popper has taken the offensive, lobbying hard for different versions of the bill over the last four years. "Most people just give up and go out of business, which is what these boards want," Popper says. "But I fought back."
The main thrust of the bill is to limit the boards' investigative powers. They would no longer be allowed to take practitioners to court simply for opening an office. "Frankly, some people in these agencies behave as though none of us has a brain," Reidelbach says. "These natural-health providers haven't done anything wrong. People have chosen to come to them."
If the bill passes, the boards could investigate under only three circumstances. Unlicensed providers doing things they're not trained to do, such as surgery, prescribing medicine, or giving radiation treatments, could expect a visit from the state. Boards could also examine individuals who failed to fully disclose their education and background to patients, or who didn't make it clear that they're not medical doctors. And the boards could still probe anyone accused of harming a patient.
"We absolutely believe that the boards have an important job to do," Popper says. "They should be there to make sure that nobody gets hurt."
Opponents say that it endangers Ohioans. "This bill purports to be about alternative medicine," Dilling says. "It's not about that. It's about unlicensed practice of medicine."
At least one board leader admits that she's lobbying against the bill partly to protect her turf. Since boards are funded by dues-paying members, Mavko worries that registered dietitians would simply stop paying their dues, let their licenses lapse, and continue practicing with impunity. "So why would they renew their license?" she asks. "Our board won't have any income. This bill would do away with our board."
The boards have another problem with the bill: Pam Popper. "I think I know some of the people you've been speaking to," Dilling told Scene. "And I would suggest that you look into their histories."
Dilling doesn't name names. He doesn't have to. People on both sides recognize Popper as the leader of the natural-health lobbying effort. When legislators discuss the bill, they often call it Pam Popper's bill, not Reidelbach's, who actually introduced it. Popper, in fact, has her own desk in Reidelbach's office.
Whenever the bill comes up for a hearing, Popper is usually the first to speak, and most of the other speakers are her clients. "Dr. Popper has been very helpful throughout this entire process," Reidelbach says.
Without Popper's involvement, it's likely that the bill would never have been introduced. She is the lone Republican in a field dominated by lefty Democrats. She's also donated $5,300 to Republican lawmakers since 2000, including $3,875 to Reidelbach. She boasts of bending the ear of Governor Bob Taft at intimate fund-raisers. "I was able to get a few moments with the governor at a function I attended," Popper says. "After I told him the situation, he asked me, 'All right. What can I do?'"
But the secrets of Popper's past could spell doom for her bill. In the late 1980s, Popper convinced stockbroker Edna Norton to found a company named Redbird Central, according to a lawsuit filed later by Norton. The company's purpose was to ensure stock sales. As a prelude to her later scraps with licensing boards, Popper falsely claimed that she had a license to sell stocks, the lawsuit says.
Officially, Popper signed on to do telemarketing and promotions as a consultant for Redbird. In reality, she used her access to steal the company from Norton, the lawsuit alleges. Popper began spreading rumors that Norton had embezzled money and stock, and that she was about to be indicted. Popper said that Norton had emotional problems, that she had lost her stock-trader's license, and that she would never be allowed to sell stocks again.
None of the rumors were true, according to Norton's suit. But they were serious enough to win employees and clients to Popper's side. In January 1987, Popper locked Norton out of the company and took full control, even though Norton still owned 100 percent of the company. Popper kept Norton on the defensive by suing her for theft; nine months later, a judge dismissed the suit.
Norton countersued. At trial, Popper lost. She appealed and lost again. In 1990, Popper was ordered to pay $1.1 million in damages.
Popper maintains her innocence, blaming the entire incident on Norton. "She stole $150,000, and she only paid it back when we locked her out of the building," says Popper.
She also refuses to pay her court-ordered settlement. "I've never paid it, and I'm never going to," she says.
No matter who's right, Popper's past feeds into the state's perception that the natural-health community is a circus of con artists. On the one hand, she's the perfect spokeswoman -- smart, well-spoken, and fearless. On the other, the allegation that she promoted herself as a licensed stockbroker drives to the heart of the current controversy, since her opponents say that she practices medicine without a license. At a hearing last month, most of her patients referred to her as "Dr. Popper." In her frequent campaign contributions, Popper reports her occupation as "doctor" or "physician."
She says she's a naturopathic doctor and received her degree from Clayton College of Natural Health, a correspondence school in Birmingham, Alabama.
"Most people think she's a real physician," says Mavko. "She doesn't say what kind of doctor she is. If this bill passes, anyone can put on a white lab coat and call themselves Dr. Pam."
Popper's past doesn't render false the many accusations against the boards. But her business history and the fact that she still owes over a million dollars in fines raise the question of whether Popper is the best advocate for loosening Ohio's rules. "You have to look at the credibility of some of these people," Dilling says.
Legislators on the House Commerce and Labor Committee have done just that, and they remain skeptical. Without the committee's approval, the bill is likely to die for the fourth year in a row. "I call it the Witch Doctor Bill," says Representative Tim Cassell (D-Madison). "It's scary. To put these people on the same playing field as doctors is extremely dangerous."
Which means that none of the combatants will get what they want. Natural-health providers will continue to practice, many in fear. The boards will continue to pursue them, but they'll catch only a fraction.
And consumers looking for a second opinion will continue to be denied the right to choose. Five months after Dan Nuzum was arrested, his clients are still waiting for his return.
"I don't think Dan did anything wrong," says loyal patient Don Zell. "I'm gonna keep going back to him -- if he ever gets out of this."