Congress's Senior Advocate.

People who say, "I just don't like politicians," are thinking of a cliche. They assume that you can pick out the budding professional office-holder by the artfully groomed hair and smile, by the carefully chosen pleasantries and by the well-planned career.

They aren't thinking about Peter DeFazio.

In the 1970s, Peter DeFazio was on staff at the Jewish Home for the Aging in San Francisco and later was assistant director of a senior companion service in Oregon. In 1977, he received a master of science in gerontology counseling from the University of Oregon.

DeFazio, a self-described "child of the Sixties" and U.S. Representative from Oregon, was introduced to long-term care and related issues during a temporary job, after he completed his military service. He views his door-to-door effort to recruit retirees for conversion from other government pension programs to Social Security as a life-changing experience. "I enjoyed meeting seniors and solving their problems. For example, I met a mother and daughter living together who were both elderly and reluctant to apply for benefits. That's when I decided to go into gerontology, thinking 'This is a group of people who are fun to work with but who really need help.'"

At the Jewish Home for the Aging, DeFazio was impressed by the burdens imposed on residents and their families by inappropriate federal policies. Before Congress raised the level of protected assets and incomes for spouses of nursing home residents, he witnessed how difficult it was for those spouses to try to live in the community while they were being impoverished. "It caused guilt and problems among the nursing home residents," he explains, "and made me a strong advocate for seniors."

DeFazio's transformation from advocate for the elderly to U.S. representative occurred almost by accident. A friend suggested that DeFazio would be well qualified for a vacancy as senior citizen ombudsman in the office of then-Congressman Jim Weaver. DeFazio's spur-of-the-moment application was successful, launching a political career that eventually resulted in his election to the Board of Commissioners for Lane County. When Weaver retired in 1986, his former aide succeeded him as the Democratic congressman from Eugene.

DeFazio has found that experience on a SNF staff provides a unique perspective on healthcare legislation. For example, during his first term in Congress, he was pressured to support the Medicare Catastrophic Coverage Act of 1988. One of its strongest advocates was Congressman Claude Pepper, then almost 90 years old and nearing the end of a half-century career of legislative advocacy for the elderly. DeFazio's own experiences, however, caused the Oregon congressman to join the ranks of the small minority that opposed the bill. "I said, 'This is not a benefit that seniors want and need, and we're paying for it by taxing seniors,"' he explains. His position was vindicated the following year when a powerful grassroots effort among elderly taxpayers resulted in repeal of Medicare Catastrophic Coverage.

The disaster of the 1988 act made members of Congress more cautious about creating programs for the elderly, but it has not made them more knowledgeable about how chronic health conditions affect the lives of older Americans. Musing about some of his colleagues' beliefs, DeFazio says, "I always kind of wonder what planet some of them are from." He believes that many in Congress think of all chronic care residents as helpless people who must be protected from their own decisions. "These are adults who want to be treated like adults and who have the right to informed consent and to make their own choices."

This core belief in informed resident choices and the pervasive '60s counterculture spirit of Oregon combine in DeFazio's signature cause of naturopathic supplements. Naturopathy is the system of treating health conditions with natural remedies, such as herbs, diet, sunlight and massage. It differs from conventional, allopathic remedies, which use manufactured medications to counter the effects of disease. For example, the allopathic approach to high blood pressure is to administer medications that lower blood pressure, while the naturopathic approach is to change diet, exercise patterns and other lifestyle factors that might contribute to high blood pressure.

Ironically, the problem with the naturopathic remedies is that government regulation of healthcare focuses on allopathic drugs, leaving the naturopathics in legal limbo. The federal Food and Drug Administration (FDA) requires extensive testing of manufactured medications before it approves their use to treat health conditions. Insurers, including the federal government, then rely upon FDA approval to determine which treatments can be reimbursed. Naturopathic remedies and dietary supplements, in contrast, usually are not investigated by the FDA and do not receive official government sanction. As a result, insurers won't reimburse the costs of naturopathic remedies, and clinicians might even be forbidden from recommending their use in treatment.

DeFazio believes that the good objective of FDA approval of patented medications has mutated, in part, into depriving older Americans of the choice of being fully informed about the risks and benefits of natural remedies. As he explains, "A lot of seniors have chronic problems that allopathic medicines can't address. These are issues such as dietary problems, chronic sleep problems and enlarged prostates. Nutritional supplements might be helpful. The problem with the current law is that since these things are not FDA-approved, physicians that recommend them could lose their licenses."

In practice, according to DeFazio, older Americans are no more or less likely than other people to try using naturopathic remedies. "They are like anybody else," he says. "They read about the success of some of these supplements in the newspaper. Doctors can say, 'I use this supplement for myself,' but they must be careful not to recommend them to patients. A lot of people are skirting or even violating the law."

Not all of DeFazio's efforts are one-man crusades. This spring, for example, he signed on as one of 305 cosponsors of H.R. 171. The truly bipartisan act would allow retired members of the armed forces who began service before 1956, and their surviving spouses and dependents, to enroll in the Federal Employees Health Benefits (FEHB) Program. If it passes, many older Americans could enroll in the same low-cost comprehensive health insurance coverage enjoyed by current federal employees. By mid-July, however, H.R. 171 had been stalled in committee for more than four months, waiting for the Bush administration to comment on the bill.

Every session, DeFazio has introduced legislation that would allow limited regulation of nutritional supplements and allow clinicians to legally provide information on their use in therapy. It would not affect most current marketing and distribution. However, he wants naturopathic supplements to be monitored for the quality and impact of their effective ingredients, without rigorous testing for efficacy. "There's a lot of promise out there," he says, "and [there are] a lot of quacks. There are proposals out there that are outlandish." Nevertheless, if government can protect the elderly from outright fraud, DeFazio believes that it should remove the barriers that keep clinicians from offering advice on natural remedies.

To date, DeFazio's naturopathy bill has not achieved much success. Without question, it is unconventional legislation that fits well with a congressman who defies so many stereotypes of the professional politician.