A Modern History of Herbal Medicine by Stephen Church

Introduction

This is a personal history, written quickly, relying in part on distant memories, anecdote and hearsay. Some of the myths and legends are impossible to substantiate, though their existence is often more telling than fact. It is anyway offered by way of a discussion document – I’m more than willing to stand corrected and, hopefully, learn more.

Some readers may need to be informed of the context – I have practised Herbal Medicine in partnership with my wife, Carol, at our home in Surrey for over 25 years. During most of this we were members of the National Institute of Medical Herbalists (NIMH), at times serving on its Council and various committees. If I seem over-concentrated on the NIMH, it is partly because it represents the lion’s share of my own experience, but equally because in most matters concerning the regulation of herbal medicine, it has lead where others have followed. Since 2002 Carol & I have practised independently, which surely in turn will colour how I organise my thoughts on the subject. Organising my own thoughts was the main motivation for undertaking this task, trying to make sense of all the tangled threads that draw us all, for better or for worse, towards a new era in Herbal Medicine.

I refer constantly to “Herbal Medicine” and “Herbalists.” Once upon a time we just had watches, until digital timepieces came along and we had to learn a new term, analogue watches, in order to differentiate. For most of my working life I was just a herbalist. Then the foreign invasions of Traditional Chinese Medicine and Ayurvedic Medicine arrived on our shores, so now I gather I’m to be known as a Traditional Western Herbal Medicine practitioner. This doesn’t sit well with me as it gives no hint that I’m part of the indigenous and unique healing system of the British Peoples, a folk tradition, which like all folk traditions only survives if it adapts and remains relevant. Like all folk traditions, it borrows from and lends to perceptions and resources from the known world of each era. It’s learnt from empirical knowledge and illuminated by anecdote. It is neither complementary nor alternative. It’s just always been there. It’s Herbal Medicine, and I’m a Herbalist!

Part of the uniqueness of British herbal medicine resides in the uniqueness of the experience of being British: if, like a good wine, we have travelled well, we have also always formed the vessel for an extraordinary admixture of races and cultures. My own working life has coincided with an era of rapid adaptation, where the “known world” has become the whole world, and in which sudden and perplexing changes in patterns of health and illness have required great consideration and invention. The tradition is, I believe, alive and well, and never more relevant. But despite this good and healing work, the custodians of the living tradition find themselves beleaguered and concerned for their future. The mainstream of Herbal Medicine is once again clamouring for recognition and status, once again in a legislative environment that is overbearing and hostile. This time, it seems, it’s prepared to sacrifice all sense of itself, to become science-orientated, doctor-like in the radically new way that doctors themselves have become, and using phytopharmaceuticals in which any sense of nature, botanical or human, is submerged. Proponents of this brave new experiment even deny that a indigenous tradition exists.

Anyone interested in the history of herbal medicine should read Barbara Griggs’ “Green Pharmacy.” It’s a history of eight centuries of “penury & persecution”. The last two centuries mark the growth of what we would recognise as “professional” herbal medicine – this in particular is a history of near-constant battles over regulation, of rivalling paradigms, of alliances and splinter-groups, of vainglorious enterprises and missed opportunities. Much of what went wrong arises from the poverty of herbalists, who on the basis that money is power, have so often found themselves powerless. Much of what went right was down to sheer bloody-mindedness. Much the same as now, in fact.

Why has herbal medicine had such an unsettled history? Partly because its own child, allopathic medicine, now in its rather naughty adolescence, has proved something of a bully. Partly because of the ebb and flow of fashion and competition. Partly because herbalists as collectives, despite the pomp and the fine words, are a bit of a rabble. But mostly one returns again and again to the same dichotomy. On the one hand, professional herbalists have yearned for official recognition and status. On the other, they are fiercely resistant to interference and control. If it’s worth listening to history, it’s to avoid making the same mistakes incessantly, and to seek new solutions to old problems.


Culture, Gender & Demographics

The NIMH, certainly until very recent times, was a near-exclusive male domain. Its members displayed all the trappings of the “professional,” at the high end of the new middle class engendered by the Victorians. Nonetheless their heartland was the industrial urbanisations of the North of England. They were clearly a lively bunch – there are stories of AGMs in the 1920s breaking out in fisticuffs requiring the local constabulary to be called in. Their process was largely self-serving, demonstrating only passing interest in “the peoples’ medicine.” Only two publications can be loosely attributed to the organisation, both pharmacopoeias (1932, 1983), of little interest to the public and, frankly, of marginal interest to practitioners.

Modern NIMH members might not be aware how much they owe to another organisation, the Society of Herbalists. Their bible was “A Modern Herbal,” (1931) derived from the work of Maud Grieve, an extraordinary woman who gained her experience practising, organising & teaching during the First World War. Hilda Leyel, who both edited & published Mrs Grieve’s notes and founded the Society, performed more or less the same role during WWII. By the end of the war, she and others such as Mary Thorne Quelch & Eleanour Sinclair Rohde had added a prodigious output of works on herbal medicine that were enormously popular & useful to the public. These and A Modern Herbal should form part of any modern herbalist’s library. The Society is no more, but there remains echoes in the Culpeper brand (the Society set up the Culpeper shops above which its members practised,) and the modern Herb Society. In sharp contrast to the NIMH, the Society of Herbalists was almost exclusively female, heavily populated by the daughters of gentlefolk, based in the South, and clearly more egalitarian.

Of interest, the two bodies appear to have coexisted surprisingly harmoniously, even joining forces in the run up to the 1968 Medicines Act. It’s whimsical to note on that occasion the NIMH took charge of lobbying the Commons whilst the Society dealt with the Peers.

Post-1960s, the NIMH ended up more or less the only show in town, although it has continued to spawn the occasional splinter group. The most significant change came in the 1980s, when Hein Zeylstra’s Tutorial Course started to attract female students in large numbers. This trend continued, to the point that over 85% of NIMH members were female. A census towards the end of the 1980s indicated that the majority of NIMH members were middle-aged single white British females. It’s also noteworthy that at the time the NIMH was still dominated by an inner core of individuals who were not only male but also fundamentalist Christians. This caused something of a culture clash with the growing preponderance of “grown-up hippies” that were now populating the NIMH. Attempts were made to discipline members who, for instance, voiced interest in things like medical astrology or Bach Flower Remedies. There was no obvious coup, but the old guard faded from power, (though some might complain ruefully that the torch for these prejudices has been passed to the new fundamentalism, western material science).

Since the late 1990s, growing numbers of graduates from University BSc courses have brought with them another shift to a younger and much more multicultural demographic, reflecting the multiculturalism of the UK as a whole. This in turn adds to the melting pot a renewed interest in global influences in herbal practice.


Education & Paradigm Shifts

The NIMH (or NAMH as it was pre-war) founded in 1864, was a group of Physiomedicalists – the origins of this transitional paradigm having its roots in Thompsonian Medicine, in turn derived from Native American practice. To this day Herbal Medicine in the UK remains not only perfused with a considerable American materia medica but equally the vitalism of American Indian approaches to healing and wellbeing. NIMH training in these early days ebbed and flowed as an admixture of distance learning and semi-apprenticeship, a number of attempts to get a “proper school” going never getting much further than the drawing board.

With the impetus of the 1968 Medicines Act, salvation came in the 1970s in the form of Hein Zeylastra, an extraordinary personality who proudly recounted how he became NIMH Director of Education on the same day he was accepted into membership. He soon got a “proper school” opened in Tunbridge Wells, initially with a Tutorial (distance-learning) Course and later a Full-time School. A Dutchman from a farming background with some foreknowledge of German herbal medicine, Hein bundled up the best of physiomedicalism with influences from the Society of Herbalists, European practices, and a mixture of both scientific and vitalistic principles in part generated by some of his early students.

Perhaps the biggest change in modern times came not from formal education provision, or indeed NIMH policy, but the flood of students looking to work in a style more consistent with post-1960s culture & philosophy. What transpired came to be know as Holistic Herbal Medicine, which espoused a closer connection to nature, an eclectic openness to influences both domestic & global, the valuing of intuition, an empowering approach to the therapeutic relationship, and preliminary work on the new “non-science” of energetics. Nothing had really been invented, rather herbal medicine had opened itself to ideas and ideals predating the NIMH by many centuries, underpinned by contemporary non-western natural healing and often identified as the “shamanic” approach. One man, Christopher Hedley, stands pre-eminent in this field. A founder tutor at the School’s training clinic in Balham, much of the current solid core of practitioners passed through Chris’s clinics, learning the lessons of holism alongside classic clinical skills. These people took it home with them to prove that holistic theory could become effective herbal practice, and a new paradigm was born. This has never really been fully described, but its advocates would contend that, by definition, holism cannot be qualified or quantified.

There were some radical changes around the turn of the millennium. Hein Zeylstra declared his School independent of the NIMH in order to pursue external validation, and, had it survived, degree status for its courses. This prompted the NIMH to look to the mainstream academic world to teach herbal medicine, arising first in a BSc course at Middlesex University, followed by others at Westminster, Preston and more, including the somewhat nonconformist and much-praised Scottish School. Inevitably most of these degree courses have had a strong and growing emphasis on science, and are squeezed into three years. It remains to be seen if it is possible to practise herbal medicine successfully using only the evidence-based, scientific approach espoused by the Universities. Given that the NIMH has also proved unable to generate a robust and well-considered postgraduate training programme, BSc graduates quickly find – and complain bitterly – that they are not adequately prepared for practice. Nevertheless some do succeed, but they tend to be individuals who before, during or after their studies have learnt both the (by now well-proven) holistic approach, and the skills required to manage a practice.

There is another element to this changing puzzle. If the backbone of current UK practice is Hein’s Tutorial Course, it may be in part because it attracted mature students who, given that they had to pay for the course entirely from their own pockets, by and large came from stable, well supported domestic environments and had further funds available for the expensive business of setting up in practice. It’s also true that practising in the 80s & 90s was a relatively popular and tolerably lucrative affair. By contrast, the University courses tend to attract younger, less settled individuals, usually graduating into debt, entering a working environment that is relatively hostile, and in a field that is seemingly in decline.


Medicines

In the early 1980s, despite a high point in terms of the public demand for Herbal Medicine, the medicines themselves were pretty dire. Crude herbs were often of such poor quality that only the most pharmacologically active could still prove remedial. So-called tinctures were mainly derived from dilutions of fluid extracts made by steam percolation, a destructive if industrially efficient process that would again leave only the most potent of herbs therapeutically viable. As if it couldn’t get worse, many of the practitioners who had come through the war years were still accustomed to using isopropyl alcohol for tincture making – not only disgusting but mildly toxic. They were given to employing polypharmacy, (often 20 or more herbs dispensed in a single mixture,) and adding up to 50% water at the end of the process. One is simply left bemused as to how all this could possibly have worked, but evidently it did.

The most significant step forward was made once again by Hein Zeylstra, who secured a licence to purchase duty-free ethanol and used it as the foundation of his new company, Phyto Products. Hein also used his connections with the herb trade to track down acceptable quality cut-and-dried herbs, and the resultant affordable, high-quality tinctures revolutionised herbal practice overnight. It also lead the way both to individual practitioners securing their own alcohol licences, and to a proliferation of new companies dedicated to supplying practitioners with these new medicines.

Part of the post-60s culture that Hein’s students brought with them was an interest in that forerunner of environmentalism, self-sufficiency. These people wanted not only to make their own medicines but from herbs grown in their gardens or gathered locally. Drying herbs on a domestic scale soon proved disappointing in terms of yield, so experimentation started on making tinctures from fresh herbs, which quickly evidenced a more viable approach. It’s a great credit to this generation that there was very little experience to draw on, and it was frowned upon officially as virtually all available research data at the time (and even now) related to dried herbs, and it was further assumed that “specific” (fresh-herb) tinctures would be too weak on account of the high water content. Such concerns proved ill-founded – most good modern practitioners can now take for granted that this approach produces the finest medicines, in part underpinned by a small number of “cottage industry” suppliers dedicated to the field.

The other success from this era, hand in glove with holistic perceptions and the growing preponderance of female herbalists, was a quiet shift from the pharmacologically very active medicines favoured by the former male-dominated regime to a more gentle, feminine approach, revisiting indigenous herbs once dismissed as being therapeutically inert such as rose & borage.

However, a quite different phenomenon appeared on the horizon towards the end of the millennium. There had always been a number of herbalists (backed by their professional associations) who were interested in developing a more “scientific” approach to materia medica, matched by the growing interest in mainstream academia and commerce to research and manufacture potent remedies produced under the strict standards and controls developed by the modern pharmaceutical industry. The outcome was not mere standardisation but enhancement of herb constituents evidenced by research to be the most pharmacologically active. This is probably a focus for the greatest division amongst practitioners. One argument says that this is Herbal Medicine at last growing up, engaging with modernity, adapting to a form of medicine that is acceptable to the science/medical communities, and able to offer predictable outcomes to defined therapeutic strategies. The opposing argument is that these “phytopharmaceuticals” are anathema to vitalistic principles, are not herbal medicines at all but weak drugs employing crude plant material as a starting point, are environmentally unacceptable, and have a great deal to do with the ascendancy of over-the-counter herbal medicines over the work of the practitioner. Many herbalists fear it is only one step away from scientifically validated herbal medicines being produced entirely by Big Pharma as the sole province of pharmacists and doctors, herbalists finding themselves redundant, despite the extraordinary but largely unsung potential of holistic practice.

Meanwhile, if there are fears that regulatory pathways will interfere with in-practice pharmacy, they have already impacted the traditional herb trade dedicated to supplying herbal practitioners. Cottage Industry and other microbusinesses that would not be able to afford the new equipment and processes required to achieve pGMP (pharmaceutical Good Manufacturing Practice), have closed down, or will do soon, or be bought out by larger outfits, despite the fact that these small suppliers are known to produce the best quality at the best prices. The two largest traditional suppliers are inevitably the front-runners, (and there are rumours of formative interrelationships with pharmaceutical interests,) in a race for the pole market position. Inevitably there are substantial hikes in price and, to experienced practitioners, an unacceptable drop in quality.

The future is very hard to predict. Regulated, science-orientated herbal practitioners using licensed, science-driven herbal medicines as a foundation for practice remains an experiment as yet unproven. Whether the public in their role as patients can afford the obvious extra costs on both sides of this equation is equally hard to predict. By the same token, if the traditional practitioners are to continue, it seems unlikely that there will be a dedicated trade left to serve them, so they will have to do as so often before, sourcing their own herbs and making their own medicines. Fortunately the skills generated in the last twenty years should stand them in good stead.


The Background of Legislation

The significant history of the modern legislation of herbal medicine must start with the 1941 Pharmacy & Medicines Act – and it starts with a shambles. Critics of the Act at the time suggested it was something to do with appeasing the Pharmacists who had temporarily been forced to charge both stamp duty and the new Purchase Tax on their stock in trade (charging a tax on a tax is apparently illegal) and rather than give them their money back the government awarded them with both greater powers and a means to increase their market share of the over-the-counter sales of medicines, (medicines, particularly during the privations of the war years, still being mainly herbal). The Act was rushed through Parliament with record-breaking haste. Herbalists themselves were not consulted, indeed, they were taken completely by surprise. It must have helped in the depleted Parliament at the time of the blitz that no less than 60 MPs were doctors. It certainly attracted widespread condemnation that the Government chose to sneak it in under the radar when it should have been concentrating on the war effort.

The Act was also worded so incomprehensibly that it was almost impossible to judge its potential legislative impact. Modern commentators (Barbara Griggs, Michael McIntyre, Jill Davies) say that the 1941 Act outlawed herbalists overnight. This is surely not the case. The very large number of herbalists that worked in herb shops were expected thenceforward, like the pharmacists, to label proprietary medicines with their contents, which if it led to more work can hardly been seen as a bad thing and certainly not a significant restraint to trade. For the consulting practitioners, the Act could have been interpreted as restricting them to prescribing dried herbs and nothing else – but there were clear assurances from the Ministry of Health that the Act would not be interpreted in this fashion, and it kept its promise. There was also the aggravation that the Act nominally handed over control of herbalists and their medicines to the pharmacists, but with the caveat that any prosecution would have to be referred to the Attorney General. Either way, it never happened.

To sum up, the 1941 Act, which remained in place until 1968, made herbalists feel persecuted (but never once prosecuted). It may have something to do with the subsequent growth in high-street chemists and the decline of herb shops, and the decline in the prescription by consulting herbalists of “patent” herbal mixtures in favour of ad hoc dispensing for individual patients. But if 27 years later the 1968 Medicines Act was a delight of clarity and fairness to herbalists, the 1941 Act set the tone for all else that came after, to the present day – a government bowing to persuasion from the immensely powerful lobbies of the allopaths and the pharmaceutical industry, tokenism applied to consultative processes, and ill-considered lawmaking that is neither comprehensive nor comprehensible.

Certainly nobody was prosecuted for illegal practice and it would appear that herbal medicine continued to grow during the war years, there being an estimated 1200 practitioners in the UK by 1951, when Aneurin Bevan, mastermind of the new NHS, was given to consider the plight of herbalists again. He was impatient both with the lack of cohesion amongst herbalists (even a squabbling alliance between the NIMH & the Herbalists Union represented a mere 40% of the whole) and equally a lack of will (or perhaps the problem was, as ever, a lack of resources) to provide either education or self-regulation to acceptable standards. The consolation prize was to be offered a role in the NHS but with only a token level of prescription subsidy and a place in the pecking order well below doctors. The NIMH & everybody else politely declined, electing to remain under the threat of prosecution for a total of 27 years.

The way the story is told of the events leading up to the 1968 Medicines Act would give you to believe that herbalists faced being wiped out once and for all by the Act and that the NIMH saved the day. This has to be modified a little. If the 1968 Act had gone through unchallenged it may well have compounded the herbalists’ sense of vulnerability, but it’s more productive to see it as an opportunity to “come in from the cold” which the herbalists of the day certainly grasped. Although Fred Fletcher Hyde, the then President of the NIMH was clearly a key player, the job was done by a coalition of the NIMH, the Society of Herbalists and representatives of the herb trade. There was sufficient lobbying of both the Commons and the Lords to get Sections 12 & 56 written into the Act, allowing herbalists to practice under a set of fairly helpful arrangements. Herbalists were free to prescribe herbs provided this was consequent upon a one-to-one consultation, and a small list of the more potent herbs were restricted to this arrangement. It was contingent on an unwritten agreement that herbalists must generate a much better account of themselves in the future in terms of standards and particularly scientific research. These arrangements were echoed throughout the English-speaking world but were unique in Europe, where the UK continues to have the only officially sanctioned professional class of herbal practitioner.

Before moving on, one of the complaints of the current pro-regulation lobby is that the 1968 Act fails to define a “herbalist,” so absolutely anyone can set themselves up as a practising herbalist with little or no training or accountability. It would seem that during negotiations the Government tabled the suggestion that a legal definition of a herbalist be incorporated in the Act, but herbalists (and particularly Fred Fletcher Hyde), were equally keen to avoid this. Whatever the current anxieties regarding a lack of definition, they appear ill-founded, as not a single example has ever been cited of an indigenous herbalist causing injury to a patient in the subsequent 40 years since the Act was passed.


The Shipman Report & Complementary Medicine

In January 2000, the conviction for murder of patients in extraordinary numbers by the GP, Harold Shipman, sent shock waves through the medical profession every bit as strong as the Thalidomide scandal forty years before, leading to a media frenzy, public clamour, a rigourous inquiry and, in due course, the Shipman Report which, amongst other things, recommended that all healthcare workers in whatever field should be brought under adequately strict state control. There is, of course, no persuasive argument that such measures could ever protect against a Shipman of the future, indeed, even in the face of such renewed zeal, doctors & nurses can and do still kill.

Why should Herbal Medicine be caught up in all this, with such a matchless safety record, particularly as a fatal dose of herbal medicine would be as difficult to administer as it would be to conceal? Partly, however annoyingly, because of the relatively poor safety record of TCM practitioners. More likely though, (and yet again), through political opportunism. The course of UK politics from Thatcher to Brown has tended towards more and more central control of aspects of everyday life not hitherto considered to fall within the remit of national government – there is a strong desire evidenced to bring absolutely everything under central government control. Add to this the professional jealousies of the allopaths, powerful lobbying by the drugs companies, unsympathetic demands from Europe, and a modicum of complicity from within Herbal Medicine itself, and the die is cast.

Two other factors have to be drawn into this arena. The Shipman frenzy has lead to regulation being progressed for all other branches of non-doctor medicine, not just “alternative” medicine right down to the last crystal healer, but even counselling and psychotherapy – indeed, if herbal medicine was under consideration a decade before the Shipman Report, it finds itself, due to the complexity of regulating herbal medicines, near the back of a very long queue. By the same token, if Shipman freshened legislative zeal in the UK, it finds itself well co-ordinated with parallel moves throughout the West, with particular emphasis on the English-speaking world.


TCM & Ayurveda

Foreign herbal medicine in the UK is nothing new – immigrants bring their own food, clothing, art, philosophy and medicine with them. Chinese medicine, for instance, has been practised quietly in the “Chinatowns” of our cities for centuries. But there have been two paradigms, Traditional Chinese Medicine (TCM) and the Indian Ayurvedic Medicine that have suddenly blossomed.

To deal with Ayurveda first, this late arrival has had a gentle impact. Most holistic herbalists have adopted a small but very useful Indian materia medica in their dispensing, underpinned by rudimentary Ayurvedic principles. There are others that have received a full Ayurvedic training and practise accordingly, often translating the principles to western herbs. There are also a growing number of Indian practitioners of Ayurveda in the UK. This has largely been problem-free, other than a few difficulties arising from misidentified Indian herbs and a few of the classic Ayurvedic formula medicines that contain minerals deemed to be toxic.

TCM, growing in the last two decades at such an extraordinary rate that it has overrun the indigenous tradition, has had a more serious impact. Once again, most indigenous herbalists have used a few Chinese herbs at some time or another, and basic oriental concepts such as Yin, Yang and Qi form part of most modern herbalists’ working language. There are also plenty of courses in TCM for westerners to study, often chosen because TCM has been so well marketed as a fully developed and comprehensive traditional paradigm. But the biggest phenomenon is the appearance, seemingly on every high street, of TCM shops, there to sell Chinese herbs and with a TCM doctor, available for consultation, at the heart of each.

TCM, however, is not the medicine traditional to mainland China (which has been successfully suppressed), but a Maoist politicised construct dominated by a Chinese orthodoxy enamoured of western material science. This is what is mostly taught here and, more significantly, this is what is marketed by TCM shops & their “doctors” (not recognised as such in the UK). They are enterprises wholly owned and controlled by the Chinese State.

Whatever one thinks, for instance, of Chinese human rights records, or the wisdom of wooing a country with a culture and political process so radically different to our own, the current UK government seems to be indulging in a business-driven love affair with Communist China, the spread of TCM in the UK being a small but direct result. There are many, many problems. Indigenous herbalists are rueful that there are no such government-subsidised facilities for them. There are complaints that Chinese “herbal medicines” often contains animal or mineral products that patients may not be aware of. There are constant revelations of supplying misidentified Chinese herbs, the inclusion of orthodox drugs in patent medicines, and serious mistakes arising from a lack of familiarity with English language, culture and mainstream medicine. People have died, been injured or had narrow escapes in consequence. On the basis that all herbal medicine in the UK has to be legislated under a single umbrella, the DoH & MHRA somewhat cynically quote these incidents as evidence of the need for regulation and control of herbal medicines and practitioners across the board. Yet no evidence of a traditional western herbal practitioner harming a patient has been cited since the 1968 Medicine Act.

It’s noteworthy that Michael McIntyre, NIMH President at the time he founded the EHPA in 1993 (and thus started lobbying for state registration), was primarily a TCM practitioner himself, and with financial interests in both the teaching and supplying of TCM. One could say that he was ideally placed to bring the two main disciplines of herbal medicine together (others thence following on) and, given the failure of herbal medicine ever to present a united front before, this must be counted as a success. But it does seem that much of the legislation drafted, good or bad, has TCM in mind. Many commentators feel that British herbal medicine should never have allowed itself to be mentioned in the same breath as TCM, given the radical differences and apparent dangers manifested by its oriental cousin. Others suspect a conspiracy in which future TCM practitioners will prosper whilst indigenous herbalists are edged aside.


The Pharmaceutical Industry

It’s easy to forget that the 1968 Medicines Act came into being in response to the panic caused by the Thalidomide scandal. It would not have seemed unreasonable at the time that although government control should be provided in the form of the Medicines Control Agency (now rebranded as the MHRA), the drugs manufacturers who had caused the problem in the first place should quite rightly go to all the trouble and expense to put things right. Like many government Agencies, the MCA had to turn a profit, which it achieved by providing licences (at considerable expense) to pharmaceutical companies for drugs that they had provided adequate proof of safety and efficacy by a rigourous process of testing and trialling. A difficulty arises in that the Agency, although constituted to protect the public, nonetheless derives its income from the drug manufacturers, and over the years has often appeared to be more their champion than ours. This may also explain why drugs manufacturers are often accused of falsifying test or trial results in order to launch new drugs quickly and cheaply – the accusations coming from a variety of sources but seldom the Agency itself, which in turn is accused of collusion with the industry. This questionable situation seems to be mirrored throughout the Western World. It might have been radically different if the process of proving medicines had been conducted by state-controlled facilities and then billed to the manufacturer, but it wasn’t to be. Unwittingly, the Medicines Act has contributed to the pharmaceutical industry becoming so rich and so influential it stands virtually outside of political control and indeed has a heavy influence on it.

Big Pharma has a particular interest in the fate of Herbal Medicine. It’s accepted business practice to try and put your competitors out of business and take their market share for yourself. We’ve already seen what a multibillion pound share of the market Big Pharma has achieved with over-the-counter sales of herbal products, notably in Europe and, as will be discussed shortly, there is also a substantial and growing market in practitioner-only herbal medicines in Europe, the practitioners in question being doctors & pharmacists. Would it be the case that doctors in the UK are unusually reticent to use herbal medicines as weak drugs like their continental colleagues simply because, uniquely, we have professional herbalists here? No matter, if the herbalists concerned are willing to adopt their products and market them as vigorously as doctors do, business will be good. Obviously the shift from plant-based to product-based notions would have to be deepened and, like everything else in the current regime of science fundamentalism, everything must be strictly controlled.

So, if you were going to write a business plan for the pharmaceutical take-over of the UK herbal market, it would include the politicising of herbal medicine, teaching product-based approaches to prescribing to students and practitioners, strict controls at all stages and, of course, the eradication of any “tree-huggers” that might stand in their way. All these things are happening and, however difficult it may be to find hard evidence, is surely no coincidence.

Of course, we are not the only victims of this process. The plight of doctors themselves, in a tail-wagging-the-dog situation as the trade overpowers the profession, is so discomforting that not even huge hikes in remuneration can stop those with any residual ideals quitting. Nutritionists are also feeling the breeze as OTC natural medicines, and practitioners’ own bespoke supplements, are legislated and manipulated into the Big Pharma camp. Homoeopathy, seeming a less convincing source of potential income, is simply held to ridicule. Just as telling, all forms of alternative therapy find themselves constantly lampooned in the media of late, prompting the question: by what influences are the media informed?

Finally, there is a profound dishonesty all on its own in the protocols by which the pharmaceutical industry has chosen to judge herbal remedies. The most aggravating is that if a single component selected from the array of active substances in a plant medicine can be extracted, concentrated, and used to cause harm (e.g. to a small white rodent) then the whole can be pronounced dangerous. This is a basis on which nothing else whatsoever is judged, and denies the basic tenet of all medicine, that what can be therapeutic in one dose can be toxic in another. There are many other examples of the clearly cynical debunking of the herbalist’s stock-in-trade, with the overbearing suggestion that only when pharmaceutical companies have taken over the manufacture of herbal medicines can they finally be pronounced safe and effective. We need to remind ourselves once more that this is a fabrication. British herbalists have never caused harm, Big Pharma can make no such claim.


Europe

It is for good reason that the problems of EU lawmaking should follow on from considering the drug trade, as it is so often complained that the European Commission seems as able to resist political influence as it is willing to acknowledge commercial influence, especially from the giants such as the Pharmaceutical Industry. At the time that the NIMH discovered in 1992 that the EEC’s CPMP had generated its bizarre list of 30 “dangerous” herbs and thus started the panic we now inherit, it was rumoured that the drug trade in Europe had allocated a “fighting fund” in the region of a quarter of a billion pounds to turn the tables on the burgeoning natural medicines market. The next rumour was that the Chair of the CPMP at the time did a moonlight flit to Argentina with over £4m in bribes received in his pocket. Neither of these things may be true, but does evidence the levels of corruption suspected in the EC, complete with its complacency that billions of pounds of its annual budget, whether by choice or mismanagement, are never accounted for.

There have been committees, negotiations, consultations, position papers, directives and regulations aplenty ever since. In 1994, EC Directive 65/65 suddenly demanded that the herb trade become subject to the same (fabulously expensive) licensing arrangements as drugs. It would have closed herbal medicine down overnight. Within a fortnight, such was the lobbying of UK MPs that government solicitors were instructed to find a way out, which they did by declaring that the traditional UK herbal suppliers were exempt as they were not employing the industrial processes to which the directive referred. Clearly it was only a temporary stopgap.

In 2004, along with a raft of legislation dealing with vitamins, minerals and other food supplements, the Traditional Herbal Medicine Products Directive (THMPD) appeared, to be implemented by 2011. This, it should be pointed out, is designed to regulate the OTC herbal remedy industry. Although it makes the manufacture of herbal medicines with a sufficient tradition of use subject to a relatively unchallenging set of evidence & licensing protocols compared to drugs, they are still expensive and onerous, sufficient to place them beyond access of small businesses.

Of critical interest to UK herbalists, this as it stands would almost certainly have put them out of business just as quickly as the 1994 debacle (because it effectively supersedes the safe haven provided by the 1968 Medicines Act), were it not for the initiative of tying medicines regulation in with the regulation of the profession. The deal, so to speak, is that a much longer list of plant medicines than were detailed in the 1968 Act would be withdrawn from public access, permitted use being restricted to “authorised health professionals”. State regulated medical herbalists in the UK could be considered duly authorised.

Before shouting foul, it has to be recognised that the THMPD is not a big issue in mainland Europe, especially not in Germany & France, where sophisticated phytopharmaceuticals have been popular as OTC products for decades. Equally it must be born in mind that although there have always been a few “proper” herbalists scattered across Europe (working quietly, because they are illegal), doctors in Europe are accustomed to prescribing these herbal products in considerable volume, employing them as weak drugs, and seemingly to good effect. The occurrence of an officially sanctioned professional class of herbalists is viewed as a British eccentricity, just as it must seem odd that UK doctors use herbal medicines so little.


Legislation at the 11th Hour

A quick recap reminds us that the current stream of legislation was, if not initiated, certainly hurried along by the point of view espoused by Michael McIntyre and his following – that the Europe-driven regulation of herbalists and herbs was looming and inevitable, and we should “either do or be done unto”. Let us also recall that the original move was towards Statutory Self Regulation (SSR). This sounded relatively attractive as, rather like the former Voluntary Self Regulation (by PAs such as NIMH), herbalists would remain largely self-governing, albeit under a single umbrella covering not only western herbalists but also TCM, Ayurveda and a handful of minor disciplines. Part of the attraction was undoubtedly that SSR is the same legislative stream enjoyed by doctors. But SSR is a very expensive arrangement, and as so often in herbal medicine, it failed in part because of the poverty of herbalists. For doctors, the SSR registration fee would have seemed a small price to pay in return for public subscription of their work through the NHS. No such benefit was on offer to herbalists who were simply expected to dip into their own pockets. Our pockets aren’t deep enough, as was pointed out time and time again over the years. Hopes that BSc graduates pouring out of the University courses would add enough to the kitty were condemned as (and proved to be) hopelessly optimistic as well. One way or another, the penny eventually dropped on the DoH, and a couple of years ago the SSR venture was abandoned courtesy of the Foster Report. Quite how Michael McIntyre survived this is a credit to his resilience – civil servants must surely have been galled that they hadn’t been properly briefed in this respect, whilst from the NIMH perspective, many years, the main efforts of its organisation, and some very large sums of money had been wasted.

It also presented something of a crisis, as the THMPD Directive deadline of 2011 was looming close. Salvation of a sort came in the form of a somewhat reticent Health Professions Council (HPC) who initially complained that their protocols could not accommodate herbal medicine, but presumably they have bowed to political pressure. We now talk simply of SR (State Regulation), a major shift in emphasis to a legislative stream where herbalists are governed rather than self-governing, and can expect to have little or no direct influence on the decision-making process. There are no doubt many reports & discussion documents & consultations yet to come, but it does seem certain that herbalists will be state regulated through the offices of the HPC, and probably just in time to be able to continue to prescribe legally from 2011. Quite what range of herbs (and in what forms) they will be using is unclear, just as it is unclear what policy will be formed in respect of the many traditional herbalists who are likely to refuse to register.


Division in the Ranks

The cynical might be forgiven for observing that there is division amongst herbalists over the regulation issue because there always is. Nevertheless there are genuine grievances concerning the undemocratic fashion in which the pro-regulation lobby has powered its way through. There has been a distinct lack of transparency, little consultation with the rank and file, few answers to key questions, and little interest in consensus.

Some of this is due to the way the NIMH organises itself. The extraordinary autocracy invested in the Presidency makes it impossible for members elected to Council representing dissent to have any real impact, and they often leave complaining of being ignored, marginalised and even bullied. It is also true that of recent years the vast majority of members do not attend NIMH AGM’s. Arguments rage as to whether this is due to apathy or antipathy, but it’s probably also to do with NIMH Conferences being expensive. Of the few that do attend, they are either Council members and their entourage, or graduates arriving to be “sworn in” as NIMH members who are neither inclined nor well informed enough to make a fuss. Thus those few (and there’s always a few) who attend to voice dissent find themselves outgunned and given short shrift. Likewise major (Council-lead) decisions go through on the nod.

Two events in particular evidence the overbearing approach of those pursuing state regulation. Throughout there had been vigorously opposition to SR, but it seemed harmless enough for NIMH members to provide its Council with a mandate, often ratified, to “explore” SR. In Autumn 1994, at a meeting convened in London to launch the campaign opposing the 65/65 European directive, Council revealed a campaign manifesto, and associated press release, that stated the NIMH was actively “pursuing” state registration. A complaint from the floor indicated that Council had no mandate for such a statement, and further the problem with a campaign manifestos is that, should one win the campaign, one would be expected to deliver the manifesto. From the podium, this was dismissed as splitting hairs; from the floor again, that this would split the Institute. (As an aside, the “official” version of how the campaign was won suggests that it was due mostly to Herbal Medicine’s headmen pulling strings with celebrities & the media. In fact it was all but ignored by the press, the defining factor being the patients of rank and file practitioners who lobbied their MPs in startling numbers).

A second event, also in London, was arranged by the NIMH Council in December 2001 to formally debate SSR: despite considerable efforts by representatives from the EHPA & the NIMH Council to stage-manage the proceedings, nevertheless this proved to be the only truly open debate of its kind – and those opposing SSR (and the spirit in which it was being conducted) won the day by a considerable margin. Subsequently Council denied that this was an “official” NIMH event, the audio recording of the meeting went missing, and it was never reported to the membership.

Going deeper, there is the problem that rank and file herbalists have virtually no access to dialogue with the EHPA, itself neither obviously democratic or accountable, and which effectively dictates to the NIMH. It’s noteworthy that “Michael (McIntyre) and his team” are conscripted almost exclusively from past NIMH Presidents, a formidable group who, rightly or wrongly, are assumed to be the real power behind the SR process, and somewhat covertly.

Inevitably herbalists can be divided into three camps – those passionately in favour of state registration, those equally passionately against it, and the largest group consisting of don’t-knows (or, perhaps, just don’t-says). This is a risky situation, as neither of the active groups can be quite sure, when their registration forms arrive on the doorstep, which way the silent masses will go (the real concern is that “going” might simply mean quitting Herbal Medicine). The active dissenters can again be divided into those that want to bring SR and all associated legislation crashing, and those that have no issue with SR for those that want it, simply asking for a safe haven for those that don’t. Reason suggests that the latter is the more viable objective.


The Tree-huggers

The anti-SR camp certainly keep a watching brief on the political process and sometimes quietly interject with their own ethical considerations (although viewers of BBC’s “Question Time” will be all too aware how adept politicians are at deflecting ethical arguments). However, their main thrust is to get on with their own plans for the future – legal, semi-legal or illegal, it comes to the same. Their ideals and consequent activities can be summarised thus:-

Human Rights: This is the principle of freedom of choice of their patients who support them, and all those who would prefer a safe form of medical treatment that is inexpensive, effective and unbureaucratised. (In truth many herbalists’ patients arrive because they have been injured, abused or abandoned by allopathic [state-controlled] medicine.)

More than just herbs: Holistic herbal medicine offers infinitely more than just the prescribing of the poor cousins of drugs. Practitioners offer a selection of other skills such as body working, diet & lifestyle advice, psychospiritual counselling, support, flower essence therapy, visualisation techniques, naturopathic treatments, and so on. They are good listeners. Their approach is to empower their patients and, echoing the original mission statement of doctors themselves, teach their patients how to claim responsibility for their own health. There is of course a great deal more, none of which are they prepared to lose.

Nature: Traditional herbalists feel that they are representatives of nature to their fellow beings, and that part of what is desperately needed by ordinary people is to reconnect with nature. Not surprisingly they resist the conversion of herbal medicine into something that seems to be going entirely in the opposite direction – materialistic, mechanistic and formulaic, and in which connection with plant nature is all but submerged.

Ecology: Nobody knows what the carbon footprint of the pharmaceutic industry is, but it must clearly be enormous. Growth in the industrialisation of the manufacture, packaging and distribution of herbal medicines must surely be reversed, not enhanced. There is a stark contrast between herbal remedies that are, for instance, grown in Europe, shipped to Australia, industrially processed and then returned for distribution in the UK, and those that are grown and manufactured by the practitioners themselves within a few metres of their consulting room. There is equal concern for endangered plant species, sustainability issues, fair trade, restoration of an indigenous materia medica and so on.

Transition Herbal Medicine: With the same ethos as the Transition Town movement, traditional herbalists are aware that energy descent and climate change will demand great adaptations of human social and economic organisation – so there is wisdom in rehearsing skills in advance of need. They are busy adapting to producing their own medicines from locally sourced plant material, to generally operate in as environmentally friendly fashion as possible, and to exit from their professional bubbles and re-engage with their local communities. Herbs need to be restored as part of the everyday way of life.

Custodianship: Perhaps the greatest single motivation for anti-SR herbalists to keep going, even in the face of impending illegality, is the sense that the “real” herbal medicine tradition is invested with a vast fund of knowledge and resources that, if they appear of marginal appeal at the moment, will prove of critical worth in the near future. In particular Herbal Medicine can remain fully functional in a very low-technology environment with little call on external resources or agencies.

A Polite Request: Generally it’s accepted that the enormous pressure from the medical profession, the drugs industry, the legislators and of course from within herbal medicine itself, will most likely result in the state regulation of herbal medicine. What is asked for is that sufficient leeway is left for the traditionalists to be able to continue about their business, on the understanding that they continue to do no harm. For the most avid proponent of state regulation, a question must nevertheless be asked: should a future British Government find itself in the position of prosecuting some very useful and much loved people with a dedicated sense of vocation who, after all, were doing no harm? Ethically this would be unacceptable, politically somewhat risky. Perhaps that is why in modern history herbalists, wandering in and out of illegality, have still been left alone.


Conclusions

This offering was prefaced with the hope that there may be lessons to learn from history. One overriding reflection is that herbalists want to be recognised but not organised. This is the “endless knot” to which the title refers. Can it ever be unravelled? How exactly do you organise people who don’t want to be organised? The answer logically is (and with some considerable evidence to back it up) – as little as possible. One of the sternest conclusions is that the “professional” herbalist (pretentious, doctor-like, aloof) of the last two centuries is itself a failed experiment. The solution may be found in venturing forth from our professional bubbles and viewing it more as an ordinary job of work – but one that is much broader based than the mere seeing of patients. More, in fact like our pre-industrial forebears, though heavens knows they had their problems too.

A more testing conclusion is that lessons from history may actually have very little to offer to a world facing the unholy trinity of unsustainable bureaucracy, energy descent and climate chaos, with precious little in the way of human experience to draw on. The tantalising thought is that, just when mainstream herbal medicine is about to jump on board the system that remains rooted in exacerbating these problems, herbalists may yet have a key role in the transition to the relocalised, low-energy, environmentally-friendly approach that is the best that ordinary people have on offer to solve this new (and potentially fatal) riddle.

It does seem that those herbalists who have clamoured so loudly for status and recognition are at last going to succeed, and one should wish them well – they will after all still be safer than (and one trusts still subtly different to) their allopathic colleagues. But I’m minded of the words of Simon Mills, setting the stage for the process under consideration who said in his presidential address to the 1990 NIMH conference, “No matter what laws are passed, no matter what fate befalls the Institute, no matter if herbal medicine has to return to its swamps and hills, it will surely go on for ever.”

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