The practice of herbal medicine is a fringe activity that occupies a culturally unique space in our society. Traditional western herbal medicine (TWHM) in the UK is a vibrant, vital and evolving practise, which is largely beyond state control. State regulation, which is underpinned by a positivist worldview, threatens the essential nature of TWHM by standardising its rich diversity of practice and criminalising independent practitioners. Listed below are just a few of the lies told in order to manufacture consent to the statutory regulation (SR) and licensing agenda.

Lie #1: Herbal Medicine is Risky Medicine

In the recent past western herbalists were happy to say ‘herbal medicine is safe medicine’, but now, in order to serve the SR/licensing agenda, herbalists are required to say ‘herbal medicine is risky medicine’. Why?

It is alleged that the poor practice of western herbalists is putting patients and the public at risk, but data on levels of poor practice among practitioners of TWHM has yet to be produced. The Department of Health (DH) could easily commission research to gather such data so that a rational and informed decision about the need for SR/licensing could be made. This has never been done. There simply is no reliable evidence base demonstrating that the public need safeguarding from practitioners of TWHM. Furthermore, were SR/licensing to be introduced without a supporting evidence base, then future judgements about the success or failure of such schemes to reduce levels of poor practice would be impossible to make.

Bureaucrats can theorise about potential risks all day long, but without a reliable evidence base demonstrating that real harm comes from the activities of western herbalists the imposition of any regulatory scheme would be completely unjustifiable. The precautionary principle applies here: if the potential consequences of an activity are severe, in the absence of full scientific certainty the burden of proof falls on those who would advocate taking action.

Lie #2: SR/Licensing Protects the Public

That SR/licensing will somehow enhance the net level of public protection is promoted as self-evident. This view is never critically assessed and simply presupposes that registered practitioners are less likely to engage in poor practice than unregistered ones. However, there is no existing research evidence indicating that SR/licensing will necessarily lessen net levels of poor practice (orthodox medical practitioners, for example, have been regulated for many years, but shocking cases of poor practice still regularly occur). Furthermore, there is no clear evidence demonstrating that state regulation will succeed in ‘protecting the public’ any more successfully than the voluntary self-regulation framework that currently exists in the UK.

We are told that the primary aim of state regulation is to enhance patient safety and public protection. Yet the loudest voices calling for intervention are in fact the ‘stakeholders’, who are in reality nothing more than unrepresentative professional interest groups that seem more concerned about enhancing the status of practitioners and attracting more students into training institutions than protecting the public.

Lie #3: SR/Licensing is Proportionate to Risk

The Working Group on Extending Professional Regulation, which was established to advise Government on how to deal with ‘unregulated health workers’, published a report in July 2009 that recommended a number of key principles inform future work on state regulation. These included:

  • State regulation, if appropriate, should range from full SR to lighter touch approaches.
  • The type of state regulation should be (a) proportionate to the risk posed by the activities of a ’health profession’ and (b) founded on a robust evidence-based approach to risk assessment.

In light of the above, it is difficult to see how the DH can determine the risk posed by practitioners of TWHM and the type of regulatory approach, if any, that would be proportionate to this risk, given the lack of a reliable evidence base (a) providing data on levels of poor practice and (b) demonstrating that real harm comes from their activities.

A Note on Adverse Drug Reaction (ADR) Reports

The MHRA claims it receives an annual 70 ADR reports relating to herbal medicines and that there have been a handful of identified UK deaths associated with herbal medicine use. At first glance these statistics seem quite damning. However, a bit of clarification shows them to be nothing but MHRA spin: Firstly, ADR reports do not distinguish between herbal medicines purchased OTC (over-the-counter) versus those prescribed by a herbalist (in the UK, the majority of herbal medicines are self-prescribed). Secondly, fatal ADR reports do not attribute causality (other factors, such as concomitant orthodox medication and underlying disease may also be contributory). The word ‘associated’ is very weak and could, for example, be applied in the case of an OTC herbal cough lozenge taken alongside a cocktail of orthodox drugs. Finally, the vast majority of ADR reports (well over 99%) relate to orthodox drugs prescribed or purchased under the auspices of the state  regulated orthodox medical profession, yet these statistics are not construed as evidence of poor practice by these practitioners.

Conclusion

Given the lack of a reliable evidence base clearly demonstrating a significant risk to the public by practitioners of TWHM, it would seem impossible for the DH to justify any cost to the public purse in implementing SR/licensing, particularly in the context of recent financial upheavals and political discussions about the need for public spending cuts. Fortunately, with a general election less than a year away and Parliament about to return from a 3 month break, SR/licensing for herbalists is hardly looming large on the political horizon.

Advertisements