Back to the future: new horizons for
Traditional Herbal Practice in the UK and Europe

by Michael McIntyre, Chairman European Herbal Practitioners Association.

For well over a century UK herbal practitioners have struggled to attain state registration. Until recently the road to registration has proved downright impassable, blocked at every turn by the implacable opposition of the medical establishment. A typical response to overtures by the herbalists was the pronouncement in 1923 by the then Chief Medical Officer of Health, Dr Charles Newman. "The object is obviously to secure legal recognition for herbalists.... No doubt the arguments of the promoters would be that if people wish to be treated by some kinds of herbalists, it is better to be treated by herbalists who have some kind of training than by those with none. I do not know how herbalist are trained, but it is at least doubtful whether a trained herbalist is any less dangerous than an untrained one."

In 1941 the UK Parliament sought a softer target than the Luftwaffe, passing the Pharmacy Act that rendered the practice of herbal medicine illegal despite the fact that right to practise had been enshrined in English law since Henry VIII's Herbalists' Charter in 1543. This ban on herbal practice remained in force until it was overturned by the heroic campaign of an alliance of professional herbalists and herb manufacturers lead by the well-known British herbalist, Mr Fred Fletcher Hyde. His efforts to rescue herbal medicine succeeded in reversing the 1941 legislation via the provisions of the 1968 Medicines Act (Sections 12 and 56) under which statute UK herbalists still practise and over-the-counter herbals are sold today.

But a remarkable sea change in government attitudes towards herbal medicine has recently occurred. Suddenly it is apparent that herbalists seeking state recognition are pushing at an open door. When Yvette Cooper, Parliamentary Under Secretary of State for Health, gave evidence to the House of Lords Select Committee whose report on Complementary and Alternative Medicine was recently published, she highlighted the need for the statutory regulation of herbal practitioners. She declared that the Department of Health was considering setting a timetable for moves towards statutory regulation of herbalists and a consultation paper on this topic. Her call for the state registration of herbalists was echoed by the House of Lords report that likewise recommended that herbal practitioners should as soon as possible seek statutory self-regulation (SSR) under the auspices of the Health Act 1999. To previous generations of herbalists, it would be nothing short of astounding to learn that the concept SSR for herbal practitioners has also recently received the backing of the British Medical Association.

Herbalists are certainly working hard toward the goal of SSR. In the past eight years under the unifying banner of the European Herbal Practitioners Association (EHPA), herbalist of different persuasions including Ayurvedic, Western and Chinese traditions have been working together to agree a common-core curriculum, a continuous professional development scheme, as well a common disciplinary code and code of ethics. (For detail of this see the website www.euroherb.com.) Now the EHPA has launched an independent Accreditation Board to accredit all UK courses in herbal medicine. The move to SSR involves gaining grassroots consent of around 1,000 practising herbalists throughout the UK and Northern Ireland, a Herculean task. Nor is it at all certain at this time exactly what SSR may involve in financial terms since no health profession has yet been registered by means of the 1999 Health Act. The exact terms of registration are still to be worked out and no one needs to tell us herbalists that the devil is in the detail. Nonetheless, there is broad agreement that statutory self-regulation is absolutely essential for the future development of the profession. Most importantly, it is what patients want. Would-be patients are understandably dismayed to find that as things stand at the moment, anyone may set up in practice as herbalist without a day of training - a state of affairs that surely cannot be allowed to continue. And there is another cogent reason driving herbalists towards SSR. Current plans by the European Commission to introduce a Traditional Use Directive are likely sooner rather than later to bring about the regulation of herbal medicines throughout the EU. As part of this process the UK Medicines Control Agency has signalled its intention to designate certain powerful herbal medicines for registered herbal practitioner use only. This stipulation was intended to come into force through the 1968 Medicines Act that reserved certain herbs like Ephedra sinica for use by herbal practitioners only rather than for general over-the counter sale. However, since the 68 Medicines Act never defined "herbalist ", these measures are clearly inadequate for protecting the public. It is interesting that the Irish Government, seeking to limit some rather powerful herbs to trained herbal practitioners (as well as doctors), is now also considering the possibility of State Registration for herbal practitioners in Ireland. This process of SSR, now in train in two EU Member States, for the same reasons in due course seems likely to be emulated in other Member States.

If it is safety issues that are driving the UK and Irish Governments and their medical establishments to accept the principle of state registered herbalists, herbalists see SSR in broader terms as a positive development enabling the integration of their skills and expertise into primary healthcare so that herbal medicine can take its proper place alongside its orthodox counterpart. Once recognised, herbalists look forward to being able to access research funds that up until now have been largely denied them. Despite the fact that Britain leads the world in the development of the practice of complementary and alternative medicine (CAM), many of the serious studies into CAM have been done abroad. As the Prince of Wales pointed out in an article in The Times (December 30th, 2000), less than 8p out of every £100 of NHS funding for medical research is currently spent on complementary medicine, a figure which the Prince called "pitiful".

When I began studying herbal medicine in the mid seventies, it was considered a part of what was generally termed "fringe medicine". Soon fringe medicine became "alternative medicine" a term that was later replaced by the description complementary medicine. These last few years have witnessed the birth of a new concept -"integrated medicine". Although the House of Lords' report is on "complementary and alternative medicine" in many ways its recommendations aim to develop integrated medicine seeking to combine the best of CAM with the best of conventional medicine. In this respect, there is much to applaud about the report but in one vital respect it does seem to have failedto comprehend the scope and potential of traditional medicine. The categorisation of traditional systems of medicine like Ayurveda and traditional Chinese medicine to the third group of complementary medicines on the basis that insufficient evidence exists of their efficacy, seems totally Eurocentric given that there certainly exists a considerable body of research demonstrating the efficacy of these ancient systems of medicine. In this the Lords' report caused needless offence to practitioners and patients who in today's multiracial society rightly consider that they are entitled to see these non-European traditional systems of health care treated on an equal basis with other forms of CAM rooted in Western traditions.

July 2001