The Path Through the Forest

Most people in the herbal world are probably already aware that over here in the UK there have been some intriguing and frankly worrying developments in the world of medicine, beginning with the finally implemented decision to enforce the ban on the sale of individual herbal medicines over the counter unless they have each been carefully tested and licensed, a process which costs thousands of pounds per product. We are also looking at a move towards the regulation of herbalists, which means that in order to practice in this country in two or three years time, every herbalist will have to have gone through degree training or a certified equivalent and be a member of the relevant professional body. At this rather critical point in time, the University of Lincoln held its first Herbal Medicine Conference, entitled ‘Medics or Magicians: Herbal Medicine for the 21st Century. This event, which proved to be a delightful weekend of herbal lectures and workshops as well as much meeting of friends both old and new, certainly provided me with a huge amount of food for thought, some of which I intend to write about here as a way of gaining some sort of perspective on the issues at hand. Please note that they are only my personal opinions and thoughts – they are not intended to denigrate or dismiss anyone else’s opinions or beliefs, merely to get some clarity on my own thoughts and opinions.

Many different questions were raised at the conference, not least the issue of how to go about defining how herbalists practice in the hopes of making us more ‘acceptable’ to the NHS as a general body. Yes, I know generalising is always a mistake however in this particular case, it does apply, as the way I see things, we have to find some way of working alongside the orthodox health professionals in the very near future. The problem is this: that herbalists are all highly individual. How do you go about defining a single way of practicing when we all practice so differently? Surely this difference is one of our greatest strengths? What happens if, in the urge to trim and prune us and force us to conform to a way of practicing that steers dangerously close to a ‘one size fits all’ mentality, we remove the very things that make western herbal medicine such a vital and profoundly powerful system of healing? Trying to get herbalists to all do the same thing is like herding cats, so that also throws up another set of problems. I suppose for myself, I am frightened by the idea that I am going to have to fight to practice the craft and art that I love so much and that I deeply want to dedicate my life to. I signed up as a herbalist because I want to heal people and to work with plants – not to have to be a warrior to defend my way of life and my way of doing things. If I have to fight, then I will, but I really, really don’t like the person that behaving in that way makes me become.

The next issue of course is that of proving herbal medicines work in the first place. Evidence based practice seems to work in terms of narrowing herbs down to a single constituent and then proving or disproving this. Not only is that an absurd way to approach things, from my perspective anyway, but its ultimately useless. Reductionist ways of proving or disproving that herbs work simply will not provide a useful picture of herbal medicine, especially not within the context of how Western herbal medicine is generally practiced. A single herb used in the way I and many others practice is a vital bundle of hundreds of constituents, all of which work in synergy to have an overall effect on the body. If we were to narrow it down to, say, one particular constituent – for example hypericin in St John’s Wort – we will not be getting a true and overall picture of how that particular herb works when given to a patient as a medicine. Therefore surely any research conducted in this fashion is severely limited in terms of how useful it will be afterwards? We do not use herbs as drugs in this country, so reducing it down to a single ‘bullet point’ chemical and declaring that that is the ‘active constituent’ is a fundamentally flawed way of looking at things (especially when later research comes out that disproves research already done – for example the hypericin / hyperforin debacle). I can’t help thinking that trying to provide evidence in this way will ultimately be throwing a bone to a dog – the problem is, if we do it this way we are throwing a bone to a dog that has already chewed our leg off.

The big problem I find when dealing with the NHS AS A WHOLE – I am rather particular about emphasising this point, because I do not believe that every single member of the NHS decrys herbal medicine – is that the NHS wants to treat everyone using the same rules and guidelines, under the assumption that the ‘one size fits all’ approach to medicine and health care is perfectly suitable. Yes, it might be suitable on paper because it ticks all the boxes and is nice and neat and tidy, but in practice it is often quite the opposite. Please don’t misunderstand me here, dear reader – I firmly believe that orthodox medicine has its place, just as herbal medicine does. Both approaches have their strengths and weaknesses – the problems arise when we try and say that herbal medicine, for example, is ALTERNATIVE, ie something to have INSTEAD OF a visit to your GP or hospital. This is, bluntly, hogwash. Herbal medicine compliments and works with orthodox medicine, but I strongly feel that this complimentary action is only possible if orthodox medicine and the powers that be who work within this system of healthcare back off and stop trying to force us all to practice in a reductionist way. One of herbal medicine’s greatest strengths is its ability to be utterly flexible, to listen to the patient and interpret what they say in order to give them the best possible, utterly individual blend of herbs that treats the whole person, not merely one symptom.

The next issue I want to grumble about is that of placebo, which seems to have become rather a dirty word these days. Placebo seems to have become a word that means ‘not effective, useless, a trick, a bluff, ultimately pointless’, certainly in the contexts within which I have seen and heard it used recently. The big problem I have with this is that if mind, body and spirit are all deeply intertwined and connected, then the use of placebo, in any of its forms – tablet, spell, ritual, meditation, visualization, anything like that – is a vital and important part of treating the whole person, not just the symptom. Perhaps we need to reclaim the word ‘placebo’ and educate people into appreciating its true, full meaning? Maybe declaring something is placebo is basically downplaying the link between mind, body and soul and turning it into a non-important factor in healing? It saddens me that orthodox medicine as a whole seems to have turned the study of the mind into a health science so divorced from that of treating the body and its symptoms.

That brings me on to the topic of education. I heard a lot of different opinions and viewpoints on how to get things to work out the best possible way for herbalists. Some people fear having to toe the party line and therefore lose all sense of individuality. Others fear having to pick one basic herbal model and stick with it, in the concern that this is basically a watered down version of making us toe the party line. One or two are in favour of working with the NHS, though I cannot help but think that with the way things are at the moment, this could turn out to be a disaster for herbal medicine as a whole and will ultimately drive all but the most scientific practitioners back into hiding. To me, the solution seems quite clear – that at the beginning of their training doctors of all stamps should be taught a module that touches on the basic tenets of herbal medicine, acupuncture and many of the other alternative methods of caring for the health, in order to ensure that future generations of doctors and health care professions retain as open a mind as possible about people and their ability to make their own choices where their health is concerned.

Lastly, the one thing that is floating around at the back of my mind where this whole subject is concerned is that perhaps the ongoing battle – and there is a battle, its just being fought rather quietly – is actually necessary to keep us all on our toes, striving to improve and grow our healing arts and professions into the future? Perhaps, without that constant challenge, the constant need to prove ourselves, we would stagnate and forget that all things in life are about change, revolve around change and result in change – in fact, the only certainty in life at all is that of change. The endless debate between orthodox and the so called ‘alternative’ medicine (I hate that term!) is perhaps part of the nature of things, just as the cat hunts the mouse, the bird of prey hunts rabbits and pigeons, and the seasons turn as they always do. Surely as a caring person wanting to help other people, we should be looking to expand medicine, to cultivate an open, enquiring and tolerant mind, to be inquisitive and bold instead of judgmental and reductionist. After all, hope is itself a powerful medicine, and that hope can come in many forms, whether whilst sitting by a doctor’s desk, speaking to a herbalist, or lying on an acupuncturist’s bed. We are all striving for the same result, which is the health and happiness of our patients. I find it very sad that so many people lose sight of that fact in the endless debate about whose toys are better.

6 thoughts on “The Path Through the Forest

  1. An excellent post Ali, and something I’ve often had a grumble about from the acupuncture side of things. It mades me sad and to be honest really angry to get into the whole ‘my way is the only way, your way sucks’ argument, one I’ve found myself in a fair few times. As you say, as caring people trying to help others, and trying to be healers, shouldn’t we be able to put such pettiness aside? I don’t understand this need to put down Acupuncture and Herbal Medicine, usually I find it’s done from an ignorant point of view with no desire to understand the mechanisms at all.

    P.S to brighten this comment up a bit, I’ve been avidly reading through your blog and website since Friday. It’s excellent and very interesting reading.

    1. I wonder how much of the negative attitude to the therapies we practice is engendered quite deliberately by the pharmaceutical companies – after all, if herbal medicine and acupuncture become more well known and respected then the big pharmaceutical companies may stand to lose out on a fair chunk of money. From a more ‘sideways’ perspective as well, herbal medicine is quite chaotic in nature – we mix up tincture blends with hundreds of constituents in and its very difficult, if not impossible, to actually measure exactly what is in any given dose. The very fact that it is impossible to do this is going to give us a bit of a bad reputation from the perspective of doctors who use drugs of one or two chemicals at a time because the ingredients and therefore the possible reactions to herbs is going to be difficult to accurately predict and quantify.

      I’m glad you’ve enjoyed the blog and website so far 😀

  2. Interesting post Ali, thanks for sharing your thought processes and making some good points. I must admit the new regulations make my blood run cold but who knows how it will all unfold in the future.
    All the best.

  3. As an Australian herbalist I so get what you are saying. I often wonder if this new conservatism in complementary medicine is our version of the Flexner Report, one hundred years later?

  4. I want to add my compliments on your blog. Very interesting and thought provoking!

    I have a number of doctors and scientists among my personal acquaintances and one of their most frustrating qualities is a total devaluation of subjective evidence. First, since my symptoms and experiences are not replicable and objectively (preferably quantitatively) measurable, they aren’t worth notice. Second, it doesn’t matter if I say that a particular treatment made me feel a certain way–they intend to tell me how I’m feeling because they know better.

    I would hate to see a similar epistemological regime forced onto the practice of herbal medicine.

    1. I think the big problem I have with the way orthodox practitioners think is that they seem to have the idea that everyone can be crammed into the same restrictive niche in terms of health – which is absolutely NOT TRUE. Every single person is completely individual and has the right to be treated as such, including their health and the choices and needs they have where health care is concerned. I suppose part of the problem for me is that as a herbalist, I have a good hour to see a patient and really talk through their needs and requirements which means that any medicine I hand out is going to be highly individualised. Indeed, herbal medicine’s generally creative nature means that such an approach is not only possible but often necessary. The orthodox practitioners only have single chemicals to hand out, and they only have ten minutes to see a patient in. Part of me feels rather sorry for them even if their general high handed ‘my way or the highway’ approach makes me want to scream at times!

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