Ofquack to regulate herbal medicine?
Posted by gimpy on April 5, 2010
The attempted regulation of herbalism looks doomed to failure with a clear difference of opinion between government and practitioners, the latter prefer statutory regulation which has been rejected as an option by government.
Last week the Department of Health (DoH) recommended that the Complementary and Natural Healthcare Council (CNHC/Ofquack) regulate herbal medicine, traditional Chinese medicine (TCM) and acupuncture. Minister for Health, Andy Burnham, said:
“Emerging evidence clearly demonstrates that the public needs better protection, but in a way that is measured and does not place unreasonable extra burdens on practitioners.
“I am therefore minded to legislate to ensure that all practitioners supplying unlicensed herbal medicines to members of the public in England must be registered with the Complementary and Natural Healthcare Council (CNHC).
The CNHC have expressed their pleasure at this announcement:
CNHC is pleased to be asked by The Secretary of State for Health to register practitioners supplying herbal medicines to members of the public in England.
The Council already registers a significant range of practitioners in complementary healthcare who meet its standards and is well positioned to expand its public protection role in this way. Since 2008 CNHC has established its reputation as a regulatory body with robust and effective standards for registration and fitness to practise. It has positive and collaborative links with the statutory healthcare regulators.
This is probably regarded as good news by the CNHC, they have had a well documented struggle for funding and have trouble attracting some of the more popular forms of quackery. Regardless of this, the CNHC are not fit for purpose, they have recently told sceptical blogger Simon Perry that they will not consider his complaints for the next 6 months:
The CNHC has now informed me that for the next six months, they will no longer be processing any complaints that are similar to the ones I’ve submitted. By similar, I take this to mean complaints regarding practitioners who mislead their clients by making unjustifiable or false statements, including practitioners who have already been cautioned by the CNHC for doing it before.
The CNHC was set up under the aegis of Prince Charles’ Foundation for Integrated Health (FIH) to be a self-regulatory body for alternative health, now it is one that is not prepared to regulate. However this is not unexpected. Organisations purporting to regulate quackery rarely do so beyond upholding the doctrines and articles of faith of the respective field of quackery, managing risks to consumer health are generally not a priority.
It would be a concern for those with an interest in exposing the practices of alternative medicine if the CNHC were to regulate herbal medicine, traditional Chinese medicine and acupuncture. This, despite the recommendations of Andy Burnham, is unlikely to happen for two reasons.
1) The government is unlikely to exist in its current form within a month or two. A general election is expected early in May and the Labour party are unlikely to win, if they are to remain in power it will be in a coalition but it is more likely that the next government will be formed from the Conservative party. None of the major parties have a clearly stated policy on the regulation of alternative medicine, nor is it likely to be a major election issue, so the Department of Health’s current proposals are likely to be mothballed for some considerable time.
2) Herbalists and TCM practitioners do not want CNHC regulation.
This latter point is the most important. The European Herbal & Traditional Medicine Practitioners Association (EHTMPA), the Register of Chinese Herbal Medicine (RCHM), the Association of Traditional Chinese Medicine (ATCM), and the National Institute of Medical Herbalists (NIMH) amongst others in the alphabetical smorgasbord that represents the various denominations of herbalism, have all campaigned for statutory regulation. Their intent was to be regulated by the Health Professionals Council (HPC), a more serious organisation than the CNHC, that regulates practitioners in proven fields of health. This statutory regulation would confer protected status on their profession, restricting the title of Herbalist to those regulated by its rules.
By and large these organisations are disappointed with the DoH’s announcement:
the government seems to have failed to deliver its promise, and has changed its mind from HPC as our regulatory body to CNHC. We would like to demand an explanation from the government on what ground it has changed its mind, as CNHC is only a voluntary body with no statutory power. From the rather short DH press release which lacks details, we doubt whether the government still wants to introduce statutory regulation, or decides to go for an alternative.
Herbalists should be regulated like other statutory regulated healthcare practitioner or, the public will lose access to properly regulated herbalists and a wide range of herbal medicines. The Government must give detailed assurances that the legal and structural basis of statutory regulation is fit for purpose or it will betray the millions of people who regularly consult herbal practitioners. So far the Government has singularly failed to provide these guarantees.
As the CNHC is voluntary these organisations have no need to insist that their members sign up, in fact as they are holding out for statutory regulation it is unlikely that they will be willing to express any support for the CNHC, to do so would undermine their campaign. This will damage the CNHC’s longterm viability, no new members means no new funding sources, and with the homeopaths mired in infighting the herbalists represent their last decent chance of acquiring new members in the medium term.
This is good news for those that are concerned about poor practice in alternative medicine. The collapse of the CNHC will further damage the reputation of alternative medicine. Hopefully a new government will take stock of the intransigence of the herbalists, the infighting of the homeopaths and the inability of the CNHC to regulate and instead apply a more robust external form of regulation for quackery.


davidp said
I notice that Wikepedia’s discussion of the CNHC says herbalism and acupuncture were soon to be statutorily regulated at the time OfQuack was proposed. I guess the herbalists have been pushing for the profits associated with statutory regulation for many years.
gimpy said
It’s hard to know what their motivation is. There seems to be some fear that the EU will ban unregistered herbalists, but there is no evidence that this is the case. The UK legislation on this matter makes no such demand. I think, ultimately, they want to be considered respectable medical practitioners, and they see statutory regulation as a route to obtain this. The logic seems to be that if they were statutory regulated then they would be mocked less and their profession would be validated in terms of having a role in healthcare, they clearly haven’t been following the problems in the chiropractic field.
Me said
Dr Evan Harris booted out. You are fighting a losing battle I tell you
davidp said
“Herbalists should be regulated like other statutory regulated healthcare practitioner or, the public will lose access to properly regulated herbalists and a wide range of herbal medicines” I agree with this – herbalists should have to be regulated medical practitioners first. Make herbal medicine a protected medical speciality.
Raphael said
thanks for the interesting blog, its one of my favorites
Au Revior, Paula Ross | The Quackometer said
[...] this. Even this strategy is now in tatters as recently the acupuncturists and herbalists have failed in the same goal. These two pseudo-medical therapies were given priority in having a go at attempting to achieve [...]
Energetic said
What is your evidence that herbal medicine is pseudo? Do you actually know anything about herbal medicine? I am a herbalist and take utterly huge offence to you calling me a quack! There are various types of herbalists all practice in different ways, but most belong to a professional body and are trained to a very high standard. For example, Most Western herbalists have graduated from National Institute Medical Herbalists (NIMH) accredited degree courses with a BSc Hons in Herbal Medicine from UK universities such as: Edinburgh Napier, Middlesex, Westminster, Lincoln, East London and the Scottish School of Herbal Medicine (a college). A Herbal Medicine degree includes; studying anatomy & physiology, clinical medicine, rigorous training on the dangers of potent herbs, the potential interactions with conventional medicines, pharmacology and toxicology, biochemistry, a thorough knowledge of diagnosis and when to refer potentially serious conditions, and 500 hours of clinical practice. All students undertake scientifically researched and referenced coursework and dissertations, which enables them to easily keep up to speed with the latest research once qualified. Clearly, qualified Western herbalists are in a good position to advise both the general public and other healthcare practitioners about herbal medicine and research and as an Ipsos Mori study commissioned by the MHRA showed, 35% of people in the UK have taken a herbal medicine. Western herbal medicine makes use of herbs which have been used continuously in Europe for the last 2000 years. The evidence base for the clinical effectiveness of herbal medicine has been valid enough for the millions who seek out and use such therapies on an annual basis.Herbal medicine has seen a growth in scientifically referenced texts in the past twenty years. There is now a substantial body of work on the analysis of the constituents of medicinal plants, and laboratory investigations of the pharmacological actions of whole plant extracts or constituents. There are many books now published with scientific evidence on the efficacy of herbal medicine – for example ‘The Principles and Practice of Phytotherapy’ by Mills and Bone (2000) and Evidence-Based Herbal Medicine by Rotblatt (2002). There are over 50 scientific journals dedicated to different aspects of herbal medicine research such as studies on isolated constituents in plants, these include publications such as Fitotherpia, Planta Medica, Herbalgram and Evidence-Based Complementary and Alternative Medicine. There are also well established databases on herbs and herbal research such as: The Natural Standard, Herbmed, and ESCOP, for example St. John’s Wort the most popular herb in the world today the herbmed database alone gives access to 351 clinical studies on this herb, 351 pharmocodynamic papers, 175 analytical chemistry papers, 109 observational/case studies and 129 clinical animal studies. To say that the herbal world is not doing scientific research and is based on quackery is complete and utter rubbish. Just because you are ignorant and uninformed about this subject does not make me hold anything against you, its the fact that you have set your self up as an authority on something clearly now nothing about that guiles me. Evidence based medicine is banded about as the be all way of prooving efficacy, but many people do not understand what EBM actually is.
Evidence based medicine (EBM), as we know it today, came to the fore in the early 90s in the US. It is based largely on ranking research models into a ‘hierarchy of evidence’ in which the Randomised Controlled Trial (RCT) is considered the gold standard. However this discriminates against other forms of research methods.The National Institute of Health and Clinical Excellence (NICE) has implemented evidence based medicine as standard research practice and many papers including ones in printed in the BMJ have argued that it is not an effective way of researching all clinical and disease questions even in orthodox medicine. EBM is not an absolute in orthodox medicine anyway it seems, for example the efficacy of the HPV (Human Papilloma Virus) vaccine will not be known for another 10 to 20 years and the only research carried out has been conducted by the manufacturers of the vaccine, yet teenage girls are already being immunised. In a 2005 Health Committee report titled ‘The influence of the pharmaceutical industry’ they highlighted that that the pharmaceutical industry has big influence on the gathering of clinical evidence used by NICE. Understandably they conduct the majority of drug research because this forms part of drug licence applications, however follow up on the long term effect and efficacy of drugs once on the market is lacking. They also found that clinicians would like to see research opened up to include patient experience and disease management, not just RCT trials.
Confusion between the objectives of science and those of the practice of medicine has perhaps led to misunderstanding and criticism levelled at EBM. Even more problematic, the term evidence is commonly used for many types of evidence of relevance to clinical practice, not just health care research evidence. For example, clinicians collect evidence of patients’ circumstances and wishes. Thus, it is hardly surprising that the term evidence-based medicine is confusing to many, who do not appreciate that its evidence is narrowly defined as having to do with systematic observations from certain types of research. Applied qualitative research provides evidence to practitioners and patients that is often better suited for the specific problems they must deal with.
If you think the NHS is working, everyone is at optimum health and been giving dietary and lifestyle advice to prevent diseases like diabetes actually occuring, you are living on a another planet. The NHS is costing millions and what us ‘quacks’ can do is help encourage better lifestyles, before it comes to the end result of serious conditions and long term medications. We have a role to play, we are well trained and intelligent people who have the outmost respect for our patients and empowering them to take control of their own health and if people come to visit us for an appointment that they have chosen to out of their own free will, what does it have to do with you and why do you have such strangly strong opinions on a subject you cleary are not the best informed about?
Nash said
You are a quack
Mojo said
“What is your evidence that herbal medicine is pseudo?”
http://www.ncbi.nlm.nih.gov/pubmed/17916871
“There are various types of herbalists all practice in different ways, but most belong to a professional body and are trained to a very high standard. [followed by long screed about where and what they are taught]”
This is not evidence that it works.
“…an Ipsos Mori study commissioned by the MHRA showed, 35% of people in the UK have taken a herbal medicine.”
Neither is this.
“Western herbal medicine makes use of herbs which have been used continuously in Europe for the last 2000 years.”
Or this.
“The evidence base for the clinical effectiveness of herbal medicine has been valid enough for the millions who seek out and use such therapies on an annual basis.”
Or this.
“Herbal medicine has seen a growth in scientifically referenced texts in the past twenty years. There is now a substantial body of work on the analysis of the constituents of medicinal plants, and laboratory investigations of the pharmacological actions of whole plant extracts or constituents. There are many books now published with scientific evidence on the efficacy of herbal medicine – for example ‘The Principles and Practice of Phytotherapy’ by Mills and Bone (2000) and Evidence-Based Herbal Medicine by Rotblatt (2002). There are over 50 scientific journals dedicated to different aspects of herbal medicine research such as studies on isolated constituents in plants, these include publications such as Fitotherpia, Planta Medica, Herbalgram and Evidence-Based Complementary and Alternative Medicine. There are also well established databases on herbs and herbal research such as: The Natural Standard, Herbmed, and ESCOP, for example St. John’s Wort the most popular herb in the world today the herbmed database alone gives access to 351 clinical studies on this herb, 351 pharmocodynamic papers, 175 analytical chemistry papers, 109 observational/case studies and 129 clinical animal studies. To say that the herbal world is not doing scientific research and is based on quackery is complete and utter rubbish.”
Can you give us links to Pubmed digests for a couple of systematic reviews of RCTs that support efficacy?
“Evidence based medicine is banded about as the be all way of prooving efficacy, but many people do not understand what EBM actually is.”
Indeed. Many people seem to think it is a conspiracy to keep “alternative medicine” down. It isn’t.
“The NHS is costing millions and what us ‘quacks’ can do is help encourage better lifestyles…”
What makes you think doctors can’t do this?
energetic said
Ha ha I see you have taken my comments off, obviously you can’t handle a real discussion, this confirms it you are the quack of debating.
energetic said
Define Quack please
Nash said
If you don’t know what is your long rant about?
energetic said
If you can’t define it, what are your opinions based on? It was not a rant, rant by definition is going off on one without having an accurate information or facts, i.e you lot, bunch of ranters. Quacks of debating, ignorant with no ability to take on board other standpoints other than your own. How dull… yawn, just keep popping those pills, watch out for the side effects, oh no I didn’t mean that! orthodox medicine is the truth and the light, there are no side effects, right?
Nash said
herbalist = quack
energetic said
NASH = Narrow minded moron, ha ha
Nash said
A you’ve pointed out, one doesn’t have to be the sharpest tool in the box to spot that you are a quack.
Robin said
Dr Evan Harris booted out. You are fighting a losing battle I tell you
sikiş said
Medicine by Rotblatt (2002). There are over 50 scientific journals dedicated to different aspects of herbal medicine research such as studies on isolated constituents in plants, these include publications such as Fitotherpia, Planta Medica, Herbalgram and Evidence-Based Complementary and Alternative Medicine. There are also well established databases on herbs and herbal research such as: The Natural Standard.
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