In a controversial move reported here, David Walker, MD (pictured), Britain’s deputy chief medical officer, decided that there is “insufficient evidence that the alternative therapy works, making it impossible to set standards of good practice.” Therefore, Great Britain will not create a “statutory register of herbal practitioners.” Walker believes herbalists would need to be “more science and evidence-based” to merit regulation. The registry would have included Western herbs and Chinese medicines. While acting against regulation of the practitioners, Walker calls “for a review of all ingredients sold in such medicines, to check their safety.” To this he would add a “voluntary register” for practitioners.
The action was presented as a policy “U-turn.” It followed two public consultations and three prior committees that found “overwhelming support” for regulation. A call for regulation goes back 15 years. Prince Charles lobbied for regulation. Pro and con arguments bounce from the idea that regulation would confer inappropriate legitimacy on herbalists to a view that failure to create the registry is a risk to the public health from unregulated herbal practices. The divisive nature of the topic was hardly put to rest. Twelve of the 26 members of the ruling party signed a letter opposing Walker’s recommendation.
Michael McIntyre, chairman of the European Herbal and Traditional Medicine Practitioners Association, said, “We are deeply disappointed by this. We feared this issue was going to be kicked into the long grass, by quietly putting something out just before the election—and that is exactly what has happened.” The association’s response to Walker’s report is here.
Comment: The news reminds me of the joke about hiring an economist. Asked what 1 + 1 is, the economist who gets the job answers, “What do you want it to be?” Three committees said evidence added up to regulation. Now, finally, Walker apparently found the kind of addition he liked in this report. Significantly, this decision was made in the context of a 2014-2023 WHO Traditional Medicine Strategy that calls for better “integrating traditional and complementary medicine services into health services delivery.” The WHO document not only promotes increased regulation of “products, practices, and practitioners” but also “integration into the national health system including reimbursement.”
For reference, the United States offers a mixed picture on regulation of herbalists. Practitioners of traditional Chinese medicine are licensed in almost all 50 states. The still small (5,000-6,000) profession of naturopathic doctors, with their extensive training in botanicals, is regulated in just 18 states while it is promoted in others. Herbalists, on the other hand, as represented by the American Herbalists Guild, have chosen not to pursue licensing. They are not regulated in any jurisdiction.
Notably, Walker’s decision—based on a purported lack of evidence—came within weeks of a powerful statement from Josephine Briggs, MD, director of the NIH National Center for Complementary and Integrative Health, at the March 2015 annual meeting of the American Herbal Products Association. As reported in Holistic Primary Care’s NIH Center to Confront Fears of Drug-Herb Interactions, Briggs speaks to the potent and underutilized value of herbs. She lambastes overuse of drugs such as antibiotics and opioids and states, “Misplaced fear about herb-drug interactions is keeping many practitioners from recommending potentially beneficial botanical medicines.” Apparently, Briggs’ clarity becomes “insufficient evidence” on crossing the Atlantic.