On Regulating Herbalists

Keeping the "medicine of the people" in the hands of the people

Chiron Teaching Medicine to Asklepios, from the illustrated Latin manuscript of Pluteo 73 cod. 16, ca. 1250 CE. From the Biblioteca Medicea Laurenziana

I’m going to present two sides of one issue in the paragraphs below in an effort to process through the polarity and express some elements of it from my view. Though I don’t claim to have the answers on how to go forward as folk practitioners in a global empire, it’s through our imaginative and creative vision and discussions that perhaps some will emerge.

Massachusetts bill that probably won’t go through but we need to pay attention!

It’s recently been brought to my attention that there is a proposed bill in the state of Massachusetts that would potentially restrict access to multiple alternative medicine practices including herbalism.

The bill is MA s.261. and you can read it HERE.

Basically the bill lays out a plan to require state regulated licensure for “alternative therapies” and though it does not mention herbalism specifically, herbalists have been the target of such laws for decades. Herbalists are not licensed practitioners and there are no state or federal standards of training.

Herbalism, in the United States, is a folk practice that has roots in multiple lineages and cultures around the world and, up until the end of the 20th century, was not a popular mainstream set of practices. Though it was and continues to be the primary source of health care for many groups of people in the US and around the world, it’s not until the mid to late 1990’s that it became a trend. When I started learning about herbs, circa 1992, the only book I could find at the book store on herbs was Jethro Claus’ book “Back to Eden”. 

Most of us, back then, learned herbs through family and/or community traditions or from some type of informal apprenticeship with another herbalist. Even what we call “clinical” herbalism (seeing clients in a clinical setting) was conducted via word of mouth. At this time to get an appointment with an herbalist you had to know one or know someone who did.

We couldn’t google “herbalist near me”.

For myself, and many others during that time, we spent years learning from an elder herbalist.

I was fortunate enough to have come under the tutelage of herbalist Kate Gilday. I spent about 10 years with her, learning, weeding her gardens, washing bottles, making formulas, studying, and eventually going along with her to see clients before I even called myself herbalist.

There was a class taught by Paul Bergner at one point that he called “How To Become an Herbalist in 30 Years or More” This speaks to the depth of training required to understand the plants and how they interact with people and their health. Here is an article he wrote with the same title where he says:

“Mastery of any topic is attained after years to decades of becoming fully engaged not only in the field, but being constantly engaged with a level of rigor and practice that steadily expands and also deepens understanding of the facts and principles of that field or topic. The master brings the subject completely alive in their own being and experience. Ultimately their career is characterized by various “threshhold events” of understanding and insight which contribute new understanding for the current generation and a legacy for future generations. Those thresholds are made possible by an intuitive synthesis of many facts and observations during the career leading up to them. This process is how a field stays current and alive throughout generations.”

https://theherbarium.wordpress.com/2009/09/22/how-to-become-a-master-herbalist-in-thirty-years-or-more/

I went on to participate in several other formal apprenticeships with Kate and other teachers. I also began seeing clients and teaching with the support and encouragement of Kate and by request from my community. The clients I saw were sent to me only by Kate at first.

She knew what my strengths were and guided those who were a good match for my skills. I also had her to help me with those initial protocols and to answer questions. I took this all very seriously. The people I was working with were often folks I knew personally and some that I had known my entire life. I was inherently accountable to not only them but to Kate. 

Exemption and Safe Harbor Laws

When I began practicing herbalism was starting to have a big resurgence and it was common knowledge that it is not technically a legal practice and, in fact, there have been herbalists who faced litigation for “practicing medicine without a license”. Groups of lawyers and advocates for health freedom worked to establish “safe harbor” laws that allowed herbalists to continue to practice as long as we were very careful not to “prescribe” or “diagnose” and to fully disclose that we are not licensed health care providers.

Many states, including MA, created exemption laws that allow herbalists the freedom to work unlicensed, again as long as they maintain the above ethics.This is because herbal medicine is a form of cultural heritage and traditional medicine that has always belonged to the people. Health freedom and exemption laws protect access to these practices by affording herbalists and other alternative health practitioners to be the primary authorities of their healing art. Not an outside regulatory state run organization.

If a practitioner has to adhere to external guidelines when determining protocols and treatments for their clients they cannot make situational, client-centered decisions if those decisions are not within the “scope” of their practice.

All licensed medical practitioners are required to work within their “scope” that is determined by external authorities. And, as we know, these external authorities are often influenced by corporate interests and political agendas.

The Case of Lyme Disease

One recent instance of not allowing primary care providers to treat patients out of scope caused great harm is in the many cases of Lyme disease that occur in the Northeast of the US. Up until about 5 years ago in New York State, primary care providers and urgent care centers could only prescribe antibiotics to people who had a positive serum test (usually ELISA or Western Blot enzyme immunoassay test) and/or a red bullseye rash.

These were required despite the fact that all of the leading experts doing research on Lyme had reported that serum tests present many false negative results and that 20-30% of people infected with Lyme never get any rash at all and many who do get a rash do not present with a bullseye. Therefore, someone with Lyme symptoms who shows up at a PCP but who does not meet these requirements could not receive treatment. 

Due to major effort and advocacy on behalf of Lyme patients, many of whom became seriously ill and misdiagnosed as a result of not being treated, the guidelines have since changed in New York and prescribers can make some calls that are outside of the guidelines. But this took years.

The Village Healer

As for herbalists and other traditional medicine practitioners, we have been trained in practices that emerged within local communities as a natural part of human life and social structure. The archetypal “village healer” comes to mind as the representative of a ground up system of health care that is available to everyone regardless of economic status. The practitioner is the autonomous governor of their own practice. 

But in a global, high-tech society our old systems of accountability have largely disappeared.

A local herbalist, in a traditional community, operates with inherent transparency. They are most often trained in a lineage of healers and elders to whom they are expected to answer to. The village knows them, knows their family, knows the outcome of their treatment of others in the community, sees where they collected herbs, and so on. 

In a traditional community if a practitioner caused harm or misrepresented their skill it would be made obvious and that practitioner would be called to answer to it through implicit social contracts and agreements that were an integral part of social life. 

Now we have the internet and social media and global commerce. Anyone can misrepresent their skill and training using pretty photos and AI generated knowledge that does not belong to them.

I have personally seen many posts and accounts from so-called herbalists that not only misrepresent their knowledge, lineage, and skill, but have created outright false personas, have plagiarized, lied, and stolen other’s images to sell their products and false identities.

Most recently a friend who is a highly skilled and trained herbalist found their writing on a particular plant word for word plagiarized by someone claiming to be an herbalist who has a big social media account and was teaching at an event held at a credible university. 

Also on blogs, advertisements, and social media I have seen dangerous claims about plants that have no traditional or scientific data to back them up. The trends around poisonous plants and plants used for abortion (stay tuned for an upcoming post on Mugwort and other artemisias) has led to a vast amount of false and potentially harmful information. Not only the potential harm caused by the misuse of poisonous plants but the harm caused by misinformation about the use of plants. Misinformation about plant attributes and actions can lead to those plants being unnecessarily regulated.

This does not mean that there are not credible and well-trained practitioners on social media and the internet that do have valuable information and teachings to share. It’s just that there is no way to discern the difference. 

There are many potential implications from this beyond the possibility of someone using a plant that could make them sick, it also can cause someone to use a plant in a way that doesn’t help or “work” because it’s not the right plant for them or the proper dosage and so on.

It basically can amount to “snake oil” style deception and it adds misinformation about the effectiveness of plants as medicine that do work when applied properly.

What is an Herbalist?

Another point of confusion is the use of the word “herbalist” and those that call themselves that. In one sense anyone who uses herbs could call themselves an herbalist. Herbalism, as mentioned above, is a very ordinary everyday practice in some respects. It doesn’t require any special advanced training to make a cup of tea or make a poultice. But that type of herbalism where we are treating ourselves or our family is different than when we are working as clinical or community herbalists in the service of the collective. 

There are some independent organizations, such as the American Herbalists Guild, in the US that do offer registration and certificates in an effort to vet practitioners based on their experience. There are some credible herb schools that provide certificate training but there are no standards that they have to meet in terms of curriculum or experience so, again, it can be tricky to discern.

This is where the core of the quandary lies; herbalism is an unregulated, unlicensed folk practice that has become so mainstream and commercialized that its traditional methods of self-regulation are ceasing to exist.

At the same time, if it becomes regulated it is no longer a folk practice. If it becomes institutionalized, or if only those that meet the standards determined by an institution, such as the state, it is no longer the medicine of the people. 

I also think it’s pertinent to add here that just because someone is a licensed practitioner or medical provider does not mean they are ethical or skilled. A simple google search will turn up plenty of instances of misdiagnosis, improper surgical procedures, and medication errors made by licensed providers. Most of us have experienced this ourselves or have someone in our lives who has. Guilds, standards, regulations, have their limits and especially in a system that is already fraught with corruption and greed. 

If it is necessary to establish some method of properly vetting herbalists and other alternative medicine practitioners, it has to allow for them to practice autonomously at the same time and in the service of their patients, not a board or outside regulating authority or we should call it something else. 

Herbalism and the training of herbalists requires tending and solution-oriented discussions about how we can keep this practice and all folk practices accessible while discerning the difference between grifters and those that are simply unskilled and experienced well-trained herbal practitioners.

I’m hoping this post inspires some generative discussion around this topic! I do believe it is through our collective creativity that we will be able to bring folk and traditional medicine to the future generations, intact, as ground up, accessible practices that remain in the hands of the people. 

Miniature black-glazed vase, mid-3rd century BC at the Baglio Anselmi Museum in Marsala, Sicily. Description: La parola lycium indicava il decotto delle radice di varie piante spinose, in particolare il rhamnus (Italian buckthorn) e la pyracantha (firethorn), usato nella medicina antica soprattutto per le malattie degli occhi. (The word lycium indicated the decoction of the roots of various thorny plants, in particular rhamnus (Italian buckthorn) and pyracantha (firethorn), used in ancient medicine especially for eye diseases.)