Organised by L’Institut pour la Protection de la Santé Naturell

Paris, France, 13th & 14th April 2013

Report by Peter Jackson-Main (IRH European Consultant).

I attended the above conference in Paris, in order to foster links with the natural medicine community in France, to monitor responses to European medicines legislation, and to gather ideas that could usefully feed into herbal medicine training, especially highlighting the ongoing engagement with herbal regulation and accreditation. The conference was mainly attended by French Herboristes, and the speakers came from a variety of disciplines – herboristes themselves, including those involved in training; pharmacists, a doctor/phytotherapist, an ethnobotanist, and legal and regulatory experts.

It is estimated that 68% or the population of France uses complementary and alternative medicine. Herbalists themselves have not been officially recognised since 1941 – the time of the Vichy Regime. Herboristes (a French term which does not translate easily into English, relating to individuals who deal in herbal medicines, including giving advice about their use) are likewise not recognised, but are tolerated to some extent, and appear to be busy people ministering to the needs of a herb-hungry population. The conference had the stated aim of exploring ways of putting political pressure on government (both the French and the EU parliaments) to give these professions some status in law.

There was a general feeling that, 1) the risks of medicinal plants are vastly over-stated, and 2) that state regulatory mechanisms are too cumbersome and complex to be applied to Natural Health practices. There was a strongly expressed demand that the government should recognise the role played by complementary practitioners (including herboristes) in maintaining the health of the nation.

It was also noted that certain key events that had the potential to call the safety of herbal medicines into question had influenced the legislators strongly in terms of mistrusting natural medicines: the “Belgian accident” was mentioned. In 1993, 70 people suffered kidney failure and two people died, after taking a Chinese herbal remedy containing an Aristolochia species plant. It was noted that the remedy, a weight-loss prescription, was administered by medical doctors – who are of course still the only people allowed to practice herbal medicine in France. It is well-established since then throughout Europe that the use of all Aristolochia species plants is prohibited.

The EU parliamentarian Mme Michele Rivasi took the stage to talk about the current EU position on herbal medicines. Mme Rivasi is known to have an interest in herbal and natural medicines, and has lobbied the EU parliament on behalf of CAM practitioners in France. Her presentation largely concerned the THMPD, initiated in 2004 and brought into full effect in May 2011. This is often known as the “traditional use directive” and licenses certain herbal remedies to be sold over the counter provided that they have been successful in proving traditional use of at least 15 years (local, European remedies) or 30 years (remedies from farther afield, e.g. TCM and Ayurvedic). Mme Rivasi did note, however, that each member state of the EU had a tendency to interpret the regulations according to their own interests. She also noted that the Directive itself had failed in its object – which was nominally to protect consumer choice in medicines – as very few licenses had been granted (about 200).

In light of this it is interesting that the trade stands at the congress were mainly presenting herbs in a raw, dried, unprocessed form. There were no licensed products to be found – indeed it would be very difficult for dried herbal material to gain a license at all, and such material seems by and large to fall into food legislation, rather than medicines – herb teas, after all, are widely used and thought of as beverages. Many herbal remedies throughout Europe continue to be sold, despite the legislation, as food supplements.

Further elaboration on the EU position was provided by Guillaume Cousyn, who outlined the complexity of the task of putting pressure on the EU parliament, due to the interlocking of legislation not only on herbs and medicines, but foods, manufacturing, agriculture, and sustainability. The round table discussion on “how to change EU law” was inconclusive, with most speakers expressing the opinion that it was difficult going on impossible, due not only to this complexity, but also to the considerable political and economic pressure exerted by the pharmaceutical companies.

There was a discussion on training standards for herboristes. A distinction was made between the requirements for diagnosing and prescribing, and those for plant identification, growing, harvesting, storing and packaging. The latter skills form the basis of Herboristorie, which Patrice de Bonneval, founder and principal of L’Ecole Lyonnaise des Plantes Médicinales, described as a metier (trade) rather than a profession. Most delegates did not consider it either necessary or appropriate to educate herboristes in universities, however, Elisabeth Busser, a pharmacist involved in the training of phytotherapists, aromatherapists and homeopaths, called for robust standards of education and training for herboristes, especially since they were often on the front line of giving advice to the public. It was acknowledged that there was a lack of practical teaching in universities.

As noted previously however, the only people permitted to practice in France are medical doctors, and their practice is referred to as phytothérapie; herbalists do exist but are completely illegal. Herboristes who cross the line between their metier of preparing and selling plants, and the practice of recommending plants for specific pathologies, run the risk of being prosecuted. Thus, on the second day of the congress, which was devoted to the topic “how to organise health in the future”, many seemed to advocate a two-tier system, wherein the herboristes would support the phytothérapistes by taking care of the practicalities of plant medicine, whilst the médecins-phytothérapistes exclusively handled the diagnosing and prescribing. However, as Dr Thierry Desgranges, a medical doctor/homeopath, oligotherapist and phytotherapist, noted, there was also a distinction to be made between Naturopaths and doctors: doctors are concerned with pathology, whilst Naturopaths are concerned with the Life Force. This distinction can blur the definition of diagnosis.

Indeed, as I reviewed the trade stands on display at the congress, I noted that herbs were being sold not to match specific pathologies, but to take care of functional axes and support specific organs – adaptogens for stress, for example, Marigold for the liver, and so forth, and as such the practitioners were indeed giving naturopathic, rather than medical advice. It was not clear the extent to which this was tolerated in law, but they seemed to be getting away with it.

Other items of interest during the conference included Clothilde Boisvert’s presentation on ethnobotany, in which she outlined the intimate connection between humans and plants in an ecological context. Mme Boisvert also pointed out the lack of practical education in university courses and emphasised the need to maintain traditional knowledge in training for herboristes and other involved in dealing with medicinal plants.

There was also a detailed and very interesting exposition from Elisabeth Busser, from a pharmacist’s perspective, of the work of an herboriste, whereby one could appreciate the very considerable levels of knowledge and skill that are required in this activity. Indeed, many UK herbalists could learn a lot from this very meticulous practice, which ranged from knowing precisely how and when to harvest plants, through the phytochemistry and optimum extraction methods for each plant, storage of raw and prepared material, recording and traceability, to the medically intuitive skills of combining plants in formulae for specific purposes. It struck me that the herboriste’s skills are greatly to be prized amongst herbalists generally, and should arguably form a far greater component of herbal training courses in the UK, which are at present weighted rather too much towards academic subjects, as a result of the emphasis on the university model of education. Although CNM’s training is far more vocational in this respect, compared with the university courses in the UK, I believe there are still good ideas to be gleaned from the French schools.

The lobbying activities of the French and Belgian practitioners are being co-ordinated through the IPSN (Institute for the Protection of Natural Health), and chiefly orchestrated by Augustin de Livois, a Belgian lawyer who specialises in EU medicines law. I spoke to M. de Livois, who studied at Reading University and is also familiar with UK law on this subject. His opinion was that we have such a different position in the UK that it would be difficult to make any comparison with the situation in France. He ventured the opinion that the complexity of EU medicines law would indeed give the UK government some headaches in trying to negotiate a special position for UK herbalists. That said, he too emphasised that different member states were able to make individual decisions on the interpretation of the regulations. He agreed that the chief issue we face in the UK is access to unlicensed medicinal plants. Clearly the THMPD has failed to protect public freedom of choice in over the-counter medicines, and that leaves only the herbal practitioners and their materia medica as a resource for those who wish to use herbs as part of their health care. As long as the 12:1 exemption stands in law (and it still does even in the new medicines act of 2012) we (in the UK) will be protected, but the general feeling is that this is an anomaly that cannot last for long.

It was very useful to get this intimate insight into the problems faced in a different EU country than our own. Whilst their problems are historically and legally different from ours in key respects, it is known that there are elements in the UK also who would like to limit complementary and alternative practice in similar ways and place all overt and explicit medical practice into the hands of doctors. Similarly to France, this shows signs of being activated chiefly through advertising standards – what you say about what you do increasingly being deployed as criteria in evaluating legality of practice. In this respect, and bearing in mind recent skirmishes with the ASA, we may well have more in common with the French position than appears at first sight. From this point of view, it is worth noting the resilience of the French practitioners in the face of prohibitive legislation, and their resourcefulness in finding ways of continuing to practice within the restrictive framework of both national and European legislation.

P. Jackson-Main, May 2013

IRH Response: Thanks to Pete for this article. Pete is Head of Department for Herbal Medicine at the College of Naturopathic Medicine in London and he would like to acknowledge their role in helping to arrange his participation in this event. It is great to forge links with those promoting herbal medicines in other countries. Several IRH members are also members of Herbalistes Sans Frontières who encourage international community among herbalists.