By John Scott
Herbal or botanical medicine is the oldest modality of healing known to humanity. All cultures have employed it and modern pharmacology could not have progressed without the knowledge of plant chemistry. In the year 1900, medicine in the United States was substantially different than it is now, in the 21st century. One was as likely if not more likely to encounter an eclectic physician, naturopath, chiropractor or homeopath, as a medical doctor as we know them today. Herbal and homeopathic remedies were in common use. What has become “western, modern, or allopathic” medicine was just in its infancy. It was said that if you went to see an allopathic doctor you would die of the treatment and if you went to see one of the other practitioners mentioned you would die from the disease.
In 1900, there were no regulations governing the sales or manufacturing of herbal and homeopathic products. These products were known to contain substances that are illegal today, such as opiates and cocaine. The original Coca Cola recipe contained cocaine. Many of these products were sold by making fantastic claims about their effects. “Snake oil salesman” was a pejorative term used to describe the peddlers of these products.
The early years of the 20th century saw the beginnings of modern “evidence based” medicine and the decline of herbal remedies and other more traditional therapies. In 1904, the American Medical Association created a Council for Medical Education. Following on June 30, 1906, President Theodore Roosevelt signed the Pure Food and Drug Act. This act was a reaction to reports from activists like Upton Sinclair who wrote about tainted food produced in horribly unsanitary facilities. One of the concerns addressed by this act is the lack of accurate labeling on food, drugs, and herbal products. Coca Cola was allowed to keep cocaine in their beverage but they had to list all of the ingredients on the label. In 1909, they received some attention from the US government for the excessive amount of caffeine in their product.
In 1911, Abraham Flexner issued a voluminous report on the state of allopathic medical education. The Carnegie Foundation funded this report. Flexner personally visited all 155 medical educational facilities in the US. Flexner’s family had emigrated from Germany and he considered medical education in Europe far superior to what was being offered in the US. His report was considered a scathing indictment of the inadequacies of medical education in this country and sparked dramatic changes in medical education.
Wikipedia states: When Flexner researched his report, many American medical schools were “proprietary,” namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit. A degree was typically awarded after only two years of study. Laboratory work and dissection were not necessarily required. Many of the instructors were local doctors teaching part-time, whose own training left something to be desired. The regulation of the medical profession by state government was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology, and the word “quack” flourished. There is no evidence that the mass of Americans were dissatisfied with this situation.
In 1938, the US Congress created the Food and Drug Administration (FDA). This was a response to criticism that pharmaceutical products were not efficacious. This agency was created to insure that pharmaceutical products were actually as effective as their labels claimed.
Over the decades since 1900, we have witnessed the establishment of the modern medical monopoly and the evolution from a totally plant based medical healing system to a system more and more reliant on synthesized chemicals. As modern medicine became more developed, natural healing modalities and herbal medicines became increasingly marginalized, until finally, there was no legitimate place for herbal medicine in conventional medical practice.
Starting in the 1970s, there was a reawakening of interest in herbal medicine. This happened about the same time the US president, Richard Nixon, visited the People’s Republic of China and sparked a new interest in acupuncture. This coincided with the counterculture, back-to-the-earth movements and a rejection by some Americans of industrialized medicine. Since that time there has been a growing awareness of many of the dangers of pharmaceutical drugs and the increasing expense of modern medicine.
The FDA is responsible for regulating and providing safe products in interstate commerce. The categories of the products under their regulatory umbrella are: Food, Drugs, Cosmetics, and since 1994, Dietary Supplements. Dietary Supplements include vitamins, minerals, and all herbal products. These substances are items designed to be added to one’s diet to address nutritional deficiencies due to modern lifestyle choices and depleted soil. The law states that for herbal products, one may only legally make claims or statements that relate to how these substances promote a beneficial change to either the structure or the function of the human body. Under these regulations, dietary supplements cannot make claims to cure disease or ameliorate symptoms unless those claims have been proven by a scientific testing process approved by the FDA. Those of us who practice Chinese herbal medicine find these legal guidelines to be extremely inadequate to describe the realistic use of the herbal products as employed by our medical tradition for over two thousand years.
In April of 2004, the FDA placed a ban on ephedra alkaloids that has effectively removed ma huang from use by trained Acupuncture and Oriental Medicine (AOM) practitioners. That event has brought an acute awareness of the inadequacies of the current FDA laws and regulations in the manufacturing and usage of herbal products.
While herbs in the Chinese Materia Medica are safe when correctly prescribed, practitioners are aware of a number of substances in the Materia Medica that should not be available for consumption to the uneducated public. There have been instances of patients harmed by wrong use of herbs. Some Chinese herbal formulas are not appropriate to be used as over-the-counter remedies, or “supplements,” since they should require prescription by a practitioner knowledgeable in correct OM diagnosis.
While the FDA tries to fit Chinese herbal medicine products into the current regulatory scheme they usually fail. The laws pertaining to medical substances were written to address allopathic medicine. Allopathic medicine developed incrementally as herbal and other traditional medicines were marginalized. It will require the concentrated efforts of the AOM community to create a place in our conventional medical system that respects and values Chinese herbal medicine. The FDA now recognizes Complementary and Alternative Medicine and knows that Americans are utilizing the practices associated with it on an increasing basis every year. The National Center for Complementary and Alternative Medicine (NCCAM) is a part of the National Institute of Health (NIH) and not the FDA. The NCCAM recognizes AOM or TCM as a “whole medical system.” Federal agencies are aware that OM and Chinese herbal medicine are a discreet medical system separate from allopathic medicine. However, the current regulatory apparatus within the FDA is not designed to recognize the place for herbal medicines as a legitimate healing medical modality in the United States.
It is clear to me and others in the AOM profession that what is necessary at the present time is to create a recognized non-drug status for herbal medicine. We must bring herbal medicine and specifically Chinese herbal medicine into the pantheon of recognized conventional medical options for all Americans. The mechanism for achieving this is to amend the FD&C Act to recognize Chinese herbal medicine and establish an appropriate regulatory structure for this class of products. Toward this end we must support the efforts of the AAAOM that is working to achieve the goal of securing the rightful role for herbal medicine in the 21st century.