Adam Smith
Science & communications officer, ANH-Intl; member and special advisor, Association of Master Herbalists; member of UK Herbal Medicines and Practitioners Working Group (HMPWG)

The end of ‘sell through’ of herbal products the UK medicines regulator considers unlicensed herbal medicines threatens many formulations relied upon by UK herbal practitioners. We report on the second meeting of the UK government-convened Herbal Medicines and Practitioners Working Group (HMPWG), set up to find solutions to this and other problems faced by the UK herbal community.

The story so far

In short: the UK government convened the Herbal Medicines and Practitioners Working Group (HMPWG) earlier this year. Its remit is to find solutions to the thorny problems raised by a clash between European Union (EU) law, in the form of the Traditional Herbal Medicinal Products Directive (THMPD; Directive 2004/24/EC), and the practice of herbal medicine under UK law. The first HMPWG meeting in February 2014 set the scene and explained why the government could not proceed with its plan, announced 3 years earlier, to grant herbal practitioners ‘authorized health-care professional’ status under Article 5.1 of EU medicines law (Directive 2001/83/EC) via statutory regulation (SR).

Products not practitioners

The second HMPWG meeting, which took place last Thursday, 1st May 2014, discussed the options for effective and realistic regulation of herbal products, as opposed to practitioners. Presently, UK practitioners of non-Western herbal medicinal traditions, most notably Indian Ayurveda and traditional Chinese medicine, are disproportionately affected by the THMPD. They rely heavily on complex, polyherbal, manufactured products, unlike Western herbalists whose practice consists mainly of individualised remedies made up onsite following a one-to-one consultation. Unfortunately, it is precisely these products that are illegal under the THMPD unless they can gain a product license, or Traditional Herbal Registration (THR), under the THMPD’s clearly unsuitable licensing regime.

Added urgency was brought to the discussions by the end of the MHRA’s ‘sell-through’ period for unlicensed herbal medicines a mere 24 hours prior to the meeting. So incensed is one HMPWG member, the Association of Traditional Chinese Medicine and Acupuncture (ATCM), over this development that it has launched a legal challenge. It’s easy to see why: the end of sell-through will undoubtedly see the MHRA train its sights on a wider range of products vital to TCM practice, and has occurred before the group set up to find solutions has even submitted a report on the matter.

Dispensing for traditions?

One potential solution that was discussed at length was the introduction of herbal dispensaries into UK practice. Attendant staff members of the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), confirmed that herbal dispensaries are presently illegal under UK law. Changing UK legislation to permit third-party herbal dispensing to some degree might offer at least a partial solution, such as when complex prescriptions are required that would be difficult for practitioners to formulate in their home dispensaries. HMPWG attendees liked the idea, but pointed out that, as ever, the devil is in the detail: it would be vital to ensure that herbalists maintained their prescribing rights under any new or revised legislation, currently protected by Regulation 3(6) of the 2012 Human Medicines Regulations. No-one at the meeting appeared to want a system of magistral prescriptions for herbal medicine, as exists in much of continental Europe.

If herbal dispensaries become a reality in the UK, they would be required to achieve Good Manufacturing Process (GMP) certification. Some attendees were also strongly in favour of certification and auditing of source materials and manufacturing facilities, regardless of location, although whether this concern was driven by commercial or professional motives is, as yet, unclear.

A role for botanical food supplements

Since one aim of the meeting was to explore routes to market for herbal products, the option of botanical food supplements was inevitably raised. Surprisingly, however, the HMPWG attendees were at best lukewarm over the idea. One attendee mentioned the legal difficulty that, according to the Food Supplements Directive (Directive 2002/46/EC), “The labelling, presentation and advertising must not attribute to food supplements the property of preventing, treating or curing a human disease, or refer to such properties.” But, since the European Court of Justice (ECJ) has repeatedly affirmed the existence of a dual route to market for herbal products – via the THMPD and as food supplements – botanical food supplements must be explored thoroughly by the HMPWG. After some discussion and my own intervention, it was added as an agenda point for a future meeting.

Warning: ‘Robust discussions’ ahead!

Of course, the HMPWG’s product-related discussions were only a prelude to the big event at the next meeting: the highly charged issue of SR versus a form of voluntary regulation for herbal practitioners. This is a highly complex debate where the positions are passionate and even entrenched, particularly on the pro-SR side. At this stage, it’s impossible to predict with any certainty how the debate will go, although my feeling is that the government has lost much of its enthusiasm for SR.

One reason for my hunch is the difficulties inherent in setting up a system of SR. As outlined by the HMPWG’s representative of the Health & Care Professions Council (HCPC), who would administer the SR scheme, the process would be complex and time consuming – and, crucially, dependent upon consistency both of consensus among those being regulated and government enthusiasm for the project.  This seems somewhat unlikely given the history of herbal medicine and SR in the UK.

Outlook: Positive

All in all, then, the outcome of the second HMPWG meeting was broadly positive. Third-party herbal dispensaries may offer the hope of a workable solution to herbal product supply, although we await with interest the results of discussions on the legal implications between the meeting Chair and the MHRA. That botanical food supplements are firmly on the agenda can only be a positive thing. But it’s the next meeting that will be crucial to maintaining herbal medicine as a viable and thriving profession in the UK – and here, we’re cautiously optimistic.

 

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