We’ve said it before and we’ll say it again: it was fantastic that the UK’s Independent newspaper ran with a front-page article on 30 December last year about the threat to herbal medicines posed by the Traditional Herbal Medicinal Products Directive. Less fantastic was the accompanying article by Professor Edzard Ernst, who made the most of the opportunity to muddy the waters, ridicule the practice of herbalism and defame herbalists themselves. We have to say, to do all this in less than 400 words was impressive – the only impressive thing about the entire piece, in fact. ANH-Intl wrote a letter to the Independent objecting to some of the points in Ernst’s piece, but they appear to have decided not to publish it. We are pleased to reproduce it for you here.

Dear Sir/Madam

Good on the Independent for placing an article about the perilous future for many herbal products in the EU on its front page (“Europe to ban hundreds of herbal remedies”, 30 December, 2010). This issue, and the important debate it highlights over personal freedom and the right to choose one’s own healthcare, is now firmly entrenched in the public consciousness.

One noteworthy omission, however, was that the full implementation of the European law on traditional herbal medicines (Directive 2004/24/EC) relates only to over-the-counter remedies sold for minor, self-limiting ailments where intervention of a medical practitioner is not required. As such, it covers only products that would be sold direct to the consumer, for example, in health stores, pharmacies, supermarkets and online. The European law specifically does not relate to products prescribed by practitioners of herbal medicine. If UK practitioners are recognised by the government and professionally regulated, they will be able to continue using unlicensed herbal medicines as per the existing exemption in UK medicines law, and a similar exemption for “authorised health care professionals” in European medicinal law. An ongoing campaign by UK herbalists seeks to secure such statutory regulation for their profession.

We were, however, concerned that Professor Edzard Ernst’s opinion piece on page 2 did little to further public understanding of the issue. Importantly, the piece was not balanced with other viewpoints. Prof Ernst has long used his position as Professor of Complementary Medicine at Exeter University as a pulpit to attack long-standing practices of non-orthodox medicine, as well as such advocates as Prince Charles. The Professor, along with a small band of UK-based skeptics – many of whom are aligned with an anti-natural medicine, pro-pharmaceutical, vaccine and biotech industry campaign known as Sense About Science – refuse to accept the validity of any healthcare approach unless it is conclusively demonstrated via randomised, controlled trials (RCTs). This dependency on RCTs as the sole arbiter of efficacy (in experimental conditions) and effectiveness (in real life) actually represents a significant departure from the formal concept of evidence-based medicine, originally proposed by Professor Sackett and others in 1992 (Evidence-Based Medicine Working Group. JAMA 1992;268:2420–2425). Evidence-based medicine should involve evaluation of all relevant peer-reviewed research, not only RCTs, as well as an assessment of relevant clinical experience.

Exemplifying just how Prof Ernst’s approach and his conclusions can distort knowledge gained from thousands of years of human experience with botanical medicine, Ernst and colleagues recently found no evidence for the effectiveness of individualised herbal medicine – for any indication (Guo R et al. Postgrad Med J 2007;83:633–637). But, to develop this conclusion, his group located 1,345 papers on the topic, discarded all but three of them for their supposed unsuitability, and then drew far-reaching conclusions on the basis of only these three papers. At this point, reductionism in science becomes neither objective nor an accurate representation of real-life processes.

Ironically, applying Ernst’s approach to conventional medicines would similarly invalidate them, for lack of effectiveness in the majority of patients for most indications. Nevertheless, their side effects are, on average, many thousands of times more severe than those reported for herbal medicines.

Clearly, there is a fascinating debate to be had over the suitability of the RCT to assess holistic traditions, including many forms of herbal medicine, but that is for another day.

“We need more research” is Ernst’s parting shot. Yes, we do, dear Edzard, but we also need more people willing to look objectively at the evidence that already exists.

Robert Verkerk PhD and Adam Smith

Alliance for Natural Health International

Dorking, UK

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