Re-presenting herbal medicine as phytotherapy: a strategy of professionalisation through the formation of a 'scientific' medicine. Edmond VanMarie Submitted in accordancewith the requirementsfor the degree of PhD The University of Leeds Department of Sociology and Social Policy & Division of History and Philosophy of Science in the School of Philosophy Submitted in March 2002 The candidate confirms that the work submitted is his own and that appropriate credit has been given where reference has been made to the work of others. Acknowledgments This work is not solely mine. Without the willingness of many medical herbalists to give me their considerationand time I would not have had their responsesto consider and analyse. For that I reiterate my personal thanks and record them here. Mention must also be made of the institutional representatives who were most helpful, and special thanks to the medical herbalists in the Leeds area who were also helpful in refining and clarifying my thoughts at the beginning of research. Any work of this nature can never be done alone. Financially, the assistance of a Research Scholarship from the University of Leeds gave me the opportunity to pursue this research. Cognitively, discussion with fellow researchers at conferences and less formal meetings has been most welcome. Finally (and motivationally), without the very patient support and guidance of Drs. Geof Mercer and Graeme Gooday I would not have maintained a clear thread of thought: I have been fortunate in having supervisors who performed their duties in the most literal meaning of 'supervisor' - keeping a watchful eye over all, seeing much more than I could, and quietly suggesting the optimum course of action. Notwithstanding the above any errors and omissions are solely mine. Abstract Previous research into complementary and alternative medicine has failed to accord each form of alternative medical intervention individual significance. This research considers medical herbalism in Britain and investigates the re-presentation of its knowledge within a scientific framework as a strategy in a process of professionalisation. Data were gathered from herbalists' own statements that provided the answers to how? and why? this occurred. Whilst it is suggestedthat much science is heavily influenced by its social and cultural enviromnent, the tenacious portrayal of biomedicine as science is taken as accepted orthodoxy. Dolby's model, whereby unorthodox science assumes the features of orthodox science to become accepted as science, is forwarded as an explanation of how herbal medicine has been re-presented as phytotherapy and therefore 'scientific'. The influences of the sociocultural enviromnent and the sociopolitical enviromnent on herbalism's recognition and acceptance by both the state and conventional medicine are suggested as explanations of why phytotherapy has been promoted by some herbalists. It is noted that such transformative measures have not radically affected the professional practice of medical herbalists, nor are they universally welcomed. The anomaly between institutional education of herbalism in terms of phytotherapy and the continuing practice of herbalism as a 'tradition' is noted. The relative identities of identity herbal institutions practitioners - with a cultural - and - with a social for discontinuity between institutional identity - is suggested as the explanation the knowledge and actual practice. It is also argued that medical herbalists have an element of altruism in their practice that is noteworthy beyond an assumed professional service orientation. Herbalists' differences of view regarding the acceptability of promoting phytotherapy as a route to recognition and acceptance appear to be subordinated by fears and anxieties about possible future govermnent legislation and EU harmonisation regulations. Chapter 5- Professional Practise III Practice Statistics III Beyond the mechanics otpractise 115 Practise and Kno 125 Communi4y and Culture 133 Community identibý and cultural 136 Chapter 6- The Sociopolitical Environment 141 Governmen 141 Herbalism in Professional Politics 145 Herbalism in State Politics 154 Fears and Anxieties 164 Chapter 7- Conclusion 168 Bibliography 176 List of Abbreviations 189 Appendix 190 I Re-presenting herbal medicine as phytotherapy: a strategy of professionalisation through the formation of a 'scientific' medicine. ChapterI- IntrooUction Medical herbalism has, perhaps, the longest history of medical strategies though it seems to have declined in credibility since the more scientific principles associatedwith biochemistry and pathology gained acceptancein and around the 19th. century. In more recent times it survived as common knowledge of folklore and 'old wives' tales' though there have always been a number of practitioners regarding it as a specialised knowledge for medical applications. The contemporary prevailing belief is that herbal medicine is a synergistic use of specific plant parts (often in combination with other specific plant parts) that aid the body's own natural healing forces to be effective. In common with several other medical strategies, herbalism seeks to treat the individual: the individual as a person with a physiological environment, a social and familial environment, an emotional environment, a mode of life, and a history - in short, it could be describedas an holistic approach. Within recent decades herbal medicine has had a resurgence of interest and popularity amongst many people. This research has two specific aims, the first is to record some of the recent history of herbal medicine and analyse current attitudes to herbal medicine expressed by herbal practitioners as individuals and expressed by professional associations as discrete communities of herbal practitioners. The second aim is to 2 integrate considerations of herbal medicine as a knowledge system and as a professional practice in Britain. The knowledge of herbal medicine has an ancient history but in recent decades has become subject to re-formulation and re-presentation by some herbalists who have apparently sought to relate herbal medicine to the sciences' of biomedicine and pharmacology. Herbal medicine as a practice also has an ancient history that has become estranged from orthodox concepts of primary medical strategies. The temporal nature of relocating herbal medicine as a knowledge and as a practice cannot occur in isolation from social existence within a society. Social existence is continually (though often imperceptibly) changing; such a process of change is influenced and shaped by many things including politics, economy, culture and religion. These same factors have also contributed to the location of herbal medicine within contemporary British society. Elements of the sociopolitical enviromnent and the sociocultural enviromnent will be argued to be strongly influential in representing herbal medicine in a more scientific form as phytotherapy, and strongly influential in the professional practice of herbalism. Thus this research aims to be more of an analytic description than a theoretical explanation of herbal medicine's popularity, efficacy, or continued existence. It follows earlier work by Whitelegg (1994) referring to paradigm changes in science in relation to alternative medicine and the work of Cant and Sharma (I 996a) which considered adjustments to homeopathic knowledge amongst horneopaths as a strategy of professionalisation. With some other forms of complementary and alternative medicine (hereafter termed CAM, following Coates & Jobst 1998), herbalism is still generally considered to be outside the mainstream orthodox strategies of healthcare that may be termed medical 3 science. Such unorthodox therapies and medical strategieshave been characterisedin four categories by Pietroni (1991). Firstly, complete systems (e.g. herbalism, homeopathy, naturopathy, Ayurvedic) have a comprehensive theoretical background and are able to treat most presenting conditions. They very often have their own explanation for causes of disease and mechanisms for cure and their own unique treatment approaches. Secondly, therapeutic strategies (e.g. massage, reflexology, aromatherapy) assist in the ease of discomfort and the promotion of perceptions of well-being. A third category, the self-care approach, gives the patient skills in practices to take care of themselves,,for example, yoga, meditation, and relaxation therapy. The fourth category relates to alternative diagnostic methods that may be used by orthodox practitioners, homeopaths, herbalists, nutritionists (e.g. iridology and muscle-testing). Although some sociological research has been done regarding various alternative therapies (including Bakx 1991, Saks 1992, Cant & Sharma 1995, Tovey 1997), none has specifically focused on herbalism. Any references to herbal medicine in academic literature seems to be lost in general discussions of alternative medicine as a heterogeneous whole. Apart from Griggs' (1997) scholarly recording of the history and contemporary developments of herbal medicine in Britain, analytic descriptions have been almost absent and any theoretical analysis entirely absent. It is suggested that considering CAM as a heterogeneous whole denies the subjectivity of perception of CAM therapies. If CAM, as appears to be the case, usually refers to several various therapies from acupuncture to the 'laying-on of hands' then each person's personal history and precognitive perceptions may dismiss some CAM therapies as 'worthless mumbo-jumbo'.