As the use of herbal medicine grows, there is an ever-increasing need for highly trained professional medical herbalists to be recognized as an integral part of the American healthcare delivery system. The Botanical Medicine Academy (BMA), and the American Herbalists Guild (AHG), have risen to the challenge of addressing these concerns, and are well on the way to offering voluntary, national exams to ensure competency among practitioners of western herbal medicine.
Voluntary Exams Are Key
The use of herbs goes back as far as humanity, and until quite recently was the major form of medicine available to maintain health and treat illness. Many consumers today feel quite comfortable—and rightly so—relying on their own knowledge to maintain their health, and to treat minor illnesses and conditions like colds, flu, bruises, etc. Many consumers also are very comfortable turning to practitioners who have an extensive knowledge of medicinal plants for more complicated conditions. However, others, particularly people new to the use of herbs, only feel comfortable using medicinal plants if they can be assured that the practitioners prescribing and dispensing these herbs have a proven knowledge of botanical medicine.
In addition, many consumers today wish to use herbs for more complex medical problems that are also being treated with prescription medicines. These consumers need to locate practitioners well versed in potential interactions between herbs and over-the-counter and prescription medications in order to avoid potential adverse reactions. They also need practitioners who can advise them on when herbs are helpful and appropriate, and when other treatment options would be more fruitful.
After long deliberation, the BMA and AHG concluded that voluntary practitioner certification best answers the diverse needs of the public and practitioners, and will ultimately help government regulators and the media as well. The BMA and AHG believe that the public should retain both the right to use herbs on their own as well as the right to seek advice from traditional healers ranging from "wise women" like Juliette de Bairacli Levy, to Native American healers, shamans, and curanderas. The BMA and AHG also believe that the public should be ensured access to practitioners well-trained in a science-based, western system of botanical medicine in addition to the many already-existing models such as Ayurveda, Chinese and traditional folkloric practices. By making certification exams voluntary, practitioners can choose to become certified or not. Traditional practitioners will be able to continue offering their services as they have done for hundreds of years, while certified practitioners can advertise their particular western science-based skills to the segments of the population that prefer that form of treatment.
The public seeks herbal advice from a broad range of practitioners. These practitioners may be conventional medical doctors, doctors of osteopathy, chiropractors, licensed naturopathic physicians, pharmacists, nurse practitioners, herbalists, dieticians, midwives, and others. Each of these practitioner groups has their own training programs, and the amount of botanical medicine taught in those programs varies widely. Some are taught a great deal, others are taught only a little, and some are taught nothing. Thus, each group has practitioners that are skilled in herbal medicine as well as practitioners who have limited or no knowledge of how botanical medicine works, and its potential clinical benefits.
Each of the 50 United States has the right to set the practice standards for each of these practitioner groups. If each state were to set different certification standards for the herbal practice of each of the practitioner groups, the result could easily be a confusing, unworkable maze of widely varying standards. A consumer getting herbal advice from a pharmacist might get significantly superior or inferior advice than a consumer getting advice from a naturopath. States might also try to relegate herbal medicine to the simple dispensing of herbal drugs, thereby losing the vitalistic integrity of true herbal healing. Therefore the BMA and AHG are jointly designing examinations to create an independent standard of clinical excellence in western botanical medicine, elevating herbalism both as a science and as an art. Because herbal medicine has always first and foremost been people’s medicine, both organizations are generally opposed to state regulation of the practice of herbal medicine, and feel that state regulation in this area would cause substantial problems and should be avoided.
National certification would provide consumers with an objective, reliable way of finding practitioners skilled in medicinal plant usage or give government regulators and media a way to find experts in the practice of western botanical medicine.* Other herbal professions — such as practitioners of traditional Ayurvedic and Chinese medicine, traditional Native American herbalists and community healers — have their own standards. The AHG maintains an admissions review process for all professional herbalists, regardless of orientation, that will not be affected by this certification.
Once in place, national certification of western botanical medicine practitioners would permit those who want to use medical doctors for their care to find a physician who is board-certified in botanical medicine, and know the practitioner has a verifiable knowledge of herbs. Another patient, preferring a chiropractor, could similarly find a provider with excellent skills in clinical botanical medicine. This scheme will also allow healthcare providers who are not themselves expert in herb use to refer their patients to other professionals who are expert and whom they trust. Ultimately, national certification will create a more holistic and integrated healthcare system that will benefit consumers.
The certification exams will be offered at two levels. The first certification level (entry-level certification) will ensure the practitioner has a solid knowledge of the most common botanical medicines and their clinical use, as well as a basic awareness of the other herbs that make up the materia medica of a skilled practitioner. The second certification level (board certification) will ensure the practitioner has an advanced understanding of how to use a wide variety of plants skillfully in a wide variety of settings. Successful completion of the advanced examination will confer national certification by the AHG. Both groups will have to participate in continuing education to maintain their certification. Thus, practitioners with a basic certification will continue to progress and eventually attain the advanced level certification while advanced practitioners will maintain a knowledge of the growing body of scientific information on plants and their many uses.
The AHG and the BMA are preparing the advanced level exam first. Given the large number of people already using botanical medicines in practice, it was felt to be more important to offer the equivalent of board certification to this group prior to offering an entry-level examination.
The process of creating the board certification examination began with a survey sent to hundreds of renowned practitioners asking them to identify the herbs they considered most important in their practice, areas they considered most important to know, and the reference texts they considered most helpful. The survey results were analyzed to identify what plants and topics should be tested, and which reference texts should be used in the exam process. An exam guideline, that identifies what will be on the exam and provides a list of references practitioners can use to prepare for the exam, is now available from AHG, 1931 Gaddis Road, Canton, GA 30115, (770) 751-6021 or at <http://www.americanherbalist.com>.
A guideline for the writing of exam questions, which will include both multiple choice and essay questions, was compiled and distributed to a group of carefully selected expert practitioners. Their exam questions will be edited and peer reviewed, and then stored in a secure database ensuring that no candidate taking the exam has previously seen any of the questions on the exam. Once this process is complete, a group of practitioners will be invited to take a "cut test" to ensure that the exam is neither too easy nor too difficult but, instead, consistently measures skill in plant use. After the cut exam process is complete, the exam will be offered on a regular basis to practitioners.
The AHG and the BMA are also beginning to create the fundamental exam intended primarily for practitioners just beginning to use botanical medicines in their practice. This exam will be prepared in a similar fashion based on survey information from teachers identifying what knowledge beginning practitioners should have.
Continuing education is needed to maintain good skills, and the AHG and BMA will jointly offer continuing education courses. Both organizations actively encourage other schools and groups to offer educational programs. They will develop a system that will approve any well-designed program for continuing education credits. This will allow practitioners to find interesting programs in their community or offered by their own professional organizations that will satisfy continuing education requirements.
How You Can Help
Practitioner certification is valuable to the public, to practitioners, the media, and to the herbal community at large. Presently, the media often attacks the use of herbal medicine, arguing that little is known about herbs—even though plants have been used safely for millennia and a large body of scientific research exists about them—and that it is impossible to know whether persons speaking about herb use know what they are talking about. Once the public is able to select a practitioner with a level and type of knowledge that they are looking for, many of these fears will be put to rest. Consumers will be able to decide whether a practitioner has the type of skill that they desire. The media will be able to contact skilled practitioners for information on plants or uses that are in the news. Government regulators will be able to identify knowledgeable practitioners for inclusion in panels and research groups related to botanical medicine. Industry will be able to more readily select expert clinical advisors. Addressing these concerns should allow herbal medicine to remain available to the public in all of its traditional forms while allowing new, and perhaps more skeptical, users of botanical medicines to find a comfort level that allows them to explore all the benefits that plants can offer.
The certification process is moving forward at a good pace, but extensive resources are needed to make the exam a reality and to make the public and practitioners aware of the certification process. The public can help by joining the AHG and spreading the word about certification; practitioners can join AHG in order to eventually sit for exam; businesses can sponsor the exams through the BMA or AHG. Additionally, comments, questions, and ideas about the certification process are warmly welcomed. The BMA may be reached at P.O. Box 1528, Vashon, Washington 98070 or 206/567-5986.
Kathy Abascal is executive director of BMA. Eric Yarnell is president of BMA and also a professional member of AHG. This article was made possible by a grant from Thorne Research to the Botanical Medicine Academy.
*A small number of practitioners in the United States are members or fellows of the National Institute of Medical Herbalists (NIMH) of the United Kingdom (U.K.). This credential requires completion of an accredited herbal medicine course (offered only in the U.K.). Consumers, media, health care providers, and others can be fairly certain that herbalists with this credential are qualified practitioners. However, most practitioners in the U.S. are not trained in the U.K. and cannot be identified through this credentialing system.