In an effort to reduce unnecessary prescriptions and promote selfcare, herbal medicine has much to offer — so, how can we step forward to support the campaign?
In June 2022, one of the UK’s leading advocates of integrated health, the College of Medicine, launched the Beyond Pills Campaign — calling for urgent government intervention on over-prescribing in the NHS. This followed the Chief Pharmaceutical Officer for England, Dr Keith Ridge’s National Overprescribing Review, which, even from the perspective of his post, found that perhaps 10% of drugs (110 million items) dispensed in primary care were inappropriate, unnecessary and could do harm, including causing premature death (1).
Beyond Pills campaign has the following mission:
To move UK healthcare beyond an over-reliance on pills by combining social prescribing, lifestyle medicine, psychosocial interventions and safe deprescribing. As well as reducing unnecessary and inappropriate prescribing, this integrated approach will improve outcomes and reduce health inequalities (2).
Over the intervening years a growing number of enlightened doctors and politicians have lent their support. On the face of it, this would seem a golden opportunity for the herbal community to step up and offer their contributions to reducing unnecessary prescriptions. In fact, such conversations have barely happened. It even looks like we are nowhere to be seen. What are we not doing right and what could we do differently?
‘Beyond Pills’: The herbal hurdles
An obvious challenge for the herbal sector is in the name of the campaign itself. It is difficult for our advocacy to overlook the fact that the vast majority of herbal consumption is in the form of ‘pills’, the tablets and capsules that are the stock material of the supplement industry. For many otherwise supportive medical professionals these ‘pills’ have even less to commend them than many pharmaceuticals, as they generally have much less evidence of efficacy and in some users may even encourage a pill-taking habit. A prescribing physician is unlikely to commend that a patient on inappropriate antidepressants take a herbal supplement when there are no guidelines that they will adequately help. They will also be aware of cautions against the use of St John’s wort, the one proven to be helpful for depression, for its potential interactions with other medications.
A counter point is that in themselves herbal supplements are not dangerous or addictive. However, their role in the prescribing lexicon will essentially be that of placebos, and professional practice guidelines are extremely wary of placebo prescription. The simple reality is that such options barely make it into discussion with medical professionals.
Unfortunately, the next option, recommending visits to a herbal practitioner, have not got off the ground either. The herbal experience of collaboration with registered health professionals is extremely limited, with only a handful of practitioners working within an NHS environment. Anecdotal reports are that even these do not engage with the day-to-day work of other professionals. Somehow the message is not getting through that we can be useful. We have not found a way to engage with conventional prescription calculations. One reason may be because we are perceived as competitive prescribers. Other complementary practitioners such as acupuncturists and osteopaths may have had a bit more luck because their modalities do not compete. Also, how do we counter the argument that although many practitioners dispense herbal medicines in formulations other than pills, they are still prescribing, and so perpetuating dependence?
Nor have we succeeded yet in making the case for a different kind of prescription, not tied to combating a symptom, instead working on nudging underlying healing processes. It’s a big message to get across. A personal experience of taking workshops with doctors is that they can ‘get it’ on the day but there is still a huge step to factoring it into their busy practice lives afterwards.
To meet the new healthcare agenda, we should redefine the herbal medicine offer. The gauntlet has been thrown down!
Herbs for autonomy
We do have one very strong card to play in this game: natural selfcare. A fundamental assumption in Beyond Pills is that by encouraging less dependence on pharmaceutical prescriptions one is simultaneously supporting greater self-reliance, more selfcare and patient autonomy. The use of home remedies without the intervention of a doctor is an ancient birth right which has only been neglected in modern times. Even older generations today will recall that mostly they managed everyday symptoms at home themselves, and with natural remedies.
There is a very strong case indeed for reviving these traditions. Experience of working with people in guiding their safe selfcare with plants is that they can feel empowered, in tune with nature. It is possible to glimpse a world where they become less dependent on interventions. Tapping into practical ways to care for oneself based on ancient wisdoms could be a potent contribution against the powerlessness and pointlessness that often accompanies illness.
There is an immediate note to make here. Much of the focus in the Beyond Pills campaigning is on providing alternatives for antidepressants through the current epidemic of mental health problems. So, there is attention on group activities and creative therapies: social prescribing often involves finding a yoga class, or walking or gardening group for the depressed patient to join so as to ‘take them out of themselves’, to counter the social isolation that is often at the heart of mental distress. Much of what natural healing can offer will similarly help make connections.
Becoming a natural health coach (and ‘physician’!)
Back in 2008 a major report on selfcare for the UK Department of Health confirmed that talking, shared advice and encouragement are the most effective generators of personal health change (3). This led to the Department that year commissioning our pioneering project, Integrated Self Care in Family Practice, co-ordinated by this author, with College of Medicine Chair Dr Michael Dixon’s GP practice, the Bromley by Bow Centre, University of Westminster and Peninsula Medical School, and leading to a scoping review by the latter (4). A key outcome was defining the role of a family practice ‘health facilitator’ that was to become the model for the social prescribing Link Worker.
At the same time, the UK National Health Service (NHS) began exploring ways to add ‘health coaching’ to health professional skills, to facilitate selfcare in long-term conditions and reduce calls on over-stretched services. This initiative has been supported by evidence that taking a collaborative approach in the clinic dramatically increases the likelihood of behavioural change (5).
Health coaching has been defined as ‘helping people gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals’ (6).
Coaching aims to:
- draw out a person’s potential rather than to instruct
- develop rather than to impose
- reflect rather than to direct
- enable rather than to train.
It is reactive and flexible – it allows for personal transition on an individual basis. A coach’s job is to work with clients to help them find the answers themselves. It involves particular practitioner skills — in motivational interviewing and goal setting. We learn to guide with a time-effective blend of asking, listening and informing, and to resist correction and confrontation with our client’s own internal arguments.
To build a more empowered and engaging client base the herbal practitioner could therefore become a ‘natural health coach’. Taking further training in motivational interviewing and reappraising one’s approach in clinic could be really important: “Do I instruct too much?” Is a question we can always keep asking.
In the coaching context we have a unique advantage, that we are also helping our patients reconnect to nature! Improved exposure to nature is a common theme in social prescribing, with much evidence accruing for the benefits (7).
The combination of coaching and nature even allows us to reclaim the original definition of ‘physician’, ultimately from the Ancient Greek physic: ‘nature’. To reflect the Hippocratic ideal of working with nature rather than invoking the supernatural, this became the practitioner discipline physikḗ epistḗmē: ‘knowledge of nature’.
Becoming a herbal activist
Better inspiring one’s patient in consultation is an important step but not the only one. As we all know initial enthusiasm for the natural self-care message can quickly dissipate when back with the all-consuming demands of home and work. As most social prescribing initiatives confirm, building some ongoing social cohesion and support is important. The evidence is persuasive that life changes are best made in conversations and group interactions; social and peer pressure has always been powerful (8).
The established ways to build a herbal practice have always included introducing one’s work to community groups. These could be those with an established interest in plants and nature, such as gardening and wildlife supporter groups, or rambler associations. It could be groups with shared health interests, such as natural childbirth, young parents, or specific condition-support groups. Most of these are looking for people to address them at their meetings and they are great opportunities for networking and building a local presence in the community. It is rare not to be able to draw in one or two patients from an evening outing. A particularly clever follow-through is to offer regular home medicine classes or herb walks to maintain a self-care momentum.
All such prospects have of course been transformed by social media. There are sometimes excellent offerings out there from herbal practitioners, many featuring selfcare tips and promoting classes and herb walks. The obvious drawback is that a remote community of followers is no substitute for real human interactions. However, many practitioners are also involved with social and eco-activism, transition towns, and other local community initiatives, lubricated by social media and spurred by climate change and other industrialised threats: this is a fertile environment to build a grassroot herbal activism too.
It is always surprising how so many otherwise angry at the impact of industrialisation still resort to antibiotics and hand their children Calpol at the first sign of an infection! There is surely scope for building another conversation in such communities based on practical and realistic natural support options. The herbalists’ expertise can then be directed to generating educational content for this audience: no one else can do this as well: get the handouts and classes ready! Setting up natural first aid posts at festivals is another tried approach to build stock that could also be extended into other gatherings.
Bring on the revolution!
The goal of Beyond Pills is actually far more limited than that we could and should be aiming for. We want a radical challenge to the top-down industrial-driven medical hegemony, that by definition generates dependency. Unfortunately, this appears to survive with the silent acquiescence of a disempowered populace that has traded in their health autonomy in favour of the easiest possible life, with the cheapest sweetest foods and most convenient medicines.
We may therefore need to work with fellow travellers outside the mainstream to help build new self-reliant communities with closer links to nature. For those with stirrings of revolution in their veins, and even those too wearied, there is a wonderful 2008 polemic by Rocky Mountain wild man and ‘anarcho-herbalist’ Laurel Luddite, which should get us onto the barricades. It is highly recommended to all readers of this piece! He powerfully extols us urgently to reconnect with our plants and their natural homes, to save us all.
As Laurel notes:
A society of people who are responsible for their own health and able to gather or grow their own medicines is a hard society to rule (9).
We should be able to see far beyond ‘Beyond Pills’ to the rediscovery of ancient truths in the service of new healthy communities.
References
- Ridge K (2021) Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions. Department of Health and Social Care. https://www.gov.uk/government/publications/national-overprescribing-review-report
- Beyond Pills All Party Parliamentary Group (APPG) launches to stop over-prescribing – college of medicine and integrated health. College of Medicine and Integrated Health. December 13, 2023. Accessed May 13, 2024. https://collegeofmedicine.org.uk/beyondpills/.
- Department of Health. (2008). Long term Conditions. Self‐Care: A National View in 2007 Compared to 2004‐05. London: Crown Copyright. House of Commons Library.
- MacKichan F, Paterson C, Henley WE, Britten N. (2011) Self-care in people with long term health problems: a community based survey. BMC Fam Pract. PMID: 21689455
- Gierisch JM, Hughes JM, Edelman D, et al. (2017) The Effectiveness of Health Coaching (Internet). Washington (DC): Department of Veterans Affairs (US). PMID: 29553632
- Bennett HD, Coleman EA, Parry C et al. (2010) Health coaching for patients with chronic illness. Fam Pract Manag. 17(5): 24-9. PMID: 21121566
- Dillon J and Lovel B (2022) Links between natural environments, learning and health: evidence briefing. Natural England. https://publications.naturalengland.org.uk/publication/5745607154335744
- NHS England (2020) Social prescribing and community-based support: Summary guide. NHS England and NHS Improvement. https://www.england.nhs.uk/publication/social-prescribing-and-community-based-support-summary-guide/
- Luddite L (2008) This is Anarcha-Herbalism: Thoughts On Health and Healing For the Revolution. https://theanarchistlibrary.org/library/laurel-luddite-this-is-anarcha-herbalism-thoughts-on-health-and-healing-for-the-revolution
