In recent times patients, consumers, the public, therapists, practitioners, have been reminded by the Labour government that there is need for more regulation. This has played well with the European Union Commission which, by its nature, is a regulator or standardiser. This is especially true of medicine. It is an area where regulations on health and safety seem to be of paramount important. The United Kingdom seems to abound in stories of lack of care, inattention to duty, and a failure to meet basic treatment needs. In addition there are horror stories that range from murderous doctors and nurses, to sheer incompetence. All this despite a wealth of regulation. All this despite training standards, registration of title and other practises that are supposed to mark out a profession.
In part the public are distrustful of the NHS and has turned in considerable numbers to alternative and complementary medicine. Recent governments have taken a benevolent attitude towards this sector and, whilst encouraging self-regulation and high standards, has done little to interfere with this sector either at treatment level or in the provision of material used. There has been little complaint or outcry from the public over treatments received and there have been very few serious problems concerning the materials of choice by practitioners. For example with herbs, herbal extracts and essential oils.
HEALTH AND SAFETY
Despite the efforts of Professor Ernst at Exeter University, little in the way of evidence to show how unsafe these treatments are has been brought forward. In fact, compared to orthodox medicines which undergo such incredible testing and research, alternative and complementary medicines seem remarkably safe. Yes, there are a few high profile examples of where people are irresponsible in home medication or where some obscure Chinese herb has been wrongly identified. But these cases only highlight the general safety of the area in which we work.
Safety has always been at the forefront of aromatherapy. Most courses have always emphasised judicious use of essential oils and a treatment pattern that does not encourage continual use. It could be argued that aromatherapy has been, if nothing else, a large scale demonstration that essential oils are basically safe. This must be very irritating to the academics, researchers and educators who normally find upon examinations of essential oils that they are loaded with allergens, toxins and things that shouldn’t be used, at least in the quantities that aromatherapists use them. This is in part because much of research is based on models of reality as perceived by the researcher rather than the reality found at street level. Working in cosmetics I know this only too well, contributing to models that demonstrate what the client/customer/company wants to know. In other words – ask the right question and you get the right answer. This is evident from the phrase “one person’s rubifacient is another person’s skin irritant”.
AROMATHERAPY and the ‘BOX SYSTEM’
By and large aromatherapy has grown well and achieved a lot. It could well be argued that until aromatherapy was introduced into the mainline educational systems, perhaps at Further Education Colleges, the standard of practise remained high. When Further Education decided to blur the edges between medicine and beauty therapy, standards definitely took a turn for the worse. This was probably due to the system’s “own box” system. A ‘box system’ means that for every area there is a speciality. People with a ‘box mentality’ cannot conceive that boxes overlap or interchange. The box system has resulted in all the specialists that we see in medicine. The box system is very antagonistic towards an holistic approach. Aromatherapy illustrates this perfectly.
Aromatherapy is a sensual system of treatment, one that crosses many boundaries and requiring a variety of skills and understandings. To cope with such a multi-dimensional practise is beyond the scope of the system. The box system would find it difficult to do anything but set a qualification for beauty therapy, clinical therapy, massage therapy, advanced aromatherapy, herbal aromatherapy, etc. The box system is ideally suited to a bureaucratic arrangement. It is ideally suited, for example, to the NHS where career paths over-ride the underlying purpose of patient recovery. In the end, as we all know, there are too many managers and not enough people to do the real work. Such also is the nature of regulation. We might ask – who wants regulation? The answer is invariably – the public want to be satisfied that they are receiving treatment from a qualified practitioner.
Dr Shipman had all the necessary qualifications!
In a non-regulated society people vote with their feet or take action through the Courts. A good practitioner is therefore inundated with work and those that are poor therapists receive little custom and a bad reputation. If they do damage they are sued. Try doing that through the NHS. And whilst the taxpayer is prepared to foot the bill very little, if any, disciplinary action is ever taken due to the strong Union position. Is that what people really want? Did John Hutton, Minister of State for Health, in his recent desire to regulate Herbal Medicine and Acupuncture, put forward proposals for statutory regulation? Many in the aromatherapy profession also believe that statutory regulation is a good thing. John Hutton wrote – “this government is committed to increasing public and patient protection and improving quality in all health care settings. As interest in complementary medicine grows, so too must our focus on public safety and ensuring effective standards. It is no longer appropriate for statutory regulation to be restricted to orthodox health care professionals such as doctors, nurses and physiotherapists.”
I would like to ask “why not?” Why is it no longer appropriate when the majority of problems have come from those who have sought to impose standards from outside. The introduction to the ‘regulation state’, the statutory self-regulation of health care professionals, helped protect patients and the public by ensuring that practitioners met agreed standards of practise and competence. I come back to the central point – who is making the demand for regulation? Certainly government; because of its very nature, without daily regulation, many bureaucrats would lose their jobs. Perish the thought that at some point, some day, some place, any country would say – Well, we have enough rules and regulations. We’ll have a moratorium for five years. What would they do?
Notice please that with this statutory regulation there is a parallel move for the standardisation of plant medicines and this applies to essential oils as well. The argument is always that we need to protect the consumer and increase quality of product or service.
AN HISTORICAL PERSPECTIVE
Not everyone likes history but surely it is there for us to learn lessons from. In the medieval period there existed a series of Guilds. In London today we still have Guild Halls. These bodies were little more than statutory authorities that held the right of work in their hands. The Guild Society was the antithesis of an entrepreneurial society and it wasn’t until the break-up of the Guilds that there was really much progress in the way of technology and working practises.
Milton Friedman argued that Guilds came about only for three reasons: money, power and control. With that in mind we should ask real questions as to whether certification and so-called qualification actually gives further protection or higher standards. Where is the evidence for this? If we look at aromatherapy we see that standardisation has rolled forward a lack of basic understanding of essential oils has also come forward compared to those early pioneering practitioners. We see that there is a set massage routine, irrespective of the needs of the patient, which even has the disadvantage of stopping original massage techniques from being maintained. Certainly the consumer or patient is not out there demanding that there be improved safety for aromatherapy. If mainline medicine is anything to go by, a certificate on the wall is not going to protect anybody from harm!
STATUTORY REGULATION versus CREATIVITY
Where then does the pressure from statutory regulation come from? There are possibly two areas.
The first is probably the academic or educational world which, under this government, seems to train everybody and everything from floor sweeping to rocket science. One wonders sometimes where the trainers actually come from. My limited experience of training in this sector showed me that the resulting training documents looked very technical and beautiful but the course itself had been de-natured diluted. Those of you who have seen the recent TV programmes with the famous cook Gordon Ramsay in action in the catering field, will have also noticed the adverse comments coming from people on those courses saying ‘is it really necessary’ to say or do x, y or z? Perhaps when they are as competent and as successful as Gordon Ramsay and have been as creative, their view would carry as much weight as his. One may also question ‘who has more certificates to put on the wall?’ Somehow I do not think it will be Gordon Ramsay.
Who else might be pushing for statutory regulation? Most likely it would be the profession itself.
Turning back to history it seems that it is generally the professions, and those in the professions, that want more regulation. In herbalism this seems to apply particularly to those practitioners who are ‘science-based’. Perhaps this is also true of aromatherapy. The European Union’s political agenda is to vilify its main trading opponent the United States. We see this at every level. For the European it is as though the United States has assumed the role of the ‘evil empire’ that the old Soviet Union used to occupy. Perhaps it is a case of Animal Farm all over again. We must accept however that the United States has and does some good things. Even in a simplistic way those that shout loudest against the United States today would not have a platform or even a country had it not been for thousands of American lives that were lost for no more than an ideal. After all, their country had never been invaded.
The United States studies on many things are quite interesting and of value and their studies show that the regulation of medicine has often resulted in poorer care, higher prices, less innovation and strident protectionism. It is often this protection of title that so concerns practitioners. In one American study it was found that up to 98,000 people died each year from medical errors. The author of the report thought that the figure was most likely conservative.
SHOULD AROMATHERAPY BE SCIENCE BASED?
In aromatherapy a large body exists that does not support the totally science-based concept. Of course it is true that the newest practitioners are being fed a diet of chemistry, mixed in with toxicological studies. They should pause and look at their forebears who have not found the theoretical problems in their practice. It is actually doubtful whether the study of chemistry has actually contributed much to the practise of aromatherapy. I would suggest that aromatherapists heart-searchingly ask themselves the question ‘when did they last use chemistry in their practice?’
In terms of blending, the Caddy Profiles have taken away much of the risk and, provided that one is not using Industrial oils, such a process works extremely well. Yes, I do accept that having a working knowledge, perhaps of functional groups, is advantageous. But a contrary argument is that the education system provides increasingly more complex studies often with little or no actual relevance to the practise. What we do see is that whilst education may be coming freer in the state sector rather than in the old-fashioned private sector, regulation has certainly increased prices for essential oils.
The thrust of the state educational system has to be biased towards the box mentality. If we accept that one of the so-called driving forces for statutory regulation is consumer safety or patient safety, we would expect to see a rise in science-based aromatherapy. Such education needs standardised or industrial oils. There is an increasing tendency to say that a particular oil “works” because it contains such and such component. Tea Tree is no longer good enough to be Tea Tree but has to be a specific chemotype, i.e. terpinen-4-ol. The suggestion is that this is the magic ingredient that makes Tea Tree work (only it is not magic, it is science which persistently seeks to analyse herbs to find the active ingredient.)
The problem with such an approach is that the consumer and the patient have already voted with their feet to avoid just such a science-based medicine. There now is a tendency to divide aromatherapy and herbalism into Western and Eastern Herbalism; the former being science based and the latter being mystic. We must remember that western medicine, despite the billions of pounds spent on it, is not satisfying the consumer or patient. Of course it does a splendid job in many sectors but, if we accept that there is a growth in the alternative and complementary medicine sector, then we should respect the fact that the consumer is looking for something quite different to that which is offered by orthodoxy. So why therefore move the alternative therapies into an orthodox mode?
If the argument hinges on safety, I can see little evidence that aromatherapy has done much harm, even in the hands of inexperienced practitioners. Problems associated with essential oils sometimes come from orthodox origins,……. the so-called professionals, or from accidental ingestion through inappropriate packaging of essential oils.
In recent times essential oils have come under attack from the Cosmetics Directive which highlighted their content of allergens. This Directive has imposed a number of restrictions in the cosmetics and perfume industry. Little or no account was taken of the fact that aromatherapy was widely available in the cosmetics industry from official aromatherapy to commercial aromatherapy such as put forward by Origins or Decleor whwreby they had not encountered any particular growth in allergic reactions. This is an example of where science based research highlights a problem that is demonstrably non existent in practical terms.
THE STANDARDISED APPROACH
One of the significant driving forces for state registration or regulation for therapists is itself state medicine. If a profession wants referrals from state institutions, such as from hospitals and doctors, then it would be a requirement for the practitioner to have some sort of state recognition. The proponents of statutory regulation basically want to be able to practise legally within the NHS, as argued above. Statutory regulation will be based around preliminary educational standards followed by the necessity to advance that education into specialities. Mostly this advance will have a western, scientific bias and, as a result, restrict aromatherapists from practises that smack of mysticism, folk medicine and other paradigms to the standardised approach. Indeed it will highlight the need for re-training into modules that are generally accepted. It seems to me that the EU has had a long-term ambition that all medical practitioners, of whatever nature, should undergo the same basic training perhaps in anatomy and physiology or the pathology of disease. Such an approach would be highly destructive to alternative or complementary medicine which sees a different basis for disease. Further, such an approach would be highly damaging to the multi-disciplinary practitioner, one who even spans beauty, skin care, massage – whatever we may call it – with the use of aromatherapy, for the promotion of health and well-being rather than the cure of symptoms.
Of course, the need for advanced courses or CPD becomes a gold mine to the educator and also becomes a lifeline to ailing professional bodies and trade unions. Having sold the idea that standards need to be raised, the educators and schools suddenly produce courses to raise the standards. This will be an unending scenario whereby more and more unnecessary skills will be demanded, biased towards western medicine, The genuine aromatherapist or healer will be marginalised and certainly those working in skin care will become second rate citizens within their own profession, even if they were the foundation on which it was established.
THE DESIRE FOR STATE RECOGNITION
In education there is a real danger of conflict of interests and paradigms. The main associations are well content with trying to establish themselves as a real profession with some sort of state recognition. This really is very strange. Aromatherapy has grown like topsy. It is obviously recognised by the consumer, judging from its popularity, and the only people who want proof of its efficacy are those in an orthodox realm who criticise it and don’t understand how it works. In truth they need to control it because it challenges their own pocket and bank balance, and little else comes into it. The other arguments so laudably presented by civil servants and bureaucrats in heavyweight papers simply ignore the medieval Guild protectionism that lies at the heart of so many professional organisations. Such organisations hate to be called trade unions but we must remember that the Royal College of Nurses is a trade union. The British Medical Association is a trade union. So are the IFPA and the IFA, although some of its members would hate for it to be thought of in this way.
Already looking back on the history of aromatherapy we can see examinations for certification and core curriculum have been difficult to achieve throughout the profession. Not only that but the final result has been a set of materials dominated by major interest groups, whereas special interest groups have become splinter movements with their own ideas. Statutory regulation is a way of controlling these splinter groups, or free-thinkers, and isolating them from the main stream of aromatherapy. It does not require much imagination to see that aromatherapy becomes very restrictive at its core with set views – the way things happen and the way things work. This is, of course, the opposite of what the consumer has expected and the opposite of where true science is taking us. After all we hardly consider, or look at, the influence of smell within our aroma therapy. This is a relatively unexplored area of therapy. It probably lies at the heart of why aromatherapy works and why some materials work better than others, etc.
A hundred years ago or more, in the late Victorian age, many professions were developed including the medical profession. The conventions developed then have almost become sacrosanct through the years. Yet our understanding of the world and the way that it works has fundamentally changed. There have been huge advances in the understanding of medicine and yet disease increases. There are alternative conventions. There are alternative ways of looking at human beings, plants, essential oils and so on. Statutory regulation is not going to help or advance that view.
Surely there are some simple solutions to safety and protection of consumers? For example I would like to see a person’s training disclosed at the initial visit, whether this be in the orthodox field or in the alternative field. Then the consumer has a real choice rather than an imposition by the state as at present. Do you have any real choice in your GP other than the fact that the nanny state tells you that everybody is the same? It is obvious that codes of conduct developed by the aromatherapy profession some time ago could have some form of state backing. Such as inappropriate sexual conduct or, perhaps, not placing the client or patient into a position whereby they have to purchase goods. These issues, if not already addressed, could be addressed in some form quite easily, allowing the therapy to maximise its development of healing without educational state interference.
It seems to me that the present government has taken us back a hundred years to a time of restricted practise that will become expensive for those who can afford to buy into the regulatory system on an annual basis. Few therapists realise that they will have to pay for their privilege of regulation. I foresee that there will be an ever increasing demand from a small clique of experts to raise educational standards to more and more expensive courses for those who are judged to be professional aromatherapists.
Aromatherapy has demonstrated that there are many different paths to the same goal. There is no single one ‘right’ form of aromatherapy. The goal of the therapist is to heal and take people to a different realm from that which orthodox medicines handle so well, such a trauma, surgery, etc. Surely we can find a way forward that does not require a regulatory system that stops the development of aromatherapy in its tracks?
WHAT DO THE PUBLIC AND CONSUMER WANT?
These days few remember the pioneers of aromatherapy who, with limited resources, struggled to develop a therapy that was under attack from the beginning. Both the patient and consumer created aromatherapy by exercising their right of choice. It’s not so long ago that Plymouth University commented that it couldn’t take an aromatherapy course forward because in effect it didn’t want to look stupid or unprofessional. Plymouth, we must remember, operated a perfumery course at that time. How short-sighted!
Today aromatherapy is a large, successful, profession. True, it is inconvenient for those in the NHS system not to have state recognised qualifications for their career paths. The patient and consumer however continue to beat a path to the door of aromatherapists in clinics, spas and other salons. They do not seem overly distressed that they cannot have free delivery of treatment via the NHS. I wonder if, at the end of the day, they will be so happy when a state regulated system is applied to aromatherapy – voluntarily by the profession or imposed from outside? If, with our medieval thinking, we put self-interest first then maybe we should look again at the real need for statutory regulation. So far, without it, we have been successful. With it, I am sure, that the profession will contract and become severely limited without the forward, dynamic movement of the past that has brought it to a point whereby aromatherapy is known for its healing capacity, the pleasure it gives and its fundamental efficacy.
Jan Kusmirek 21/05/2004