Josef Brinckmann explores what it takes to make a herbal medicine practice part of the sustainable herbal supply chain.
First, do no harm… neither to the patients nor to the natural habitats of medicinal plants
As a medicinal plant researcher, I (really) enjoy digging around in the intersections of traditional medical knowledge, biogeography, ethnoecology, conservation biology, history of trade, and archaeobotany. Over thirty years ago, when working in San Francisco at the community clinic of the American College of Traditional Chinese Medicine (ACTCM), I wondered about the geographic origins, the ecosystems, the lives of the people, where the several hundreds of dried medicinal plants in our pharmacy came from. The herbs were simply procured from importer/traders in Chinatown. No traceability to a specific production site back then. Those importer/traders had procured the herbs from their counterpart exporter/traders, far across the ocean in China, the world’s most populous country and third largest country in terms of area. End of story…
…until around the start of the 21st century… by the early 2000’s, botanical supply chain visibility (transparency and traceability) into verifiably sustainable production sites around the world, gradually became more-and-more possible with the emergence of credible international voluntary sustainability standards (VSS) (1), some that were designed specifically for medicinal plants, coupled with the emergence of good agricultural and collection practice (GACP) standards for medicinal plants (2). Nearly impenetrable since colonial times, the veil of botanical supply chain secrecy was slowly being lifted.
About ten years ago, after having worked on a medicinal plant sustainable production initiative in China (3), I brought a Chinese delegation to ACTCM, including representatives from the World Wide Fund for Nature (WWF China), the State Forestry Administration of China, and Chengdu University of TCM, to discuss a proposed new curriculum that aimed to educate TCM students and practitioners on the conservation status and sustainability of medicinal plants used in clinical practice, and other innovations to modernize formulations in order to substitute the use of animal ingredients with sustainably harvested plants (4).
When herbs became traceable
By the 2010’s, significantly increasing quantities of medicinal plants in global trade were becoming traceable to specific harvest sites, to the commercial enterprises managing the harvest, and the people who handle and process the herbs throughout the value chain. This new reality was one of the positive outcomes of a consumer-driven market trend that had been growing slowly but steadily since the 1990’s, driving increased demand for herbs that are harvested, handled, processed, and traded sustainably, as determined by audits of independent third-party inspection and certification organizations (5).
Introducing certification and labels
In the 2020’s, while not common enough (yet!), it is also not rare for herbal medicinal raw material batches to be traded between companies with documentary evidence of sustainable production (albeit for discerning customers willing to pay the fair price), i.e., with certification(s) showing compliance with one or more VSS, such as the
- Organic Wild-crop Harvesting Practice Standard (6)
- FairWild® Standard (7)
- Ethical BioTrade Standard (8)
- Fair For Life Standard (9)
- Fairtrade International Standard For Herbs, Herbal Teas & Spices (9,10)
- Fair Trade USA Agricultural Practice Standard (11)
as well as wildlife-friendly standards such as the
- Certified Elephant Friendly™ Standards (12)
- Giant Panda Friendly Products Standard (13)
The sustainable herb trade in the herbal practice
While VSS certification logos are increasingly visible on consumer herbal healthcare product labels at retail, it is not as clear how practitioners and patients can participate in the sustainable herb trade in the clinical setting. If every medical herbalist were able to dispense safe and effective medicines, prepared from local native species, obtained from (verifiably) sustainable wild collection operations or from local medicinal plant farms that follow biodynamic (14), or permaculture, or regenerative organic agricultural practices (15) that would be awesome, would it not?
While I am a proponent of local self-reliance, especially local food, in the case of herbal medicine, I think it may be a bit more complicated for the busy clinician serving an urban population. Of course, the situation varies by region. In the United Kingdom, some medical herbalists do maintain dispensaries of 100 to 200 herbs, prepare their own tinctures and mixtures of dried herbs for preparation as decoctions or infusions. On the other hand, here in California, many (possibly most) herbalists, whether they practice as a licensed acupuncturist (LAc), Ayurvedic doctor (AyD), naturopathic doctor (ND), or certified nurse midwife (CNM), do not generally stock dried herbs in their private practice. Generally, they stock a small range of packaged “professional products”, supplied by selected trusted brands that primarily service practitioner’s clinics – with products that are not commercially available in retail shops. Practitioners also recommend selected commercially available herbal products that the patient can pick up at a natural food store or purchase online for home delivery.
Furthermore, there are TCM compounding pharmacies, which enable the LAc to login, enter the prescribed formula with the patient’s details, for same day pick-up or delivery. While such practices are understandable, they can place a greater distance between the herbalist and the herbs – and the ability to know, with any degree of certainty, when, where and how the herbs were harvested, by whom, and under what conditions.
The reality in the herbal clinic
In reality – many practitioners are serving urban patient populations, and do not live in a megadiverse ecozone – one that could keep their dispensaries stocked with the possibly hundreds of medicinal plants needed for formulations. The fact is that apothecaries and clinics in Europe and the Americas have relied on a range of imported herbs for many hundreds of years. Even China, where most herbs used in TCM, until recent years, were harvested within China, has become an importer of some herbs. Due to dwindling plant populations, certain herbs are being imported into China from neighboring countries, especially from Vietnam (16), Bhutan, Nepal (17), Kazakhstan, and Russian Federation (18).
I hesitate to recommend a practice that I could not practice myself. Most of the medicinal plants that I choose to use – as healthy food or as medicine (or both!) – do not occur in Northern California, nor would many of them grow well here if transplanted. If I insisted on using only local herbs for food and medicine, I would need to move, far away! To illustrate this point:
- Firstly, food and beverage: The CNS stimulant Arabica coffee that I drink in the morning is native to tropical forests of Ethiopia and Sudan (19) (but introduced and grown in forests of Central- and South America). The carminative and stomachic cardamom seed that I mix in the coffee, is native to rainforests of the Western Ghats region of South India (20). And, the carminative and stomachic cinnamon tree bark, sprinkled on morning toast, comes from forests of Indonesia, Vietnam, and Southern China (21).
- Secondly, preventive medicine: The extract of wild bilberry fruit, that I take to improve microcirculation, is native to forests of Europe. And the turmeric rhizome, taken as an anti-inflammatory, originates from the Indo-Malayan Region of southern and southeastern Asia.
- Thirdly, treatment: When a sore throat is coming on, I rely on a Chinese preparation ‘chuan xin lian’ antiphlogistic pills (andrographis herb, isatis root, and Mongolian dandelion herb). And for allergic rhinitis symptoms, I experience good results with a 12-herb formulation ‘bi yan pian’ nose inflammation pills (magnolia flower, xanthium fruit, phellodendron bark, forsythia fruit, liquorice root, schisandra fruit, anemarrhena rhizome, chrysanthemum flower, schizonepeta herb, platycodon root, fragrant angelica root, Siler root).
None of the aforementioned daily – or occasional – use botanicals in my cupboard or home medicine chest are produced anywhere near my neck of the woods. What is the herbal practitioner and patient to do? – to have some certainty, that the herbs, having travelled from distant deserts, meadows or forests to the clinic or pharmacy (or kitchen), have been harvested non-destructively, without detriment to the survival of the species, or its pollinators, or to any of the flora and fauna that share habitat. How do the practitioner and patient know if the herbs were valued fairly and traded ethically, not dependent on exploitive labour of marginalized people to keep the prices low?
Herbs with evidence only?
Likely an overwhelming feeling, for an individual practitioner, to aim towards dispensing herbal medicinal preparations, composed only of herbs that possess documentary evidence of sustainable production.
Firstly, you are not alone in this. Fortunately, much (but not enough) progress has been made in recent decades with the advent of VSS that have been designed with medicinal plants in mind, whether wild-collected or grown on farms. Secondly, be curious enough to ask your bulk herb and herbal product supplier(s) tough questions about the herbs. Thirdly, be insistent enough to encourage answers. You can also ask your preferred supplier(s) to begin stocking certified fair and organic dried herbs and herbal medicinal products on your behalf – bolstered by your commitment to pay the premium that covers the cost of sustainable production. Uncertified, undocumented, non-traceable herbs will, of course, cost less. The assurance of sustainable and ethical production is important in my view, in part, because I believe that the medicine is impacted in some way by every person who has handled it on its journey from the alpine forest or the semi-arid steppe to the urban clinic. No person in the natural medicine value chain should be struggling in abject poverty or be subject to exploitive labor and trade practices, nor should the natural environment be damaged, in the course of bringing medicinal herbs to the clinic for the health and wellbeing of the client or patient.
Today, there are increasing numbers of small-to-medium-size distributors, making some visible level of commitment to sustainable herbs, that service cottage industry, small health food or herb shops with bulk bins, and individual practitioners. The practitioner can find these progressive handlers in the databases of the standards-setting-organizations. For example, one can find information on the certified producers and registered processors and traders operating in the FairWild trading system. Certificate holders in the Union for Ethical BioTrade Programme can be found on UEBT Sourcing. And details on certified operations in the Fair for Life – Social & Fair Trade Certification Programme are provided by FairForLife. However, for “voluntary” sustainability standards to be part of the solution, clients, consumers, patients, everyone, must also “voluntarily” agree to pay higher prices to cover the true costs of sustainable production, equitable and ethical trade. It is not free. The costs for an herb production operation to implement standards with annual audits and fees for inspection and certification, and the additional personnel needed to manage standards compliance, is not insignificant.
You may not be able to prescribe certified sustainable herbs and formulations straight away. Be pragmatic, start small and build gradually. Pick one herb at a time, to get better acquainted with, then another, and so on. In my experience, once I started looking into this fascinating area of sustainable resource management in the botanical supply chain, it was not long before I was hooked. No turning back! Enjoy the journey.
References
- Brinckmann JA. The long road to sustainable licorice. Journal of Medicinal Plant Conservation. Spring 2020:19-21. Available at: https://unitedplantsavers.org/ups-journal-2020/.
- World Health Organization. WHO Guidelines on Good Agricultural and Collection Practices (GACP) for Medicinal Plants. Geneva, Switzerland: World Health Organization; 2003. Available at: https://www.who.int/medicines/publications/traditional/gacp2004/en/.
- Brinckmann JA, Morgan B. Linking a wild medicinal plant cooperative to socially responsible companies: Experiences from China and USA. In: Asen A, Savenije H, Schmidt F, eds. Good Business: Making Private Investments Work for Tropical Forests. Wageningen, the Netherlands: Tropenbos International; December 2012:54: 73-80. Available at: http://www.etfrn.org/publications/good+business+making+private+investments+work+for+tropical+forests.
- Larson B. ACTCM meets with delegates from China to discuss innovative herbal curriculum pilot. American College of Traditional Chinese Medicine Blog. 01 February 2011; Available at: https://www.actcm.edu/blog/blog/actcm-meets-with-delegates-from-china-to-discuss-innovative-herbal-curriculum-pilot.
- Brinckmann JA. Sustainable Sourcing: Markets for Certified Chinese Medicinal and Aromatic Plants. Geneva, Switzerland: International Trade Centre (ITC); 2016; Available at: https://www.intracen.org/publication/Sustainable-Sourcing/.
- United States Department of Agriculture. NOP 5022 Wild Crop Harvesting Internal Rev01 07 22 11. Washington, D.C.: United States Department of Agriculture; 22 July 2011. Available at: https://www.ams.usda.gov/sites/default/files/media/5022.pdf.
- FairWild Foundation. FairWild Standard: Version 2.0. Weinfelden, Switzerland: FairWild Foundation; 2010; Available at: https://www.fairwild.org/the-fairwild-standard.
- Union for Ethical BioTrade. Ethical BioTrade Standard. Amsterdam, The Netherlands: Union for Ethical BioTrade; 2020; Available at: https://www.ethicalbiotrade.org/resource-pages/standard.
- Ecocert SA. Fair for Life Certification Standard for Fair Trade and Responsible Supply-chains. L’Isle Jourdain, France: Ecocert SA; 2020; Available at: https://www.fairforlife.org/pmws/indexDOM.php?client_id=fairforlife&page_id=root_2_3&lang_iso639=en.
- Fairtrade International. Fairtrade Standard for Herbs, Herbal Teas & Spices for Small Producer Organizations and Traders. Current version: 01.05.2011_v1.2. Bonn, Germany: Fairtrade International; 2011; Available at: https://www.fairtradeamerica.org/app/uploads/2020/08/HerbsHerbalTeasSpices_SPO_SP.pdf.
- Fair Trade USA. Fair Trade Agricultural Production Standard. Version 1.1.0. Oakland, CA: Fair Trade USA; 2019. Available at: https://www.fairtradecertified.org/business/standards/documents/agricultural-production-standard.
- Wildlife Friendly Enterprise Network. Certified Elephant Friendly™ Standards. Bainbridge Island, Washington: Wildlife Friendly Enterprise Network; 2019; Available at: https://wildlifefriendly.org/wp-content/uploads/2020/01/Certified-Elephant-Friendly-Standards-FINAL-v2.1.pdf.
- Brinckmann JA, Luo W, Xu Q, et al. Sustainable harvest, people and pandas: Assessing a decade of managed wild harvest and trade in Schisandra sphenanthera. J Ethnopharmacol. 2018;224:522-534. https://doi.org/510.1016/j.jep.2018.1005.1042.
- Biodynamic Federation Standards Committee. Production, Processing and Labelling. International Standard for the use and certification of Demeter, Biodynamic and related trademarks. Darmstadt, Germany: Biodynamic Federation – Demeter-International e.V.; 2021. Available at: https://www.demeter.net/sites/default/files/20201204_bfdi_standard_for2021_final_sc.pdf.
- Regenerative Organic Alliance. Framework for Regenerative Organic Certified™. Ventura, CA: Regenerative Organic Alliance; 2021. Available at: https://regenorganic.org/wp-content/uploads/2021/02/ROC_ROC_STD_FR_v5.pdf.
- Cunningham AB, Brinckmann JA, Bi YF, et al. Paris in the spring: A review of the trade, conservation and opportunities in the shift from wild harvest to cultivation of Paris polyphylla (Trilliaceae). J. Ethnopharm. 2018/08/10/ 2018;222:208-216.
- Cunningham AB, Brinckmann JA, Schippmann U, Pyakurel D. Production from both wild harvest and cultivation: The cross-border Swertia chirayita (Gentianaceae) trade. Journal of Ethnopharmacology. 2018;225:42-52.
- Brinckmann JA, Cunningham AB, Harter DEV. Running out of time to smell the roseroots: Reviewing threats and trade in wild Rhodiola rosea L. Journal of Ethnopharmacology. 2021;269:113710.
- Moat J, O’Sullivan RJ, Gole T, Davis AP. Coffea arabica (amended version of 2018 assessment). The IUCN Red List of Threatened Species 2020: e.T18289789A174149937. https://dx.doi.org/10.2305/IUCN.UK.2020-2.RLTS.T18289789A174149937.en. 2020.
- ICAR-Indian Institute of Spices Research. Cardamom – Extension Pamphlet. Kozhikode, Kerala: ICAR- Indian Institute of Spices Research; 2015.
- Oketch-Rabah HA, Marles RJ, Brinckmann JA. Cinnamon and Cassia Nomenclature Confusion: A Challenge to the Applicability of Clinical Data. Clinical Pharmacology & Therapeutics. 2018;104(3):435-445.
