by Eric Brand

The California Acupuncture Board recently announced that they will reduce the proportion of herbal medicine questions on the licensing exam from 17% to 11%. Apparently this decision was made following an occupational assessment- practitioners weren't using herbs so the emphasis on herbal medicine will decline in the exam. Yet again, instead of raising the bar so that people rise to the challenge, the bar is being lowered. Like an army that can only march at the speed of the slowest soldier, the entire Chinese medicine field suffers when our professional standards drop.

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In the past, the California board exam was harder than any other exam in the country. The California exam required more comprehensive study of Chinese medical theory than the old national exam required, because herbal medicine was a mandatory aspect of the California test. Now that the new test will have only 22 questions on herbal medicine, there is a fear that the schools will reduce their emphasis on herbs in response to the widespread student demand for easier curriculum that teaches to the test.

The schools themselves would prefer to maintain a stronger emphasis on herbal medicine, since this allows them to sell more classes and produces graduates of a higher caliber. Word on the street is that some schools are organizing a response to the Board, but the potential impact is still unclear. As they say in Spanish, "cosas de palacio van despacio" (affairs of the palace move slowly).

Most practitioners would prefer to see the exams get progressively more rigorous, because students will always rise to pass a harder test. By making the test easier, we risk bringing in new practitioners who lack adequate training in herbs. This will create more adverse events and more negative press and regulation. The graduates of today are our public face of tomorrow, so already licensed practitioners want to see only the most educated new practitioners entering the market. We don't want the market flooded with poorly-trained practitioners.

Already, our schools lack adequate training in many aspects of herbal medicine, such as herbal pharmacy. Unlike China, where pharmacy is a specialized subject and trained pharmacists manage ordering and dispensing, practitioners in the U.S. are often doubling as both the doctor and the pharmacist. Yet our training in pharmacy issues such as avoiding dangerous substitutes and ineffective counterfeits is often lacking. Schools have no place for these classes in their curriculum, and the many students that do not want to use herbs already complain bitterly about the emphasis on herbs in California schools. Having an exam that further reduces the herbal emphasis allows the non-herbally inclined students to complain more vigorously, which further limits the potential of all students to study herbs at an advanced level.

At the moment, we are fighting just to maintain our right to practice herbal medicine. The new generation of FDA laws requires greater vigilance on the part of the herbalist, and the increasing scrutiny on our profession demands that we be well-informed on the safe practice of herbal medicine. Herbs are the most effective tool we have, but their responsible use requires solid training. Many practitioners have never even heard of high-profile safety issues like aristolochic acid and substitute medicinals. We are already sitting ducks for regulators because most schools offer no training on the key public safety issues of herbal pharmacy. The last thing we need to do is reduce the amount of herbal medicine material on our exams.

On the bright side, the field of herbal medicine is expanding tremendously. Acupuncture had explosive growth in the early arrival of Chinese medicine to the West, and the next era of explosion will revolve around herbal medicine. Anyone wishing to distinguish themselves can easily focus on herbs, simply because there is so little professional competition. Assuming that poorly trained practitioners don't get herbs banned for all of us, it will be progressively easier to distinguish oneself as a TCM internal medicine specialist if most of the community lacks sophisticated herbal skills. But it seems a bit twisted to squeeze even a drop of optimism out of such a poor shift in examination policy.