As i said before, i often use this place to dump thoughts rather than to communicate. There’s an obvious corollary to that: is there really any difference, practically, between keeping a diary in writing and keeping a blog? Clearly there is, but it would presumably involve intending to communicate with others. If all i’m doing here is talking to myself in public, whereas it might satisfy me there seems little point to it.

I suppose there are two reasons for this blog. One is to make a public record of first-hand accounts of autonomous education to erode misunderstanding of the nature of this activity. The other is to do the same for herbalism. That’s not necessarily the same as a braindump.

Therefore, i’ve been asking myself recently whether this place is a good advert for either of those things, or whether it serves any other purpose than massaging my ego. I think on balance that’s what this is for, and as a result i don’t think i’ll be writing any more until i solve this problem. I wouldn’t hold your breath before the next entry.

The thing is, i’ve been keeping a diary since 1975. I can carry on doing that whether or not i do this, so i might as well not bother to do this bit. It won’t be missed.

There’s more, actually, which is that the business purpose of a blog is marketing. Now, i’m aware that marketing doesn’t work for what i do, so really i’m just wasting my time and energy here.

I tend to talk to myself. I do so partly in order to clarify my thoughts, but there is another purpose: i do it to dump my thoughts and get them out of my head so i can concentrate on something more productive.

Then there’s the internet, in particular the Halfbakery. More than anywhere else, for me that site is somewhere i can dump distracting ideas. Instead of constantly thinking about, say, whether binoculars could be made with mirrors instead of lenses, i can just stick it there and it can quietly natter away to itself while i get on with more important tasks, avoiding the distraction of the voice in my head trying to invent a new kind of binocular.

However, the trouble with the HB is that people tend to read what i’ve posted and respond to it, thereby drawing me into a discussion or argument, so as a dumping ground it doesn’t work very well. It’s rather like a landfill site where people pour their unwanted custard, machines that convert colours into sound ([Malakh]) or urinal pee testers ([Supercruiser]), and if you don’t move fast you can easily sink into a pool of abandoned custard or snag yourself on a Hullaballoon ([BRISTOLZ]). Therefore the issue there is that people listen to you.

So here’s the blog. The purpose of this place is partly to act as advocacy for herbalism and autonomous education (or whatever it’s called). It has the advantage of not being read. The problem is that i might fool myself into thinking that people are reading this. In case you are, i shall quote our friend from Highfields: “I wasn’t talking to you”. It would be nice to know if people were listening but it’s important to be realistic about this. This is effectively a diary i’ve accidentally on purpose left open on a park bench.

Maths is frequently confused with its rather marginal subset arithmetic, to the extent that access to non-arithmetical mathematics is sometimes restricted unnecessarily until competence in the fairly irrelevant discipline of arithmetic is achieved. My subject here is therefore not really the wider subject of mathematics at all, but that small bit on the edge, numeracy.

A crucial thing to remember about numbers is that they are not strings of figures or sequences of any other written, printed or spoken signs or symbols. Once you’ve got past that, it gets easier to realise the nature of the problem. Imagine an alien with a hundred and twenty-one thousand three hundred and ninety-three tentacles on which it counts. It uses those tentacles to indicate whole numbers, integers that is, to signal how many of something there are, and can register such numbers at a glance. It has a spoken language with a large number of different sounds which enables it to have a single-syllable word for each of those numbers. It has a concept for zero, another for one and so on up to the number of tentacles it has, and it can clearly visualise each of these numbers. Due to all of this, it can do a number of things almost instantly and intuitively with the arithmetic of non-negative integers. It can add and subtract anywhere within that range, multiply any two “three-figure” numbers instantly, integer divide any “five-figure” number by any other number with “up to four figures” and raise numbers to any positive integral power up to four. All of these things it can do as soon as it comes out of the egg. It can glance at a field of crops, a pebbled beach and a forest and tell immediately how many plants, stones or leaves it can see. It can look at a tabby cat and know without thinking how many light and dark hairs are visible on it. The reason this aliens can do all this is that it has a distinct idea of each of its tentacles and their positions, just as we have distinct ideas of the positions of our fingers and thumbs.

This is what numbers are really like, except that the being in question would have an infinite number of tentacles. They are completely different than the way we write or say them. However, since we often have less faith in our own ability to count in this way, many of us humans have ended up counting in tens, simply because we have ten digits on our hands. Therefore we have gotten hung up on the idea that the quotes around the words in the paragraph above aren’t really there, or at least that the words can be replaced by a series of the following squiggles: 0, 1, 2, 3, 4, 5, 6, 7, 8 and 9. We use ten squiggles because of that accident of our evolution. This is a great pity because ten is a truly awful number to choose. It divides by five and two. Twelve, by contrast, divides by two, three, four and six. Other numbers are also useful for different reasons, for instance two tends to reveal truths about logic and provide a link with that.

So far as i can tell, the only links decimal allows people to make fairly easily are with the pentadactyl limb and the metric system. It makes arithmetic unnecessarily difficult. Consider the following list:

Duodecimal (base twelve) fractions: 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 0.A, 0.B
Decimal fractions: 0.08333…, 0.1666…, 0.25, 0.333…, 0.41666…, 0.5, 0.666…, 0.75, 0.8333…, 0.91666…

Similarly, duodecimal times tables only rarely throw up patterns of final digits which are hard to remember or learn. We make life harder for ourselves by sticking to the decimal system, and the apparent advantage of metric is simply the result of previous insistence of counting in that way.

English spelling is similar, but unlike the decimal number system it has a more interesting and more educational history.

English was first written in the current Latin script when St Augustine brought it over to Canterbury. At the time it was almost perfectly phonetic, being written as Latin was, though in order to make that possible, letters had to be added for sounds absent from Latin such as the native þ and ƿ, the digraph æ and the letter ð and the Greek letter Y, which had been used in Latin for Greek words alone but was now employed for the same sound in English. There was really no spelling at all at this point: people simply read out the letters as they were written and wrote them down as they were spoken. English was served well by this system, which was unaffected even by the Viking invasion because they did the same with their language, until towards the end of the First Millenium when we stopped making any distinction between I and Y and the letters got confused and used interchangeable.

All that changed when William the Bastard invaded in MLXVI. Norman French had its own history and handwriting, which began to influence English, particularly in the South. While Midlands English continued to be written sensibly, the Normans replaced our long U with their OU, gradually phased out our native letters and encountered a problem with long lines of uppy-downy letters like U, M, I and N, making it hard to read words like “come” and “love”, and leading them to replace our short U with O for clarity’s sake. In the meantime in the Midlands, a bloke called Orm tried to reform spelling by doubling letters after short vowels, but it didn’t catch on.

Time passed. In the thirteenth century, the Plantagenets started to lose French territory and nobles and royals started to lose lands and had to stay here instead of nipping off to the continent on a regular basis. French words started to enter the lingo, leading to more confusion because their spelling didn’t change. The Southern method of spelling was then adopted by the rest of the kingdom.

Then what can only be described as a disaster for English spelling struck. Possibly due to the Black Death, the way we pronounced long vowels and diphthongs started to shift away from the previous pronunciation and therefore also the spelling. This is sometimes blamed on the Plague because it meant many people had to leave their homes in the North and move southwards, leading to people with different accents struggling to make themselves understood, though the real reason is unknown. In addition, many letters started to fall silent, in particular the E’s on the ends of word and the likes of the K in “know”. While all this was going on, the printing press was invented, leading to some basic standardisation. However, there was still a fair amount of flexibility until something like the end of the eighteenth century (i can’t actually place this) when standardisation in two forms – American and that of the British Empire – took place. Since that time there have been small shifts, for example in the spellings of “shew”, “phantasy” and “O”, but on the whole it has frozen.

English spelling as it stands today is confusing because of that history, but does have some principles. The morphemes – basic units of meaning in a word – don’t often shift in spelling. Words taken from other languages are not forced to conform to English spelling. The spelling of words doesn’t change according to pronunciation. There is method in all this madness.

Now look at those two accounts, of numeracy and literacy matters. The account of spelling goes on and on because it recaps our history, but the account of numeracy is much shorter because it provides fewer resources. This is why i feel ambivalent about spelling reform. Its nature helps us understand our story as a nation, with the Danes, Normans, loss of French lands, the use of particular styles of handwriting dictated by the nature of quill, ink, parchment and vellum, the Black Death, the invention of movable type, the expansion of the Empire and the independence of the American colonies. It also helps us understand what we mean because every part of a word has its own clearly legible form and the fact that we spell differently than we speak makes it easier for us to learn the languages related to those from which we have inherited our vocabulary, which in the case of Europe and former colonies probably constitutes those spoken by most of the world’s population. However, it is also disabling because it makes literacy harder to acquire than it has to be.

There are parallels between how we use numbers and how we read and write because in both cases there are unnecessary complications. With numbers though, there is little educational compensation and more or less presents a pure obstacle to learning. By contrast, though English spelling presents a similarly formidable obstacle to literacy, it also acts as a considerable educational resource. The way English is spelt is a lot more useful than the way numbers are written.

What to do?

This is mainly about the films because though i’ve read the book i can’t remember it very well, so i may get details wrong. I’m going to assume you know the story in one form or another.

Five children out of many millions get a Golden Ticket and get to visit Willy Wonka’s factory. What statements do each of their stories make about probability and fairness?

Some stories need to be allowed a certain degree of improbability because it helps to make them remarkable and therefore worthy of being told in the first place, so it’s only fair to the storyteller to let them have one coincidence or lucky break in their plot for free. Probable stories with no such element, depending on their genre, could be less interesting, though it would probably pay to work at a plot to exclude any unlikelihood. It’s like the anthropic principle. Certain things in the world just are the way they are because without them, there would be nobody around to notice that they weren’t. Similarly, Charlie’s world has to be one in which he wins the ticket or it would be a different story, though perhaps still a good one.

Veruca Salt’s story is the most straightforward from the viewpoint of probability. Her character, the fact that she wins a ticket and her fate are all connected to her father’s indulgence of her – it is in a sense a tragedy. She gets whatever she wants because her father is wealthy, and she gets a ticket because he has the money to buy enough bars of chocolate to increase her probability of finding one. In this respect she is the opposite to Charlie, who has no money and few opportunities.

Augustus Gloop is similar in some respects, and a similar contrast to Charlie. He eats a large number of chocolate bars and so is more likely than average to find a ticket, though he is still the luckiest of a number of doubly fictitious chocolate “gluttons”. Hence, though it wouldn’t work for this story at all, there is a rather less varied but more likely version of CATCF with four Augustus Gloops and one Veruca Salt. Looking at it this way reveals another fact about the probabilities involved: Augustus Gloop represents a mode of behaviour which is more likely to lead to finding a ticket but he is not more likely as an individual to find a ticket than Veruca, and Veruca is the beneficiary of the most improbable approach to finding one because not many fathers would both have those resources and be that indulgent. In real world terms, it is also improbable because it makes no business sense to stop productive work in a factory to devote it to finding a ticket, having bought millions of bars of chocolate from which the profit margins will be small. I now have visions of complicated VAT situations and the possibility of a new line of chocolate coated nuts.

Augustus Gloop’s story is also tragic: his character flaw is the essential factor both in reaching the factory and his downfall.

Mike Teevee’s tale is more complicated. His story is altered in the second film. Whereas in the book and the first film, he simply got lucky, so far as we know, Tim Burton depicts him as “cracking the code”. He works out where the ticket will be as a result of his computing prowess, which is linked to his obsession with gaming. This leads to a problem because it makes him the only child to have made an effort to find a ticket, and in that sense his fate is unfair compared to Charlie’s. Charlie could be seen as winning the factory unfairly because he just got lucky whereas Mike worked to find a ticket. There are, however, other stories to tell about Mike. For instance, he is interesting to compare to Augustus because the latter, like him, has acted in such a way as to increase the probability of finding a ticket but did so as a form of self-indulgence. Whether Mike enjoyed cracking the code might become relevant, and that raises the question of whether there are higher and lower pleasures. Is the enjoyment of chocolate, being sensual, a less worthwhile pleasure than the intellectual enjoyment of cracking a code? Mike is, however, punished, and his cracking of the code is in a sense a form of cheating, one which is in fact frowned upon by the Hollywood establishment.

That leaves Violet Beauregarde. She is purely lucky. Whether Charlie’s poverty makes him luckier to win a ticket than her is unclear because she prefers chewing gum to chocolate. I have a vague inkling that there may be a line somewhere in the story which says she switched to chocolate for the duration of the competition. If that is so, for her that is a form of self-sacrifice. In the more recent film version, she is the only child with an average probability of finding a ticket. The other thing about Violet is that her vice is the mildest. Her fate has similarities with Mike’s.

Then there’s the question of justice. By the rules of the story, the “best”, i.e. the most virtuous, child, should have the happiest ending in order to please the reader. This may not be reflected in reality, except where there is a direct causal link between the child’s vice and their fate. There are probably a lot of Augustus Gloops in the world, but their supposedly just deserts would be shortened life expectancies. The question of whether this is really just is another one entirely. Mike Teevees also exist: there are in fact overlaps between him and Augustus. Charlie is of course portrayed as the most virtuous child, though this is arguable because of Mike Teevees position and the question of the work ethic.

There is another aspect to this. Taking the depiction of virtue and vice at face value, there are four vicious children and one virtuous one. If this is a random sample, though it is small it intuitively suggests that about 80% of children are nasty pieces of work. However, it can be reduced because in several cases the children’s winning tickets is connected to their vices. This applies to Veruca, Augustus and possibly Mike, depending on whether one sees his activity as connected to getting a ticket or not and whether it is actually a misdemeanour. That leaves Violet and Charlie as the truly random sample, and statistically it’s awful because a sample of two is very hard to extrapolate from. Looking at it that way, the rather poor statistical intuition with which most people operate suggests that half the children in the world are like Violet, with a minor vice, and half are like Charlie, virtuous. That isn’t a valid inference of course, but it is one which follows common sense.

Finally, i would say this intuition is borne out by Charlie’s and Violet’s fate, because of all the children their endings are the happiest in my view. I realise this view is very much in the minority, but i would justify this by saying that all Violet did wrong was to chew gum a lot, which in anyone’s book has got to be a very minor crime. Charlie, of course, wins the factory, making it a rags to riches story, though i’m really not sure he deserved it the most.

I was brought up in the aftermath of the Oil Crisis, at a time when people were acutely focussed on the fact that fossil fuels were a finite resource, and as a result i saw a lot of television programmes like ‘Survivors’ and ‘Connections’ which centred on the idea that we had built an elaborate interdependent technological trap for ourselves.  For instance, if the oil ran out, the tractors would grind to a halt, the lorries delivering the food to the supermarkets would stop and the refrigerators keeping certain perishable goods fresh would cease to function.  Fossil fuels are just one aspect of this situation.

I have to say that these thoughts preoccupy me and drive me to make many of the decisions i take in my life, and it also seems that this situation has gotten a lot more pronounced than it was when i was a child.

Now let’s compare two approaches to medicine.  One involves considerable dependence on the infrastructure.  I’m going to take pharmaceuticals as an important component of this approach to illustrate what i mean.  These are currently commonly manufactured in factories reliant on specialised facilities, a reliable electricity supply, sometimes uses non-renewable resources or raw materials which are scarce and not locally available.  An example would be the cancer chemotherapy drug cisplatin, which contains platinum, but there are plenty of other examples – that’s just a particularly spectacular one.  These drugs are then transported to places where they can be dispensed to the public or be given as prescriptions.  Nowadays, little dispensing or preparation takes place in pharmacies and many older drugs are unavailable.

There are some other examples.  The NHS relies heavily on the internet and digital electronic information technology to work today.  Hospitals have emergency generators but they need fuel to work.  The traditional skills of physical examination are largely replaced by blood tests and others which are undertaken using dipsticks or in distant laboratories and the information is then placed on a database.

All of this is very dependent on a complex and therefore vulnerable technological infrastructure.

Then there’s the way i practice herbalism, an approach which others can also choose to take.  I have to presume that my approach as a herbalist is common.  I interview people about their health problems, make physical examinations, give lifestyle advice and prescribe and dispense remedies.  Let’s look at those remedies.  They are, on the whole, widely available locally and often considered to be weeds.  Two useful examples are dandelions and stinging nettles, and there are plenty of other species which would generally be considered to be common weeds or invasive plants.  I can get and prepare these remedies without recourse to the use of fossil fuels or electricity, although as of yet only a minority of the remedies i use are sourced in this way.  The others are from suppliers growing food on farms in the next county.  I could theoretically walk to this farm if i had to source herbs i couldn’t replace locally, but whether i would need to is another question.

These remedies can be sustainably harvested from renewable biological sources which can be processed easily without recourse to industrial production techniques.  They can also be dispensed without relying on such approaches.  Moreover, all my patient records are on paper, written in ink, and i am able to make my own paper, ink and pens from locally available resources such as oak galls, rainwater, grass cuttings and feathers shed by nearby waterbirds.  Then there are the techniques of physical examination i undertake.  With one exception, the otoscope/ophthalmoscope, i do not use electricity at all when i do this.  I use a mercury sphygmomanometer, which has of course been manufactured through industrial processes but need not have been – mercury was available since ancient times though it may not be available locally.  The rest are easy:  interviewing, patella hammers, stethoscopes, tuning forks – none of these need an electricity or fossil fuel supply to work and all of them can be produced without recourse to industrial age processes.  In the case of the otoscope, i am able to manufacture batteries from widely available resources if i was really pushed which would work with the scope, though i would not be able to replace the bulbs.

So the point is this.  I practice medicine in a manner which could continue with minor adjustments in a situation where there were no telecommunications facilities, no fossil fuels, no electricity supply and no resources which were not available locally.  I also contend, of course, that the proposition that herbalism is not efficacious is an extraordinary one – see previous blog entry.  I would also say that the skills and knowledge i use to practice in this way are worth learning and preserving.  Compare this to a hospital or a health centre.  Some of what they do could continue in the absence of electricity, fossil fuels and telecommunications, but most of it would run down after a while and the skills to continue providing the service are often not widely found today.

Suppose herbal medicine is much less effective than modern drugs.  Even then, provided it has more than no effect, it is still worth preserving.  I don’t see any resilience being built into the mainstream healthcare system as it stands, and i consider this situation to be dangerous.

So even if there is no other reason to preserve herbalism, this is a good enough one.  It makes as much sense to keep it going as it does to replace the batteries in a smoke alarm or wear a seatbelt when driving.  It’s really that simple.  Unless similar sustainability is developed in the NHS, orthodox practice elsewhere and the pharmaceutical industry, failing to preserve herbalism is extremely reckless.

This is a major reason why i’m a herbalist.  There have to be herbalists just in case the worst happens.

It is extraordinary to claim that the majority of traditionally used plant remedies are ineffective.

It could be said that this is a straw man because it overstates the real claim, which is that studies show there is more evidence against the remedies tested than there is against pure compounds against the same medical conditions.  However, such a claim could only be made if there were agreed protocols and there are not, and there would also need to be pure compounds used rather than the polypharmacy currently practiced on both sides in such studies.  Therefore i would strongly dispute that this is a straw man unless someone can produce an example of a research protocol agreed between CAM practitioners and mainstream medical researchers which has been used to conduct research which supports the claim.

There are three reasons why i describe this as an extraordinary claim:

1. Plants are often both edible and nutritious.  If someone has a disease in which a dietary deficiency is a factor, and that disease has not yet involved irreversible structural change and a plant exists which contains the requisite nutrients in sufficient quantities, it is odd to claim that ingesting appropriate quantities of that plant could not help.
2. Plants are often toxic and elicit predictable pathological responses as a result of ingestion which are dose-dependent.  Whereas the specific toxicity of a particular plant is unpredictable, it is always possible to find a dose which is almost guaranteed not to elicit a meaurable physiological response (note the cautious terminology of this sceptic).  The issue then becomes one of the toxic plant’s therapeutic index, the starting point in assessing the safety of a remedy, which is, loosely, a ratio between a toxic dose and an effective dose.  This is because a herb eliciting a pathological response which occurs at a dose a long way above the dose which elicits a minimal physiological response would seem to be useful if such a response is in the opposite direction to a pathological change taking place in a patient.  Randomly chosen examples are Datura stramonium and bronchodilation and Viburnum opulus and smooth muscle relaxation.
3. Where a plant toxic to a parasitic fungus or arthropod is applied topically, it can be expected to have a different level of toxicity to the host organism than to the pathogen in the mode in which it is presented to that organism in order to be useful.  Hence simply because a herb is toxic by mouth, it doesn’t entail that it is either dangerous or useless when applied topically.
4. Herbalism has a long tradition of use and is pre-industrial in origin, if it can meaningfully be said to have an origin at all.  There are many examples of pre-industrial artefacts still in use and other instances where the technique is still in use.  Into the former category fall humpbacked bridges, buildings, sundials, church bells, church clocks and pipe organs.  All of these still fulfil their function today and were not designed or built using industrialised approaches.  There is little rigorous scientific method in their design, they are not mass produced and their parts are not necessarily standardised.  In the latter category are a larger number of examples, including navigation, the planisphere, the compass, microscopes, telescopes, wheels and screws.  Here the technique of production is industrial but their existence does not depend on mass production as such.  A planisphere may be made of plastic and printed with modern inks but it does the same job as an engraved brass astrolabe.  The application of herbalism today is akin to hunting with a long bow instead of a rifle, crossing a river using a humpbacked bridge instead of a suspension bridge or living on a country estate or in a castle rather than in a towerblock.  I acknowledge that many people used to live in hovels, but though this was unsanitary, uncomfortable and unhealthy, the lucky few had better conditions than the average council estate dweller nowadays.  You can’t realistically claim a portakabin is better than a palace.

Hence the extraordinary claim that the majority of traditionally used plant remedies are ineffective suggests the following beliefs:

1. Fruits and vegetables are not significantly nutritious and it’s a better idea to take vitamin pills than eat a balanced diet.
2. The therapeutic index of the majority of toxic plants is too small for them to be of any use.
3. The toxicity of topically applied herbal preparations is ineffective against most parasitic infections and infestations while at the same time being toxic to the patient.
4. Even though there is much technology still in use today which has advantages over industrial technology, this mysteriously does not apply to herbal medicine.

So, I would put the following questions to someone who describes themselves as sceptical of herbalism:

1. What is the difference between the ingestion of ordinary fruits, vegetables and culinary herbs and spices and the therapeutic ingestion of the same plants?
2. What is the common factor which leads to the small therapeutic index of toxic plants which does not apply to compounds used in mainstream medicine?
3. What causes the highly specific toxicity of a plant to one organism but not another when neither organism encounters that plant in normal circumstances?  Why would  plant which tends to be toxic to any member of the hemimetabola which attempts to parasitise it mysteriously become toxic to a human but not to a headlouse when applied to the scalp?
4. What differentiates herbalism from other pre-industrial technology which is still widely in use?

My point is, of course, that scepticism about herbalism in particular is misplaced.  I can’t comment on CAM therapies because i’m not an alternative therapist.  I’m a herbalist.  I would claim that the belief that herbalism is ineffective is the extraordinary claim here and requires extraordinary evidence to support it, which is not forthcoming.

As a parent committed to autonomous education, I believe that the children in this family at least, if not others, are able to learn what they need to thrive.  In order to help them with that, i sometimes feel the need to share my own learning and experience with them.  It seems appropriate to do so because i’ve lived longer than they have, though of course i am also open to learning from them just as i’m open to learning from my clients, most of whom have lived longer than i have.

In the realm of professional practice of any kind, this translates into the notion that a professional has invested time in acquiring the skills they sell to their clients.  Since they wish to profit from such an investment, they tend to act as gatekeepers for those skills and services rather than extensively sharing them with their clients.

I try not to do this.  My approach to clients is to empower them by describing in detail what my plan for their treatment is and explaining the rationale behind it.  This is in accordance with the idea of Open Source and is akin to the principles expressed in this licence:

http://www.gnu.org/licenses/gpl.html

Clearly i’m not offering software as such but i consider every detail of what i do to be in the public domain.  There is full disclosure.

Many potential clients hold the view that they know enough to maintain and improve their own health through the use of herbal remedies without consulting a herbalist.  In a sense, my role as a herbalist practicing in the traditional way is to undermine that self-confidence.  I am not comfortable with that.  These potential clients attach a low value to the services herbalists offer, and in this they may be correct.  Since i don’t meet them, i can’t assess that.  However, it does have certain implications.  It means that they need the skills and learning on the scale of a medical degree in order to address their own health issues effectively.

I would claim that this is in fact entirely feasible.  The majority of people could come to know enough to qualify as doctors and deal with their own health matters at that level of competence, except that they wouldn’t be able to keep their hands in, as it were, with physical examination.  They would of course need to spend some time reaching such a level of competence, but perhaps not so much as medical students for an important reason linked to autonomous education:  they would be motivated to learn by the personal connection they have with the subject, i.e. their own health issues, and they would be able to pursue their current interest more effectively than a set curriculum delivered in a set order.

In the meantime, the following understandable situation has arisen in certain professional bodies:

• They are responsible for approving courses in complementary and alternative medicine at institutions of higher education.

• A practitioner should only teach above a certain level of knowledge if they are involved in such a course.

This is because the professional bodies are concerned that people would otherwise represent themselves as professionals without the requisite level of competence, which would endanger the public and bring the profession into disrepute.

I disagree with this position.  Whereas i recognise the professional competence of herbalists, it appears that the profession has long ago been brought into disrepute by the very courses the professional bodies endorse.  There remains no good reputation to preserve.  Moreover, whereas a course in herbal medicine could lead to a student becoming a competent professional, the apparently intractable low profile medical herbalists experience means that there is simply no market to support herbalists financially.  I am trying hard to suspend judgement on this, but it appears to me that inviting applicants for degrees in herbal medicine without actively pointing out that the profession is not financially viable is fraudulent.  This does not mean there should be no degrees in herbal medicine, but it does mean that they should not be promoted as they currently are, because this itself can bring the profession into disrepute.

There are of course ways of making money from herbalism:

• You can teach on a course or run seminars in continuing professional development.  There is however only a small market for this which does not seem to be connected to the needs of the public or clients.  It amounts to making a living by enrolling others into the training without realistically being able to provide services to the public.  Unless the profile of herbalists change, this is the reality of the situation.  There’s a common term for such a practice:  it’s a pyramid scheme.
• You can write.  This is good in many ways because it has an educational role and empowers people.  However, there are any number of books on the subject and a limited number of readers, so again, it’s not really viable.
• You can endorse or market products with a high profit margin or sales volume.  I would hasten to add that this practice is rightly firmly condemned by professional bodies.  The problem is that over-the-counter sales can lead to inappropriate self-medication, which as well as being bad in itself could bring the status of herbal remedies into disrepute.

For all of these reasons, it seems to me that a more ethical approach to herbalism could be achieved by adopting the following measures:

1. Recognise that currently the primary role of a herbalist is to promote the competent efficacious practice of herbalism by the general public, that this role is educational and that the extent of that education should be determined by the needs of the patient or student rather than attempting to preserve the effectively mythical good reputation of herbalists among the public.  The vast majority of people don’t even know we exist, so we can forget that.
2. Continue to promote courses in herbalism in institutions of higher education, but with a different angle.  Make it clear that endorsement of such courses depends on their promotion by institutions including a positive claim that the probability of using the degree to make a living is very low, and therefore that the courses are general degrees akin to, say, psychology, economics or physics, rather than having a vocational intent.  Perhaps this could be signalled by placing them in the Humanities faculty rather than calling them BSc’s.  They are general degrees, not degrees in medicine in the sense that one would be able to practice as a consultant herbalist as one’s main job when one graduated.  This is an honourable position to be in:  I have two degrees in Philosophy and have every respect for it as an academic discipline, but its vocational element, though possibly larger than that of herbalism, is somewhat limited.

What must not be allowed to continue is the promotion of the delusion (firmly-held belief in the absence of evidence) that the most effective way to promote herbalism is to practice as a consultant herbalist whose role is not primarily educational.  This is harmful because continuing to pursue this is suicidal for herbalism as a therapy.  Since it is a form of self-sufficiency, herbalism must be preserved because we cannot be sure that the technological infrastructure which maintains mainstream medicine in the developed world is sustainable.  In fact, we can be pretty confident that it isn’t.  We need there to be something in the fire extinguisher when the house starts to burn down, and that’s what herbalism is.

First of all, I want to point out that I do not consider Professor Colquhoun to be an adversary as such. Our only duty is to the truth. I have to word this carefully: if what I do with patients is not of benefit to them in comparison to the other approaches which they have tried and which have been tried with them, there is an argument that it should change. This individualises the situation rather, as there could be other benefits to the existence of herbalism such as saving NHS resources by having practitioners of therapies which are only imagined to work treat patients with non-diseases. This view is entirely compatible with the idea that CAM medicine is completely ineffective. Obviously it isn’t what I believe.

However, it should also be noted that we are not comparing like with like here. The NHS is publically funded and often perceived as free, it lacks the resources to give patients the time they may need and doctors the time to maintain clinical skills. Herbal medicine, which incidentally I don’t regard as complementary medicine, is private medicine where the practitioner has the luxury of time to listen to the patient, elicit a host of clinical signs, carry out appropriate examinations, take a full medical history, facilitate concordance and so forth. As it happens, I don’t think this is a desirable way of practicing herbalism on the whole because it disempowers the patient.

Moving on to Professor Colquhoun’s points, I would address them as follows, and I am by no means in conflict with all of his views.

One of the criticisms he made of herbal medicine courses was the issue of tasting tinctures as a means of judging their actions, a practice which he regarded as evidence of an unscientific approach. I would describe the tasting of tinctures as a form of observation. There is a pharmacology of taste of course, but leaving that aside, the tasting of other substances provides evidence for their composition and actions. For instance, a sour taste suggests acidity, a sweet taste a rather unreliable piece of evidence for the presence of sugar and a salty taste a rather more reliable piece of evidence for the presence of sodium chloride. Similarly, the taste of a tincture provides evidence for its activity. Astringency suggests the presence of tannins, bitterness the presence of bitter principles and to some extent alkaloids, and spiciness a local circulatory stimulant action or perhaps the ability to stimulate pain receptors. This is simply observation. If you see a plant leaf with parallel venation, it is likely to be a monocotyledon. A woody flowering plant is much more likely to be a dicotyledon. Flavonoids are yellow, tannins tend to be red and saponins cause froth to form in solutions when taken. This is all perfectly straightforward and part of the scientific method. It is completely unclear to me why this would be seen as absurd.

Having disagreed with Professor Colquhoun on this point however, I would also say that I heartily agree with him on the question of course management. It is most emphatically true that the practice of herbal medicine courses nowadays includes content which is hard to reconcile with scientific method. Whether or not it is effective, such content should indeed be eliminated from any course in herbal medicine. There is adequate well-supported content more deserving of coverage which is less controversial. There is also, however, a problem which I will address later.

There is in fact a much wider issue here, with higher education in general. In vocational terms, there appears to be a discrepancy between the expectations encouraged in potential students and the results of gaining qualifications. People need to be competent at what they do for society to function at all. The discrepancy between competence and qualification or achievement in academic terms needs to be kept as small as possible. However, this applies to any course with a vocational element. There are many other courses which fail to disclose their content – see my earlier response to Ben Goldacre. This is a general problem with the academic world, and is a major one. In fact, it is far wider-reaching than the question of the efficacy of complementary medicine.

Then there is the question of disclosure. To the extent that course content is a commodity, it has to be regarded as intellectual property. This is inappropriate in academia but there is a strong tendency for it to take place. Another example is the Serials Crisis.

What’s not clear here is whether the situation with respect to herbalism has deteriorated. My impression is that it has, and in fact Hein Zeylstra raised this point himself when he established the College of Practitioners of Phytotherapy. One point he made at the time was that the institutions which were pursuing the possibility of offering courses in herbalism did not have a scientific background. It is therefore clear that this corresponds to a concern expressed within the profession of herbalism itself.

Then there are the questions of research and of what exactly is being studied. Research methods carried out by pharmacologists often seem inappropriate to herbalists. For example, they appear to use extracts of herbs consisting of a few compounds at a specific dosage obtained by means considered inappropriate by herbalists. One example is the use of pentane as a solvent. Moreover, and this applies to herbalists too, there seems to be no agreed protocol for research between herbalists and orthodox practitioners. Unless this can be agreed, it would be surprising if any meaningful dialogue can occur between the factions. There shouldn’t even be factions – our duty is ultimately to the truth and to patients and the public, not to our professions. Incidentally, this absence of a protocol is a reason for remaining agnostic on the issue of whether other therapies work. It may be that theory is incompatible with the claims of, for example, homoeopathy, but that is entirely irrelevant in the absence of an agreed protocol, which does not appear to exist. Theories are falsifiable. One apparent example is the question of the shapes of electrons and the incompatibility of the Standard Model and Supersymmetry in physics. However, that discussion seems to take place in an atmosphere of mutual respect.

Herbalists have equally failed to address opportunities to provide evidence in a useful manner. There are something like seven hundred herbalists practicing in the UK. Each of us see patients and carry out physical examinations, often including quantifiable results such as blood and urine tests, peak flow, blood pressure, resting pulse rates, goniometry and many others. We carry out these tests before and after treatment and we record the nature of that treatment in general. However, as individuals we cannot provide large enough data sets to process in a statistically meaningful way. This can be remedied however. If we were simply to anonymise our records and have them collated centrally, we would easily be able to provide enough data ethically to determine the efficacy of our treatment, or otherwise, in many cases.

Finally there is the question of reflective practice. Professor Colquhoun seemed to think this involved practitioners convincing themselves that their therapy worked. I have no idea how other herbalists approach this but I can give examples of what I have done as forms of reflective practice.

• Early on in my practice, Piper methysticum was a widely used herb in the EU, though it is now banned. One of the things I noticed about patients who were on Piper methysticum was their eagerness to take the herb, and my intuition suggested to me that it was more than the usual eagerness. This is all soft evidence of course. My conclusion was that there might be an abuse syndrome associated with it and I ceased to prescribe it. This was some time before the controversy regarding liver damage arose.

• I have also been aware that some patients with autoimmune conditions have experienced a recurrence of dormant symptoms after taking Echinacea angustifolia. As a result, I no longer use E. angustifolia at all. This is, incidentally, entirely consistent with the idea that Echinacea modifies specific immune responses.

• After some time attempting to treat conditions using Verbena officinalis, I noticed that there was often no improvement in symptoms addressed using that remedy and therefore I no longer use it at all.

• More widely, some more examples of reflective practice I have undertaken include addressing the issue of events such as the two incidents of patients committing suicide, poor concordance and the discrepancy between observable and quantifiable signs of improvement and patients’ own perceptions, both in terms of patient “optimism” and patient “pessimism”.

One more thing: despite the copious material I sent Ben Goldacre regarding the content of the course I pursued, I have not received a response from him on the matter.

The only emotional investment I have in herbalism is that I dearly wish I could cease practicing because it is not a viable source of income. I do believe this can be addressed, but not without the cooperation of various people and bodies from which it does not seem to be forthcoming. In the meantime, I am continuing to search diligently for another source of income. However, I am convinced that there is sufficient evidence to support the efficacy of herbal remedies appropriately applied, and also believe that herbalism brings other benefits to society besides the efficacy of the therapy. However, that’s a different matter which I’ll cover at another time.

I also want to reiterate that Professor Colquhoun is absolutely spot-on about management culture in higher education institutions and that I am as passionately in agreement with him about that as I am passionately in disagreement about the rest.  There should also be some meeting of minds here.

Different options with leather itself:

Traditional methods of leather preparation vs. industrial age methods.  To some extent, like is being compared with like if contemporary methods of leather production are considered, since both use processes which are environmentally questionable.  The issue of tanning is also significant because tannins can be derived from galls, bark or herbs.  Bark would be best pollarded or coppiced but galls or herbs would also be sustainable, though the use of galls risks the death of gall wasps.

Potential sources of real leather which have died without wilful human intervention such as frozen mammoths, wooly rhinos, ground sloths – there are estimated to be 150 million mammoths in Siberia preserved at different levels of preservation.  Each mammoth of the largest species weighed about eight tons when alive, compared to the largest breeds of cattle at 1.6 tons.  Assuming they are the same shape as cattle, that provides 2.9 times the area of leather per animal.  Mammoths are of course already a source of ivory but this is restricted in case elephant is passed off as mammoth ivory.  Mammoth leather might also be prepared in the traditional way without many additional resources because the traditional method of making leather involves the use of the animal’s brain and excrement, and the brain is generally proportionate to the size of the hide needed.   Mammoths were also more cephalised than odd or even-toed ungulates, so this is very likely to be feasible for a well-preserved mammoth.  There is evidence that mammoth hide was used to make tents in palaeolithic times, so it is biodegradable over a period of less than twelve millenia in the form produced.

Ground sloths are less useful because only their hides are preserved, although they have the advantage of being bulletproof.

Woolly rhinos are another option.  The considerations are similar except that they were smaller and less cephalised than mammoths.

All three of these types of animals are extinct and their habitats are remote.  Therefore, unless they are cloned and revived, which raises further ethical issues, they are effectively being mined rather than constituting a sustainable resources.  Rhinos are also a source of horn and all three are a source of animal fibre.  The fact that they are in remote, fragile environments means there may be risks regarding transport.

More recent dead sources are the likes of roadkill.  These are probably not a good source because they are often small, their skin is damaged and it may be difficult to prepare the hides.  It also probably deprives scavengers of food.

Another source would be voluntarily donated human skin, but this would probably be ruled out on the grounds of the “yuck factor”.

A further question is whether leather is a by-product of meat production or the other way round.  This is only a relative point, in terms of how much or little support the consumer gives to animal farming.

There are also a few points of comparison to the following substances:  honey, beeswax, shellac, cochineal, silk, byssal thread, fur, wool, feathers, ivory and horn.

Here are a few rather off-beat thoughts on the matter:

In utilitarian terms where the utility principle is understood to include death of individuals in isolation only, as opposed to wider environmental effects, the question of a species or subspecies being endangered or the effects of interaction on other individuals in the same community, it could make sense to use the largest animal possible.  This would of course be a blue whale.  However, that not only assumes that whale hide is suitable as a source of leather but also that other considerations are not relevant, and that a felicific calculus, that is, a way of ranking and comparing pleasure between individuals, which in this case are of a different species, is both possible and can include the value of an individual life rather than the presence or absence of suffering.  Other metaethics exist, for example intuitionism, deontology/prescriptivism, at least two versions of emotivism, ethical scepticism, theistic and atheistic theological voluntarism and virtue-based metaethics of several different kinds such as Stoic, classical and Christian virtue-based metaethics, and choosing between these is an additional issue which may influence every one of the points i’m making here.

There are also what i’m going to call two “fantasy” alternatives:  vat-grown skin converted to leather (which avoids all three of my major reasons for vegetarianism – tropic level, welfare and health of the user) and dextrorotatory amino acid polymerisation (or for that matter laevo-rotatory) for the synthesis of virtually “real” leather which has never been anywhere near an animal (though there could be a biotechnology problem with this).  These are high-tech solutions which bring with them the usual problems of a “techno-fix” – they would be cargo cults in a way, and it suggests a certain kind of unsustainable environment for them to happen at all.

The mention of the word “fantasy” brings up a subject close to my heart:  sexual fetishism.  I am lucky enough not to be a leather fetishist, but i have a complicated relationship with this subject because of my own paraphilias.  Their existence means i have a degree of insight to the viewpoint of leather fetishists but may lack empathy in other areas.  There is probably also a lot of individual variation in this area.

A relevant question would then be:  how important is it to a fetishist that it really is leather?  If it is, is that connected to its origin?  If so, it seems to take us into similar realms to the crush fetish, which implies that to be consistent it would simply have to be condemned and the interests of a leather fetishist would be considered irrelevant.  On a subjective level, the question would then be to what extent the fetish could be indulged merely in fantasy and to what extent it could be reduced.  That raises the further questions of what sex is or is supposed to be about and how much control someone has, which is often considered relevant as a defence against homophobia.  However, clearly a line of some kind is usually drawn because of almost universal disapproval of paedophilia.  So if leather fetishism is necessarily connected to the death or suffering of other species, it places it morally in the same category as crush fetishism and paedophilia.  This is not to say that that isn’t another moral minefield, but does seem at least to reduce it to that area.

Another set of considerations are what i describe as the “radical” option of simply not using anything like leather at all.  This is akin to planning a vegan diet from scratch rather than simply replacing the likes of dairy and flesh with substitutes.  However, whereas I-Tal is apparently the only vegan tradition outside our own (Jains are not vegan), there are plenty of non-leather using traditions, so we have an advantage there.

Simply not replacing leather may include the likes of going barefoot, using canvas shoes, linen bags, not wearing belts and so on.  The biggest issue here seems to be bikers’ leathers, as it’s common to claim that it’s irreplaceable.  I can’t comment on this because it involves practical experience of something to which i have no access, but i would welcome input.

Then there’s the question of second-hand leather.  This has applied to me in the past.  I used to own a second-hand wallet made of leather, and because leather is durable it might make sense to continue using it on the grounds that the consumption of a series of other wallets would be less sustainable.  Similar considerations apply to footwear.  However, it also lays one open to charges of hypocrisy and it may simply be distasteful.  That suggests to me that there are non-cognitive considerations in the metaethics of the person evaluating that act, which is interesting.

Finally, there are the “cradle to grave” concerns:  everything that has to happen for something to become a leather-like substance.  What are the raw materials?  What by-products are produced?  How much energy is used in production?  Are there health risks to the workers?  Do they have realistic alternative sources of employment which are less harmful?  How well are they paid?  What are their working conditions like otherwise?  How can the energy be provided to produce the material?  What are the transport issues?  What about refuse-reuse-repair-recycle?  Are there risks in everyday use to the user, others and the environment or individuals of other species?

Finally, here’s a short list of the options as i see them:

Leather produced by modern techniques

Leather produced by traditional techniques

PVC – risk of scleroderma, carcinogenic, xeno-oestrogenic.

Polyurethane – Gives off harmful fumes when burnt but can be made from plant-derived polyols.

Rubber – sources of latex vary, it needn’t be rubber trees.

Vulcanised rubber

Linoleum or something similar

Moccatan – i don’t know what this is.

Gutta percha.

Oilcloth

Naugahyde – this is notoriously dangerous to the user’s health.

Leatherette

Koskin

Poromeric imitation leather – this is porous polyurethane.

A felt of acrylic and nylon fibres.

A number of proprietary artificial leathers whose composition and manufacture are trade secrets and which cannot therefore be evaluated.

More to come!

1. Identify different metaethical positions, e.g. is the issue emotive, do the ends justify the means, what would happen if everyone did the same, is it about numbers of deaths, suffering, a hierarchy of organisms?

2. Identify the options, e.g. bovine leather versus other leathers, skins from animals which have died of natural causes, environmental impact of synthetic substitutes, possibility of “natural” substitutes, sustainability of vegetable sources used for them.

3.  Sort of arrange the whole lot in a grid.  That means the number of issues involved is something like the number of possible ethical positions multiplied by the number of options, though it might reduce a bit because, for example, maybe the issues of PVC versus silicone are not important because there’s a trade-off between their environmental impact and it’s swings and roundabouts.  However, given the number of options i’ve mentioned in (1) and (2), that would prima facie give us about thirty-six sets of issues.  That’s probably a drastic underestimate.

So, can you see why i haven’t said anything about it yet?