AROMATHERAPY FOR THE MEDICAL PROFESSION
A USEFUL THERAPY, BUT TRAINING QUALITY
AND SAFETY STANDARDS ARE A LOTTERY

By Martin Watt
Significant inroads into the mainstream clinical environment have been made
in recent years by various forms of complementary medicine including
aromatherapy (1). Therefore is the time not overdue for the medical
professions and regulators to critically evaluate the quality of education
provision, as well as examine the trades true ability to self regulate?

The UK Ministry of Education, Department of Health and Department of Trade
and Industry have all been involved in discussions with the aromatherapy and
essential oils supply trade organisations. Yet, the very people these Civil
servants are having discussions with, are the ones responsible for oiling the
trades hype machine over many years. Examining in detail if what their
therapists are being taught is accurate always takes second place to
establishing fallacious standards of conduct, ethics, procedures, etc. All the
procedural niceties in the world are useless, if what some therapists may be
doing (due to bad training) is dangerous or unhelpful to the conditions being
treated.

Once trained, the methods of information provision to individual therapists has
mainly been via trade journals and organisations (2). Any journal that relies on
advertising revenue will of course not publish anything that their advertising
customers will not like. Also rarely will they publish anything that
challenges the knowledge base of the trades teachers. Such reluctance
to publish controversial articles or letters, has resulted in an almost complete
suppression of discussion on fundamental principles, education quality and
trading practices. Only with the less censored medium of the Internet, have a
small body of people started challenging accepted trade norms. Note: The later
has now been overtaken by the numerous awful quality Internet blogs.


Over the years, huge efforts have been made to try and make some of the
leading therapies and their leaders look respectable (3). The tendency has
been for individual therapies to form themselves into centralised bodies who
then supposedly "set standards" for training, codes of ethics, etc. However,
adequate analysis of the effectiveness and quality of education provision seems
to have taken second place to empire building and political manoeuvering.

Since the medical profession revolves around numerous so-called ‘professional’
organisations (4), the complementary world has been forced down that same
road. Once these trade organisations became established the medical and
education establishment seemed quite happy to accept they were capable of
regulating their respective trades and setting standards - NOT SO. The lack of
effectiveness of trade self regulation was bought into question over the UK
General Medical Council and its perceived weaknesses. In addition, in the UK, a
'Health Which' report (February 2001 pp 18-20) exposed the trades inability to
police the sale of fake and misleading essential oils.

Trade associations (with a few exceptions), have rarely been a significant force
for setting adequate standards of quality of education and trading practices.
Because of that consumer law has become increasingly used in recent years.
However, health care officials seem happy to assume that because a particular
aromatherapist, or even nurse aromatherapist, is a member of the respective
trade body, that they must be adequately trained and safe to practice - NOT
SO.
Below are some examples of malpractice and misinformation propagated by
different aromatherapy trade associations and their leading lights.

1. Therapeutic attributes of the essential oils.
(a) Many of the therapeutic properties attributed by aromatherapy authors to
essential oils, are a corruption of the activity attributed to the herbal
preparation. For those that do not know, an aqueous or alcoholic herbal
preparation contains a significantly different mixture of chemicals to those in
the same plants essential oil. Indeed, the water soluble chemicals responsible
for a range of known therapeutic activities of herbs, do not occur in most
essential oils at all. An example is the difference between peppermint oil and
peppermint tea. The former is an acknowledged stimulant of the CNS, whereas
tests have shown that the later has an initial excitant action followed by a long
lasting sedative effect (5).

(b) Few (if any) of the early aromatherapy writers had knowledge on the
differences between the oil phase and the water phase of a plant. Therefore,
when they came to write their books they were packed with totally incorrect
therapeutic actions and numerous other errors. This information has been
proliferated ad infinitum by numerous subsequent authors. The majority of
aromatherapy training courses still recommend students to use such
books as "recommended reading”
(6).

2. Safety.
Despite there being publications on the market containing researched safety
data (7). many aromatherapy suppliers (particularly in the USA and Canada)
continue to sell dangerous essential oils without adequate warnings. We even
had/have a few here in the UK using illegal medicinal claims. Therefore, if you
come across a website with explicit medicinal claims please report them via the
MHRA (UK) web site: http://www.mhra.gov.uk/ or in the USA the
www.cpsc.gov

Despite the clear evidence of certain oils having harmful effects, the IFA (UK),
published articles promoting very hazardous oils. For example, in the Autumn
1999 edition, it carried an article promoting the use of Verbena essential oil.
The author a well-known figure in the trade, states that this oil "used sensibly
is safe". This advice flies in the face of all well-documented evidence proving
this oil should never be applied to the skin. The International Fragrance
Research Association (IFRA) that advise the International fragrance trade on
safety issues say: "(1998-12-18) Verbena oil should not be used as a
fragrance ingredient based on test results showing sensitising and
phototoxic potential".

In the Summer 2000 edition of the IFA journal, there is an article written by
one of their teachers, promoting the use of Tibetan Acorus Calamus oil. She
even recommends this oil is used as a gargle. Yet what do the The
International Fragrance Research Association (IFRA) say: "(1998-12-18).
Essential oils containing cis and trans-Asarone (e.g.calamus oils)
should not be used at a level such that a total concentration exceeds
0.01% in consumer products".
Calamus oil can contain up to 80% of
asarone's but the oil in question is believed to contain around 40% of these
potentially carcinogenic chemicals (8).

Most aromatherapy journals have articles promoting the use of essential oils on
which there is either no known safety data, or on which there is sound safety
data, but the authors fail to point out hazards. The readers are mainly qualified
therapists who will presume writers in their journals are knowledgeable and
would not promote dangerous practices. Clearly not the case.

Other aromatherapy organisations promote the use of little known essential
oils. Most of the information on these oils is derived from just one or two
therapists mainly based in France. No adequate safety data is provided and in
some cases the internal use of these oils is recommended. As the 'Health
Which' February 2001 pp 18-20 article has proven, the practitioners just do not
know what they are giving people with the internal use of many essential oils.
The students on courses that advocate internal use of oils are free to purchase
their oils from anyone. As some of us know, the most clever con artists in the
trade tend to be the ones these therapists buy their oils from.

3. Skin absorption.
This is a subject which many aromatherapists are adamant about, i.e. that
their oils work by being absorbed by the skin and thence to the bloodstream.
Sound scientific evidence simply is not there to support such a mode of
action. Therefore, the claimed clinical effects on internal organs, attributed to
skin absorption, cannot be justified. On the other hand, there is now a
substantial body of sound scientific evidence that the vapours from essential
oils do indeed get into the bloodstream, but they get there because the highly
volatile gases are inhaled (9).

Clearly the psychological effects of fragrance can be potent (10) and massage
can have significant physiological benefits (11), but that does not validate most
of the claimed effects from dermal absorption of essential oils.

4. The supply of essential oils.
Many in this trade are well aware that a lot of so called ‘essential oils’ are not
half as natural as the sales hype suggests (12). It is a sad fact, but many
essential oils are low grade, adulterated, or occasionally totally synthetic.
Therefore, if a perfume compound is used for certain therapeutic applications,
then anticipated advantageous effects may not occur and indeed adverse
effects are possible. It is known that at least one clinical trial failed because of
the researcher being supplied with an adulterated oil (13).

This adulteration of essential oils is a great concern now that we have
therapists being trained on their internal use. If members of the medical
profession attend such courses, and then purchase their essential oils from
dubious sources, they are playing with fire. Such courses also teach the use of
certain essential oils on which no sound adverse effects testing have ever been
undertaken. For example ravensara, niaouli, kanuka, yarrow, Moroccan
chamomile, etc.

So you may ask what is the trade doing about all this? The short answer is not
a lot. The trade as such have no control on what individual authors write
(freedom of expression). The publishers of aromatherapy books don’t care
much about the accuracy of their publications, as long as they sell tens of
thousands of copies. Trade organisations have little influence over competing
organisations; few if any discipline their own members for breaking their own
rules.
Examples of hazardous information taught to many nurses.
 
Benzoin essential oil.
Commonly recommended on many aromatherapy courses and in most books,
as ideal for application to wounded skin.

FACT: This oil can be a powerful skin sensitiser. The I.F.R.A. recommended
member companies do not use the unrefined grades in cosmetic products for
application to the skin. To make matters worse, there is no such thing as a
natural essential oil of benzoin.
To make this resin pourable it must have
synthetic solvents such as DPG added. This process negates the whole
principle of 'naturalness' of aromatherapy.

Bergamot essential oil (expressed).
The use of the dangerous unrectified oil is still promoted in aromatherapy
courses. A few aromatherapy authors still recommend its use rather than the
safe FCF processed version. The advocates say that “as long as the client is not
exposed to sunlight there will be no problem”. However, what initiates a
reaction is ultra violet light which can be strong even on dull days, and
particularly at high altitudes. Not a problem maybe in the UK, but what about
places around the world such as Arizona many parts of which are 7000 feet
high! Also of course the problem of photosensitisation caused by sunbeds. See
separate articles.

FACTS on bergamot: It is a very powerful photosensitiser, restricted in the
cosmetic and fragrance trade for many years. Espersen E. 1952. Acta.
Dermatovener. 32, 91, reviewed the literature and noted that Kuske H. 1940.
Dermatologica 143, 137, had found more than 100 papers published on this
subject.
Extensive studies of the effects of Bergamot oil on all skin types were reported by:
S. Zaynoun Et al. 1977. Cont. Derm. 3: 225-239.
S. Zaynoun 1977. Br. J. Derm. 96, 475 & S.
Zaynoun Et al. 1974. Brit. J. Derm. 91: suppl. 10:14.
Meyer. J. 1970. Bull. Soc. fr. Derm. Syph. 77, 881.

Wormseed essential oil (Chenopodium).
The sale of this essential oil (other from registered pharmaceutical premises)
was prohibited under the UK 1968 Medicines Act.

FACT: Until the middle 1990s this oil was offered for sale by leading UK
aromatherapy suppliers. Therefore, it was being sold over 25 years after its
sale to the public was banned.
One supplier was a leading light in the
aromatherapy trade organisations and advised them on legislation - what a
joke!

Summary:
Fragrance has been proven to have wide ranging effects on the brain (14). The
popularity of a good aromatherapy treatment is clear by the numbers of people
practising it and their clients reporting beneficial effects. If it were more widely
used by the medical profession drugs bills may well be lower and clinical
results improved. A significant volume of sound scientific data exists on the
known and potential uses of essential oils from plants. This is available to
those that care to spend the money and time seeking it out, as well as
evaluating its potential worth. Unfortunately,Very few aromatherapy courses
provide students with sound referenced material.

So nurses and doctors; beware of clinical efficacy claims made by
aromatherapists, ask for references and check those references are valid.
Beware of what products are used on your patients.

Never assume that membership of trade organisations represents a stamp of
quality on your therapist, it is no such thing. Ask any medical organisations
that you have influence on not to automatically assume that leading members
of the complementary medicines organisations know what they are talking
about. Often these people are simply good salespeople or political animals, the
true depth of their knowledge is frequently highly debatable. Most
aromatherapy organisations have not attempted to ascertain if their member
schools are teaching accurate information. Instead they rely on unmonitored
useless codes of conduct and course guidance documents.

Finally, beware of aromatherapy books written by nurses, often they are little
better than the popular novels on the subject. These nurses - who seem so
well qualified - have often learnt all they know from the trades biggest con
artists.

References:
1. Comp. Therapies In Nursing journal & several reports in other nursing journals. A
few reports in the Lancet, about the numbers of nurses taking aromatherapy courses.

2. International Federation of Aromatherapists. International Society of Professional
Therapists. Aromatherapy Today. International Journal of Aromatherapy, and others.

3. Various UK organisations such as the C.C.M; R.I.C.M; B.C.C.M; I.C.M; A.T.C; A.O.C;
I.S.P.A; R.Q.A; I.F.A; IFPA; The Aromatherapy Consortium, etc. Plus overseas
organisations.

4. Royal colleges of: Physicians; Midwives; Nurses; Obstetrics; Gynaecologists;
Surgeons; Physicians, etc.

5. Della R. et al. 1989. Fitoterapia. V.LXI. No. 3. 215-21.

6. ITEC. Recommended reading: Julia Lawless. The Encyclopaedia of essential oils and
Patricia Davies. Aromatherapy An A-Z.
The IFA. Recommended: The Complete Guide to Aromatherapy by Salvatore
Battaglia.
College courses recommend these and other trade novels!
Beauty organisations recommend a similar range of the trades novels!

7. Essential Oil Safety by Tisserand. Churchill Livingstone.

8 (a). Chromosome damage - Abel G. 1987. Planta Medica. Pp 251-253.
8 (b). Carcinogenicity-Habermann RT. 1971. Report to the FDA June 16, 1971.
8 (c). Many additional references in the W.H.O. Toxicological evaluation of food
additives reports 1981. No A.D.I. was allocated due to concerns over adverse effects
of calamus oil from many animal studies.

9. Absorption of d-limonene by inhalation in humans . Falk-Filipsson A. 1993. J.
Toxicol. Environ. Health. 38: 77-88. & 1,8-cineole was detected in the blood of mice,
following inhalation. Kovar K. Et al. 1987. Planta Medica 53. p.315.

10. (a) Jasmine fragrance was tested for its effects on work efficiency. Jasmine
increased b -band activity suggesting mental stimulation. The study concluded that
the use of lavender, orange and rose would elevate work efficiency and reduce stress
levels. Sugano H. & Sato N. 1991. Chem. Senses. 16: 183-184 and same author and
journal, 1989. 14(2) 303.
10. (b) Lavender oil as night time sedation. Hardy M. Kirk-Smith M. & Stretch D.
1995. The Lancet. April. Vol. 346. 701. Plus numerous other references that I have
collected.

11. Increase of plasma b-endorphins in connective tissue massage. Kaada B. et al
1989. Gen.Pharmac.V.20 no. 4. pp 487-9. Plus many others are available.

12. Aromatherapy Quarterly Issues 53-54-55 and 'Health Which'. Feb. 2001. pp18-20.

13. Letter from Alan Barker in Aromatherapy Quarterly issue 54. Re failure of a clinical
trial due to impure essential oil supplied.

14 (a). When the air was scented with Jasmin, a study on keypunch operators found
that their errors dropped by 33%. See also lemon and lavender. Kallan C. 1991.
Prevention. 32(10): 38(6).
14 (b). Lavender administered by inhalation on humans proved to have a sedative
effect No effects were detectable on alertness tasks. Imberger I. Et al. 1993. Prog.
Abst. 24th Symposium on Essential Oils.
14 (c). Lemon fragrance was reported to significantly improve people’s perception of
their health and well-being. This trial used a control of people who had no scent
administered. Fewer adverse health symptoms were reported by those people who
were breathing lemon oil than the control group. Knasko 1992. Chemical Senses.
17(1). 27-35.
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