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Posts from the ‘Research & Writing’ Category

Basics of Botanical Research

The research process is beautiful. And fun! You get to navigate and interact with the landscape of information about a subject, and figure out where the strengths, weaknesses, and opportunities exist in our knowledge base. In the process of digging into research, you can see the origins of the rumors spread about herbs, gain some clarity about it and weed through misinformation. Certainly, botanical preclinical and clinic research is an incremental way of building undertanding, much like an ant procuring crumbs of food to bring back to the colony. And it doesn’t tell us everything: there are many rich sources of information to draw from in botanical medicine, with traditional use chief among them. The skilled herbalist exercises good judgment and critical thinking by achieving fluency in these different areas, and knows how to apply them to help people.

I’ve been in the research field for 6 years–first in anthropological research at the Center for World Indigenous Studies, then as a botanical research assistant and writer for several clinicians, and now in R&D for a medicinal mushroom company. And I’m passionate about supporting herbalists in navigating the scientific research about botanicals and supplements to improve decision-making.

Let’s use an example. Say you’ve been heard about Thyme Oil as a Powerful Natural Antibiotic on social media sites and want to dig further into it. When we’re looking for at the evidence base of a claim, we want to go to the primary research and see the studies that have actually been done. Not reviews, not news articles, but real studies.

Frame the question to structure the inquiry.

I usually make 2 columns: the first lists the substance I’m searching for. This can be a specific plant, phytochemical, or just plants in general. Use the latin name for plants (in this case Thymus vulgaris), and include potential misspellings. Then in the second column is the subject: the name of a condition, keyword, or associated biomarker (you can use the term antibiotic or antibacterial). In this case, there’s a MeSH term for anti infective agents, which would cover the territory nicely.

Get better at searching.

You can then use this basic format to search the databases. Searching MEDLINE via PubMed will be more helpful with complex searches, as you can specify which fields you’d like to search. I also like to search Google Scholar. It indexes MEDLINE as well as other databases. The search is wider and you get more results, but you can’t customize it as well as you can with PubMed. Below is the search builder on PubMed. As you can see, you can add lots of different criteria for more wheat and less chaff.

Screen Shot 2014-12-13 at 10.14.37 AMAnd get to know your journals–PLOS, PubMed Central, BioMed Central, and anything from the Hindawi Publishing Group is free full text. My favorite botanical/phytotherapy journals are Fitoterapia, Phytotherapy, Phytotherapy Research, and Planta Medica. The Journal of Ethnopharmacology is also a great one, but I get the feeling that it’s a bioprospecting publication.

Use reference management programs to store and organize citations.

Once you start generating citations, programs like EndNote, Papers, Mendeley (free), Zotero (free), and Sente (pictured below, my personal favorite) can store, track and organize your citations. With any software, each have their different strengths and weaknesses. For example, EndNote is great for formatting citations in a final publication, but not the best at organizing into folders, tagging, storing PDFs. Sente is my personal favorite because I can sync these libraries with research colleagues, store and annotate PDFs, and having standing searches to keep up on new search results as they come in. Mendeley is a nice free/open source program, and is a good place to start.

Sente screenshotI have several of these programs installed. I can import and export citations as needed, depending on the project.

Going from A to B: know how to extrapolate and interpret data relevant to your inquiry.

This is where the true skill lies in research. Investigators set up replicas of reality in their labs. I can’t stress enough that research findings are specific to that setting, model, and process. Assessing the relevance of a finding is crucial. How do we translate study A to real world situation B? This takes some understanding of human biology, test methods, and the strength of different types of research methodologies and evidence (which I’ll address in future posts).

Back to thyme oil: once you complete your search, you’ll see that there is some data on antibacterial effects. Great! You have something to work with. Then the researcher should consider:

  • Were these done in test tubes (in vitro), animals, or humans?

In vitro studies are done in test tubes, often by culturing cells with botanical extracts, concentrates or isolates. They’re done to investigate the mechanism by which something works, and/or to see if there’s enough of an effect for research efforts to progress to animal studies. As the body would metabolize these compounds differently than what’s done in petris, findings should be taken with a grain of salt as they’re difficult to extrapolate to real world situations.

  • What kind of bacteria? What exactly were the effects?

This is very important! Just because a substance has an effect on a particular genus, species, or class of bacteria doesn’t mean that it will be effective in others. This error in applying a finding to other non-related pathogens or conditions is rampant in discussions about herbal medicine (see my post on Herbs for Ebola). Remember: this information is for a certain preparation in a certain type of experimental model. A may not always translate to B.

  • Is the dose and preparation relevant to what people would actually use?

I can’t stress this enough. Many natural substances can have an effect in test tubes and animals, but getting those amounts in humans would not be feasible. If possible, a critical examination of study doses and concentrations should be part of your research toolkit.

This is the first of a series on botanical research. Please leave your questions and feedback in the comments!

On the Subject of “Herbs for Ebola”

In October there was a torrent of Facebook and blog posts on herbal remedies for treatment of Ebola virus infection. The outbreak has been raging in West Africa for several months. But when the possibility of one on US soil emerged, so did the hysteria. Common suggestions for antiviral treatment by posters on the net included “classic antivirals” like elderberry, lemon balm, St. John’s wort. Elderberry has been studied for influenza A/B, lemon balm with HSV, and hypericin (from St. John’s Wort) has shown some in vitro activity against a few viruses, but when it comes to testing them in humans against Hep-C and HIV infections, effects were nil. Garcinia kola seeds were a popular remedy-turned-meme based on a single 15-year old lab test.

I know there is little harm in these thought experiments of devising treatments for these deadly outbreaks. Similar conversations occurred during the fear of the swine flu pandemic. Is it not better to speculate about protocols than do nothing?

When it comes to terms like herbal antivirals (or herbal antibiotics, etc)–I don’t think this is an a good way to describe the ways in which herbs work. Herbs are chemically complex molecular multitaskers–the polar opposite of single agent pharmaceuticals with a single biological target. Calling something an ‘herbal antiviral’ is cramming a square peg into a round hole and does not play to the strength of herbs either. When you’re holding a hammer, everything looks like a nail. But it behooves a practitioner to be aware and cognizant of the limits of tools and methods. If not, than you’re just a prosletyzer, preaching the endless merits of your chosen practice. Are you a pragmatist or a preacher?

What I take issue with the most is the misinformation clustered around this topic. First, most the information used in the development of these protocols are gleaned from in vitro data. Many substances and phytochemicals exhibit antiviral properties in vitro, and these are usually isolates or concentrated extracts, on organisms in test tubes. This makes extrapolation into a live human body difficult.

My concern is not that herbalists stretch botanical therapeutics and try to come up with something new. Instead, I take issue with the assertion of a ‘remedy’ without consideration or discussion of where the information originated.

My parting words on Herbs for Ebola: critically appraise the origins and habitat of information, and be transparent about it. Always look under the hood, because it’s common for people to stretch or sweep away information.

Exponential Medicine – Recap & Reflections

I just got back from attending the Exponential Medicine (#xMed on Twitter) conference hosted by Singularity University in San Diego. This conference, similar to TEDMED, aims to share innovative ideas and developments in medicine and healthcare. It seeks to answer “what’s next?” in these fields.

The conference and innovation lab was predictably occupied with speakers and companies in the fields of stem cell research, tissue engineering, bioprinting, regeneration, synthetic biology, big data, mobile app technology, AI.

I’m very intrigued on conversations about the future of anything, but most importantly when it comes to medicine or healthcare. These fields are vital for the continued evolution of humanity, and all life on earth. When something becomes ordained as The Future of X, it becomes a self-fulfilling prophecy. We race to get to the future first, chasing the next big thing. So I watch these developments with as much of a critical eye as I can muster, especially attentive to the origins, trajectories, and meanings of these ‘futures’. These innovators rarely, however, examine our past or roots. Or the ecological context in which they are an inextricable part. They can’t. The whole field is too specialized. But how can you assert a future without a global view?

I am not against technological development or advancing medical technology as much as possibly. On the contrary: these technologies can and will save lives and improve quality of life for those who can access it. But I stand as an outsider looking at the greater social context, and wonder.

I did not see anyone questioning the fundamanetal tenets of their field– a practice which could surely expose blind spots or reveal some kind of blue sky for future developments. A couple speakers argued that better access and more meaningful patterns from big data can provide patients and providers with more relevant and actionable knowledge than RCTs–a good point. Data mined from real patients in real situations is more realistic than trial patients, who are often excluded if they have a comorbid condition. (That and I think RCTs testing treatments against placebo is unethical, but that’s another post.) No one, except for Paul Stamets (pictured above), advocated for even a remotely ecological or cross-species view of health. With an increasingly myopic view of heathcare, we lose context and are therefore subject to poorly performing interventions.

These technologies are beautiful. I’m excited for what they can bring. But we may well go even further by flipping the subject and seeking innovation in tradition, examining why we do what we do, how we know what we know. I’d love for medical educational programs conferences to philosophize a bit more with these subjects. I think only then do we fully engage the subject and envision the future we want to create.

And the setting? Lovely.

IMG_1595

Hotel Del Coronado

The Herbalist’s Chain of Custody

In my practice I often play the role of an ambassador, explaining the thought processes & approaches of a clinical herbalist. One of the ways that makes practicing herbalists distinctive from other professions is the chain of custody of their medicines, and their embedded connection with the living, breathing landscape.

Herbalists occupy & triage the continuum between patient, practice & Earth. This is especially true when they make their own medicines–they oversee and craft a chain of custody. When I supply a formula of marshmallow root & chamomille flowers that have come from my garden, I’m not offering just a product. I’m offering a deep understanding of how those plants grow, evolve, and interact with their environment. In overseeing the craft of that product, it’s not just better quality–we invite a dimension of knowing unique to our practice. We are helping our patients evolve their narrative and understanding. This is an important aspect of the long-term healing process.

It’s as if we have one hand stretching into the landscape; formulating, crafting. And with the other, we can offer another a connection, language and, in some ways, a truth.

Interview with Mel at HerbGeek on the Future of Integrative Herbal Medicine

Hey everyone–I recently had a conversation with Mel at HerbGeek on the future of integrative herbal medicine. We discussed free clinic work, narrative medicine, whole systems design, the upcoming Dandelion Seed Conference. It’s basically my ruminations on the art & science of recontextualizion in herbal medicine–and I think you’ll enjoy it. Read the full interview here.

cal poppy dryingMelanie:  Your eclectic background includes studies and research in medical anthropology, ecological healing, and whole systems design. Can you explain how these separate fields all relate to one another and how they’ve shaped your approach to herbal medicine?

Renee: Why, thank you! You do great interviews (and feature important questions), so I’ve been looking forward to this.

Regarding these different areas of knowledge, there’s a method to the madness. It all starts with the observation that humans are doing completely unprecedented things to their bodies, other people, and other species. These disciplines and areas of inquiry–medical anthropology, environmental health, and whole systems design–offer language and insights that help us understand the unfolding story and empowers us to draft an alternative. How we understand and respond to these new evolutionary trajectories and technologies relies on the integration of currently disparate knowledge bases. Ultimately, I find the language and constructs of these areas extremely useful for understanding the human condition and illuminate new directions for integrative herbal medicine.

In 2008, I joined the researchers at the Center for World Indigenous Studies on projects relating to traditional medicine and sciences and environmental diplomacy. My post involved analyzing and building policy frameworks, and as I grew in this position I developed a great interest and respect for the language and insights of whole systems design. It helps me consider aspects of complex systems such as scale, paradigms, leverage points, systems attractors and feedback loops. Simply put, I just understand it as the science of hacking. Social hacking in particular.

The field of herbal medicine is vast, complex, and life affirming. It is humanity’s oldest form of medicine. The legacy of plants and humans in healing contexts spans hundreds of generations, and across all cultures. We’ve co-evolved with these plants–they’re an inextricably part of our bodies and identities.

In the last few decades, technological developments have totally altered our bodies and ecosystems. We have new, deeper ways in which to intervene. And these interventions are risky because we don’t yet have a grasp on the complexity of the systems that we’re tinkering with. Sometimes, or pretty often, actually, our interventions are naïve and end up damaging adaptive capacities or spur unintended consequences.

Now, I’m not anti-development, nor do I romanticize the past. I do point out that we’re moving forward in radical development as an entire species with fragmented understandings of health & ecological interdependencies. Medicine is decontextualized, the medical field is fragmented and led on a leash by corporate entities. I don’t see the reality of our ecological dependencies being considered as we’re designing future humans or plotting to colonize other planets. I don’t see much leadership from our healers on the biggest questions humanity has ever faced. Medical practice & health care should be proactive instead of purely reactive. Who’s in the driver’s seat here? Read more

Is health a right or a privilege?

On one hand, health is a right and it should be available to us all. This is the basis from which most healers practice. It’s even recognized in the UN Declaration on Human Rights. The World Health Organization Constitution “enshrines the highest attainable standard of health as a fundamental right of every human being.” Health is attainable and an inalienable right. We empower people to take charge of their own health.

But health privilege also exists. It lives in unexamined notions of health, disease, and shapes the meaning of these experiences. Much like racial, gender, or socioeconomic privilege, health privilege shames the individual for being ill, attributing illness to New Age judgements of spiritual impotency, or impure thoughts/actions. It rears its head when someone asks you if you’re “still taking those crazy medications?!” or tells you that daily consumption of bentonite clay would have prevented it. When you enjoy unexamined health privilege, you may think that someone is ill because they ate poorly, or haven’t learned a karmic lesson yet, possess stuck/suppressed emotions, lived dis-harmoniously with Nature, or lack chuztpah or spiritual willpower. And we pass judgement. In the clinic, this can disrupt the healing process. I think it can even cause harm.

Herbalists, specifically community-oriented ones, can better understand and serve our clients & communities if we examine the types of health privilege we enjoy. This way, we can be better allies and be more effective partners in the healing of people & planet by taking responsibility for our constructs of health & illness.

Ecology, Learning & the Subconscious

The more I learn, grow, develop new skills, reach out to new groups, try to engage creative social change, I’m consistently reminded that most of our thinking and decision making is driven by unconscious processes. (One of the articulations of this is Buddha’s metaphor of the Elephant and the Rider—where the rational, conscious mind is the rider, and the elephant, the subconscious. A crude metaphor, yes. But the take-away is valuable—where the elephant goes, so does the rider. It’s why marketers, politicians, and anyone else that tries to persuade does so through engaging your deeper emotional being, despite their methods appearing so artless to our neocortex.) And I think this is a source of a lot of resistance to creative change and evoluation in groups, communities, and societies.

I was at mycology seminar this past weekend, and spent a minute or two considering ecological innovation in leading the way for subconscious thought transformation. The developments in mycology today are jaw-dropping—medicinal mushrooms and their ability to support immune system adaptation, mycelium to filter agricultural waste and water-born contaminants, bioremediation of petrochemicals & nuclear waste, mycopesticides. And I’m thrilled to be working so closely with them.

Read more

Interview with Poppyswap on Community Herbalism

I had the pleasure of having a conversation with the amazing, inspiring folks at Poppyswap, where I shared some information and background on the Olympia Free Herbal Clinic and the Dandelion Seed Conference: Herbal Medicine for Community and Social healing. Check out the post here. Here are some excerpts to tantalize you.

I think we’re going to be seeing the emergence of a new model of herbal practice and education, for a couple of reasons: An adaptation to changes in the healthcare industry and regulatory agencies, and to engage the larger social system and other social and environmental movements in large-scale change. Herbalists are uniquely positioned to be agents of change and transformation because they stand and work at the nexus of human and Nature, and are oriented to affirming and nurturing life in all its manifestations.

Herbalists innately understand life, complexity, diversity, and resilience. These ideas and topics are now becoming very in-vogue and seen as innovative with social change theorists, social entrepreneurs, activists, etc. But they’re the very foundation of herbal practice, and that’s been with us since the beginnings of mankind. This is our heritage; the torch we carry onto the next generations.

And when asked advice I’d give to new herbalists:

I think the most valuable piece of advice I could give is to encourage people to stay open, curious, and inquiring. It’s so often the case that we get extremely inspired or even overwhelmed by the work of others. It can either light up, expand and energize us, or fold and turn inward, closing us and inciting insecurity, envy, and smallness. Herbalism is a beautifully brilliant, dazzingly complex and dynamic field. People spend their whole lives developing mastery, and always feel like there’s more to learn. My best teachers have been ones that I’ve observed to be open, humble, inquisitive, and ever supportive of other herbalists. It’s being a stepping stone, and someone that empowers others, even if it doesn’t feed your ego. Just be open, be happy to learn, support the success of others, and welcome the hard and necessary lessons. Try not to take things personally. And also, try not to be a jerk. (It’s just a good life strategy in general.)