The need for long-term thinking in medicine: Cinnamon as a case study

Here in Vermont, we are approaching the first anniversary of a storm that, over less than a day, poured an incredible amount of rain over the mountains, down the streams, and into narrow river valleys. The hill towns were quickly overwhelmed and literally swept away on huge torrents of water. These types of events are outliers, “hundred-year” floods. We tend not to think about them until they happen. If a river floods one spring, and washes away our garden, we could just build a retaining wall and be fine for years. But in Vermont, it seems that sort of thought process may have contributed to the severity of last summer’s event: narrower valleys, more constrained riverbeds, actually increased the torrent’s force and destructive power. As we rebuild, civil engineers are taking this into account.

In fact, there is a growing realization in many professions and disciplines that we need to approach the world with much more long-term thinking. Perhaps pumping out wetlands and building cities isn’t the best idea. It might be smart to consider sources of energy that aren’t going to run out fairly soon. When educating, connection to long-term curiosity might be better than passing the next test. Social and ecological concerns in market-based economies might trump the need to make a buck.

I dare say that medicine is beginning to embrace this trend, too – or at least people are. People who are interested in real food that may not require contaminating the water supply to cultivate, and who feel like this food might be better for their long-term health (though missing the tasty nacho cheese). People who consider a fever the sign of a healthy reactive response, and watch it for a bit rather than immediately suppresing it. People who are beginning to think that diabetes may be connected as much to ubiquitous, unregulated sugar in the food supply as it is to increased weight, lack of exercise, or “poor self-control”.

Which brings me to cinnamon. A recent meta-review found a small but significant effect from the powdered bark of this fragrant member of the Laurel family in treating the elevated blood sugar levels associated with Type 2 diabetes. I recommend this plant to clients concerned about this disease, either as part of breakfast or – my favorite – mixed with stevia, almond butter and cacao and rolled into “bliss balls”. It is best to take it regularly, as part of a long-term habit that includes real, bitter food and lots of movement. In this context it’s delicious, easy to take (doses are in the teaspoon range), and effective. 

The effect is, indeed, small when observed in isolation and for short periods of time. But diabetes (at epidemic levels) isn’t a problem that develops overnight, folks. I doubt anyone in the food industry, somewhere between the middle of the 19^thcentury and the middle of the 20^th, was saying “whoa - wait a sec, guys. I think that all this tasty sweet stuff (and elimination of all botanical biodiversity in the diet) might actually lead to epidemic levels of a sugar-metabolism disease in the next century!” No, that would have required seriously long-term thinking in matters of public health. And a little more knowledge of the human body.

Well, today we have a little more of  both. But research still looks at botanicals for three to four months most of the time – and this is partly because research is still beginning. When more time and interest are devoted to certain plants, such as the 2012 analysis that showed soy food consumption leads to lower recurrence of estrogen-positive breast cancer, striking results are revealed. But even this research only followed ten thousand women for seven years. Would that we had multi-generational followup data for cinnamon, endive, and dandelion roots! We might see a reversal of the grand experiment in carbohydrate refinement that gave us the current diabetes epidemic.

Short-term thinking gives us a need for dramatic, immediate results that might fit within the constraints of our current research model. This is great for many acute and chronic diseases, but not as great for matters of public health or for analyzing cultural patterns that lead to the diseases themselves.  Often, we learn about these matters from retrospective studies – discovering a problem after it’s already well-established. Long-term thinking takes a break and asks “if left alone, what might this situation look like?” Long-term thinking wonders how the river might handle a hundred-year flood if we hadn’t intervened to alter its course, how a population’s blood sugar might look if we hadn’t altered its food supply. 

Type 2 diabetes is a long-term effect of short-term thinking (satisfy my hunger now, and in a way that can be easily produced, stored, transported and packaged!) Its solution has to be based in long-term thinking, and part of that might very well include herbs such as cinnamon. The reason they are important is that, unlike a pharmaceutical solution, they provide an inroad to self-care based on whole plants and food – elements of life which, along with movement, end up being the keys to successful prevention of diabetes. If your mother started making cinnamon bliss balls when you were little, you might grow up eating them and eventually making them for your friends and family. Who knows what other bizarre plants you might consume along the way. Lo and behold, two generations later population levels of diabetes, obesity and heart disease are lower. I’d give you a rose to celebrate, but we all know there’s no research showing roses are effective as mood-lifters.

Some argue that, since the effect of a botanical such as cinnamon is small compared to conventional drugs, it should be rejected as part of our approach to diabetes. Ironically, the argument is that using cinnamon perpetuates a pill-driven, not lifestyle-driven, mentality for handling the disease. Call me crazy, but I’d respectfully argue that it’s probably pharmaceuticals that are driving this mentality, and that the search for a cinnamon capsule as an “alternative” is a first baby-step towards a different way. In the hands of an herbalist, baby steps turn into hikes in the forest. That could be a good thing – and a complex, multi-layered approach to diabetes that includes cinnamon most certainly is. 

Say what you will about an over-reliance on short-term clinical trials to drive therapy (or just read the British Medical Journal). Aside from the caveats (some of which I mention above), the approach is often a good one. But the offhand rejection of botanicals such as cinnamon, especially when they show promise, is actually harmful to public health. It is also a product of very short-term thinking. This is a problem that we need to resolve if we want to advance the cause of medicine and improve global quality of life – and herbalists, as those who, across the world, know what local plants do, are well placed to be part of the solution. Herbalists know the plants, but they also know that moving your vegetables over a little and supporting the community of cattail and calamus by the riverbank might be a better choice than a retaining wall, though it requires a (small) sacrifice in the short-term. Herbalists know that a bouquet of flowers makes you happy even though there’s not a single study out there to prove it. And they are usually inspiring teachers, too – the perfect choice for a diabetic patient. 

All this requires a change in thinking about medicine. We need to be looking further over the horizon, at a future where the advancement of our species sometimes includes a return to older technologies – not because they’re old, but because they’re damn smart in a long-term context. A future where we observe and mimic nature in designing our systems not because it’s “natural” but because, in the end, it’s in our own self-interest (global warming? Hundred year flood?). Herbal medicine fits in perfectly here. It is the precise modality that offers cultural connection, self-empowerment, ecological awareness, and effective remedies! It is both a blueprint for the future and a safety net for the present. As a design element for the next century of medicine, it can bring long-term thinking into a branch of science struggling with its own pressing challenges, helping it to harness the tools of complexity and deep ecology that are driving other industries. Long-term, complex herbal therapy won’t look as flashy in the short term – but that does not mean it has no value. Give it time, and skilled hands – a garden takes a season to come to fruit.

Plant medicine heals more than just people

We often discuss how effective plants can be at supporting and gently bringing human beings back to a state of "wellness" (meaning that resiliency, vibrancy, passion are maximized). I've spent a lot of time exploring how this happens, reading through the historical record and perusing modern research, and on balance it seems pretty clear that medicinal herbs, trees, mushrooms and more are good at helping folks in need. But that's not what I want to discuss today.
Rather, I'd like to posit the idea that working intimately with the botanical world alters our lives in ways that transcend individual health. Of course, this is not a surprising idea: reality mirrors itself, and the skin is barely more than an illusory boundary. Nevertheless, as a person whose life was redirected, and perhaps saved, by trees and herbs, I want to share three ways in which these allies can have powerful effects beyond the individual.

First, the people. Herbalists, gardeners, and other plant folk are consistently the most cooperative and compassionate people with whom I've had the pleasure of working. They share knowledge freely, contributing to a vibrant living oral (and now digital) tradition. They are often excellent communicators, speaking easily in language of metaphor and myth, forest and field. Even the most "beginning" herbalists have taught me amazing lessons and come up with amazing insights - which is why I avoid ranking plant people based on experience, training, or whatever else. Nature's gifts aren't reserved for the well-learned - and those of us who have spent a lot of time studying may find that, in the end, we return to the simple source of life for lasting truth, and books fall away in the light of the green world. This engenders gratitude, and may be the reason plant people are generally gentle, compassionate, and giving. They are often amazingly creative, too - coming up with new pictures, herbal formulae, and solutions where science falls short. I don't mean to disparage any way of "knowing", as all ways are necessary. I simply feel that knowing through plants is so very beautiful, and makes its people beautiful, too.

Next, herbal medicine has a way of reconnecting our species to nature. Clearly a no-brainer: we get outside more, we tend to eat differently, we appreciate a woodland walk differently when we have an intimate knowledge of the green folk living all around us. This gets into our heads slowly, insidiously, and deliciously. Before we know it, we may find ourselves kneeling on a city sidewalk looking at plantain (the horror)! But I feel like the gift of reconnecting to nature that herbal medicine offers us is most clearly evident in what happens when nature and wild plants are removed from human life: this is what, in Western culture, we've been working on for a few hundred years. The results are dramatic: epidemics of chronic disease affect the population, not because of the rise technological medicine, but because of a removal of traditional medicine! Additionally, to support homogenized, un-wild, unchallenging food systems we are also creating epidemics of chronic disease in the environment: new chemical signals that affect fertility, waste material that alters climate and ecosystem balance, disorganized living arrangements that sprawl over the landscape. I may be overly optimistic, but I believe that we don't need to remove technology to fix these issues: we simply need to bring plants back in to daily life. Once we develop the botanical habit, herbs begin to mess with our heads (where we all too often live). As we lose our heads, we save our spirit - and spirit being all-encompassing and transcending the human species, we participate in a more sustainable dance with the rest of nature.

Which leads me to my final point of appreciation for herbal medicine: mystery. Anyone who has seen a plant effect a cure knows that there is something magical about this process, as it may never be able to be replicated again. The herbalist, plant, and client have somehow managed to work together, in that one timeless moment, and the feeling all (plant included!) are left with is similar to what you feel when you run in to a random friend in a random place at just the right moment. It is synchronicity beyond coincidence, and we glimpse for an instant what it is like to be the immortal Universe. A healing modality that respects and welcomes mystery is my kind of medicine: because in the end, no matter how much we dress it up or understand its details, a human physiology brought back in to balance always reveals an awe-inspiring mystery. All good scientists know this. Einsten, for instance, tells us:

The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science. Whoever does not know it and can no longer wonder, no longer marvel, is as good as dead, and his eyes are dimmed.

I have great faith in the power of herbal medicine to heal not only people, but also culture, species, and ecology. It's really pretty simple: we really need plants in our lives. Even only a little bit. And once their green tendrils begin to grow in our hearts, like the first pea vines of spring, there is no turning back. Thank goodness - thank greenness.
In gratitude, I leave you with the words of Peter Conway, English herbalist, philosopher, and erstwhile humorist.

The future of herbal medicine is the past of herbal medicine - self care & psychedelics - serious...

Integrative student clinic at Johns Hopkins

Allegra Hamman has just been hired as a clinical herbalist to complement the care provider team at Johns Hopkins' Student Health and Wellness Center. She is a nurse practitioner (advanced training, similar to that received by a physician's assistant) with years of experience in the conventional medicine field. This June she received her Master's Degree in herbal sciences from Tai Sophia Institute, making her eminently qualified for her new position.
Though I don't know Allegra or her professional style, I am encouraged to see prestigious institutions such as Johns Hopkins responding to the demand they see in their clinics. As Alan Joffe, clinic director, put it: "There is clearly a group of students at Hopkins who prefer approaching health from a perspective other than what traditional Western medicine has to offer; I want to provide those students with some of those services."
Finally, I believe herbalists, as "generalists" well-equipped to handle a variety of complaints commonly seen in the "family practice" setting, can do a lot meet the needs created by a nationwide physician shortage. We represent an effective treatment modality, with a long historical record and excellent safety. Of course, there will always be those at institutions such as Hopkins who have to push back hard against these changes - largely, I might add, out of ignorance of the herbalists' skills and qualifications.

Canadian herbal product regulation

There's a somewhat alarming development afoot in Canada relating to the sale, use and dispensation of herbal medicines and "natural" supplements. We've been following the discussion on herbal product regulation here in the United States, and looked briefly at the impact that Canadian legislation passed in 2004 (very similar to the FDA's current rules) and the impact it's had on herbalists.
Now, the Canadian Ministry of Health is attempting to pass a bill that would radically step up enforcement of the new, stringent rules. These regulations are largely based on the framework of the Codex Alimentarius, a global agreement designed to 'harmonize' the preparation and dosing of various medicinal substances, from vitamins to herbs. Therefore, herbal products would have to be of ineffective potency and completely divorced from any health claims to be able to skirt this new legislation. No longer interested in regulating only drugs, the Canadian government wants to broaden its scope of oversight to all 'therapeutic substances' with this new law. Oh, and it steps up resources for enforcement and lowers the requirements for search and seizure (beware the herb police).
Many are showing righteous concern (here's a good legal summary from a concerned perspective). If the trends continue, we could see this coming in the United States soon.

Herbs regulated as drugs?

Michael McGuffin, President of the American Herbal Products Association wrote an interesting counterpoint in response to an editorial in the journal Clinical Pharmacology and Therapeutics (full text for both should be available for all starting in April 08). J.D. Morrow, a pharmacologist from Vanderbilt University, essentially argued that the FDA has had way too little authority under DSHEA, the act passed in 1994 that classes herbal supplements as 'foods' and regulates them as such. His concerns:
. "A major problem with the DSHEA is that the FDA bears the burden of proof if it decides to assert that a supplement is unsafe".
. "Many supplements contain active ingredients with the potential for serious adverse pharmacological effects if administered in excessive—or, in some cases, even recommended—dosages".
. "The sheer amount of usage and number of products available make adequate oversight of dietary supplements extremely difficult and provide the potential for agents with significant toxicity to enter the marketplace".
Well, thankfully, in order to safeguard us from certain doom, the FDA issued its final rule last summer to help address some of these concerns. Indeed, J.D. Morrow was involved in the commission that pushed for the approval of tighter standards. Nevertheless, he continues:
. "These needed regulations have been a long time in coming but are clearly designed to make more uniform the quality of products sold to the American public".
. "Again of concern, however, is the ability of an understaffed and underfunded FDA to enforce these regulations without additional support".
As I have always suspected, the FDA will require an armed enforcement unit! Only then can we ensure adequate product uniformity.
Morrow concludes that "there is little, if any, evidence that most agents are medically efficacious" (really?) and that therefore "enhanced regulation of the dietary supplement industry (...) must be done immediately".

McGuffin provides some needed clarification in the description of the current regulatory framework. Under DSHEA,
. "a statement for a dietary supplement may be made if…the manufacturer of the dietary supplement has substantiation that such statement is truthful and not misleading".
. "[Starting on] 22 December 2007, all marketers of supplements (and nonprescription drugs) must submit reports of serious adverse events that they receive. The FDA’s role in regulating dietary supplements has thus been expanded significantly".
. "Criticisms of herbal supplements tend to focus on areas in which federal regulatory agencies fail to enforce the current laws. (...) But these are not failures in the law; these are examples of
the need for more active enforcement of existing law".
As for the new GMP (Good Manufacturing Practices) rules in last summer's FDA pronouncement,
. "These regulations are much more extensive than the standard cGMP rules for conventional foods. The FDA acknowledged that some provisions of the new cGMP rule “may be similar to
the existing drug CGMP regulations,” and many sections of this new rule are borrowed directly from the cGMPs for drugs".
. "In addition, the FDA has assigned itself records-inspection powers that greatly exceed its authority in the conventional food sector".
And, McGuffin concludes,
. "An “herbs as drugs” option could only be seriously considered for the United States marketplace if there is also a willingness to allow claims for the use of these products in the treatment, cure, and prevention of disease and if legitimate historical records are accepted to support claims for traditional use".

That is, the 'gold standard' of the double-blind, placebo-controlled trial would need to be altered for substances that have a long, substantiated track record of historical use.

It will be interesting to see what eventually happens in the United States, since the regulation of herbal medicine has been in a virtual state of 'limbo' compared to Europe, Australia, and the rest of the world. If we had a crystal ball, we might be able to see how heightened regulations and 'professionalization' of herbalists and herbal products might affect our ability to practice our art in the future. Oh, but wait -- we have Canada (which works almost as well):

So many of us are afraid we’re going to go out business. Some people plan to go underground, some people plan to go defiant and see if they’re actually willing to put us in jail . . . we are like the weeds and will never be eradicated.

So spoke an unidentified Canadian herbalist in response to the new regulations that govern natural health products (NHPs). Here is a brief summary of the historical context:

"Until recently, NHPs in Canada were regulated as either foods or as drugs, as stipulated by the Food and Drugs Act. A major impetus for the creation of new NHP regulations was widespread concern that the Food and Drug regulations were inappropriate for NHPs (...) A new regulatory framework came into law January 1, 2004, with a transition period of 6-year. NHPs, including herbs, vitamins, minerals, essential fatty acids and homeopathics which are used to prevent, diagnose or treat disease, restore or correct function or maintain or promote health are now classified as drugs at the level of the Food and Drugs Act".

Very much like the progression we're seeing folks like Morrow advocate. For Canadian herbalists, these new regulations are much more difficult and may well force many underground. As American herbalists have oft lamented,
"smaller companies tend to be run by people who are herbalists, and herbs are their life, and they are very fussy about the quality of the herb and the manufacturing of the herb (...) They're going to make it very difficult for small manufacturers to continue to operate. I really think that they’re treating NHPs as if the risks associated with them were equal to the risks associated with drugs".

We need to think deeply about the costs and benefits associated with increased regulation in a framework that relies on conventional approaches to research, manufacturing, and delivery of medicines. All the components of such a network are extremely different in American herbalism (and, in fact, a unified framework is very difficult to pin down). But if we can be flexible and examine the effects of substances based on their historical context, modern research, and current folk wisdom, then perhaps we can learn to alter our entire approach to health care. After all, form follows intention, and as long as we advocate abstracted, culturally disconnected research as the only way to 'truth', we will continue to experience increased costs, side effects, adverse events, and chronic disease.

Michael Pollan and Real Food

Food - our basic sustenance, one of our most primal interfaces with the natural world - plays a crucial role in the ongoing creation of ourselves, and in the maintenance of the all-important "internal balance". So, when we begin to lose our balance with the food we consume, it is no wonder that "disease" sets in. And it is no wonder that these "diseases" are slow to progress, leaving us in a state of chronically deteriorating health.
So, to re-enliven the body, mind, and spirit, herbalists have always been strong advocates for an old-time, whole-food, plant-rich diet - with some extra punch now and again in the form of herbs and spices. I've read some excellent thoughts on this subject over at The Herbwife's Kitchen, and have become quite suspicious of any larger company (witness Kashi / General Mills) trying to sell me something in a box.
So it was with great pleasure that I listened for a little while to Michael Pollan, author of The Botany of Desire (one of my favorite modern descriptions of the human/plant bond). Amy Goodman interviewed him on Democracy Now! and his comments clearly articulate the perils of overthinking and overprocessing the food we eat. The wide-ranging interview discusses the history of the food-industrial complex in the USA; 'nutritionism'; chronic disease and its link with food; whole foods, local foods; biotechnology; and more. Some comments:

And, in fact, one of my tips is, don’t eat any food that’s incapable of rotting. If the food can’t rot eventually, there’s something wrong. (...)

And the last premise of nutritionism is that the whole point of eating is to advance your physical health and that that’s what we go to the store for, that’s what we’re buying. And that’s also a very dubious idea. If you go around the world, people eat for a great many reasons besides, you know, the medicinal reason. I mean, they eat for pleasure, they eat for community and family and identity and all these things. But we’ve put that aside with this obsession with nutrition. And I basically think it’s a pernicious ideology. I mean, I don’t think it’s really helping us. If there was a trade-off, if looking at food this way made us so much healthier, great. But in fact, since we’ve been looking at food this way, our health has gotten worse and worse. (...)

Cholesterol in the diet is actually only very mildly related to cholesterol in the blood. It was a—that was a scientific error, basically. We were sold a bill of goods. (...)

We learned how to grow food with lots of synthetic fertilizers made from natural gas, pesticides made from petroleum, and then started moving it around the world. So now we take about ten calories of fossil fuel to produce one calorie of food energy. Very unsustainable system. (...)

and, in conclusion:

Well, the interesting thing is that most traditional cuisines are very healthy, that people—that the human body has done very well on the Mediterranean diet, on the Japanese diet, on the peasant South American diet. It’s really interesting how many different foods we can do well on. The one diet we seem poorly adapted to happens to be the one we’re eating, the Western diet. So whatever traditional diet suits you—you like eating that way—you know, follow it. And that—you know, that’s a good rule of thumb.

There’s an enormous amount of wisdom contained in a cuisine. And, you know, we privilege scientific information and authority in this country, but, of course, there’s cultural authority and information, too. And whoever figured out that olive oil and tomatoes was a really great combination was actually, we’re now learning, onto something scientifically. If you want to use that nutrient vocabulary, the lycopene in the tomato, which we think is the good thing, is basically made available to your body through the olive oil. So there was a wisdom in those combinations. And you see it throughout.

Pharmaceuticals in tap water

An investigation by the Associated Press reveals some disturbing facts about the presence of a variety of medications in the public water supply of at least 41 million Americans. Major metropolitan areas were sampled along with representative rural communities from all 50 states.
The array of pharmaceuticals includes seizure medications, antibiotics, mood stabilizers, steroids and other hormones, and more. While it may be in the best interest (of someone) to over-medicate the American psyche with antidepressants and muscle relaxants, it is of immediate concern to see high levels of antibiotics entering the environment and registering appreciable quantities in water. It is no wonder antibiotic resistance is so prevalent amongst pathogenic bacteria.

FDA supplement regulation update

Ever since the Food and Drug Administration released its 'final rule' on the manufacture of dietary and herbal supplements, herbalists have been wondering exactly how some of the byzantine record-keeping requirements might be enforced, and whether small-scale or one-time batches of custom formulas might be exempted, or at least overlooked.
This is a special concern for practitioners who, despite Ernst's protestations, continue to blend individual formulas for individual clients. There has been concern that these formulas might be subject to the same rules of production (not in your kitchen - unless you just installed that negative pressure fan and have no pets or food in there) and record-keeping (samples of batches for years) that large supplement companies now have to follow.
Well, apparently Vasilios Frankos, Ph.D. (Director of FDA's Division of Dietary Supplements) clarified the situation a little at a recent workshop in Washington, D.C. on Traditional Chinese Medicine. He was speaking in reference to a direct question on the requirements for practitioners of herbal medicine working in one-on-one consultations. Here are some quotes:

'We are not going to be enforcing the GMP for practitioners in
one-on-one consultations'.


'We are going to stay out of the individual practitioner relationship'.

Seems like a decent turn of events: we're still breaking the rules, but they promise to leave us alone (for now). Because, of course, the FDA still retains 'enforcement discretion'.

Herbal research often of 'higher quality'

A study published last year in the Journal of Clinical Epidemiology looked at over 80 clinical trials in Western phytotherapy and compared them to similar trials (matched in size, power, scope, and results) in conventional medicine. It's often believed that trials focused on herbal medicine are of inferior quality, relying on poor methodology, and therefore less trustworthy. Of the studies analyzed in this review, over 20% of those focused on herbal medicine were deemed of 'higher quality', while only 5% of those for conventional medicine met the same standard.
While this is not conclusive proof that studies on herbal remedies always have better methodology (see this correspondence for an good opposing viewpoint), it does at least make us question the validity of the mainstream rhetoric that always portrays herbal science research as inferior and therefore unreliable.

Chemically modified curcumin

Curcumin, one of the polyphenols present in Turmeric, has a long track record of positive research relating to its anti-inflammatory, anti-cancer, and liver-protective effects. It is a mild and generally well-tolerated addition to the diet, and even concentrated extracts of the Turmeric rhizome (like New Chapter's TurmericForce) work well without having to take multiple daily tablespoons of the spice (see here for my articles on this spice).
Now, Japanese researchers have gone in and chemically modified curcumin, which is already an isolated constituent of Turmeric and contains none of its beneficial mucilage and fewer aromatic constituents, and given these modified chemicals to rats with colorectal cancer. The results: the new chemicals seem to work better.
My main comment on this research, other than the fact that it was performed on rats, is that it continues the misguided trend of taking botanical substances, refining them, and modifying them for an 'enhanced' effect in the human physiology. Historically, my favorite example of this trend is the opium -> morphine -> heroin chain, which has certainly done wonders for the human race. The problem with this approach is that we have no understanding of, and therefore no way to predict, the effects of long-term supplementation with substances our physiology hasn't ever seen. This is in contrast with unaltered, whole-plant preparations, which are not only familiar to our metabolic pathways, but probably created those pathways to begin with.
In the long run, many modified chemicals, while potent in the short term, leave the body with unwanted side-effects and often further weaken the system. I am fully in support of ongoing research into the chemistry and effects of plant constituents, but please, let's wait a little until applying them to humans in refined, or modified, forms.

AHG Symposium - Part 3

This is the third and final post in a series reporting on this year's Herbalists' Guild convention. Part 1, Part 2.

Simon Mills, author of some of my favorite herb books such as Out of the Earth, lectured on his idea of acupharmacology. The basic concept is that part of herbal medicine's effects can be understood by observing their effects on the gastric mucosa, an internal second skin, and the reflex pathways between the gut wall and the rest of the physiology as modulated by the central nervous system. This is just one of the ways herbs do their thing - but if you've ever seen the effects of a demulcent on anxiety, you know what I mean.
Simon went on to discuss the relationship of gut tissue not only with neurons, but also with the immune cells and tissues embedded in the gastric lymphatic system. The endocrine / immune secretions from these tissues serve as another channel of systemic effect, modulating stimuli received from herbs. He continued with a fascinating exploration of the role of the immune system in many pathological states. Some highlights:
- Pierre Graber, old-school immunologist, described a different understanding of the immune system in a 1974 paper in the Lancet (not much info available online). Rather than a "police squad", he viewed the immune system as a clean-up crew to support digestive processes (by removing any antigenic protein chains left undigested) and to support tissue autolysis (help clean up old pieces of tissue to make way for the new). Additionally, antibodies seem, in Grabar's view, to be more like transport proteins than markers of certain doom. They attach to these incompletely digested proteins and pieces of old "self" to make sure they don't interfere with cell-to-cell signaling as they get escorted to phagocytosis.
- Protein sequences on bacterial cell walls can be very similar to sequences found on our own cells. This has led to the identification of initial "insults" by bacteria which activate the immune response and lead it to attack self: for instance, Kelibsella and ankylosing spondylitis; Proteus bacteria and Parvovirus in rheumatoid arthritis; Mycobacteria and E. coli in Crohn's disease. This is not only interesting in terms of understanding autoimmunity, but reinforces the idea that herbs can modulate these inflammatory processes by acting through the immune system (and thus across the whole physiology) without their metabolites ever needing to leave the gut.

Along these lines, Kevin Spellman went into a fascinating discussion, including the presentation of his original research, on the role of Echinacea and Dandelion roots in treating an allergic reaction. The details:
- three cases involving rashes, hives and anxiety following the ingestion of an unknown Chinese herbal formula (different in each case, I presume).
- treatment with high doses (1tsp every 30 minues, roughly) or Echinacea and Dandelion root tinctures, which helped almost immediately (after the second dose).
- Kevin proposed that Echinacea (and Dandelion, though differently -- perhaps through inulin and its acupharmacological effects) helped diminish the acute allergic Type-4 hypersensitivity in the three cases.
- Echinacea modulates the expression of pro-inflammatory cytokines by acting on cannabinoid receptors on the surface of immune cells, and lessening the production of NF-kappaB and therefore the transcription and expression of inflammatory proteins.
- Kevin (and Nadja Cech, amongst others) showed that Echinacea alkylamides suppress IL-2 production, a pro-inflammatory cell-to-cell signaling molecule. This build on previous research showing similar results.
- Coupling these new results with Echinacea's history of use as an immune booster, we see a complex emerging picture of this plant as a true immunomodulator. Regardless, it gives us an interesting hypothesis for understanding how and why this plant might have helped in an allergic reaction! And, it continues to debunk the idea that Echinacea shouldn't be used in autoimmune conditions.

Robert Duggan, President of Tai Sophia, gave the keynote lecture at the banquet (love that Sheraton, guys!). He offered some beautifully iconoclastic pearls of wisdom:
- Don't let people off the hook by telling them you will "treat" their disease. Illness is an ally!
- Natural healing modalities function as ways to increase perception and consciousness, thereby allowing one to listen to and act upon the messages illness brings.
- Don't let herbalism become what acupuncture has - licensed, squabbling over recognition, standardizing treatment. And this from a man who, though he regrets it, spearheaded the original licensing push by acupuncturists.

Chris Hobbs talked about herbs for the respiratory tract. (His powerpoint for the lecture should be available soon). Some new info for me:
- Useful expectorants: young fresh tips of English ivy; Maidenhair ferns; Smilacina (False Solomon's seal) roots.
- Willow bark should be collected in the spring, well before leaves appear, and only from small, juicy branches. Its aromatic, wintergreen-like smell should be clear and strong. Higher elevation sources seem more potent.
- Honeysuckle (Lonicera japonica) for fevers - cooling and delicious!

There was an infectious disease round-table in which I participated. We talked about the emerging problem of antibiotic resistance (esp. MRSA in clinical herbal practice) and herbal approaches to treatment: Echinacea, Baptisia, Cryptolepsis, Artemisia, and topical preparations. We also discussed the threat of pandemic influenza, and divided its risk into two main categories: the pathogen itself, which can kill people with weak immunity (young and old, especially); and the inflammatory cytokine storm that accompanies the infection in those with strong immunities, basically liquefying their lungs. In the latter case, immunomodulants like Scutellaria baicalensis (and perhaps high doses of Echinacea alkylamides, see above) might be more useful than actual antivirals.

Finally, it was great to see old friends and make new ones. Mischa is getting a study together on the use of Wild Carrot seed in contraception. I got to meet Maria, of Dirt Under My Nails fame. Check out her symposium post for info on lectures I didn't attend. And many thanks to Jillian, who was kind enough to host us, join in some late-night music making, and expose us to some interesting Aguardiente combos from the Amazon. I came home inspired with new ideas, and excited about the new herb school we're starting in Montpelier.

AHG Symposium - Part 2

This is a continuation of the conference report for this year's gathering of the American Herbalists' Guild.
Pam Fischer, from Berkeley, CA, discussed the free clinics she's set up and been involved with for over 7 years. It was an interesting discussion, and I enjoyed looking at diverse models of herbal care accessibility, hearing 7Song talk about the Ithaca Free Clinic, and mentioning my own work. Pam had some interesting models to discuss, and some pearls of wisdom from her own experience:
- herbalists have been joining up with pot clubs in the Berkeley area to offer their help with medicinal herbs other than Cannabis. Great idea! Tough here in Vermont.
- echoing my own experience, Pam recommends hiring a paid administrator / staff person to prevent volunteer burnout. I highly recommend this.
- running a clinic that is completely "free" can be politically correct, but it can also shut out folks who might want to contribute financially. Pam's clinic is entirely by donation; she calls it a "community herbal clinic", and focuses on its role in supporting the herbal community rather than its "freeness". This is an interesting point; I'm still not sure where I stand on this issue (having generally seen good compliance rates, good followup, and plenty of donations even when advertising as "free").
- compensation for the herbalists is derived from a pool of funds. This pool is fed by individual private practice sessions, donations, apothecary sales, and student tuitions.

Paul Bergner, of Medical Herbalism fame, gave a nice introduction on energetic assessment and its importance in the herbal consultation and in formulating a treatment plan. After all, if we can't tailor our recommendations to individual constitutions, we're just treating disease! Generally, herbs work a heck of a lot better if they're matched to individual constitutions. This also is the basis of one of my complaints with the double blind, placebo-controlled trial: almost none have a way of dividing populations based on simple constitutional profiles: diaphoretics may help improve circulation in a 'hot' constitution with cold hands and feet, but will do little for a 'cold' constitution with the same issues. Some interesting points:
- Three polarities: vitality / deficiency; hot / cold; moist / dry. You can figure these out with just a little common sense and good observation!
- If there is low vitality, there are usually three potential reasons why: low rest, low digestive fire, or poor food. To this I'd add an assessment of exercise and movement, too.
- As vitality is restored and the physiology becomes more capable of producing an inflammatory reaction, it will. This is the 'healing crisis', and follows Hering's Law of Direction of Cure.
- Healing crises show up in personal relationships (plateau -> conflict -> higher level) and in society as a whole. If fact, Paul made the case that our society is very deficient in vitality, because it doesn't react violently anymore. There are few protests, and little activism, compared to 45 years ago. His assessment: an acute illness that flared in the 1960s was generally suppressed. Emotional symptoms followed, and were expressed in the 1980s with its greed, corruption, and societal stratification. This was also suppressed, and now in the 21st century our illness has become spiritual...
- The rest of the lecture was a review of pulse and tongue assessment and its role in determining relative degrees of heat and moisture. Paul was clear to say, and I agree, that pulse and tongue are merely corroborating signs, and not definitive diagnostic tools.

...more to come, including Simon Mills and acupharmacology; Robert Duggan and some amazing philosophy of healing; infectious disease clinical roundtable; some herbs for the respiratory tract as suggested by Chris Hobbs; and original research by Kevin Spellman on Echinacea, Dandelion, and autoimmune inflammation.

AHG Symposium - Part 1

Well, this year the American Herbalists' Guild conference is being held in Columbia, MD at a big Sheraton in the middle of a corporate office park. Certainly not my favorite setting -- but some excellent people nevertheless.
The session began on Friday morning with the annual meeting of guild members. It was led by Aviva and Tracy Romm, President and office manager for the Guild (Tracy also organizes the conference). Some highlights from the conversation:
- Aviva is interested in growing the Guild, recruiting more members, gathering more funds. She also lamented the fact that the grassroots, volunteer-based flavor that shaped the Guild ten to fifteen years ago has fallen away as full-time staff has taken on greater responsibility. My feeling is that putting money into a national organization might not be as effective as mobilizing the grassroots again. And, as K.P. Khalsa (herbalist and finance guy) pointed out in his report, the Guild makes between $2,000 and $5,000 a year in profit, which it's put in the bank and is just sitting on.
- We talked for a while about a national certification exam for clinical herbalists. The general consensus: not a good idea. This reassured me. Certification usually, historically, leads to assimilation. In the case of herbalism, this would not only hurt our discipline, but also cut off the potential for rebalancing the modern healthcare paradigm that herbalism offers.
- Lupo, a young herbalist currently living in Connecticut, was elected to the Guild Council as a general member. I think she will bring an excellent voice to the Council -- and those of you who may know her would probably agree.

Jonathan Treasure, whose personal philosophy I resonate with and whose writing I thoroughly enjoy, gave a talk later on Friday called "Herbs don't work". The point, of course, is that the inherent vitality of the physiology does most of the work, and that herbs and herbalists are catalysts and helpers for the process. Other interesting tidbits:
- Part of magic is the ability to manipulate human consciousness. Our current culture seems to be an expression of a massive 'spell' cast upon millions.
- When a magician comes to believe his/her own spells, a dangerous fanaticism can ensue. To me, this means that the wholesale acceptance of any model that describes reality is risky and leads to inflexibility, a lack of adaptive power, and a tendency to reject those who do not share your world-view. This seems to be what has happened to our modern medical paradigm - a seductive spell, to be sure, but the resultant fundamentalism is all too apparent when we look at obsessions like 'evidence-based medicine'.
- The idea of 'integrative medicine' can mean many different things. Today, some MDs and medical clinics practice what they call 'integration' - but in many cases, this simply means using meditation, biofeedback, and occasional standardized herbs as adjuncts to practice. There is no shift in philosophy, no shift in belief. This is simply co-opting, not integrating! JT recommended Ken Wilber for his work on defining true integration and holism. Check out Integral Psychology and Integral Spirituality for more.
- Once we accept magical flexibility and integrate ourselves into whole beings, the distinction between hero (healer / herbalist / doctor), villain (disease / doctor / herbalist), and innocent (patient / herb / drug) disappears as we see the trinity synthesize into oneness. Practically speaking: herbalists must talk to the modern medical community, with compassion, with friendship. It comes back to what I've always maintained: no personal philosophy should take precedence over client well-being!

Antibiotic resistance update

Bacteria are getting better at eluding technological medicine's open attacks. I've been following the mainstream media's reports on this subject for a while now, and especially in this last year things seem to have begun an exponential rise.
Of chief concern is a variety of Staph bacteria, known as MRSA, that is highly resistant to powerful antibiotics, as well as being way more virulent. And now some numbers are in: MRSA has killed an estimated 19,000 Americans in 2005 and made 94,000 seriously ill.
Additionally, a strain of bacteria sometimes involved in middle ear infections (Streptococcus pneumoniae) is evolving antibiotic resistance that may have come as a response to increased vaccination rates and the overuse of drugs for ear infections.
Folks around the country are getting worried as these bugs spread from the hospital to the community. Dallas, where a teenager died from MRSA in March, is monitoring local schools. Bedford, VA has shut down all its schools after a student died of MRSA today.
This is getting scarier, and it seems to me that a moratorium on antibiotic use (unthinkable to mention even 10 years ago) for all but the most dire emergencies is almost in order. But if we can't use antibiotics, what on earth can we use to treat ear, skin, and lung infections? We are powerless!

Custom herbal formulas just don't work

There's new research out that attempts to answer the question of whether individualized herbal blends, as formulated by a practitioner, are better than single standardized herbs. I'll just skip right to the editorializing bit, because it's so well-reasoned and balanced:

This study sets a new benchmark for the tailored approach: not only must herbalists demonstrate that individualised treatment is superior to placebo, they must also
show, for reasons of cost and safety, that it is superior to standardised treatment. Claims by herbalists who use the individualised approach that their practice is evidence based are disingenuous; this is because evidence supporting the use of herbs for any indication has come almost entirely from the study of single, standardised herbal extracts, not from studies of individualised herbal medicine using combinations of several or many different herbs prepared from inherently variable raw plant materials. The paucity of data supporting the effectiveness of individualised herbal medicine, and the important safety concerns associated with this particular form of phytomedicine, should be taken into account by policymakers
concerned with the regulation of practitioners using this modality.

Overall, the results of the three studies included in this review do not provide support for the use of individualised herbal medicine in any indication.

So there you have it. Custom blending of herbal formulas just doesn't work.
This study is really just a research project where the authors selected 3 randomized, controlled trials from over 1,300 pubmed results. The trials covered Western herbs for osteoarthritis of the knee, Chinese herbs for irritable bowel, and Chinese herbs for chemotherapy support (this last one was terminated early due to difficulty recruiting subjects). With such limited results, why do the authors choose to call for increased regulation of herbal practitioners, rather than more, better, research?
Perhaps because Ed Ernst is at the helm. Jonathan Treasure has been following this man's career for the last little while, and the history is pretty interesting (his herblog reviews this latest study fully for your pleasure, although it comes with an 'adult language' warning). To me, it's just another fairly immature and certainly non-productive use of research time and money. In this climate of diversification, increased government worry and oversight, and the grassroots integration of effective, individualized herbalism into the modern medical system, Ernst's editorials may actually be irresponsible, too. I wish someone paid me a lot of cash to tool around pubmed with an agenda.

2007 Herbal Convergence report

The Northeast Radical Healthcare Network hosted its second annual Herbal Convergence at Seven Arrows farm this past weekend. This gathering has been amazing so far - low cost, community organized, non-hierarchical, inclusive, conscious, accessible. I can't say enough about the organizers and the people there.
Lots was going on. It is a tumultuous time in the herbal world, and I think the discussions reflected that.

Wendy gave us an update from the herbal care unit of the Common Ground Free Clinic in New Orleans. A non-profit, the Clinic's board of directors felt that unlicensed herbalists should not be practicing in the clinic the way they'd been doing since Katrina left most of the city's healthcare network crippled. While this might have seemed the end of an experiment in truly integrative free healthcare, the herbalists in New Orleans turned things around. They enlisted Phyllis Light, a professional AHG member, to supervise their work, and created defined protocols for herbal treatment in specific situations. Integrative practice continues!

Chris Monteiro of Providence, RI spoke about her acupuncture practice where low-cost and sliding-scale treatments are given to many people at once, reducing overhead and engendering a sense of 'peaceful community' for those relaxing in the treatment room.

I talked a little about the free clinics we run up here in Montpelier, now through the VCIH, and how coupling educational opportunities and community-grown medicines with the free clinic can help make it sustainable.

Rebecca Hartman talked live about her herbal philosophy, with a special focus on seeing the human physiology as an ecological system. She described insights for practice from a relational, ecological, and network-based vantage point (definitely good stuff, summarized here on her blog).

We heard reports from Just Food, where folks are organizing communities and local farmers in and around New York City to encourage community food production, fresh food availability, urban chicken and bee keeping, and networks of distribution and barter.

The Rhizome Collective in Austin, TX has been continuing with its urban sustainability work, organizing efforts, and ecological preservation. We heard about how they got a $200,000 grant to clean up and preserve a ten acre brownfield they now own. I was especially impressed by the construction of a floating island of plastic in a stormwater collection pond: anchored to this structure are wetland plants that help purify and control the water.

Mischa Schuler talked about her practice and work as a community herbalist in Cambridge, MA. I missed her class on herbal support for eating disorders, because my workshop on herbs and psych med use was at the same time, and was very disappointed about that. Mischa is a thoughtful herbalist who shared with us many of the practicalities of an herbal practice: making a comfortable space, finding the right place to work in and the right people to share space with, creating methods of recordkeeping, accessibility, and more. Living in Boston has strengths and weaknesses - but this place called the Fells sounds pretty awesome...

During and after my talk on the history of medicine in the US over the last 200 years, a lot of crucial issues were brought up. I feel that we are at a similar juncture in the history of herbal medicine to the one the Eclectics (and everyone else) faced in the mid-1800s: unregulated, diverse healthcare practices with a central government threatening (an imposing ) regulation. Onerous regs might create a two-tiered system: licensed and lay herbalists, 'professional' and 'kitchen' healers. How to avoid this split, avoid assimilation, and avoid 'banishment'? Some ideas, such as 'community-shared herbalism' where a collective group makes tinctures for itself, came out of the mix. This is something we want to try to build in Montpelier; I know others are working on it as well. But licensure will continue to be a hot debate!

I spoke with Kale (I believe that was the name) about research on the role of neuronal myelination in disorders such as bipolar depression and schizophrenia. This research seems to point at low mylelination levels for the former and higher levels for the latter, both in the brain's while matter and in the corpus callosum. Kale, if you can keep in touch about your research, I'd love to hear more!

Mary Blue, who is one of the organizers and a hostess for the gathering, also talked about her community living and farming project, called Farmacy, that involves urban sustainability, a farm and herb garden, composting toilets and graywater processing, and a kid's camp -- all from a small lot in Providence, RI. She makes tinctures and other medicines for local distribution. I commented to her how interesting, from a semantic and philosophical point of view, her choice of the name 'Farmacy' is: in the 70s, herbalists were moving out of the underground, and the tincture company was called 'Herb Pharm' (and still is - great company!). This name puts the 'Ph' into an earthy, farmlike concept: it injects science into nature's grounding force. Now, in the 21st century, herbalists create an organization like 'Farmacy'. This name puts the 'F' into a scientific concept: it injects nature's grounding force into science. I guess we've had a few years to think about it, but I do like the latter way of doing things quite a lot. And the Convergence is doing a good job of distilling this new, radical herbal instinct and bringing it into the light.

Hyperactivity linked to food additives

A British study published in the Lancet has documented the effects of certain specific food coloring agents (sunset yellow coloring, also known as E110; carmoisine, or E122; tartrazine, or E102; ponceau 4R, or E124; the preservative sodium benzoate, or E211; and other colors) and preservatives (primarily sodium benzoate) in kid's drinks. Over 300 children, roughly split between three and eight year olds, underwent the blinded trial. The results were striking: the drinks with additives were linked with higher rates of impulsivity, inattention, and general hyperactivity.
Critics of the study were quick to point out that this is simply an association, not a "cause-and-effect" phenomenon. True enough, but many variables were controlled in this research: drinks, which were given to children in a double-blind fashion, were the only sources of additives. Assignment of the laced drinks was random. And this study builds on previous data gathered by the British government (which is why it awarded over $1 million for this recent research).
So, in my opinion, we are beginning to get scientific backing to the herbalist's idea that synthetic food additives are not only damaging to the liver and metabolism, but also interfere with the psyche. In fact, as many herbalists might tell you, the link between the liver and the spirit is a very real one, and the metabolism of toxic synthetics can lead to inflammatory processes all over the physiology, not just in the nervous system. Back to whole, local foods!

Herbal medicine commentary: are we 'chasing fairies'?

"By proper Herbalism, I mean the variety practiced by Herbalists who have devoted many years of study to the application of herbs for medical purposes, as opposed to the fairy chasing brigade who hijack any therapy that they can practice with minimal effort..."

This quote is part of an interesting piece I was reading on ProgressiveU.org. The author comes down pretty hard on therapeutic ideas like "hot stones placed on (the) body, or ... mystical energy massages from Maori tribesmen", attempting to differentiate more modern, unsubstantiated modalities from traditional Herbalism as a valid, ancient art.
Let me clarify two points at the outset:
-first off, I work with fairies everyday in my garden. They help me out a lot, and the spirits that inhabit plants have broad-ranging powers and may be responsible for much of nature's medicine. In making this statement I am being very grounded and scientific: in my experience, 'fairies' are real, and have observable and testable effects.
-secondly, I deeply value thought processes that transcend reason and rationality, and I believe these processes are a vital part of the herbal tradition. Nevertheless, they cannot function alone. Throughout history, human beings (and animals) have evolved systems for understanding nature and functioning more efficiently as part of her. These systems rely on rationality, at least on a temporary basis, and greatly facilitate learning. Herbalism employs many such systems (energetics, herbal actions, physiology, phytochemistry, direction of cure, doctrine of signatures, and many more) and I love them all. In my opinion, it is a balance between intuitive, acausal, non-linear feeling and creative, pattern-based, rational thinking that makes an effective human. Herbalism teaches both!

That said, the author of the piece has some very valid opinions that made me stop and think. For instance:

"When somebody introduces certain herbs and plants into the body they have a tangible and explainable effect. Herbalism does not rely on some magical explanation, despite the fluffiness of some of the people who practice the tradition and their assertions to the contrary".

Not all effects can be 'explainable'. Modern doctors will be the first to agree with this! Besides that, what does 'explainable' mean? You can provide meaning to any set of circumstances. I think the point here is that herbalism does have a grounded component to its therapy, and that phytochemistry and biochemistry have danced together a bit and come up with some nice stories to tell. But, just because the effect of Rose elixir taken on the tongue is best explained magically, doesn't mean there is no effect.

Where Herbalism gets the short end of the stick scientifically, is in the fact that many herbal preparations have not been scientifically tested in controlled clinical trials. As a result preparations which have a history of effectiveness in treating ailments don’t have official scientific verification, not because they have failed scientific testing, but because they haven’t received it. Quacks and other alternative therapists exploit this to make a case for their remedies.

Two important points: a long history of traditional use is somehow not seen as evidence of validity, while scientific trials are. Couple this with the inability to patent crude plant preparations, and you have and perennial inadequacy set up for herbal medicines. The answer isn't necessarily just more trials (though this is great, too). It's to change the system that defines validity.
I can't argue that some 'quacks' exploit my attitude. And I hadn't really thought about that so much until I read this article.

Personally, I believe that legitimate Herbalists need to take a stand and speak out against suspect therapies in an effort to protect consumers and distance their discipline from the quacks. Herbalists should make greater efforts to safe-guard their patients from exploitation rather than just fighting with Western doctors. As an advocate of integrated medicine, I see the constant bickering between much of the Herbalist and Western Medical community as just tiresome and regressive.

This, to me, makes a whole lot of sense. We just have to be really careful in defining a 'suspect therapy': I can see that issue becoming a slippery slope all the way back to 'evidence-based medicine' and its exclusive reliance on the double-blind, placebo-controlled study.

I feel, from a deep, non-rational place inside me, that these issues (and others) are going to come swiftly to the fore of herbalist's discussions as the community evolves and interfaces with the American culture in all its craziness. I only ask that we try to be aware of the forces and ideas that are shaping our philosophies and worldviews, and stop briefly to ponder them. And that's the rational place coming out, right where it belongs.

Antibiotic resistance update

Reuters brings news from China that many bacterial lung infections that cause pneumonia are resistant to antibiotics. We've been following the reports of drug-resistant pathogens, mostly bacteria, and the response that government and healthcare establishments are considering.
Resistance seems to spread from centers of antibiotic use, with hospitals acting as 'universities' for bacteria to swap information and reduce their sensitivity to drugs (by altering metabolic pathways, structures in their cell walls, or both). While 70% of pneumonia cases were resistant in the Chinese 'countryside', that number reached 90% at major hospitals in cities like Beijing.
What's troubling is that, unlike poor manufacturing processes that lead to product recalls, antibiotic resistance is much like carbon emission: it has global reach and impact. Pneumonia can indeed be deadly, especially in weakened constitutions; and we do have drugs that the bacteria still aren't resistant to. But the trend in the last ten years is undeniable: let's not wait until all modern antibiotics are ineffective, and start incorporating more crude botanical preparations into the treatment protocols, especially for stronger folks, especially in hospitals!

Some herbs for active, moist pulmonary infections:

Warming expectorants: elecampane, lobelia
Antibacterials: garlic, thyme, eucalyptus, usnea
Diaphoretics: boneset, elderflower, ginger, cayenne
Antiinfectives: echinacea, osha

...and for convalescence: astragalus, red reishi

Of course, the sooner you begin addressing any lung distress, the better the final outcome. Still, I see no reason why some of these plants couldn't be incorporated into hospital regimens -- and it will happen, probably sooner than we think.

Bush dictates terms for state healtcare coverage

In a not-too-surprising move, the federal government has issues strict guidelines making it virtually impossible for states to offer health insurance to those over 200% of the poverty line. This is all done in the name of "returning focus to low-income children": but for a single mom with one child, 200% of the poverty level is just over $25,000 a year. Rent and utilities can easily take away more than half that income, and you can quickly begin to see why states might want to extend health care to families who make a bit more.
The article in the New York Times gives more details:

...states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.

Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”

And Cindy Mann, a research professor at the Health Policy Institute of Georgetown University, said, “No state would ever achieve that level of participation under the president’s budget proposals.”